การพัฒนาคุณภาพการวางแผนจำหน่ายสำหรับผู้ป่วยโรคไตวายระยะสุดท้ายที่ได้รับการล้างไตทางช่องท้องอย่างต่อเนื่อง โรงพยาบาลนครพิงค์

Abstract

Discharge planning is a systematic process for preparing patients and caregivers before discharge to promote continuity of care from hospital to home. It employs participation from a multidisciplinary healthcare team, patients, and relatives. This developmental study aimed to improve the quality of discharge planning and to study problems and obstacles related to its implementation with end-stage renal disease patients with Continuous Ambulatory Peritoneal Dialysis (CAPD). The study framework included the FOCUS-PDCA quality improvement process and the D-METHOD model. The participants were 25 patients, 25 caregivers, and 103 members of a multidisciplinary healthcare team. The study instruments consisted of 1) an interview guide regarding needs of discharge and referral care (for patients and caregivers); 2) a focus group interview guide regarding the process and problems of discharge planning (for the multidisciplinary team); 3) a discharge planning manual (for the multidisciplinary team); 4) a self-care manual (for patients and caregivers); 5) a discharge planning record form (for the multidisciplinary team); 6) a checklist of discharge planning practices (for the multidisciplinary team); 7) an assessment form on the knowledge and ability of patients and caregivers regarding self-care for CAPD; 8) questionnaires for collecting information about problems and suggestions related to discharge planning after quality improvement implementation; and 9) a satisfaction assessment form regarding discharge planning (for patients, caregivers, and the multidisciplinary team). The quality of all instruments was confirmed by five independent experts. The Kuder-Richardson (KR-20) coefficients of knowledge and ability assessment of patients and caregivers regarding self-care were 0.84 and 0.89, respectively. The Cronbach’s alpha coefficients of the satisfaction assessment tool for patients and caregivers, and for the multidisciplinary team were 0.86 and 0.93, respectively. Data were analyzed using descriptive statistics and content analysis. The study results revealed that: 1. The quality of discharge planning after the implementation was as follows: 1) The mean score for the practices of discharge planning by the multidisciplinary teams was at a very good level. 2) The mean scores for knowledge regarding self-care for CAPD, ability to do peritoneal solution exchange, and exit site dressing assessment of patients and caregivers was at a very good level and higher than those before receiving the discharge planning (Z = 4.30, p < .001; Z = 4.05, p < .001; Z = 3.77, p < .001). 3) The mean score for patient and caregiver satisfaction with the care in the discharge planning process was at a very good level. 4) The mean score for the multidisciplinary team’s satisfaction with the care in the discharge planning process was at a good level. 5) The average length of hospital stay decreased from 10.39 to 5.12 days. 6) The average medical expenses for each patient decreased from 56,463 to 23,808 Thai baht per case. 2. The problems and obstacles regarding patient discharge planning included: 1) the multidisciplinary team had a high workload; 2) there was a lack of a key person responsible for coordinating the discharge planning team; 3) the caregivers were overburdened, and it was difficult to contact them; and 4) the teaching materials were not diverse and were inappropriate for some elderly patients and patients with reading problems. Suggestions included: 1) head nurses should assign and manage staffing appropriately; 2) head nurses should assign a nurse in their unit to be responsible for coordinating the discharge planning team; 3) the discharge planning team must provide for the caregiver starting from admission, finding multiple ways to contact caregivers, including using technology; and 4) the discharge planning team should use new technological teaching materials to suit each patient. This study proved that discharge planning served the multidisciplinary team as an appropriate approach to prepare end-stage renal disease patients with CAPD, and their caregivers, for discharge. It is also beneficial for nursing administrators in determining discharge planning strategies and monitoring the discharge planning care process for end-stage renal disease patients with CAPD among the multidisciplinary team in Nakornping Hospital.