Clinical Best Practice Guidelines: Care Transitions


This nursing best practice guideline is a comprehensive document providing resources for evidence-based nursing practice and should be considered a tool, or template, intended to enhance decision making for individualized care. The guideline is intended to be reviewed and applied in accordance with both the needs of the individual organizations or practice settings and the needs and wishes of the client. In addition, the guideline provides an overview of appropriate structures and supports for providing the best possible evidence-based care. Best practice guidelines are systematically developed statements to assist nurses and clients make decisions about appropriate health care (Field & Lohr, 1990). This guideline provides evidence-based recommendations for nurses and other members of the interprofessional team who are assessing and managing clients undergoing a care transition. 


  • How to use this document
  • Purpose and scope
  • Summary of recommendations
  • Interpretation of evidence
  • RNAO Expert Panel
  • RNAO Best Practice Program Guidline Team
  • Stakeholder Acknowledgement
  • Background
  • Practice Recommendations
  • Education Recommendations
  • Organization and Policy Recommendations
  • Research Gaps and Future Implications
  • Implementation Strategies
  • Evaluating & Monitoring this Guideline
  • Process for Update & Review of the Guideline
  • Reference List
  • Appendices
  • Accreditation Canada


Contact Person/Organization: 

Registered Nurses Association of Ontario

Type of Tool:

Publication Date: 

Promoting Patient and Family Centred Care in a Digital Era

Long-Term Care Best Practice Spotlight Organization Proposal Information Session