During discharge, which should be done first and why?

• A. End the discharge process
• B. Write new outpatient orders first, because they may need to be linked to an active problem
• C. Resolve all problems before prescribing medications
• D. Reconcile medications

Answer: (B)

During discharge, the first step is to write new outpatient orders, especially because they may need to be linked to the active problem. Placing these orders upfront ensures the outpatient plan directly corresponds to the issue currently active in the patient’s chart, which preserves continuity of care and makes the handoff to the outpatient team clear. If you end the discharge process before these orders are in place, the plan may lose its context and important follow-up actions could be missed.

Medication reconciliation and resolving problems are essential parts of discharge, but they come after establishing the outpatient orders that tie tightly to the active problem. Starting with the outpatient orders creates a coherent bridge from inpatient care to the outpatient setting, and then you can finalize meds and the overall plan with the correct linkage in place.