Implementing PODS (Patient Oriented Discharge Summary) in an acute medical urban health setting in Vancouver, Canada

The transition from hospital to home or community is a vulnerable time for patients and families, who face risks associated with misunderstanding instructions about medications, self-monitoring and when to seek emergency care. The quality of the discharge process can have a significant impact on patient confidence, overall patient experience, ability to manage health at home, and hospital readmission rates. Patient Oriented Discharge Summary (PODS) is a standardized form and set of process changes, utilized to overcome communication barriers faced at discharge. We implemented PODS in two Acute Medicine units of a tertiary care hospital in western Canada and used a mixed-methods approach to evaluate the four process changes (PODS form, use of teach-back, engagement of caregivers in discharge teaching, follow-up phone calls). Evaluation showed that 60% of patients received PODS and 87% found the form helpful. There was a large increase in the percentage of patients who felt adequately prepared at the time of discharge, and a 10% increase in the number of patients who rated their overall hospital experience positively. Healthcare providers reported that using PODS they were more confident that patients were adequately prepared to return home. The update of PODS on the implementation units has been sustained at 60% for 18 months. Implementation of the PODS form and process can be accomplished with an interdisciplinary team, leadership support and by working closely with Patient Family Partners. PODS can improve the discharge process even in the complex urban acute medical environment in ways that offer wide-reaching benefits. Experience Framework This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Cardiovascular risk-related knowledge, practices, and risk factor control in individuals with stroke : implications for primary and secondary prevention

Background: Recurrent strokes, which may comprise up to a fifth of all stroke, are more severe than first events. Optimal secondary stroke prevention may require changes to health-related behaviours and improved vascular risk factor control. While patients’ knowledge regarding stroke, health-related behaviours, and cardiovascular risk may improve with secondary prevention strategies, there is little information available to guide programs for patient and family education for stroke prevention. Purpose: First, to assess the knowledge of individuals with a recent stroke about stroke symptoms, risk factors, and prevention. Second, to explore the association between stroke knowledge and health behaviours and cardiovascular risk factor control. Last, to explore perceived barriers and facilitators for participation in secondary prevention programs for stroke survivors and their caregivers, and to examine the effectiveness of nursing interventions on modification of stroke risk factors among stroke survivors. Methods: A prospective cross-sectional study was conducted to assess the knowledge of individuals with recent stroke and its relation to health-related behaviours and cardiovascular disease risk. Then, a longitudinal qualitative study was conducted using individual interviews with stroke survivors and their caregivers to understand changes in their perceptions regarding secondary stroke prevention in the stroke recovery period. Lastly, a meta-analysis of randomized controlled trials was conducted investigating the role of nurses in secondary stroke prevention. Results: The cross-sectional study revealed that stroke patients lacked knowledge about stroke, and those who had better stroke knowledge had better health-related behaviours. Those who were physically active prior to their stroke had better cardiovascular risk factor control. In the qualitative study, stroke was perceived as a soul-searching experience by stroke survivors and their caregivers, motivating them to consider its causes. Despite experiencing some barriers, stroke survivors made lifestyle adjustments, transitioning through different stages of change. The meta-analysis found that nursing interventions were associated with improvements in blood pressure control, diet, physical activity, medication adherence, and knowledge of stroke risk factors. Conclusions: The findings demonstrate the importance of strengthening current programs for secondary stroke prevention. Further, the findings suggest that developing patient- and family-centered programs may improve the knowledge and health-related behaviours to optimize secondary stroke prevention.Medicine, Faculty ofGraduat