IMPROVING DISCHARGE

COMMUNICATION
BY: ELIANA VELAZQUEZ, RN & YOLANDA ENG, RN
 PROBLEM
PATIENTS ADDRESSED MULTIPLE CONCERNS REGARDING THE DISORGANIZATION OF DISCHARGE
INSTRUCTIONS. THE ADDRESSED CONCERNS WERE IN REGARDS TO FOLLOW-UP APPOINTMENTS,
PRESCRIPTIONS, TESTS, GENERAL INFORMATION AND EDUCATION.
THE SOLUTION WAS TO DEVELOP DISCHARGE TABS (5 DIVIDERS, AVAILABLE IN ENGLISH OR
SPANISH)
1. PRESCRIPTIONS - RECETAS
2.FOLLOW UP APPTS - CONSULTS/CITAS/CONSULTAS
3. LABS/TESTS LABORATORIA/EXAMENES
4. PATIENT EDUCATION - EDUCACION
5. MISC. - MISELANEO
 PICO
P- PATIENT/POPULATION: WOMENS SURGICAL, WEST TOWER 3, & THOMASON TOWER 3
I- INTERVENTION: IMPLEMENT THE USE OF DISCHARGE TABS BY PLACING THE TABS IN
ADMIMISSION FOLDER LOCATED IN PATIENTS ROOM AND ORGANIZING THE DISCHARGE
INSTRUCTIONS BY CATEGORY.
C- COMPARISON: THE USE OF ADMISSION FOLDER ONLY
O- OUTCOME: TO ACHIEVE AN INCREASE IN HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE
PROVIDERS AND SYSTEMS (HCAHPS) INPATIENT CORE SURVEY BY NURSING UNITS SCORES IN THE
FOLLOWING AREAS: NURSE COMMUNICATION, COMMUNICATIONS ABOUT MEDICATIONS,
DISCHARGE INFORMATION AND TRANSITION OF CARE
ADMISSION FOLDER & DISCHARGE TABS
 PURPOSE OF THOSE AREAS
NURSE COMMUNICATION:
- CLEAR COMMUNICATION BY NURSES
COMMUNICATION ABOUT MEDICATIONS:
- EXPLANATION OF NEW MEDICINES
- COMMUNICATION OF POSSIBLE SIDE EFFECTS
DISCHARGE INFORMATION:
- TALKING TO PATIENTS ABOUT HELP AFTER DISCHARGE
- PROVIDING WRITTEN DISCHARGE INSTRUCTION
TRANSITION OF CARE:
- TALKING TO PATIENT AND FAMILY REGARDING NEEDS AFTER DISCHARGE
- PATIENT HAD A GOOD UNDERSTANDING OF INSTRUCTIONS
- PATIENT UNDERSTOOD PURPOSE FOR TAKING MEDICATION PRESCRIBED AT DISCHARGE
 EVIDENCE BASED PROJECT QUESTION

WILL THE USE OF THE DISCHARGE TABS IMPROVE HCAHPS INPATIENT CORE SURVEY BY
NURSING UNITS SCORES IN THE FOLLOWING AREAS: NURSE COMMUNICATION,
COMMUNICATIONS ABOUT MEDICATIONS, DISCHARGE INFORMATION AND TRANSITION OF
CARE?
 IMPORTANCE OF EVIDENCE BASED PROJECT
QUESTION
BECAUSE CLEAR COMMUNICATION FROM NURSES TO PATIENTS ALLOW FOR FULL
UNDERSTANDING OF FOLLOW-UP APPOINTMENTS, REFERRAL INFORMATION INSTRUCTIONS
AFTER DISCHARGE AND DIRECTIONS ON HOW MEDICATION IS TAKEN, THE PURPOSE OF THE
MEDICATION, THE DOSE AND THE SIDE EFFECTS OF THE MEDICATION.
 DATA COLLECTION

OCTOBER 2016 JANUARY 2017: GATHERED AND COMPARED INPATIENT CORE SURVEY BY
NURSING UNITS SCORES IN THE FOLLOWING THREE UNITS; WSU, WT3 & TT3
FEBRUARY 2017 DISCHARGE COMMUNICATION IMPROVEMENT (DISCHARGE TABS) IN-
SERVICE OF ALL REGISTERED NURSES IN WSU, WT3 & TT3
MARCH 2017 NOW: GATHER AND COMPARE INPATIENT CORE SURVEY BY NURSING UNITS
SCORES IN WSU, WT3 & TT3 UNITS TO DETERMINE IF THE USE OF DISCHARGE TABS MAKE
DISCHARGE INSTRUCTIONS MORE ORGANIZE AND IN TURN INCREASE THE UNIT SCORES
WHILE AVOIDING READMISSIONS
PRE & POST DISCHARGE TAB SCORES
PRE &POST DISCHARGE TAB SCORES
PRE & POST DISCHARGE SCORES
 CONCLUSION

EVEN THOUGH THE USE OF DISCHARGE TABS WAS IMPLEMENTED BY ALL NURSING STAFF
MEMBERS DURING THE DISCHARGE PHASE. THE CONCLUSION IS THAT THE ORGANIZATION OF
THE DISCHARGE IS NOT AS IMPORTANT AS THE ACTUAL TEACHING. IT IS DIFFICULT TO
DISCHARGE A PATIENT IN A TWO HOUR PERIOD WHEN THE NURSE HAS TO GET THE
DISCHARGE INSTRUCTIONS TOGETHER, THE PRESCRIPTION, THE SUPPLIES, AND HAVE FIVE TO
SIX OTHER PATIENTS NEEDING ASSISTANCE ALL AT THE SAME TIME. IN OUR OPINION AND
BASED ON WHAT WE HAVE EXPERIENCED IN THE FLOOR, IT WOULD BE IDEAL TO HAVE A
DISCHARGE NURSE ON THE FLOOR AT ALL TIMES.
 REFERENCES

KRYSTAL LOPEZ, RN, BSN, FORMER ASSISTANT NURSE MANAGER, WOMENS SURGICAL UNIT
CHRISTOPHER MORALES, SUPERVISOR GUEST SERVICES
DAVID G. SMEAD, DIRECTOR, CARE MANAGEMENT