Title : The role of the outpatient nurse in the inpatient setting-discharge medications: a collaborative quality improvement initiative
The transition of care from the inpatient to outpatient setting can be a confusing & fearful prospect. Patients & families leave the security, supervision, safety & familiarity of the unit and staff. They face living with a disability in their home as well as having to navigate the unfamiliar outpatient world. Breakdown in communication and modification in supplies & resources can result in patient-family dissatisfaction, a concern for patient safety, and possible readmission.
I work at a freestanding rehabilitation facility that has both inpatient units and outpatient clinics in the same building. I have had many years of experience working with the outpatient pediatric population and have seen firsthand what issues arise at discharge-especially with medications. It is not uncommon for families to call with questions: how to give if the medication had been prepared differently in the community; medications ordered were not in their outpatient formulary and were not approved by insurance; they were unsure of when to give and whom they should follow up with for refills. The growing number of these calls led to a quality improvement initiative, led by the outpatient nurses at our facility.
The Outpatient pediatric nurses initiated a meeting with the inpatient discharge team. Physicians and nurses on the inpatient unit were not aware of the volume of calls and common issues, which arise post-discharge. The team agreed that the outpatient RN would round weekly with the inpatient team to do a discharge handoff where by the outpatient nurses could meet the patients, and review the discharge plan for medications. This provides an opportunity for the outpatient nurse to identify issues that might arise and work with the physicians, nurses and pharmacist on a solution.
This collaborative effort has paved the way for improved quality of patient care; improved communication across the continuum of care; improved patient satisfaction; improved patient safety, and a decrease in medication post-discharge calls.