To purchase teaching sheets or write in-house: That is the question

Consider available resources and evaluate the pros and cons

Which is best? Purchasing commercially produced teaching sheets or writing your own to distribute via the Intranet? The answer is not as simple as the question seems; there are many issues to consider.

"You have to look at your internal resources and whether or not you have sufficient staff to accomplish creating your own material. It is time-intensive and it requires a watchful eye to maintain a decent process and ensure accuracy and availability. If you don't have those internal resources, you really are far more likely to go to commercially produced products," says Zeena Engelke, RN, MS, patient education manager at the University of Wisconsin Hospital and Clinics in Madison.

It's important to look at the purpose of the piece, what the use will be and the audience, advises Kathy Ordelt, RN-CPN, CRRN, patient and family education coordinator at Children's Healthcare of Atlanta.

"We try to produce any materials that address topics that are high risk or high volume because we want our own input in it. — our own physicians dictating what the teaching sheets say; our own staff saying this is our process for taking care of this particular topic," says Ordelt.

Evaluate your patient population to determine if it has unique educational needs, says Cindy Latty, BSN, RN, patient education coordinator at Riley Hospital for Children, Clarian Health Partners Inc. in Indianapolis. If a patient education manager works at a specialty hospital teaching sheets from a commercial vendor might not be geared toward the diagnoses, conditions, and procedures physicians would need to educate a patient on.

"Also evaluate whether or not you have the time to create materials or, looking at it from the other side, if you have the time to review the materials on a regular cycle," she adds.

While cost is frequently a factor patient outcome is far more important, says Engelke. "You can't look strictly at how many dollars it takes to produce a certain piece or the time it took to create it but rather does it say what patients need and as a result are they able to carry on the self-care skills that relate to that disease or health care episode," she explains.

If patients are able to follow self-care instructions correctly the institution may save thousands and thousands of dollars in follow-up calls or return hospital visits, says Engelke.

Commercial material was reviewed at Riley Hospital for Children but it was determined the teaching sheets would need to be further customized and therefore it was not a good use of funds, explains Maureen Battles, BSN, RN, who shares the duties of patient education coordinator with Latty at the pediatric facility.

One draw of commercially produced materials is that they are often translated into many foreign languages; however Battles says if they had to customize the English versions they would need to do the same with the foreign language versions.

At New York-Presbyterian Hospital in New York City the primary patient education materials distributed via the Intranet are created in-house. However, commercially produced medication handouts that are updated quarterly are used, and Virginia Forbes, MSN, RN, program director of patient and family education, says they have been pleased with the commercial product.

Yet, she says the large and diverse organization where she works is fortunate to have the human resources and support needed to create institution-specific teaching materials.

"It is important for us to know exactly what information is being given to our patients and how it is presented. When evaluating some of the available products we were not completely satisfied with the content and/or presentation, diversity, or readability it offered," explains Forbes.

Impossible to do it all

While Children's Healthcare of Atlanta has about 550 teaching sheets on the Intranet in both English and Spanish, Ordelt says they also have purchased a number of programs and loaded them on the Intranet. "We realize that no matter how many teaching sheets we would ever be able to produce we could never do it all," she explains.

Recently in addition to other commercial teaching sheets they added Pedi-Pals, a pediatric version of drug information sheets, as the generic drug information is as good as their own teaching sheets and is available in multiple languages. They will do away with their own medication sheets, which also eliminates the time they spend reviewing them, says Ordelt.

There are pros and cons to both materials produced commercially as well as in-house.

One of the drawbacks of creating teaching sheets in-house is the process. There must be a well-honed mechanism in place to ensure accuracy; make sure the inventory is maintained, updated and revised on a routine cycle and when practice changes; and material must be produced in a timely manner. (To learn more about the process of producing materials for the Intranet, see article below)

Latty agrees. She says keeping up with the demands for new and revised materials is a lot of work especially for patient education managers that "wear other hats."

Forbes says the benefits of creating materials in-house include the ability to have overall control of content, format, and style. The institutions' clinicians provide their clinical expertise and follow the organization's guidelines for writing and creating materials. Templates can be created and evaluation takes place according to preset standards.

The upside of purchasing materials and databases is that the commercial vendor does all the work and keeps the material updated, says Ordelt. Most of the databases are updated quarterly so institutions get the latest and greatest information, she says. However, commercial products cost money and may or may not be as easily accessible to clinicians as the in-house material depending on how many links they must go through on the computer to access it.

