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Documentation is one of the first pieces of evidence surveyors from the Joint Commission look for to determine if patient education is not only taking place, but also is interdisciplinary. As a result, many health care facilities are implementing interdisciplinary patient education records.
"The one recommendation the Joint Commis sion made the last time they were here was that we needed one place for all disciplines to document, and we have taken that recommendation and developed an interdisciplinary form," says Joyce Dittmer, RN, MSN, director of education services at Saint Joseph’s Hospital of Atlanta.
Nursing is very good at documenting on the form, but with a Joint Commission survey scheduled for April, other disciplines need to improve, says Dittmer. One problem is that they refuse to let go of the other places where they document teaching in the patient record. Therefore, they see the request as double documentation.
Dittmer is persistent in her pursuit of interdisciplinary documentation on one patient education form. She constantly tells all disciplines that the form is a communication tool and is best for the patient. Documenting on one form saves time in the long run because it helps disciplines avoid duplicating tasks.
Several months ago, a multidisciplinary committee at Grant/Riverside Methodist Hospitals in Columbus, OH, determined that patient education should be documented on an interdisciplinary form. It wasn’t a new concept; several versions of these forms had been implemented in the past, and only certain disciplines used them. However, this time was different. "This time we had multidisciplinary input on the form up front," explains BJ Hansen, BSN, patient education coordinator at the hospital system. (For information on creating an interdisciplinary documentation form, see this month’s guest column, p. 32.)
Seven basic areas of knowledge were incorporated into the form: diet, activity, medication, procedures and treatments, disease process, procedures and tests, and community resources. Disciplines with expertise in each of these areas were asked to choose three basic outcomes that would be preprinted on the form.
For example, in the diet category, dietitians chose such outcomes as "can describe foods to avoid." "I find the biggest barrier to documentation is time and ease," says Hansen. With the form just implemented in December 1999, she has yet to determine if the ease of documentation will improve performance.
While it’s important to make sure documentation of patient education is easy, it also must be pertinent and thorough, says Virginia Forbes, MSN, RNC, CNA, patient education coordinator of New York Presbyterian Hospital, New York Weill Cornell Center in New York City.
Therefore, documentation of patient education is part of every employee orientation and is part of the annual mandatory review process in nursing and other disciplines. "Sharing the results of medical record reviews at departmental meetings also helps raise staff awareness about documentation," says Forbes.
To get disciplines to document on one patient education form, apply Prochaska’s Stages of Change theory, advises Cezanne Garcia, MPH, CHES, manager of patient and family education services at the University of Washington Medical Center in Seattle. According to this theory, people may or may not be ready to change based on what stage of change they are in at the moment. The stages include pre-contemplation, contemplation, preparation, action, and maintenance. (For more information on using this theory to create behavior change, see Patient Education Management, February 2000, p. 22.)
Applying the theory, Garcia partners with the clinics and units ready to use the form and on-line system that are in the action stage. Because they do a good job, she is able to use them as an example for others in order to improve documentation throughout the medical center. With these examples, she tries to move disciplines that are in the pre-contemplation or contemplation stage into the action stage. Garcia is able to determine which stage disciplines are in as she works with them.
This works because she is able to show these noncompliant units that by documenting outcomes, they can monitor whether their education is having the intended effect for which it was implemented. For example, fewer patients call back with questions or patients aren’t readmitted. Health care outcomes are becoming very important and are beginning to equal liability and communication as incentives to document education, says Garcia.
"I get a lead person from the clinician team that is successfully using documentation as a way to look at outcomes or achieve successes with their patient care to talk to the other teams. The greatest power is to use clinicians who have had success," says Garcia. n
For more information on making the teaching process interdisciplinary, contact:
• Joyce Dittmer, RN, MSN, Director, Educational Services, Saint Joseph’s Hospital of Atlanta, 5665 Peachtree Dunwoody Road, N.E., Atlanta, GA 30342. Telephone: (404) 851-7524. Fax: (404) 851-7406. E-mail: Jdittmer@sjha.org.
• Virginia Forbes, MSN, RNC, CNA, Patient Education Coordinator, New York Presbyterian Hospital-New York Weill Cornell Center, 525 East 68th St., New York, NY 10021. Telephone: (212) 746-4094. E-mail: vforbes@ nyp.org.
• Cezanne Garcia, MPH, CHES, Manager, Patient and Family Education Services, University of Washington Medical Center, 1959 Pacific St., N.E., Box 356052, Seattle, WA 98195. Telephone: (206) 598-8424. Fax: (206) 598-7821. E-mail: firstname.lastname@example.org.
• BJ Hansen, BSN, Patient Education Coordinator, Grant/ Riverside Methodist Hospitals, 111 South Grant Ave., Columbus, OH 43215. Telephone: (614) 566-5613. Fax: (614) 566-8067. E-mail: email@example.com.