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Discharge instructions and medication directions can be overwhelming for older adults, which can lead to potential medication errors, noncompliance, readmissions, and patient safety concerns. At a specialty lung clinic, the goal is to improve patient safety and to decrease the chance of errors by standardizing the discharge process via a Teach-Back education policy and protocol. Without consistency, there is a potential for mistakes and misunderstandings. The Agency for Healthcare Research and Quality (AHRQ) and the Institute for Healthcare Improvement (IHI) considers the Teach-Back discharge method as best practice and should be considered universal practice among health care workers. Using the Always Use Teach-Back Toolkit for education and evaluation provided strategies and resources for the project. Five nurse practitioners and a physician assistant, who are responsible for discharge instructions, participated in the study by viewing an online teaching module and completing written surveys. The Conviction and Confidence Tool revealed 100% of the clinicians agreed that Teach-Back education was '10-Very Important' and were '10-Very Confident' in their abilities to apply the Teach-Back methods using a 1-10 Likert scale. Likewise, the practitioners showed significant improvements when comparing the pre-implementation and one-month, post-policy implementation, as indicated in the paired t test of the second part of the Conviction and Confidence Teach-Back Tool. Nursing plays a pivotal role in positive social change by using an evidence-based education method, which improves patient care through medication compliance and decreased readmission rates, thus showing significant transformation in chronic health management.

This purpose of this quality improvement project was to develop an educational training curriculum designed for staff nurses to use the teach-back method with patients with low health literacy during discharge instructions. Health literacy is associated with the ability to read, comprehend, and make appropriate healthcare decisions; the teach-back method asks patients to restate or explain health information in their own words, aiding retention and literacy. Effective staff education plays a critical role in the education of patients during discharge teaching: Nurses must help to ensure that patients and their families understand healthcare information and apply this information in their daily lives. The program was planned in an ambulatory care setting and used conceptual frameworks including the Iowa model and the Plan-Do-Study-Act cycle for quality improvement. The program was informed by evidence in the peer-reviewed literature. The curriculum was contextualized by needs of the care setting. The evidence was organized and analyzed using a review matrix to identify common findings among major studies that were applicable to the context. As an aid to operationalization of the program, an implementation plan and an evaluation plan were developed for use by the institution to move the program forward without additional planning. This project may effect positive social change by addressing a health care need that exists throughout the population and is prevalent in those of lower socioeconomic status. Increasing health literacy among patients is likely to promote improved health outcomes among those who are most vulnerable to illness.

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Background: Diabetes mellitus (DM) affects more than 29.1 million Americans. Standardized clinical practice guidelines recommended by regulatory healthcare agencies are the standard of care for diabetic patients and must be adhered to by healthcare professionals providing care. Purpose: The purpose of this quality improvement project was to identify Centers for Medicare and Medicaid Services’, Joint Commission on Accreditation of Healthcare Organization’s, and other professional healthcare organizations’ guidelines for nurses’ knowledge of evidence-based discharge practices; determine level of nurses’ knowledge on evidence-based discharge practice process; develop a quality improvement plan, including development of an evidence-based guideline for diabetic discharge instructions; present guideline to stakeholders; implement the guideline in fall of 2017; and evaluate nursing compliance with the guideline at a for-profit adult care hospital in South Florida. Theoretical Framework: The chronic care model was utilized as the framework. This model has been used for improving practice and preventing many chronic illnesses. Methods: Two quantitative nonparametric descriptive designs were used, the Wilcoxon signed- rank test and a paired t test. An online demographic survey and pre- and posttest surveys were administered to determine nurses’ knowledge of diabetes discharge guideline practices. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool evaluated the guideline, and data were analyzed with Wilcoxon and paired t tests. Results: A statistically significant difference was found in the pre-posttest survey responses for question 5 (p=0.046 Wilcoxon; p=0.041t test), and question 13 (p= 0.022 Wilcoxon; p=0.018 t test), indicating improvement. With the AGREE II tool, the multidisciplinary team evaluated the guideline at 100%, and 76% of Advanced Practice Registered Nurses (APRNs) and Registered Nurses (RNs) demonstrated compliance with guideline use. Conclusion: A standardized diabetic discharge guideline incorporated into the hospital’s discharge process provided APRNs and RNs with tools for educating and providing diabetic patients for increase in quality of life after discharge. The guideline was recommended by the administrative team for continued use throughout the hospital. Implementation of an evidence-based standardized diabetic discharge guideline to promote nurses’ adherence results in effective nursing practices and an informed patient population.

