2. NURSING CORE COMPETENCIES:
FOR INTERDISCIPLINARY DISCHARGE PLANNING
Communication
“The Nurse of the Future will interact effectively with patients, families,
and colleagues, fostering mutual respect and shared decision making to
enhance patient satisfaction and health outcomes” (Masters, 2014, p.78).
Teamwork
“The Nurse of the Future will function effectively within nursing and
interdisciplinary teams, fostering open communication, mutual respect,
shared decision making, team learning, and development” (Masters,
2014, p.78)
3. WHAT IS COMMUNICATION?
A process that includes 5 factors:
SENDER – encodes a message to be transmitted;
MESSAGE – the ideas, symbols, signals being transmitted;
CHANNEL/MEDIUM – the means by which a message travels;
RECEIVER – receives and decodes the message; and
FEEDBACK – Receiver provides feedback to Sender to signal effective
reception of intended message (Oxford University Press, 2014;
Communication Models andTheories, n.d.).
5. NURSE-PATIENT COMMUNICATION:
SUCCESSFUL INTERACTION
Scenario: During Admission Intake, Nurse Hope Soeiltry would like to obtain a
medication list from PatientWill U. Listinclose for a safe medication reconciliation.
Sender (Nurse: Hope) – encodes her message with words by asking a question
Message (The Question) – what medications do you take at home? Can you tell me and
write them down on this paper to include the name, dose, and time you take them?
Channel/Medium (Verbal/Written) – both verbal and written responses
Receiver (PatientWill) – decodes the message; begins to tell Nurse Hope his medications
from home while writing them down
Feedback (Patient:Will) - asks if he should write down his over-the-counter medications
while showing Nurse Hope his medication list in progress. Nurse Hope nods in agreement
while saying,“absolutely correct!”.
Outcome of Communication: SUCCESS!
6. EFFECTIVE COMMUNICATION:
BARRIERS TO SUCCESS
Noise or Interference – ambient noise, alarms, bells, televisions, radios;
Medium chosen poorly – incompatible language, incompatible medium
i.e. hearing impaired (chose verbal transmission), visually impaired or
illiterate (chose written transmission);
Message – unclear, inappropriate, incongruent, lacks context;
Receiver – emotionally/psychologically compromised (angry, anxious,
sad, fearful, uncooperative/unreceptive); physically compromised (pain,
fatigue, altered mental status);
Feedback – Receiver did not provide feedback to ensure successful
communication occurred; Sender did not request for feedback
(Communication Models and Theories, n.d.).
7. STRATEGIES TO OVERCOME BARRIERS:
EFFECTIVE COMMUNICATION
Sender – is clear, concise, and congruent during message transmission
process;
Reduce or Eliminate – sources of interference with a calm, quiet, and
timely delivery environment for the communication to take place;
Select Appropriate Medium – relative to the age, ethnic/cultural, and
language determined to be compatible with the receiver;
Assess the Receiver – for readiness i.e.Alert, oriented, well rested, with
a reasonable mood disposition; and
Request Feedback – ask the receiver if they understood the message
delivered; exercise a repeat-back and verify process to ensure successful
delivery.
8. DISCHARGE PLANNING AND EFFECTIVE
COMMUNICATION: WHAT &WHEN
Definition:
“Preparation for moving a patient from one level of care to
another within or outside the current health care agency”
(Bulechek, Butcher, Dochterman, & Wagner, 2013, p.150).
When:
“Planning for discharge begins during the initial contact with the
client by establishing the expected outcomes and anticipating
follow-up care that may be needed” (Harkreader, 2007, p.206).
9. DISCHARGE PLANNING AND EFFECTIVE
COMMUNICATION: RATIONALES
Poor Planning and Discharge Communication is Costly:
“Poor communication can endanger patients’ lives and waste fiscal and
human resources” (Lattimer, 2011).
“Delays, omissions, and inaccuracy of discharge information are
common at hospital discharge and put patients at risk for adverse
outcomes” (Harlan, 2010).
“It’s often poor communication, coupled with an expectation that
patients or caregivers will remember and relate critical information,
which can lead to dangerous, even life-threatening, situations” (Lattimer,
2011).
10. RN DISCHARGE ACTIVITIES: OVERVIEW
NURSING INTERVENTIONS CLASSIFICATION (NIC) SUMMARY
Assist patient/family/significant others to prepare for discharge;
Collaborate with interdisciplinary team/patient/family/significant others;
Coordinate with other providers for a timely discharge;
Identify patient / caregiver knowledge or skills required for discharge;
Identify patient teaching required for post-discharge care;
Communicate patient discharge plans as appropriate;
Monitor readiness for discharge;
Formulate discharge maintenance plan;
Arrange post-discharge evaluation; and
Discharge to next level of care (Bulechek et al., 2013 p.150).
11. CASE MANAGEMENT: OVERVIEW
DISCHARGE ACTIVITIES
Screening and Intake – identify discharge disposition / placement and destination;
Assess needs – financial resources, treatment plans coordinated with physician,
patient and family for smooth discharge transitions;
Service planning – initiate plan of care, identify barriers to outcomes achievement,
post-discharge service need identification, setting mutual goals with family/patient;
Link patient to what they need – resource utilization, appropriate length of stay
planning, evaluation of expected outcomes progress;
Implement InterdisciplinaryTreatment Plan – monitor expected outcomes, begin
arranging post-discharge arrangements, re-evaluate discharge destination if needed;
and
Evaluate Patient Care Outcomes – based on plan of care progress towards achieving
outcomes; round with the attending physician to obtain progress feedback (Cesta,
2013).
12. DISCHARGE COMMUNICATION:
INTERDISCIPLINARY STRATEGIES
Team Approach:
Discharge Planning Teams (Rose & Haugen, 2010).
Standardizing Communication:
“S-B-A-R” (Bengasco et al., 2013).
Evidence-Based Discharge Education:
“Teach-Back” (Kornburger et al., 2013).
13. DISCHARGE PLANNINGTEAMS:
MULTIDISCIPLINARY INTERVENTION STUDY
Based on a study conducted in a Progressive Care Unit (PCU) in a
Midwestern Hospital (Rose & Haugen, 2010):
Problem – Current Discharge Process Concerns
Incomplete / Inaccurate Discharge Summaries
Incomplete Prescriptions
Inconsistent Discharge Education
Communication Gaps regarding: Discharge dates, time, and disposition
Intervention – Formation of Discharge PlanningTeams
Possible Outcomes – Effective Discharge Planning
Decreases Re-admissions
Promotes Cost-effective Use of Inpatient Beds
Increased Patient / Staff Satisfaction
15. DISCHARGE PLANNING TEAMS:
ACTIVITIES PER DISCIPLINE
Physician & P.A.:
Education on pathology and surgical reports,
Writes discharge prescriptions the night before discharge, and
Completion of discharge summaries;
Registered Nurse:
Education on post-discharge care requirements night before discharge
and on the day, and
Coordinate follow up for outstanding discharge items to be completed;
Pharmacist:
Fills prescriptions at Hospital Outpatient Pharmacy; and
Verifies insurance information as soon as possible to fill script promptly
(Rose & Haugen, 2010).
16. DISCHARGE PLANNING TEAMS:
JOINT ACTIVITIES –SURVEY, AUDIT & RESULTS
Pre-implementation of Discharge Planning Teams:
Discharge Summaries – 60% completion rate,
Prescriptions Written – 45% completed night before discharge,
Nursing Staff Satisfaction – 37% contentment with discharge process, and
Patient Satisfaction – 93% perceived a smooth process;
Post-implementation of Discharge Planning Teams:
Discharge Summaries – 91% completion rate by 2007,
Prescriptions Written – 88% completed night before discharge by 2007,
Nursing Staff Satisfaction – 91% contentment with discharge process by 2007, and
Patient Satisfaction – 100% perceived a smooth process by 2007 (Rose & Haugen,
2010).
