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Teach how to talk with surveyors on compliance
The biggest challenge to complying with the standards of the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations is education of staff, says Kathy Ordelt, RN, CRRN, CPN, patient and family education coordinator at Egleston-Scottish Rite Children’s Health Care System in Atlanta. Staff need to understand how the hospital globally applies the standards and how their own department complies with Joint Commission, she explains.
To educate staff and make sure all departments were in compliance with the Joint Commission’s standards for patient education, the health care system began an education campaign about 18 months before the survey.
Following is a list of the educational methods employed:
• Explain standards in a variety of print methods.
Each month, an in-house nursing publication featured a Joint Commission patient education standard in question form, then provided the answer. For example, employees might be asked: "How do we educate patients about medications and potential food and drug interactions?" Ordelt would provide the answer in bullets following the question.
The information also was sent to managers on a flyer and as an e-mail message. "I made sure all the managers knew it was a piece of information the Joint Commission was concerned about," says Ordelt.
The 750 pediatricians associated with the health care facility were sent the flyers on patient education standards as well.
• Make learning fun by playing games.
A core team was assembled with leaders for each chapter of the standards. Ordelt was selected for patient education. This team created games to help employees remember standards and went to each department to play the games with staff in those areas.
The games also were played with different physician groups where patient education questions were included. One of the favorite games was "Joint Commission Feud," where the employees would divide into teams and compete to answer questions about standards appropriate to their area.
If an area did not do well with patient education questions, Ordelt would return with the game and focus on patient education topics.
Another game was similar to the TV game show Jeopardy!. A large nylon board with pockets had categories across the top and answers to questions in each pocket. As the answers were pulled from the pockets, competing teams would have to give the question. Candy or yogurt coupons were handed out as prizes whenever games were played.
"We had a sign-up sheet so the departments could borrow all our games from the education department and take them to their staff meetings and inservices," says Ordelt.
• Verbally test employees on standards.
Ordelt would visit different units and stop employees as a surveyor might to ask questions about patient education. For example, she might ask an employee to explain how he or she personally meets the standard for education on food and drug interaction with the patients on the unit.
• Thank staff for their efforts.
When the survey is completed, send out thank-you notes immediately, advises Ordelt. Don’t wait until the results of the survey are known. Also, celebrate good results and the effort of staff to achieve them. "After we found we got our third accreditation with commendation, we had a very large dessert party and invited all staff to come," says Ordelt.