Kick start pre-surgery education in the clinics
Cooperation built by providing materials
Q: How can patient education managers partner with physicians in outpatient clinics on pre-surgery education? What teaching can patient education managers expect from staff in the clinics, and what should be completed in the inpatient setting?
A: Providing physicians with the tools they need for patient education is one way to gain cooperation. That’s why staff at Providence Hospital in Anchorage, AK, produced a pre-op teaching video that targets parents bringing children in for day surgery. "Basically, it is a seven-minute program that follows a family through the various stages of day surgery," explains Lee Stark, RN, BSN, education coordinator at the hospital. Its purpose is to link the education efforts between outpatient and inpatient to reduce cancellations from unprepared patients. Copies are distributed to the surgical and pediatric physicians’ offices. The film also is shown at the day surgery center.
At Riverside Regional Medical Center, staff worked with physicians to develop handouts for the top admitting diagnoses for surgery. The booklets are distributed through the pre-surgery center and physicians’ offices. "The patient may get the same booklet twice, but that is OK. What we want is consistency," says Julie Stern, RN, BSN, quality outcomes coordinator for Peninsula Health Care in Newport News, VA. (Until recently, Stern was patient education coordinator at the medical center.).
Yet, creating materials does not guarantee the physician will cooperate. If you want physicians to use educational materials to prepare patients for surgery, you must get buy-in, says Stern. This is best accomplished by getting their approval as the booklets are created. While a committee is formed at the medical center to either develop booklets or purchase them, once selected, the materials are sent to other appropriate committees for approval. Depending on the surgery, these committees might include the various physicians’ practice committees, surgical liaison committee, or oncology committee.
Several physicians also are asked to review the content of the pamphlets. To simplify the process, Stern sends a memo that lists the key information she wants from the physicians. Each question has a yes or no check box so the physician can complete the task quickly. Questions might ask whether the physician likes the material or if they would use the booklet. The sheet is self-addressed and stamped, so the physician can fold, staple, and mail it back when complete.
Once approved, educational materials progress through a chain of committees so everyone in the hospital is aware that they are available. "A couple of years ago, we did not send handouts to all the committees, but we found that although we developed useful materials, no one ever knew about them. It’s not an approval process but more of a communication process," says Stern.
A medical liaison also is used to promote the use of the booklets to physicians and take orders for them. The patient education office tracks orders of educational materials from physicians’ offices to determine which physicians are using the information. The information is sent to the liaison who discusses the merits of the booklets with those physicians who don’t make use of the materials.
To encourage use of the pre-op videos for day surgery at Providence Hospital, physicians are encouraged to customize the tapes for their patients. The video was designed so that physicians can add three minutes at the beginning of the video and four minutes at the end. They can discuss their protocol and answer the most frequently asked questions, says Stark.
To promote use of the generic day surgery video, the staff at the center plan to have a luncheon for staff from the physicians’ offices to teach them how to use the tape and what patients need to be taught before surgery. "It worked in the past when we did diabetes education, so we are assuming it will be the same kind of response," says Stark.
Verify outpatient teaching
Patient education that is started in the outpatient setting must be coordinated with the education that takes place during the inpatient setting. To track teaching in the inpatient setting and to verify that pre-op instructions were given in the outpatient setting, a documentation tool is initiated upon admission at Riverside Regional Medical Center. "The admitting nurse initiates the documentation tool and identifies what education the physician or pre-surgery center has provided for the patient," explains Stern. The patient’s learning is assessed to make sure he or she understands the information given by the physician.
The documentation tool follows a teaching standard specific to the procedure. This includes instruction for pre-procedure, post-procedure, diet, activity, medications, rehab techniques, medical equipment, and health improvement behaviors. There also is a patient pathway that is distributed to patients upon admission to the hospital. Many physicians’ offices keep copies of the pathway to help staff answer patients’ questions about the recovery process. However, they do not give the pathway to patients because the surgeon does not have time to go over the material with the patient. (To review an example of the teaching standard, documentation tool, and patient pathway, see copies, pp. 55-58 and insert.)
In some cases, the education for a surgery is too time-consuming for the patient to be taught at the physician’s office or during his or her hospital stay. With such procedures as open heart surgery or total joint replacement, the teaching must be done in classes prior to surgery, says Stark.
Yet before creating a class, Stern advises patient education managers to look at what is available throughout the health care system. She helped organize a breast cancer surgery task force at Riverside to determine what educational resources were available and how they could be coordinated. To assess what was available and how people accessed the information, the task force developed a flow diagram. They determined that there was an opportunity for education at the outpatient mammography units, physician’s office, surgeon’s office, pre-surgery center, hospital, and the cancer resource center. However, people were not receiving information at all these venues. For example, no education took place in the mammography units.
Therefore, appropriate materials were selected for each area such as self-breast exam pamphlets in the mammography units. The complete educational package is available in the resource center. "In all our handouts, we reference the cancer resource center so at any point patients can refer themselves to the center for more information," says Stern.
[Editor’s note: Do you have a question about patient education? Patient Education Management can provide you with specific expert advice gathered from your peers. Write: Patient Education Management, Susan Cort Johnson, P.O. Box 740056, Atlanta, GA 30374. Telephone: (916) 489-3769. Fax: (404) 262-7837. E-mail:[email protected].]
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