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  1. Educate the patient and family in plain language about the patient’s condition, the discharge process, and next steps throughout the hospital stay. Assess how well doctors and nurses explain the diagnosis, condition, and next steps in the patient’s care to the patient and family and use teach back.

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  2. The goal of the IDEAL Discharge Planning strategy is to engage patients and family members in the transition from hospital to home, with the goal of reducing adverse events and preventable readmissions.

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  3. The facility must develop and implement an effective discharge planning process that focuses on the resident’s discharge goals, the preparation of residents to be active partners, and effectively transition them to post-discharge care, and the reduction of factors leading to preventable

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  4. INSPIRED 2.0 invites and engages the client in the planning for and understanding of their disease (Patient-Focused) Care Providers: Case-Managers, Respiratory Educators and other Interdisciplinary Team members as required. Care Components match the COPD Discharge Bundle.

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    • Step 1: Download The Template
    • Step 2: Fill Out The Discharge Plan
    • Step 3: Educate The Patient and Store The Plan

    Download the Discharge Plan Template, fill out patient details, assess the patient's medical condition, functional abilities, and support systems, and establish recovery goals. We've also included a discharge plan example for your reference.

    Start by determining if the patient will be discharged to their home or another healthcare facility. List all medications, dosages, and administration instructions while educating the patient and caregivers about proper medication management. Next, identify and provide the necessary medical equipment, assistive devices, and supplies required for re...

    Finally, the patient and caregivers should receive comprehensive education on proper care for a successful recovery. Organize and securely keep all documentation related to the patient's care. This ensures easy access for future reference.

  5. Discharge Planning Checklist for Case Managers. 1. Review the patient's medical record. Assess the patient's current health and functional status. Identify post-discharge needs. Approval: Medical Staff for discharge status. Develop discharge plan. Coordinate with patient's family or support system. Coordinate with external service providers.

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  7. Case managers focus on care coordination, financial management, and resource utilization to yield cost-effective, patient-centered solutions. They decide what the patient needs during a single episode of care. Case managers can play an especially important role in discharge planning for patients with more complex needs associated with an

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