How technology can transform your patient education department
How technology can transform your patient education department
Meaningful but simple changes through technology
Although it is sometimes difficult to abandon tried-and-true methods, even simple changes can improve patient education programs. Usually, there are warning signs that the current method isn’t working. A solution doesn’t have to be complicated. Sometimes, it starts small.
When it became a challenge to get consistency in the patient education manuals that were being created at the New Mexico Veterans Affairs (VA) Health Care System in Albuquerque, Carol Maller, RN, MS, CHES, patient education coordinator, began to contemplate automating the process so that they would reflect a standard of care in keeping with the Joint Commission on Accreditation of Healthcare Organizations standards. To standardize the process, she hired a consultant to develop a macro, which is an electronic file that automatically generates certain text.
She wrote the manual with the consultant, leaving blank spaces in strategic places where the author would need to create copy unique to the program. For example, the evaluation and documentation process is the same for any patient education teaching so that is automatically generated on the macro. The developer would write such copy as the learner objective and the content of what the patient is to be taught. "Whenever a new manual is developed, all the author has to do is sit down with the file and plug in the missing pieces. The macro knows where to put the missing pieces," says Maller.
Each manual is a three-ring binder and all have tabs with identical sections. The first section has the goals and needs assessment; the second holds the patient outcomes; the third contains the educational resources; the fourth has information on community resources; and the fifth section covers documentation. "One of the major advantages is that when the manuals need to be updated, I just pull out my macro and do a couple editing changes. I can update it in a matter of minutes," she says.
Technology has impacted other facets of management as well. Distribution and oversight of more than 350 titles of patient education materials created in-house became extremely burdensome. "It was very labor-intensive to transport the materials around the medical center, and managing the inventory was time-consuming. I would get orders from staff on a daily basis," says Maller.
Therefore, she decided to automate this system as well. The medical center implemented a web-based system of handouts that had been pilot-tested at a VA hospital in Amarillo, TX. Providers can access the materials on the intranet, and patients also have access to them via the Internet. "All the updates are done on a regular basis by the company, and they offer three times as many titles as we had," she says.
The clearinghouse for print materials at M.D. Anderson Cancer Center in Houston also is no longer necessary. However, rather than using a web-based system, all in-house materials now are on-line and can be accessed on the intranet, says Louise Villejo, MPH, CHES, director of patient education. "It is convenient for the staff, and we can make changes in real time, we don’t have to wait to deplete an order. It’s a cost savings because we don’t have to have materials printed," she says. Also, affiliates of the cancer center around the country have access to the patient education database.
Now that the technology is available for electronic documentation, Maller no longer has to manage the 50 paper forms that formerly were used to document patient education. In addition, auditing the documentation of patient education has been simplified. "We can generate a report of the documentation being done across the medical center, and we can show that it is interdisciplinary. We have already run those reports for our upcoming Joint Commission survey," says Maller.
Catalysts for change
Time constraints often are the catalyst for change in programs. Now that tight staff schedules have made regular meetings of interdisciplinary patient education committees difficult to arrange, more communication takes place via e-mail, and there are fewer meetings, says Villejo.
About every two to three years, clinical staff in the various areas covered by committees are interviewed so the committee can assess the program and obtain feedback on which materials are being used. "Once we determine what a clinical area needs, we work individually or in small groups," she says. Often, just certain key people need to be involved, such as the clinical coordinator and the pharmacist or dietitian.
Evaluation of programs routinely is continued through patient and family assessments, and with materials on-line, it is easy to generate a report on handouts to determine the ones that are being used and the ones that aren’t, says Villejo.
Annette Mercurio, MPH, CHES, director of patient, family, and community education for City of Hope National Medical Center in Duarte, CA, has found that it is easier to assess educational needs on a small-scale basis than by conducting a large, institutionalwide needs assessment. Now, when she does an assessment, she either focuses on a particular high-volume patient population with complex education needs, one particular medical area, or uses available data to assess needs, such as that generated by patient satisfaction surveys.
"If I have data indicating a problem, I do a performance improvement project vs. the really broad needs assessments that require a lot of time," she says. Mercurio realized she could look at data for smaller projects, make changes, and follow through in a shorter period of time, focusing realistically on something that could make a difference.
