Discharge Care Plan

Discharge
Care Plan

Date &
Sign.
Plan and Outcome
[Check
those that apply]
Target
Date:
Nursing Interventions
[Check
those that apply]
Date
Achieved:
  (_) 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

 

__________________________

RN signature