Pathways big boost to education
Improves timeliness, sequence, getting job done
Question: Do critical pathways improve patient education? What is involved in the development of a successful education portion of the pathway? What role do patient education managers play in their success?
Answer: During the development of pathways, staff at the University of Utah Hospitals and Clinics became acutely aware of how fragmented patient education is, says Cheryl Kinnear, RN, BSN, coordinator of clinical programs at the health care facility in Salt Lake City. It also became obvious that patients weren’t always taught at the appropriate time.
Creating the pathway gave staff an opportunity to review the sequence of patient education and the timeliness of teaching, which resulted in a better education plan. "Our pathways cover the continuum of care, starting with the clinic visit and ending with follow-up. What the teams I have worked with have done is reorganize where the education happens along the continuum so it occurs in a more timely way," says Kinnear.
For example, information that might have been taught on an inpatient basis following a procedure is now taught in the clinic when the patient is more alert and ready to learn.
Because critical pathways outline the education process, teaching is not forgotten. "The plan is articulated, and the expectations are stated so what needs to be presented to the patient and taught is very clear," says Verdell Williamson, MS, ONC, advance practice nurse in orthopedics at Northwestern Memorial Hospital in Chicago.
Make teaching a separate category on the pathway, says Williamson. When the committee creating the pathways for total hip and knee replacement at Northwestern wrote the first draft, education was blended with treatment and activity.
While it seemed that teaching was always taking place, staff determined that there was certain information that patients needed to know, and the pathway was revised. For example, staff was instructed to teach hip precautions one day and review them the next. (See the pathway, p. 155.)
"It’s difficult to go through the whole pathway to find out what was taught," says Williamson. "It’s much easier to look in the teaching section and see what was taught and what needs to be done. "
Pathway strengthens documentation
Another benefit of a critical pathway is that it improves documentation of patient education, says Allison Reid, MS, RNC, an educator at St. Francis Hospital & Health Center in Blue Island, IL. Although it doesn’t eliminate the need for a patient teaching record, it helps ensure that all teaching is documented. Also, it makes certain that the hospital is meeting other Joint Commission on Accreditation of Healthcare Organizations requirements in addition to documentation, such as assessing a patient’s readiness to learn, she explains.
Staff at St. Francis have also determined that patient pathways, which mirror the critical path but are written in lay terms, help form a partnership between patient and staff. Because the patient understands his or her responsibilities during the recovery process following surgery, medical outcomes improve, says Pat Pacewic, RN, BSN, manager of clinical pathway development at St. Francis. For example, the patient prepares his or her home for discharge, removing such hazards as throw rugs, making an accident less likely, she explains.
"The path sets expectations for patients and prepares them for learning. It also reduces anxiety," says Reid.
Involve appropriate disciplines in design
To assemble a pathway, pull together each discipline involved in the patient’s care. In that way, the team can look at the role each discipline has in the care and education of the patient and outline that information in the pathway, says Pacewic.
"For hip and knee replacement surgery, the physical therapist and occupational therapist have very specific things they need to do during the patient’s hospital stay, and they need to provide education based on what they are doing," says Pacewic.
At St. Francis the team separated activities that needed to take place during a patient’s hospital stay in "care categories." Depending on the pathway, these care categories might include: key nursing activities, physical therapy, education, spiritual care, and consults. What needs to take place each day is then bulleted out according to each category.
For example, on day two of the diabetes pathway, the dietitian teaches meal planning, and the pharmacist gives blood glucose monitoring instruction.
"In that way disciplines are not only accountable for providing or doing the skill, service, or treatment but for providing the education to the patient as well," says Reid.
What does the coordinator do?
The role of the patient education coordin-ator in the pathway development process is to look at the entire continuum of education on the pathway and make sure that it meets Joint Commission standards and is consistent, says Reid. The coordinator also should make sure the team is aware of all available teaching materials when making its selection for the pathway.
Also, he or she ensure that educational outcomes are specific, advises Madge Patyk, MS, RN, patient education coordinator at Northwestern. For example, giving the patient a surgery booklet should not be an outcome. The content of the booklet the patient needs to know is the outcome, she explains. For example, a good outcome would be: "Patient verbalizes understanding of signs and symptoms of infection."
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