miércoles, 22 de marzo de 2017

Taking Care of Myself: A Guide for When I Leave the Hospital | Agency for Healthcare Research & Quality

Taking Care of Myself: A Guide for When I Leave the Hospital | Agency for Healthcare Research & Quality

AHRQ News Now

New AHRQ Grantee Profile Highlights Work of Boston University’s Brian Jack, M.D., To Help Prevent Avoidable Hospital Readmissions

Jack
A new grantee profile explores how the AHRQ-funded work of Brian Jack, M.D., a professor of family medicine at Boston University School of Medicine, lowered rates of return trips to the hospital. He developed the Re-Engineered Discharge, or RED, protocol, which uses strategies to promote safer patient care and reduce avoidable hospital readmissions. AHRQ also worked with Dr. Jack to develop an implementation-ready toolkit and guide for patients (in English and Spanish) to extend his work so that health providers can apply RED and address language barriers in health care communications. Check out the profile of Dr. Jack and other AHRQ grantees who have made major advances in health services research.

publication cover of Taking Care of Myself: A Guide for When I Leave the Hospital






Taking Care of Myself: A Guide for When I Leave the Hospital

Contents

Using the Guide

Taking Care of Myself: A Guide for When I Leave the Hospital is a guide that providers can use to give patients the information they need to help them care for themselves when they leave the hospital.

How to use the fill-able PDF file:

Note: Some Web browsers may not allow you to fill in the blanks in this PDF file. To add your personal information to the guide, you may have to save the file to your computer and open it in Adobe® Acrobat® or Acrobat Reader®.
To save your additions, you have to use Adobe® Acrobat®. Follow these steps:
  1. Download the PDF file and save it to your computer.
  2. Open the file using Adobe Acrobat and type your information in the spaces provided.
  3. Save the completed file to your computer.
  4. Print the file, if desired.
You can view and add information to the file using Acrobat Reader®, but you will not be able to save your additions. Follow these steps:
  1. Download the PDF file and save it to your computer.
  2. Open the file using Adobe Reader and type your information in the spaces provided.
  3. Print the file.
    Note: You will not be able to save any changes made to the PDF file.

Hospital staff use:

  • Download the PDF Version to your computer and complete all of the information in the guide (except patient question sections).
  • Talk with patients about the information in the guide.
  • Confirm that patients understand instructions by asking patients to describe, in their own words, what they will do when they leave the hospital (e.g., when and how they will take their medicine, when they will go to their doctor's office).
  • Give the patient a copy of the completed guide to take home and instruct them to take it to future medical appointments.

Patient use:

  • Become familiar with the information covered in the guide before you enter the hospital.
  • Make sure that the information about you in the guide is correct (e.g. medication allergies, contact information, primary care provider information).
  • Study the guide with your clinicians to make sure you or your family members understand everything that is in it and how to care for yourself when you get home.
  • Take the guide to your future medical appointments.

How to Order A Copy of This Guide

To get a free copy of this guide, send an E-mail to the AHRQ Publications Clearinghouse at AHRQPubs@ahrq.hhs.gov or call 1-800-358-9295 and ask for AHRQ Publication No. 10-0059. For other consumer and patient materials, go to the AHRQ Web site at: http://www.ahrq.gov/patients-consumers/.

Taking Care of Myself: A Guide for When I Leave the Hospital

To use this guide you should:
  • Talk with the hospital staff about each of the items that are listed in the guide.
  • Take the completed guide home with you. It will help you to take care of yourself when you go home.
  • Share the guide with your family members and others who want to help you. The guide will help them know how to help take care of you.
  • Bring the guide to all of your doctor appointments so the doctor knows what you have been doing to care for yourself since you left the hospital.
When you leave the hospital, there are a lot of things you need to do to take care of yourself. You need to see your doctor, take your medicines, exercise, eat healthy foods, and know whom to call with questions or problems. This guide helps you keep track of all the things you need to do.
My name: _______________________________________________
When I'm leaving the hospital _______________________________
If I have questions or problems, I should call:
________________________________________________________
Phone number: __________________________________________
If I have a serious health problem, I should call:
________________________________________________________
Phone number: ___________________________________________
Bring this plan to all your medical appointments.
What is my medical problem?
______________________________________________________________________________
______________________________________________________________________________
What are my medication allergies?
______________________________________________________________________________
______________________________________________________________________________
Where is my pharmacy?
______________________________________________________________________________
______________________________________________________________________________
What exercises are good for me?
______________________________________________________________________________
______________________________________________________________________________
What should I eat?
______________________________________________________________________________
______________________________________________________________________________
What activities or foods should I avoid?
______________________________________________________________________________
______________________________________________________________________________

What medicines do I need to take?

