Pediatric clinical and social concerns identified by home visit nurses in the immediate post-discharge period

Aim: To describe pediatric post-discharge concerns manifesting in the first 96 hours after hospital discharge. Design: Analysis of nursing documentation generated as part of a randomized controlled trial evaluating the effect of a nurse home visit on healthcare re-use. Methods: We analyzed home visit records for 651 children (age 18) hospitalized at a large Midwestern children's hospital in 2015 and 2016 who were enrolled in the trial. Registered nurses documented concerns in structured fields and free-text notes in visit records. Descriptive statistics were used to summarize visit documentation. Free-text visit notes were reviewed and exemplars illustrative of quantitative findings were selected. Results: Overall, nurses documented at least one concern in 56% (N=367) of visits. Most commonly, they documented concerns about medication safety (15% or 91 visits). Specifically, in 11% (N=58) of visits nurses were concerned that caregivers lacked a full understanding of medications and in 8% (N=49) of visits families did not have prescribed discharge medications. Pain was documented as present in 9% of all visits (N=56). Nurses completed referrals to other providers/services in 12% of visits (N=78), most frequently to primary care providers. In 13% of visits (N=85) nurses documented concerns considered beyond the immediate scope of the visit related to social needs such as housing and transportation. Conclusion: Inpatient and community nurses and physicians should be prepared to reconcile and manage discharge medications, assess families' medication administration practices and anticipate social needs after pediatric discharge.