When planning patients’ discharge it is essential to ensure that best practices are followed. Ensuring that all necessary care has been provided to a patient while hospitalized and identification of needs and resources of the patient after discharge are crucial. In addition, it is imperative that patients are educated on how to care for themselves after being discharged including sharing what appointments will be needed as follow-up, medications and dosage, nutritional needs, and knowing who to contact in the event extra care or community resources are necessary. Finally, it is important to assess the patient’s ability to achieve optimum recovery by understanding needs such as transportation and family support.
There are a variety of tools and resources available to assist discharge planners that have the ability to execute a patient’s discharge effectively. Ten of the top resources are:
Culture Care Connection
This resource center has been developed by Stratis Health with the mission of providing support to healthcare providers and staff, as well as administrators, with the intention of improving cultural competence in Minnesota healthcare facilities.
Possessing cultural competence allows one the ability to see potential issues that may prevent a patient from recovering as one might expect. This resource center can help planners to better understand how to help those of various socioeconomic and cultural backgrounds.
Quick Guide to Health Literacy
Created by the U.S. Department of Health and Human Services, The Quick Guide to Health Literacy overviews fundamental concepts of health literacy and how to improve it through various techniques aimed at communication, education and advocacy. It also outlines examples of best practices and ways to improve health literacy.
Health Literacy Universal Precautions Toolkit
Provided by the Agency for Healthcare Research and Quality, this toolkit is 227 pages long. It helps healthcare staff to analyze and improve their services by providing means to examine health literacy considerations.
Project BOOST’s Overview of the Teach-Back Process
This resource helps healthcare staff to understand and utilize the Teach-Back Process. This process can be used throughout the stay of the patient from admissions to discharge. The essential premise of the process if that the patient is eventually effectively able to provide all information about the medications they are prescribed including name, dosage, reasons for taking them, side effects, and how to respond if an issue occurs.
CMS’s Discharge Planning Checklist
This is a resource providers can give to patients and caregivers to help them to build their knowledge and formulate questions about matters related to discharge. Some topics include continuing care and community based resources.
TARGET: Geriatric Evaluation for Transitions
Created by Project BOOST this tool can be used to help providers determine the readiness of a patient for discharge from the hospital. Its focus is on geriatric patients.
Transitional Care Planning Model
Composed by the New York State Discharge Planning Workgroup, this model is useful for providers to build knowledge on how to screen, assess, and identify those patients whose risk for readmission is high.
Discharge Knowledge Assessment Tool
This resource can be used by discharge planners to understand patients’ readiness for discharge by determining their comprehension of instructions for care after release from the hospital.
Taking Care of Myself: A Guide for When I Leave the Hospital
This tool can be provided to patients to assist in development of a post-discharge care plan.
Hospitalized Patients’ Understanding of Their Plan of Care
This article focuses on determining how much patients understand their care plans and can be accessed on the National Institute of Health Website.
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