1. Rusk County Memorial Hospital AIM Statement: Our goal is to reduce our readmissions by 20% yet this year by improving discharge instructions and increasing understanding related to medication compliance and to keep follow-up appointments.

2. Rusk County Memorial Hospital TEST CYCLEPREDICTIONFINDING 1. Med/Surg and Swing Bed Units Staff to be easily engaged Would have initiative champions Staff found initiative recommendations time- consuming and not user friendly. Need to scale back and start small asked 2 RN’s to use tools and make suggested changes- pick willing volunteers. Decide what to adopt or adapt or abandon. 2. DKAT (Discharge Knowledge Assessment Tool) Start early, before discharge. Easy to complete. Start August 1. Presented to House Supervisors and Charge Nurses on July 25 and to all nursing staff at August Staff meeting. “What does patient understand?” Discharge time hectic; patients want to leave; incomplete use of DKAT; teach as you go---involve family early. 2

3. Rusk County Memorial Hospital TEST CYCLEPREDICTIONFINDING 3.EMR Med/Surg Teaching Documentation Form revision Medications -Diagnosis Teaching -Lab Tests -Imaging Tests -Specimens Needed- reason -Follow-up-appts made Great use---checklist reminder! Poor use---lack of documentation---staff not taking credit for what they do! Post discharge calls to all patients within 24-48 hours. 3

4. 1 Rusk County Memorial Staff Safety Assessment Staff feedback on readmissionsWhat you learned from that -or- action steps taken 1. What do you think are the most common factors resulting in a patient being readmitted? 25 Responses from nursing staff including department Coordinators/ Managers/Directors Readmission Factors: Inadequate discharge instructions Medication non-compliance Need support at home Poor knowledge comprehension 2. Please describe what you think we can reasonably do to prevent or minimize readmissions Prevention Strategies: Improve discharge instructions i.e., increased understanding Improve outside support services access Keep follow-up appointments---increase emphasis importance at discharge Family education

5. Rusk County Memorial Summary SUMMARY: Based on our finding with our tests using tools for documentation we “started over”. Restarted small by using 2 RN’s as nurse champions to use the tools and make recommendations for improvements, adjustments, etc. to make tools user friendly. We are currently monitoring use of the DKAT and auditing the teaching documentation EMR form. Follow-up phone calls have been very successful in answering questions post-discharge and reminders for follow- up appointments