Hospital created simple, effective discharge tool

Nurses helped create it

An effective and simple discharge checklist is the ideal tool for hospital nurses and others who handle the patient discharge process.

The University of New Mexico Hospital in Albuquerque, NM, has developed one that meets both of these goals and has received high marks from nurses who use it.

The hospital developed the tool after becoming involved in Project BOOST (Better Outcomes for Older adults through Safe Transitions), which is sponsored by the Society of Hospital Medicine in Philadelphia, PA.

"One of the things we've had some success with is our discharge checklist for nurses," says Percy Pentecost, MD, assistant professor of medicine at the University of New Mexico Hospital.

"What we found is there is not a lot of consistency in the way discharges were done, so we tried to make that more consistent," he explains. "The way we've done that is to come up with a discharge checklist that all the nurses on our trial floor utilize every time they discharge a patient."

For example, if a patient has his prescriptions in hand or has a way to obtain his or her prescriptions before arriving home, this will improve the patient's discharge process.

"If you hand somebody prescriptions at 8 p.m., it doesn't do them any good because the pharmacies are all closed," Pentecost says. "So we're trying to anticipate the details needed for discharge."

Another example of a discharge detail involves making certain patients understand and can repeat back all of the warning signs of problems.

"So if they're admitted with pneumonia, they should be able to articulate to the nurse before the discharge that they know to call their medical provider or return to the emergency room if their breathing gets more difficult or if they develop a cough or fever," Pentecost says.

"The checklist is implemented on our trial floor, and the nurses are quite pleased with it, and they feel it adds consistency and helps them organize their thoughts," he adds.

The hospital's nurses helped develop content for the discharge checklist, which consists of one page.

"The nurses wanted to keep the checklist to one page," Pentecost says. "In fact, we gave them our trial version of four things, and they're the ones who said, 'That's a good start, but we also need this and this and this.'"

Based on that positive beginning, the checklist was revised and improved.

"The tool has helped us develop some unity and purpose in trying to improve discharges," Pentecost says.

The hospital plans to share its checklist with other hospitals through Project Boost, and Pentecost already has discussed it with peers in Project BOOST conference calls.

Project BOOST on its Web site already has a toolkit that includes a discharge checklist that has been used successfully by other hospitals, Pentecost notes.