Make sure the right patient education measures are in your electronic records
Make sure the right patient education measures are in your electronic records
Patient educators need to be part of team that designs system
Most would agree that patient education jumped to the forefront in the 1990s, shortly after the Oakbrook Terrace, IL-based Joint Commission on Accre dita tion of Healthcare Organizations (JCAHO) included the topic in its standards. Although not all health care facilities hired patient education managers, they at least formed a committee to create policies and procedures and oversee the process.
Now, poised on the cusp of a new millennium, there are new challenges and opportunities that patient education managers must become aware of, says Leah Kinnaird, EdD, RN, a consultant for Creative Healthcare Management in Minneapolis.
One of the most pressing issues at the turn of the century is the implementation of computerized patient records. Because we are in the age of information, computerized records are destined to be a part of every health care institution in a few years. Patient education managers need to be at the table when these systems are being designed and implemented at their institutions so patient education won’t be overlooked, says Kinnaird.
They also need to pay attention to what is happening nationally in this area so the language used to measure patient education in their computerized record system can be benchmarked against other settings. This will provide a better way to evaluate patient education and prove its worth. "Patient education managers will position themselves in a more powerful position within their organization if they know what is happening," explains Kinnaird.
Another important issue in the national forefront is a drive by several researchers, working in concert with the American Nurses Association (ANA) in Washington, DC, to develop vocabulary and classification systems specific to the delivery of nursing services and its importance to quality patient care. These systems are being used to capture outcome data that validate the importance of nursing.
Why is this important to patient education managers? Patient education is included in many of these vocabulary and classification systems and can be used to validate patient education outcomes, as well.
"We are now able to collect much more information about the quality of care and relate it to the structure and processes that are being used to deliver care. Although this is still in its infancy, the hope is that as more data are collected, better decisions can be made about how care is delivered," says Kinnaird. Much of the language that is agreed upon will become part of the computerized patient record, she explains.
Several of these vocabulary or classification systems have been recognized by the ANA, including the Nursing Intervention Classification and Nursing Outcomes Classification. To help set national standards, this organization established a committee and invited all who had created such systems to submit their tools to be evaluated by the committee.
These tools focus on patient problems, the intervention used, and the outcome, although some have only one of these components, while others have two or three, explains Connie Delaney, PhD, RN, FAAN, associate professor and researcher at the University of Iowa in Iowa City. (To learn more about how the classification systems relate to patient education management, see story, p. 135.)
In addition, the ANA evaluates computerized patient records that have been placed on the market through its Nursing Information and Data Set Evaluation Center, which Delaney chairs. "We developed a set of criteria that are similar to JCAHO and evaluate data sets that vendors develop against those standards to see if they measure up," she says. If the data sets pass the criteria, they are recognized by the ANA with a stamp of approval which should help health care facilities evaluate the software before purchase, notes Delaney.
Examples of the criteria Delaney used are standards for nursing data sets that support nursing practice.
Included were the following:
1. Nomenclature.
N1 — Terminology in data dictionaries and tables as appropriate to the nursing domain.
N2 — Structured terminology in data dictionaries or tables is available to document all phases of the nursing process.
2. Clinical associations.
CCA2 — Choices displayed as a result of branching pathways among assessments, diagnoses, expected outcomes or goals, interventions, and actual outcomes reflect current knowledge, and are therefore complete, appropriate, and accurate.
3. Clinical data repository.
CDR1 — Patient-specific data are stored permanently in electronic form in an accepted standard database format (such as ANSI). If data are not stored in a standard database format, evidence is provided that data can be exported to standard databases.
Comparing apples to oranges
While all these tools to collect data were being set in place, it became apparent that even with these information systems, there could be a problem comparing outcomes from hospital to hospital or from unit to unit within the same organization. That’s because there was no way to clearly describe the context in which care was delivered.
For example, turnover can affect the quality of care, yet there was no way to know if staff on a unit were regular staff or temporary workers just in for the day. "If staff are in and out for just a day or a shift, that affects the continuity of patient care," says Delaney.
Therefore, Delaney co-developed the Nursing Management Minimum Data Set, which has 17 variables describing the environment, the personnel, and the financial aspects of the setting. Now health care organizations can know if they are comparing similar situations when evaluating outcomes. For example, if staff are temporary workers, that can be noted.
The nursing vocabularies and classifications that have been created follow the Nursing Minimum Data Set template developed in the 1980s, which collects data on diagnosis, intervention, and outcome, says Delaney. Many of these new vocabularies and classifications are patterned after this data set because it is recognized by the ANA.
"Now we have a fuller picture. The Nursing Minimum Data Set advocates capturing the patient care process, and the Management Mini mum Data Set is the context. When you marry both of those, you can finally do all these outcome studies beyond a single patient or a single unit," she explains.
Another aspect of evaluation that patient education managers should pay attention to in the new millennium is the surveys for quality that include patient education statements. While administrators usually select the surveys used at an institution, PEMs need to give input on how the questions should be asked so they don’t conflict with policies and procedures on how patient education is delivered. "The patient education manager tailors the questions so they are appropriate for their specific institution without varying from benchmark standards," says Kinnaird.
For more information on these issues facing patient education managers in the new millennium, contact:
• Connie Delaney, PhD, RN, FAAN, Associate Professor, University of Iowa, 464 NB College of Nursing, University of Iowa, Iowa City, IA 52242. Telephone: (319) 335-7113. Fax: (319) 335-7129. E-mail: connie-delaney@ uiowa.edu.
• Leah Kinnaird, EdD, RN, Consultant, Creative Healthcare Management, 1701 E. 79th St., Suite One, Minneapolis, MN 55425. Telephone: (800) 728-7766 or (612) 854-9015. Fax: (612) 854-1866. E-mail: [email protected].
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