Discover the best’ practices for comparison
Try multiple sources based on sound principles
Question: "What do you use as best practice standards for patient education? Where do you go to get information on best practices? How do you ensure that your staff are adhering to the best practice standards you have established?"
Answer: There is not a single source for patient and family education best practice standards, says Kathy Ordelt, RN, CRRN, CPN, patient and family education coordinator at Egleston-Scottish Rite Children’s Healthcare System in Atlanta.
Ordelt uses multiple sources, including:
• Patient Education Management newsletter;
• journal articles;
• books;
• Joint Commission information and publications;
• networking at conferences;
• telephone conversations;
• e-mail;
• experiences at her own facility.
"We try things based on sound principles, and they work or don’t work. We try again until we find what works best for our staff and our patient population," explains Ordelt. In her quest for best practice, Ordelt uses a performance improvement (PI) model called FADE. The acronym stands for: Focus, Analyze, Develop, Execute/Evaluate.
"One of the things that is very helpful to me regarding best practice is a citywide group of patient education directors and managers that I co-chair," says Judith Nierenberg, RN, MA, patient education manager at St. Luke’s-Roosevelt Hospital Center in New York City. "The sharing that goes on there is invaluable."
The group currently is trying to find the best way to motivate staff to use a single interdisciplinary form for documenting patient teaching — and there’s universal resistance to it.
The group is examining and evaluating the effect of using customized forms for specific diagnosis-related groups rather than forms with areas for narrative information. The group wants to determine which type of form gets the best compliance.
When creating a teaching sheet, BJ Hansen, BSN, patient education coordinator at Grant/ Riverside Methodist Hospitals in Columbus, OH, does a literature search and also looks at materials from other patient education sources such as associations and publishing companies.
Compare Internet info with literature
She uses the Internet, but always tries to back up information gathered from a Web site with other literature. "I work with the clinicians in the specialty area to make sure it matches our practice as well as practice standards in the field," she says.
Fran London, MS, RN, health information specialist at Phoenix Children’s Hospital, has found the most practical definition for best practices on a Web site: www.best4health.org. According to this Web site, a protocol, guideline, standard, clinical pathway, or outcome can be considered a best practice if it:
• has been implemented and produces superior results;
• leads to efficient and exceptional performance in cost, quality, and speed, or is innovative;
• satisfies key stakeholders (patients, clinicians);
• is recognized either internally or externally as being the best practice (an award or presentation in publication, by an expert, by a consortium, etc.).
"I have not been able to find any examples of best practices that I know meet the four-part definition," says London. She contends that health care facilities need to create their own best practices, based on the research available.
These best practices should be individualized to a facility’s regional health environment, strategies and mission, organizational or community culture, or practice systems. Then institutions should share these best practices with other health care providers so that all benefit. (To learn more about how to apply patient education research findings to practice, see editor’s note at the end of this article.)
If a protocol, guideline, standard, or clinical pathway produces superior results and satisfies the key stakeholders, professional staff will embrace it because they are among the satisfied key stakeholders, says London.
Ordelt has put into place a system to ensure that staff practice what is considered best practice for the Atlanta children’s health care facility. This includes thorough inservices and education, management support to promote compliance, and evaluation through the PI structure. "I firmly believe that the best resource we have for great patient education is a well-informed and knowledgeable staff," she says.
Virginia Forbes, MSN, RNC, CNA, patient education coordinator at New York Presbyterian Hospital in New York City, agrees. "It is essential that staff are aware of the requirements and how to incorporate them into their practice," she says. This information is provided to each orientation group and reviewed in annual mandatory education programs.
A Patient and Family Education Handbook is kept in each clinical area and department so staff can quickly review such information as guidelines for teaching patients, cultural and religious considerations and barriers to learning, and teaching through the life span. The handbook was produced in-house.
It’s not enough to provide the tools, however. Patient education managers must evaluate as well in order to determine if the process works. "We performed a survey of patients who were near discharge with the intent of learning the patients’ perception of what was taught, who taught it, and how satisfied they were with the teaching, including the methodology," says Forbes.
The survey showed that 93% of the patients surveyed were satisfied with the teaching and its method during the course of their hospitalization. Follow-up phone calls to a sample of those patients revealed overall continued satisfaction with information received.
It is important to evaluate education and how it is delivered to determine if the institution’s standards have been met, says Ordelt. For example, evaluations have been done on asthma education. Skill checks are used to evaluate patient and family learning as well as monitoring factors that would indicate problems with the education, such as readmission for inpatient teaching and re-encounters for outpatient teaching.
The most concrete way to check staff compliance with patient and family education is through documentation, says Ordelt. "I check patient and family education via a bimonthly PI monitor," she says.
(Editor’s note: Details on how to apply patient education research findings into practice are offered in: London F. No Time to Teach? A Nurse’s Guide to Patient and Family Education. Philadelphia: Lippincott Williams and Wilkins; 1999.)
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