Form provides compliance for JCAHO patient education documentation
Simple, well-organized forms that are accessible work best
A good form does not guarantee that all staff from all hospital disciplines who may be teaching a patient will comply with Joint Commission on Accreditation of Healthcare Organizations (JCAHO) documentation requirements. However, it is an important element in boosting compliance in documentation of patient education.
“The design is extremely important because, in my experience, compliance with documentation is better at the hospitals that have more user-friendly forms,” says Yvonne Brookes, RN, clinical learning program coordinator and patient education liaison at Baptist Health South Florida in Miami.
Brookes, who is involved with five hospitals, says when time is spent designing a form that is short and easy to use, more people will utilize it. It also is important to take into account the needs of everyone who may be teaching the patient. For example, to accommodate the needs of a dietitian, there must be a place to document teaching about the patient’s diet.
To make sure the documentation form met everyone’s needs, it was designed by the multidisciplinary patient education committee at the hospitals within the Baptist Health system. Before a design concept was created, every committee member had to gather at least five forms from colleagues at other institutions for committee review.
Using the best elements from each form, the committee designed the documentation tool with the help of the graphics department and a representative from medical records to ensure that the layout would work and the form could be kept in the electronic archives. Brookes says one of the forms from Baptist Health South Florida is used by the JCAHO in their literature as an example of a good documentation form.
User-friendly forms are important, agrees Diane C. Moyer, MS, RN, program manager for Consumer Health Education at The Ohio State University Medical Center in Columbus. “The less time involved in being able to fill out the form, the better it is as far as compliance,” she says.
If forms are standardized throughout the institution or across several departments, the staff within the various hospital disciplines will more readily understand the format and comply with documentation, says Moyer. “Keep in mind who is going to be using the form and what they have been used to in the past, such as filling in the blanks or check boxes,” she advises.
Also, it is important to make sure staff are not asked to document the same information on two forms. If the information is documented in another area, simply make a note on the new form that indicates where it can be found.
To increase compliance for documenting patient education, the form at the Deborah Heart and Lung Center in Browns Mills, NJ, was redesigned to mirror the interdisciplinary care plan. The old form for documenting patient education was six pages long, had too much redundancy, and did not flow well, recalls Laura Gebers, BSN, RN, BC, PCS programs health education coordinator at the health care facility.
“Our staff found the new form easier to understand. The information was organized and easily found to document appropriately,” she explains. Compliance increased from 40% to 90% when the new form was introduced.
Gebers created the concept design for the form with the advice of the health education advisory council. “Each discipline made suggestions for what information should be present to ensure completing their documentation was worth their time,” she explains.
Is that all there is?
While a form must be succinct, there is more to documentation compliance than the form design, says Ruthie Gohl, MSN, director of medical services at Southwest Washington Medical Center in Vancouver.
Before a team of staff nurses at the health care facility tackled the problem of noncompliance in documenting patient education, they explored the reasons for noncompliance. A survey indicated that staff were spending about 90 minutes per patient teaching and documenting what was taught. As a result, compliance for documentation was around 40%.
Staff members teach all the time, but they don’t always document. The solution was to design a system that prompted documentation, explains Gohl.
First, a patient education record was designed, which increased documentation by about 15%. That form was followed by the implementation of a plan of care for various diagnoses. All material needed to teach the patient about the particular diagnosis comes with the plan of care along with the education record and a daily planning record that prompts the appropriate education for the day.
The education record is printed with areas for documenting what was covered in the care plan by codes to keep documentation simple.
For example, if a patient with congestive heart failure is taught smoking cessation, the teaching material is included in the plan of care including information on why the patient should quit smoking, what will happen when he or she quits, and community resources available for support. Areas for documenting the review of this material with the patient are preprinted on the education record for ease of documentation. Also on the record is the standard education process for educating a patient, such as the assessment for readiness to learn, teaching method, and how the education is evaluated.
The staff nurse group that designed the system determined that, if they did not have to find information in a file on the floor or pull it off the computer and print it every time they needed it, they were able to provide better education and comply more readily with documentation requirements.
It has worked, says Gohl, and documentation now is at 88%. In addition, follow-up surveys indicate the amount of time it takes to document patient education has been cut in half.
