Nurse team creates patient education model

IDEA system is road map to problem solving

When surveys from local home care agencies showed that teaching — or communication about discharge teaching of patients — was lacking at Hartford (CT) Hospital, a team of nurses was put together to find a way to solve the problem. Using the hospital’s IDEA (Identify Opportunities for improvement, Determine root causes, Establish an action plan, and Act on it) program, they created a patient education model that solved the problem.

Without adequate teaching, continuity of care is compromised, the team found. And if the patients are taught, but that teaching isn’t documented, then repeating what has already been taught to patients wastes time.

The desired outcome, according to the team’s charter plan of action, was to create progressive and individualized teaching and a "synergistic approach to caring across the continuum."

The team then looked for root causes. Among them, they found that current documentation didn’t have a place to document what teaching specifics and tools were used. There was also limited time to teach patients, or to document how far the patient has progressed in his or her learning. In some areas, the team found a lack of consistency in the tools used, and a lack of consistent teaching methods among caregivers.

And in some cases, if the patient’s condition has a critical pathway, the document which would note any patient teaching didn’t accompany the patient into home care, but rather stayed with the patient chart.

The action plan the team established included creating preprinted forms that were easily accessible to staff. Communication with home care staff should be increased, and perhaps facilitated with more use of faxes. There were suggestions to print forms in triplicate so that a copy could go to home care agencies or clinics, to the patient, and the remaining copy could stay at the hospital.

Lastly, the team decided to ensure all new staff and home care agency personnel are oriented to the teaching process and new and existing discharge "hand-off" tools when they become available. They also decided to invite the home care agencies that returned surveys to participate in meetings designed to improve the patient education process.

As a result of all of those efforts, interim scores from surveys show an improvement in patient education.

Laura Caramanica, RN, PhD, Co-Director, Women’s Health & Cancer Programs, Hartford Hospital, Hartford, CT. Telephone: (860) 545-2635.

Emmet Murphy, PhD, President and CEO, EC Murphy, LLC, Amherst, NY. Telephone: (716) 836-5552.