A nurse is preparing discharge plans for several patients on the medical-surgical unit. Which patients should the nurse refer to social work as part of safe discharge planning? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Social work referrals are integral to safe discharge planning whenever a patient's social, financial, safety, or community-resource needs threaten the medical plan or safety. Choices 1, 2, 3, and 5 each describe a clear unmet psychosocial or safety need: (1) a 45-year-old patient with end-stage liver disease, active alcohol use disorder, and transportation barriers to follow-up; (2) a 72-year-old patient who lives alone, requires home oxygen, and reports difficulty paying for utilities and medications; (3) a 16-year-old patient with possible child maltreatment (parent appears intoxicated and bruising inconsistent with history), which is also a mandatory reporting situation where social work supports the nurse and the patient/family; (5) a 34-year-old woman disclosing intimate partner violence and asking for help finding a safe place to stay. Choice 4 is incorrect — a patient discharged home with unchanged medications, mobility, and environment, and without new resource needs, does not require routine social work referral. Discharge planning still includes clear medication and follow-up instructions, but referral is targeted, not routine.
Social work involvement is integral to discharge planning whenever a psychosocial, financial, safety, or community-resource gap threatens the safe execution of the medical plan. The nurse identifies indications, makes the referral, and coordinates the resulting plan with the multidisciplinary team. High-yield referral indications include intimate partner violence (with the patient's safety and autonomy guiding what action is taken), suspected child or elder maltreatment (which is also a mandatory reporting situation), substance use disorder with access or transportation barriers, housing insecurity or homelessness, financial hardship interfering with medications or basic needs, complex post-discharge needs such as new home oxygen or wound care without resources, and end-of-life or hospice planning. Routine discharge of a stable patient with unchanged medications, mobility, and home environment does not require social work; nurses still provide medication reconciliation and follow-up teaching but referral is targeted to identified needs.
A nurse is preparing discharge plans for several patients on the medical-surgical unit and considers which patients require a social work referral as part of safe discharge planning.
When to Refer to Social Work — High-yield indications: intimate partner violence; suspected child or elder maltreatment; housing insecurity or homelessness; substance use disorder; financial hardship preventing medication or basic needs; complex post-discharge needs (new home oxygen, wound care, infusion) without resources; transition to hospice or palliative care; mental health crisis without follow-up; transportation barriers.
Discharge Planning Framework — Begins at admission. Nurse identifies anticipated post-discharge needs, coordinates with social work, case management, pharmacy, and rehab/PT/OT as needed. Discharge teaching includes medication reconciliation, follow-up, red flags, and home equipment. Targeted referrals are made for specific gaps; routine referral is not the standard.
Mandatory Reporting Coexists with Referral — Suspected child maltreatment, elder maltreatment, intimate partner violence (in some states), and certain communicable diseases require mandatory reporting to the appropriate agency (CPS/APS, public health). Social work supports the nurse with the report and the patient/family with services; reporting is not deferred for the social work consult.