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Implementation of a Health Literacy Universal Toolkit to Improve Postdischarge Care at an Urban Trauma Center


doi: 10.1097/JTN.0000000000000446

Topic: Low health literacy impacts the financial burden of hospitals up to $238 billion annually. A trauma center located on the East Coast implemented a Transitional Care Management (TCM) model targeting individuals at risk for readmission, but not every patient receives this service.

Purpose: A gap analysis of the facility's discharge process identified a deficit in the formal evaluation of health literacy upon discharge. The purpose of this project was to implement a Health Literacy Universal Toolkit to assess and improve medication education for low literacy patients. Included in the toolkit were the Rapid Estimate of Adult Literacy in Medicine Short Form (REALM-SF), an evidence-based health literacy screening tool, and 2 interventions, additional education on their inpatient or discharge medication list, and a Brown Bag Medicine Review of medications at a postdischarge clinic appointment.

Conclusion: Seventy-one patients were screened using the REALM-SF. Sixty-two percent (n = 44) of patients scored at a high school reading level, 30% (n = 21) scored at a seventh- to eighth-grade reading level, and 8% (n = 6) scored at or below a sixth-grade reading level. Eight percent of patients scored as having low health literacy, 30% scored as having marginal health literacy, and 62% scored as having adequate health literacy. Twenty patients received additional medication education with My Medicines Form or a Brown Bag Medicine Review.

Key Points: Regardless of literacy level, patients appreciated the additional medication education interventions. Health care providers should observe universal health literacy precautions regardless of literacy level.

University of Maryland School of Nursing, Baltimore.

Correspondence: Theresa J. Nowak, DNP, RN, AGACNP-BC, ACCNS-AG, CCRN (

This work was completed by Dr Nowak under the supervision of Dr. Linda Costa, PhD, University of Maryland School of Nursing.

The author declares no conflicts of interest.

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Copyright © 2019 by the Society of Trauma Nurses.