Es Discharge Planning Components

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name: es-discharge-planning-components
description: This skill outlines the core components to include in comprehensive diabetes discharge planning for hospitalized adults. It is triggered by questions such as "What should be included in diabetes discharge planning?" and ensures education on survival skills, referral for outpatient DSMES, follow-up scheduling, and medication/supply access.
---

# Include core components in comprehensive diabetes discharge planning

## STEP 1 — Gather Information
Collect patient diabetes type (T1D/T2D), current insulin regimen, recent HbA1c, medication list, supplies (glucose meter, strips, insulin, pump supplies), risk factors for readmission (age ≥65, CKD, hypoglycemia history), admission reason (diabetes-related vs comorbid), and patient/caregiver learning needs and barriers (health literacy, numeracy, physical limitations).

## STEP 2 — Rule In / Rule Out
Rule in: All adult patients with diabetes hospitalized for noncritical illness should receive inpatient diabetes education as part of discharge planning. Rule out: Patients who lack decision‑making capacity and have no surrogate available to participate in education, or who explicitly refuse education after capacity assessment.

## STEP 3 — Classify or Stratify
Stratify by priority for education when personnel are limited: high priority for patients at high risk for readmission, those admitted for diabetes‑related issues, and those newly diagnosed with diabetes or newly starting insulin; standard priority for all others.

## STEP 4 — Decide
Provide inpatient diabetes education covering: (1) survival skills – medication administration (including insulin), BG monitoring goals and technique, basic meal planning, hypoglycemia/hyperglycemia prevention and treatment, and emergency contacts; (2) referral for outpatient DSMES; (3) schedule diabetes follow‑up appointment within 1 month; (4) verify patient has prescriptions and sufficient supplies (medications, glucose monitoring supplies, pump supplies) before discharge.

## Clinical Guardrails / Mimics / Pitfalls
Do not provide education without validating patient understanding (teach‑back). Do not assume medication access — confirm insurance coverage, pharmacy availability, and patient ability to obtain supplies. Do not delay education until the day of discharge; integrate throughout hospitalization. Do not overlook patients with cognitive or physical impairments; adapt teaching methods accordingly.

## Concrete Clinical Example
A 68‑year‑old woman with T2D admitted for community‑acquired pneumonia is on basal‑bolus insulin. She reports checking glucose twice daily at home. During hospitalization, a DCES teaches her how to adjust insulin doses based on BG, demonstrates proper injection technique, reviews hypoglycemia signs, and provides a written action plan. The DCES refers her to an outpatient DSMES program, schedules a follow‑up visit with her endocrinologist in 2 weeks, and confirms she has prescriptions for insulin, metformin, and sufficient test strips before discharge.

**Source:** Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278