Discharge Nutrition Plan

Patient Name: [Patient full name]

MRN: [Medical record number]

DOB: [Date of birth]

Admit Date: [Admit date]

Discharge Date: [Discharge date]

Discharge Disposition: [home / SNF / rehab / hospice]

Author/Credentials: [Name, credentials]

Date/Time: [Date and time of note]

Summary

[Brief discharge nutrition summary] (3–5 sentences covering: key inpatient nutrition problems and current status; nutrition route at discharge [oral / oral + supplements / enteral / oral + enteral]; high-risk factors such as aspiration risk, malnutrition severity, tube dependence, food insecurity, or metabolic concerns. Include active nutrition diagnoses in PES format if facility uses NCP terminology. If critical details are unknown, document the gap and who will resolve it.)

Discharge Nutrition Plan

Diet: [Diet type and restrictions] (Include texture level and liquid consistency using IDDSI terminology if dysphagia-modified; key limits/targets such as sodium, fluid restriction, protein target; allergies or dietary constraints.)

Oral Nutrition Strategy: [Meal pattern and key strategies] (Protein/energy emphasis and symptom-targeted strategies as relevant. Omit if patient is NPO or fully tube-fed.)

Supplements: [Product, dose, frequency, timing, indication] (If PRN, define trigger. Include alternatives if cost/availability is a concern. Omit if none prescribed.)

Hydration: [Hydration target or restriction with practical guidance] (Include thickened liquid specifications if applicable. Omit if standard hydration without special considerations.)

Micronutrients: [Specific supplement(s) with dose, frequency, duration, monitoring plan] (Include only if indicated by diagnosis or procedure such as bariatric surgery, malabsorption, or severe restriction. Omit otherwise.)

Home Enteral Nutrition

(Include this section only if patient is discharging on tube feeding; omit entirely for oral-only plans.)

Access: [Tube type] | [Gastric / Jejunal] | [continuous / cyclic / bolus / gravity] (Note aspiration precautions if ordered.)

Regimen: [Formula name/type], [Total volume/day], [Rate or bolus volume/frequency], [Schedule] (Include advancement plan with stop conditions if applicable.)

Flushes: [Routine flush volume and frequency] | [Medication flush guidance] (Note free-water boluses for hydration and fluid restriction constraints if applicable.)

Medications via Tube: [Drug-feed interactions and hold parameters if applicable] (State that medications should not be mixed into formula.)

Supplies & Coordination: [Equipment needed] | [Supplier/DME and contact] | [Delivery schedule] | [Authorization status and interim plan if pending]

Troubleshooting:

• If [GI intolerance: vomiting, distension, severe diarrhea] → [action] → call [contact]
• If [aspiration signs: coughing with feeds, respiratory distress] → stop feeds, sit upright → call [contact] or seek emergency care
• If [tube problem: clogging, dislodgement, leakage, stoma infection] → [action] → call [contact]
• If [metabolic concern if applicable] → [action] → call [contact]

Education

Learner(s): [Patient and/or caregiver] (Note interpreter use if applicable.)

Teaching Method: [verbal / written materials / demonstration]

Topics Covered: [Topics relevant to discharge plan]

Verification: [Teach-back or return demonstration results]

(If education incomplete, document reason and mitigation plan such as home health training or follow-up call.)

Red Flags & When to Call

• [Inability to keep fluids down or signs of dehydration]
• [Minimal or no intake beyond specified threshold]
• [Rapid unintentional weight change]
• [Severe swallowing difficulty, choking, or suspected aspiration]
• [Tube emergencies: dislodgement, persistent clogging, leakage, stoma concerns] (if applicable)
• [Other patient-specific red flags as relevant]

Who to Contact: [Clinic/provider and phone for business hours] | [After-hours instructions] | [When to call 911 or go to ED]

Follow-up & Monitoring

Home Monitoring: [Parameters to track and frequency] (e.g., weight, intake, tolerance, glucose if relevant)

Appointments: [Outpatient RD timing] | [Specialty follow-up] | [Home health if applicable]

Pending Items: [Unresolved nutrition-impacting items with owner and timeline] (e.g., formula authorization, lab results, swallow study)

Information Transfer: [Confirmation that plan was communicated to receiving providers and suppliers]