Angel McGarrity-Davis, RN, CDONA, NHA

Everyone is talking about rehospitalizations. Can you please simplify this for me? As the leader in my facility, where do I start? 

Great question: Indeed, the days of discharging patients and not being accountable and/or responsible for them are over. Nursing facilities are under the microscope from executives in the local hospitals, which are facing penalties for readmissions. 

The top reasons for readmissions are: medication compliance, lack of physician follow-up and misunderstanding of disease processes. So let’s take an overview of these issues when it comes to discharge planning.  

Start by reviewing your current discharge policies and procedures. Have a quality assurance program. Seek resourceful ways of working with hospitals by having the practitioners — i.e., hospital members and pharmacists — on your committee.    

When preparing residents for discharge, it is essential to ensure that necessary resources are arranged according to the needs of the patient and his or her family. In addition, it is fundamental that patients and families are educated on how to care for themselves after being discharged. This includes: 

making necessary appointments for follow-ups

medications with dosages list 

nutritional needs list

knowing preventative steps to take and signs/symptoms of the specific disease process

knowing who to contact in the event extra care is needed

Today the correct terminology instead of “discharging” is “transitioning.” The success of our healthcare system is in our hands. By embracing partnerships with hospitals, we can increase residents’ quality of life and improve care.