Bringing a Parent Home From the Hospital: Checklist for the 72-Hour Discharge Window

Bringing your parent home from the hospital is a moment that brings great joy to the family. The treatments are done, discharge paperwork is completed, and now the family is ready to start normalizing their routine.

The majority of the care your parent will need will be in the first 72 hours after arriving home.

New prescriptions, follow-up visits, wound care, dietary restrictions, limited movement, changes to care instructions, and other factors will be challenging for the family to manage. Missing a prescription dose, missing a follow-up appointment, or ignoring signs of complications may lead to hospital readmission.

The care your parent will need will begin before they are able to sit in their favorite chair. Your parent will be able to recover in a safe and comfortable manner if you are better able to prepare for your parent's return home, which will include outlining the necessary medications, preparing the home, arranging the equipment, reviewing the care plan, and identifying the warning signs that require contacting a doctor. The better prepared and more organised you are during the first three days after discharge, the safer your parent's recovery at home is likely to be.

Home Care: The First Three Days Post-Discharge

Reduced muscle strength, a weaker appetite, and poor sleep integrated with the medications initiated at the hospital will lead to a higher risk of hospital readmission during the first few days after discharge.

Falling, medication errors, post-surgical and wound infections, and dehydration are the leading causes of hospital readmission. The first 3 days of the home care structure will prevent these four problems from taking place. Each problem may appear to be difficult, but are relatively easy to manage if you have a well-structured three days.

Day Zero: Complete Your Tasks Prior to Leaving the Ward

Have the Discharge Summary Explained to You, Line by Line

Request that the treating doctor or nurse explain the summary to you. Take note of the diagnosis, what procedures were done, what medications were added and/or removed, any activity restrictions, dietary instructions, steps for wound care, and when the next appointment is. If your parent does not read English or medical jargon well, request the instructions in their preferred language, and take a picture of each page.

Perform Medicine List Reconciliation

Hospital prescriptions would usually supersede any prescriptions written for your parent prior to admission. Ask whether each medicine your parent was taking before admission should be continued, stopped, or taken at a different dose. For blood thinners, diabetes medications, blood pressure medications, and pain medications, written instructions must be taken. Also, ask if meals are to be rescheduled and any restrictions on over-the-counter medications.

Ask for a Written List of Warning Signs

It's best to ask for two lists: one for symptoms that warrant a phone consultation on the same day and one for symptoms that need a visit to the emergency room. The one that requires a trip to the hospital would include fever, breathlessness, chest pain, bleeding, sudden confusion, reduced urine output, leg swelling, and wound redness with increased discharge.

Organize the Transfer Home

Consider how your parent will move from the bed to the car and from the car to the house. After a lengthy hospital stay, some people find it difficult to navigate stairs or long walkways. A folding wheelchair, or a rollator like the one found at AGEasy, will allow your parent to walk for part of the transfer and will help to relieve any exhaustion from walking.

Day 1: Prepare the Home for the Person

Make a Clear Path to the Bathroom

People fall most frequently when walking to a toilet, especially in the middle of the night. There should be no loose rugs, trailing wires, or low furniture in the way. Install a night light. Anti-slip mats should be used at the entrance to the bathroom and wet spots should be covered.

Make Adjustments to Support Weight Shifting

Your parent may be temporarily losing strength, but getting on and off the toilet and shower will use the strength you have lost. A grab bar makes a firm hold for both sides, and a shower chair will make it unnecessary to stand during the bath.

Don't Match the Walking Aid to the Past Ability

A parent who previously walked unaided before surgery will likely require support to walk for a few weeks afterwards. Someone who needs support for maximum stability will need a walker without wheels, while a person who needs support for a short period of time will need a wheeled walker. Both types of walkers are included on the AGEasy website. Prior to use, the physiotherapist should adjust the height of the walker, as an improperly adjusted walker poses a fall risk.

Establish a Medical Station

Pick one place that will be most visible and near the dining table. It should contain all the medicines, a pre-written schedule, a glass and water, and a notebook. The schedule should be written as times of day and not drug names, as this will allow it to be easily read by any family member or attendant.

Day 2: Medications, Monitoring, and Daily Care

Administer Medications on a Schedule, Not from Memory

Set phone alarms for each dose, and document each dose given in the notebook. This practice, when two family members share caregiving, prevents double dosing, which is the most frequent medication error at home.

Monitor the Vital Signs

Most discharge instructions provide a few parameters to monitor. BP, pulse, temperature, blood glucose, and oxygen saturation, cover most. Daily monitoring is easy with a home blood pressure monitor and fingertip pulse oximeter. They even have a wrist BP monitor with voice output designed for parents that are visually impaired. Record the readings with date and time and bring it to the follow up appointment.

Protect the Skin, and Dignity

Increased mobility may heighten risk for pressure sores within days, especially over the bony prominences of the hips, heels, and lower back. For a parent that is bedbound, position changes every two hours are essential. Keep the skin clean and dry and inspect bony prominences often. Undersheets that are disposable protect the bed from messes without needing to do full bed changes as often, and bath wipes provide gentle cleansing when a shower is not safe. If recovery involves loss of bladder control, order adult diaper pants that fit well. They will reduce nighttime potty trips, which is one of the biggest fall risks during this time.

Monitor Food and Fluid Consumption

Appetite naturally declines for all people following a hospital visit. It is best to offer smaller meals more frequently rather than three large ones. Further, it is advisable to include a protein source into every meal so the parent can rebuild lost muscle. Encourage them to drink, unless directed otherwise by the doctor, as increased fluid intake decreases the chances of dizziness, constipation, and confusion due to dehydration.

Day 3: Movement, and Following Up to Determine if Further Action is Needed

Start Moving, as Permitted

Bed rest beyond what is necessary for medical reasons weakens muscles very fast. Assuming the discharge plan does not state otherwise, assist your parent in sitting in a chair for meals, walking short distances within the home, and perform any exercises that were prescribed by the physiotherapist. You should stop if your parent feels breathless, experiences chest pain, or light-headedness.

Understand What Needs to Be Done in the Event of an Emergency

Keep the ward number, treating physician's office number, and the emergency department number stored in your phone and on the refrigerator. Agree in advance who drives, who stays with your parent, and where to access the hospital file.

Getting Additional Support

If your parent requires assistance with dressing wounds, giving injections or dealing with catheters, and help with toileting and bathing, ask about a home nurse or attendant. A physiotherapist who visits the patient a couple of times during the first two weeks can accelerate recovery and prevent falls. These arrangements do not mean you have failed. They lessen the burden on family members who are trying to balance their work and caregiving responsibilities.

72 Hour Checklist

Here is a quick 72-hour checklist to help you track your preparation:

• Understanding and reading the discharge summary
• Medication list reconciled and documented with a time schedule
• Warning signs written down and shared with all family members at home
• Walking aid arranged and set to the right height
• Bathroom equipped with a grab bar, anti-slip mat, and shower chair
• Path from the bed to the bathroom is clear and well lit
• Vitals log commenced
• Daily skin and pressure point checks
• Tracking of small frequent meals and fluid intake
• Follow up appointments scheduled
• Emergency contacts saved and displayed

Print this list and tick off the completed tasks. The 3 days of work will be the foundation of the recovery period that will last three weeks.

This article provides general advice to family caregivers. Please follow discharge instructions from your parent's treating team, and consult with the doctor before making any changes to medications, diet, or activity level.