Updated August 2022

Contents of this guide

• General info about discharge planning
• Suggested info to include in standardized handoff
• How to place discharge-related orders
• Medication reconciliation
• Discharge order set
• Includes key items such as: DME orders, follow-up appointments, return precautions, etc
• Used for ALL patients
• Home health order set
• Used for certain patients who may need: skilled nursing, home aide, central line care or infusions at home, etc.

Proper Discharge Planning Requires:

• Medications reconciled and ordered for discharge
• Home health set-up
• Discharge orders completed
• Follow-up appointments scheduled
• Communication with specialists
• Communication with ancillary staff
• Patient/family education
• Transport home arranged
• Etc.

Standardized Handoff Information

[ ] Meds: All medications have been fully reconciled, ordered for discharge, and available for pickup

[ ] CM/HH: Any case management or home health needs?

[ ] SW: Has social work been consulted

[ ] Consultants: Have all consultants cleared patient for discharge and provided final recommendations?

[ ] Transport: Any transportation needs

[ ] F/u appts: Have follow up appointments been scheduled/confirmed

[ ] PMD comm: Has the PMD been forwarded the discharge summary or contacted?

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Consider incorporating this checklist into your team’s written handoff and signout!

How to: Placing Orders

Open up the Discharge Navigator here. If not available look in your dropdown menu

Open up the Discharge Order menu by clicking here

How to: Medication Reconciliation

1. Please check ALL medications a few days before discharge to see if a prior authorization is needed. If not on formulary, ask the discharge pharmacy (https://medi-calrx.dhcs.ca.gov/home/cdl)

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• Check with the discharge pharmacy if they stock suspension medications, or if they need to be compounded. This should be done BEFORE discharge

Select to continue home medication that was not ordered on admission

Select to change dosing on home medication that was not ordered on admission

Discontinue home medication

Box will turn transparent when med rec completel

Prescribe or discontinue new medication for home

Home medication that changed during in patient stay, click “+” OR the pencil to modify and prescribe

How to: Navigating Order Sets

Tip: “Favorite” the order sets you use the most!

Several order sets have already been pre-loaded onto your EPIC

1. Use PED Discharge to Home or Facility
2. For Spanish-speaking patients, use “PED Discharge to Home – Spanish” so that the AVS prints correctly
3. Also use Home Health for patients needing specific home health assistance (line care, antibiotics, home health aide, etc). Discuss with case management on this

Discharge Order Set (for ALL patients)

These are the sections of the order set when collapsed

Place the discharge order when a patient is ready for discharge

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Goal discharge time: 10am

Order DME several days prior to discharge via the order set. Include details in the comments of each order

Every patient needs follow-up ordered. *The 1^st option goes to our discharge appt coordinator who will call families to set-up the appointment

This section of the order set prints on the AVS to help relay to families/other providers what results need to be followed up on or what needs to be ordered

Home Health Order Set

Use this order set for certain patients, such as those needing home antibiotics

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Discuss these orders with case management, families, and the attendings early and regularly during admission

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ATTENDING to complete HH attestation if needed

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Skilled nursing if needed for line/dressing care, etc.

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You can use these lab order sets or add your own. IMPORTANT: Forward results to the consultant responsible for the patient

How to Order LDA Care:

• Wound care or Ostomy: supplies (bags/dressings), detail how often bag changes, how to do a stoma assessment, and site care
• NG/ GT/JT/PEG/Pump device: detail feeding plan (ex 30cc/hr over 12 hours), any supplies (include size of GT/NG/etc, number of syringes for flushes and medications per month) as well as extra in case of dislodgement.
• PICC or CVC: dressing changes, troubleshooting, flushing the line, cap care

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Discuss with your attending/GI re TPN ordering

Preview the AVS

Tip: After inputting discharge orders, always preview the AVS to make sure the appropriate info is included for families!

Special Considerations for NICU Patients

For NICU and newborn patients who have never been home, confirm the following before discharge

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o Car seat: pass/fail

o Hearing screen

o Pulse oximeter screening

o Newborn screen

o Immunizations/Vaccines

o CPR video for parents

o Formula/Breastmilk supplies

o Lactation consult

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