Extent of discharge teaching (Frustration-Vent, Curious)

[gentle]

While at work over the weekend, I went "over the top" with my discharge teaching. I left a patient/family member extremely confused with entirely too much information and ended up switching patients, I wanted to do so. Despite trying to change my behavior, I still tend to do this: provide too dang much information. This was one of those occassions.

I guess my questions are as follows: 1). who is doing the discharge teaching in your facilities? 2). to what extent/detail are the nurses performing the discharge teaching?

I learned today, that we are only to teach those interventions that we as nurses provide. All other instruction must come from the appropriate department or doctor.

I have not seen the pharmacist instruct patients very often regarding medications. I have seen an awful lot of passing the buck: "the doc was supposed to do that". I have also seen patients forget what the docs told them due to "too much information, new diagnosis, stress, etc."

Some of our surgery patients don't follow up with their docs for 3 to 6 weeks. I know that some facilities have nurses who call to check on their surgical patients who have already gone home; but this is not available where I work.

Unfortunately, I just learned of a person, discharged from our hospital with limited teaching. It turned out that they had no idea what to expect at home or how to care for themselves. They followed up with their surgeon, but, still remained confused with home self-care. Yes, I understand this is the patient's responsibility to push for clarification; but, what about before the person was discharged? This was one of those people with a 3-6 week follow up appointment.

Any information is appreciated. Thank you to everyone, in advance.

[Fiona59]

If you are the nurse assigned to the patient then you do the discharge teaching. Hand over the script and instructions for use, follow up info and surgeons card, if home care is involved the contact number is given. If ostomies are involved then the nurse educator visits them several times before discharge to ensure that the patient or a family member is capable of doing ostomy care.

Ultimately, we are dealing with adults and they have to be responsible for their own health. We can only advise.

[rn undisclosed name]

Sounds like possibly this might be a situation where home health might benefit the patient. If I have any doubt the pt is able to care for themselves at home I ask them how they would feel about a nurse coming to the house. Granted I don't have a lot of post surgical patients but I don't think it hurts to have a nurse check on them especially if their first appointment is in 3-6 weeks.

But I do agree these patients are responsible for themselves. We must give them some guidelines with our teaching so they aren't clueless and hopefully won't wait at home too long if something were to go wrong or they developed a complication.

Kelly

[meownsmile, BSN, RN]

We do all our own discharge teaching. The physicians number is clearly on the discharge papers and we call most scripts to their pharmacy if they want. Thats just one less thing they have to deal with. I have patients call sometimes a couple days after discharge to ask questions. Thats ok though, even though they werent my patient id rather have them call us and ask than not find out. After you are in your unit long enough you will be ok with talking to a post surgical after they go home. And if it is something i dont know about, i tell them they should visit the ER if they are uncertain if there is a problem or call their doctor and the service will have him call them. As long as most of the information you are giving them is in writing so they can reread it after they get home you should be fine. We send home discharge care sheets along with their instruction sheets that help also.

[gentle]

Sounds like possibly this might be a situation where home health might benefit the patient. If I have any doubt the pt is able to care for themselves at home I ask them how they would feel about a nurse coming to the house.

But I do agree these patients are responsible for themselves. We must give them some guidelines with our teaching so they aren't clueless and hopefully won't wait at home too long if something were to go wrong or they developed a complication.

These patients are not given option of home health. Family members take them home. In some cases, doctors have not been available to help patients or change the medications. As a matter of fact twice over I have instructed patients to call their PCP as soon as they arrive home due to blood pressure medication issues.

We will be starting new computer system with discharge teaching soon; but only for a few diagnoses. Not all the doctors are on board with the patient teaching instructions.

We do all our own discharge teaching. The physicians number is clearly on the discharge papers and we call most scripts to their pharmacy if they want. Thats just one less thing they have to deal with. I have patients call sometimes a couple days after discharge to ask questions. Thats ok though, even though they werent my patient id rather have them call us and ask than not find out. After you are in your unit long enough you will be ok with talking to a post surgical after they go home. And if it is something i dont know about, i tell them they should visit the ER if they are uncertain if there is a problem or call their doctor and the service will have him call them. As long as most of the information you are giving them is in writing so they can reread it after they get home you should be fine. We send home discharge care sheets along with their instruction sheets that help also.

Meownsmile,

Thank you for your post as well. Interestingly, your response correlates quite closely to my own views. However, I noticed that you hail from the midwest. I grew up in the midwest as well. Unfortunately, in my new place of residence, this is not an accepted practice, to answer patients questions after they call back to the hospital with questions. We are expressly informed that these patients are to be referred back to the doctor's office. The doctors don't or aren't able answer the patients' questions.

It is illegal to call prescriptions in for the patients in this location.

I've been working here for a while. Due to politics, angry docs, litigation issues and whatever else, things just keep a changing.

To heck with theorists Orem or Sister Callista Roy, this is unfortunate.

I have emailed my state BRN to see exactly what the law says. I'll let everyone know when they email or call me back.

[gentle]

If you are the nurse assigned to the patient then you do the discharge teaching. Hand over the script and instructions for use, follow up info and surgeons card, if home care is involved the contact number is given. If ostomies are involved then the nurse educator visits them several times before discharge to ensure that the patient or a family member is capable of doing ostomy care.

Ultimately, we are dealing with adults and they have to be responsible for their own health. We can only advise.

Thank you for your reply.

Do you review the instructions with the patients and family members before giving the instructions to the patient for home use? Do you ensure that both patient and family member signs instructions that identify they both understand the instructions. I usually do this but I don't know about most nurses. I'm just curious, how other nurses handle discharge teaching.

We write the name and numbers down for follow up appointments and give this with the last assessment to the patients on our discharge paperwork. Sometimes home health is involved in a patient's care but more often than not, the patients do not qualify for home health or rehabilitation stays. They go home with the families. Again I agree, families must advocate on the patient's behalf not my problem.

[Fiona59]

Our Health Authority has a Discharge Summary sheet which outlines pretty much that needs to be covered when discharging a patient. You fill in the appropriate areas and mark them off and initial it as you go through the education.

At the end the patient signs (or the family member if teaching is given) and the nurse signs. Patient gets a copy and the chart gets a copy.

Covers us when they say they didn't get their narcotics script or no discharge teaching.