Discharges

Question 1

What are the 5 types of discharges?

Answer 1

1. Discharge home
2. Home with assistance
3. Discharge to another facility
4. Against medical advice
5. Death

Question 2

Why is a patient discharged home?

Answer 2

Patient no longer requires treatment.

Question 3

Why is a patient discharged home with assistance?

Answer 3

Patient requires some form of support at home as part of their recovery process such as daily dressing changes or home care support services.

Question 4

Why is a patient discharged to another facility?

Answer 4

Patient may require higher level of acute care, or patient is no longer acute care and requires extended care or assisted living.

Question 5

What is discharged against medical advice?

Answer 5

A patient may decide to go home even though the doctor has not completed treatment

Question 6

What are the 12 steps a NUC must do when a patient is discharged home?

Answer 6

1. Ensure there is a Doctor’s Order for the discharge
2. Notify the assigned RN
3. Advise Bed Control of discharge or discharge in computer, if applicable
4. Record on Daily Activity Sheet
5. Erase patient from whiteboard
6. Notify Housekeeping
7. Discard Kardex (and addressograph prn)
8. In the patient’s chart:
   
   • File all diagnostic / lab reports
   • Transcribe all orders
   • Dispose of unused chart forms
   • Remove MAR from med binder and place in current section of chart
   • Ensure forms from Nurse’s clipboard are filed in correct section of chart
   • Remove all labels
   • Locate old and thinned charts
   • Place Admission/Separation Form and Discharge Summary on top
   • Place dismantled chart in Health Records tray
9. Arrange transportation prn
10. Ensure patient receives valuables prn
11. Notify any community health professionals prn
12. Book any follow-up appointments

Question 7

What are the 12 steps a NUC must do to discharge a patient to another facility?

Answer 7

1. Ensure there is a doctor’s order for discharge
2. Notify the assigned RN
3. RN will call the HCF to make arrangements for a mutually convenient time to transport the patient and give a report
4. Arrange for ambulance prn
5. Photocopy information that will go with the patient:
   
   • Admission / Separation Record
   • Physician’s Orders
   • Hx Sheet / Consultation Reports
   • Diagnostic & Lab Reports
   • Pertinent Interdisciplinary Reports
   • Current MAR
   • OR records, if applicable
   • Relevant misc. information
6. Advise Bed Control when patient leaves or discharge in the computer
7. Record on Daily Activity Sheet
8. Erase patient from whiteboard
9. Notify Housekeeping
10. Discard the Kardex (and addressograph prn)
11. In the patient’s chart:
    - File all diagnostic / lab reports
    - Transcribe all orders
    - Dispose of unused chart forms
    - Remove MAR from med binder and place in current section of chart
    - Ensure forms from Nurse’s clipboard are filed in correct section of chart
    - Remove all labels
    - Locate old and thinned charts
    - Place Admission/Separation Form and Discharge Summary on top
    - Place dismantled chart in Health Records tray
12. Ensure patient’s valuables are sent with the patient

Question 8

Do you send original forms with the patient to the new facility?

Answer 8

No, always send photocopies

Question 9

What are the 8 steps for a discharge against medical advice?

Answer 9

1. Addressograph / label requisition (AMA) for patient to sign
2. Notify Physician, if requested by RN
3. Advise Bed Control of discharge or discharge in computer
4. Record on Daily Activity Sheet
5. Erase patient from whiteboard
6. Notify Housekeeping
7. Discard Kardex (and addressograph prn)
8. In the patient’s chart:
   
   • File all diagnostic / lab reports
   • Transcribe all orders
   • Dispose of unused chart forms
   • Remove MAR from med binder and place in current section of chart
   • Ensure forms from Nurse’s clipboard are filed in correct section of chart
   • Remove all labels
   • Locate old and thinned charts
   • Place Admission/Separation Form and Discharge Summary on top
   • Place dismantled chart in Health Records tray

Question 10

What are the 12 steps when discharging upon death?

Answer 10

1. Notify Doctor in the hospital to pronounce the death
2. Advise Bed Control of patient death or enter death in computer
3. Record on Daily Activity Sheet
4. Erase patient from whiteboard after porter has removed body from the unit
5. Addressograph/label mortuary tags for body
6. Addressograph/label a Death Notice form for the RN to complete
7. Have a Medical Certification of Death form ready for the doctor to complete
8. Contact religious counsellor for family or social worker, if requested
9. Call porter to transport body to morgue when advised by RN.
10. Notify Housekeeping after body has been removed
11. Discard Kardex (and addressograph prn)
12. In the patient’s chart:
    - File all diagnostic / lab reports
    - Transcribe all orders
    - Dispose of unused chart forms
    - Remove MAR from med binder and place in current section of chart
    - Ensure forms from Nurse’s clipboard are filed in correct section of chart
    - Remove all labels
    - Locate old and thinned charts
    - Place Admission/Separation Form and Discharge Summary on top
    - Place dismantled chart in Health Records tray

Question 11

Where does a completed Death Notice go?

Answer 11

With the porter to the morgue

Question 12

Where does a completed Medical Certification of Death go?

Answer 12

With the porter to Admitting

Question 13

What is an autopsy?

Answer 13

Examination and dissection of a body after death to determine the extent of disease, the cause of death and is some cases medical research.

Question 14

Who can sign an autopsy consent form?

Answer 14

Next of kin

Question 15

What is a Coroner?

Answer 15

A Public Officer whose principal duty is to inquire by an inquest into the cause of any death where there is reason to suspect the death is not due to natural causes.

Question 16

What 6 types of death does the BC Coroners Act require immediate reporting of?

Answer 16

1. As a result of violence, accident, negligence, misconduct, or malpractice
2. As a result of self-inflicted illness or injury.
3. Suddenly and unexpectedly when person was apparently in good health and not under the care of a medical practitioner.
4. From disease, sickness or unknown cause for which the person was not treated by a medical practitioner.
5. During or following pregnancy in circumstances that might reasonably be attributed to pregnancy.
6. All child deaths (< 19 years).

Question 17

What is organ donation?

Answer 17

Donating or giving one’s organs and/or tissues after death. The donor may specify which organs they wish to donate, Ex. corneas only

Question 18

What are the 4 tasks of a NUC regarding organ donation?

Answer 18

1. Addressograph/label patient’s personal information on required requisitions.
2. Process any bloodwork or testing required prior to the surgical procedure.
3. Make any calls that are required by RN or Physician.
4. Follow routine D/C where applicable.