Documentation forms that mirror teaching flow sheets tailored to particular units or disease processes provide a convenient method for documentation at The Ohio State University Medical Center. Required teaching can easily be checked off on the form, says Moyer.
Prompts or triggers for documentation can be key — not only on the form, but in other areas as well, says Brookes. For example, an area on the admission form can prompt nurses to initiate the teaching record. Also, it is a good idea to have a patient education discharge-teaching tab in the medical record so staff will know where to look for the teaching record for documentation.
Codes, such as letters, on forms work well to streamline documentation, says Brookes. “Use the documentation form as a summary and have it refer to the tools used, such as a handout that was reviewed or video,” she advises. Everything can have a code — from barriers to learning, such as pain, to the method for evaluating teaching, such as question and answer or demonstration and return demonstration.
If a form has been updated, streamlined, or redesigned, staff must be advised of changes before it is implemented.
When a new form is introduced at Baptist Health, a patient education liaison takes it to his or her unit to explain how it works. In addition, large posters of the form are printed that have short descriptions of each area with arrows pointing to them. And before the form is introduced, articles about its implementation are run in the employee newsletter.
At the Deborah Heart and Lung Center, members of the Health Care Advisory Council were accessible on their units to help staff with form completion when the new design was introduced. The form was essentially the same tool used before only streamlined with a better design, says Gebers.
While form redesign can improve documentation, Moyer warns that often it is not the form that is the problem with low compliance in documentation of patient education. “Often it is more a matter of being certain that the staff identify and recognize the importance of the documentation, and knowing that it captures the teaching they are doing. They see and value the information as an important part of the patient’s care,” she explains.
Many staff members think no one reads the education record, so it is a waste of time to write down what was taught, says Moyers.
Janice Reynolds, RN, OCN, a staff nurse who chairs the patient education team at Mid Coast Hospital in Brunswick, ME, says, although many attempts have been made to streamline the documentation of patient education, compliance still is low.
The facility has been using computer documentation for about three years, first providing an education section where staff could access various subjects such as pain management and simply click on what was taught, who was taught, materials reviewed, and patient and family response to teaching. When they received various complaints about the time it took to go to a special section, patient education was added to the flow sheet where nurses do 90% of their documenting. The simple point-and-click documentation was used.
Reynolds says many nurses at the community hospital do not see the documentation of patient education as priority. In a class on effective documentation and communication, she teaches annually, she tells nurses that patient education is one area for malpractice that they are held responsible.
If documentation of patient education is a problem, before changing the form, find out what prevents staff from documenting teaching and then address the problems, suggests Moyer. It could be the form is not easily accessible. Or it could be staff do not value it as an important part of the care that is provided.
Staff members must understand, although they may not see their health care team looking at the education documentation form, it is a key piece for the long-term record of care provided for a patient, she says.
Sources
For more information about creating a form to improve documentation of patient education, contact:
• Yvonne Brookes, RN, Clinical Learning Program Coordinator, Patient Education Liaison, Baptist Health South Florida, 1500 Monza Ave., Suite 200, Miami, FL 33146. Telephone: 786-596-1333. E-mail: [email protected].
• Laura Gebers, BSN, RN, BC, PCS Programs Health Education Coordinator, Deborah Heart and Lung Center, 200 Trenton Road, Browns Mills, NJ 08015. Telephone: (609) 893-1200, ext. 5258. E-mail: [email protected].
• Ruthie Gohl, MSN, Director of Medical Services, Southwest Washington Medical Center, P.O. Box 1600, Vancouver, WA 98668. Telephone: (360) 514-3717. E-mail: [email protected].
• Diane C. Moyer, MS, RN, Program Manager, Consumer Health Education, The Ohio State University Medical Center, 1375 Perry St., Room 524, Columbus, OH 43201. Telephone: (614) 293-3191. E-mail: [email protected].
• Janice Reynolds, RN, OCN, Chair, Patient Education Team, Mid Coast Hospital, Brunswick, ME. Telephone: (207) 729-5932. E-mail: [email protected].
A good form does not guarantee that all staff from all hospital disciplines who may be teaching a patient will comply with Joint Commission on Accreditation of Healthcare Organizations (JCAHO) documentation requirements. However, it is an important element in boosting compliance in documentation of patient education.
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