It’s a moment of great relief for families when their loved ones are discharged from the ICU. However, nurses need to be prepared for the discharge process in order to ensure a successful transition for patients and their families.
You may be asking yourself, “why do I need to know how to discharge patient’s from the ICU?” Based on the current state of the healthcare system and bed availability, many patients and nurses are finding ICU length of stays increasing due to these conditions causing discharges to take place in the ICU.
We will discuss nursing tips for discharging patients from the ICU. We’ll cover everything from preparing the patient for discharge to helping with follow-up care at home. Read on to learn more!
Table of Contents
What is the discharge process for patients in the ICU?
The process of discharging a patient from the ICU can be broken down into three main phases: pre-discharge, during discharge, and post-discharge.
Pre-discharge planning begins when the patient is admitted to the ICU/hospital. This is the time when the care team will develop a plan for the patient’s discharge. During this phase, it is important to involve the patient and their family in the decision-making process.
The second phase, during discharge, is when the actual discharge takes place. This is typically a busy time for the nurse as they are coordinating with multiple members of the healthcare team.
The third phase is post-discharge where the patient will follow up with the appropriate providers hopefully eliminating the need to be readmitted.
What are important factors to consider for discharge planning?
There are many factors to consider when discharge planning for a patient in the ICU. Here is a discharge checklist that you can discuss during multidisciplinary rounds:
- Has a discharge plan been discussed with the patient/family? Has this been documented?
- Are there any transportation needs after discharge? Is the patient returning to a Long Term Acute Care Hospital (LTACH) or Nursing Home?
- Are there any medications requiring prior authorization? Some insurance companies will require pre-authorizations for anticoagulants, inhalers, transplant medications, or diabetes medications which could take a few days.
- Is the patient on any new medications that will need to be started after discharge?
- Do they understand how to take the medication and what the side effects are?
- Do they have enough of their current medications for after discharge?
- Is there any at-home or outpatient antibiotic drips that require additional setup?
- Have we verified the patient’s pharmacy?
- Are there any consultant clearances we are waiting on for discharge? Who hasn’t signed off care?
- Have the consultants been called/texted if appropriate?
Physical Therapy, Medical Devices, or Durable Medical Equipment
- Are there any DME needs such as a wheelchair, walker, oxygen, or bedside commode?
- Does the patient need to be seen by PT/OT before discharge?
- Does the patient need any at-home tube feedings, LifeVest, or other medical devices that need to be delivered?
- Does case management need anything before discharge?
- Is there any paperwork that needs to be signed for transfer?
- Does the patient/family have any needs from case management before discharge?
- Are there any critical appointments that need to be made for the patient prior to discharge? To prevent readmissions it is always a good practice to help the patient make their appointments prior to discharge for follow-up.
What are some of the challenges nurses face during discharge from the ICU?
There are many challenges nurses face when discharging patients from the ICU. One of the biggest challenges is making sure that the patient and their family are completely comfortable with everything before they leave. This includes their medications, understanding the discharge instructions, and having all of their appointments set up.
Another challenge nurses face is coordinating with all of the different members of the healthcare team. This includes the doctors, case managers, physical therapists, and any consultants that were involved in the patient’s care. It is especially difficult when the discharge is waiting on consulting providers to see the patient and sign off.
The last challenge, which is probably the most important, is making sure that the patient is actually ready to be discharged. This includes making sure that all of their lab values are within acceptable limits, they are able to eat and drink, and they are able to ambulate without any assistance or have care in place to assist with ambulation upon their arrival home. For example, if you have an elderly patient who is status post hip replacement being discharged home and does not have any support to help with ambulation around the house, this may be an unsafe discharge.
Always reach out for assistance from your charge nurse or unit manager if you are feeling overwhelmed with the discharge process. They will be able to help guide you and make sure that the patient is discharged safely.
If you feel the discharge is not safe, always advocate for your patient. This is their life and health that you are responsible for. The goal is to always discharge patients safely so they can continue to receive the care they need at home from either family support or other resources.
Once the patient is discharged, what are the next steps for the nurse?
After the patient is discharged, the nurse will need to complete a few final tasks. These tasks include updating the discharge paperwork, completing any outstanding orders, and documenting the discharge in the patient’s chart.
There are a few things that need to be discussed in the discharge paperwork during discharge. This includes the diagnosis education, patient’s medications, symptom management and what to watch for, any restrictions or special instructions, ambulation status, when to return to the emergency department, and provider follow up instructions. If any medications or diagnostics are new, it is best to educate the patient on the those new things. It is also important to make sure that the patient signs any consent forms or releases prior to leaving.
The nurse will also need to make sure that all of the patient’s belongings are gathered and ready to go home with them. This includes their clothes, personal items, and any medications or durable medical equipment that they were discharged with.
The nurse will want to remove any IV lines or other monitoring devices such as telemetry that the patient no longer needs and make sure that they are comfortable before leaving.
The nurse will then need to say goodbye to the patient and their family and wish them well.