Pennsylvania Nurse, Front Page 71(4) | Page 9

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