Provide cross-continuum communication
Involve allied fields in education coordination
Question: "How do you coordinate patient education with outpatient care? What do you do to ensure that the education the patient receives in his or her physician office or from home health does not conflict with inpatient teaching? What steps do you take to provide a continuum of care?"
Answer: A good way to coordinate patient education with outpatient care is to involve physicians in program design, says Melinda Spolski, BSN, MSN, education services coordinator at Holy Family Hospital in Spokane, WA.
To create a maternity education program across the continuum of care, the physicians on staff and the nursing staff determined what information patients needed to know before discharge and what could be taught later. As a result, education was split, with the necessary information taught before discharge and the rest taught in a follow-up phone interview or during a home visit.
"We have a maternity support center that contacts the moms by telephone three to seven days postpartum. At that time, a nurse conducts a learning assessment over the telephone to determine what the patient needs to know. If she still has a lot of learning needs, a home visit is arranged," says Spolski.
The woman's physician receives a copy of the learning goals and objectives, patient instructions, and handouts the patient is given from the hospital's medical records department. Hospital staff used to ask the patient to take the teaching materials to their physician on the next visit, but patients weren't reliable, says Spolski.
It takes communication to make sure that the education does not conflict, says Michele Knoll Puzas, RNC, MHPE, pediatric nurse specialist at Michael Reese Hospital & Medical Center in Chicago. If a home health nurse is going to help care for the child after discharge, arrangements are made for the nurse to come to the hospital before the patient goes home. That way, the nurse can become familiar with the medical equipment the patient will use at home. Also, the nurse receives the same educational packet the hospital provides for the parent and child, says Knoll Puzas.
In some cases, the pediatric staff at Michael Reese Hospital will adjust teaching to fit the protocol of the home health agency. For example, pediatric diabetics sometimes reuse their needles at home, although they would never be allowed to follow this practice in the hospital. Therefore, the nurse educator will sometimes call the home health agency to determine its standard of care, so nurses aren't teaching the parent and child something different from what they will be expected to do at home.
"Parents of pediatric patients often get different opinions from different people, and sometimes the information is confusing or they don't know whom to trust. You want to avoid that as much as possible, especially if it is something they will have to continue to do when they leave the hospital," says Knoll Puzas.
Involve physicians in approval process
Physicians become aware of the educational materials distributed at the hospital if they are asked to be involved in the approval process when it is selected, says BJ Hansen, BSN, patient education coordinator at Grant/Riverside Methodist Hospitals in Columbus, OH.
As Hansen and the patient education committee work to integrate the teaching materials from two merging hospitals, copies are sent to physician offices that specialize in the area of patient care. Once approved, the materials are implemented.
"If the material is internally developed and printed in our print shop, we offer the new material to the offices free of charge in an effort to provide consistent information and encourage the education process to begin before admission and continue after discharge," says Hansen.
When a physician creates a discharge instruction sheet, it is provided for patients on the units. To keep all sheets uniform, Hansen helps the physicians develop the sheet. The unit nurse or office nurse alerts Hansen when a physician inquires.
Hansen then contacts the physician to ask him or her to write down the content. "I revise the content if needed to lower the reading level and define medical jargon. I send it back to the physician, and we continue to revise it until it is in its final form," she says. Once finalized, it is sent to the print shop to be printed in the proper format.
At Holy Family Hospital, all patient education handouts are sent to the physicians on the clinical monitoring committee. The committee distributes copies to the appropriate physician's offices for approval. "We do not implement materials until the clinical monitoring committee has approved them," says Spolski.
While it is important that all parties involved in a patient's care know what teaching took place in each setting, it is equally important to have opportunities for education across the continuum of care, says Hansen. That's why the Wellness Roundtable, a hospital committee with representatives from all the service lines and care sites connected with the health care facility, created a chart. Each chart lists the resources and programming that support the patient in various settings. (See example of the chart, Orthopaedics Across the Continuum, p. 79.)
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