The fast-paced ED requires rapid education
Tailor education to fit small window of opportunity
In the emergency department at most health care facilities, education must occur in a very short window of time. In addition, patients often are in pain or experiencing a high level of stress.
"The turnover in the emergency room is quicker than elsewhere. There is a limited time to teach, and you have to deal with the patient’s complaint. If they are in a lot of pain or if their diagnosis is uncertain, they don’t want to hear what the nurse has to say. Education is difficult," says Suzanne Balbosa Saunders, RN, assistant nurse manager in the emergency department at Baptist Hospital of Miami.
To provide education in a quick and timely manner, instructional sheets are used at The Ohio State University Medical Center in Columbus to reinforce verbal education. "We provide patient education handouts on every disease process along with medication information," says Jocelyn Zerkle-Kidd, RN, nursing program manager for emergency services at the medical center. The sheets are available on the medical center’s Intranet system so they can easily be printed out as needed.
While many handouts have been created that are specific to the emergency department, such as cast care, nurses have access to educational pieces from all departments. Therefore, if a patient has been diagnosed with hypertension and needs a sheet for a low-sodium diet, the nurse can quickly obtain the information from the cardiac unit materials.
Baptist Hospital of Miami uses Logicare, special software designed for the emergency department by Logicare Corp. in Eau Claire, WI. The nurse tailors an information sheet to a specific patient by typing information into a form before printing it out. For example, if the patient was diagnosed with non-specific abdominal pain, the nurse might want to instruct the patient not to drink milk for 24 hours.
"If the nurses come across a frequent complaint that is not in the computer, we meet with a multidisciplinary group to create a sheet," says Balbosa Saunders.
Because teaching time is so limited and the patient’s readiness to learn varies, patients receive a follow-up call the next day, even when family members are incorporated into the teaching. Baptist Hospital has three quality assurance nurses dedicated to this task in order to make sure patients understand the instructions they were given and to answer any questions they may have, explains Balbosa Saunders.
During the telephone conversation, the nurse tries to determine if patients have filled the prescription and made a follow-up appointment with their physician. If they can’t afford the medication, a prescription for a generic drug may be called in to the pharmacy. The nurse also mails instruction sheets to patients who left without taking a handout with them.
Flagging’ patients who need more attention
At The Ohio State University Medical Center, a primary care resource manager calls patients who have been "flagged." A patient may be flagged if the nurse is not sure the patient understands the material or if the patient is using the emergency department as a source for primary care. During the call, teaching that targets the problem takes place.
For example, people are educated about the importance of having a primary care physician and connected to resources within their community. Many clinics provide care on a sliding fee scale, says Zerkle-Kidd.
Although education in the emergency department focuses on the patient’s complaint, other issues are often addressed. Staff members try to encourage appropriate use of the emergency department by teaching patients how to differentiate between a health care problem that should be handled by their primary care physician and a true emergency. The visit also is a chance to provide general preventive health care education so the patient can stay healthy.
The wait at the emergency department is a good time to provide general education, says Zerkle-Kidd. At the OSU Medical Center, posters in the lobby area provide education on a disease of the month, such as hypertension or breast cancer. In addition, one television set in the waiting area is dedicated to educational videos that run continuously.
Certain health problems often trigger unnecessary emergency department visits, and the OSU Medical Center has begun to target these, beginning with asthma. An asthma protocol to teach patients how to determine when an episode requires a trip to the hospital was initiated about four months ago, says Zerkle-Kidd. Asthma patients receive a packet with medications, an inhaler with a spacer, a peak flow meter, and educational materials.
Before patients are discharged from the emergency department, they must demonstrate their ability to use the peak flow meter and inhaler. Also, they receive education on how to manage their asthma and when to visit the emergency department. The patient care resource manager makes an appointment for them with a physician as well.
A similar protocol for people with migraine headaches is in the planning stages. "We are trying to focus on one particular disease process at a time and fine-tune it before moving on to the next. When we start the new protocol, we will be able to look back at the other and see what worked and what didn’t work," says Zerkle-Kidd.
Baptist Hospital also is beginning to address health problems that don’t require emergency department visits. For example, because the hospital is located in an area with a large Latino population, the facility sees a lot of patients with nonspecific abdominal pain complaints. These cases often occur around holidays when big meals are served.
"Often, the abdominal pain is based on how much food people eat and their diet. This is one problem where people could go to their physician, but to them, they are dying, so they end up in the emergency department," says Balbosa Saunders.
Nurses in the emergency department teach patients the signs and symptoms of a gall bladder attack caused by foods high in fat and how to control the problem with the proper diet. Other areas of education include fever in young children and renal colic. Part of the education is teaching patients what the emergency department is for, says Balbosa Saunders.
[Editor’s note: For more information on Logicare software, contact Logicare Corp., P.O. Box 224, Eau Claire, WI 54702. Telephone: (800) 848-0099. Web site: www.logicare.com.]
For more information on education in the ED, contact:
• Suzanne Balbosa Saunders, RN, Assistant Nurse Manager, Emergency Department, Baptist Hospital of Miami, 8900 North Kendall Drive, Miami, FL 33176. Telephone: (305) 596-1960, ext. 5280. E-mail: [email protected].
• Jocelyn Zerkle-Kidd, RN, Nursing Program Manager, Emergency Services, The Ohio State University Medical Center, 450 West 10th Ave., 108 Means Hall, Columbus, Oh 43210. Telephone: (614) 293-8302. Fax: (614) 293-4838. E-mail: [email protected].
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