Aim: To describe paediatric postdischarge concerns manifesting in the first 96 hr after hospital discharge.
Design: Analysis of nursing documentation generated as part of a randomized controlled trial evaluating the effect of a nurse home visit on healthcare re-use.
Methods: We analysed home visit records of 651 children (age <18) hospitalized at a large Midwestern children's hospital in 2015 and 2016 who were enrolled in the trial. Registered nurses documented concerns in structured fields and free-text notes in visit records. Descriptive statistics were used to summarize visit documentation. Free-text visit notes were reviewed and exemplars illustrative of quantitative findings were selected.
Results: Overall, nurses documented at least one concern in 56% (N = 367) of visits. Most commonly, they documented concerns about medication safety (15% or 91 visits). Specifically, in 11% (N = 58) of visits nurses were concerned that caregivers lacked a full understanding of medications and in 8% (N = 49) of visits families did not have prescribed discharge medications. Pain was documented as present in 9% of all visits (N = 56). Nurses completed referrals to other providers/services in 12% of visits (N = 78), most frequently to primary care providers. In 13% of visits (N = 85) nurses documented concerns considered beyond the immediate scope of the visit related to social needs such as housing and transportation.
Conclusion: Inpatient and community nurses and physicians should be prepared to reconcile and manage discharge medications, assess families' medication administration practices and anticipate social needs after paediatric discharge.
Impact: Little empirical data are available describing concerns manifesting immediately after paediatric hospital discharge. Concerns about medication safety were most frequent followed by concerns related to housing and general safety. The results are important for clinicians preparing children and families for discharge and for community clinicians caring for discharged children.
目的: 描述出院后96小时内出现的儿科出院后问题。 设计: 分析作为随机对照试验的一部分生成的护理文档,评估护士家访对再利用医疗护理的影响。 方法: 我们对2015年和2016年在中西部某大型儿童医院住院的651名儿童(十八岁以下)的家庭探访记录进行分析。注册护士在结构化字段中记录问题,并在探访记录中提供自由文本笔记。采用描述性统计方法对探访记录进行总结。对自由文本探访笔记进行评估,并挑选了说明定量研究结果的样本。 结果: 总体来看,在56%的探访中(N=367),护士记录了至少一个问题。最常见的情况是,他们记录了对药物安全性的担忧(15%或91次探访)。具体来说,在11%的探访中(N=58),护士担忧照护人员缺乏对药物的全面了解,在8%的探访中(N=49),未对访问家庭开出院用药。在所有探访中,9%(N=56)记录有疼痛情况。护士在12%的探访中完成了转诊给其他医疗服务提供者/医疗服务机构(N=78),其中最常见的是转诊给初级医疗服务提供者。在13%的探访(N=85)中,护士记录了在探访即时范围之外考虑的与住房和交通等社会需求有关的问题。 结论: 住院部及社区护士、医师应做好出院药物的协调和管理工作,评估家庭用药行为,并预测从儿科部出院后的社会需求。 影响: 很少有经验数据可用于描述儿科医院出院后立即出现的问题。药物安全性相关担忧问题最多,其次是对住房和一般安全性的担忧问题。本项研究结果对临床医生使儿童和家庭做好出院准备以及社区医生照顾出院儿童具有重要意义。.
Keywords: discharge planning; home visit; hospital discharge; medication safety; nurses; nursing; paediatrics; postdischarge; transitions.
© 2020 John Wiley & Sons Ltd.