IDEAL Discharge Planning Overview, Process, And Checklist
IDEAL Discharge Planning Overview, Process, and ChecklistEvidence for engaging patientsand families in discharge planningKey elements of IDEALDischarge PlanningNearly 20 percent of patients experience an adverseevent within 30 days of discharge.1,2 Research shows thatthree-quarters of these could have been preventedor ameliorated.1 Common post-discharge complicationsinclude adverse drug events, hospital-acquired infections,and procedural complications.1 Many of thesecomplications can be attributed to discharge planningproblems, such as:Include the patient and family as full partners in the Changes or discrepancies in medications before andafter discharge 3,4 Inadequate preparation for patient and family relatedto medications, danger signs, or lifestyle changes3,4,5 Disconnect between clinician information-giving andpatient understanding3 Discontinuity between inpatient and outpatientproviders3Involving the patient and family in discharge planning canimprove patient outcomes, reduce unplannedreadmissions, and increase patient satisfaction.6,7More and more, hospitals are focusing on transitions incare as a way to improve hospital quality and safety. Asone indicator of this, the Centers for Medicare andMedicaid Services implemented new guidelines in 2012that reduce payment to hospitals exceeding theirexpected readmission rates.To improve quality and reduce preventable readmissions,[insert hospital name] will use the Agency for HealthcareResearch and Quality’s Care Transitions from Hospital toHome: IDEAL Discharge Planning tools to engagepatients and families in preparing for discharge to home.discharge planning process.Discuss with the patient and family five key areas toprevent problems at home:1. Describe what life at home will be like2. Review medications3. Highlight warning signs and problems4. Explain test results5. Make followup appointmentsEducate the patient and family in plain language aboutthe patient’s condition, the discharge process, andnext steps throughout the hospital stay.Assess how well doctors and nurses explain thediagnosis, condition, and next steps in the patient’scare to the patient and family and use teach back.Listen to and honor the patient’s and family’s goals,preferences, observations, and concerns.This process will include at least one meeting to discussconcerns and questions with the patient, family of theirchoice, and [identify staff].What does this mean for clinicians?We expect all clinicians to: Incorporate the IDEAL discharge elements intheir work Make themselves available to the [identify staff]who will work closely with the patient and family Take part in trainings on the processGuide to Patient and Family Engagement:: 1
How do you implementIDEAL Discharge Planning?Educate the patient and family in plain languageabout the patient’s condition, the discharge process,and next steps at every opportunity throughout thehospital stay.Each part of IDEAL Discharge Planning hasmultiple components:Include the patient and family as full partners in thedischarge planning process. Always include the patient and family in teammeetings about discharge. Remember thatdischarge is not a one-time event but a processthat takes place throughout the hospital stay. Identify which family or friends will provide careat home and include them in conversations.Discuss with the patient and family five key areas toprevent problems at home.1. Describe what life at home will be like. Includethe home environment, support needed, what thepatient can or cannot eat, and activities to do oravoid.2. Review medications. Use a reconciled medicationlist to discuss the purpose of each medicine, howmuch to take, how to take it, and potential sideeffects.3. Highlight warning signs and problems. Identifywarning signs or potential problems. Write down thename and contact information of someone to call ifthere is a problem.4. Explain test results. Explain test results to thepatient and family. If test results are not available atdischarge, let the patient and family know whenthey should get the results and identify who theyshould call if they have not gotten results by thatdate.5. Make followup appointments. Offer to makefollowup appointments for the patient. Make surethat the patient and family know what followup isneeded.Getting all the information on the day of discharge can beoverwhelming. Discharge planning should be an ongoingprocess throughout the stay, not a one-time event. Youcan: Elicit patient and family goals at admission andnote progress toward those goals each day Involve the patient and family in bedside shiftreport or bedside rounds Share a written list of medicines every morning Go over medicines at each administration: Whatit is for, how much to take, how to take it, andside effects Encourage the patient and family to take part incare practices to support their competence andconfidence in caregiving at homeAssess how well doctors and nurses explain thediagnosis, condition, and next steps in the patient’scare to the patient and family and use teach back. Provide information to the patient and family insmall chunks and repeat key pieces ofinformation throughout the hospital stay Ask the patient and family to repeat what yousaid back to you in their own words to be surethat you explained things wellListen to and honor the patient and family’s goals,preferences, observations, and concerns. Invite the patient and family to use the whiteboard in their room to write questions orconcerns Ask open-ended questions to elicit questionsand concerns. Use Be Prepared to Go Home Checklist andBooklet (Tools 2a and 2b) to make sure thepatient and family feel prepared to go home Schedule at least one meeting specific todischarge planning with the patient and familycaregiversGuide to Patient and Family Engagement:: 2
