How to Discharge a Patient at VUMC¶

Verify the correct pharmacy with the patient (Vanderbilt MCE pharmacy if using meds-to-beds) and if refills of existing medications are needed
Select ‘Transfer-Discharge’ on the navigator panel on eStar select ‘Discharge’ tab on the top of the page
Select ‘Rx Routing’ on the left panel. Choose one of the three options. This choice will set the default prescribing choice for new medications at discharge or refilled medications. This can be changed manually within each Rx order
Default = will e-prescribe to pt’s pharmacy
Print = will print all Rx’s and not e-prescribe (printed to nursing station on pt’s floor)
Do not print and do not e-prescribe (This is used for pt going to SNF or IPR)
Select ‘Discharge Orders’ on the left panel. This will open a reconciliation navigator
Reconcile the home medications with the current inpatient medications. The red tab on the right side of the screen will become green when all medications are addressed
For new medications or refills, make sure the ‘Class’ in the prescription is set to ‘Normal’ for electronic prescriptions. Otherwise, to add the medication to the list without a prescription, choose ‘No Print’
The medications will e-prescribe to the pharmacy selected at the bottom of the order panel on the right side of your screen
To send to multiple pharmacies, select the primary pharmacy at the bottom of the order panel on the right side of your screen, then choose ‘Send to Multiple Pharmacies’
Note that meds-to-beds will arrange to deliver meds AFTER the "discharge" order is signed; if discharge is time-sensitive, can call to ask if meds can be delivered in advance
Next, select ‘Order Sets’ at the top of the Discharge Orders panel
In the order box on the right, type “Adult General Discharge”
Right-click on the option and select “Add to Favorites”. Now, this option will be available on the Order Set page for future patients.
Open Adult General Discharge order set
- Select the appropriate choices pertinent to current pt
  - For SNF/LTC, include RN orders like diet, activity order/restriction, wound care, etc.
- On the right side of the screen, you can add Ad Hoc orders such as:
  - Hospital Follow-up with "X" service (place these as soon as you know!)
  - Ambulatory Referrals
  - Post-discharge labs
  - Important for ID labs in addition to INR checks, place fax number for which provider that will be following up results in the comments section. If labs will be done outside of Vanderbilt system, must select "External Non-VMG"
  - Medications not listed on reconciliation list
When all sections are completed, click ‘Sign – Print and/or E-prescribe Now’
Select ‘Follow-up Providers’ on the left panel.
Select the providers that you want to receive the discharge summary. Provide personal instructions to the patient
Select ‘Instructions’ on the left-hand panel
Free-text your personal comments and instructions to the patient, 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)
This section appears FIRST in the pt’s printed AVS