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Make sure patients understand disease
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When Donna Zazworsky, RN, MS, CCM, FAAN, vice president of community health and continuum care for Carondelet Health Network in Tucson, AZ, ran a community case management program for high-risk congestive heart failure patients, she was surprised to discover that many of the patients did not understand their diagnosis or their discharge instructions.
"About 50% of patients don't understand what to do after discharge. When the discharge instructions are complicated and the person is ill and frail, it's even harder to make sure they understand," adds Cory Sevin, RN, MSN, NP, director of the Institute for Healthcare Improvement.
Before they leave the hospital, patients need to know what is wrong with them and what the condition will mean to their long-term health, such as how it will affect their ability to function, if it will increase susceptibility to other health problems, and factors that will decrease the possibility of a recurrence, Zazworsky says.
Make sure that patients understand where they are going after they leave the hospital, know what to expect, and know that they have access to follow-up care, Zazworsky recommends.
Case managers should educate patients on what they need to do when they get home, including any dietary restrictions, fluid intake, exercise restrictions, appointments for tests and other follow-up visits, and return to work, she adds.
In addition to ensuring that patients have a follow-up visit with a physician, make sure they understand that if they feel worse or begin to have symptoms, they should call their physician's office immediately and not wait until their appointment, Zazworsky adds.
"Patients often leave the hospital, and they don't know who to call, when to call, or how quickly to call if they have problems. They should have written information on who to call after discharge if they have questions or concerns," she says.
Make sure that the information and materials you give patients fits with their cultural backgrounds and that they understand it fully, Zazworsky says.
"As case managers and discharge planners, we need to be aware of how we address the questions that need to be answered for the patient before discharge," Zazworsky says.
Health care professionals need to communicate with patients in ways that they can understand so they can use the information, she adds.
Don't overwhelm patients with a lot of information. Instead, focus on the key things they need to know, and make sure the information is clear and concise and that they understand it, Sevin says.
This includes medication instructions, what symptoms mean they should call their physician, and who they should call.
Be specific around each patient's clinical condition, she says.
Use the teach-back method to make sure patients understand.
"Nurses are taught to educate by telling people things. This isn't very useful. If they ask the patient to repeat what they have been told, it can close the loop," she says.
Make sure the messages are consistent throughout the continuum of care.
"To be more effective, the home health nurse should be providing the same information as the nurse on the hospital unit. Patient and family members should be hearing the same message and not being confused by multiple ways of teaching," Sevin says.
"Many times, case managers make the assumption that patients who are educated understand everything you are saying, but that's not always the case," Zazworsky says.
For instance, if you tell a patient they can eat something in moderation, find out what moderation means to the patient.
No matter how good your discharge education is, it won't be effective if patients can't understand it, Zazworsky points out.
"When patients first come into the hospital, case managers should determine if they can read, understand, and act on the health education they are going to provide," she adds.
She suggests using the rapid assessment of adult literacy in medicine tool, part of the Case Management Adherence Guidelines developed by the Case Management Society of America, to determine if patients will be able to understand their discharge instructions of if they will need extra help.
The tool asks patients to pronounce a list of words. If it takes the patient more than five seconds to say the word or if it's mispronounced, it is incorrect.
Here are the elements of the tool:
Fat, flu and pill are not scored.
"A patient who scores six or less is at risk for poor health literacy. This means that you have to spend more time explaining specifically what you mean when you give discharge instructions and should make sure that they understand," she says.