Persistence key to achieving goals

Documentation improved dramatically 

Before Julie LaBreche, RN, CDE, was hired as patient and community education coordinator for Saint Francis Medical Center in Grand Island, NE, in 1997, she worked for six years on the nursing units in intensive care, dialysis, and med surgery. 

Now her duties include developing and overseeing patient education activities throughout the 189-bed hospital, three clinics, a skilled nursing care unit, and the oncology outpatient services that make up the Saint Francis health care system. 

As coordinator of patient education, LaBreche develops teaching materials and other educational resources for inpatients, outpatients, family members of all ages, and the community. 
Also, she communicates to the appropriate personnel any changes within the patient and family education standards implemented by the Joint Commission on Accreditation of Healthcare

Organizations based in Oakbrook Terrace, IL. In addition, she provides recommendations on how to achieve compliance with the Joint Commission requirements. 

As a certified diabetes educator, LaBreche assists with outpatient and inpatient diabetes education. "We are an ADA- [American Diabetes Association] recognized diabetes program, so we offer diabetes classes every month, which I assist with, and we provide inpatient diabetes teaching also," she explains.

There are other educators within the educational services department in addition to patient and community education: diabetes education, employee wellness education, and clinical outreach education. LaBreche reports to the department director, who is under the vice president of mission and community outreach/corporate responsibility officer. 

Although LaBreche does not have a staff to support her efforts in patient education, a committee of 13 meets quarterly to review and revise patient education material and discuss compliance issues with the Joint Commission.

In a recent interview with Patient Education Management, LaBreche discussed her philosophy on patient education, the challenges she has met, and the skills she has developed that help her to do her job well. 

Question: What is your best success story?
Answer: "In one year, documentation of patient education jumped from 33% to greater than 90%. The improvement occurred when protocols to simplify the computerized documentation of patient education were developed and we made sure that the resources for education and the components for documentation were in one place.

"Also we went to the nursing managers and got their support. During chart audits, if we found that an individual was not documenting patient education we followed up with the nursing manager either by e-mail or in person. 

"Those who did a good job on documentation were given an Angel Praise’. Employees of Saint Francis can use Angel Praises to purchase items at the cafeteria or gift shop."

Question: What is your area of strength?
Answer: "Persistence. I knew that documentation could be improved and I would keep strategizing and brainstorming until the goal was achieved."

Question: What lesson did you learn the hard way? 
Answer: "Not everyone has the passion or expertise in patient education I do. Staff say they will document patient education; therefore, you think it will happen but, when you review charts three months later, there has been no improvement. 

"I learned that you have to consistently reinforce the importance of documentation and realize other people just don’t have the same passion. 

"Or with developing patient education handouts, people write the material at too high a reading level. It’s important to realize that not everyone has your expertise."

Question: What is your weakest link or greatest challenge?
Answer: "Time and money restraints. Nursing doesn’t have a lot of time, and length-of-stay is about 3.4 days. Patients admitted to the hospital are acutely ill, and it is harder for nursing to find time to do a good job of educating patients and documenting the teaching.

"Although we have a nice budget, you always wish for more elaborate things such as a personal computer in each patient room that we could download educational programs onto."

Question: What is your vision for patient education for the future?
Answer: "I really think patient education is going to be a driving force when patients choose a hospital; therefore, health care institutions will need to branch out more. Our patient resource center

offers cardiac teaching, dietary classes, and diabetes support groups. 

"More outpatient services to help people manage chronic diseases need to be available. The media has covered hospital safety a lot lately, and patient education correlates with patient safety. As the length of stay decreases, hospitals will need to use more technology to impact the patient’s outcomes, which will include patient education."

Question: What have you done differently since your last JCAHO visit?
Answer: "We were surveyed in June 2004, so we began working with staff in January doing tracers — asking what they did to educate their patient, what the plan of care was, and how education was part of the plan. With the new method for surveying, we wanted to get staff familiar with tracers and talking to surveyors. We did very well in patient education during the Joint Commission survey."

Question: When creating and implementing new forms, patient education materials, or programs, where do you get information and ideas?
Answer: "A group of patient education coordinators working in Nebraska and Iowa meet quarterly to discuss things we all struggle with, such as documentation of patient education. I also use the patednet listserv.

"If I have a question on JCAHO standards, I go to our risk manager."