Complying with Joint Commission patient education standards
When in doubt on implementation give the department a call
In her position as associate director in standards interpretation at The Joint Commission in Oakbrook Terrace, IL, Virginia McCollum, RN, MSN, answers questions on how to meet standards including those in reference to patient education.
She also sees the areas surveyors most often identify as needing improvement. One such standard is in the patient care chapter PC.6.10. This standard reads: "The patient receives education and training specific to the patient's needs and as appropriate to the care, treatment, and services provided."
To meet this standard, a learning needs assessment must be completed that is available to any health care practitioner working with the patient. The assessment addresses cultural and religious beliefs, emotional barriers, desire and motivation to learn, physical or cognitive limitations, and barriers to communication.
Needs assessment element shows planning
"If I see any RFIs [requirements for improvement], I often see them written on this one. There isn't a learning needs assessment and the education for the issue hasn't been planned or documented," says McCollum.
It is the needs assessment that helps staff members tailor the education to a specific patient and create a teaching plan, she explains. For example, to teach a Hispanic patient newly diagnosed with diabetes, a look at the learning needs assessment could tell the educator that the patient's primary language is Spanish and that he or she is unable to read and write in Spanish but is very motivated to learn and responds to teaching methods that use verbal and pictorial cues.
If the patient is physically and cognitively functional, but has elevated blood sugar, he or she will need to understand the issue to incorporate lifestyle changes that will prevent or lessen the side effects of diabetes. The learning needs assessment guides the health care professional for preparation to teach. For example, by employing an interpreter who would need to be present or gathering appropriate teaching materials and possibly family members who would be available to help the patient manage the disease.
The Joint Commission standard directs education on several topics including:
- the plan for care, treatment, and services.
- basic health practices and safety.
- the safe and effective use of medications.
- nutritional interventions, modified diets, or oral health.
- safe and effective use of medical equipment or supplies when provided by the organization.
- understanding pain, the risk for pain, the importance of effective pain management, the pain assessment process, and methods for pain management.
- habilitation or rehabilitation techniques to help the patient reach the maximum independence possible.
- According to McCollum, another area many institutions have a challenge in meeting is located in the ethics, rights, and responsibilities chapter. RI.2.160 states that patients have a right to pain management. This means patients are assessed for pain and they along with their family members, are educated on managing pain.
"Part of care and assessment of pain is not just the medication or physical therapy or whatever is ordered, it is the teaching and understanding. Therefore, patient education is vital," says McCollum.
It is important for patient education managers to remember that The Joint Commission is not a regulatory agency, says McCollum. It is an organization that provides guidance and knowledge to health care organizations based on research, theory, and sentinel events.
There are many standards that have an educational aspect that should not be forgotten. Many are in the ethics, rights, and responsibilities chapter. For example, RI.2.20 states that information on patients' rights and responsibilities is not only provided but explained to patients.
According to RI.2.30, patients must be involved in decisions about their care and treatment. Yet in order for this to happen, they need to be taught about their diagnosis and given information.
RI.2.40 covers informed consent. Before any operative procedure or with any type of care, treatment or service for which a patient needs to sign a consent form, education about the benefits, risks, side effects, potential problems, the likelihood of achieving goals, and any reasonable alternatives must take place. The expectation is that before a patient signs a form, they understand what it is they are signing. Education is also required for standard RI.2.60 that states that patients must be given information about the people responsible for the delivery of their care, treatment, and services. The patient must be able to tell the difference between the nurse, the physician, and other health care providers.
While the standards refer to areas of education, how that education is provided depends upon the patient population. Some cultures may be comfortable learning in a group setting and find class instruction appropriate, yet others value confidentiality and prefer one-on-one education.
That is why assessment is key before conducting all patient education, says McCollum. Often if the surveyors do not see a needs assessment, they will drill down to see how the organization assesses the patients' learning needs, she explains.
[Editor's note: If you need clarification or help interpreting any of the standards, call The Joint Commission at (630) 792-5900 and speak to an associate director in standards interpretation.
In addition, there are resources for patient education available on The Joint Commission web site at www.jointcommission.org. One McCollum recommends is "Speak Up." These initiatives promote safety through communication in areas including surgical errors, infection control, medication mistakes, living organ donations, medical test mistakes, and clinical research studies.
Another resource McCollum recommends is The Joint Commission International Center for Patient Safety. Also available through The Joint Commission is a book titled Patient and Family Education that was edited and reviewed by staff members in standards interpretation.]
For further information about complying with Joint Commission patient education standards, contact:
- Virginia McCollum, RN, MSN, associate director, standards interpretation, The Joint Commission, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: (630) 792-5900.