Shortly after admission, begin making your discharge plans for home. After that, adjust that plan whenever your family member’s health status changes. I make that recommendation because hospitals are notorious for coming in the day before and saying, “Are you ready to go home tomorrow?” when all the while, you’ve been thinking your family member will be there at least another week. Suddenly, you’re scrambling to get ready to go home. Furthermore, you will likely receive this announcement on a Friday afternoon or the day before a holiday when stores close at 5 p.m. Never trust the hospital to inform you about their thoughts or tell you the truth about discharge times.
Getting Discharged Takes Hours
If a doctor says he will write your discharge when he leaves your room, don’t think that means you’re going home soon. That comment only means he is starting the process for you to go home. The following still needs to be completed by nursing:
- Medication orders still need to be written,
- Final lab work ordered for the future and labs from the current day received and reviewed,
- The time frame for your follow-up visit is determined and then scheduled,
- Calls should be made to your primary care doctor and any specialists to update them on your follow-up care needs or to schedule additional testing required after discharge.
- Schedule transportation home if you need a wheelchair or stretcher transport, or confirm you have a driver if the family is taking you home.
- Arrange the delivery of supplies to your home. Identify who will be there to receive them and learn to use them.
- Arrange for home health to arrive within a certain number of hours after discharge if ordered.
- Medications called into the local pharmacy or filled within the hospital
- Determination regarding the next meal—do you need a tray or not?
- What do you need immediately to perform treatments at home, if needed, related to supplies? If you need supplies delivered to your home, they must determine who your supplier will be, who will pay how much, and when your first delivery will be.
So, wait to put on your coat.
When to Start Thinking Discharge
When the patient finishes most of their antibiotics, the pain score is lower, and they can move around unassisted and start thinking about going home.
Getting into the House
Decide before your family member comes home if you can get them into the house alone. Tell the case manager about the obstacle preventing access to the patient’s home or bed if you can’t. Hopefully, the case manager can help remove the obstacle or provide a “workaround.”
Clear Away Obstacles
Identify your access route, take measurements, and clear a pathway to the bedroom or your family member’s favorite recliner. Move furniture around to make it easier to get in and out of the areas you need to access the day you come home.
Prepare the Bed
Unless you have a Sleep Number bed, hospital bed, or another brand that controls head or leg movements, helping your family members get comfortable in bed when they first get home may be challenging. If they stay in bed often, you may need extra pillows or wedges to help prop them up and support more body parts.
Preparing a Work Area
If you frequently need to perform any type of treatment or other procedure, you might want to set up an area close by where you plan to do the work, with the supplies you will use organized according to when you need them. Anything you can set up to save time and free your hands can help. Another idea is to put supplies into clothes or gift baskets to help keep them organized. Bring a waste basket close to your workstation, too.
Medications
Before you leave the hospital on the day of discharge, ask the nurse to write down exactly which medications she gave that day and what time she gave them so that you don’t give your family member the same medicines again when you get home or miss a dose by accident. The discharge instructions often don’t tell when the patient last received the medicine.
The doctor probably ordered discharge medications. Remember to pick them up on your way home.
Bathroom Concerns
When you first arrive home, you will likely need to overcome two more big huddles. One is to help them go to the bathroom, and the other is to take a bath. Here are some helpful suggestions on those topics.
BATHING | Tub | Shower |
Can Do it Alone | Obtain a hand grip or other device to hold onto as they get into and out of the tub. They will be weak and more likely to fall. They could use a chair as a balance. Have non-skid rugs only. Having a chair in the room for them to sit and dress is a good idea. | A shower chair to sit in while showering is a good idea because they will be weaker than they realize. Hand grips to hold onto to get into and out of the shower are also a good idea to help with balance. Caution them from using water that is too hot. |
Needs Assistance | They can sit on a stool in the tub while someone helps them with their bath. Let the patient do what they feel they can, and the assistant can do the rest. I prefer giving them a bed bath. | Patients can sit on a stool in the tub while someone helps them with their bath. Let the patient do what they feel they can, and the assistant can do the rest. |
Needs Someone to Do Everything | Don’t use. May do bed bath instead | Use a shower chair with the patient secured to a chair or do a bed bath |
| TOILETING |
Can Do it Alone | He does not need assistance, can get to the bathroom alone, and has no special needs. |
Needs Assistance | Needs assistance getting to the bathroom. Need handrails as an attachment around the sides of the toilet. May need medications such as oral laxatives and stool softeners to help stimulate movements. Also, have the option of beside commode or bedpan. |
Needs Someone to Do Everything | Lifting equipment is necessary to take patients to the bathroom or to assist with bedside commodes or bedpans. Patients may also need a suppository or enema. |