Each day, follow this schedule:

Morning Medicines

Medicines name (generic and name brand and amount)Why am I taking this medicine?How much
do I take?
How do I take this medicine?
    
    
    
    
    
    
    
    

Afternoon Medicines

Medicines name (generic and name brand and amount)Why am I taking this medicine?How much do I take?How do I take this medicine?
    
    
    
    
    
    
    
    

Evening Medicines

Medicines name (generic and name brand and amount)Why am I taking this medicine?How much do I take?How do I take this medicine?
    
    
    
    
    
    
    
    

Bedtime Medicines

Medicines name (generic and name brand and amount)Why am I taking this medicine?How much do I take?How do I take this medicine?
    
    
    
    
    
    
    
    

What other medicines can I take?

 Medication name
and amount
How much
do I take?
How do I take this medicine?
If I need medicine for a headache   
If I need medicine to stop smoking   
If I need medicine for
______________
   
If I need medicine for
_____________
   
If I need medicine for
_____________
   
If I need medicine for
_____________
   
If I need medicine for
_____________
   
If I need medicine for
_____________
   

When are my next appointments?

Day ____________Date ____________
Time _____________________
Doctor's name ______________Specialty ____________________
Address _____________________________________________________________
____________________________________________________________________
Reason for appointment ___________________________________________________
Doctor's phone number ____________________________________________

Questions for my appointment

Check any of the boxes below and write notes to remember what to discuss with your doctor.
I have questions about:
___ My medicines ________________________________________________
___ My test results ________________________________________________
___ My pain _____________________________________________________
___ Feeling stressed _____________________________________________
Other questions or concerns ________________________________________
         ___________________________________________________________

When are my next appointments?

Day ____________Date ____________
Time _____________________
Doctor's name ______________Specialty ____________________
Address _____________________________________________________________
____________________________________________________________________
Reason for appointment ___________________________________________________
Doctor's phone number ____________________________________________

Questions for my appointment

Check any of the boxes below and write notes to remember what to discuss with your doctor.
I have questions about:
___ My medicines ________________________________________________
___ My test results ________________________________________________
___ My pain _____________________________________________________
___ Feeling stressed _____________________________________________
___ Other questions or concerns ____________________________________
         __________________________________________________________

When are my next appointments?

Day ____________Date ____________
Time _____________________
Doctor's name ______________Specialty ____________________
Address _____________________________________________________________
____________________________________________________________________
Reason for appointment ___________________________________________________
Doctor's phone number ____________________________________________

Questions for my appointment

Check any of the boxes below and write notes to remember what to discuss with your doctor.
I have questions about:
___ My medicines ________________________________________________
___ My test results ________________________________________________
___ My pain _____________________________________________________
___ Feeling stressed _____________________________________________
___ Other questions or concerns ____________________________________
         __________________________________________________________

When are my next appointments?

Day ____________Date ____________
Time _____________________
Doctor's name ______________Specialty ____________________
Address _____________________________________________________________
____________________________________________________________________
Reason for appointment ___________________________________________________
Doctor's phone number ____________________________________________

Questions for my appointment

Check any of the boxes below and write notes to remember what to discuss with your doctor.
I have questions about:
___ My medicines ________________________________________________
___ My test results ________________________________________________
___ My pain _____________________________________________________
___ Feeling stressed _____________________________________________
___ Other questions or concerns ____________________________________
         __________________________________________________________

When are my next appointments?

Day ____________Date ____________
Time _____________________
Doctor's name ______________Specialty ____________________
Address _____________________________________________________________
____________________________________________________________________
Reason for appointment ___________________________________________________
Doctor's phone number ____________________________________________

Questions for my appointment

Check any of the boxes below and write notes to remember what to discuss with your doctor.
I have questions about:
___ My medicines ________________________________________________
___ My test results ________________________________________________
___ My pain _____________________________________________________
___ Feeling stressed _____________________________________________
___ Other questions or concerns ____________________________________
         __________________________________________________________

Notes about my medical problem

 

About the Guide

Taking Care of Myself: A Guide for When I Leave the Hospital is adapted from the Project RED (Re-Engineered Discharge), which was funded by the Agency for Healthcare Research and Quality and the National Heart, Lung, and Blood Institute and operated by the Boston University Medical Center. Project RED showed that preparing patients to care for themselves when they leave the hospital can improve patient safety and reduce re-hospitalization rates. Giving patients an easy-to-understand discharge plan is 1 of 11 elements in the RED process.
More information about Project RED and tools to support some of the other elements of the RED can be obtained at: https://www.bu.edu/fammed/projectred/ Link to Exit Disclaimer
More detailed tools for implementing RED, and revisions of existing tools to ensure that diverse populations—especially patients with limited English proficiency, are now being developed. The tools will be completed by late 2012 and posted on the AHRQ Web site and the Boston University Medical Center's Project RED Web site.
Page last reviewed April 2010
Page originally created April 2010
Internet Citation: Taking Care of Myself: A Guide for When I Leave the Hospital. Content last reviewed April 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/patients-consumers/diagnosis-treatment/hospitals-clinics/goinghome/index.html

