Make sure your patient education is effective
Putting education in pathway key to success
Patient education can cut costs and readmission rates, improve quality of care, and even save lives. You know, for example, that a myocardial infarction (MI) patient who learns to stop smoking is much less likely to return to your cardiac unit. But how do you make sure he or she got that information, and how do you prove it helped?
1. Get it on the clinical path.
Clinical pathways that help you document, validate, and demonstrate what you have to offer are key to successful patient education, says Carolyn Brown, RN, MN, CCRN, cardiology clinical coordinator at Emory University Hospital in Atlanta, GA. Pathways standardize your approach, which improves quality and gives you instant documentation that is especially helpful when dealing with managed care groups. "In the fast-paced cardiac care environment with rapid turnover of patients, education has to be well-orchestrated," Brown says.
Emory uses pathways developed for each specific diagnosis or procedure, such as MI, congestive heart failure, and pacemaker, to organize and increase quality of care. Teaching plans included in the path provide a script tailored to each diagnosis that helps new nurses and serves as a review for others.
2. Streamline your strategy.
A streamlined documentation strategy makes it easy for staff to comply and hard for anything to slip through the cracks, explains Mary Welch, RN, MSN, cardiovascular case manager at Moses H. Cone Memorial Hospital in Greensboro, NC. At Moses Cone, a teaching guide for the specific diagnosis is inserted in the clinical pathway kept with patients’ charts. Any staff member from physician to nurse to dietitian to physical therapist can look on the user-friendly form to see what patients have already learned and then check off additional information they have given the patient. Resources are coordinated so each of the hospital’s cardiac units gives the same information on stents, for example, or angioplasty.
"The nurses are glad to have only one tool to guide their teaching efforts and one place to chart them," Welch says. "It saves so much time. You can spend more time teaching and less time on paperwork."
3. Choose your battles.
With lengths of stay shorter than ever, there isn’t enough time to teach a patient everything you know. It helps to let the patient select a couple of risk factors, like smoking and hypertension, to focus on while in the hospital. "We try to put the decision-making in the patient’s hands," Welch says. "The patient traditionally is out of the decision-making process from the moment he or she walks in the door and has to give up his or her clothes for a hospital gown. It’s a waste of time if the patient is not interested in learning."
Moses Cone provides patient care guides that explain everything from pre-procedure to home care. Patients are also informed about follow-up classes, home health, and community resources that can help them with anything that post- procedure fatigue, stress, or simple lack of time made it hard to learn during their stay.
4. Document your work.
The cardiovascular patient education form (see sample forms, pp. 33-35) developed at North Carolina Baptist Hospitals in Winston-Salem lists desired learning outcomes such as:
• safe and effective use of medication;
• potential drug/food interactions;
• nutrition intervention/modified diets;
• cardiac rehabilitation;
• information about tests and procedures;
• cardiac risk factor modification;
• community resources;
• exercise/activity instruction;
• disease management of MI/Angina/CHF;
• discharge instructions.
Staff use codes to document the action they have taken under each outcome: L for literature given, ID for information discussed, IR for information reviewed, or OM for outcomes met, says Lisa Kiger, RN, MSN, CCRN, clinical nurse specialist, cardiology. The form, inserted in the patient’s clinical pathway, moves with the patient throughout the hospital and is proving helpful in rounding with physicians. "It helps, not only among nurses, but with our physicians," Kiger says. "Someone will say, this patient’s lipids show this, shouldn’t he be on lipid-lowering agents?’"
5. Evaluate your efforts.
Baptist Hospital uses multidisciplinary management teams to collect and analyze data relating to specific diagnoses. Currently, data is being collected on what percentage of MI patients receive counseling on nutrition, exercise, home activity, cardiac rehab, and smoking. The MI management team will assess whether patient education goals are being met and if not, why and compare the results to length of stay, readmission rates, vascular complications, and internal and external benchmarks.
Emory plans ICD study
At Emory, the school of nursing has applied for a National Institutes of Health grant to further study outcomes of internal cardioverter defibrillator (ICD) patients. A 1995 study by Sandra Dunbar, RN, DSN, SAAN, associate professor, of symptoms ICD patients had after discharge led to changes in the patient education tool. Information was added on sleep, pain control, and mobility. The proposed study would look at what kinds of interventions are needed to reduce ICD symptoms. The hospital is also beginning to track readmission rates and planning to start a return phone call program that would ask patients specific questions such as "did you get enough information to understand your disease process."
Patient surveys are used at the VA Medical Center in Albuquerque, NM, says Carol Maller, MS, RN, CHES, patient education coordinator. Patients in the medical center’s group program complete a satisfaction form (see form, pp. 36-37) and a knowledge-based form. A third form asks specific questions tied to Joint Commission on Accreditation of Healthcare Organizations standards, such as providing understandable information and teaching about medications. "Just because you document that you’ve given patients certain information, it doesn’t mean they are going to change their behavior," Maller says. "That’s why we stress repetition and why we follow up in a group setting when they’re more ready for learning and can bring family members to help."
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