Meeting The Joint Commission Patient and Family
Transcription
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 7 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 9 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 11 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 14 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? 17 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? 18 PLAN & IMPLEMENT 19 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? 20 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 26 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 27 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 29 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 30 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 31 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 40