Ontario Hospital to Home Discharge Protocol
Family Caregiver Critical Action Items & Readmission Prevention
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1. 48 to 24 Hours Before Discharge
Meet with the Hospital Social Worker / Discharge Coordinator
Confirm whether an in-home care assessment request has been formally dispatched to Ontario Health atHome (formerly CCAC/LHIN).
Clarify Patient Designation (Avoid Involuntary ALC Surprises)
Inquire if the patient is considered medically stable or placed on Alternate Level of Care (ALC) status under Ontario Bill 7 (More Beds, Better Care Act).
Occupational Therapy (OT) & Physical Therapy (PT) Mobility Sign-off
Ensure the PT has evaluated weight-bearing status, transfer capabilities, and whether 1-person or 2-person assistance is required at home.
2. Medication Reconciliation & Pharmacy
Obtain the Formal Written Hospital Discharge Medication Summary
Ensure the attending physician or hospital pharmacist clearly identifies which pre-admission home medications are to be continued, altered, or stopped.
Coordinate with Community Pharmacy for Blister Packing
Notify your local Ontario pharmacy (Shoppers, Rexall, IDA, or independent) to prepare new 7-day blister packs matching the revised hospital discharge sheet.
Secure High-Risk Medication Instructions (Blood Thinners, Insulin, Antibiotics)
Ask specifically for red-flag symptoms: what signs of bleeding, hypoglycemia, or allergic reaction require an immediate 911 or ER visit?
3. Home Safety & Medical Equipment Requisition
Arrange Mobility Aids & Assistive Devices (ADP Program)
Confirm delivery of required assistive equipment: hospital bed, walker/rollator, raised toilet seat, shower bench, or wheelchair.
Clear Home Fall Hazards & Secure Lighting
Remove loose throw rugs, clear clutter from hallways, ensure bright nightlights in pathways between bed and bathroom.
Secure Lockbox & Emergency Access for Visiting PSWs
Place an exterior key lockbox or smart lock code. Share the secure code with authorized caregivers inside QuestCareConnect Care Vault.
4. Day of Discharge & Transit Logistics
Verify Patient Clothing & Mobility-Friendly Footwear
Bring loose, comfortable clothing (elastic waist pants, wide-mouth shoes with non-skid rubber soles, warm layers).
Confirm Accessible Transport (Wheel-Trans, DARTS, or Family Car)
Ensure the vehicle can comfortably accommodate transfers. If specialized van transit is needed, book at least 24 hours in advance.
Collect All Paperwork & Diagnostic Disk Copies
Do not leave the unit without: printed discharge summary, specialist referral letters, and follow-up appointment booking instructions.
5. The First 72 Hours at Home
Set up the QuestCareConnect Digital Care Circle
Invite all siblings, adult children, and visiting PSWs. Post the first shift log and synchronize the medication reminder schedule.
Schedule Follow-Up with Family Physician (GP)
Ontario guidelines recommend an in-person or virtual follow-up appointment with the family doctor within 7 to 14 days of acute hospital discharge.
Monitor Daily Vitals & Red Flag Symptoms
Log blood pressure, temperature, and wound drainage daily. Use the QuestCareConnect shift log to detect infection or heart failure fluid retention early.
QuestCareConnect Hospital Discharge Checklist • Empowering Family Caregivers Across Ontario • www.questcareconnect.com