Streamlining The Discharge Process On A Postpartum Unit By Implementing A Discharge Nurse Role
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2021
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University of Hawaii at Manoa
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Background: Hospital discharge planning is mandated by the federal legislature arguing that education classes increase the knowledge and skills of parents to better care for themselves and their newborn (Wagner & Washington, 2016), which likely reduces readmission. Instrumental teaching involving physical and psychological changes which affect the woman and/or newborn health such as jaundice and postpartum blues and depression are a necessary part of the discharge teaching (Suplee, Kleppel & Bingham, 2016). The American College of Obstetrician and Gynecologists (ACOG) released Committee Opinion number 736 which encourages revision of the postpartum care plan in the transition from intrapartum care to postpartum care (ACOG, 2018). Purpose and Objectives: The purpose of this evidence-based quality improvement project was to reduced couplet discharge time to meet the target goal of discharge within 2 hours from the discharge order by using a designated discharge nurse to facilitate patients transition back to the community. Methods: Data was collected during three phases. The first phase conducted an informal author-developed survey of the MBU staff and couplet discharge baseline data via a retrospective chart review. The second phase included direct observations of the discharge process. The third phase consisted of a post-implementation author-developed survey and chart review. Results: The pre-implementation chart review was compared to post-implementation chart review data and an overall decrease to the patient’s discharge time was evident. Discharge times during the pilot project decreased to an average of 2 hours post-written discharge order, meeting project goals and reducing discharge times by 1-2 hours as compared to pre-implementation data. Discussion: This evidence based-practice project reflect discussion found in the literature review that the role of a discharge nurse can enhance the patient’s readiness for on-time discharge. Staff survey participation decreased in the post-implementation survey from 22 participants to 13 focusing on nurses who predominantly worked day shift during the peak hours of couplet discharges and indicated similar pre-intervention concerns such as pharmacy delays and the need to have a discharge tool as a checklist. Short-term objectives were met with an overall decrease of on-time discharge from 3-4 hours to 2 hours and increased staff satisfaction measured using Likert scale questions. The implementation was to originally run from March 1 to March 31, it stopped on March 23 due to unavailability of the assigned discharged nurse. This resulted in lower patient sample numbers during the implementation chart review. Conclusion: Adaptation of a discharge nurse role can enhance patient discharge education, increase nurse’s satisfaction, and decrease on-time discharge delays. By adding a discharge nurse role into any hospital unit, discharge patient readiness is increased.
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