School of Nursing, University of Wisconsin at Madison, Madison, Wisconsin 53792, USA.
J Am Geriatr Soc. 2013 Jul;61(7):1095-102. doi: 10.1111/jgs.12328. Epub 2013 Jun 3.
To examine how skilled nursing facility (SNF) nurses transition the care of individuals admitted from hospitals, the barriers they experience, and the outcomes associated with variation in the quality of transitions.
Qualitative study using grounded dimensional analysis, focus groups, and in-depth interviews.
Five Wisconsin SNFs.
Twenty-seven registered nurses.
Semistructured questions guided the focus group and individual interviews.
SNF nurses rely heavily on written hospital discharge communication to transition individuals into the SNF effectively. Nurses cited multiple inadequacies of hospital discharge information, including regular problems with medication orders (including the lack of opioid prescriptions for pain), little psychosocial or functional history, and inaccurate information regarding current health status. These communication inadequacies necessitated repeated telephone clarifications, created care delays (including delays in pain control), increased SNF staff stress, frustrated individuals and family members, contributed directly to negative SNF facility image, and increased risk of rehospitalization. SNF nurses identified a specific list of information and components that they need to facilitate a safe, high-quality transition.
Nurses note multiple deficiencies in hospital-to-SNF transitions, with poor quality discharge communication being identified as the major barrier to safe and effective transitions. This information should be used to refine and support the dissemination of evidence-based interventions that support transitions of care, including the Interventions to Reduce Acute Care Transfers program.
研究熟练护理机构 (SNF) 护士如何将从医院转入的患者的护理工作交接好，他们在交接过程中遇到的障碍，以及与交接质量变化相关的结果。
使用扎根维度分析、焦点小组和深入访谈的定性研究。
威斯康星州的 5 家 SNF。
27 名注册护士。
半结构化问题引导焦点小组和个人访谈。
SNF 护士严重依赖医院出院沟通的书面记录来有效地将患者转入 SNF。护士提到了医院出院信息的多个不足之处，包括药物医嘱的常见问题（包括没有开具阿片类药物来止痛）、很少有心理社会或功能病史，以及关于当前健康状况的不准确信息。这些沟通不足需要反复打电话澄清，导致护理延迟（包括疼痛控制延迟），增加 SNF 工作人员的压力，使患者和家属感到沮丧，直接导致 SNF 机构形象不佳，并增加再住院的风险。SNF 护士确定了一份他们需要的特定信息和组件清单，以促进安全、高质量的交接。
护士指出医院到 SNF 的交接存在多个缺陷，其中沟通不畅是安全有效的交接的主要障碍。这些信息应被用于完善和支持传播支持交接的循证干预措施，包括减少急性医疗转科计划。