For example, to determine how to improve integration of patient education materials into practice and learn whether staff were using materials, the patient education department focused on one patient-care area. A staff survey was conducted that found that staff in this area thought materials were disorganized and they didn’t have the handouts they needed such as those that explained tests that were ordered for patients. Therefore, this particular patient care area was focused on for a period of time until considerable improvement was seen. "I think this is more practical given the limited time we have to work with," says Mercurio.
Changing from one-on-one teaching to group instruction is improving staff morale because it helps caregivers make better use of their time, says Barbara Petersen, RN, patient education coordinator at Great Plains Regional Medical Center in North Platte, NE. The first program targeted was diabetes teaching. That’s because the two diabetes educators, as well as dietitians, were saying the same thing to patients five times a day. "Now instead of taking a dietitian’s time and nurse’s time five times a day, it is being done once a week," she says.
Group teaching for total hip and knee surgery also is being implemented. Physical therapists at Great Plains just don’t have time to see patients on an individual basis before surgery. "We will include case management and our pre-op nurses to get all three educational portions completed on the same day during one session," says Petersen.
Research articles have provided staff information on how to collect some data before beginning the pre-op teaching for total hip and knee patients that can be used to evaluate the effectiveness of the program once it has begun. After the program has been up and running for a while, they can collect the same data to see if there have been any measurable improvements, says Petersen.
To improve participation in educational activities as well as save resources, the New Mexico VA Health Care System is integrating its traditional group education classes into group clinic visits. Adult learners are more willing to participate in a group clinic than class, says Maller.
To fill a class, she has to schedule double the amount of participants because about half fail to show up. Also, it is costly to have staff come in to teach when only a few patients are present. However, staff already are at the clinic, she says.
"It integrates patient education into the clinical visit. You don’t want education as a separate entity you want it integrated into every clinic visit so it is part of every encounter with a clinician," says Maller. In addition, this setting helps patients become more actively involved in their care.
Innovation not always necessary
Changes in patient education programs don’t have to be based on innovative new methods of patient education or the latest technology to make sense. At City of Hope, the patient education department has been working on streamlining the materials given to new patients. It probably will save money and be more effective from an educational standpoint, says Mercurio.
In the past, all the patients received an expensive orientation booklet to all the services available at the health care facility, including the patient education resource center. A booklet similar to the desk services portfolio found in hotel rooms soon will be kept in a plastic folder in patient rooms on a permanent basis.
Great Plains ordered all its patient education materials from vendors until recently when staff began to generate handouts in-house. "It seems like we were spending so much money on external patient education materials, and staff really didn’t like it. The satisfaction of the clinicians now is higher that we have started producing it here and it is available on-line," says Petersen.
When the idea was first suggested many said that the facility was not large enough to produce its own materials, and it would be too costly. However, Petersen worked with the public relations director to come up with a template so handouts would be standardized and have a disclaimer. "Patients, no matter what point of access, will get the same handout with the same format on-line, and it is accessible to everyone," says Petersen.
Sometimes patient education managers become use to a certain routine, but it isn’t working. For example, Mercurio routinely had the library run a monthly search on patient education literature. The librarian would send a list of all the new articles that were published, and Mercurio would check off the ones that she wanted to read. However, when they reached her office, they would pile up and she would never find time to read them.
"Now, instead of having that search done every month, I wait until I am starting to work on a project or think about a project, like developing a patient orientation program, and I have the library do a literature search on that topic," she says.
There’s always someway to do something better, says Mercurio. "If you don’t have the answer to something, someone else may have a little different perspective on it and have figured out how to do it better," she says.
Sources
For more information about changing patient education programs, contact:
- Carol Maller, RN, MS, CHES, Patient Education Coordinator, New Mexico VA Health Care System, 1501 San Pedro Drive, S.E., Albuquerque, NM 87108. Telephone: (505) 265-1711, ext. 4656. E-mail: [email protected].
- Annette Mercurio, MPH, CHES, Director of Patient, Family and Community Education, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010-0269. Telephone: (626) 301-8926. E-mail: [email protected].
- Barbara Petersen, RN, Patient Education Coordinator, Great Plains Regional Medical Center, 601 W. Leota, North Platte, NE 69101. Telephone: (308) 535-8640. E-mail: [email protected].
- Louise Villejo, MPH, CHES, Director of Patient Education, MD Anderson Cancer Center, 1515 Holcombe-Box 21, Houston, TX 77030. Telephone: (713) 792-7128. E-mail: [email protected].
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