Convenience improves patient education efforts
Readily available tools, simplicity key
To improve patient education at LifePath Hospice in Tampa, FL, staff in the education department asked patients and family members what information they needed and how they liked to be educated. The same needs assessment was done with paid staff to determine what they thought the greatest learning needs of patients and families were.
From that assessment, about 150 patient education tools were assembled, says Janice Lowell, BSN, MPH, RN, C, director of education at the hospice. These tools included information on pain management, home safety issues concerning durable medical equipment, and symptoms experienced at the end of life.
A special list of all the tools was developed so field staff could document what was taught. Staff mark a check by the tool on the list, indicating whether it was the patient or caregiver who was taught. The documentation form also has a place to document whether the person taught could demonstrate or verbalize understanding, and another column to indicate if he or she wasn’t ready to learn.
The documentation form was piloted by one field team for three months. Their input was used to make a few revisions before it was implemented institution-wide. Each team was inserviced on the form before they began using it.
Quarterly chart audits revealed that the documentation form was not well-received by staff. They said it was too complex and they hated having another piece of paper to use and carry around. The education department decided to incorporate documentation for the educational tools into normal charting. While staff still were using the special form, a new documentation method was created and piloted with a field team.
Staff charted using the acronym FAIRS, which stands for: Focus, Assessment, Implementation, Response, and Subsequent action. "They wanted to fit the documentation into how they normally chart, so we added an E [for education] after the I and the acronym became FAIERS. We wanted the education to be prominent, but it is really a subset of implementation," says Lowell.
After staff were inserviced on the new method for documenting patient education, the old form was tossed. In hindsight, Lowell says they should have paid more attention to staff complaints about all the forms they had to fill out. They also should have done more than one inservice before implementing the documentation form. "I underestimated the amount of inservicing that needed to be done and the resistance to any change of behavior," she says.
While management currently is doing the quarterly chart audits, staff soon will take over the job and audit their own charts. They tried this with pain management documentation and found that staff seemed to develop a better understanding of what needed to be involved in documentation.
A change also was made in how educational tools are distributed. Lowell kept them in folders, with about 30% of the tools in an admission book given to the patient and family. However, she discovered that field staff weren’t picking up the tools and taking them to people’s homes.
Therefore, about 80% of the tools were placed in the three-ring admission binder kept in the home. When staff teach on a specific subject, they can use the patient’s resource manual, find the teaching sheet, and highlight or write notes on it, explains Lowell.
"Our method got simpler as we went along , and the simpler we could make it, the higher the compliance was," says Lowell.
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