Discharge is included in every patient's plan of care. It is considered a basic procedure but, without a clear definition of each provider's responsibilities during discharge, duplication of tasks and errors of omission occur (Byrnes et al., 2009; Gawande, 2009). On a medical unit in a Silicon Valley hospital, RNs (Registered Nurse) are often inundated with auxiliary tasks in the hours before discharge. This is partly due to their proximity to the patient, but is mainly from the lack of a standard RN discharge procedure. Such norms jeopardize the RN's ability to provide care and can increase hospital readmissions (Jack et al., 2009; Jencks, Williams & Coleman, 2009).
This Clinical Nurse Leader (CNL) project set out to determine the core elements of the RN role at discharge and create a checklist to support nursing practice and improve patient outcomes. Key stakeholders on the medical unit were involved in the design process to increase accuracy and buy-in. The final checklist was made into a “Badge Buddy” for portability and ease of use. To evaluate efficacy, the average length of time to complete a discharge was collected before and after tool distribution. Additionally, RN surveys were performed to determine the tool's utilization and perceived benefit. Results showed no significant reduction in the average length of time to perform discharge, but the survey suggests 60% of the staff find the tool enables a higher quality discharge. Future recommendations include continued distribution of the tool and review of readmission rates and HCAHPS scores to evaluate long-term benefits.
- Clinical Nurse Leader,
- Quality Improvement,
- badge buddy
Available at: http://works.bepress.com/rachel_keene/1/