Checklist makes patient ed documentation much easier

New process increases staff’s documentation efforts

Many patient education managers struggle with staff documentation of teaching. No matter how many forms they create or inservices they conduct, the numbers on documentation remain low.

Only 12% of staff were documenting on the interdisciplinary patient education form at CareAlliance Health Services in Charleston, SC, when Jennifer Robinson, RN, MHS, patient education coordinator, brought a radical suggestion to the patient education council. Toss the form and include teaching documentation in the interdisciplinary progress notes, she suggested.

"All the samples from the literature and other hospitals showed a separate form. I hated to go against the norm," says Robinson. Yet within 16 months after systemwide implementation of the new process in 1999, chart audits showed an increase of documentation to 93%, and it consistently has remained above 90% for several years. Right now, it is 98%.

The progress notes are the foundation for all documentation and patient education was made a visible section on the form. "We made the documentation of patient education something that was part of the regular interdisciplinary progress notes; therefore, they can’t forget about it because it is always in front of them," says Robinson.

The documentation system is a checklist that is set up according to the patient education standards created by the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL. Both pain management and safety are included in the checkboxes. "We have the same boxes on the admission sheet and on the discharge sheet, and we have put them in the same order so the nurses can get used to that consistency," says Robinson. 

Also, if the Joint Commission were to issue new education standards, they would be very easy to add to the form, she says.

The checklist also focuses on the survival needs of patients, which they will need for self-care, such as nutrition and medication education.

To introduce staff to the new system of documentation, Robinson attended management meetings with a flyer that showed how to document on the progress notes. She frequently presents at management meetings and partners with management on all patient education projects.

In addition, the use of the form was supported throughout the year with seasonal flyers that were posted in the employee restrooms. In fall and winter, the flyers read: "Fall into the Habit, Document Patient Education." The backgrounds for the flyers were leaves falling and snow falling as appropriate to the season. For spring, kites were the background and hot-air balloons in the summer. The copy read: "Soar to New Heights, Document Patient Education."

Joint commission surveyors such as the documentation system implemented at CareAlliance Health Services, says Robinson. However, before a survey, the facility makes sure that all staff learn how the health care system meets the patient education standards including documentation.

One innovative method used to prepare for a Joint Commission survey is themed education fairs. The health care facility held an education roundup, which had a rodeo theme, an education celebration with a Mardi Gras theme, and an education cruise. There is a lot of excitement generated with the education fairs with prizes games and music. "Staff members think they are coming to a party. They don’t realize they are being educated at the same time," says Robinson.

For example, the mood for the cruise theme was created by placing a sailboat in the auditorium, and participants were eligible to win a small cruise in the local harbor. The sea otter mascot from the local aquarium stood at the door to greet people. Anyone who visited all the booths and completed a posttest received a coupon for a free cookie and drink at the cafeteria.

After each education fair, the education department created a themed book with the information from each booth included. The books were distributed throughout the hospital so those who were unable to attend the fair could prepare for the Joint Commission. "We still use the storybooks," says Robinson.

A peer-support system provides education on documentation of patient education throughout the year regardless of whether or not a Joint Commission survey looms in the near future. Each department selects people to monitor the charts for documentation; and if they discover that a particular person is not documenting consistently, they follow up with him or her. "It isn’t just monitoring for the sake of numbers, it is monitoring to see if there is someone who has not gotten into the habit yet or missed learning about it," explains Robinson.

The designated support people give Robinson the numbers from their chart audits, and she creates graphs so each unit or department can see if staff members are consistently documenting patient teaching.

The documentation system is quick and efficient, and it is visible, says Robinson. "The visibility is what makes patient teaching a priority," she says.

[Editor’s note: The checkboxes for patient/family instruction on the interdisciplinary progress notes at CareAlliance Health Services include nutrition, medications, activity/rehab, safety, signs/symptoms, wound/skin care, pre/post-op care, equipment, procedures, treatments, pain management, PEARLS (patient education and resource library), and others. The educator checks the topic of teaching and writes the process in the progress notes.

For the teaching outcome, a one or a two can be written in the box. The number one means that patients are able to state understanding and/or return demonstration. Number two means that patients are unable to state understanding and/or return demonstration and continued reinforcement of teaching is necessary.

There also are checkboxes for learning barriers. Choices include no barriers, physical, cognitive, emotional, language, reading difficulties, lacks motivation, and lacks readiness.

A code for the discipline documenting also is entered on the form. For example, a registered dietitian is an RD, and a physical therapist is a PT.]


For more information on the documentation system for patient education at CareAlliance Health Services, contact:

  • Jennifer Robinson, RN, MHS, Patient Education Coordinator, CareAlliance Health Services, 316 Calhoun St., Charleston, SC 29401. Telephone: (843) 724-2130. E-mail: