New tracer survey methodology successful
The new tracer methodology for surveying the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations (JCAHO) implemented in January 2004 is working well, according to Michael Alcenius, MS, PA, associate director for the Standards Interpretation Group.
It is a much better way of evaluating a patient education program at an institution than the old method, he says. In the past, surveyors sat in interviews with leadership in organizations responsible for managing patient education. These dedicated educators could explain policies and what went into development of education programs, but surveyors were never able to observe whether the system set in place really was working, says Alcenius.
Now that the surveyors actually go to the point of care, select a sample of patients, and use their medical records as the tracer tool to follow the patient through their treatment and care, they are able to focus on various areas including education, he explains.
For example, if the patient is admitted for diabetes, the surveyor observes how insulin administration is taught as well as nutrition in relation to his or her disease process. The surveyor also checks to see if the patient’s learning needs assessment is being addressed.
“We go to the medical record to look for those keys to indicate compliance with patient education standards. We then discuss it with staff and the patient to make sure that what the staff is telling us, what the record documentation indicates, and what the patient is telling us is consistent,” says Alcenius.
JCAHO is finding that organizations really are quite compliant with patient education standards. Quarterly, the agency publishes the top 10 challenging standards areas, and patient education is not one of them. “We have not seen a significant amount of noncompliance issues with patient education,” he says.
Since patient education standards were introduced more than 10 years ago, they have undergone a considerable amount of revision to make them clearer. The modifications consistently improved the standards making them easier to implement, and patient education has become an established part of most health care facilities.
Therefore, when JCAHO integrated the patient education standards with those covering assessment, care, and continuum of care in a new chapter titled “Provision of Care” at the same time it changed the method for surveying there was no adverse impact.
Surveyors look for evidence
Alcenius describes the patient education standards as prescriptive but open. They are purposely written this way to fit the needs of a wide range of health care facilities from small, home care organizations that provide respiratory care for patients, to university-based medical centers that provide complex care.
“The way they are written, they require organizations to all do essentially the same thing, but they allow them to determine how best to come into compliance with the standards,” says Alcenius.
For example, the standards require that institutions conduct a learning needs assessment to determine the patient’s motivation to learn and if there are any physical or cognitive limitations or cultural and religious beliefs that need to be considered when teaching. Some organizations have a formal needs assessment in place, and others address this standard in the nursing assessment notes, he notes. “The requirement is there, but how the organization meets compliance is up to them, [as long as] they can evidence attention to those particular requirements,” Alcenius explains.
According to Alcenius, there are two areas in which many health care institutions need improvement. One is documentation of patient education. “Frequently, I find there is much more education occurring than what has been documented,” he says.
Documentation is important to JCAHO because it assures a continuity of education. Without knowing what was taught the day before, a provider cannot pick up where his or her colleague left off and continue the education process.
There are many ways to meet the requirement for documentation without making it a burden for staff, says Alcenius. For example, some institutions use the SOAP note, which is a format for an encounter with a patient as explained below:
- Subjective — what the patient is telling the provider; their complaint and their own perception
- Objective — refers to the clinician’s observation
- Assessment — considers both the patient’s and clinician’s observations, so a diagnosis can be made
- Plan of care
“Organizations that use this format may add a [second] SOAP — one plan for treatment and one for education, where they write what they discuss with the patient from an educational standpoint,” says Alcenius.
In addition to documentation, another area for improvement is the learning needs assessment. Once patients have been assessed on how they learn best and for barriers to learning, the findings must be taken into account when teaching.
“You may see sort of a template approach to patient education that really isn’t in the spirit of our standard. We want everything — care plans and patient education plans — to be specific to the patient and the needs of the patient,” explains Alcenius.
The new tracer methodology for surveying the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) implemented in January 2004 is working well according to the associate director for the Standards Interpretation Group.
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