Meeting The Joint Commission Patient and Family

Optimizing Patient Education
to Meet the Standards and
Improve Outcomes
HCEA Webinar – March 3, 2011
Diane Moyer, MS, RN, Associate Director, Patient
Education, The Ohio State University Medical Center
Kathy Ordelt, RN, CPN, FAHCEP, Patient and Family
Education Coordinator, Children’s Healthcare of Atlanta
Objectives
By the end of the program you will be
able to:

Identify key Joint Commission patient education
standards and requirements

Discuss the process of assessing, planning and
implementing, and evaluating a patient and family
education (PFE) program to meet Joint Commission
standards
2
Desired outcome:
Teaching and Learning
are “mirror” images of each other
Scott Kim
Graphic. Used
with permission
3
Patient care and patient education
are inseparable
Adapted from slide by
Fran London, RN, MS. Patient
and Family Education
Coordinator,
Phoenix Children’s Hospital
Used with permission
Care by self
and family
Care by health
professionals
The goal is to integrate treatment and education so
completely that equipping the patient with the knowledge
and skills becomes as important as patient care.
JCAHO 2007
4
The patient-centered education process
Document
Document
&
and
communicate
communicate
Evaluate
Evaluate
learning
learning
Assess
Individualize
and
teach
5
Patient/Family Centered Care
Access to understandable health information
is essential to empower patients to
participate in their care and patientcentered organizations take responsibility
for providing access to that information.
From Crossing the Quality Chasm
Institute of Medicine
6
New Communication
Requirements speak to:
Effective communication
 Cultural competence
 Patient/Family centered care
 Quality care, patient safety
 Patient satisfaction
 Adherence with treatment

Effective January 2011,
scored January 2012
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New Communication
Standards in a nutshell

Plain language for all
communications (oral and written)
with patients and families
•
•
Other languages and cultures
Special needs

Translations - what documents and which
languages need to be provided to meet needs
of community served

Interpreter and translator qualifications

Access to support person throughout encounter
8
New Medication Reconciliation
(NPSG) in a nutshell


Provide written information for
discharge medications
Explain the management of
medication information
• List to physicians
• Update information when
medicines added, discontinued,
changed
• Carry medicine list at all times
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ASSESS
Organizational needs assessment

Scope and organization of PFE program

Are PFE needs assessed r/t key elements?
•
See Patient and Family Education, PC.02.03.01
Assessment Grid
•
Throughout continuum of patient encounter

Interdisciplinary collaboration

Patient populations served
•
Disease, physical, cognitive,
economic mix
•
Cultural, spiritual, language, literacy mix
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Organizational needs assessment

PF centered care and
communication

National Patient Safety Goals

Continuum of care/discharge

Curriculum, resources, OnDemand videos and patient ed
materials

Documentation practices and
audits

Staff competency
12
Organizational needs assessment


What are patients having done?
•
Common diagnoses
•
Frequently done procedures
•
Readmission rates
•
New procedures or treatments
•
New specialties in organization
Is there a consistent level of PFE and resources
across the spectrum of care?
13
Organizational needs assessment
Assessment methods:






Statistics and data
Medical record audits
Observation
Questionnaires
Interviews
Focus groups
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Staff knowledge & performance
Are staff members:
•
Aware of the education resources available and how
to access them?
•
Using the resources available?
•
Using resources that are not “approved”?
•
Aware of how to get new materials if needed?
•
Aware of policies r/t patient education?

What education needs do staff have r/t PFE?

Do you have designated educators in your
system?
15
Assessing individual PFE needs
Learning Needs Assessment
• Who needs to be taught
• What needs to be taught
• How it needs to be taught (learning
style and communication needs)
• Readiness to learn
• Health literacy – comfort with
reading and completing forms
• Factors that may impede learning
• Interventions to address factors
16
Assessing individual PFE needs

Is PFE provided based on identified needs and
abilities to learn (LNA)?

Is the coordination of education evident through
documentation?

Are all disciplines involved as needed?

Are appropriate PFE materials and resources
used?
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Assessing individual PFE needs

Is an evaluation of learning
with reinforcement
documented?

Are discharge referrals done
for ongoing PFE if needed?

Are discharge instructions easy to read and
understand?
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PLAN & IMPLEMENT
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Culture, language, and literacy –
“3 legs of the same stool”

What do we know about our patients?
•
Cultural background
•
Spiritual beliefs and practices
•
Languages spoken in community
•
Literacy level in community

Do we address Title VI and CLAS requirements?

Do we provide necessary services to diverse
populations in our service community?
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Cultural diversity

Use Kleinman questions to
understand PF view of illness and treatment

Train staff to work with interpreters and use
language services

Provide signage in English and major
languages served
21
What languages are needed?

