1. Discharge Pathway Ascertain within first 48 hrs:
Independent ADL (Directly observed: Gets to bathroom without assistance.)
Willing & able caregiver at home
Insurance for outpatient SN, rehab, IV, drugs
IF NO TO ANY:
Medicare qualifying stay? (3 midnights)
IF NO: Reconsider discharge. Consider subacute rehab (SNF)
If considering medical discharge:
>1 skilled nursing need: monitoring, IV, drains, g-tubes, open wounds, trach, injectables (heparin, insulin, foleys don’t count)
>1 significant medication change past 2 weeks
ICU past 2 weeks
IF YES: SNF qualifying dx?
Unsafe at home: FTT, dementia, neglect, abuse
Hospice appropriate, no caregiver at home
IF YES: Get social services involved ASAP
Doorway thoughts:
Hemodynamically
stable for 24 hrs?
Needs to be seen by
MD daily?
What if misses doses
for next 24hrs?
IMAGINE the discharge plan WHILE you write the admitting orders.
9/19/2018
Rodin 12/04