Browsing Doctor of Nursing Practice (DNP) Projects by Subject "Aftercare"
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Early Hearing Detection: Using Pre-Discharge Education and Standardized Referrals to Reduce Lost-To-Follow-Up RatesBackground: There are lags in ensuring that infants who do not pass their hospital newborn hearing screens receive the follow-up testing they need by the recommended three-month benchmark. The purpose of this project is to address disparities in infants lost to follow-up (LTF) by implementing a program for pre-discharge education and referral plan to free follow-up care at a suburban hospital in a mid-Atlantic state. Intervention: A partnership between the state department of health and a local university audiology program provided education and free follow-up testing of infants who did not pass the newborn hearing screen. Audiology technicians provided a screening result card to families, which also included hearing developmental milestones. Families received brief verbal education about the test result and the urgent need for a retest for those who did not pass. Infants requiring follow-up received appointments with the partner audiology clinic for a free evaluation. Results: 216 infants were born at the site and 214 babies received the in-hospital hearing screens. All 214 babies passed the in-hospital screens and did not require referral. An additional three babies were referred to the university clinic from other sites. Conclusion: This project did not yield opportunities for evaluation of LTF due to low birth volume during the short data collection period. However, this project indicated future potential for positive change. Families responded well to the cards and engaged with the education. This partnership provided opportunities for follow-up of at-risk infants in the region and is likely a model worth continuing and expanding.
Effects of a Post-Discharge Telephone Follow-up Call on Psychiatric Readmission RatesProblem & Purpose: Preventing early psychiatric readmissions presents a significant challenge to inpatient psychiatric units. Thirty-day readmission rates continue to rise using a significant amount of resources and increasing hospital costs. An inpatient psychiatric unit specializing in treating severe mental illness has a high readmission rate (20%). A quality improvement (QI) project was designed to reduce inpatient psychiatric readmission rates. The purpose of this QI project was to implement a nurse-led follow-up phone call within 72 hours post-discharge to identify issues related to patient understanding and ability to adhere to discharge plans. Identification of barriers encountered in the follow-up plan and early resolutions was posited to reduce thirty-day readmission rates. Methods: Psychiatric nurses in a 24-bed adult high acuity unit were educated to conduct post-discharge phone calls using a detailed script tailored to the organization. A corresponding documentation tool evaluating data collected on medication reconciliation, confirmed follow- up appointment, the patient’s medication regime, and the patient's understanding of discharge instructions was assessed and an intervention during the call was provided as needed. Night shift RNs audited the documentation tool. The phone call was to be completed on each patient discharging over a twelve-week period. Phone call and audit completions were tracked weekly and thirty-day readmission rates were tracked monthly. Results: Findings suggest the use of a post-discharge phone call was a successful intervention that can be adopted on psychiatric units. Phone call and audit completions reached the goal of 100%. This indicates nurses were able to accommodate the extra tasks without disrupting the milieu. Thirty-day readmission rates decreased 2% compared to the same time in the year prior. Conclusions: Post-discharge phone calls is a cost effective intervention that has shown to be a successful in reducing thirty-day readmission rates in this psychiatric settings. Future QI projects should consider this intervention in different psychiatric specialties.