Improving the Pathway to

Discharge

Jane Moeller, MSN, RNC-MNN

Christina Crook, BSN, RN-BC

Objectives

• Identify optimal times for education

on Mother Baby unit.

• Identify three elements of discharge

process.

• Discuss implications of project

results to other patient areas.

Purpose

To improve the

efficiency and

effectiveness of the

discharge process on a

Mother Baby unit

Death by Power Point

Elements of Discharge

Maternal care info Shaken baby prevention

Infant care info Bottle-feeding info

Breastfeeding info Vaccinations

Infant CPR Birth certificate

Safe sleep video Signing of paperwork

Staff Survey Results

Staff Survey Results

Literature Review

➢ Teach when patient is more relaxed to increase retention

➢ Educate throughout patient stay

➢ Consider patient’s perceived discharge readiness

➢ Gen Y and Gen Z respond to technology-based learning

Education Accessed via IPads

Visual Tool

Staff

Education

Does the Discharge ProcessStress You Out????

Staff

Education

Tasks will be completed at timed

increments,

versus all at once

before they go home.

How about a Pathway

to Discharge to help

get these things done

throughout their stay?

Labor and

DeliveryArrival to 2nd Maria

0-12 Hours

12-24 Hours

24-36 Hours and

Final Discharge Teaching

Staff

Education

What needs to be done to get a Patient home?

Baby: � Circumcision� 24 hour testing and PKU

Videos: � Room to Breathe� CPR� Shaken Baby

Paperwork:� Birth Certificate� Tdap Consent� Shaken Baby � Safe Sleep Waiver

Teaching:• Mom• Baby

Final Discharge:• MD Order • Discharge Instructions• Prescriptions

Staff

Education

Speed Bumps/Road Blocks

that have been removed…

VACCINES:

Per Dr. Oakman:

Tdap Vaccines can now be

given when they are available -

No need to wait until discharge.

Staff

Education

Speed Bumps/Road Blocks (cont’d)

Mom and Baby Teaching Videos

will now be available on the

iPads.

• Parents can watch at their own

convenience

• Saves time for the Nurse

Pregnancy Icon

Staff

Education

Questions?

This is an ongoing process.

We welcome any feedback,

suggestions or questions.

Jane Moeller and Christina Crook

Today is

The Day!

Results: Discharge Timing

Di

Results: HCAHPS

Results: Post-Survey of Staff

Results: Post-Survey of Staff

Percent of Tasks Completed Prior to Day of Discharge

PDSA Process

Revised Pathway

Pat hw ay

t o

D isc har geEducational Videos

Introductory Videos

Caring for YourselfCaring for Your Baby

ImmunizationsTdap

Rhogam

Flu

MMR

Signed Paperwork

Shaken Baby

Birth Certificate

Safe Sleep

Tdap Consent

Shaken Baby

Room to Breathe

CPR

Conclusion & Implications

• Improved learning opportunities

• More efficient discharge process

• Decreased length of stay = cost

savings

• Buy-in essential for change

• Potential benefit for other patient

demographics

References

Ciaramella, J., Longworth, N., Larraz, L., & Murphy, S. (2014). Improving Efficiency,

Consistency and Satisfaction on a Mother-Baby Unit with the Discharge Nurse

Position. Nursing for Women's Health, 18(4), P. 333-339.

Logsdon, M. C., Davis, D., Eckert, D., Smith, F., Stikes, R., Rushton, J., … Sparks, K.

(2015). Feasibility of two educational methods for teaching new mothers: A pilot

study. Interactive Journal of Medical Research, 4(4), e20. doi: 10.2196/ijmr.4583.

Malagon-Maldonado, G., Connelly, C., & Bush, R. (2017). Predictors of readiness for

hospital Discharge after birth: Building evidence for practice. Worldviews on

Evidence-Based Nursing, 14(2), p. 118-127.

Shatto, B. & Erwin, K. (2017). Teaching millennials and Generation Z: Bridging the

generational divide. Creative Nursing, 23(1), 24-28. doi:10.1891/1078-

4535.23.1.24.

Suplee, P., Kelppel, L., & Bingham, D. (2015). Discharge education on maternal morbidity

and mortality provided by nurses to women in the postpartum period. Journal of

Obstetric, Gynecologic & Neonatal Nursing, 45(6), p. 894-904.