Discharge kits boost patient satisfaction 65%
Repeat calls for instruction drop from 96% to 4%
Kits that help ease the headaches of at-home care by consolidating easy, step-by-step instructions with full color illustrations and enough supplies to start patients on the road to recovery are earning high marks not only from patients but from case managers and clinicians.
Developed by Care Products in Northbrook, IL, Careguide kits first became available to hospitals in summer 1998. They cover a variety of procedures, including breast surgery, cardiac surgery, intermittent catheterization, and indwelling catheter care. Given to patients at the time of discharge, the kits, which include sufficient supplies to last for at least five to 10 days, are designed to ease patients’ transition to home — not to provide all the wound care supplies they will ultimately need.
Surveys indicate that along with simplifying at-home care, the kits also help make case managers’ jobs easier by reducing the number of telephone calls from patients seeking guidance on how to perform the various self-care procedures. In fact, "We introduced them as much for the sake of the hospital in saving time and money as for the benefit of the patients," explains Shirley Grey, MSN, vice president of Care Products and president of the Illinois Case Management Society. "By calling back for repeat instructions, they were taking the nurses away from their other duties. Also, when patients feel helpless about finding the right gauze, tape, pads, and other supplies, the nurses try to help out by giving them away, and that becomes a cost to the hospital,"
Rush Presbyterian St. Luke’s Medical Center in Chicago first began using the products in 1998. A management team developed five basic home-care wound kits, each designed for a variety of patient populations as well as to meet patients’ initial needs at a reasonable cost. From those five, a pilot was developed using two: damp-to-damp with normal saline (Kit No. 1) and dry dressing change with ABD pads (Kit No. 3).
To determine their effectiveness, patients and staff nurses were surveyed before and after the hospital implemented the use of the kits. The results were positive. In addition to increasing patients’ satisfaction with the discharge process from 35% to 100%, the surveys showed that, as a result of using the kits, the percentage of discharged patients calling back for repeat instructions dropped from 96% to 4%. Equally significant, the surveys also showed a healthy increase in the nurses’ overall satisfaction with discharge teaching materials, from 70%, up to 91%.
"Many of our patients are discharged with wounds requiring at-home treatment. As we are an urban teaching hospital, they run the gamut from the very sophisticated to the opposite end of the spectrum. Since many of them are actually unable to speak English, we needed to develop a kit that would be generic," says Debra Levin, RN, CCM, Rush Presbyterian’s clinical resource coordinator.
One disconcerting finding of the study, according to Levin, was that even many of the large pharmacies carry only small amounts of dressing supplies. As a result, patients who have just been discharged often wind up having to go to several pharmacies to get what they need, or even worse, actually having to wait several days while the items are being ordered. "A lot of things that come in the kits are the kinds of disposable items that payers will not cover, such as gauze pads or rubber gloves. We actually went around to the bigger pharmacies ourselves. And we found it [wasn’t] easy. Many simply don’t carry large quantities in stock," she says.
At Rush Presbyterian, response to the kits, which come in sealed boxes, has been overwhelmingly positive — not only from patients but also from the nursing staff, who like the fact that the kits make it easy to keep track of items that in the past were hard to quantify and as a result were frequently overlooked. "Now that we have a controlled stock, it seems the loss from supplies going out the door really is reduced," says Levin.
Johns Hopkins Medical Center in Baltimore began purchasing kits for mastectomy patients in March 1999. "[Before], patients who had undergone mastectomies were responsible for assembling their own kits, based on information they were given at discharge," says Amos Drummond, manager of the outpatient pharmacy, who helped develop and outsource the kits. "Receiving a [breast cancer] diagnosis is stressful enough. And then, to have to go from one pharmacy to the next, looking for the kind and amount of supplies they needed, it was like going out and arbitrarily picking apples, oranges, and cherries from an orchard."
In light of that, it’s hardly surprising that most patients wound up either over- or underpurchasing the necessary items. "They’d end up buying $60 or $70 worth, when all they really needed was enough to last 14 days," says Drummond. By including exactly the amount and kind of supplies needed to get through the recovery period, Drummond adds, the Careguide kits can completely eliminate the guesswork. "People call me all the time, just to say, Thank you. This has made my life so much easier,’" he says.
Hinsdale (IL) Hospital has been distributing the post-surgical kits to its breast patients for the past year and a half. "One hundred percent of our patients report that they appreciate having all their supplies organized and ready at discharge," says Nancy Bevan, MSN, clinical specialist of surgical services.
"From a nursing standpoint," she adds, "nothing is more important than patient satisfaction. Everything is contained — so from a cost standpoint, that, needless to say, is good for us."
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