Purpose: The purpose of this project was to redesign the discharge education process for our lower extremity arthroplasty (LEA) patients, incorporating evidence-based practices that were found in the literature. The objectives were to: 1) Implement discharge instructions with both the patient and their significant other present. 2) Assess compliance with discharge instructions at one week and five weeks after discharge. 3) Compare degree of compliance following implementation of including the significant other in discharge education and telephone follow-up with the degree of compliance prior to those changes.
Description: Prior to this project, our LEA patients frequently didn’t remember the post-discharge education given to them during hospitalization and often didn’t refer to the copious written discharge information given to them. As a result, many patients did not follow their post-discharge instructions. Readmissions for complications, particularly opioid-induced fecal impaction, occurred. And our Press-Ganey scores showed that patients did not feel they were adequately educated prior to discharge.
A literature review showed that there was room for improvement in our discharge education process in two areas: family caregiver education and post-discharge follow-up. We redesigned our discharge education program to include a 30-minute discharge education class for patients’ family caregivers and implemented post-discharge phone calls by the one discharge education nurse. We also developed a “refrigerator magnet” using the acronym M.I.L.E.S. (medications, issues, legs, elimination, and site dressing) to highlight important items to monitor post-discharge.
Evaluation/outcomes: Family caregivers of 42 hip and 80 knee arthroplasty patients participated in the 30-minute discharge education class. Post-discharge phone calls were made at one and five weeks to assess compliance with discharge education and to answer any questions patients or family caregivers had. Both patients and their family caregivers were asked to participate in the phone calls. They received specific dates and approximate times for the phone calls. A 12-question compliance survey guided questioning during each follow-up phone call. Analysis of data from the compliance survey showed that patients and their family caregivers were following their discharge instructions. Patients and family caregivers said the M.I.L.E.S. magnet helped them remember the important items they needed to review each day. We compared Press Ganey scores on four discharge-related questions for one year prior to starting the family caregiver discharge education class and one year after offering it. Scores on those questions showed improvements to the highest score of 4.5% 7.2%, 8.7%, and 9.1% after we implemented the class. Physicians reported improved compliance with post-discharge education. Readmissions for complications decreased.
Adding a 30-minute family caregiver discharge education class had a positive effect on our patients’ recoveries because of improved understanding of post-operative care. Family caregivers stated they felt better prepared to care for patients after the class. There were no readmissions for preventable post-operative complications because patients and family caregivers were able to recognize signs and symptoms of potential complications and notify the physician. Use of the M.I.L.E.S magnet was an effective monitoring reminder for patient and family caregivers.
Evidence-based references 1. Brennan, C. & Parsons, G. (2017). Enhanced recovery in orthopedics: A prospective audit of an enhanced recovery program for patients undergoing hip or knee arthroplasty. Medsurg Nursing, 26(2), pp. 99104. 2. Cano-Plans, S., Lacueva-Perez, L., Cabrera, E. & Zabalegui, A. (2018). Knowledge expectations of orthopaedic patients. International Journal of Nursing Practice, 24, e12639. doi: 10.0000/ijn.12639. 3. Estes, A. M, Schreuder, A. M., Vermeulen, H., van Dijkyum, E., J. M. N., & Chaboyer, W. (2019). Developing an evidence-based and theory informed intervention to involve families in patients care after surgery: A quality improvement project. International Journal of Nursing Sciences, 6(4), 352-361. 4. Darcy, A. M., Murphy, G. A. & DeSanto-Madeya, S. (2014). Evaluation of discharge telephone calls following total joint replacement surgery. Orthopaedic Nursing, 33(4),188-195. 5. Van Citters, A. D., Fahlman, C., Goldmann, D. A., Lieberman, J. R., Koenig, K. M.,…Bozie, K. J. (2014). Developing a pathway for high-value, patient-centered total joint arthroplasty. Clinical Orthopaedics and Related Research, 472, 1619-1635. doi:10.1007/s11999-013-3398-4.