Facilitating Patient Understanding of Discharge Instructions Workshop Summary (2014) / Chapter Skim
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5 Approaches to Developing Improved Discharge Instructions
5 Approaches to Developing Improved Discharge Instructions
Pages 33-42
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From page 33... ...
PROJECT RED: REENGINEERING THE DISCHARGE PROCESS1 In his initial comment to the workshop, Michael Paasche-Orlow noted that the issues that had been discussed are relevant to all transitions in the clinical setting when information is being exchanged between a health care provider and a patient. "I hope that as people learn and touch different parts of this elephant, we can share information and really expand together," he said.
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From page 34... ...
The challenge, he explained, is conveying to an organization's staff that management cares about the work they do with their patients not only when they are within the health care setting but also when they leave. "This is a different type of focus," said Paasche-Orlow, one that goes from "who is taking the next admission" to a perspective that says, "I value the work that you do in preparation for your patient to go home and succeed." As had been mentioned earlier during the workshop, the electronic systems for producing discharge instructions depend on the quality of the data in EHRs, and it is well known that EHRs are full of bad data.
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From page 35... ...
Unless someone takes the time to go over the discharge instructions before the health care provider hands those instructions to the patient, and unless the health care provider takes time to review the discharge instructions before talking to the patient about them, the opportunity is ripe for the patient to receive something with little value and for the health care provider to be embarrassed. Thinking of the care plan as a process instead of a form allows the health care provider to think about every document that goes to the patient in terms of how that document meets an educational agenda, explained Paasche-Orlow.
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From page 36... ...
DISCHARGE INSTRUCTIONS: PATIENT VALUES AND CHALLENGES2 The mission of Polyglot Systems is to develop practical, affordable multi-language technology solutions to improve access to health care and reduce disparities for underserved patients and those with limited profi 2 Thissection is based on the presentation by Charles Lee, president and founder of Polyglot Systems, Inc., and the statements are not endorsed or verified by the IOM.
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From page 37... ...
Improving understanding also requires the use of visual aids to reinforce written concepts and the use of font sizes that the elderly and visually impaired can actually read. Lee agreed with Paasche-Orlow that patient discharge is a process, not just a form, and it is essential then that the discharge instructions include specific actionable items presented in a way that is both personalized and encourages dialogue with the health care provider.
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From page 38... ...
Lee's final example described a solution for creating customized discharge instructions using a template-based format. This tool allows the health care provider to select a condition, which then populates the system with a list of associated instructions, personalize the instructions available through dropdown menus to make the instructions relevant to the patient, and then print the instructions in English or the patient's preferred language.
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From page 39... ...
Patients preferred the dual-column format because it enabled other English speakers in their household to be able to read the instructions. When asked, patients who received the Meducation discharge instructions described the
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From page 40... ...
He noted that one of the challenges to creating these types of documents is that they need to accommodate both science and art. The science part includes research-based best practices, such as the use of the Universal Medication Schedules; appropriate grade reading level; layouts that are visually pleasing and easy to read; and reinforcements of educational messages.
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From page 41... ...
Once a form has been developed for a particular customer, it becomes instantly available for every other customer, he said. Given the complex issues involved in pain relief medication and the potential for abuse or unintentional habituation of pain medications, Isham asked, how does one deal with those challenges in discharge instructions for a low literacy population and those with limited English proficiency?
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From page 42... ...
Acetaminophen is particularly difficult because not only do prescription products contain the drug but also so do many over-the-counter products. In the end, he said, one has to talk with one's patients because there is only so much a discharge form or an electronic system can do.
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