should also be included in the
patient teach-back process. There
is an increased chance that the
patient will not receive optimal
care upon discharge if the caregivers do not understand the
instructions.
Discharge instructions should
only be delivered to patients who
are ready to receive them. The
patient should be cognitively
well or have a caregiver who is
able to receive the directions.
Alarms should be silenced and
instructions should be given in
an environment free of distractions. Patients will have greater
satisfaction, better recall, and
improved compliance if they
are not distracted or do not feel
rushed by the provider (Gignon et
al., 2014).
Use of Technology
Patient safety requires that the
patient understands what happened to them in the ED, as well
as what the next steps should
be. Enrolling patients in the
hospital’s secure internet communication system allows them to
communicate via a patient portal
(Osborn, Mayberry, Wallston,
Johnson, & Elasy, 2013). Using
the portal, they can reach providers, check medical records and
labs, update their medical history
(Arora, Goldberg, & Menchine,
2014), check information about
their ailment (Stribling & Richardson, 2016), and fill prescriptions.
“
If your hospital
computers, equipment,
and policies look
the same as they did
three years ago, you
are a dinosaur in this
business”
Jason R. Secrest, leadership consultant
personal communication, August 25, 2016
Use of Technology to
Improve the
Discharge Process
Visual Aids and Databases
A national assessment of adult
literacy showed that only 3%
of older adults effectively grasp
health literacy skills (Choi,
2016;2015). Simplifying discharge
instructions and using pictures,
cartoon (Hill, 2014), and pictographs (Choi, 2016;2015) have
been shown to be more effective
than text alone in facilitating
comprehension. A computer
program that prints visual aids to
accompany discharge paperwork
is helpful. This is especially true
for the older population who use
the ED at a higher rate and present with more complicated issues
(Shetty, Shankar Raju, Hermiz,
Vaghasiya, & Vukasovic, 2015).
Databases linked with electronic
health records track readmitted
patients who return to the ED.
Organizations can track metrics to monitor and evaluate the
success or failure of staff and
processes allowing these discharge
failures.
Translation Services
Verbal reinforcement is important
when providing instructions to
patients who speak limited English. The use of a bilingual interpreter to review the instructions
has been shown to increase recall
(Agency for Healthcare Research
and Quality, 2014). All discharge
instructions should be written in
both English and the patient’s
native language. It is ethically,
medically, and legally irresponsible to give discharge orders in
English when the patient does not
speak English.
Fall 2016 Pennsylvania Nurse 7