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Discharge Care Plan

Discharge Care Plan

Date &
Plan and Outcome
[Check those that apply]
Nursing Interventions
[Check those that apply]
  (_) The patient/family's discharge planning will begin on day of admission including preparation for education and/or equipment.

(_) On the day of discharge, patient/family will receive verbal and written instructions concerning:

  • Medications
  • diet
  • Activity
  • Treatments
  • Follow up appointments
  • Signs and symptoms to observe for (when to contact the doctor)
  • Care of incisions, wounds, etc.

(_) Other:


  (_) Assess needs of patient/family beginning on the day of admission and continue assessment during hospitalization.

(_) Anticipated needs/services:

  • Respiratory equipment
  • Hospital bed
  • Wheel char
  • Walker
  • Home health nurse
  • Home PT/OT/ST

(_) Involve the patient/family in the discharge process.

(_)Discuss with physician the discharge plan and obtain orders if needed.

(_) Contact appropraite personnel with orders.

(_)Provide written and verbal instructions at the patient/family's level of understanding.

(_) Verbally explain instructions to patient/family prior to discharge and provide patient/family with a written copy.

(_) Ascertain that patient has follow-up care arranged at discharge.

(_) Provide verbal and written information on what signs and symptoms to observe and when to contact the physician.

(_) Assess if any community resources should be utilized (i.e.: Home Health Nurse), and contact appropriate personnel.

(_) Document all discharge teaching on Discharge Instruction Sheet and Nursing notes.

(_) Other:________________



Patient/Significant other signature


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