Patient education remains strong one year after JCAHO changes

Accepted as an integral component by JCAHO and health care administrators

The Children’s Hospital of Philadelphia was surveyed by the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in February 2004. In the aftermath of this survey, Linda S. Kocent, RN, MSN, coordinator of patient-family education at the institution, is convinced patient and family education still is a critical concern of the accrediting agency.

However, she did not like the idea of eliminating the separate chapter on patient education and integrating these standards with those covering assessment, care, and continuum of care in a new chapter titled "Provision of Care," which the Joint Commission introduced in January 2004.

"I thought it diminished the importance of patient and family education. I had to keep in mind that patient and family education is part of everything that we do, so blending it into the big picture was logical. The survey itself convinced me that it is still a critical concern of JCAHO," says Kocent.

Like Kocent, many patient education managers were concerned about the impact the elimination of the separate chapter would have on patient education. In an article published in the October 2003 issue of Patient Education Management, many stated that the separate chapter had given patient education prominence, and they feared it would no longer be emphasized. Now many see that the change shows education is an integral part of patient care.

"Over the 22 years that I’ve been a patient education manager, patient education has progressed from being seen as fluff’ to being well accepted as an integral component of care. The fact that patient education is woven into the Provision of Care chapter underscores that acceptance," says Annette Mercurio, MPH, CHES, manager of patient, family, and community education at City of Hope National Medical Center in Duarte, CA. The integration of the chapters has advanced the role of patient education as an integral part of care, she says.

In preparing for a March survey by the Joint Commission, the medical center has been conducting biweekly tracers since June 2004. The Joint Commission implemented the tracer survey methodology in January 2004, where a patient’s care experience is traced from admission to discharge.

"How the patient’s educational needs are being addressed is assessed when we conduct practice tracers with staff, just as all other aspects of the patient’s care are examined. Patient education is treated as part of the care process — not as a separate activity," she explains.

During a February 2004 survey at The Children’s Hospital of Philadelphia, education was evaluated as part of each tracer, says Kocent. Staff, patients, and families were asked about education, and the surveyors asked to see handouts and patient-family education flowsheets. Also, they asked to see how education was reflected in the electronic documentation in the ambulatory care centers.

"Education was never an afterthought," she says.

Patient education now is where it should be — interwoven with the fabric of patient care, says Kathy Ordelt, RN-CPN, CRRN, patient and family education coordinator at Children’s Healthcare of Atlanta.

Most of the questions from the surveyors during the institution’s September survey were directed to frontline staff, she says. They looked at both care and patient education from a continuum perspective to make sure that all caregivers were on the same page and that the information was communicated from one point of care to the next. Also, the surveyors consistently looked to see if education and documentation was interdisciplinary.

Patient education gets more exposure

Education now seems to have many opportunities for exposure. As the coordinator of patient and family education, Ordelt is responsible for the institution’s compliance with the patient education standards. Therefore, she is part of the team that overlooks the Joint Commission’s Provision of Care chapter, the team for the Leadership chapter, and the Patient Rights chapter because all contain patient education standards.

Patient education also is well represented at City of Hope National Medical Center, with Mercurio facilitating the Provision of Care Functional Team and also a member of the institution’s survey preparation steering committee.

Mercurio has found that the preparation for the new form of survey helps uncover areas that need improvement. The biweekly tracers have shown that they continue to have gaps in documentation of patient education.

"I will soon be helping to conduct tracers in patient care areas and will be able to review patient education documentation as I’m looking at documentation of specific patient’s care," she says.

To improve the continuum of patient education across the areas of care before the 2004 survey date, Cindy Latty, BSN, RN, and Maureen Battles, BSN, RN, patient education coordinators for pediatrics at Riley Hospital for Children, Clarian Health Partners in Indianapolis, developed a new multidisciplinary care plan that addresses planning patient care on a multidisciplinary level. They are beginning to see the results of this change along with a new pain management flowsheet that was also implemented.

While survey preparation helps improve patient education, the new surveying method also is beneficial. "In the past, our preparations for the survey were focused on meeting the standard for the sake of being accredited. Now our preparations really look at patient outcomes and patient care, and our results more clearly reflect what we need to do to improve the quality of care," says Mary Szczepanik, MS, BSN, RN, manager of Cancer Education, Support, and Outreach at OhioHealth Cancer Services in Columbus.

While constantly improving, patient education has become an established part of most health care facilities; therefore, the changes the Joint Commission made in 2004 has not had an adverse impact.

"Patient and family education are so well integrated into our policies and procedures that the change in the JCAHO system didn’t affect our practice," says Szczepanik.

OhioHealth has a dedicated patient education coordinator and several people like Szczepanik in service lines such as oncology, neuroscience, women’s health, orthopedics, and heart that have responsibility for patient education. There are clinical nurse specialists and nurse practitioners who provide education, she says. Also clinical pathways for several major diseases include patient education, and they work as an automatic reminder to the nurse to teach and document teaching.

Patient education had a systemwide focus before the changes were made by the Joint Commission and still does at Riley Hospital for Children. "New staff are oriented to patient education, and we continue to look at new and innovative ways to educate our staff," says Latty.

The new survey format may provide a better showcase for patient education as well. "Though we personally have not experienced a true test of the new system, I believe it has the potential to offer a more accurate reflection of actual patient care services within an organization. By tracing an episode of care, you get a real snapshot of that situation across settings and with a variety of disciplines," says Zeena Engelke, RN, MS, patient education manager at the University of Wisconsin Hospital and Clinics in Madison.


For more information about the impact of the new tracer methodology used in Joint Commission surveys or implementing patient education standards, 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. Telephone: (608) 263-8734. Fax: (608) 265-5444. E-mail:

Linda S. Kocent, RN, MSN, Coordinator, Patient-Family Education, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104. Telephone: (215) 590-3661. E-mail:

Cindy Latty, BSN, RN, or Maureen Battles, BSN, RN, Patient Education Coordinators, Pediatrics, Riley Hospital for Children, Clarian Health Partners Inc., 702 N. Barnhill Drive, Indianapolis, IN 46202. Telephone: (317) 274-8845. E-mail: or

Annette Mercurio, MPH, CHES, Manager, Patient, Family and Community Education, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010-0269. Telephone: (626) 301-8926. E-mail:

Kathy Ordelt, RN-CPN, CRRN, Patient and Family Education Coordinator, Children’s Healthcare of Atlanta, 1600 Tullie Circle, Atlanta, GA 30329. Telephone: (404) 785-7839. Fax: (404) 785-7017. E-mail:

Mary Szczepanik, MS, BSN, RN, Manager, Cancer Education, Support and Outreach, OhioHealth Cancer Services, 3535 Olentangy River Road, Columbus, OH 43214. Telephone: (614) 566-3280. E-mail: