NR 652 Week 6 Policy Recommendation Example

Policy Recommendation Document: Add a Telephone-Interpreter Step Before Any Family Member Interprets at Discharge, and Extend PC-114's Discharge Clause to All Adult Inpatient Units

Student Name

College of Nursing, Chamberlain University

NR 652: Healthcare Policy Concluding Graduate Experience II

Instructor Name

Month Day, Year

Policy Recommendation Document: Add a Telephone-Interpreter Step Before Any Family Member Interprets at Discharge, and Extend PC-114's Discharge Clause to All Adult Inpatient Units

Recommendation

Amend PC-114 so that, at discharge teaching, a nurse who cannot reach a qualified interpreter in person or by video must request a telephone interpreter before any family member interprets, and documents the attempt; and extend the discharge teaching clause from the three medical-surgical units to all adult inpatient units, effective 1 June 2027.

Proposed Wording

The proposed wording can be pasted into the policy as it stands, without further editing. It keeps the existing emergency exception, separates minors from other family members in line with the federal rule, and adds one step and one documentation requirement.

Scope

Binds: registered nurses delivering discharge teaching to adult inpatients on all inpatient units, including critical care, the cardiac unit and the orthopedic unit.

Exempt: emergency care, clinic visits and procedure suites, which have their own workflows and are outside the policy section being amended; pediatric units, which have a separate language access procedure; and patients who use sign language or other hearing accommodations, covered by the hospital's separate policy.

Effective date: 1 June 2027, allowing the Nursing Practice Council in April, the Policy and Procedure Committee in May and a four-week education period, with a recorded shift-start message as the fallback if any unit's huddles are canceled.

Resources, in the Site's Units

Telephone interpreter minutes: the language line is billed per minute under the existing vendor contract. February's 15 to 28 period had 10 discharges on the three units with "Not available" or "Family member"; if half of such discharges hospital-wide moved to the telephone line at about 20 minutes each, the estimate is about 30 additional hours of telephone interpreting a month across all adult units, billed at the contract rate.

Nursing time: no new positions. A telephone-interpreted teaching session may take ten minutes longer than an English-language session.

Equipment: speaker phones in rooms that lack them; the facilities office counts 22 such rooms on adult units, and the phones are a stock item.

Build, after approval: one new value, "Telephone interpreter requested, not reached," added to the existing required row; about two analyst hours.

No new license is required.

Evidence, Compressed

Compared with relatives and untested staff, trained interpreters go with fewer mistakes and patients who understand more (Karliner et al., 2007; Flores, 2005). Ad hoc interpreters make errors with potential clinical consequences (Flores et al., 2003). Clinicians get by without interpreters when interpreters are hard to reach (Diamond et al., 2009). Under the 2024 federal rule, covered hospitals may lean on relatives, and on minors especially, only in narrow cases (U.S. Department of Health and Human Services, 2024). Locally, after the row became required, 10 of 35 discharges were recorded as "Family member" or "Not available," which is the gap the telephone step is designed to close.

The Trade

Discharge may take longer for some patients who need an interpreter, mainly in the afternoon, when devices are busiest. Some families will be asked to wait while a telephone interpreter is reached. The trade is time against accuracy, and the recommendation chooses accuracy for the minutes it takes.

Alternatives Considered

Prohibiting family interpretation at discharge outright, without a telephone step, was rejected because it leaves the nurse with no option when devices are busy, which is when clinicians tend to work around rules (Diamond et al., 2009). Requiring discharge to wait for an in-person interpreter was rejected because labor relations would treat it as a change in duties and because in-person interpreters are not available on evenings. Doing nothing was rejected because the required row now shows the gap every month, and a committee that has seen the gap is unlikely to accept no response to it.

Monitoring, With an Owner

Owner: the nursing quality coordinator. Measure: the existing monthly report, by unit, showing each value of the required row, including the new value. Reviewed: monthly by the Nursing Practice Council for six months, then quarterly. Trigger for review: "Family member" above 10% of qualifying discharges on any unit for two consecutive months.

Why a Telephone Step and Not More Devices

More devices would help, and Patient Experience added two in February. But devices are a purchasing decision outside nursing policy, and they will always be busy at some hour. A telephone step is available at any hour, needs only a speaker phone and is already covered by the vendor contract. Policy can require it; it cannot require devices to exist. The recommendation puts in policy the step nursing controls.

Who Was Consulted on the Wording

PC-114's keeper in Language Services edited the proposed sentences on 8 March. The labor relations manager confirmed on 10 March that adding a request step and a value to an existing row does not change job duties. Two unit managers from outside the three units read the scope section and asked that critical care be named explicitly, which it now is.

What This Recommendation Does Not Do

It does not add devices, change the vendor contract or extend to the emergency department. It also does not change the definition of a qualified interpreter, which follows the national standards of practice already cited in PC-114. Each was raised during implementation; each belongs to another owner and is listed for Patient Experience.

Why Now

The policy's three-year review is now complete, and a second amendment at the six-month mark keeps PC-114 aligned with what the required row has shown. The data from 15 to 28 February are the first look at what happens when every discharge must be sorted, and they point directly at the step this recommendation adds.

References

Diamond, L. C., Schenker, Y., Curry, L., Bradley, E. H., & Fernandez, A. (2009). Getting by: Underuse of interpreters by resident physicians. Journal of General Internal Medicine, 24(2), 256-262. https://doi.org/10.1007/s11606-008-0875-7

Flores, G. (2005). The impact of medical interpreter services on the quality of health care: A systematic review. Medical Care Research and Review, 62(3), 255-299. https://doi.org/10.1177/1077558705275416

Flores, G., Laws, M. B., Mayo, S. J., Zuckerman, B., Abreu, M., Medina, L., & Hardt, E. J. (2003). Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics, 111(1), 6-14. https://doi.org/10.1542/peds.111.1.6

Karliner, L. S., Jacobs, E. A., Chen, A. H., & Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research, 42(2), 727-754. https://doi.org/10.1111/j.1475-6773.2006.00629.x

U.S. Department of Health and Human Services. (2024). Nondiscrimination in health programs and activities (Final rule, 89 FR 37522). Federal Register.