What should be on a PODS - Part 4

How should we tell patients about danger signals to watch out for?

-        -   Guidelines in a timeline if the patient feels a certain way on a certain day, they should do x 

-         -  Include visuals of possible symptoms and what to do if have them which may include multiple steps such as first take meds and if that doesn’t work go to hospital

-         -  Traffic light symptoms - green are normal, yellow are minor, red go straight to the ER

-          - How feel now correlated to how the symptom may change and get worse and what to do if it does

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What about reporting on symptoms in general? 

-          Should we include a self-care log for patients to record symptoms

o   With names and pics of possible symptoms

o   With a visual rating scale

What should be on a PODS - Part 3

What resources do patients want? What from this list would you include?

-          - Websites 

-          - standard patient education information 

-         -  phone number for medical records 

-         -  Community resources such as community centres

-         -  Social network support

-         -  Helpline

-         - recipes, exercise videos 

-           - legal assistance

       - kid friendly activities

        - child care

        - pet care

What should be on a PODS - Part 2

Here is a look at how we can include medication information on a PODS. 

-         Most of the groups at our event agreed that the medications should be presented in some sort of chart with potentially any or all of the following details

o   name of medication

o   picture of time of day to take the medication

o   picture of what the medication looks like

o   picture of dose (e.g., number of pills to take)

o   with check box of am, pm, hs

o   picture of whether the medication should be taken with or without food

o   side effects

o   a reason why to take each medication

o   contraindications and drug interactions 

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       Here are some other things to think about:

           - Should the medications be colour coded?

-                    - Should we include a sticker sheet to match the chart to the actual medication bottles?

-                  - Should we include other follow up activities with the medications in a daily chart of time, med/activity, dose/amount?

What should be on a PODS and how should it look - Part 1

Over the next week, I will be posting daily thoughts on different items that we think should be on a PODS and some options for how to include them. 

We would love your input!

Here is the first one - 

What to expect the first week home and beyond - patients want to know how they can expect to feel.A lot of patients are surprised at how long it takes them to fell somewhat normal again and they want to know what is normal. If it is normal for them to feel like garbage for 2 weeks, that is fine. They just want to know.

At our design event, the groups came up with various ways to include this in a PODS.

-         -  On a calendar with maybe an icon to show how you an expect to feel or a note of when you may begin to feel less tired, etc

-          - On a timeline (with pictures?) of how you can expect to feel at discharge, at one week, and at 2 weeks

-          - A picture and description of what success looks like and when it is expected to happen

-          - A list of how do the patient feels now (at discharge) with arrows corresponding  to how the symptom may change into a danger signal (e.g. now have less energy à go to H if can’t get out of bed)

-       -   A list of normal symptoms with icons

The Beyond Words PODS Design Event

This past Thursday, groups of patients, providers, designers, patient relations representatives, and patient education representatives came together to design patient oriented discharge summaries. The day was a big success and the groups worked together amazingly well. After a brief introduction to the project, we got right to work.

The groups rotated through 4 stations, each with a case study of patient's stay in hospital. The groups were faced with the task to be creative and think of the ideal PODS for that patient in 20 minutes. Meet our 4 case studies:

1. Wen-Yang, the 10-year old refugee, new to Toronto with his mom and younger brother who is diagnosed with pneumonia and spend the night in the hospital. Due to mis-communication, Wen-yang end up returning to the ER unnecessarily 2 days later.

2. Lisa, an 87 year-old Italian woman who loses her independence after an unexpected bypass surgery due to chronic heart failure. She cannot keep on top of all the guidelines surrounding her many new medications.

3. George, a 22 year-old international university student from Greece, who is in a car accident and suffers many injuries. He suffers memory loss and has trouble getting back into the swing of things.

4. Jose, a middle-aged taxi driver suffering from kidney failure, diabetes, and obesity among other things. He is in the hospital for something minor and ends up with a hospital-contracted infection.

The solutions that resulted were amazing. They were more traditional discharge summaries that were enhanced with multiple languages and images to make things more clear to patients. They all included key information patients wanted such as phone numbers of who to call with questions and expectations of what to expect in the first week home form the hospital. Almost all of the solutions contained some sort of calendar view. There were solutions that developed apps to connect patients to their care plan, their families, resources int he community, and their doctors. There were solutions that included interactive patient portals with educational videos. There were solutions that came with stickers to color-code your medications,areas for patients to write notes, and checklists for them to keep track of all their follow up plans. There was even one solution that included a weighted placemat that looked like a calendar and held all the patient's pills. If the patient missed a few pills, the next of kn would receive an automatic message.

The Beyond Words project team is going to systematically review all the solutions and designs. I can't wait to see what comes out of this amazing event. Here are some pictures from the event.

What Information Do Patients Want at Discharge?

“If something is important enough to mention at discharge, it really should be written down”

“A discharge form in ‘plain English’ should be standardized”

These are quotes from patients we interviewed. We have repeatedly heard from patients that they want written instructions and studies have shown that patients cannot remember what they are told in hospital and when they have something to refer to (either in written or video format) once they are home, they do much better. 

We have been talking to a lot of patients and they have been telling us what information they would like to be given at discharge. The items listed here are grouped by the number of patients and caregivers who mentioned them. The most popular items were mentioned by at least 10 patients and caregivers and are highlighted in green. The second group was mentioned by at least five patients and caregivers and are highlighted in blue. The third group was mentioned by at least three patients and caregivers and are highlighted in yellow.

-          Medication Schedule

-          How to fill and refill medications

-          Follow up care schedule

-          What to expect the first week home

-          What is normal, what is a minor danger signal, and what is a major danger signal

-          Who to call in the cases of a minor or major danger signal

-          Phone numbers for go-to people

-          Follow up appointments with phone numbers

-          Names of medications

-          Medication side effects

-          When to resume various activities

-          Lists of relevant resources

-          Pointers to additional information

-          List of supports they can expect at home

-          Why they are being prescribed each medication

-          A number to call for prescription issues

-          Diagnosis and diagnoses considered

-          Short synopsis of hospital stay and tests done

From our research, we have also discovered other tips that can help us when we design the PODS.

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            -  Put the most important information first

-        -   Simplify the written instructions - use plain language for all content and headings, think about what each thing means to the patient.

-         -  Use large fonts

-         -  Include an illustration of the care/medication schedule

-         - Use other communication besides verbal – text/illustrations

-         -  Include the patient’s voice in the follow up plan and include caregivers as well

-        -  Include a checkmark space for patients to check off what they have completed from their plan

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Do you agree with this list? Would you add anything? Share your thoughts with us!

THE CICC INVITES YOU TO A DESIGN EVENT ON PATIENT-ORIENTED DISCHARGE SUMMARIES

We are inviting patients, caregivers, healthcare providers, and designers to attend a design event hosted by the Centre for Innovation in Complex Care. Patients and caregivers will join teams of healthcare providers and designers to work on co-creating patient oriented discharge summaries. What should be on a discharge summary that a patient will take home from the hospital and how should it look?

          When: Thursday, February 13^th, from 1:00 pm to 4:00 pm

         

          Where: Toronto General Hospital, 13^th floor, room 13N 1382

Please email Shoshana Hahn-Goldberg at:

shoshana.hahn-goldberg@uhn.ca

with any questions and to confirm your attendance.