Written Discharge Instructions

In addition to creating a discharge letter or summary for principal care providers, it is important that patients leave the hospital with printed reminders of key aspects of their aftercare plan to use as a reference. They do not require many of the elements of the discharge summary, although there will be some overlap (See Discharge Plan above in Universal Patient Discharge Checklist section).

When generating an older patient’s post-hospitalization care plan, the following principles should be remembered (Williams, Davis et al. 2002):

• The print must be large enough to be read by patients. In general, a font size of at least 14 points is desirable. Avoid using all capital letters and italics. If handwritten, ensure legibility and large printing.
• Avoid jargon, technical words, and medical abbreviations.
• Lists are helpful.
• Keep sentences simple and short.
• Highlight important elements in bold.

Creating the correct balance of information to include on the patient care plan is difficult. Too much information may be confusing or unnecessary. Insufficient information may lead to confusion or misunderstanding. The following elements of the patient care plan are essential:

• A statement about the reason for the hospitalization (i.e., the principal diagnosis).
• A list of medications with name (brand or generic or both, as appropriate), dose, route, frequency, and when relevant, reason for prn, written in lay terminology. Ideally, the list would indicate which medications were old, new, or changed and which medications the patient was on prior to admission that he or she should no longer take.
• Statements about what types of complications (e.g., related to their principal diagnosis or medication side effects) may occur and what to do if they happen (i.e., warning signs and symptoms).
• A list of follow-up appointments for tests and clinical visits, with their dates, times, and locations.
• A list of relevant contact information (e.g., principal care providers, the VNA, the pharmacy, the hospitalist).

See the Toolkits section within Clinical Tools for the Patient PASS and see the DPET Tool for examples of written discharge instructions which you may want to adapt for your use.

Ideally, the hospital’s information system can be used to create the patient care plan in order to avoid the redundancy of creating this form in addition to the discharge summary and also in an effort to avoid errors related to inaccurate copying of patient information (eg, medications or follow-up appointments).