IDEAL Discharge Planning ProcessThe elements of the IDEAL Discharge Planning process are incorporated into our current discharge. The informationbelow describes key elements of the IDEAL discharge from admission to discharge to home. Note that this processincludes at least one meeting between the patient, family, and discharge planner to help the patient and family feelprepared to go home.Initial nursing assessment Identify the caregiver who will be at homealong with potential back-ups. These are theindividuals who need to understand instructionsfor care at home. Do not assume that family inthe hospital will be caregivers at home. Let the patient and family know that they canuse the white board in the room to writequestions or concerns. Elicit the patient and family’s goals for whenand how they leave the hospital, asappropriate. With input from their doctor, workwith the patient and family to set realistic goalsfor their hospital stay. Inform the patient and family about steps inprogress toward discharge. For commonprocedures, create a patient handout, whiteboard, or poster that identifies the road map toget home. This road map may include things like“I can feed myself” or “I can walk 20 steps.”Daily Educate the patient and family about thepatient’s condition at every opportunity, suchas nurse bedside shift report, rounds, vital statuscheck, nurse calls, and other opportunities thatpresent themselves. Use teach back.Who: All clinical staff Explain medicines to the patient and family(for example, print out a list every morning)and at any time medicine is administered.Explain what each medicine is for, describepotential side effects, and make sure the patientknows about any changes in the medicines theyare taking. Use teach back.Who: All clinical staff Discuss the patient, family, and clinician goalsand progress toward discharge. Once goals areset at admission, revisit these goals to makesure the patient and family understand how theyare progressing toward discharge.Who: All clinical staff Involve the patient and family in care practicesto improve confidence in caretaking afterdischarge. Examples of care practices couldinclude changing the wound dressing, helpingthe patient with feeding or going to thebathroom, or assisting with rehabilitationexercises.Who: All clinical staffGuide to Patient and Family Engagement:: 3
Prior to discharge planning meetingWhen: 1 to 2 days before discharge planning meeting. For short stays, this meeting may occur at admission. Give the patient and family Tools 2a and 2b: BePrepared to Go Home Checklist and Booklet.Who: Hospital to identify staff person to distribute,for example a nurse, patient advocate, or dischargeplanner.Discharge planning meetingWhen: 1 to 2 days before discharge, earlier for moreextended stays in the hospital Day of discharge Review a reconciled medication list with thepatient and family. Go over the list of currentmedicines. Use teach back (ask them to repeatwhat the medicine is, when to take it, andhow to take it). Make sure that patients have aneasy-to-read, printed medication list to takehome.Who: Hospital to identify staff person to reviewthe medication list with patient and family.Because this involves medications, we assume itwould be a clinician — nurse, doctor, orpharmacist. Give the patient and family the patient’sfollowup appointment times and include theprovider name, time, and location ofappointments in writing.Who: Staff who scheduled appointment. Give the patient and family the name,position, and phone number of the person tocontact if there is a problem after discharge.Make sure the contact person is aware of thepatient’s condition and situation (e.g., if theprimary care physician is the contact person,make sure the primary care physician has a copyof the discharge summary on the day ofdischarge).Who: Hospital to identify staff person to writecontact information, for example a nurse, patientadvocate, or discharge planner.Use the Tools 2a and 2b: Be Prepared to GoHome Checklist and Booklet as a startingpoint to discuss questions, needs, andconcerns going home. If the patient or family did not read or fill outthe checklist, review it verbally. Make sure toask if they have questions or concerns otherthan those listed. You can start the dialogueby asking, “What will being back home looklike for you?” Repeat the patient’s concerns in your ownwords to make sure you understand. Use teach back to check if the patientunderstands the information given. If another clinician is needed to addressconcerns (e.g., pharmacist, doctor, ornurse), arrange for this conversation.Who: Hospital to identify staff to be involved inmeeting, for example the nurse, doctor, patientadvocate, discharge planner, or a combination.Patient identifies if family or friends need to beinvolved. Offer to make followup appointments. Ask ifthe patient has a preferred day or time and ifthe patient can get to the appointment.Who: Hospital to identify staff person to do, suchas a patient advocate or discharge planner.Schedule discharge planning meeting with thepatient, family, and hospital staff.Who: Hospital to identify staff person to distribute,for example a nurse, patient advocate, or dischargeplanner.Guide to Patient and Family Engagement:: 4
