Paediatric clinical and social concerns identified by home visit nurses in the immediate postdischarge period

Abstract

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 toreconcile 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. | 1395TUBBS-COOLEY ET aL. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section.

Safety elements and understanding of guidelines at discharge from Neonatal Intensive Care Units

“…In line with the literature (18) , it is observed that medication administration errors are among the main adverse events after hospital discharge. A recent study conducted in the United States with caregivers of pediatric patients after hospital discharge found medication safety as the main concern of the nursing team during home visits, with the main problems being those related to family administration of drugs and medication reconciliation (18) .…”

Nursing consultation with newborns in a capital city of the Legal Amazon: the need for teaching and learning about the theme

“…When considering that professionals working in PHC must be prepared to assist children and contribute to the qualified care, as well as to the protection and promotion of the health of this clientele (Tubbs-Cooley et al, 2020;Silva et al, 2018), this research aimed to identify components that interfere in the practice of NC to the NB in PHC.…”

Is It Time to Revisit Pediatric Postdischarge Home Visits for Readmissions Reduction?

“…1,7 If home visits are not ultimately a solution to pediatric reutilization reduction, they may nonetheless still enable families to effectively manage the concerns that families endorse following discharge, including medication safety and social hardships. 8 In summary, Riddle et al not only provided important context for the unexpected outcome of a well-designed randomized clinical trial but also provided a rich source of qualitative data that furthers our understanding of a child's discharge home from the hospital through the perspective of multiple stakeholders. While the authors offer well-reasoned next steps in narrowing the intervention population of interest and enhancing connections of families with PCP care, it may be time to broadly revisit postdischarge interventions and outcomes to identify new approaches and redefine quality measures for hospital-to-home transitions of children and their families.…”

“…In contrast to the increasing presence of hospital reimbursement penalties among state Medicaid agencies for readmissions, a shift in focus toward outcome measures that are patient‐ and family‐centered is imperative 1,7 . If home visits are not ultimately a solution to pediatric reutilization reduction, they may nonetheless still enable families to effectively manage the concerns that families endorse following discharge, including medication safety and social hardships 8 …”