Re-Engineered Discharge (RED) Toolkit | Agency for Healthcare Research & Quality

Re-Engineered Discharge (RED) Toolkit | Agency for Healthcare Research & Quality

AHRQ News Now

New AHRQ Grantee Profile Highlights Work of Boston University’s Brian Jack, M.D., To Help Prevent Avoidable Hospital Readmissions

Jack
A new grantee profile explores how the AHRQ-funded work of Brian Jack, M.D., a professor of family medicine at Boston University School of Medicine, lowered rates of return trips to the hospital. He developed the Re-Engineered Discharge, or RED, protocol, which uses strategies to promote safer patient care and reduce avoidable hospital readmissions. AHRQ also worked with Dr. Jack to develop an implementation-ready toolkit and guide for patients (in English and Spanish) to extend his work so that health providers can apply RED and address language barriers in health care communications. Check out the profile of Dr. Jack and other AHRQ grantees who have made major advances in health services research.

The cover of the Re-Engineered Discharge (RED) Toolkit

Re-Engineered Discharge (RED) Toolkit

A variety of forces are pushing hospitals to improve their discharge processes to reduce readmissions. Researchers at the Boston University Medical Center (BUMC) developed and tested the Re-Engineered Discharge (RED). Research showed that the RED was effective at reducing readmissions and posthospital emergency department (ED) visits. The Agency for Healthcare Research and Quality contracted with BUMC to develop this toolkit to assist hospitals, particularly those that serve diverse populations, to replicate the RED.
Select for the Taking Care of Myself: A Guide for When I Leave the Hospital, a booklet for patients based on the RED Toolkit.
Related Content
Prepared by:
Boston University
Brian Jack, MD
Michael Paasche-Orlow, MD, M.P.H.
Suzanne Mitchell, MD
Shaula Forsythe, M.P.H.
Jessica Martin, M.A., M.P.H.
Agency for Healthcare Research and Quality
Cindy Brach, M.P.P.
Contract No. HHSA290200600012i