IDEAL Discharge Planning ChecklistFill in, initial, and date next to each task as completed.Patient Name:Initial Nursing AssessmentIdentified the caregiverat home and backupsTold patient and familyabout white boardElicited patient andfamily goals for hospitalstayInformed patient andfamily about steps todischargePrior to DischargePlanning MeetingDuring DischargePlanning MeetingDistributed checklist andbooklet to patient andfamily with explanationScheduled dischargeplanning meeting/Discussed familyquestionsReviewed dischargeinstructions as neededScheduled for/Discussed patientquestionsat[time]Used Teach BackOffered to schedulefollowup appointmentswith providers.Preferred dates / timesfor:PCP:Other:Day of DischargeMedicationReconciled medication listReviewed medication list with patientand family and used teach backAppointments and contact informationScheduled followup appointments:1) Withon//at[time]2) Withon//at[time]Arranged any home care neededWrote down and gave appointments to thepatient and familyWrote down and gave contact informationfor followup person after dischargeGuide to Patient and Family Engagement:: 5
IDEAL Discharge Planning Daily ChecklistFill in, initial, and date next to each task as completed.Patient Name:Day 1Day 2Day 3Day 4Educated patient and familyabout condition and usedteach backEducated patient and familyabout condition and usedteach backEducated patient and familyabout condition and usedteach backEducated patient and familyabout condition and usedteach backDiscussed progress towardpatient, family, and cliniciangoalsDiscussed progress towardpatient, family, and cliniciangoalsDiscussed progress towardpatient, family, and cliniciangoalsDiscussed progress towardpatient, family, and cliniciangoalsExplained medications topatient and familyMorningNoonEveningBedtimeOtherExplained medications topatient and familyMorningNoonEveningBedtimeOtherExplained medications topatient and familyMorningNoonEveningBedtimeOtherExplained medications topatient and familyMorningNoonEveningBedtimeOtherInvolved patient and family incare practices, such as:Involved patient and family incare practices, such as:Involved patient and family incare practices, such as:Involved patient and family incare practices, such as:NotesGuide to Patient and Family Engagement:: 6
References1. Forster AJ, Murff HJ, Peterson JF, et al. Theincidence and severity of adverse events affectingpatients after discharge from the hospital. AnnIntern Med 2003;138(3):161–7.2. Jencks SF, Williams MV, Coleman EA.Rehospitalizations among patients in the Medicarefee-for-service program. N Engl J Med2009;360(14):1418–28.3. Kripalani S, Jackson AT, Schnipper JL, et al.Promoting effective transitions of care at hospitaldischarge: a review of key issues for hospitalists.J Hosp Med 2007;2(5):314–23.4. Anthony MK, Hudson-Barr D. A patient-centeredmodel of care for hospital discharge. Clin Nurs Res2004;13(2):117–36.5. Popejoy LL, Moylan K, Galambos C. A review ofdischarge planning research of older adults 1990–2008. West J Nurs Res 2009;31(7):923–47.6. Bauer M, Fitzgerald L, Haesler E, et al. Hospitaldischarge planning for frail older people and theirfamily. Are we delivering best practice? A review ofthe evidence. J Clin Nurs 2009;18(18):2539–46.7. Shepperd S, McClaran J, Phillips CO, et al.Discharge planning from hospital to home.Cochrane Database Syst Rev.2010;20;(1):CD000313.Guide to Patient and Family Engagement:: 7
care as a way to improve hospital quality and safety. As one indicator of this, the Centers for Medicare and Medicaid Services implemented new guidelines in 2012 that reduce payment to hospitals exceeding their expected readmission rates. To improve quality and reduce preventable readmissions, [insert hospital name] will use the Agency for Healthcare Research and Quality’s Care Transitions .
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IDEAL 4810-95 IDEAL 4850-95/EP IDEAL 5221-95EP IDEAL 6550-95EP B C A 4 x Only IDEAL 4810-95, IDEAL 4850-95/EP, IDEAL 6550-95EP Remove the stand from the wooden pallet. Only IDEAL 4810-95, IDEAL 4850-95/EP, IDEAL 6550-95EP 4 strong people are required to lift the machine from the pallet and place it on the stand. Secure with 4 .
Objectives Explain the goals and process of discharge planning. List the key standards for discharge planning as described by CMS. Describe considerations and needs for patients with pulmonary disease when transitioning out of the acute care setting. List the outcome measures used to ensure the discharge planning process'success. Discharge planning is an
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discharge needs for each applicable patient within 24 hours after admission or registration. The AH's discharge planning process must require regular re-evaluation of patients to identify changes that require modification of the discharge plan. The discharge plan must be updated, as needed, to reflect these changes.
From 1/1/2010 - 4/20/2010, the average time from discharge order to discharge for the 5th floor was 3 hours and 32 minutes. From 7/26/2010 - 8/20/2010, the average time from discharge order to discharge for the 5th Floor was 2 hours and 5 minutes. Average improvement with the discharge nurse pilot: 1 Hour and 27 minutes per discharge Improve
upward stroke and compressed air pushes the discharge valve off its seat and air fl ows by the open discharge valve, into the discharge line and to the reservoirs (see Figure 5). As the piston reaches the top of its stroke and starts down, the discharge valve spring and air pressure in the discharge line returns the discharge valve to its seat.
