ENTERING DISCHARGE INSTRUCTIONS

Discharge as a team sport

Jamie Golden, MSN StudentUCLA School of Nursing

Objectives• Clarify or reinforce the unit expectation with respect to

initiating discharge instructions

• Describe the significance of starting instructions early

• Suggest elements of discharge instructions that may be started in advance of day of discharge

• Provide everyone a job aid that offers step-by-step instruction for entering discharge instructions in CS-Link, as well as other useful tips and suggestions.

“Discharge planning starts at admission”

The Unit Expectation

RNs on 7NW are expected to initiate discharge instructions

before the day of discharge.

Whose Responsibility Is It?

It’s the shared responsibility of all RNs throughout a patient’s

hospital stay.

Purpose of Discharge Instructions

Reinforce (not replace) discharge education performed throughout a

patient’s hospital stay.

(Krohn, 2008)

Significance INSTITUTION-WIDE GOAL:

Discharge before 11 AM

• Numerous nursing tasks in the process of discharge Order DME Fax Paper Prescriptions Discontinue Lines Enter & Review Discharge Instructions Discharge Teaching Arrange Transportation Reconcile Patient Belongings Resolve Care Plan & Patient Education

• Helps expedite discharge and

supports the discharging RN to achieve to this goal

Significance

THE BIG PICTURE

• Early discharge frees up beds for patient “parked” in recovery after surgery

• Improves patient flow

• Decreases patient wait time

(Institute for Health Improvement, 2008)

Significance THE BIG PICTURE

• Press Ganey Associates found the following relationship relationship between hospital wait time and patient satisfaction:

(Based on 4,830,042 survey responses from 989 facilities received between Jan. 1 and Dec. 31, 2012)

• Financial implications now that hospital reimbursement is tied to HCAHPS scores

Hospital Wait Time

PatientSatisfaction

(Stempniak, 2013)

Job Aid

• Step-by Step Instruction for Entering Discharge Instructions:

Entering & Navigating the SmartText Template

Editing Discharge Instructions

Adding & Editing Healthwise® Patient Care Instructions

Previewing & Printing the AVS

Job Aid Features: Notes Margin

FYI Notes

• Navigation tips

• Suggestions where to find certain information for discharge instructions

• Ways to tailor instructions to the patient

• Cautionary points

Before Day of Discharge

Suggestions

• Enter the SmartText Template

• Add in the Procedure/Condition

• Check Orders and Clinician Notes for insight into:Assistive devices (e.g. does PT recommend they go home with a

walker?)ActivityNew medications (e.g. Lovenox injections) Diet

Before Day of Discharge

More Suggestions

• Attach relevant Healthwise® instructions about:New medications or vaccines orderedPrecautions (Hip precautions)Patient-specific condition(s)/procedure(s)

• To the Report the Following Symptoms to Your Physician field, add common symptoms of infection (e.g. fever, redness, foul odor) and reasons to seek emergency medical treatment.

Before Day of Discharge

More Suggestions

• Check Additional Signed Discharge Orders in the Discharge activity, where other disciplines sometimes enter discharge orders in advance.

• If the patient is going to have home health, add the Home Health Care Coordinator’s contact information for his/her reference.

• Look-up/Add the Physician’s office phone number in the Follow-Up Appointment(s) field.

Summary• It is possible to start discharge instructions early

• It is important for improving discharge efficiency and supporting one another in accomplishing the 11 AM Discharge Goal

• Implications for patient satisfaction and hospital reimbursement

• Refer to your job aid for tips or any questions you may have about entering quality discharge instructions

Thank you very much for your time

References

Institute for Healthcare Improvement. (2008). Transforming Care at the Bedside

how-to guide: Increasing nurses’ time in direct patient care. Retrieved from

http://www.ihi.org/resources/Pages/ToolsTCABHowToGuideIncreasing

NursesTimeinDirectPatientCare.aspx

Krohn, D. A. (2008). Discharge instructions in the outpatient setting: Nursing

considerations. Journal of Radiology Nursing, 27(1), 29-33. http://

dx.doi.org/10.1016/j.jradnu.2007.10.001

Stempniak, M. (2013). What, no wait? Health and Health Networks, 87(11), 30-35.

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