Document Type

DNP Project

Date of Degree

Spring 2021

Degree

Doctor of Nursing Practice (DNP)

Primary Advisor

Karen S. Kesten, DNP, APRN, CCNS, CNE, FAAN; Margaret Venzke DNP, RN, FNP-BC

Keywords

IDEAL Discharge Protocol; Quality Improvement Initiative; Older Adults; Discharge Process

Abstract

Background: Readmissions are costly and adversely affect patient outcomes. Readmissions significantly impact older adults’ ability to manage post-discharge. Older adults are more likely to have challenges with understanding newly prescribed medications after discharge and therefore are less compliant with medications. Older adults are also less likely to follow-up with their primary care physician after discharge. Engaging patients and families in a collaborative discharge process is a key foundational element needed to improve patient outcomes and reduce avoidable readmission rates.

Purpose: This quality improvement initiative engaged patients and families in an evidence-based discharge protocol to reduce avoidable readmission over three months.

Methods: The Define, Measure, Analyze, Design, and Verify (DMADV) improvement process was used to implement the initiative. The IDEAL Discharge Protocol was piloted on one medical-surgical unit targeting adults 65 years or older with no cognitive deficits and discharged home. The IDEAL Discharge Protocol focused on implementing a structured process to include patients and their families in a collaborative care process focused on discussion, education, and post-discharge follow-up.

Results: Forty-four participants engaged in the study. A 4 percent decrease in the pilot unit readmission rate was observed. Before implementation, the readmission rate was 17 percent. After implementation, the readmission rate was 13 percent. Post-discharge follow-up resulted in the completion of 52.2 percent follow-up calls and 45.5 percent follow-up appointments scheduled. Of the 44 participants engaged in the intervention, two were readmitted, resulting in a 4.5 readmission rate for the study participants. Medication compliance was assessed and found to be 93.3 percent, and 100 percent of participants received education while engaged in the study.

Conclusion: The IDEAL intervention aided in improving the discharge process to better equip patients with the tools to successfully transition home after discharge and showed a trend toward reducing the pilot unit’s readmission rate.

Open Access

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