17. DISCHARGE PLANNING TEAMS:
KEYSTO SUCCESSFUL IMPLEMENTATION
Communication Remains Open – Across all disciplines must be
open to facilitate acceptance of changes in processes;
Multidisciplinary Involvement – input from various disciplines
facilitated the efficiency of workflow by identifying barriers related to
other departments/services; and
Continuous Improvement Process – teams must be cognizant of
the changes in health care environment: Payer systems, regulatory
agencies, and processes, ready to adapt to changing conditions (Rose &
Haugen, 2010).
18. STANDARDIZING COMMUNICATION:
RATIONALES FOR IMPLEMENTATION
Good Communication is characterized by:
Timeliness,
Standardization of Content, and
Well coordinated between disciplines (Reilly, Marcotte, Berns, & Shea, 2013).
Errors in Communication results in:
Adverse Events with Negative Patient Outcomes,
Negative Emotional Impacts for Patients & Caregivers,
Increased associated Costs,
Increased Length of Hospital Stay,
Loss of PatientTrust, and
Increased Risk for Litigation (Bagnasco et al., 2013; Reilly et al., 2013).
19. STANDARDIZED COMMUNICATION:
PROPOSED METHODS
S.B.A.R – Situation, Background,Assessment, &
Recommendations:
Recommended as a Standardized CommunicationTool, and
HasWritten andVerbal components for Communication at Patient Hand-
off andTransfer (Bagnasco et at., 2013).
Proposed Benefits – S.B.A.R Implementation:
Mitigation of Risk associated with poor Communication during Patient
Hand-off and Transfer i.e. Memory Failures,
Standardizes Communication Styles of various healthcare workers to create
uniformity, and
Optimizes communication timing via Standardized reporting procedure
(Bagnasco et al., 2013).
20. DISCHARGE EDUCATION:
EVIDENCE-BASED STRATEGIES
“Teach-Back” Process – “a comprehensive, interdisciplinary, evidence-based
strategy which can empower nursing staff to verify understanding, correct
inaccurate information, and reinforce medication teaching and new home care
skills with patients and families” (Kornburger et al., 2013).
Proposed Benefits – “Teach-Back”: Implementation
Provides opportunity toVerify Understanding, Correct Inaccurate Information, and
Reinforce Medication Education and Home Care Skills;
Valuable, Easily Implemented and Understood, and Cost-effective Education Strategy;
Engages Patients and Families in learning activities;
Patient and Family-centered Education Strategy (Kornburger et al., 2013).
21. DISCHARGE EDUCATION:
TEACH-BACK PROCESS
“Teach-Back” Goal – Effective Family / Patient Self-Management:
Step 1:Teach a New Concept or Skill,
Step 2: Clarify or Correct Misunderstandings,
Step 3:Acknowledge any Questions Patient/Family may Have, and
Step 4: Continue the Process until Concept or Skill is Understood (Kornburger et al.,
2013).
Nurse Competencies – Understand Health Literacy Principles:
Encourage Patient/Family Questions,
Use Plain Language,
Limit Teaching to 3-5 Concepts, and
Document “Teach-Back” education in the approved form (Kornburger et al., 2013).
22. SUMMARY & CONCLUSION
Communication Highlights:
Is a vital function to ensure Patient Safety;
Failures occur mostly during points of Transfer of Care;
Failures carry a significant potential for Adverse Patient Events;
Standardized Communication methods optimize outcomes;
Discharge Planning Highlights:
Requires an Integrated, Multidisciplinary & Team Approach;
Begins at Admission, is ongoing, and is constantly re-evaluative in nature;
Is Patient and Family-centered; anticipating needs constantly;
Requires effective communication between patients, family, and Healthcare Team; and
Requires pre-emptive, evidence-based discharge Education from entire team
(Bagnasco et al., 2013; Kornburger et al., 2013; Reilly et al., 2013; Rose & Haugen,
2010).
23. REFERENCES
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Bulechek, G., Butcher, H., Dochterman, J., & Wagner, C. (2013). Nursing Interventions Classification
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Cesta,T. (2013). Back to Basics:A Day in the Life of a Hospital Case Manager - Part 1. Hospital
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24. REFERENCES
Kornburger, C., Gibson, C., Sadowski, S., Maletta, K., & Klingbeil, C. (2013). Using
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