June 2005

Ideal Discharge for the Elderly Patient: A Hospitalist checklist

Checklist Particulars Must Keep Optional
Medication • Written schedule of medication x
Education • Include Purpose (reason) and (if apt) Cautions(s) for x
each medication
• Clinical Pharmacist involvement (especially if x
cognitive impairment, or ≥ 3 Medication changes
Cognition Rather than a Folstein score, some description mention of
mental capacity such as:
• Lucid (full capacity for understanding and x
executive function, such as being able to follow
• Forgetful (some senescence or impairment of x
• Dementia (or "Brain Failure" - incapable of reliable x
recall and/or executive function)
Discharge Needs to be written with the receiving caregiver in mind,
Summary including:
• Presenting problem(s) that precipitated x
• Primary and secondary diagnoses x
• Key findings and test results x
• Brief hospital course x
• Discharge Med Reconciliation (see above) x
• Condition at discharge (including functional status Cognitive status
and cognitive status, if relevant)
• Discharge Destination (and rationale if not obvious) x

Developed by SHM HQPS Committee, 2005
©2005 Society of Hospital Medicine (SHM). All rights reserved.

X up issues Follow-up Plan: 2 weeks generally.June 2005 • Any anticipated problems and suggested X interventions. . All rights reserved. or sooner if hazardous medication or X fragile clinical condition. • Follow-up appointments with suggested x management plan • Pending labs or tests x • Recommendations of any sub-specialty consultants x • Documentation of patient education and confirmation of patient understanding through x teach-back Patient ε Provide instructions written at 6th grade level X Instructions ε Any anticipated problems(s) and suggested X intervention(s) ε 24/7 call-back number X ε Teach-back to confirm patient understanding x Hazardous Plans for proximate follow-up (about one week) tests x Medications and/or visits for patients taking (new or changed): (Forster et al) ε Warfarin Med specific ε Electrolyte-disturbing medications (diuretics) management ε CV drugs ε Corticosteroids. 2005 ©2005 Society of Hospital Medicine (SHM). Include any testing and/or provider visit appointments x Developed by SHM HQPS Committee. or Hypoglycemic agents ε Narcotic analgesics Providers Identify referring and receiving providers • Record in summary X • Contact them and communicate immediate follow.

or "Comfort measures only" X Disease-specific Disease specific checklist targeting evidence-based practice X Checklist • Pneumonia (immunizations.Resar MD-IHI) x • New Meds x • Modified Meds x x • Unchanged Meds Code Status Code status (and any other pertinent end-of-life issue X stipulations) discussed with patient and included in the Summary. ACEI or ARB.June 2005 ε Date x ε Name x ε Address x ε Phone number x ε Visit purpose or x Responsible person to whom a pending test will be sent. etc). All rights reserved. Including at the least one of the following designations: • Full code (unrestricted full therapy) X • DNR (Do not resuscitate) X • Hospice-type care. . X smoking cessation) Developed by SHM HQPS Committee. discharge weight) • Myocardial infarction ( ASA. beta-blocker. 2005 ©2005 Society of Hospital Medicine (SHM). ε Explained • Designate: • "Meds you should no longer take" (R. smoking cessation. ACEI. Patient X instructions. smoking cessation) X • Heart failure (LVEF. x Medication List: ε NO TEARS Tool x ε Pruned ε Indication(s) required for Continuing Care (Nursing x ε Reconciled Home.