Improving Patient Understanding of Surgical Site Discharge Instructions

Purpose: This evidence-based project aimed to increase patient knowledge and preparedness regarding the care of their surgical site at the time of discharge.

Relevance/significance: By reviewing past patient satisfaction scores an area of improvement was noted on a medical-surgical unit in the area of discharge preparedness. Patients reported they did not feel adequately prepared or educated on the signs and symptoms of infection when discharged. After a literature review, an evidence-based incisional care instruction handout was created with the objective to increase patient knowledge regarding the care of their surgical incisions. This scholarly project included the implementation of education to nurses about evidence-based patient discharge instructions on incisional care, closure for incisions, and signs and symptoms of surgical site infection.

Strategy and implementations: The new incisional care instructional program was implemented by nurses who performed discharge for surgical patients. The study occurred during a twelve-week project implementation period. The new incisional care educational tool included strategies on how to prevent infection and care for incisions, care for specific surgical closures, and concerning signs and symptoms. The participating nurses were educated on the new educational tools, and then subsequently used these for surgical patients being discharged. Patients included in the analysis were inpatient, surgical patients with a focus on patients who underwent gynecological, urological, and general surgery procedures.

Evaluation: Patients satisfaction with discharge education was then recorded using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveying techniques with questions regarding preparedness for discharge and signs and symptoms to look for at home. The new education initiative was implemented in September 2019 through December 2019 and included 105 patients. All surgical patients were sent an anonymous follow-up survey the month following discharge, which included questions evaluating their perception of preparedness for discharge. The 105 patients in the sample ranged in age from 18 to 93 years old (M = 52.61, SD = 17.03), and 72% were female. A one-tail independent samples t-test was used to evaluate the data. A higher proportion of patients reported they received written information regarding surgical care after the intervention timeframe of September 2019 to December 2019 (M = 95.3%, SD = 4.27) compared to before the intervention timeframe of January 2019 to August 2019 (M = 89.9, SD = 4.00, t(7) = 1.87, p = .05). In evaluating these findings, since multiple nurses were providing the discharge education, there is a potential that education was not provided consistently between participating nurses. Additionally, the response rate of patients who returned surveys during this timeframe was 20%. This may have led to response bias.

Implications for practice: Although surgical patients receive some degree of instruction upon discharge, many patients can leave the hospital feeling unprepared and may not recognize the education they received as part of a comprehensive transition home. Utilizing evidence-based patient instructions and consistent nurse to patient discharge education can help increase patient perception of receiving surgical care education, which may lead to improved patient experience, confidence, and knowledge for self- care.