Background Patients with inadequate health literacy often have poorer health outcomes and increased utilization and costs compared to those with adequate health literacy skills. Implementation was based on a quality improvement framework with a focus on acceptability adoption appropriateness feasibility fidelity Cetirizine 2HCl and sustainability. Support was gained from nursing leadership education and training was provided a documentation change was rolled out feedback was obtained and uptake of the new health literacy screening items was monitored. Results Between November 2010 and April 2012 there were 55 611 adult inpatient admissions and from November 2010 to September 2011 23 186 adult patients made 39 595 clinic visits to the three primary care practices. The completion (uptake) rate in the hospital for November 2010 through April 2012 was 91.8%. For outpatient clinics the completion rate between November 2010 and October 2011 was 66.6%. Conclusions Although challenges exist it is feasible to incorporate health literacy screening into clinical assessment and EHR documentation. Next steps are to evaluate the association of health literacy with processes and outcomes of care across inpatient and outpatient populations. Health literacy is the degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decisions.1 It is a necessary skill for successful navigation of the health care system communication with providers and management of chronic conditions. However an estimated 90 million adults in the United States have low health literacy 2 which is associated with lower rates of preventive .care poorer disease control and greater mortality as well as Cetirizine 2HCl increased health care utilization and costs. 3 4 Addressing health literacy is therefore a national health priority.1 5 Health literacy is also a function of the complexity of the health care system and many leading health care organizations have provided recommendations and toolkits to appropriately address health literacy.1 6 Raising awareness of health literacy and integrating health literacy strategies into quality improvement efforts and interpersonal communication are among the attributes of a Cetirizine 2HCl health literate organization.11 Such Tal1 efforts are expected to improve patient-centered care as well as patient outcomes. Since 2012 The Joint Commission has required that hospitals specifically address use of effective oral and written communication and documentation of patients’ communication needs without dictating the manner in which this be done.1 12 The 2004 Institute of Medicine report on health literacy recommended that “health literacy assessment should be a part of health care information systems and quality data collection.”1(p. 16) This would facilitate large-scale studies of the associations and consequences of low health literacy as well as evaluation of system interventions designed to improve patient care by addressing health literacy.1 However we are unaware of any institutions that have done so on a large scale. Nurses are ideally positioned to systematically screen and document patients’ health literacy skills.13 A number of health literacy assessment tools exist with demonstrated validity and Cetirizine 2HCl reliability but these measures are typically conducted by trained research staff and are too time-intensive to be feasible in routine practice.14 In the last several years shorter screening tools have been developed and validated.15 However use of such tools by clinical personnel is not well described except for one outpatient study in which 98% of patients found health literacy screening acceptable.16 Given the importance of health literacy in delivering care at both individual and system levels our institution sought to establish a standardized approach to health literacy assessment and documentation. In this article we describe the implementation of a three-item measure 17 18 which we refer to as the Brief Health Literacy Screen (BHLS) in inpatient and outpatient practice at a large academic medical center. The multicomponent implementation strategy entailed selection of a tool well-suited to nursing workflow; garnering key nurse leaders’ support and participation; education; electronic health record (EHR) integration; and ongoing evaluation and feedback. We measured the success of implementation using outcomes and.