Contents

Acknowledgments
Tool 1: Overview
   Purpose of the Toolkit
   Reasons To Re-Engineer Your Discharge Process
   Impact of RED
   New and Improved RED Toolkit
   References
Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital
   Purpose of This Tool
   Eleven Steps To Implement the Re-Engineered Discharge
       Step 1: Make a Clear and Decisive Statement
       Step 2: Identify Your Implementation Leadership
       Step 3: Analyze Your Readmission Rates and Determine Your Goal
       Step 4: Identify Which Patients Should Receive the RED
       Step 5: Create Your Process Map
       Step 6: Revise Current Discharge Workflow To Eliminate Duplication
       Step 7: Assign Responsibility for RED Components
       Step 8: Train Discharge Educators and Followup Telephone Callers
       Step 9: Decide How To Generate the After Hospital Care Plan
       Step 10: Provide the RED for Diverse Populations
       Step 11: Plan To Measure the Progress of RED Implementation
   Sample Training Agenda
   References
Tool 3: How To Deliver the Re-Engineered Discharge at Your Hospital
   Purpose of This Tool
   Role of the Discharge Educator
   The After Hospital Care Plan
       What Are the Components of the After Hospital Care Plan?
       What Is the Patient Information Workbook and the RED Workstation?
   Steps To Deliver the In-Hospital RED Components
       Obtain and Review Patient Information From Medical Records
       Confer With the In-Hospital Medical Team
       Arrange To Meet With Patient, Family, and Other Caregivers
       First Meeting With the Patient
   Tool 3 Continued
       Follow Up on Test or Lab Results That Are Pending at Discharge
       Organize Postdischarge Medical Equipment and At-Home Services
       Identify the Correct Medicines and a Plan for the Patient To Obtain Them
       Reconcile the Discharge Plan With National Guidelines
       Teach the Content of a Written Discharge Plan in a Way the Patient Can Understand
       Assess the Degree of Patient Understanding
       Review What To Do if a Problem Arises
   Postdischarge Components of the RED
       Transmit the Discharge Summary to the Postdischarge Clinician
       Provide Telephone Reinforcement of the Discharge Plan
       Staff a Discharge Educator Help Line
   Other Teaching Opportunities Included in the AHCP
   Components of After Hospital Care Plan (AHCP)
   Example After Hospital Care Plan (AHCP)
   AHCP Template for Manual Creation: English-Speaking Patients
   Template for Manual Creation of the AHCP: Spanish-Speaking Patients
   RED Discharge Preparation Workbook
   Contact Sheet
   Examples of Diagnosis Pages
Tool 4: How To Deliver the Re-Engineered Discharge to Diverse Populations
   Purpose of This Tool
   Role of Culture, Language, and Health Literacy in Readmissions
       Culture and Its Relationship to Readmissions
       Language and Its Relationship to Readmissions and Patient Safety
       Health Literacy and Its Relationship to Readmissions
   Preparations for Providing the RED to Diverse Populations
       Hiring Bilingual, Bicultural Discharge Educators
       Providing Cultural and Linguistic Competence Training
       Ensuring Availability of Interpreter and Translation Services
   Overview of Delivering the RED to Diverse Patient Populations
   Getting Started With the RED for Diverse Populations
       Assessing Communication Needs
       Using Nonverbal Communication Styles While Teaching the RED
       Understanding Health Beliefs, Alternative Healers, and Attitudes About Medicines
       Understanding Patients and Communicating Across Differences
   Teaching the AHCP to Patients With Limited English Proficiency
   Using Qualified Medical Interpreters To Create and Teach the AHCP
       Working With Qualified Medical Interpreters
       Accessing Interpreters by Phone and Video
       Handling Patient Refusal of Language Assistance
   Understanding the Role of Family and Community
   Additional Considerations
       Dietary Patterns
       Religious Observances
       Gender Preferences
       Sexual Orientation and Gender Identity
       Mental Health
   References
Tool 5: How To Conduct a Postdischarge Followup Phone Call
   Purpose of This Tool
   Preparing for the Phone Call
       Ensure Continuity of Care
       Learn How To Confirm Understanding
       Review Health History and Discharge Plans
       Check Accuracy and Safety of Medicine Lists
       Identify Problems Patients Could Have With Medicines
       Arrange for Interpreter Services
   Conducting the Phone Call
       Whom and When To Call
       What To Say
   Documenting Your Call
   Communicating With the PCP
   Contact Sheet
   Postdischarge Followup Phone Call Script (Patient Version)
   Postdischarge Followup Phone Call Documentation Form
   Phone Call Role Play
Tool 6: How To Monitor RED Implementation and Outcomes
   Purpose of This Tool
   Getting Started
   Selecting and Specifying Measures
       Implementation Measures
             Is the RED Being Delivered to Target Patients?
             Is the Correct Information Being Collected?
             Is Evidence-Based Care Being Delivered?
             Is Appropriate Followup Care Being Arranged?
             Are Patients Being Prepared for Discharge?
             Are Patients Receiving Postdischarge Care?
             Selecting Implementation Measures
       Outcome Measures
             Hospital Reutilization Measures
             Connections With Outpatient Providers
             Knowledge for Self-Management
             Patient Satisfaction
   Collecting Data
       RED Workbooks and Contact Sheets
       Electronic Health Records and the RED Workstation
       Patient Surveys
   Measurement Timing and Frequency
   Other Means of Monitoring the RED
       Root Cause Analyses
       DE Help Line Logs
       Direct Observation
   Taking Action
   Summary
   Discharge Measures Used by Other Organizations
   How CMS Measures the "30-Day All Cause Rehospitalization Rate" on the Hospital Compare Web Site
   Patient Outcome Survey (mailed version)
   Patient Outcome Survey (phone version)
   References
Tool 7: Understanding and Enhancing the Role of Family Caregivers in the Re-Engineered Discharge
To augment the Re-Engineered Discharge Toolkit, Carol Levine and Jennifer Rutberg of United Hospital Fund and Brian Jack and Ramon Cancino of Boston University School of Medicine have developed Tool 7: Understanding and Enhancing the Role of Family Caregivers in the Re-Engineered Discharge Link to Exit Disclaimer (PDF File, 428.5 KB).
The authors of this guide are responsible for its content. The opinions expressed in this document are those of the authors and do not reflect the official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. Statements in the guide should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Acknowledgments

We would like to thank the following consultants who gave feedback on earlier versions of this tool: Linda Barnes, MD; William Barron, MD; Frances Bonardi, RN; Erica Dobson, PharmD; Luke Hansen, MD; Steve Martin, MD; Carol Mostow, LICSW; Victoria Parker, DBA; and Jeff Ring, MD
We would also like to thank the hospitals who implemented the RED using an earlier version of this toolkit and provided insights that were used in finalizing the toolkit.
Finally, we thank Carol VanDuesen Lukas, EdD, and Sally Holmes, MBA, from the Boston University School of Public Health for conducting interviews and compiling lessons learned.
Page last reviewed February 2017
Page originally created March 2013
Internet Citation: Re-Engineered Discharge (RED) Toolkit. Content last reviewed February 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/red/toolkit/index.html