Intervention Title:
Consolidating Discharge and Prescription Forms for Heart Failure Patients—Del Sol Medical Center; El Paso, Texas

Goal:
Consolidate discharge and prescription documentation for acute myocardial infarction (AMI) and heart failure patients to improve compliance with core discharge measures.

Innovation:
Staff developed a one-page, carbon-copy form to simplify the AMI and heart failure patient discharge process for physicians and nurse practitioners.

Result:
Since implementation, the core measures data for AMI and heart failure patient discharge at Del Sol Medical Center have consistently reached 100 percent.

Institution:
Del Sol Medical Center
10301 Gateway West
El Paso, TX 79925
P: (915) 595-9000

From the C-Suite:
"Despite best intentions, sometimes the reality is that discharge tools and processes are not as user-friendly and efficient as they could be. With the new patient discharge and prescription tool, our team has been able to implement a low-cost and highly effective intervention that helps our staff perform better and reduces the possibility of documentation errors. Now our cardiac patients are receiving the best discharge instructions possible, while our staff enjoy a more productive work environment."

Jennifer Suitonu, M.B.A.-H.C.M., M.S.N., R.N.
Director, Cardiovascular Services

Profile:
Del Sol Medical Center is a 336-bed facility in El Paso, Texas, and is part of the for-profit HCA system.

Clinical areas affected:

• Cardiac care units
• Pharmacy

Staff involved:

• Cardiologists

• Nurses, nurse practitioners and nursing administrators

• Hospital and community pharmacy staff

Timeline:
Six-month development process, including a three-month testing and improvement period

Contact:
Jennifer Suitonu, M.B.A.-H.C.M., M.S.N., R.N.
Director, Cardiovascular Services
Jennifer.Suitonu@hcahealthcare.com
P: (915) 487-5193

Innovation implementation:
The challenge of efficiently discharging patients is something that staff in many hospitals struggle with. Even the seemingly simple step of writing prescriptions during the discharge process provides the possibility of significant pitfalls for patients. At Del Sol Medical Center, the discharge process for AMI and heart failure patients was a barrier to meeting core discharge measures in that prescriptions were written individually and separately from discharge orders and instructions. The result was that staff wasted time duplicating documentation while patients did not always receive the best discharge information or documentation of discharge information and prescriptions were not always complete.

To address this, staff at Del Sol created a consolidated discharge form and prescription tool for AMI and heart failure patients. The new form brought together all of the necessary information onto a single sheet of paper and provided physicians with a perforated, carbon-copy section at the bottom to prescribe medications. This improved efficiency by eliminating duplicate steps and reduced errors of documentation omission for the core discharge measures for AMI and heart failure.

The Del Sol team developed the tool by consulting with everyone who would use or be affected by it, including physicians, nurse practitioners, the hospital pharmacy department and even community pharmacists. The input of the pharmacists was crucial to ensuring that the team used and followed the proper content and format for prescriptions.

The staff tested the new tool and monitored its usage for three months. The data showed that some physicians were having difficulty locating the form in the patients' charts and were therefore not using it with all cardiac patients. By adding a chart tab to the form so that it could be easily located, the compliance rates soon reached 100 percent.

Advice and lessons learned:

1. Involve everyone. To ensure that the improvement efforts addressed the needs of everyone affected, the Del Sol team solicited input from everyone, including hospital staff and any relevant individuals outside of the system.
2. Test and revise innovations. After creating the first form that seemingly addressed all of the staff's needs, the Del Sol team still noticed physicians did not use it with all cardiac patients. By assessing the problem and revising the form accordingly, the tool quickly reached 100 percent usage.

Cost/benefit estimate:
The development and implementation costs for the Cardiovascular Discharge Orders/Prescription Tool were low and required few additional staff resources beyond the planning and testing process. The significant pay-off is Del Sol meeting AMI and heart failure patient discharge core measures 100 percent of the time.

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