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Discharge Instructions
Discharge Instructions
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Created by Qualaris Staff
Inpatient Nursing
Table of Contents
Audit Form
Audit Form
Discharge Instructions
Description
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Required
Observed Date
Unit
ED
ICU
Med-Surg
PACU
Rehab
Discharge Educator
Discharge Planner
Social Worker
Nurse
Case manager
Discharge Instructions Checklist
Mark all as...
Discharge planning meeting conducted with Patient?
Yes
No
Discharge planning meeting conducted with family/caregivers?
Yes
No
N/A
Discussion of diagnosis conducted?
Yes
No
Discussion of any comorbidities conducted?
Yes
No
N/A
Patient given copy of their Discharge/After Hospital Care Plan?
Yes
No
Discharge follow-up appointment(s) scheduled?
Yes
No
Plan for followup of test/lab results pending at discharge established?
Yes
No
N/A
Medical equipment listed and instructions for obtaining reviewed?
Yes
No
N/A
At-home services/Home health agency listed and instructions for obtaining reviewed?
Yes
No
N/A
Medication reasons for prescribing and side effects reviewed?
Yes
No
N/A
Plan for obtaining medications established?
Yes
No
N/A
Plan reviewed for what to do if a problem arises?
Yes
No
Patient understanding of plan assessed?
Yes
No
Pt contact information and preferences for follow-up phone call collected?
Yes
No
Discharge summary transmitted to follow-up clinicians within 24 hours of discharge?
Yes
No
N/A
