The "Discharge Checklist" (see below) can help families make sure that the six main areas

essential
to a good discharge plan are covered. These six areas are:

MEDICATIONS:
I am instructed to take medications after food
I have been instructed to keep a medication track log evryday
I was instructed not to stop medication even though i feel better after taking medications
I was instructed that my family member/Relatives will monitor my medications everyday and i can
not refuse this monitring from my family members/relatives:
I am aware that if i stop the prescribed medication there will be a relapse of symtoms and
rehospitalization is required
In case if my symptoms gets relapsed i will be rehospitalized involuntarily or voluntarly

Follow up:
I was explained about the importance of the followups/cosultations/counselling.
I will regualrly come for counseling with out fail.
I will be coming after 15days for psychiatric consultation.

I was rewied by multidisciplanry team before discharging

Activities of Daily Living:

I am aware about the basic life skills

I will follow the planned activities of daily living given by the counselor

Education, fiancial assistance and other needs:

I was psychoeduacted about my illness and know how to recognize the symptoms of my illness

i have been assessed for risk suicidal/sucidal thoughts before discharging

I am able to explain the conditions when i got admitted in the hospital....

I am aware that for every patient who is identified at potential risk of adverse health
consequences without a discharge plan; and the patient’s representative, or the attending
physician requests such evaluation i will not discharged

I am aware that i was violent towards the staff during my stay and i was physically
restrained

I and my family were educated about my after-acute care hospital/post-acute care facility
care plans.
. Individuals who will be providing care should know and be able to demonstrate and
verbalize the patient’s care needs. You should
provide the patient and family/caregivers with information and written and verbal
I and my family were instructed in preparation for my after-acute care hospital,
including:
- Discharge options;
-Medications to discontinue or take and how to use them properly after discharge;
-What to expect after discharge; and
-What to do if concerns, issues, or problems arise.

You must document the following in the patient’s clinical record:

Discharge planning evaluation activities;
Results of the discharge planning evaluation were discussed with the patient and family/
caregivers;
Refusal of the patient or the patient’s legally responsible representative to participate in
discharge planning or comply with a discharge plan if applicable

A recapitulation of the patient’s hospitalization which includes a summary of the patient’s

stay, including symptoms, treatments, and pain management;
A summary of the patient’s condition on discharge. This summary will be available for
release to authorized individuals and agencies, with the consent of the patient or the
patient’s legal representative;
A summary of medication therapy changes and instructions; and
Recommendations for appropriate services for follow-up or aftercare.

The discharge summary must include:

I am able to elicit the reasons for my admission to the hospital as Inpatient
Nursing and health care providers’ notes (such as social workers);
A plan that outlines psychiatric, medical, and physical treatment and medication therapy
management, as applicable;
A list of medications and instructions how to take medications were explained to me by
nurse and health care providers

Risk assessment and discharge planning

• It is important that the same evidence based
continuous risk assessment processes are
consistently applied across the care pathway.
• It is important to ensure that the practical and
social reasons influencing the admission have
been addressed.
• Specific attention should be given to
ensuring staff competence in the care and
discharge planning for service users with
‘dual diagnosis’ problems.
• Specific discharge co-ordinator posts can
help organise and expedite discharge
arrangements across the service system.
• Medicines management should be a core
component of discharge planning.
• Discharge information should be sent to
the GP prior to the service user’s discharge
from hospital.
• Service users with ‘dual diagnosis’ problems,
the homeless, and those with a history of
violence or self-harm are especially vulnerable
and need rapid follow-up arrangements to
be put in place.

Discharge information, both written and verbal, should be reviewed with the patient/family caregivers with
an emphasis on assessing and ensuring comprehension. In one interview study of patient perception and
understanding of discharge instructions, among discharged patients aged >65 years who felt that they
had good understanding of their discharge instructions, 40 percent were unable to accurately describe the
reason for their hospitalization and 54 percent did not accurately recall instructions about their follow-up
appointment [30].

Teach back is a technique by which the provider asks the patient or caregiver to explain the recently
taught concept in the patient's own words [31]. This technique permits the provider to identify and correct
any misunderstandings in real time, with the intent of preventing adverse events related to inadequate
comprehension of discharge information. While the teach back method has been validated in teaching a
patient a new skill (eg, administering insulin or changing a dressing), teach back has not been studied
specifically as a mechanism for reducing readmissions.