When evaluating a commercial product for use on the Intranet to make sure it is right for your institution, Forbes advises patient education managers to get the answers to the following questions:

  • How is it maintained?
  • What is the frequency of updates?
  • Who are the members of the content advisory board?
  • Are there licensing fees per edit/change in content or addition of logos?
  • Can additional resources be uploaded to the library?
  • Is an interface required?
  • What are the terms of the agreement?
  • Is on site or 24-hour support available?

Create process to write in-house materials

For best results establish guidelines and oversight.

Once an organization has made the decision to create teaching materials for the Intranet in-house a process should be established for producing the pieces.

At New York-Presbyterian Hospital in New York City the guidelines for creating materials are located on the Intranet in the patient education handbook for easy access by all staff.

"The staff are able to follow a step-by-step guide to creating a resource from idea through submission," explains Virginia Forbes, MSN, RN, program director of patient and family education.

In a flowchart, staff are first directed to check the approved resource list to see if the resource already exists. If it does not exist, they can proceed. If one does exist, it is suggested they evaluate the material to see if it meets their need.

If the material does not meet their need and cannot be revised, they follow the guide and create a new resource according to the template. The resource must be evaluated by at least three content experts and references must be provided. Finally a member of one of the patient education committees evaluates it using a more extensive evaluation form.

At Riley Hospital for Children in Indianapolis content experts have been identified in service and procedural areas to assist with teaching materials. When a piece is being created they are asked to provide information on what should be included in the document. In addition, an author's checklist and a sample document is available for the person drafting the teaching material.

"Once we get a draft document, we send it to stakeholders asking for feedback within a certain time frame," says Cindy Latty, BSN, RN, patient education coordinator.

The reviewer can write directly on the teaching sheet but must also complete a form when he or she provides feedback. If Latty and colleague, Maureen Battles, BSN, RN, also a patient education coordinator, have questions about the changes they present them to the content experts. The final draft is then sent to the multidisciplinary Patient Education Council for approval.

The council not only provides input but also distributes it to people who have expertise on the subject.

However it's important to get feedback from those who do not have expertise on a topic because teaching materials are written in laymen's terms, says Latty.

"Sometimes when you are creating a product you are so close to the material you don't notice you are using terms that may not be at the right language level," she explains.

Following this review the document is completed and placed on the Intranet.

At Children's Healthcare of Atlanta experts in a field write the educational material using an electronic template that can be found on the patient and family education Intranet site. There are templates for information sheets on disease, procedures, medications, clinical nutrition, medical equipment, and other topics. The expert simply writes the information in the appropriate sections. For example, when writing on a disease they would answer, "What symptoms would the child have?"

"The writer must have a physician sign off on the material if it is a medical topic and patient and family members if appropriate and then they send it back to me. I send it to risk management. All our teaching materials go through our risk management department," says Kathy Ordelt, RN-CPN, CRRN, patient and family education coordinator at Children's Healthcare of Atlanta.

The Family Centered Education Council gives the final stamp of approval on written materials.

To help clinicians become better writers Ordelt created a toolkit that contains the 10 top tips for writing for patients and families. Also four-hour interactive writing workshops are offered twice a year.

"If people can't get to the class or devote the four hours to it they can use the toolkit," says Ordelt.


For more information about making the decision to write materials in-house or purchase them commercially for the Intranet, contact:

  • Zeena Engelke, RN, MS, patient education manager, University of Wisconsin Hospital and Clinics, 3330 University Ave., Suite 300, Mailbox drop 9110, Madison, WI 53705. Phone: (608) 263-8734. Fax: (608) 265-5444. E-mail:
  • Virginia Forbes, MSN, RN, program director of patient and family education, New York-Presbyterian Hospital, 525 East 68th St., New York, NY 10021. Phone: (212) 746-4094. E-mail:
  • Cindy Latty, BSN, RN, or Maureen Battles, BSN, RN, patient education coordinator, pediatrics, Riley Hospital for Children, Clarian Health Partners Inc. Indianapolis, IN Telephone: (317) 274-8845. E-mail: or
  • Kathy Ordelt, RN-CPN, CRRN, patient and family education coordinator, Children's Healthcare of Atlanta, 1600 Tullie Circle, Atlanta, GA 30329. Phone: (404) 785-7839. Fax: (404) 785-7017. E-mail: