Health Literacy Safety Project

1. Assignment #2
Jose Rodriguez,aresidentof Monterrey,hadbeenworkingforEl Mercado Truckingas a longhaul driver
for 3 years. Hisroutesoftenbroughthimintothe southernU.S. He dreamedof movingtothe lowerRio
Grande area withhiswife Juanita,ahighschool teacher. InJanuary of 2016, he was askedtodelivera
loadto a warehouse inMcAllen,Texas. Withhiscompany’spermission,he wasallowedtobringhis
pregnantwife withhimtomake the delivery. He wasexcitedtoshow herthe landhe hadspokenof
often. Thiswouldbe herfirsttripout of Mexico.
While onthe trip,Juanitawentintolaborearly. She and Jose Rodriguezdelivered theirson,Raul,at33
6/7 weeksEGA viaa spontaneousvaginaldelivery. Uponadmissiontothe NICU,Raul was diagnosed
withlarge PatentDuctusArteriosusorPDA. Raul progressedwell andwasdischargedafter3days inthe
ICU and 4 daysin the newbornnursery. The Rodriguezfamilywasgiventhe standardizeddischarge
instructionsforPDA fromthe facility’sEMR. The instructionswere notavailable inSpanish. Raul was
dischargedhome onindomethacinandaskedtofollow upwithacardiologist.
Raul’sparentsreturnedthe infanttothe emergencyroom10 days afterdischarge. Raul had
tachycardia,tachypnea,andweightloss. Whenhisparentswere askedif the infanthadseena
cardiologist,theyreportedtheydidn’trealizethe child neededtobe followedbyacardiologist. While
Jose spoke some English, hisvocabularywasmostlyrelatedtohiswork. (Ex:drivingdirections,
unloadingthe truck,gettinggas,orderingfood,etc.) Juanitaspoke verylittle English,butcould
understandsome spokenwords.
The discharge instructionsforRaul are attached.
Assignment:
Step#1
As a team,reviewthe instructionsusingcurrentrecommendationsforindividualswithlow health
literacy. Underline orhighlightthe areasinneedof improvement.
 Doesyour teamfeel healthliteracywasafactor inthisreadmission?
o Yes,the parentsdidnot understandthatthe childneededtofollow upwitha
cardiologistandthe instructionstheyweregivenwerenotinSpanish.
 Doesyour teamfeel the discharge instructionswereclearinthiscase?
o No,the instructionswere notclearforseveral reasons.First,theywere full of medical
jargonthat a normal personwouldnotunderstand.Second,the instructionswere in
Englishwhenthe patient’sparentsonlyspeakafew wordsof the language (none of
whichpertainstothe medical field).
 Doesyour teamfeel the standardized(pre-developed,general) formwas the bestoptioninthis
case?
o No,the general formwasnot the bestoptionforthis patientandhisfamily.The form
was lengthywithlotsof medical jargonandexcessiveinformationandwasnotwritten
inEnglish.
 Doesyour teamfeel all of the informationonthe formwasneededfor the parentsto
understandyouhow care fortheirinfant? If not,what informationwasfluff thatcouldbe
removed? Whatinformationwasmissing?

2. o No,the parentsdidnot needall of the excessive informationandmedicaljargonthat
was presentinthe general form.Namingall of the possible diagnosticteststhe
cardiologistmayrun,frivolouslyindepthmedical explanations,andall the extra
possible medicationshe couldpossiblyreceivecouldbe considered“fluff”.While the
formlistedthe symptomsof decompensation,itneverexplainedtothe parentswhatto
do if theyobservedthem.The formcouldalsohave beenbrokenupintosmallerchunks,
had more color,and clearerimagestoaide inthe parent’sunderstanding.
 What couldhave preventedthisreadmission?How couldthat have beenconveyedonthe form?
o If the providerhadaskedthe parentstorepeatthe instructionsgivenandexplained
them,he wouldhave realizedthattheydidnotunderstand.If the instructionswere
writtenata lowerhealthliteracylevel andinthe parent’sprimarylanguage,the
readmissioncouldhave beenprevented.
Step#2
Developyourowndischarge instructions(1page) forthisfamilyusingcurrentbestpractice
recommendationsforindividualswithlow healthliteracy. The instructionsshouldbe inEnglishbutcan
reference Spanishif youteamdesires.
Due Date: 3.20.17 by2359

3. Utopia General Hospital
Great Care – Closer to Home
Patient Name: Raul Rodriguez
Diagnosis: Patent Ductus Arteriosus
The ductus arteriosus(DA) isanimportantstructure infetal life. The DA connectsthe pulmonaryartery
to the aorta and servestoshuntbloodawayfrom the lungsintothe umbilical placental circulation
where gasexchange takesplace.Atbirth,closure of the DA is an essential partof postnatal adaptation.
In some infants,there isapersistentopeningbetweenthe twovessels. Inpreterminfants,failure of DA
closure afterbirthcan be associatedwithanincreasedincidence of chroniclungdisease (CLD),
intraventricularhemorrhage (IVH) andnecrotizingenterocolitis(NEC). While asmall openingbetween
the two vesselsdoesn’tcause problemsand,inamajorityof cases,doesn’tneedtreatment,alarger
opening, inmostcases,will require treatmentwithaprostaglandininhibitororsurgery. Leftuntreated,
the defectcouldcause cardiomyopathyorpulmonaryhypertension. Symptomsof decompensation
include anorexia,cachexia,shortnessof breath,tachypnea,fatigue,andtachycardia.
Infantswithlargerdefectsshouldbe evaluatedbyacardiologist. If the cardiologistsuspectsDA,he or
she may orderan ECG, chest radiographs,echocardiogram, orevencardiaccatheterization. For
premature infants,the drugof choice isindomethacin. OtherNSAIDSsuchasibuprofen,Advil,orMotrin
may alsobe prescribed. Inyourinfantisn’tresponsive to conservative treatmentorthe DA is causing
significantcomplications,the cardiologistmayrecommendsurgery.
Regardlessof yourchild’sdiagnosis,all newbornsrequire on-goingcare withaPCPor pediatrician.

4. Utopia General Hospital
GreatCare – Closer to Home
Patient:Raul Rodriguez
Diagnosis:PatentDuctusArteriosis
Medications:Indomethacin
What isPatentDuctus Arteriosis(PDA)?
The ductus arteriosisavessel thatisnormal inan unbornbaby,but shouldclose whenthe babyisborn.
However,if the babyisborn early,the vessel maynotclose whichcancause problemswithbloodflow
inthe heartand lungs.
What isIndomethacin?
Indomethacinisamedicationthatwill helptoclose the PDA.Itis importanttogive thismedicationas
writtenbelowtoavoidfurthercomplications.
How doI give Indomethacin?
 Give ______ mg (dose)
 Give _______ timesperday (frequency)
 Give at ______ and ______ (timing)
 Give by __________ (route)
IF YOUNOTICE ANY OF THESE SIGNS,GOTO THE EMERGENCYROOM
 Not wanting to eat
 Weightloss
 Trouble breathing
 Breathing rapidly
 Extremelytired
These are all signsthat your baby’s conditioncould be getting worse and needs to be seen by a doctor
as soon as possible.
At home todo list:
___ Followupwitha cardiologist
___ Attendregularpediatricianappointments
___ Administermedication
___ Monitor forthe symptomslistedabove