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JCAHO will expect proof of team approach
(Editor’s note: This month, we continue our series on perplexing problems in patient education with an article on ways to ensure that teaching is interdisciplinary and documented. The Joint Commission looks for evidence of interdisciplinary teaching, and we show you how health care facilities are proving that their education process is a collaborative effort. In February, we tackled another difficult issue: physician involvement in patient education. We’ll look at providing consistent education across the continuum of care.)
Short hospital stays can be good for patient education. How? They can make teaching more interdisciplinary because busy nurses are more likely to call in other disciplines when the teaching is outside their area of expertise, says BJ Hansen, BSN, patient education coordinator at Grant/ Riverside Methodist Hospitals in Columbus, OH.
Also, departments and disciplines have come together out of necessity to develop more efficient patient teaching plans, observes Virginia Forbes, MSN, RNC, CNA, patient education coordinator at New York Presbyterian Hospital and New York Weill Cornell Center in New York City. These teaching plans specifically stress teaching "survival skills" in the inpatient setting and the use of referrals to outside sources for follow-up throughout the continuum of care.
Outside referrals are a good way to accomplish interdisciplinary teaching. The atmosphere is usually more conducive to learning, says Joyce Dittmer, RN, MSN, director of educational services at Saint Joseph’s Hospital of Atlanta. It’s often difficult for all the appropriate disciplines to schedule time with a patient due to shortened hospital stays.
In addition, patients are frequently too sick to learn while in the hospital. Community-based programs at Saint Joseph’s now provide interdisciplinary teaching on an outpatient basis. What the physical therapist and dietitian used to try to teach at bedside as part of the cardiac rehab team, for example, is now taught at the heart school.
Much is being set in place to foster interdisciplinary teaching at Saint Joseph’s. Employees understand that education is the responsibility of all disciplines; it’s part of administrative policy, and it’s included in their orientation and evaluation process. Charts are audited to ensure that interdisciplinary teaching is being done.
An interdisciplinary patient education committee guides all the patient teaching in the hospital. Teaching materials are reviewed by the committee and approved by physicians. Interdisciplinary teaching is part of all care pathways, and there is an interdisciplinary patient education record that all disciplines document on, explains Dittmer.
The model for developing teaching plans at the University of Washington Medical Center in Seattle is interdisciplinary. Whether developed by the hospitalwide patient education committee or a clinic, the team is to be mixed, says Cezanne Garcia, MPH, CHES, manager of patient education services. People support what they help to create, she explains. "Key clinicians that will be impacted by whatever practice expectations we’re going to have really need to be part of the dialogue," says Garcia.
Interdisciplinary teaching can be triggered in many ways. At Grant/Riverside Methodist Hospi tals, prompters on the patient health assessment completed during the admission process trigger a referral to the appropriate discipline. For example, if a diabetic is having trouble understanding the appropriate diet, a dietitian would be contacted.
The clerk on the unit enters the information into the computer, so the disciplines are automatically notified. Clinical pathways and preprinted physician orders automatically result in a consult with the indicated discipline as well, adds Hansen.
"Teaching has been a multidisciplinary effort for a long time, becoming more collaborative and interdisciplinary in recent years. It often flows automatically as part of a plan of care," says Forbes. The plan of care usually is completed during patient care conferences and includes education issues.
Referrals also are prompted in other formal and informal ways. For example, if a nurse were to encounter a patient on several medications with potential interactions, the pharmacist can be called for assistance. However, teaching provided by physical therapy evolves from a formal consultation requested by the physician or nurse practitioner.
If a patient is put on a new diet, the dietitian is automatically notified via the computer system. However, regular, informal communication among health care providers is essential to ensure the development of an effective teaching plan, says Forbes.
No matter what system of interdisciplinary teaching is in place, there must be proof of it when the Joint Commission comes to survey, or you don’t always get credit. There are several ways to provide the evidence. "The most prominent evidence is in the medical record on the interdisciplinary teaching record," says Forbes.
Other evidence of collaboration at her health care facility includes the work of the interdisciplinary patient and family education committee, a hospitalwide policy on the process of patient education, and an interdisciplinary mechanism for review and approval of resources. Interdisci plinary teams also develop and evaluate patient education programs.
Documentation shows that teaching took place and what the outcome of that teaching was, while the other evidence reveals the collaborative processes that are in the background, says Forbes.
During a recent Joint Commission survey, the collaborative process was important to the surveyors. "They were particularly interested in how resources were reviewed and approved and whether the process was interdisciplinary," she explains. (For more information on documentation, see article, p. 28.)
It’s important to provide clear evidence that education is interdisciplinary, says Garcia. She creates a two-page document on all quality improvement initiatives pertaining to patient education. These written records describe which disciplines were actively involved in developing the process improvement. She also keeps records of all interdisciplinary documentation forms that have been customized by teams.
However, the best evidence of collaboration is found on the unit floor when surveyors interview staff, says Garcia. Examples include a nurse telling whom the contact person is at the pharmacy for food and drug interaction information or a care team member explaining how education fits into patient rounds. To help prepare staff for these interviews, Garcia has created work sheets on how to prepare for Joint Commission surveys as an individual clinician and as a clinical team.
To help prepare staff for these interviews, Garcia has created work sheets on how to prepare for the Joint Commission survey as an individual clinician and as a clinical team. The Joint Com mission staff preparation checklist for individuals is a multiple-choice guide that is tailored to the University of Washington Medical center processes and procedures for patient teaching. Staff check off the examples that demonstrate how they apply each of the principles to their practice.
The department preparation checklist is a guide used by managers to prepare their clinical service area for the site visit. The intent of the guide is to help management and staff by focusing their responses for the Joint Commission interview to reflect the medical center’s patient education systems structure, tools, and policies. "It helps highlight what the specific clinical service area team does well and how and where they can improve their team’s practice. The checklist also informs the team of some options and resources available to help their team with preparing for JCAHO," explains Garcia.