Tracking ensures that teaching is complete
System promotes reinforcement of education
Although a great amount of education for bone marrow transplant (BMT) patients takes place before they are admitted to the hospital, teaching continues across the continuum. Yet retention of information varies at each stage of the transplant process.
"Patients do well with the education during the pre-transplant period with the conditioning. That is why we try to cover a lot of information during that period of time," says Susan Hanauer, BSN, nurse clinician two at the University of Wisconsin Hospital and Clinics in Madison.
During the inpatient stay following the transplant, BMT patients often are very ill, and teaching must be reinforced repeatedly to ensure learning. Therefore, a good documentation system is essential. At the University of Wisconsin, patients are given a binder filled with the information they need to know such as pre-transplant testing and nutrition after discharge.
Education is monitored using a numbering system. Each page, for example, includes essential information for the patient. Beside each piece of information is a series of numbers from 1 to 3. The number 1 means teaching started; 2 means teaching is in process. The number 3 indicates that the information is covered and understood. As the nurse goes over the information with the patient, either the nurse or the patient checks the correct number so teaching can be continued at a later date if necessary.
"It's not a documentation tool per se because it is their binder. However, it helps with communication between the nurses," says Hanauer.
Much of the inpatient teaching at the University of Utah Hospitals and Clinics in Salt Lake City is focused on the discharge planning. Teaching is tracked by all disciplines on the patient education record and covers all information patients need to know before discharge.
"We rate patients' learning, giving them a 0 if they don't understand the objective at all, a 1 if the patient partially understands it, and a 2 if they have learned it," says Robin Phillips, MSN, RNC, nurse manager for bone marrow transplants at the health care facility.
A computerized documentation form is used to track education at Fairview-University Medical Center. The electronic form has various teaching categories, such as medication, diet, and disease information. Each category is separated into documentation sections. For example, disciplines can document whether the patient needs more instruction, whether the family was present during the teaching, and how much time was spent teaching.
"It's easy to see if the patient was taught about dietary drug interactions. We don't have to sift through papers. It helps to have one location to look for education and the patients' response to teaching," says Leslie Parran, MS, RN, blood and marrow transplant clinical nurse specialist at the health care facility.
The same computer documentation system is connected via a network to the clinic so professionals in both the inpatient and outpatient settings can follow the BMT patient across the continuum of care.
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