Patients will frequently require equipment to enable them to return home. Ensuring that all required equipment is available and in working order before discharge facilitates a smooth transition to home (Elliott and DeAngelis [13]). The equipment needs of each patient should be assessed at pre‐admission and throughout their stay to ensure nothing is omitted.

Patients may require new additional services at home, such as oxygen, which should be prescribed using the appropriate national Home Oxygen Order Form (HOOF) and the Initial Home Oxygen Risk Mitigation Form (IHORM). In 2017, NHS England changed the process for ordering home oxygen to make it safer as it had been found that patients were not always being asked to sign consent forms when they were started on oxygen (NHS Sunderland Clinical Commissioning Group [36]). The IHORM was therefore introduced to reduce the risk of a serious incident occurring when medicinal oxygen is installed in a home environment. Before a patient is initiated on oxygen, the clinician must ask the patient some relevant questions in order to ensure they understand the risks and give informed consent.

The HOOF and IHORN forms need to be faxed to the local oxygen supplier but often the task of ordering oxygen is completed by the patient's local clinical commissioning group, which usually has details on its website along with the facility to download forms. It is useful to know how the local procedures work and to ensure consideration is given to the monitoring and reviewing of the patient on oxygen once at home.

Before a patient is discharged, the nurse needs to ensure that the patient and, where appropriate, the carer are competent to self‐administer medication at home. Evidence suggests that there are often limited resources in hospitals to ensure patients who are capable of self‐care regarding medication maintain their independence (QNI [44]) so supportive measures must be considered. In some areas, tablet dispensers are provided, particularly for those who have difficulty opening containers or who lack competency in remembering which tablets to take when (Figure 3.4). If carers and/or community nurses are involved in giving a patient medication at home, a medicines administration record (MAR chart) should be given on discharge, clearly stating the name of the drug, the dose and frequency, and any special instructions (Figure 3.5). Special considerations are required for medications prescribed for pumps and drivers (e.g. for patients who require end‐of‐life care or symptom management), and in such circumstances local policies should be referred to.

In some cases, patients may be receiving nutrition via feeding tubes, known as ‘enteral feeding’. The common routes for enteral feeding in the community are:

Dietitians and/or nutrition nurses normally facilitate arrangements for these patients when they are going home. It is important that community teams including nurses and dietitians are contacted in advance of a patient being discharged with supportive feeding in situ to ascertain what information and support they need to facilitate the patient's safe and timely discharge home.

It is important to recognize that some patients will have additional needs due to their status or health condition – for example, a continuing disability, learning difficulties, a mental ‘illness’ or dementia. Patients who live alone or who have limited financial resources also need specific consideration to ensure their needs are met and that they are not vulnerable to further problems once discharged.

There may be practical issues about the transfer home that patients have not considered themselves while in hospital. If, for example, the patient lives alone or is very frail, simple tasks such as shopping may be very difficult. Some trusts have services to provide food packs for elderly patients (QNI [44]) but otherwise arrangements will need to be made prior to discharge to ensure the patient has adequate food provisions. Talking to the patient about what they will need and how they will manage is essential. Carers, family and neighbours should be involved and appropriate local agencies and services considered.

Age UK (www.ageuk.org.uk) provides information and support for older people. Its factsheet on hospital discharge gives useful advice for patients about practical issues to consider when leaving hospital (Box 3.1).

Each year, almost a third of people over the age of 65 fall (NICE [40]). Where patients are frail or at risk of falls, ensuring that they know that a community pendant alarm system or other personal alarm system can be installed may provide them and their family with some reassurance. Information regarding these alarms and local providers is usually held by the local authority (see Chapter c07: Moving and positioning for more information). For many dependent adults, adaptive technologies provide a means to independent living and a decrease in reliance on support from family members or more costly social services.

On discharge, consideration may need to be given to patient accommodation, such as the suitability of the accommodation and alterations required. The hospital occupational therapy team usually leads on this and makes a domiciliary visit to ensure appropriate aids (e.g. hand rails) are put in place and changes are made to facilitate the safe transition of the patient home. A home visit may also be necessary to ensure the property is habitable – for example, if the patient's property is in a poor state or there are issues in relation to hoarding. This may need to be done by or with social services. Where the patient is a home‐owner, however, the housing department may be less likely to intervene, in which case it is up to the patient and their family to address such issues.

It is also possible that prior to admission a patient will have been homeless, or they may become homeless during their hospital stay. The patient may need to be supported to access accommodation through the local authority homelessness team. As part of the process, the patient will need to provide evidence of eligibility for social housing, which will require specific supporting documentation. It is worth noting that all housing assessments are carried out online, which can be difficult for patients who have little or no knowledge of computers, so extra support is needed for such patients to prevent delay in discharge.

The use of a discharge checklist or centralized discharge planning record that can be accessed by all hospital staff can aid the process and facilitate rapid transfer of information between teams (Lees [18], Winfield and Burns [54]). The same checklist can be used for all patients whether they have simple or complex discharge needs, as it minimizes omissions or duplication in discharge actions and ensures a good record of the planning process. An example of a discharge checklist is given in Figure 3.6.