Running head: FINAL SUMMARY REPORT 1

Final Summary Report

Michelle Arslan

Bon Secours Memorial College of Nursing

Synthesis of Nursing Practice

NUR 4242

Wendi Liverman, MSN, CEN, RN

April 01, 2017

On my honor, I have neither given nor received aid on this

assignment or test, and I pledge that I am in compliance with the BSMCON Honor

System.
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Final Summary Report

A change needed to be made on the average discharge teaching and overall discharge

process as far as time management. So I set out with my nurse manager to make and implement

the necessary changes. At Mary Immaculate Hospital within the Birthing Center parents and

their infants are discharged daily. The question was raised why does it take so long, and will the

patients retain the patient education that they are receiving? I set out with my nurse mentor

which is the Nurse Manager of both Mother Baby and NICU to make a change in the discharge

process to condense the amount of paperwork given to parents; our goal was to worry about

quality not quantity. In addition our goal was to provide clear-cut patient education and not to

bog down parents with frivolous information. In the end we came up with time and money

saving options for our unit; that are now adopted and implemented.

A change needed to be made because discharge teaching and planning was taking entirely

way to long and was being conducted on evening shift were all infant tests are being run and

parents are sleep deprived. My greatest concern that spurred this change was a question are our

parents retaining the information, and do they feel well prepared to leave the hospital with their

infant? In my heart I felt that the answer was no, and so I started a wave of positive change.

Some back ground information, on average new time parents are sleep deprived and

would like a clean bill of health so that they may head home with their infant. Prior to the change

if a mother receives a discharge order in the morning she will not be discharge home until after

lunch because of large amounts of paperwork that needs to be filled out, and the patient

education that needs to be provided. My solution is simple; we would start discharge teaching at

the time of admission, and originate all discharge paper work at the time of admission. If we

know that our patients are healthy and just going through a natural process of life why would be
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prolong their discharge. On average a nurse on postpartum will conduct a teaching session for

about one hour. In my opinion that is way too long, most parents are sleep deprived and are

usually in system over load with all the sights and smells within the hospital. Our goal was to

shorten the sessions to thirty minutes and allow the last thirty minutes for any questions that the

parents may have. In addition to discharge teaching that was shortened we also gave only a

limited amount of paper work to the patients, only the essential documents. Prior to the change

parents were given about nine documents, however we are mandated to provide the required four

documents cutting our paperwork by 56% thus saving unit funds. The essential documents that

are required is the delivery summary, newborn medical record, immunization records, and a list

of important helpful contact numbers that parents may need such as a contact numbers for their

OBGYN, lactation consultants, and the number to their pediatrician. Some issues that we faced is

few mothers felt rushed out the door or they felt their questions were not answered. In those

cases we made sure that all our families receive compassionate care, and also provided a direct

contact number at the birth center should a concerning questions arise at home. Having a direct

contact number to the Birthing Center placed many mothers at ease.

The research that I conducted was to survey our process along the way, I studied the

effects on both the parents and nursing staff. A patient survey of 100 parents was collected as

well as a staff survey with a 100 patients discharged was collected to ensure the quality of the

change and to ensure that the change is beneficial to the patients as well as the staff. In addition

the staffs input was essential and eye opening an allowed me to see that we needed to make

additional changes. With this gained information I learned that some changes needed to be made

and that nursing staff as well as doctors were not happy with the process due to the timing of the

projected discharge teaching. So I set out to conduct an additional survey and PDSA cycle while
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making changes that both benefitted medical staff and patients. Originally the process was set

that all discharge teaching was to occur in the morning. However, morning assessments and

physicians needed to conduct their morning rounds so discharge teaching was changed to when

lunch trays are distributed, this allowed nursing staff to chat with patients and their families

about all discharge instructions and any concerns they may be having prior to leaving the

hospital. With the change to the new discharge process I conducted an additional survey of fifty

mothers during the time frame of March 1-22, 2017 it appeared that the nursing staff as well as

patients had a positive experiences with the new changes.

In closing two cycles needed to be implemented in order to bring about a positive change.

I learned a lot while conducting this study, I learned that even though you may have good

intentions the perception of the staff may be a negative one and that the change needs to benefit

all parties involved. I learned many things along the way; a QI project goal is to improve on a

process and while conducting a PDSA cycle change, we must study and know that an

improvement has been made. To ensure that a PDSA cycle will be productive is to ensure that

the will, ideas, and execution are documented and studied and all variables are taken into

consideration. While conducting my project charter I followed five steps to implement change

that includes:

1. Set an aim

2. Establish measures

3. ID changes

4. Test changes

5. Implement changes (Institute for Healthcare Improvement, 2016)

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I was able to create a positive lasting change on my unit that will save time and unit

funds; additionally parents that receive less stress and more essential information and

documentation will thrive in the community. With the change that we have made in our plans

new families will also be able to have a contact number for the triage nurse within the Birthing

Center should any concerning questions arise, thus improving the discharge process allowing the

unit to be more productive with its resources.

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References

Institute for Healthcare Improvement (2016). QI 102: How to Improve with the Model for

Improvement. Retrieved from

http://app.ihi.org/lms/coursedetailview.aspx?CourseGUID=41b3d74d-f418-4193-86a4-

ac29c9565ff1&CatalogGUID=6cb1c614-884b-43ef-9abd-

d90849f183d4&LessonGUID=00000000-0000-0000-0000-000000000000