Guidelines: Discharge of Patient and Related Discharge Instructions


 
POLICY:
 
A member of the Provider Staff (must be M.D., DO, DPM, or 
DDS) will authorize the discharge of all patients via a 
written, signed order.  At the discretion of the provider 
performing the procedure, a patient may be discharged by a 
competent clinical employee through the use of 
previously-established criteria.  The patient is responsible 
for his/her transportation home and for provision of an adult 
caretaker; any exception to this policy must be ordered in 
writing by the attending Provider Staff member.  Such Staff 
member may refuse to discharge a patient, regardless of 
physical condition, not accompanied by a responsible party or 
for whom the safety of home care arrangements is in question.
 
A (M.D., DO, DPM, or DDS) must be present until the medical 
discharge of the patient. Medical discharge refers to 
discharging a patient following clinical recovery from 
surgery and anesthesia.
 
Licensed Personnel qualified in advanced resuscitative 
techniques are present until all patients operated on that 
day have been physically discharged. 
 
PROCEDURE:
 
1.  Competent clinical personnel determines if the patient
    adequately meets all discharge criteria, including: 
 
    A.  Full consciousness and awareness
    B.  Cardiovascular stability
    C.  Absence of active hemorrhage
    D.  Orthostatic vascular stability (able to tolerate 

       sitting without dizziness and able to ambulate at 
        pre-operative level, unless precluded by surgical 
        intervention)
    E.  Gastrointestinal stability
 
2.  At the request of the provider of care, the Post
    Anesthesia Score Sheet will be employed; the Discharge
    Score Sheet Consists of the following; no patient will
    be discharged with a score of less than 10:
 
    Respiration
        Able to breathe deep and cough...............2
        Limited effort--splinting and dyspnea........1
        No spontaneous effort........................0
 
    Color
        Normal skin color and appearance.............2
        Pale, dusky, jaundice........................1
        Frank .......................................0
 
    Consciousness
        Fully awake..................................2
        Arousable by calling.........................1
        Unresponsive.................................0
 
    Activity
        Able to move all extremities.................2
        Able to move two extremities.................1
        Not able to move upon demand.................0
 
    Circulation
        BP 20% preanesthetic level...................2
        BP 20-50% preanesthetic level................1
       BP 50% preanesthetic level...................0
 
3.  Staff will verify discharge order with the physician.
 
4.  Staff will verify that the patient and caregiver receive
    written and verbal instructions and document receipt of 
    such instructions for self-care, activity, diet, 
    treatments, exercise, use of equipment, medications, 
    follow-up appointment with physician, who to call in 
    case of emergency, and dressing care; as applicable. 
    These instructions will also include information 
    regarding the best means to contact the Physician 
    following discharge. The instructions will be explained 
    to the patient and the caregiver with adequate  
    oportunity given for questions.  

Approved By Governing Board    
PS.2
Control #71.6
GUPTA GASTRO