Improving discharge instruction comprehension of mothers of NICU graduates: a quality improvement study

The mothers of neonates being discharged often do not clearly understand the discharge instructions. This may lead to breach in the continuity of care of the newborn at home, wrong medications and readmissions in few cases. We found mothers of our neonatal intensive care graduates had poor understanding of the advice being given at discharge. Therefore, we decided to address the issue and conduct a quality improvement study to improve the understanding of mothers. We did a baseline evaluation of the understanding of the mothers when they brought their baby for follow up in the outpatient department. An internally validated questionnaire with 10 questions was used for evaluation, in which the maximum score was 10. A mean baseline score of understanding of the mothers was 5.7. The aim was to improve the score from 5.7 to 9 over a period of 9 months by quality improvement steps. We identified the gaps by a fish bone analysis. A series of Plan-do-study-act (PDSA) cycles were adopted to improve the understanding of mothers. Interventions like informing the parents about discharge in advance, use of a picture booklet and ensuring the presence of the father during discharge counselling were adopted. We interviewed 312 mothers over a period of 9 months to assess the impact of each PDSA cycle. After a baseline score of 5.7, three PDSA cycles were adopted and the score gradually improved to 9.6 at the end of 9 months. The sustenance scores 1, 2 and 15 months after the completion of the study were 9.7, 9.5 and 8.0 respectively. Discharge process should be given due time and consideration. The counselling process at discharge should be structured and there should be active participation by the parents. All units should be sensitized towards the need to improve the discharge process by quality improvement. Sustenance of the improved process is crucial to achieve long-term benefits. Not applicable.