CE: 0.25 contact hours
By Daniel M. Edgar, BSN, RN, CEN, PHRN
DISCHARGE FAILURE:
When a patient is harmed or otherwise failed by flaws in the discharge process.
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This article will discuss how the
use of emergency department
(ED) discharge teaching and
written discharge instructions can
impact the cultural, safety, legal,
ethical, financial, and regulatory
consequences of the hospital.
When basic discharge steps are
not followed, there is a risk that
the patient will return to the
hospital due to unresolved pain,
poor medication compliance, lack
of proper follow up, or exacerbation of the original complaint.
As a result of discharge failures,
patients may be readmitted, pursue litigation, or avoid becoming a
patient in the offending hospital.
Discharge failures can also be
fatal.
Consequences
There are consequences to poor
discharge teaching and written
instructions. Unless the patient
is admitted to the hospital, the
ED’s final act is the discharge
teaching to the patient. The
results can be dangerous if the
teaching methods are poor or the
patient does not grasp the information.
Patient Death
Of course, the worst consequence
of a hospital stay is a patient
death. The risk for this is greatest
in the older population (Hastings
et al., 2011). Care should be taken
to ensure that instructions are
carefully printed, given to the correct patient, and will address the
right diagnosis (Rau, 2016).
should also be documented. If a
patient decides to leave against
medical advice (AMA), discharge
instructions should be given and
placed in the patient’s chart with
orders to return to the ED at any
time. Discharge instructions for
AMA should also include a risk
section clearly stating that the
patient’s condition could worsen
and that they could die if they
leave the ED.
Litigation
A patient death, injury, or worsening condition due to following
erroneously written discharge
instructions or medication reconciliation is fodder for litigation if
not caught by a registered nurse
(RN), doctor, or pharmacist (Rau,
2016). Even if the best treatment is given to a patient, poorly
written discharge instructions or
charting could negate that care if
brought before the legal system,
regulators, or licensing boards.
Pain scores, fall scores, and vital
signs should be documented at
discharge (Domagala, 2009). A
discussion about how the patient
plans on safely getting home
According to Bartley (2014, p.
315), “The process for discharging a patient from the hospital
as AMA should be identical to a
regular discharge.” Some institutions will automatically flag a
patient’s chart for review after an
AMA discharge by a risk manager
or someone in the legal department (Bartley, 2014).
Lack of Patient Compliance
According to Gignon, Ammirati,
Mercier, and Detave (2014, p.
51), literature shows that “21%
to 41% of patients do not understand their diagnosis … between
12% and 20% do not fill their prescriptions.” They concluded that
Fall 2016 Pennsylvania Nurse 5