PPS and other rehab industry changes will make patient education more vital

North Carolina facility develops patient book

As rehab facilities try to improve patient outcomes while reducing costs and length of stay, they’ll realize what the home care industry has known for the past couple of years: Patient education is crucial to clinical and financial success.

This means that it’s not enough to hand patients and their families a batch of written materials and expect them to learn most of what they need from that. Rather, rehab facilities will need to develop comprehensive educational programs that are multidisciplinary and diagnosis-specific. That is the conclusion reached by managers of the University of North Carolina (UNC) Health Care Rehabilitation Centers in Chapel Hill. The 30-bed rehab facility is developing an ambitious educational program that will coordinate all educational materials, including those for staff, patients, and community members, in a multidisciplinary fashion.

"Education has been one of our major initiatives over the last few years," says Susan Evers, MPH, administrative director for the department of physical medicine and rehabilitation. "We’ve developed an education committee and educational rehabilitation pathways," Evers says, "and we’re giving staff more training in crisis management."

Prior to the new program, each department conducted its own patient and staff education, often overlapping and sometimes missing important aspects, says Stephanie McAdams, MA, CCC-SLP, education coordinator. "In addition, while we were doing community outreach and community education projects, they weren’t as extensive as we wanted them to be, so we had to beef up things there as well," McAdams says. 

The educational program has resulted in new patient manuals, filled with information that helps patients navigate the rehab facility, find community resources, and learn about their particular injury.

Here are some of the different aspects of the new educational program:

Form an education committee.

The committee comprises representatives from all disciplines, including a physical therapist, occupational therapist, speech-language pathologist, recreational therapist, social worker, nurses, neuropsychologist, rehab physiatrist, rehab technician, physical therapy assistant, and occupational therapy assistant.

Assess existing educational materials.

Everyone on the committee brought existing educational materials from their department to the first meetings. Then the entire group reviewed and assessed each piece of material. "They gave their opinions by writing comments, explaining their dislikes and likes for a particular item," McAdams says. "The educational items that most people didn’t like were discarded."

These discarded items usually included educational materials that had some virtues but were not cohesive or could be easily replaced with better quality materials.

Committee members also brought in new educational material to suggest adding it to the revised program. Once the committee agreed on a consensus of items, the package was brought to the hospital’s education department for approval and subsequent purchase.

Develop a patient information manual.

The rehab facility’s goal is to make sure patients receive all necessary educational materials prior to discharge, Evers says. In response to this goal, the committee developed an educational notebook for patients. Various materials and information are collected in a three-ring binder, and the information is specific to the patient’s diagnosis.

Committee members broke into smaller teams to develop materials for patients in three groups: spinal cord injury (SCI), traumatic brain injury (TBI), and stroke. Educational binders directed toward patients with other diagnoses will be completed later, but those three were the priority diagnoses, McAdams says.

Divide patient binders by information sections.

The binders are divided and indexed by section. For example, there is a section with general hospital information, a section that identifies the patient’s rehab team, a section dealing with medical issues, and one that discusses cognitive issues. There are separate books for the specific diagnoses, including SCI, TBI, cerebral vascular accident (CVA), amputation, orthopedics, and coronary artery bypass graft.

Beginning this month, the rehab facility will distribute these notebooks to patients when they are admitted. Patients and their families will keep these notebooks with them throughout their stay, and will be able to take them home. Additional materials, such as discharge instructions, will be added as necessary.

Make changes according to patients’ needs.

In conjunction with the educational improvement process, the rehab facility assessed its patient satisfaction survey data to see if they offered any clues about what information patients thought they needed.

"A couple of years ago when our satisfaction surveys came back, one area that was low was that people didn’t feel like they were provided with information about community resources," says Becky Binney, MEd, TRS, CTRS, senior recreational therapist. "So I developed a continuous quality improvement project that tracks the educational books we’re putting together," Binney says.

The CQI project involves having the education committee put information related to community resources into the patient binders. The committee will then see if patient satisfaction results improve, Binney adds. Those results should be available sometime in 2001. 

Produces patient orientation video.

The rehab facility, using the hospital’s audio-visual department, made a nine-minute video that orients new patients and their families to the facility.

"We wanted to modify our initial orientation to the rehab center," McAdams says. "Before the video, the orientation was done verbally and with written materials, and we wanted to augment that."

The video guides patients and families through the entire rehab process, beginning with initial admission, continuing with an introduction of the rehab team and examples of specific roles of each team member, and ending with discharge planning and rehab continuum.

Patient is central character’

Other features include rehab scheduling, community re-integration activities, daily conferences and training, and a look at the goal-setting process and how this is focused on the family’s needs.

"The patient is the central character in the entire process," McAdams says.

Before creating the video, the education committee looked at sample videos from other rehab facilities and hospitals, again discussing what they liked and disliked.

"We wrote an outline and had team members give input," she explains. "Then we made that into a script and started shooting the video footage."

Create an orientation manual for new staff.

A new committee, slightly different from the first education committee, was formed to create the staff orientation manual. This committee also was represented by all disciplines.

The committee brought in orientation manuals used by the various disciplines to review.

"We were interested in what the other disciplines were doing and thought it would be good for everybody to know," McAdams says. "This doesn’t replace the general department orientation, but supplements it."

The new manual is in the form of a booklet, and it has an orientation checklist. It includes specific competencies for rehab items, such as a handicap van competency and rehab evacuation competency.

Staff education occurs on Internet

It’s set up partially as a self-learning tool, and also will have training observational competencies. "We have portions of it on the hospital Web site and hope to get a larger share on the hospital Web site so the parts that can be self-learned are," McAdams says.

Each discipline was strongly involved in establishing discipline-specific education, and each new employee will receive orientation for all members of the rehab team. All employees will receive the new orientation manuals, including nursing students, medical staff and residents, nurses, therapists, psychologists, and therapy assistants.

"This helps to give staff a better understanding of what all team members are doing and what their roles are on the unit," McAdams says.

The staff orientation manual is continuing to be revised, but here are some examples of information included in it:

— rehabilitation center’s scope of service, mission statement, and admission criteria;

— visiting hours and how to provide exceptional customer service;

— team meetings/family conferences/rounds;

— phones and paging systems, information security, and hospital abbreviations;

— domestic violence intervention program;

— utility systems - basic staff response;

— medical gas shutoff, evacuation procedures, bomb threat, infection control, and latex allergies;

— age appropriate competencies;

— body mechanics/transfers/evacuation techniques and restraint policy;

— rehabilitation documentation, including documentation policy;

— protocols, including neutropenia, neurological assessment, pressure relief, skin integrity, total hip protocol, and oxygen therapy;

— equipment, such as use policy, equipment descriptions, Hoyer lift, Miami J Collar, Hill-ROM bed, Vail bed, vital signs monitor, pulse oximeter, defibrillator, and others;

— competencies and quizzes on fire safety, bomb threat, swallowing/aspiration, customer satisfaction, transfer competency, and others.