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How to Discharge a Patient at VA

Complete the following steps in this order to ensure info will be accurately reflected on the DIPN.

  • Medication reconciliation
  • The list of outpatient medications at the end of your reconciliation is the final medication discharge list.
  • In the medication tab, transfer new inpatient medications to the outpatient medication list by right-clicking and select ‘Transfer.’
  • Select “Pick up at window,” as this will ensure the patient will have the medication prior to leaving the hospital.
  • Order new supplies (wound care, tube feeds, etc) by placing new outpatient "med" order.
  • Review the existing outpatient medications to determine if they need to be continued and if the pt has an adequate supply at home - refill meds if necessary.
  • Discontinue any outpatient medications that you do not want the pt to continue taking. Right-click and select ‘Discontinue.’
  • Return to clinic (Primary care).
  • Critical to tag PCP on discharge summary to ensure they are alerted to hospital stay. Can also tag consultants and office coordinators (RNs) can be cc’d to DC summary by resident.
  • For PCP follow-up, no longer need to place an RTC, will be coordinated by PACT on the clinic side.
  • Ask VA Inpatient Chief for "welcome to VA wards" info with instructions to place subspecialty hospital follow up appts, as there is variation (page fellow vs e-consult vs RTC).
  • Complete DIPN
  • The DIPN contains all of the discharge instructions.
  • Start a new note and select ‘DIPN’ template. This will open a pre-templated note - follow the prompts and select finish. All sections need to be addressed to proceed.
  • Discharge related orders will generate after you finish the DIPN prompts, which includes vaccinations, removing IV, removing Foley catheter, etc.
  • The DIPN is valid for 24 hrs; thus the DIPN may be pre-signed one day prior. If DIPN is pre-signed, final changes to pt instructions and medications need to be addended.
  • [Optional but strongly recommended] Provide personal instructions to the patient at the top of the DIPN (coach your interns to do this!), such as:
    • A simple statement for why the pt was admitted.
    • Changes made to pt’s medications that you feel are important to highlight.
    • Home instructions (daily weights, diet changes, wound care, etc).
    • Key follow-up plans (main appointments, labs, or tests).
  • Sign the DFF (discharge from facility) order:
  • The DFF order is found under the “Discharge Orders” tab in CPRS orders.
  • Once all steps are completed, DFF can be signed and pt will be discharged from facility.
  • Discharge summary: right click dropdown menu "identify additional cosigner" ALWAYS add the patient's PCP, may add other consultants or subspecialists for continuity.