Process improvement teams revamp teaching programs to fit busy schedules
Process improvement teams revamp teaching programs to fit busy schedules
Re-engineer old patient education methods to fit era of change
The hospital was not meeting its quality indicator to have 100% of the 200 to 250 patients who had open heart surgery each month at St. Joseph’s Hospital of Atlanta attend a class before discharge. Only about 80% of the patients made it to the open heart class.
With patients being discharged within 31¼2 to four days, there was only a small window of opportunity to get patients and family members to class, explains Joyce Dittmer, RN, MSN, director of education services at St. Joseph’s Hospital. Although the class was offered once a day, six times a week, patients’ family members couldn’t always attend due to work schedules and other commitments.
Therefore, the education department assembled a multidisciplinary group that worked with open heart surgery patients. The group’s purpose was to determine how to re-engineer or streamline the education process to better meet a shorter length of stay (LOS).
The class needed to be available at any time, the group determined, so they developed a video of the class to show on the hospital’s on-demand, closed circuit television system. Patients who attend the class can watch it again in their rooms. Patients and family members who can’t attend in person at the scheduled times can still hear the content.
The group also determined that the class content needed to be streamlined because the patients were not at their optimum learning level due to their illnesses. About two-thirds of the content was transferred to a community outreach program called Heart School offered by St. Joseph’s. Before the patient is discharged, he or she is signed up for Heart School, which is scheduled twice each month. School curriculum includes risk factor modification, stress management, and details on diet and exercise. Heart patients attend three or four weeks post-surgery when they are starting to feel better and recognize they need to make lifestyle changes.
Review education process
At a time when hospital LOS is becoming shorter and staff have too many duties and not enough time, patient education managers must find a way to work smarter, not longer. The solution is to review the process and determine ways to streamline and re-engineer patient education, says Dittmer.
While CQI efforts frequently uncover areas for process improvement, the questions staff ask and the issues and ideas they present also help pinpoint areas for improvement. For example, nurses at Mercy Center for Healthcare Services in Aurora, IL, were spending so much overtime charting patient care and education that it was a budget problem. A process improvement team combined forms to make less paperwork and emphasized checklist documentation rather than the narrative type.
"There was a lot of duplication. For example, a patient’s vital signs were documented on three or four different forms," says Rita Smith, MSN, RN, education coordinator for Mercy Center.
By improving work activities on the unit, such as charting, more time will become available for patient teaching, says Dittmer. For example, patients at St. Joseph’s who were on orders not to have lunch because of a scheduled procedure would come back to the units hungry. Nurses would have to request a late tray for the patients and send someone to the kitchen to pick it up.
"Staff were making phone calls and chasing trays at all times of the day, so a group was formed to solve the problem. They came up with the procedure lunch," says Dittmer.
If a patient is scheduled for a procedure, a sack lunch is sent up with the breakfast tray so it is easily accessible, and no time is wasted that could be devoted to other more urgent matters, she says.
Another way to create more time for teaching is to simplify lesson plans, says Sharon Moore, BSN, patient education coordinator at Rapides Regional Medical Center in Alexandria, LA. Moore is in the process of streamlining old educational plans to fit nurses’ busy schedules. The streamlined version has teaching points for each day of the hospital stay that can be attached to the mirror in the patient’s room with a magnet. With this tool, nurses quickly know what needs to be taught that day. The sheets are kept in a packet along with all the other education materials the patient will need for a safe discharge. (See example of streamlined teaching packet for CHF in educational supplement, inserted in this issue.)
Because there isn’t always enough time to do a thorough job of teaching, even when more time for teaching is made available, hospitals must become resources for education, says Yvonne Brookes, RN, patient education liaison for Baptist Health Systems of South Florida in Miami. To reach patients in the outpatient setting, education departments must work with physicians’ offices, she says.
To improve the education process across the continuum of care, a committee developed a wellness prescription pad that is sent to physicians’ offices. It lists programs available through Baptist Health Systems such as smoking cessation, stress management, diabetes education, cardiac rehabilitation, nutrition counseling, weight loss, complementary cancer therapies, women’s health, and senior services. With the prescription pad, phone numbers are easily accessible so physicians can enroll patients in the programs.
Catch staff when you can
Staff not only have difficulty finding the time to teach; they have no time to attend inservices to learn themselves, says Moore. Therefore, process improvement for patient education also must include staff development issues. Inservices need to be flexible, she says.
As Moore streamlines education plans, she creates poster boards that explain how to use all the information in the packets. It takes staff about 15 minutes to review the materials on the poster board, and they can do it any time during their shift. She creates six poster boards and rotates them through the nursing units and interdisciplinary departments.
Also, Moore uses portable inservices when educating staff on other topics. A "Just Do It" patient education inservice, for example, focuses on adult and pediatric learning principles. It includes a video to watch, a short booklet to read, a test, and program evaluation. The poster boards remain on each unit for at least one month so all staff have time to complete the mandatory inservice.
"The poster boards aren’t only convenient for staff, they save us time too. We don’t have to go from unit to unit doing inservices," says Moore. (For more tips on how patient education managers shave time from their schedules, see story, at right.)
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