Giving Health Education During Discharge: Gaps and Recommendations

This paper discusses the gaps and deficiencies in the discharge planning process and the importance of health education during discharge. It also provides recommendations for future practice. The report is based on the author's own experience as a nurse in a hospital.

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Giving health education during discharge
Student Name
Student ID
Course Name
24thSep, 2018
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Abstract
There are many reasons why gaps exist in making discharge planning of patients an
effective and perfect process. Lack of proper research, education, intervention or
support from caregivers to transfer patients smoothly from one care unit to another
care unit and this can lead risks for the health of patients. This makes it imperative
for medical practitioners to focus more on educating patients, families, and
caregivers. This paper is about an incident about hospital discharge done to patients
who are discharged from hospitals and the gaps and deficiencies which exist and
some recommendations. This is my own experience.
Table of Contents
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Introduction...................................................................................................................4
Knowledge Identification area......................................................................................4
Evidence of analytical knowledge.................................................................................6
Getting Help at Home..............................................................................................7
Discharge to a Facility.............................................................................................8
Paying for Care After Discharge............................................................................8
What if You Feel It’s Too Early for Discharge?....................................................9
Gaps and Deficiencies in arguments............................................................................9
Recommendation for Future Practice.........................................................................10
Strategies for Progress Evaluation.............................................................................11
Relevance of Literature..............................................................................................12
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Introduction
Discharge from a medical care is always a situation which families and patients find
highly overwhelming. There is high level of risk associated with the post discharge
health care of the patients. The family members of the patients as well as the
patients themselves have certain misunderstandings and commit medical errors.
From my work experience, I have realized that the medical practitioners consider
health education at the time of discharge as a very crucial process which needs
planning. This planning is utilized for deciding what a certain patient requires for a
smooth transition from one level of care to another level (Rodakowski, Rocco and
Ortiz, 2017). In specific situations, doctors need to prescribe that the patient who is
released from a hospital must be helped by a case manager, nurse or any other
ideally suited for their post discharge care. This is an effective part of post discharge
planning. An ideal discharge plan comprises of evaluation of a patient by an expert,
discussion with the patient, planning for care transfer, determination of a caregiver,
referrals made to any home care support agency and arrangement of follow-ups
(Ewing, Austin, Jones and Grande, 2018).
This report is about the health education which is given to patients and their families
when they are discharged, the gaps which exist in the planning and some
recommendations and strategies to enhance its qualities. In this report incidents
experienced by me at the hospital where I worked as a nurse, have been used to
form the research paper.
Knowledge Identification area
To gain more knowledge in this context, it is required to understand what an effective
and proposed discharge summary for patients who are discharged from a hospital or
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medical setting is (Ashbrook, Mourad and Sehgal, 2012). I have always experienced
how discharge planning is done very carefully when patients are transformed into
different care facilities.
The important points which an ideal discharge plan of a hospital must have been
mentioned below:
• A very extensive medical list on discharges.
• An in-depth medical data or information about medication name, generic names,
dosage details, dose, directions to use, administration route, PRN, and regular
monitoring.
• Duration and indications to be given for new medication to be taken.
• Any changes made to the current medications.
• In-depth medication-related management plan and management requirements and
recommendations for the home or care facility medication management and review
(Greysen, Harrison and Kripalani, 2016).
Physicians often make the assumption that hospitalized patients being discharged
are already educated to follow the prescribed medication, discharge plan and doses
even at home. Most of the times, it can be achieved by understanding the
management plan for the discharge of patients. There are many aspects of a
discharge plan which needs to be planned in advance. When the discharge
education is incomplete and the planning is inadequate, many problems are faced
post discharge. After a recovery the disease might relapse in the patients due to lack
of health care at home, not going for regular check-ups at hospitals or clinics,
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delayed diagnosis, etc. There are gaps in the planning system which lead to
drawbacks in care after discharge among patients.
