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Basic Information
Discharge Education
discharge education
WHAT KNOWLEDGE and SKILLS DOES the FAMILY NEED?
Discharge planning is the process of working with a family to help them successfully transition from the NICU to home.
To this end, each family will need to participate in a comprehensive discharge planning program that has been tailored to their and their infant’s specific needs.
In preparing for discharge, your team will have to set clear criteria for what each family and infant need to accomplish to be ready to transition from the NICU to home.
The NICU team should work with the family and confirm that the family understands the NICU discharge planning process.
It is important that families understand that it is difficult to plan for a specific discharge date because discharge readiness is often conditional (e.g., the infants has no further spells, is able to gain weight, pass a car seat test, etc.) The fluid and uncertain nature of discharge readiness can be a source of frustration for families. To help minimize frustration and avoid misunderstandings, it is important to have consistent messaging, emphasizing that there can be wide variations in when an infant is discharged based on clinical indications and medical opinions.
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Discharge Educational Content
Each family will need to have infant care knowledge and skills to be able to provide care at home for their infant.
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Communicate to the family the skills that need to be mastered prior to discharge and the expected timing of discharge.
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Families need to have demonstrated appropriate technical infant care skills and knowledge prior to discharge. Common infant care topics that families need to understand prior to discharge include the following:
Preparing the home environment
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Preparing a crib, bassinette, or bed at home for the infant and creating a safe sleep environment
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How to dress their baby for sleep
How they will safely feed their baby
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How to support feeding at the breast
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How to feed their baby using a bottle
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How to feed their baby if they have a feeding tube
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How to mix formula
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How to increase calories in breast milk
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How to pump and store breast milk
How to bathe their baby
How to dress their baby appropriately for the weather
How to diaper their baby
What is a typical number of bowel movements or wet diapers for their baby to have each day
Circumcision + umbilical cord care
How to protect the infant from infections
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Handwashing and hygiene instructions
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Importance of vaccinations for infants
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Importance of vaccinations for parents and siblings
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Information on RSV and other respiratory infections - and what to watch for
When and how to use a bulb syringe
How to give their baby medications
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Medicines (including vitamins and other supplements) that their infant will take when they are at home
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Medical indication for each medication - Why they are taking the medications
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Administration instructions for each medication - How to give the medications
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When to give the medications
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What to do if the infant misses a dose of the medication
How to recognize fever and other potential signs of illness
Who they should call with their medical questions and concerns
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When to call the pediatrician
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When to call 911 or emergency services
Arranging for help that the family may need at home
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The importance of vaccinations for caregivers
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Sharing Safe Sleep practices
Importance of having a medical home for the infant with primary care providers who are familiar with the needs of infants who have been in a NICU
When and how to do tummy time
Understanding infant enrollment in special programs for preterm infants and infants with special medical or developmental needs
Safe use of infant-related technology
Infant-specific cardiopulmonary resuscitation (CPR)
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Discharge instructions should facilitate family’s understanding of major and/or significant diagnoses.
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Discharge instructions should include the following information:
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Primary care follow-up location, date, and time.
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Follow-up medical specialist appointments that have been scheduled, as well as appointments that are needed but have not yet scheduled.
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Medical indication and/or rationale for each medial specialist service follow up.
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Advice about who to contact in case of an unanticipated occurrence.
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FAMILY PREFERRED EDUCATIONAL MODALITY
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Identify how the family prefers to receive and review information. Their preferred method should be used for the discharge planning process.
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Offer remote discharge teaching if a caregiver is located in a different physical location, making use of technology with a preference for video instead of just audio (e.g. FaceTime, Zoom, Skype, etc.).
FAMILY COMPREHENSION
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Invite family members’ questions. But instead of asking, “Do you have any questions?” say, “Did I leave something out?” or “Does that make sense?” Communicate clearly that you expect they will have questions, both now and in the future. Let them know who can help answer those questions.
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Confirm the family’s comprehension of the infant’s diagnoses and conditions and their knowledge of medical follow-up appointments by inviting the family to repeat or “teach back” their understanding.
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Ensure the family’s comprehension of infant care skills, confirmed by return demonstrations of their knowledge. Encourage families to demonstrate by suggesting, “Now you try it”.
TIMING OF DISCHARGE EDUCATION
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Families’ technical infant care skills and knowledge discharge preparation should occur based on the family’s availability, regardless of time of day. When possible, have at least two caregivers that are familiar with the infant care skills and knowledge.
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Establish that the family feels comfortable with their ability to provide care at discharge. This may require changing the baby’s existing care schedule to accommodate parent availability and/or an overnight stay.
FAMILY EDUCATION SUPPORT
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Some families may want to record infant care skill demonstrations for later reference or to show a family member who was not present during the demonstration. Follow hospital protocol to allow video recording as appropriate. Note: if there is no policy, it may be necessary to create one to support a family’s use of recording as part of the education process.
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Supplement discharge skill demonstrations and discharge education in the family’s preferred learning style and language (i.e. written, visual, live demonstration, or recorded) to reinforce instruction and increase knowledge retention. Allow multiple educational opportunities and skill demonstrations. Give families adequate time to process information and ask questions. Accommodate the family when additional consultation or a review is requested.
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