Follow-up calls improve discharge instructions
Contact helps with problems, reinforces opportunity
A process for making follow-up calls after new moms are discharged with their babies from Sacred Heart Medical Center in Spokane, WA, has helped to improve discharge instructions at the health care facility. Performance-improvement projects have been initiated by reviewing the answers to the questions asked during the interview. This process can work just as well in other areas.
This helps pinpoint areas where the information taught might not be clear, says Julie Emery, RN, assistant nurse manager at the Women’s Health Center. For example, if many of the women have questions about sore nipples while breast-feeding, more education may be needed on this topic, she says.
Postpartum follow-up calls are made 24 hours after discharge; again at 72 hours, and a third call is made if the mother is having difficulties with the baby. Registered nurses who work the help line at the center make the calls.
The calls are scripted so all nurses ask the same questions. A comment section on the assessment form is used to note details on each patient because the nurse that makes the call 24 hours after discharge doesn’t necessarily call back at the 72-hour interval.
The questions focus on both the mother and the baby. For example, the nurse will ask the mother questions about her breasts to uncover problems such as engorgement. Questions about the baby include the position he or she is sleeping in, because Sacred Heart recommends that babies sleep on their back to help prevent sudden infant death syndrome.
The calls provide an opportunity to remind new mothers about their baby’s immunizations and follow-up visits. A general question about how staff at Sacred Heart could have made their stay better also is included.
Very often, a new mother has problems with breast-feeding. If the RN making the call can’t answer her questions, a lactation consultant takes the call. "We always have one lactation consultant working the help line," says Emery. The new mothers can make an appointment to see one of the lactation consultants at the Women’s Health Center as well.
If patients cannot be reached at the 24- or 72-hour intervals a message is left on their answering machines only if they have given their permission to do so. "If we can’t reach them at all after the 72 hours, we send a postcard and tell them to call us any time," says Emery.
Teaching for new parents is initiated before the birth of the baby during a one-hour pre-delivery visit at the Women’s Health Center. Information about the visit is mailed to the couple so they can go over the questions before their appointment. Teaching includes care of the mother and baby following delivery, safety concerns, and breast-feeding. The couples also create a birth plan.
"We get their chart started here, and then we take it over to the birth place and it is continued there. This gives us an opportunity to get to know them a little bit before we talk with them later on the phone after they deliver," says Emery.
Initiating other calls
The postpartum calls through the help line at the Women’s Health Center have been so helpful to patients that the nurses have begun calling women following such surgeries as hysterectomies, mastectomies, and bladder repairs.
The calls are made 72 hours following discharge, with questions covering such issues as pain, care of their incision, problems with drains, whether they have enough help at home, and if they have made their follow-up appointment with their physician.
If pain is not being controlled effectively, the patients are told to call their physician. When a problem is detected, the physician is notified and the Health Center faxes the comment sheets to his or her office.
"We are in the process of expanding our program and will be calling more people," says Emery. Next, women who have to return for additional views following a mammogram will be called to ensure that they make their appointments and to answer any questions they may have.
"In health care, I think follow-up calls are beneficial in all areas," says Emery. People often don’t understand the information they are given or they don’t have enough time with their physician to have all their questions answered, she explains.
Source
For more information about follow-up calls after discharge, contact:
- Julie Emery, RN, Assistant Nurse Manager, Women’s Health Center, Sacred Heart Medical Center, P.O. Box 2555, Spokane, WA 99220. Telephone: (877) 474-2400 or (509) 474-5058. E-mail: [email protected].
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