Quality Development of Discharge Planning for Patients with End Stage of Renal Disease using Continuous Ambulatory Peritoneal Dialysis, Nakornping Hospital

Abstract

This action research aimed to study the quality development of discharge plan, problems, and obstacles in developing discharge plan for patients with end stage of renal disease using continuous ambulatory peritoneal dialysis at Nakornping Hospital. The samples were 25 patients with end stage renal disease using continuous ambulatory peritoneal dialysis, 25 carers and 103 multidisciplinary healthcare staff. The research instruments were 1) interview guidelines for patients, caregivers, and multidisciplinary healthcare staff regarding discharge plan; 2) discharge planning model; 3) a record about the incidence of hospitalization, 4) a checklist of discharge planning practices, 5) selfcare assessment form, 6) questionnaires for the assessment of problems and suggestions related to discharge planning; and 7) a satisfaction assessment form regarding discharge planning developed by research team and tested by five experts. The Kuder-Richardson 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, caregivers and the multidisciplinary healthcare staff were 0.87, 0.89 and 0.93, respectively. Data were analyzed using descriptive statistics, Wilcoxon Sign-Rank test, and content analysis.

The results revealed that 1)  Ninety four percent of the multidisciplinary healthcare staff were able to follow the discharge planning at a very good level; 2) The patients and caregivers' knowledge about self-care in changing peritoneal solution and exit site dressing 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 average length of hospital stay decreased from 10.39 to 5.12 days; 4) The average of medical expenses for each patient decreased from 56,463 to 23,808 Thai baht per case; 5) The patients and caregivers' satisfaction with the care in the discharge planning process was at a very good level (Mean= 4.76, S.D. = 0.26;   Mean= 4.74, S.D. = 0.36) and 6) the multidisciplinary healthcare staff's satisfaction with the discharge care plan was  at a very good level (Mean= 3.95, S.D.= 0.62).

The result of this study shows that discharge plan helps the multidisciplinary healthcare staff to prepare for discharging patients with end-stage renal disease patients using CAPD appropriately. These are 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 healthcare staff in Nakornping Hospital.