Involve all departments to create a successful education plan
First, create a policy, then take steps to make it work
Four years ago, most patient education at Homestead (FL) Hospital was conducted by nurses. Today, in a dramatic turnaround, all disciplines are involved, says Yvonne Brookes, RN, patient education liaison at the hospital. The radical change occurred when the hospital formed a patient and family education committee, and that committee developed a unique interdisciplinary patient teaching record.
"The record is really the trigger because it is kept at the bedside as a constant reminder and was designed by all the disciplines," says Brookes. "It has a documentation section for nursing, pharmacy, clinical nutrition, social work, respiratory therapy, and physical therapy." (For more information on developing a follow-up plan for patient education, see related story, p. 107.)
The emphasis on interdisciplinary teaching at Homestead coincided with the big push for well-orchestrated patient teaching by the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations. In 1993, the Joint Commission separated patient education as a distinct set of standards that sent many hospitals scrambling to bolster their patient education efforts. Although most have developed policies and procedures for patient education, many are still struggling with the interdisciplinary aspect. Standard PF.4.2 in the education section requires that "the patient and family educational process is collaborative and interdisciplinary, as appropriate to the plan of care."
Many hospitals have chosen multidisciplinary documentation forms to show proof of a collaborative education effort. The forms are usually kept in the patient’s chart, so anyone who teaches the patient can easily document on them.
Put plan in place
The patient education committee at Homestead knew it takes more than a teaching record to prompt various disciplines to participate in patient education. There must be a system in place to orchestrate the teaching and decide which discipline can best meet the educational needs of the patient. Therefore, the patient’s educational needs and who can best meet them are decided during multidisciplinary rounds twice a week. Nurses act as gatekeepers between rounds.
"They have complete authority to call other disciplines. They don’t have to wait on a physician to give an order," says Brookes. For example, if the nurse notices that a patient has an unsteady gait, he or she can notify physical therapy to come teach the patient about home safety and how to use a walker. The physical therapist would obtain the physician order if needed. By referring to the interdisciplinary teaching record kept at bedside, the nurses can quickly see what the patient already has been taught.
Northwestern Memorial Hospital has taken a slightly different approach to incorporating interdisciplinary patient education. At the Chicago health care facility, critical pathways are essential to interdisciplinary teaching. When one of the 150 pathways is initiated, each department, whether nutrition or pharmacy, knows when a member of its staff needs to teach and what must be taught, says Magdalyn Patyk, MS, RN, patient education coordinator at Northwestern. When patients aren’t on a critical path, orchestration of interdisciplinary teaching is more difficult. Currently, the hospital is working on a plan for multidisciplinary rounds for the patients that aren’t on a pathway.
At Nyack (NY) Hospital, various disciplines are often alerted to the teaching needs of patients via physician orders or contact by a nurse. Within the last year, the hospital started using case managers to ensure that teaching by the appropriate disciplines is complete before discharge, says Mary Loftus, RN, BSN, CDE, patient education coordinator at the hospital. The education is tracked on an interdisciplinary form. (See an example of Nyack’s documentation form and the forms of all hospitals mentioned in this article in the educational supplement, inserted in this issue.)
Hospitals use many methods to trigger interdisciplinary teaching, but there is no "right way." However, make sure that the policy you have set in place is followed, warns Anne Kobs, MS, RN, associate director in the department of standards at the Joint Commission. For example, if a hospital’s policy states that the dietitian will complete the dietary teaching for diabetic patients, the surveyor during the accreditation process will ask patients if they have been taught by the dietitian.
Break mindset of nurse as only teacher
Often, old mindsets must be changed to promote interdisciplinary teaching.
"There is an expectation that nursing can and will do all the education, even though not all nurses are good teachers," says Betsy McCune, RNC, MS, clinical pathway coordinator at Providence Alaska Medical Center in Anchorage.
To break that mindset, new nurses at Homestead are taught during orientation that they aren’t expected to do all the teaching. Instead, they learn how to incorporate other disciplines into the teaching process. Also, when the multidisciplinary teaching form was initiated, the patient education department conducted unit-based inservices to teach nurses when it is appropriate to involve other disciplines in teaching. They were given examples of actual cases and asked who should be involved in the teaching.
"It was case manager-type training," says Brookes. Posters reviewing the information were put up on nursing units to reinforce the teaching.
When the distinction of which department should teach is not clear, developing criteria can help.
"Our biggest problem is pharmacy," says Brookes. "Staff feel they are needed in the pharmacy and don’t have time to see patients. So we set criteria."
When certain drugs are prescribed, such as Coumadin, a pharmacist must do the teaching. When a patient must be taught about food and drug interactions, either the dietitian or the pharmacist can do the teaching.
Loftus has noticed a difference in cooperation between departments since they began working together on interdisciplinary patient education committees.
"I can remember when it was blame the other department’ when things didn’t get done," says Loftus. "People forgot that we are all here for the same reason. It’s not nursing against dietary, against home care. We are a team. By serving on interdisciplinary committees we have learned to work together."
To help reinforce the idea of teamwork, Nyack Hospital held hospitalwide inservices on team building two years ago. A professional was hired to teach nursing staff about team building. The nursing staff then conducted inservice sessions for approximately 20 staff until all were educated. Departments involved included physical therapy, respiratory therapy, dietary, and nursing.
Some of the barriers to education that are brought on the changing nature of health care actually promote interdisciplinary teaching. A shortened length of stay makes cooperation imperative, says Patyk.
"What we taught in two weeks now has to be completed in four days, so everyone has to be extremely efficient," she says. "All the disciplines have always taught, but in the current health care climate, it is very important for them to work together as a cohesive team."
[Editor’s note: For questions on the multidisciplinary documentation forms used to orchestrate teaching, contact the patient education coordinator at the appropriate hospital. Yvonne Brookes, patient education liaison at Homestead (FL) Hospital (305) 242-3530; Mary Loftus, patient education coordinator at Nyack (NY) Hospital (914) 348-2589; Madge Patyk, patient education coordinator at Northwestern Memorial Hospital in Chicago (312) 908-2212; Lee Stark, education coordinator at Providence Alaska Medical Center in Anchorage (907) 261-3011.]
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