Based on Health and Human Services, Title IV
“Safe Harbor” actions related to interpretation
•
Hospital provides written translations for each
language group in service area that
constitutes 5% or 1000 persons, whichever is
less
A Roadmap for Hospitals, Joint Commission
Page 67
Language resources
Provide both interpretation and
translation services

Not all interpreters have the skill set to translate
accurately

Computer translation programs do not provide
accurate document translation; may be okay for
single word translation

See Selected References handout for several
resources for translated PFE materials
23
Health literacy
Nearly 1 in 3 people have issues with
health literacy
 Materials at the 6th-8th grade readability
level reach a majority of patients and are
more effective in patient learning

Patients who read at
college level prefer
written health materials
at 7th grade level

Literacy and foreign language
resources



Use pictures, models, video-on-demand and
other learning aids as appropriate
Other than Spanish,
few commercial vendors
provide patient education
materials in foreign languages
Ensure that translated print documents are
readable by population served
25
Patient and family-centered care
Patient education begins and ends
with the patient

Involve PF in their care to improve patient safety
and satisfaction for patients and staff

Address barriers to involvement-low literacy,
language and cultural issues

Identify possible disparities

Coordinate care across
disciplines, specialties and
spectrum of care
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PFE Resources
Bottom line: use “plain
language” for everyone
(Universal Precautions)
 Create/purchase plain language print materials in
common languages for vital documents and higher
volume diseases, treatments and procedures
 Use video-on-demand, pictures, models, dolls and
computer based learning modules
 PF resource centers - consumer library as stand
alone or part of medical library
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Patient safety program

Have PFE resources available to address
standards

Ensure staff members are aware of NPSGs,
what to do, what to teach, and resources
available

Ensure documentation as
appropriate

See NPSG - Patient and Family
Involvement handout
28
Continuum of care and discharge

Have processes in place to coordinate PFE
across all aspects of the care continuum

Ensure services are available after discharge for
the PF to obtain more health education

Create a communication tool
for care providers after
discharge that incorporates
the PFE provided and
evaluation of PF
understanding
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Securing leadership support


Low tech, low cost, low risk –
high return
Decreases complications,
readmissions and reencounters
Improves discharge times and saves money
 Enhances organizational effectiveness
 Aligns with national quality indicators,
accreditation standards

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Securing leadership support




Meets accreditation standards
Improves relationships between patients,
physicians and staff
Enhances family centered-care
and public image
Improves quality of care
•
Patient outcomes
• Patient safety


Meets cultural and language needs
Meets health literacy needs
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EVALUATION
32
Evaluation measures
• Length of stay
• Readmits
• Home health and physician follow-up
• Complications at home, legal issues
• Cost-effectiveness
• PF satisfaction
• Staff satisfaction
• The Joint Commission, NPSG, legal
and quality measures
33
Evaluation
PF Satisfaction
 Patient satisfaction
surveys
 Customer complaints
 Lawsuits
 Incident reports
Staff Satisfaction
• PFE programs and
policies
• PFE resources
• PFE training and
inservices
• Documentation tools
34
Evaluation
Cost Effectiveness
•
PFE has been shown to decrease
complications, improve outcomes
and decrease length of stay
•
Patient education not often
reimbursed, but is key to safety and
satisfaction
•
Organizational support for provision
of patient education resources
•
Group classes versus individual
education
35
Evaluation of Documentation
Patient-centered communication tool for the entire
interdisciplinary team = quality care and patient
safety
 Provides legal record
 Validates regulatory standards are
being met
 Provides reimbursement record
 Source of information for research
and performance improvement
Chart audits can also show areas of improvement
and strengths
36
Evaluation
Ideas to consider r/t documentation:
Do staff members:

Know why they document?

Know what and how to document?

Know where to document?

Have easy-to-use documentation
forms and tools?

Understand the how’s, why’s, and where’s, but are just
not doing it? (moves it from an education to a compliance
issue)
37
Ideas for improvement
• Include patient education in:
o
o
o
o
o
Acuity reports
Clinical staff orientation
Annual evaluations
Yearly “mandatory’s”
Leadership reports
• Purchase/develop patient education materials
• Investigate translation of key documents
• Align with family-centered, patient safety,
cultural, language and literacy goals and groups
• Investigate grants and other funding sources
38
Designing a future state
Design outcome
indicators and tools
Realistic plans
and goals
Evaluate Outcomes
Design Future State
Gather Support
Build a Case
Assess Current State
Patients, family,
staff, physicians,
leadership
Family-centered care, patient
satisfaction, safety,
communication, outcomes
Patients, families, staff, physicians, internal
and external forces
39
Contacts
Diane Moyer, MS, BSN, RN
Ohio State University Medical Center
[email protected]
614-293-3191

Kathy Ordelt, RN, CPN, FAHCEP
Children’s Healthcare of Atlanta
[email protected]
770-785-7839

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