When I worked at Michigan Public Hospital as a medical practitioner, I learned that it
is important to plan a discharge plan for the patients. Knowledge to caregiver and
patients are to be given when patients are discharged. The patient, their family, and
caregivers must be given a list of accurate medications which the hospital
prescribers on discharge. There must be guidance given about the right way to store
the medications, the doses, and the action to be taken if someone misses a dose
and the probable side effects. The family and caregiver are specially educated about
the symptoms and signs which call for immediate attention or calling the hospital or
pharmacists. Information which is partial must be filled up by making a proactive
approach from the patient, family, and caregiver (Makaryus and Friedman, 2005). It
is recommended that eve information or education regarding health given during
discharge must be in a written format. The strategies the patient needs to adapt to
take the medication and follow the guidance easily is to be conveyed. The patient
must be educated to follow up and read medication instructions quite often to ensure
nothing is missed up. Medication trial is sometimes a process used by pharmacists
in hospitals to see practically whether the patient can independently take their
medications before even the discharge happens. Around 50 patients of this hospital
were observed. Secondary data was used from various feedbacks received by the
hospital from time to time.
Safety for patient medication can be achieved in the best possible manner if the
partnerships made with the hospital, patient, patient family and caregiver or care
facility support. More and more follow-ups and monitoring for patients who are just
out of serious treatments can greatly reduce the number of errors (Kerzman, Baron-
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Epel and Toren, 2005). Caregiving can be personalized based on the type of patient
one is dealing with. The main idea of the success of discharge planning is to make
the medication regiment as simple as it is possible such that it is not a burden for the
patient or their caregivers. A common example can be aids to dose administrations
where dosage boxes are used with medication placed inside each box. It is a simple
and direct way to lower the risk and stress for the patient as every medicine is pre-
planned. The aim here is to ensure that the patient consistently takes medication
which he or she has been told to take when they are discharged. At times,
irregularity in medical consumption can lead to worsening of patient health condition.
Sometimes patients are even readmitted which is a complete discomfort and
financial hassle for them.
Evidence of analytical knowledge
There is ample analytical knowledge out there which explains the details of what is a
good discharge planning and why it is significant. Effective planning lowers chances
that the patient will have to be readmitted to the hospital again as an effective
dishrag plan ensures a speedy recovery, makes sure medication is consumed as
prescribed, tests are made, and prepares one to get effective care. Hospitals are not
successful in achieving such a state. American Medical Association offers varied
recommendations to discharge planning. However, there is exists no universal
standard system of such recommendation.
Moreover, patients can be released in a statement from hospitals where they are not
cured fully and hence ensuring more crises to add up on discharge. Studies and
literature research made in these areas showcase that around 4% of patients who
are of the age of 65 and above experience medication errors once they have left the
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hospital. Around 18 % of the patients are often readmitted right within 30days of their
discharge (Forster, Clark and Menard, 2015). It is not good either for the patient or
the hospital or the financial support agency. Be it private or public medical insurance
it is an unfavorable condition. Hence excellence in discharge planning by educating
the patient, their family and the person responsible for post-discharge can reduce
such readmissions (Finn, 2016).
Basic formalities – One of the simplest measures is ensuring that 24 hours a day
and even on weekend telephone number of caregivers must be open for providing
help and care information. It is essential that all errors which are likely dangerous
help review to make discharge plan better (Hesselink and Schoonhoven, 2012).
Role of caregiver – The staff who is discharging is not familiar perhaps with the
condition of the patient. Hence the caregiver plays a very big role to give an overview
of it. Discharge planners must communicate with caregiver and family member or
relatives and show ability and willingness to offer care. There can be many physical
or financial constraints. However, all the limitations must be known, and education is
the basis of good quality care (Halasyamani, Kripalani and Coleman, 2016).
Home help – There are different responsibilities which the family member must need
to make when the patient comes back home on their discharge from the hospital.
These are personal care, healthcare, emotional care,and household care. Educating
communist organizations or such caregiving agency about the detailed needs of the
patients can help out. However, the service provider must understand the medical
and mental background of the patient. Even they need guidance from the family
member. When an agency is chosen for caregiving one must take into consideration
the cultural and language-related backgrounds as well (Kripalani, 2015).
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Discharging to a facility – When patients are discharged to a facility such as
another nursing home or e rehab facility there can be effective planning made about
the transition. This must ensure that care is made continuously as if it is an extension
of hospital care. Hence clarification of patient health information must be made
effectively. With information and data exchange the facility will never become a
cause of stress for the family of the patient.
Gaps and Deficiencies in arguments
The process to transit the patients on discharge is a highly complex process. It
requires the completion of many different tasks which involves collaborative care
planning, educating the patients and taking support from external physicals and
caregivers. Such transitions are complex which at a time leads to gaps. Following is
a list of deficiencies.
