Patient Education, Discharge, and Follow-Up
Discharge is a teaching event, not a signature
Discharge criteria typically require stable vital signs, return to baseline consciousness and orientation, controlled pain and nausea, minimal bleeding, patent airway, ability to ambulate as appropriate, and a responsible adult escort with instructions not to drive or be left alone for 24 hours. Verify the patient understands restrictions: no driving, no operating machinery, no alcohol, no making important legal decisions, and no strenuous activity for the period specified.
Teaching that actually works
Use plain language, avoid jargon, chunk information, and confirm with teach-back ("Tell me in your own words what you will do if the pain is not controlled"). Provide written instructions at an appropriate reading level, involve the escort, and use a qualified interpreter - never a family child - for limited-English-proficiency patients. Address health literacy, hearing/vision deficits, and cultural preferences.
Content of discharge instructions
- When to call the facility versus 911: fever, uncontrolled bleeding, worsening pain, persistent vomiting, difficulty breathing, chest pain, inability to urinate.
- Wound care, dressing changes, bathing restrictions.
- Medication plan, including analgesics, antiemetics, and resumption of home medications.
- Follow-up appointment and a routine follow-up phone call (commonly within 24-72 hours).
- Special populations: caregivers of children, older adults at fall risk, and breastfeeding mothers.
Traps
The myth that mothers must "pump and dump" for 24 hours after sedation - current guidance supports resuming breastfeeding once the mother is awake and alert. Assuming a patient who nods remembers verbal instructions. Discharging without documented escort. Failing to document the teaching and the patient's response.
Rule of thumb
If it is not documented as taught, with the learner's response, it did not happen - chart the teach-back.