Tips From The Field

Try this novel idea: Have staff teach staff

Staff participation counts

SunPlus Home Health of San Diego tried something a little different when teaching staff about the Outcome and Assessment Information Set (OASIS): The agency used peer instructors.

"I believe in staff participation and I think there’s more buy-in and acceptance because people don’t adapt to change well," says Estelle Wolf, RN, BS, former director of professional services for the freestanding agency, which covers San Diego County.

SunPlus, which is participating in one of the federal OASIS demonstration projects, has received OASIS reports from the Center for Health Services and Policy Research (CHSPR), in Denver. CHSPR is the organization that created the OASIS data set.

Try peer-taught inservice

Based on OASIS reports, agency officials decided to focus on two areas of improvement: urinary tract infections (UTIs) and wound care. SunPlus formed a committee that included a supervisor from two offices, a nurse, a therapist, an aide, and a social worker. The committee conducted a quality improvement project to find out how the agency could improve its outcomes.

"We wanted to see the incidences, commonalities, causal factors, and standard practices followed and to see whether there was any deviation from that," Wolf says. "The next part was to take all this information and determine how to educate the staff."

She asked the committee to decide what needed to be taught and helped them gather educational tools, write the lesson plan, and prepare to make the inservice presentation. The peer-taught inservice was a success, she says. Staff responded positively to the committee members’ instructions on how to fill out data sheets properly, for example. "They were saying, We didn’t realize it was so important, and we thought it was another piece of paper.’"

Here’s how they did it:

1. Wolf guided the peer instructors, helping them prepare an introduction that explained the significance of OASIS. The inservice explained that OASIS is not just a paper exercise or just a comparison of an agency’s outcomes to a national benchmark. It’s also a good way to gain insight into all of the aspects of quality care performed by a particular agency.

2. Peer instructors were told to give employees a good explanation of why they needed to improve their documentation and use the tool. "I don’t believe in giving anybody a job unless they understand what the job is and how it impacts them personally," Wolf says. "We did a broad education of what was the purpose of the tool."

3. Instructors worked on individual assignments of preparing for the portion of the inservice that they would present. For example, one instructor prepared to discuss the care planning process, and another prepared to discuss excellent documentation.

4. Peer instructors spent about two weeks pre paring for the inservice, and the agency gave them time away from clinical work, making the inservice a priority. "I think preparation is extremely important," Wolf says.

5. Peer instructors used the agency’s own clinical forms as the tools to teach staff. The earlier quality improvement project had shown that the tools were satisfactory, but they simply were not being completed as accurately as they could have been.

6. The 1.5-hour inservice was broken into smaller segments, and each instructor was allotted a certain amount of time for presentation. Peer instructors were given a specific order in which to make their presentation.

7. The peer instruction team chose to use handouts, including the following: handouts of the tools used, information on the disease process, the standard of practice for wound care, and signs and symptoms of UTIs.

8. The agency followed the inservice with a chart review and comparison of wound care and UTI data, and the follow-up showed improvement. Wolf says she attributes the improvement to the staff having a better understanding of the diseases and OASIS documentation.