 Delays in discharge (Ornstein, 2013).
 Lack of making early assessments.
 Insufficient or absence of any discharge planning.
 Attention not been given to sensitive groups such as patients who are elderly,
disable or cognitive impairment cases.
 Inadequate notice of discharge.
 Insufficient engagement of the patient, family member or the caregiver
(Allaudeen, Vidyarthi and Maselli, 2012).
 Poor level or coordination and communication between hospital services or
post-hospital related services.
 Early avoidance of readmissions.
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 The discharge which is sometimes untimely even before proper coordination
is made about post-hospitalization services.
 Lacking in any related therapeutic reconciliations.
 Insufficiency in therapy management.
 Lack of transfer service planning.
 No follow up or delayed follow up.
 Insufficiency in the teaching of detecting warning signs.
 No plan for follow up treatment or tests.
 The absence of communication or poor level of coordination among the family
member of patients and the healthcare service providers.
 Improper communication in between hospital personnel and post-discharge
service providers (Pollack, Backonja and Miller, 2016).
Recommendation for Future Practice
Discharge planning is not a process which is very consistent,and it is varied from one
hospital to another. Hence the quality of discharge planning made hugely depends
on who has done the planning, when it is made, how it is made, what style of follow
up is being used and whether the caregivers are getting total accessibility to the
patient for providing care services. Hence from one scenario to another the quality
and effectiveness of discharge planning are distinguished. Hospitals do make money
when their beds are being occupied. However, discharge or transitional care at any
time can be a situation where there is no revenue generation. Often this is left
neglected,and often a lot of in-depth discharge planning is considered as stress full
for not just caregivers but also for patients.
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Improvements are needed to be made in transitional care and planning. The center
of focus is always recommended to be on the improvement of the condition of the
patient, education and training people, take preventive care and involve all caregiver
as one single member base for healthcare teams (Waring, Waring and Bishop,
2014). Steps can be taken to promote the importance of discharge planning if the
entire caregiving units begin acting as a team. Some of the policies which are
recommended and were used in this hospital incident to be changed are as follows:-
• Recognizing the role of members in a family of the patients and the varied
caregiver role is to be made effectiveness as a part of a single most team of
healthcare, assess competencies and measure willingness and eagerness of
caregiving.
• Coordinating and collaborating across the varied sites, facilities, hospitals to
enhance the level and quality of communication between hospitals and community-
based services.
• Development of enhanced educational materials which can be made available in
multiple different languages helping caregivers and patients to navigate different
care systems and scenarios and understanding the different kind of help which can
be made available to them during and after the hospital stay (Thompson and Sunil
2015).
• Make considerable improvement in the training of healthcare of the staff
enhancing different ways and mediums of response regarding culture, language, and
literacy differences.
• Ensure that the eligibility of public based programs and expanded and simplified.
Transitional care, reimbursement benefits, policies all must have better home-based
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care added (Greysen and Schiliro, 2017). Rewards and acknowledgment for
physicians, hospitals, caregivers and at home care support will encourage people to
work better and reduce readmissions.
Strategies for Progress Evaluation
Once the patients have left the hospital, it becomes highly crucial that with right
support and guidance they follow the medication instructions efficiently. If one fails
to get the planning for discharge in the right manner can result in patient readmission
to hospitals adding up to the expenses (Schillinger, Piette and Grumbach, 2013).
Moreover, the reputation of the hospitals also lowered if there is unsatisfactory
development in patients once they are discharged. Once a patient is discharged the
progress is to be monitored and evaluated using any of these strategies.
The inclusion of patient family members as collaborators to ensure effective
discharge planning
In every meeting of discharge, the family member of the patient is required to be
involved at all times (Horwitz and Moriarty, 2013). The process of discharge does not
end when the patient leaves the hospital premises. Members who will take care of
the well-being of the patient at home must know the detailed plan in order aid in
faster recovery and effective use of guidance and medication post discharge.
Education and knowledge for the patient and their family
It is an important strategy to use simple language to educate patient and patient
family about the medical condition, the process to be followed after discharge and
the steps which will be followed in every step after the hospital stay is here. All
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information must be given in a written document as well as discharge planning is
indeed an overwhelming process. In the hospital incident, every time nurses and
management has made health education priority.
Relevance of Literature
A large number of studies are made,and these literature give a lot of understanding
and knowledge about the effects of discharge planning and its importance to ensure
good health and fast recovery of patients. This literature about transitional care
makes more focus to show the actual advantages which can be brought in the lives
of patients and lower down readmission and rehospitalization rates (Waring, Waring
and Bishop, 2014). To make this research different secondary data in the form of
journals are referred. These have helped immensely in understanding the challenges
and gaps which exist in discharge planning and it is mainly due to lack of proper
collaboration and cooperation between patients and caregiving agencies and
personnel. The focus is also made in the literature about how changes made in
policy and regular and effective interventions can be made to enhance the quality of
discharge planning (Naylor, Brooten and Campbell, 2014). According to Palonen,
et.al, (2015) discharge education is very important for the old people as they fail to
understand how they should take care of their health after going back home.
Similarly, the members of the patients’ family should also receive discharge
education so that the care and treatment which the patients receive at the hospital is
continued through constant care at home as well. This sustenance of the care is very
important because after the immediate need of the patient is fulfilled they are
discharged from the hospital but their persistent care is needed for them to heal
completely. However adequate education at the time of discharge is missing at most
of the care units. The main reason for lack of this discharge education is that the
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hospitals are not planning well and in advance for their patients regarding their
discharge. Discharge planning is very important as the patients are made acquainted
about their current health status so that they can further cater to their health needs.
They must also plan how the patients and their family members would get the
required education at the time of discharge. There is need for better training of their
family members of the patients along with the patients so that they can take the
preventive care and also further precautions so that the patient can stay fit and
healthy at home post discharge. The use of proper medications and following a
proper healthy schedule on daily basis is very important. After recovering from a
disease it is very important to take good care of oneself so that they can heal
completely. Post discharge the patients lack the education regarding their daily
eating, sleeping and work habits that they need to follow to take care of their health
conditions. Moreover regular intake of medicines that have been prescribed is also
needed but ignorance and lack of attention by the patients’ family members lead to
further deterioration post the discharge of the patients. On a regular basis the
hospitals need to conduct training program for the patients’ family members so that
they are prepared to take care of their patients at home. Moreover the care givers to
take care of the patients back at home after their discharge also need relevant
training for the same. Above all, the patients themselves need to be gradually trained
and educated to take care of their own health after they are discharged from the
hospital and start their routine life back at home (Gholizadeh, et.al. 2016)
To conclude in the above discharge planning made in the hospital incident where I
worked, it is clear how important education and awareness is for patient’s faster
recovery and avoidance of readmissions. Proper follow ups, evaluation via
questionnaires, survey and telephone about the improvement in conditions can all
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give proof to hospitals whether the recommendations are working or not.
Involvement of family member and education given to them plays a major role to
achieve enhanced discharge management of transitional care for patients.
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Referencing
Allaudeen, N., Vidyarthi, A. and Maselli, J. (2012).Redefining readmission risk
factors for general medicine patients. Journal of Hospital Medicine. 6(2), pp.54–
60.
Ashbrook, L., Mourad, M. and Sehgal, N. (2012). Communicating discharge
instructions to patients: A survey of nurse, intern, and hospitalist
practices. Journal of Hospital Medicine, 8(1), pp.36-41.
Ewing, G., Austin, L., Jones, D. and Grande, G. (2018). Who cares for the carers
at hospital discharge at the end of life? A qualitative study of current practice in
discharge planning and the potential value of using The Carer Support Needs
Assessment Tool (CSNAT) Approach. Palliative Medicine, 32(5), pp.939-949.
Finn, K. M. (2016). Improving the discharge process by embedding a discharge
facilitator in a resident team. Journal of Hospital Medicine. 6(9), pp.494–500.
Forster, A. J., Clark, H. D., and Menard, A. (2015). Adverse events among
medical patients after discharge from hospital. Canadian Medical Association
Journal, 170(3), pp.345–349
Gholizadeh, M., Delgoshaei, B., Gorji, H.A., Torani, S. and Janati, A., 2016.
Challenges in patient discharge planning in the health system of Iran: A
qualitative study. Global journal of health science, 8(6), p.168.
Greysen, S. R. and Schiliro, D. (2017).Out of sight, out of mind: housestaff
perceptions of quality-limiting factors in discharge care at teaching hospitals.
Journal of Hospital Medicine. 7(5), pp.376–381.
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Greysen, S., Harrison, J. and Kripalani, S. (2016). Understanding patient-
centered readmission factors: a multi-site, mixed-methods study. BMJ Quality &
Safety, 26(1), pp.33-41.
Halasyamani, L., Kripalani, S. and Coleman, E. (2016). Transition of care for
hospitalized elderly patients—development of a discharge checklist for
hospitalists. J Hosp Med.1(6), pp.354–360
Hesselink, G. and Schoonhoven, L. (2012). Quality and safety of hospital
discharge: a study on experiences and perceptions of patients, relatives and care
providers. International Journal for Quality in Health Care, 25(1), pp.66-74.
Horwitz, L. and Moriarty, J. (2013). Quality of Discharge Practices and Patient
Understanding at an Academic Medical Center. JAMA Internal Medicine, 5(4),
pp.55-56.
Kerzman, H., Baron-Epel, O. andToren, O. (2005). What do discharged patients
know about their medication?. Patient Education and Counseling, 56(3), pp.276-
282.
Kripalani, S. (2015). Promoting effective transitions of care at hospital discharge:
a review of key issues for hospitalists. J Hosp Med. 2(5), pp. 314–323
Makaryus, A. and Friedman, E. (2005). Patients' Understanding of Their
Treatment Plans and Diagnosis at Discharge. Mayo Clinic Proceedings, 80(8),
pp.991-994.
Naylor, M. D., Brooten, D. and Campbell, R. (2014). Comprehensive discharge
planning and home follow-up of hospitalized elders: a randomized clinical trial.
JAMA. 281(7), pp. 613–620
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Ornstein, K. (2013).To the hospital and back home again: a nurse practitioner-
based transitional care program for hospitalized homebound people. J Am Geriatr
Soc. 59(3), pp.544–551.
Palonen, M., Kaunonen, M., Helminen, M. and Åstedt-Kurki, P., 2015. Discharge
education for older people and family members in emergency department: A
cross-sectional study. International Emergency Nursing, 23(4), pp.306-311.
Pollack, A., Backonja, U. and Miller, A. (2016). Closing the Gap. Proceedings of
the 2016 CHI Conference on Human Factors in Computing Systems - CHI '16,
1(1), pp.22-23.
Rodakowski, J., Rocco, P. and Ortiz, M. (2017). Caregiver Integration During
Discharge Planning for Older Adults to Reduce Resource Use: A
Metaanalysis. Journal of the American Geriatrics Society, 65(8), pp.1748-1755.
Schillinger, D., Piette, J. and Grumbach, K. (2013). Closing the loop: physician
communication with diabetic patients who have low health literacy. Archives of
Internal Medicine. 163(1), pp.83–90.
Thompson AG., Sunil R. (2015). Expectations as determinants of patient
satisfaction: Concepts, theory and evidence. International Journal of Quality
Health Care. 7(2), pp. 127-141
Waring, J., Waring, F., and Bishop, S. (2014). An ethnographic study of
knowledge sharing across the boundaries between care processes, services
andorganizations. Health Service Journal, 5(4),pp 2-3.
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Appendix
Action Plan
Here is an action plan to make sure that readmission is avoided due to negligence or
improper patient care after discharge.
Objectives Tasks Resources Monitor
Impart health
education not only
to the patient but
also to their
caregivers and
family
Inclusion of a
member of
caregiver and
family member of
the patient is
needed to be
made present in
discharge
education
Special advisory
in-charge doctor
and nurse along
with necessary
requirement tool
kit
Head
management
should make sure
that all the patients
receive the
education before
getting discharged
by making them fill
a feedback paper
as a record.
Efficient use of
technology in
health services for
follow ups and
complains if any
The patients and
their family
members should
be encouraged to
use the mobile-
friendly app to
provide details of
health
development of
a mobile
application
software should be
prepared by the
hospital which is
easy to use by the
patient and the
family members to
attain all the
The management
of the hospital
should ensure that
collection of data
is done through
the usage of
mobile apps
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the patient after
discharge
records
Ensure follow up
appointments and
tests are done.
A helpful health
test list should be
initiated via the
mobile app.
Technicians to
develop the
reminders for tests
Managers of the
firm should ensure
that the results of
the tests are
updated for every
patient.
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