If the discharging physician can clearly show in the medical record that the patient's ability to make an
informed decision was done in a competent manner, an AMA discharge is generally protective for
malpractice claims.

If a patient is deemed competent and demands to leave the hospital, the physician is obligated to inform
him of the consequences and to allow the patient to exit. This is done under the caveat that the patient is
not a clear danger to himself or to others and is able to care for himself. It is clear that the courts demand
that physicians fulfill their professional and legal duties to the patient. It should always be the clinical staff,
not merely an AMA form, that provides the patient with information about the potential consequences and
risk of being discharged AMA.

In order for the patient to be deemed safe and ready for discharge to home or to a non-acute environment
(rehabilitative, transitional, or chronic care), a provider must take into account a number of factors beyond
the medical determinants. These factors include:

●Patient cognitive status

●Patient activity level and functional status
●The nature of the patient's current home and suitability for the patient's conditions (eg, presence of
stairways, cleanliness)
●Availability of family or companion support
 ●Ability to obtain medications and services
●Availability of transportation from hospital to home and for follow-up visits
●Availability of services in the community to assist the patient with ongoing care

The first step is having an accurate medication list at hospital discharge, which depends on the following:

●Having an accurate preadmission medication list.

●Having an accurate list of medications being taken by the patient at the time of discharge.
●Having knowledge of what medication changes were made during hospitalization and the reasons
for the changes. As examples:
•Was a proton-pump inhibitor (PPI) initiated for stress ulcer prophylaxis and therefore no
longer required, or is ongoing PPI therapy necessary for treatment of an ulcer?
•If a different agent from the same class as one taken prior to admission was substituted
during the hospitalization, was there a clinical indication for making that change or was this a
therapeutic substitution made based on the hospital’s formulary preference? If a therapeutic
substitution, then the discharge medication should revert to the medication that the patient was
taking prior to hospitalization.

Patient instructions — At the time of discharge, the patient should be provided with a document that
includes language and literacy-appropriate instructions and patient education materials to help in
successful transition from the hospital.

These documents should be brief, focused on critical information to the patient, and primarily directed at
what the patient needs to understand to manage his or her condition after discharge.

One model for patient materials, developed by the National Patient Safety Foundation, is called Ask Me 3
[29]:

Below mentioned questions were asked to me by the health care provider:

●(1) What is my main problem? (ie, why was I in the hospital?).My responses...................................
●(2) What do I need to do? (ie, how do I manage at home, and what should I do if I run into
problems?) M responses...............................................
●(3) Why is it important for me to do this? MY responses...............................................

PSYCHOSOCIAL REVIEW:

If i have developed skill acquisition like: Domestic, Safety, community, personal management
like : pshysical care , safety and emergency skills
Skills acquisition
These skills needs to be taught and practised on a regular basis. (Some clients will not be able to
acquire or practise some of these skills due to some physical disability, use of medcation ,Home
management like : cleaning,care of clothes, maintenace,Meal Preparation like: Planning,
shopping, cookng ,.)Budgeting like:, transport and travel, Leisure skills,social skills and personal
skills, occupational skills

If my Star recovery scores are more than average that is score >5 is considered for discharge.
My GOALS SHORT term.........................AND LONG TERM..................................

Action plan/strategies to acheive my goals

What are my strengths............................needs......................

abilities.................
My caregivers were brified on my needs, and informed with
other resourse available.......
Contact details given to me before discharging me and my
family members.
I was informed to come for follow up, within a specified time-
frame.
Importance about the need for continuing medications and
follow up were explained to me

Miscellenous:
My discharge has been done by multidisciplinary team after
dicussion with me and caregivers

A copy of discharge checklist and care plan was given to me or

carer.

The assigned nurse gave me the discharge medication,

prescription,
And i have understand stood the medication regime, and know
how to obtain the next prescription.
The assigned nurse has returned my stored property in the
office like:.........
Psychiatric review
I am able to recognize Early signs of relapse: Yes or Now

I am aware of my treating doctors and counselor:

Medicines to be monitored by family/relative/friend/attender

I have been addressed about the reasons influencing my :