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"This was a good transition": Piloting a standardised, comprehensive discharge documentation and medication package
Kate Gorell1, Clare Stephenson1, Ash Smyth2
1Acute Care of the Elderly, Canberra Health Services, Yamba Drive, Garran, 2605, Australia; Centre for Ageing Research and Translation, University of Canberra, Canberra, Australia.
Introduction:
In Australia, nearly 400,000 people live in residential aged care, of those, 40% experience a hospital admission annually. High-quality care transitions are crucial for ensuring safe and effective continuity of care. Ineffective information sharing increases risks of harm for already vulnerable consumers, contributing to adverse health outcomes, creating care delays and causing distress to individuals moving between care settings.
Aim:
This study aimed to co-design, pilot and evaluate the implementation of a comprehensive discharge documentation and medication package aligned with the electronic medical record to support quality care transitions between hospital and residential aged care.
Methods:
Mixed-methods, participatory action approach, incorporating workshops, surveys, and interviews. Ten RNs from four residential aged care sites participated, and ten hospital-to-residential aged care transitions were evaluated.
Results:
80% (n = 8) stated the discharge package met the standard for providing comprehensive care, and 100% (n = 10) identified improved medication safety. Three themes were identified from the interviews: 1) Enhancing system improvements supports more effective care transitions; 2) Effective cross-sector information sharing depends on well-defined and replicable processes; 3) Historical standards drive lower expectations.
Conclusion:
This participatory action research co-designed an effective discharge package for hospital-to-residential aged care. Developed by a nurse-led multidisciplinary team, this work established a strategy that supports patient safety, quality information sharing, and is aligned with hospital and residential aged care standards. Based on the difficulties of effective communication, the use of the documentation package demonstrates an effective tool to support information sharing processes between hospital and residential aged care.
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01:31Discharge Summary Forms
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01:29Documentation in Long-Term and Home Healthcare Setting
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01:20Introduction to Documentation and Reporting
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01:26Guidelines for Nursing Documentation II
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