Standardized Discharge Education Plan Improves Patient Outcomes, Satisfaction

Researchers sought to develop a chemotherapy discharge class for patients and families.
Researchers sought to develop a chemotherapy discharge class for patients and families.
The following article features coverage from the 2017 Oncology Nursing Society's Annual Conference in Denver, Colorado. Click here to read more of Oncology Nurse Advisor's conference coverage.            

DENVER, CO — Preparing patients to manage their care at home enhances patient safety, decreases the frequency of unnecessary emergency center visits and unplanned readmissions, and improves patient satisfaction, according to a presentation at the 2017 Oncology Nursing Society Annual Congress.

A microsystem analysis on the unit needs, trends, and areas for improvement of a 36-bed mixed medical oncology unit at a National Cancer Institute-designated cancer center revealed that the unit's Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score for the domain of “Discharge Information” was below the hospital average. Furthermore, the unit did not utilize a standardized discharge education plan, explained Julianne Brogren, MS, RN, CNL, OCN, of the University of Texas MD Anderson Cancer Center in Houston, Texas.

Therefore, Ms Brogren collaborated with the unit leadership team and patient education department to develop a standardized unit-based discharge education plan. The development team's goals were to establish a chemotherapy discharge class for patients and families, identify risk assessment guidelines, and increase the HCAHPS score on Discharge Information by 10%. 

Patient-centered care is supported by current research as promoting active participation by patients in their care and health care decision-making. The researchers designed the interactive class to provide adult patients with a review of medications, potential adverse effects, home care management, and instructions for when to seek emergency medical care.  Content was developed based on surveys of patients undergoing chemotherapy conducted between November 2, 2015, and November 13, 2015. The surveys queried patients on their knowledge of potential adverse effects, understanding of home care management, awareness of when to seek emergency care, and knowledge of how to access available resources.

The classes, led by the unit's clinical nurse leader, are offered daily and are open to patients undergoing chemotherapy and their families. Staff nurses were instructed on the curriculum in order to  reinforce patient discharge instructions. 

Discharge criteria were established that stratified patient risk based on diagnosis, history, and treatment plan. Patients assessed as high risk were scheduled to receive a follow-up phone call within 72 hours of discharge. High-risk criteria included patient discharge after cycle 1 of chemotherapy, patients with new drains or lines of wounds, and patients admitted with a primary diagnosis of pain.

The discharge education plan was implemented on December 1, 2015. Initial feedback from patients and caregivers attending the class demonstrated overwhelming support for the program. Four months after implementing the plan, the unit's HCAHPS scores improved from an average of 88% to an average of 94%.

Because most of the patients on the unit have genitourinary cancers, future plans include collaborating with the outpatient genitourinary clinic to offer the chemotherapy discharge class at a patient's first appointment so he or she can feel better prepared when admitted for chemotherapy.

Read more of Oncology Nurse Advisor's coverage of the 2017 Oncology Nursing Society's Annual Conference by visiting the conference page.

Reference

1. Brogren J. Initiating a chemotherapy discharge teaching class on a mixed medical oncology unit. Oral presentation at: Oncology Nursing Society 42nd Annual Congress; May 4-7, 2017; Denver, CO.

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