The wave of the future: Computer-based patient education
Computers offer consistency, distribution ease
Many providers involved in coordinating the care of patients upon discharge are finding that in an environment where time is of the essence and fewer employees are performing more duties, computer-based patient education and computer-generated handouts can provide very real benefits.
A common complaint among discharge planners and other health care professionals is that many patients forget or misunderstand much of what they are told by providers. This makes educational handouts an important component of their ongoing care after discharge. Increasing competition and consumerism in health care has intensified the demand for this kind of patient education. Documentation of patient education is now a routine part of discharge planning and a requirement for hospital accreditation. In addition, patients are more likely than ever to want to be fully informed about their conditions and to participate in their treatment.
Practitioners using these computerized patient education systems, which can be purchased from a vendor or developed in-house, report more comprehensive distribution of educational materials with content that is consistent and up to date. Although cautioning that the investment in setup and training time can be daunting, they list the following benefits:
* Computer-generated materials are literally at your fingertips. You do not have to look for them in a materials storage area, or discover that the hospital has run out of the handouts you need. With patients in the hospital for increasingly shorter stays, speed of access is important.
"Patients are here for that window of time," says Mary Wolcott, RN, patient education coordinator at Methodist Hospital in Omaha, NE. "When they need the information, they need the information."
* There is no storage issue, as there is with hard copy. Although some practitioners may print a few copies to have on hand in various departments, computer-generated materials eliminate the need for vast storage areas -- and the problem of faded copies that have deteriorated during storage.
* The information is standardized and consistent. The patient is not given slightly different instructions by the various care providers involved.
* In cases where a patient education database is purchased from a vendor, the hospital saves the staff time that otherwise might be spent researching, writing, and updating their own materials. Another alternative, soliciting preprinted materials from the various sources that provide them, also can be labor-intensive and time-consuming. (See what questions to ask about computer systems, p. 57.)
"Particularly in rural areas, hospitals do not have the personnel to work on creating, or even locating appropriate material," Wolcott notes.
"If I had to create [materials] from the get-go, there is not only the resource utilization, but the time to create an accurate document," adds Debbie Wayman, RN,C, clinical program coordinator for Lake Hospital System in Painesville, OH. "I would have to make sure I'm speaking to the current research and current practices, that I was writing in a fourth- to sixth-grade level, and then go through some sort of approval route. By the time I had it typeset, formatted, and out for implementation, it's not just an exaggeration to say that enough time could have passed that the practices [could have changed]."
* Computer-based materials can be individualized to varying degrees. This can range from having a place to add the hospital's name and perhaps the patient's name, to being able to edit the content to make it more relevant to your patients.
"We're able to put a header on [computer-generated handouts] for our facility," says Wayman. "With two structured hospitals and multiple other facilities [in the hospital system], it's helpful for that document to list that hospital with an address and phone number. It's one more resource."
* Most patients want as much information about their medical conditions as possible.
Before her hospital purchased its patient education program, Wolcott conducted a survey of emergency department patients that revealed that 98% of patients thought such materials would be helpful to them -- feedback that was difficult to ignore.
She continues to include an evaluation sheet in the educational materials that are given to patients in which she asks whether the amount of information provided is too extensive -- something she initially was concerned about.
"I've never had a patient say there was too much," Wolcott notes. "When it's your condition, you really can't get too much information."
Cautions for computerized education
* Training staff to use the system may take more time than you think.
"The disadvantage [to a patient education database] is the number of hours required for initial training," says Wayman. "You're constantly worrying with that, and in most places now, the number of staff you have is the number you need. There's no fluff, so [training] is not something you can do during work hours."
Her employees receive four hours of initial training on the database, plus whatever investment is necessary for ongoing training to ensure proficiency, she says. The initial training was conducted after hours.
The hospital uses two patient education programs from Denver-based Micromedex called CareNotes and AfterCare. "There are on-screen instructions, so if you can read, you can get in and out," Wayman says.
* Patient education databases may not lend themselves to producing photographs or other illustrations. Ideally, a database would include photographs and graphics, Wolcott and Wayman say; however, the products they use are text-based only.
Sometimes a picture is truly worth a thousand words, Wolcott explains. "If you show a picture of an arm, then you don't have to worry about someone having low literacy skills, or whether [the document] is written in French," Wolcott says.
Wayman adds that it is invaluable to have a detailed illustration in a patient instruction guide on, for example, an implantable port. She predicts that with the growing use of CD-ROM, patient education databases will soon offer more illustrative possibilities. In fact, Micromedex expects to release those capabilities in CareNotes by the end of 1996, a company spokeswoman says.
At Methodist, Wolcott uses a product called Patient Drug Education PC by Indianapolis-based Medi-Span. The company expects to offer illustrations in its 1997 product line.
Create your own material
Creating on-line materials in-house is another patient education option. Wolcott draws on an in-house, on-line collection of more than 600 patient education handouts, about 300 of which she and other hospital personnel created. The remainder include materials purchased from about 180 vendors, and some that are provided free by such organizations as the American Cancer Society, the National Cancer Institute, and the American Diabetes Association.
"The materials I have created I have on computer disk, and I do have the capability of putting those on the network system," she says. "Different offices can get those and print them out. They may give information about having a particular test, or how to care for your incision."
In an effort to make better use of the resources available, Wolcott works with representatives from different areas of the hospital system who, as part of their job responsibilities, are involved in the distribution of patient education materials.
"I just started meeting monthly with these people to find out how we can work together better, so one hospital isn't developing the same thing another is already working on," Wolcott says. "That can be a battleground because everyone still wants their own identity."
Wolcott is always seeking ways in which patient education can be used even more effectively, such as giving patients discharge information before they get to the hospital. "For example, we put some discharge information into the total hip and total knee books that patients are given before surgery," she says. "We have them in the doctors' offices, and if the doctor hasn't given it to them, we offer to mail it to them when the scheduling [for surgery] is done."
This material suggests that the patient begin thinking about discharge before entering the hospital, taking such actions as preparing meals and freezing them for future use, arranging to have a person stay with them if they live alone, and removing throw rugs that could increase the chance of a fall. *
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