IDEAL Discharge Planning Checklist Fill in, initial, and date next to each task as completed. Patient Name: Prior to Discharge During Discharge Initial Nursing Assessment Day of Discharge Planning Meeting Planning Meeting Identified the caregiver Distributed checklist and Discussed patient Medication at home and backups booklet to patient and questions Reconciled medication list family with explanation Told patient and family Discussed family Reviewed medication list with patient about white board Scheduled discharge questions and family and used teach back planning meeting Appointments and contact information Elicited patient and Reviewed discharge family goals for hospital Scheduled for instructions as needed Scheduled followup appointments: stay 1) With / / at Used Teach Back on Informed patient and [time] Offered to schedule family about steps to / / at [time] followup appointments discharge 2) With with providers. on Preferred dates / times for: / / at [time] Arranged any home care needed PCP: Wrote down and gave appointments to the patient and family Other: Wrote down and gave contact information for followup person after discharge
IDEAL Discharge Planning Checklist Fill in, initial, and date next to each task as completed. Patient Name: Initial Nursing Assessment Prior to Discharge Planning Meeting During Discharge Planning Meeting Day of Discharge Identified the caregiver at home and backups Told patient and family about white board Elicited patient and family goals for hospital stay Informed patient and family about steps to discharge Distributed checklist and booklet to patient and family with explanation Scheduled discharge planning meeting Scheduled for / / at [time] Discussed patient questions Discussed family questions Reviewed discharge instructions as needed Used Teach Back Offered to schedule followup appointments with providers. Preferred dates / times for: PCP: Other: Medication Reconciled medication list Reviewed medication list with patient and family and used teach back Appointments and contact information Scheduled followup appointments: 1) With on / / at [time] 2) With on / / at [time] Arranged any home care needed Wrote down and gave appointments to the patient and family Wrote down and gave contact information for followup person after discharge
Strat4_Tool_1_IDEAL_chklst_508.docx