Heart failure is a complex heart disease that incapacitates more than 5 million people, is associated with increasing healthcare cost, and remains the leading cause of admission in the United States. As the United States faces increasing financial burden related to readmission of heart failure patients within 30 days of discharge, many healthcare institutions are evaluating interventions to determine the most effective opportunities to improve systems, including nursing practice. The purpose of this doctoral project was to improve readmission rates within 30 days of discharge from an acute care facility through the development and implementation of a standardized, evidence-based, patient-centered discharge education toolkit using the Teach-Back method. Orem's self-care theory and the situation-specific theory of heart failure self-care were utilized as a theoretical framework to inform this doctoral project. The sources of evidence were obtained from the Get With The Guidelines-Heart Failure database and through a review of nursing and health-related databases. Descriptive statistics were used to compare the pre- and posteducation session readmission rates. The rate of readmissions occurring within thirty days of discharge pre- and post-educational session retrieved from the GWTG-Heart Failure database were 9.4% and 0.0% respectively. These results showed that this discharge toolkit reduced heart failure 30-days readmission rates. The limitations and strengths of this project will be used to guide further research on heart failure readmission and self-care management. This DNP project will promote positive social change for clinicians, who can use this discharge toolkit to improve self-management in adults with heart failure and thus decrease the costs related to readmission.

The purpose of patient education is to provide patients and their families with the tools needed to care for themselves after discharge from the hospital, but shortened hospital stays, limited health literacy, language, and age can impede the patient's comprehension of the information provided. Researchers have found that the lack of effective patient education is related to 30-day hospital readmissions. The Power of 3 educational tool, designed by Sanchez and Cooknell, addressed the factors that impeded effective patient teaching by using the adult learning theory and low health literacy concepts. The Power of 3 was implemented as a quality improvement project in the Total Joint Center in October 2014. The purpose of this project was to assess the effect of an adult learning-based educational tool on the readmission rates for venous thrombus embolism and infection and on the effect on mobility in total joint surgery patients. This goal was accomplished by performing a retrospective chart review on 90 randomized patients, 45 before and 45 after implementation. The Power of 3 demonstrated a statistically significant change in the length of time a patient remained out of bed on the day of surgery after implementing the educational tool (0.75 hours vs. 1.514 hours, p = 0.0182, CI 95%). In addition, the number of patients that nursing staff documented who were out of bed was also statistically significant on the day of surgery (12 patients vs. 24, p = 0.0461, CI 95%). This educational tool can facilitate patient teaching by addressing language and educational barriers between patients and health care workers.

The targeted transplant center's abdominal organ transplant unit had difficulty providing adequate education to patients prior to discharge, which had resulted in a 24% readmission rate within 30 days due to infections. Patients and caregivers were unavailable to receive education despite multiple attempts, which made it challenging for health care providers to complete this aspect of their job, resulting in a negative impact on patients' long-term outcomes. A more structured educational environment was needed to provide appropriate and effective patient and caregiver education to increase adherence and positive outcomes. The health promotion model served as a foundation for the development of the evidence-based educational process and materials. A panel of 6 experts was invited to review the evidence-based, theory-supported educational materials along with the staff and caregiver educational process developed for the unit. Five experts participated in the formative and summative evaluation of the educational process, materials, and the evaluation tool. Results of the evaluations demonstrated that a majority (83%) of the experts found the educational materials and process were essential, accurate, and provided a more structured environment that afforded health care providers the ability to maintain compliance with the targeted transplant center's education policy. The materials, process, and evaluation tool will be implemented at the site. Social change will result from increased patient engagement and confidence in self-care; improved caregiver ability to assist the patient; and reduced risk of noncompliance, readmissions, and poor outcomes.