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Nurse-led strategy to improve the Care Transition in patients undergoing colorectal cancer surgery


ABSTRACT: Interventions: Control Group: Usual care and discharge process. Number of participants: 59 patients Intervention Group: Number of participants: 59 patients On the first day of admission to the surgical unit: a nurse, previously trained, will identify a family member/caregiver who will accompany the patient at home; identify the patient’s and family’s aims for hospital stay; inform the patient and family about the steps and needs identified for discharge; discuss the discharge plan with the doctor and patient. After the surgery: meeting to prepare the patient and family for discharge - the nurse will identify needs and concerns about going home, educate the patient and family about the patient’s condition and use the teach-back technique; which consists of a method used to confirm the understanding of the patient and family about what is being explained. In this way, the nurse will explain the care for the surgical wound, use of medications, and catheters (if applicable) for the patient and family. On the day of discharge: the nurse will make a telephone call to the patient’s primary care unit of reference and pass the case / main needs of the patient to the nurse (or on the first business day following discharge); review the reconciled drug list with the patient and family; deliver a multidisciplinary hospital discharge plan/summary to the patient, with data on clinical follow-up, tests performed, diagnosis, medications in use, medications for continuous use, length of stay, a brief history of hospitalization and guidelines for the patient on continuity of care in Primary Health Care; inform the patient and family of the nurse’s name and telephone number of the Basic Unit who will be the person and unit to be contacted if there is a problem after disch;I02.233.332;E02.760.169.125 Primary outcome(s): From the intervention that the nurse will perform with the patients in the intervention group, it is expected to reduce the length of stay in hospital after colorectal cancer surgery, it will be verified through the days spent in the sector confirmed through the data in the patient’s record. ;From the intervention that the nurse will perform with the patients in the intervention group, it is expected to reduce unplanned hospital readmission in 30 days, 60, and 90 days, it will be verified through the data from the patient’s record.;From the intervention that the nurse will perform with the patients in the intervention group, it is expected to reduce emergency visits in 30, 60 and 90 days, it will be verified through data from the patient’s record.

DISEASE(S): Transitional Care,Patient Readmission,Colorectal Neoplasms,C-18

PROVIDER: 2558621 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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