Let’s get rid of discharge teaching!
I’m wondering if we should even use the term “discharge teaching” any more. That implies we teach at discharge. Clearly, that’s the wrong time to teach – staff don’t have time, and patients just want to leave the hospital.
Besides, the content of the education isn’t about discharge – “discharge” is just rolling out the door. The content is about how to care for yourself after you leave the hospital. Maybe, for accuracy, it should be called “self-care teaching.”
Anyway, we’re finally moving toward focusing on evaluation of understanding of self-care behaviors. The Society of Hospital Medicine has posted on their website some Quality Improvement Clinical Tools, including:
— Discharge Patient Education Tool (DPET)
— Discharge Knowledge Assessment Tool (DKAT)
These are clearly designed to evaluate patient’s understanding of the hospitalization and continuing care. These forms could really support a useful conversation.
But there is a part I would change on the DPET. A nod and an initial do not provide evidence of understanding. I would have the patient tell me, rather than initial these statements:
• I understand which medicines I took before I came to the hospital and will now stop.
• I understand the medicines I will continue taking and new medicines I will take.
• I understand why and when I need to take each medicine.
• I understand which side effects to watch for.
What do you think? Is this a transition your organization can make? Can we evolve toward self-care teaching and evaluation of understanding? Can we get rid of discharge teaching forever?
©2010 Fran London, MS, RN
The Society of Hospital Medicine: http://www.hospitalmedicine.org/Content/NavigationMenu/QualityImprovement/QIClinicalTools/Quality_Improvement.htm
4 Responses to “Let’s get rid of discharge teaching!”
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Fran:
I love the idea of changing the term discharge teaching to self-care teaching. Your comments bring into focus how essential teach-back or show-back is to providing evidence that the patient and family has understood the concepts. If we would think in behavioral terms of what we expect the patient to know or do, it would be easier to evaluate what actions they will take. I would take it a step further, however, and try to evaluate whether or not they will be able to use the information in self-care, by giving them a problem or issue to solve. Rehearsal is important if they are to solve problems at home with regard to their care.
Just a thought …
Sany
Sandy:
Absolutely! That would definitely be the way to go:
- make sure they understand the information
- make sure they can apply the information to life
- then coach them so they actually do apply the information!
It’s one thing to know what a healthy diet is, and another to buy the right food. But none of that matters if you don’t choose to eat those foods every day.
I agree that teaching at discharge is inappropriately named. Mary Naylor at University of Pennsylvania is someone whose research has focused on care during and after the transition from the hospital to the home.
Joan,
Thanks for that tip! I just found a description of Mary Naylor’s Transitional Care model at http://www.innovativecaremodels.com/care_models/21/leaders.
We derive our views from the same research, which indicates most effective education involves the patient in the process and individualizes teaching. Her site says,
“Actively engaging each patient and his/her family/caregivers in management, education, and support are important components to this model.”
and
“Tailored, ongoing communication makes a significant difference in patient care. During the inpatient stay, the amount of information that needs to be conveyed is extensive, but because hospitalization is a stressful and vulnerable time for most patients, the extent information is absorbed and translated into self-care is diminished. In the first visit, the Transitional Care Nurse spends a fair amount of time reviewing the discharge instructions and medication instructions to ensure that the patient really understands them. There is a significant need for “translating” information between physicians and patients to ensure that each really understands what the other has communicated. Excellent communication between and among the patient, family/caregivers, and providers and the transfer of data, aided by clinical information systems, proves paramount.”