Patient Safety Tool: Medication History/Discharge Order/Patient Instructions Form From Kearney County Health Services

Kearney County Health Services, based in Minden, Neb., provided a medication history/discharge order/patient instructions form for use in a medication reconciliation toolkit developed by the Critical Access Hospital Network and available on the website of the Nebraska Hospital Association.


The two-page form addresses several critical components of a safe patient discharge, including medications to continue at home, new medications, restrictions on activities, restrictions on diet and guidelines for wound/incision care.


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Down the discharge form (doc) for adaptation and use in your facility.

Learn more about the Critical Access Hospital Network medication reconciliation toolkit.


Note: View our database providing 90-plus reports that link to free, downloadable and adaptable tools for use in surgery centers, hospitals and other organizations by clicking here.


Related Articles on Medication Reconciliation:

20 Questions Surgery Centers Should Ask to Ensure an Effective Safe Medication Management Program

AORN Urges Safety During Six Phases of Medication Administration Process

Top 10 Patient Safety Issues for 2011

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