Bringing the big job of materials distribution and managment down to size

Select system, train staff, create guidelines for writing and review

The process of managing patient education materials and databases is a big job. "I had no idea this could be a full-time job for maybe even two people to manage a system of patient education material. It takes so much more time than I have on a daily basis to devote to it," says Ashley Ave, a health education specialist at Children's Hospital Central California in Madera.

What makes it such a big job? Centralizing patient education materials means uncovering all the different handouts used by staff across the continuum of care. And when there are redundant teaching sheets, there must be agreement among clinicians on what information to include in the revised single copy. One document took a year to consolidate and revise, says Leslie Catron, RN, BSN, who co-chairs the patient and family education committee with Ave and works as a clinical educator and student coordinator at Children's Hospital Central California.

There's also the issue of getting material into the hands of clinicians in an uncomplicated manner and making them aware of the inventory so it will enhance their teaching and benefit patients with up-to-date information.

To get control of the process, patient education managers must determine how to identify the handouts that will be used across the continuum of care, train staff on the nuances of the system, and provide guidelines for the creation and review of materials.

The first step is creating a system or method for the distribution of materials.

At Children's Hospital Central California two databases are used. One is a commercial database with about 4,000 titles that was purchased by the health care system a couple of years ago and the second is a smaller database with documents that were created in-house.

The educational materials created in-house are instructional, while the items on the commercially produced Health Encyclopedia provide general information. For example, there is an in-house sheet on cast care but a description of orthopedic care would come from the commercial database.

At The Ohio State University Medical Center in Columbus, patient education materials are available through the institution's Intranet and Internet sites and the expectation is that clinicians will print copies as needed for patients, says Diane C. Moyer, BSN, MS, RN, program manager, consumer health education.

A number of disease-specific books that are a collection of various handouts can be ordered on-line for delivery to the units for distribution to patients and family members. The books include information on diabetes survival skills, heart failure, cardiovascular surgery, and bariatric surgery. Additional resources are available in person, by e-mail, or by phone through the Library of Health Information, says Moyer.

Vendors can meet needs

Although the vast majority of items are created in-house, certain titles are created by outside sources. Clinicians have access to several products from MicroMedex for medication instructions and alternative therapies.

"The medication instruction sheets were just too hard to keep up with as part of internal inventory and the alternative therapy component adds information on various herbs and other treatments that we did not have in our internal inventory," says Moyer.

In addition, the health care facility has a link to foreign language materials created as a joint effort by several health systems in central Ohio.

"The link to the translated materials was done rather than having to spend the time and manpower to load them into our system and update them," says Moyer.

While there are many good commercial products available that provide easy-to-access written materials for patient education, The Ohio State Medical Center had such a large inventory of in-house handouts, which had been worked on for readability, it would be difficult to find a product to meet its needs.

"Because our system has so many specialty areas and new treatments and technologies, we would still need to supplement most products to keep our clinicians happy," says Moyer.

In addition, staff have been developing more materials for the outpatient services and often those are not part of the packages commercial vendors offer.

A wide selection of materials is available to clinicians at Children's Hospital & Regional Medical Center in Seattle through a web-based database with search functions as well as many commercial databases such as Pediatric Advisor and Health and Wellness.

In addition, about 500 handouts developed at Children's are available to print on demand for educational purposes, says Melissa Tumas, MPH, a health educator.

While a wide selection of handouts seems like a good way to enhance patient education, clinicians are not always sure what vendor might be the best choice or which piece to choose. Therefore, the patient and family education department created what is called "toolkits" for various departments.

"We have been hearing for years from nurses and doctors that they wanted information accessible on the web and they didn't just want to go to Google and search for something. They wanted to have reliable sites and they wanted to have everything, even the Children's-produced pieces, to be print on demand," said Tumas.

The education toolkits are housed on the Intranet and are a collection of materials and resources pertinent to a department. Staff can go to their own clinical page to find the most pertinent educational pieces produced in-house. And there are links to five additional information sites where clinicians can search for items. There also is the option of sending patients to the Family Resource Center.

Distribution more than a system

While a good system is important, it will not be used if staff are not aware of the options they have for educating patients. Patient education managers must get the word out.

