Out-the-Door, Dinosaur: Assessing Health Literacy to Improve Discharge Education

BACKGROUND: Identifying caregivers with limited health literacy is an organizational care issue. Health care organizations need to prepare nurses to identify low-literacy caregivers and to equip caregivers with tools to make informed care decisions. LOCAL PROBLEM: In a pediatric cardiovascular intensive care unit performing biventricular and single-ventricle repairs, caregiver satisfaction with understanding what was taught by nurses during hospitalization was below the national benchmark of 80%. Thirty-day readmission rates following surgical repair were above the national benchmark of 10%. METHODS: A quality improvement project was conducted. Nurses screened caregivers' health literacy within 24 hours of patient admission using a validated literacy screening tool. Nurses provided discharge education in 5 key areas: medication administration, wound care, cardiopulmonary resuscitation, nutrition, and need for additional medical care. Education was provided to the caregiver at the identified literacy level using the teach-back method. Data on project outcomes were collected via anonymous surveys and readmission rates were analyzed for trends in care management. RESULTS: Over a 12-month period, 150 caregivers were screened. Sixty-four percent of caregivers demonstrated adequate literacy, 23% displayed limited literacy, and 13% met criteria for low literacy. Caregiver satisfaction with discharge education during hospitalization increased to 100%, and caregivers indicated that they felt confident performing required posthospitalization tasks. Thirty-day readmission rates following surgical repair decreased by 1.8%. CONCLUSION: Increasing health literacy awareness is essential for improving patient health outcomes and empowering caregivers to make informed care decisions. Literacy tools can help nurses educate caregivers with limited health literacy to improve postdischarge care.