A Strategic Plan for Improving the Discharge Process on the Acute Rehab Unit



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A Strategic Plan for Improving the Discharge Process on the Acute Rehab Unit
















A Strategic Plan for Improving the Discharge Process on the Acute Rehab Unit

The discharge process remains a significant hurdle for most healthcare organizations who want to improve patient satisfaction scores and reduce readmissions. One of the issues is mostly in part because patients do not understand the medication regimen ordered at the time of discharge. Currently at Mercy Fairfield Acute Rehab Unit (MFARU), the discharge process consists of the registered nurse (RN)printing the after-visit summary, reviewing the written information with the patient, providing prescriptions for any new medications from the current stay, answering any questions, and calling for transport to get the patient to the lobby for discharge.

According to Stricker (2018), two of the most common reasons for readmissions are misunderstanding and miscommunication regarding medications. The discharge process at MFARU does not take into count that most of the patients have been in the hospital for several weeks and may have missed routine appointments with primary care physicians to receive prescriptions of home medications; possibly leaving the patient with minimal amounts of the medicines.“Hospital admissions and discharges are complex events, characterized by multiple handoffs among health care providers and numerous changes to the patient’s therapeutic plan” (Poon, 2017, para. 2). Having a well-thought-out discharge process personalized to the individual patient population on the MFARU may bring about an increase in patient satisfaction. Reported patient satisfaction surveys for the MFARU have shown poor scores when it comes to discharging. The unit has also noted a rise in patient calls requesting prescriptions for required home medications that were not provided upon discharge.A new discharge process protocol for the MFARU is needed. Comment by Short, Jeannie: Problem statement Comment by Short, Jeannie: Problem statement


Background Discussion

“Dhruv Khullar, M.D., a resident physician at Massachusetts General Hospital and Harvard Medical School recommends incorporating the attention to detail in the admissions process into the discharge process” (Cambridge Management Group, 2016, para. 3).The problem with the current discharge process used on MFARU is directly related to the medication reconciliation process upon admission and during the patients stay. “Medication reconciliation is the process of comparing a patient’s new medication orders with all the medications the patient had been taking prior to changing levels of care” (Hennen & Jorgenson, 2014, p. 72).Most of the admissions to the MFARU are patients coming from within the hospital. The patient is discharged from the medical unit then readmitted to the acute rehab unit. The difference from an internal transfer and readmission is that Epic will recognize medications in the system that the patient discharged on, as now being the home medications for the patient. “The nurse can help prevent rehospitalization by assessing the patient at discharge and reviewing the plan of care, including medication reconciliation, to ensure the patient understands medications he or she will be taking and the plan for furtherfollow-up and home care” (Fredricks, 2018, p. 330). It is the responsibility of the admitting nurse to differentiate between medicines that are new to the patient from the current hospitalization and the medications the patient was taking at home. The process will consist of an accurate medication reconciliation that involves the patient, family, pharmacy, and other health care providers.“Measurement and understanding of the patient, caregiver, and family experience of healthcare provides the opportunity for the reflection and improvement of nursing care and patient outcomes” (Berkowitz, 2016, p. 1). Comment by Short, Jeannie: Problem addressed

In the end, the key purpose of discharge medication reconciliation is to avoid readmissions and unintentional medication errors created by hospitalization.In the long run, some form of discharge reconciliation needs to be present. The biggestchallengefaced by discharge reconciliation is incorporating it into the over-all discharge process, which already includes multiple actions on the part of all the health care professionals involved.


The stakeholders from within the MFARU that will be directly impacted through this strategic plan are as follows:Mercy Hospital, the medical director, clinical coordinators, registered nurses, patients, patient’s familyor caregiver, and the unit-based educator. The unit-based educator’s knowledge and experience will serve as an essential resource to the project leader in providing support and guidance on the creation of the new discharge process protocol.

Outcome Statement and Evaluation Plan

A strategic plan can be implemented to achieve the following result: To improve the patient satisfaction scores related to discharge on the MFARU from three stars to five stars, after implementation of a new discharge process protocol, by April 30, 2019. This plan will involve a 5-star discharge paper that provides detailed information regarding the patients’ updated medication regimen. The sheet will be provided in the patients’ room upon admission and reviewed with the patient with each medication change and then at the weekly care conferences. Upon discharge, the paper will have a final review between the patient and nurse, ensuring that the patient has the needed prescriptions for ordered medications, then signed by both, stating understanding of the information provided on the sheet. Comment by Short, Jeannie: SMART goal or outcome statement clearly stated

The evaluation process involves the comparison and analysis of the past years’ patient survey scores related to discharge before the new 5-star discharge paper is implemented and data obtained duringsix weeks after the process is initiated.The charge nurse will monitor and ensure the new procedure is followed by staff involved. After the analysis of the data, it will be determined whether the 5-star discharge paper increased patient satisfaction scores related to discharge from the current three stars to the desired five stars. Comment by Short, Jeannie: This clearly states how the outcome statement will be measured


The initiation of a new discharge process will benefit the hospital, MFARU,and the patients served. “As reimbursement and performance policies have become more normative within healthcare, the patient experience has become a metric to measure payment systems for quality” (Berkowitz, 2016, p. 1). Patients have more choices when it comes to where they receive their care so the better the patient satisfaction scores,the more likely this will be the provider of choice for patients.








Berkowitz, B. (2016). The patient experience and patient satisfaction:Measurement of a complex dynamic. OJIN: The Online Journal of Issues in Nursing 21(1, Manuscript 1).https://doi.org/10.3490/articleJet21089676767

Cambridge Management Group. (2016). More strategies to reduce readmissions. http://cmg625.com/strategies-reduce-readmissions/

Fredericks, T. (2018). Medication reconciliation. MEDSURG Nursing 27(5),329-330.

Hennen, C., & Jorgenson, J. (2014). Importance of medication reconciliation in the continuum of care. The American Journal of Pharmacy Benefits,6(2), 71-75. https://www.ajpb.com/journals/ajpb/2014/ajpb_marapr2014/importance-of-medication-reconciliation-in-the-continuum-of-care

Stricker, P.(2018). Best practice strategies to reduce hospital readmission rates.https://www.tcshealthcare.com/clinical-corner/best-practice-strategies-and-interventions-to-reduce-hospital-readmission-rates/