SECTION:	H - Clinical 

TITLE:	DISCHARGE INSTRUCTIONS 

POLICY #:	6.106 

EFFECTIVE DATE:	05/01/96 

APPROVED BY: 

 

Discharge instructions will be given to every patient based on the surgeon/physician's orders. 

 

The Post-Operative Instruction Form will be signed by a responsible adult who will be caring for the 

patient and will be witnessed by the Recovery Room nurse. The original copy will be given to the patient 

and responsible adult and the yellow copy will be retained as a part of the medical record. Recovery 

Room nursing personnel must document on the medical record that instructions have been given to the 

patient and responsible adult. 

 

When a transportation service is designated to take a patient home after discharge, a responsible adult is 

available at home to care for the patient. Facility staff should document the name(s) of the individual who 

has been given telephone instructions as well as giving the original copy of instructions to the 

patient/transportation service. 

 

In addition, all patients who have received an anesthetic are given "General Post-Operative Instructions," 

which are printed on the reverse side of the Post-Operative Instruction form. 

 

A Medication Side Effects form is given to each patient, advising them of the potential side effects of 

medications received during the course of care at the facility. 

 

If available and requested, a copy of the surgeon's post-operative instructions will also be given to the 

patient. 

 

Healthcare providers given responsibility for continuing care of patients following facility discharge will 

be provided with discharge instructions and other information necessary for the continuation of quality 

patient care. 

 

Sample Post-Operative Discharge Instructions Forms follow this policy.