Discharge Checklist for 70-Year-Old Female with Sepsis, SSTI, and HFpEF
The patient should be discharged only when hemodynamically stable, euvolemic, established on evidence-based oral medication, and with stable renal function for at least 24 hours before discharge. 1
Infection Management
- Complete Dalbavancin 1.5g IV x1 prior to discharge (per ID recommendation)
- Confirm blood cultures are negative after repeat draw
- Document resolution of leukocytosis (continue daily CBC until discharge)
- Ensure wound care plan is in place:
- Continue zinc oxide topical QID
- Dakins 0.125% solution BID per wound care recommendations
- Document wound measurements and appearance at discharge
- Schedule outpatient follow-up with ID in 1-2 weeks
Heart Failure Management
- Confirm euvolemic status:
- Daily weights stable for 24 hours
- Resolution of pitting edema
- Respiratory rate <25, no dyspnea
- Oxygen saturation >92% on room air 1
- Convert from IV to oral diuretics:
- Transition from Bumex 1mg IV BID to oral equivalent
- Document plan for diuretic dosing at home
- Monitor electrolytes and renal function daily until discharge 1
- Document baseline weight at discharge for home monitoring
- Schedule cardiology follow-up within 2 weeks of discharge 1
Anemia Management
- Confirm hemoglobin is stable (goal >7)
- Document plan for outpatient iron supplementation after infection resolution
- Schedule hematology follow-up if needed
Respiratory Management
- Ensure oxygen saturation >92% on room air for 24 hours
- Document sleep study referral for suspected OSA
- Document PFT referral for outpatient follow-up
Disposition Planning
- Resolve discrepancy between PT recommendation (home) and OT recommendation (SNF)
- Consider patient's functional status and home support
- Document specific rehabilitation needs
- Coordinate with APS for Monday 10:00 AM meeting
- Assess home safety and caregiver capability (son)
- If discharge to home:
- Arrange home health services
- Ensure wound care supplies available
- Confirm medication access
- If discharge to SNF:
- Complete SNF referral paperwork
- Ensure SNF can manage wound care needs
- Transfer medication orders appropriately
Medication Reconciliation
- Complete medication reconciliation
- Document plan for Bumex dosing at home
- Ensure prescriptions are sent to pharmacy
- Document medication teaching completed
Patient Education
- Provide comprehensive written discharge instructions including 1:
- Diet (sodium restriction)
- Medication schedule and side effects
- Daily weight monitoring instructions
- Activity recommendations
- Signs/symptoms requiring medical attention
- Follow-up appointment schedule
- Wound care instructions
Follow-up Appointments
- Schedule primary care follow-up within 1 week of discharge 1
- Schedule cardiology follow-up within 2 weeks of discharge 1
- Schedule ID follow-up for infection management
- Schedule wound care follow-up
- Document sleep study referral
- Document PFT referral
Social Support
- Document APS meeting outcome and recommendations
- Assess need for additional home support services
- Evaluate need for medical equipment at home
- Consider case management referral for complex care coordination
Communication
- Communicate discharge plan to primary care provider
- Document handoff to next provider
- Ensure patient and caregiver understand discharge plan
- Document contact information for questions after discharge
This checklist addresses the key components needed for a safe discharge based on the patient's complex medical conditions. The most important factors are ensuring infection resolution, euvolemic status, stable renal function, and appropriate follow-up care 1, 2. The decision between home with services versus SNF should be based on functional status assessment and home support availability 1.