Opioid Administration Post-operatively: Reviewing the Process and Identifying Standards and Expectations for Safe, Effective Care

Abstract

As healthcare faces demands to decrease length of stay and increase patient satisfaction, hospital staff seeks to streamline the discharge process. Evidence suggests an interdisciplinary discharge process results in increased nurse satisfaction, reduced incidence of medical errors and hospital acquired infections. The purpose of the Vascular Surgery and Transplant Unit (VSTU) Discharge by Eleven Project is to identify barriers to discharge and increase efficiency throughout the discharge process. A patient database was developed to detect variables affecting early discharge. An improvement plan was implemented focusing on timeliness of writing discharge orders by surgical residents and early recognition of potential discharge by nursing, medical and casemanagement staff. Subsequently, the ‘VSTUResidentSurvival Guide’was createdhighlighting the expectationsof nurses rounding daily with attending physicians and residents to identify discharges for the next day. Methods of communication included the team leaders, who served as discharge champions, and utilization of the assignment board as a visual cue.Nurseswere instructed to communicate that discharge occurs before eleven to every admission. Discharge times and customer satisfaction scores were posted weekly. The five month study showed an increase in the satisfaction with speed of the discharge process (75 to 89.3) and overall satisfaction with the process (83.6 to 89.3) based on Press Ganey raw scores. The percent of discharges by eleven increased from 11% to 15% and late discharges decreased from 50% to 37%. These findings suggest that by targeting unit specific variables early discharges can be increased.