There are a number of ways to promote the use of databases for accessing patient education, says Tumas. She has used a resource fair held either in the cafeteria, front entrance to the medical center, or at the Family Resource Center. In-house communication channels also work, such as a weekly central e-mail that broadcasts information throughout the medical center, and system-wide newsletters.

"We have a group of patient education liaisons who are generally nurses and clinical educators in both ambulatory and inpatient clinical areas that we access quite a bit as well. They are the one patient education champion in their area," says Tumas.

It is difficult to make staff aware of the wealth of resources available, says Moyer. Information is given during nursing staff orientation and some details are given during department orientations.

"We try to spread the word during accreditation fairs, in-services, and newsletters but often staff are not aware of what is available except for maybe a few books they use on the unit all the time," says Moyer.

Colorful, laminated cards that explain how to access the health encyclopedia were made and distributed to the computer stations in each department at Children's Hospital Central California by members of the patient and family education committee. It is the responsibility of committee members to communicate with staff about both the commercial database and access to in-house materials, says Ave.

As part of the health care organization's quarterly clinical updates, staff took a screen shot of the directions for accessing the Health Encyclopedia and Intranet site and explained how to retrieve materials.

Some staff are having difficulty changing from a paper filing system to a print-on-demand database, says Catron. However, all staff understand that with a database the copy can be up-to-date, evidenced-based information, Ave says.

Commercial vendors automatically update the material they offer on a regular basis. When copy is written in-house, a review process must be enacted.

"We send out about 1,000 titles each year for clinician review and ask them to let us know if changes are needed or if the title should be deleted. In addition, as clinicians see the need for changes on titles, they may send us revisions at any time and we make those revisions," says Moyer.

When Ave gets an e-mail from an author of one of the documents on the Intranet telling her the process has changed, she pulls the sheet until the revisions are complete and then uploads it again. When the date comes for a document to be reviewed, she pulls it and has the author or a content expert revise it as needed. Copies of each revision are kept for tracking and historical purposes, says Ave.

Just as policies must be in place for review of materials in a database, there must also be guidelines for creating the pieces.

Moyer says there is a "request to develop" form that must be filled out at her institution. In this way people can be notified if someone is already working on a topic or if there are other areas that may be interested in working on the title. The requests come to the review committee and the response is given to the author. If a handout already exists, it might be sent back to the author as well to see if the title meets the intended need or if alterations might be made.

Requests to create a handout are sent directly to Ave at Children's Hospital Central California and because she is familiar with the databases, she is able to let them know if a similar piece exists. The staff member who made the request is sent a copy of the handout to see if it meets his or her needs.

If the staff member writes a new piece, it is with the aid of Ave or another member of the patient and family education committee so they can make sure health literacy principles are followed and the handout is easy to read.

Tumas says when requests for writing handouts are made at Children's Hospital, the author is asked to research existing sources. "Developing materials is time-intensive and there is so much material available, we don't want to write something if something really good already exists," she explains.

One danger of having so many choices for written handouts is that patients might be inundated with information. Moyer says it is difficult for some clinicians to understand that more is not always better and they don't need to give patients all the information at once.

"With some of our books we started with everything the patient could possibly need to know for the life of the illness, and over time and revisions we keep narrowing the content because of patient and family input," she says. n


For information about distributing and managing patient education materials, contact:

  • Ashley Ave, health education specialist, Children's Hospital Central California, 9300 Valley Children's Place, Madera, CA 93636. Phone: (559) 353-5908. E-mail:
  • Leslie Catron, RN, BSN, clinical educator & student coordinator, Children's Hospital Central California, 9300 Valley Children's Place, Madera, CA 93636. Phone: (559) 353-5592. E-mail:
  • Diane Moyer, BSN, MS, RN, program manager, consumer health education, The Ohio State University Medical Center, 1375 Perry Street, Room 524, Columbus, OH 43201. Phone: 614-293-3191. E-mail:
  • Melissa Tumas, MPH, health educator, family resource center, patient and family education, Children's Hospital & Regional Medical Center, 4800 Sand Point Way NE, T-5112, Seattle, WA 98105. Phone: (206) 987-2893. E-mail: