SE6 The organization provides opportunities to improve nurses’ expertise in effectively teaching a patient or family.
Provide one example, with supporting evidence, of an educational activity provided by the organization focused on improving nurses’ expertise in teaching a patient or family.
NAME OF INITIATIVE
Discharge Planning Education for Nurses
BACKGROUND AND PURPOSE
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) initiative provides a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care. The HCAHPS survey contains 21 patient perspectives on care and patient rating items that encompass 9 key topics: communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, quietness of the hospital environment, and transition of care. At the system level and at Homestead Hospital, scores in the discharge domain have been inconsistent. To address this and other areas of opportunity, Baptist Health Quality and Patient Safety Steering Council (QPSSC) spearheaded a system-wide Discharge ACT (Accelerated Change Team). ACTs focused on systematically improving the performance of internal systems and organizational processed through the multidisciplinary teams. Each team established a statement of work to define:
- Background and current state-related data pertaining to the issues
- Statement of work (SOW), project plan & goals
- Stakeholders needed to address issues
- Estimated project timeline
METHODS AND APPROACH
Educational Activity
QPCCC started the Discharge ACT in February 2011. One of the subcommittees in this team was Education. This group developed a 1-hour computerized-based training (CBT) module titled, “Discharge Planning Process,” that could be accessed through Baptist Health University (BHU). (SE6 01 BHU Screenshot) This course was specifically designed to educate nurses and other health care providers on how to effectively discharge patients to improve patient safety and prevent financial loss and readmissions. The course description indicated that the overall goals for discharge planning must include ensuring the patient and family understand all they need to be responsible for to manage their health after they leave the facility. The learning objectives for the learning module were as follows:
- Summarize legal, regulatory and accreditation requirements for discharge education.
- Describe the elements involved in the discharge planning process.
- List ways to incorporate principles of patient and family centered care in patient teaching and the discharge process.
- Demonstrate the Teach-Back method of patient teaching.
- Identify methods to communicate among health care team members what patient teaching and discharge needs are necessary for a patient.
Improving Nurses’ Expertise in Teaching a Patient/Family
Homestead Hospital nurse leaders believed that this module would enhance the nurses’ expertise in teaching patients/families, especially with the reinforcement of the Teach-back method. Teach-back is research-based health literacy intervention that promotes adherence, quality, and patient safety by asking a patient (or family member) to explain—in their own words—what they need to know or do, in a caring way. (www.teachbacktraining.org) This technique gives healthcare providers a means to validate understanding of information provided to patients/family. This method also supported the organization’s patient education policy, which aimed to engage patient/family in an active dialogue about their healthcare needs using a method of instruction that matched their level of understanding. (SE6 02 HH-400-2000-711 Patient and Family Education Policy) So, the nurse leaders required that nurses at all levels, that is, clinical nurses, supervisors, managers, and directors, complete the module. This was also endorsed by the Clinical Practice Council (CPC). In addition, CPC recommended assigning the course to all nurses in order to facilitate compliance. Then, the Roll-Out Subcommittee took over the logistics of the education roll-out. This group oversaw prioritization, scheduling and deployment of hospital-wide initiatives. They met in March 2013 and decided to dedicate the entire month of May 2013 for the module’s education roll-out. (SE6 03 Roll-out Subcommittee Meeting Minutes 3/3/13) Clinical Learning department uploaded the module in BHU to appear in the “assigned learning” tab when nurses logged in.
Organizational Support
This initiative garnered the full support of hospital senior and nurse leaders. Nurses were paid for the time spent in completing the module if they chose to work on it from home or outside of their scheduled work time. Clinical nurse educators from various nursing units facilitated and monitored the education roll-out. To complement this initiative, Homestead Hospital purchased education booklets and magnets for Heart Failure patients to streamline education that were given to this patient population. The system Discharge ACT also developed discharge folders to help patients organize discharge literature and paper work. These folders were handed out to patients upon admission and were given for them to take home when discharged. Magnet Project Director Julie David, ARNP and Clinical Nurse Specialist Rosemary Lee, ARNP represented Homestead Hospital in the Discharge ACT.
PARTICIPANTS
The nurses who were involved in rolling out this initiative were:
Name/Credentials |
Title |
Department |
Role in the Team |
Elva Diaz BSN, RN, CDE |
Diabetes Educator |
Nursing Administration |
Roll-Out Chair |
Rosemary Lee DNP, ARNP, CCNS, CCRN, ACNP-BC |
Clinical Nurse Specialist |
ICU/PCU |
Member; Discharge ACT member |
Sandra Jones BSN, RN, CMSRN |
Clinical Nurse Educator |
3 South |
Member |
Beverly Johnson, BSN, RN, CMSRN |
Clinical Nurse Educator |
MS4 |
Member |
Aracely Olvera, BSN, RN, CMSRN |
Clinical Nurse Educator |
MS5 |
Member |
Karen Anding, BSN, RN |
Clinical Nurse Educator then; Patient Care Supervisor now |
MS3/Staffing Office |
Member |
Alicia Brown-Rowe, BSN, RN |
Special Projects Coordinator |
ICU |
Member |
Julie David MSN, ARNP, ANP-BC |
Magnet Project Director |
Magnet Designation |
Member; Discharge ACT member |
Jenny Lawton |
Coordinator |
HR Learning Management |
Member; ran BHU reports |
OUTCOMES
According to the BHU report, 434 students completed the course. (SE6 04 BHU Course Completion Report) Utilizing Kirkpatrick’s model, the “Discharge Planning Process” course was evaluated as follows:
Level 1 Reaction - The nurses rated the course favorably based on the responses to the class evaluation.
Level 2 Knowledge - The new knowledge acquired by the nurses was evaluated through a post-test at the end of the course.
Level 3 Behavior– Clinical nurse educators and nurse leaders observed, monitored and reinforced use of teach-back technique in the patient discharge education process. This was an important element that promoted its integration into daily nursing practice.
Level 4 Results
Exhibit SE6a: Homestead Hospital Inpatient HCAHPS Top Box Percentile Rank on the Discharge Information Domain Question
Analysis: Above graph depicts that the inpatient HCAHPS top box percentile rank for Homestead Hospital has improved after the education intervention and the improvement was sustained for 5 consecutive months with ongoing monitoring and reinforcement provided by nurse leaders and clinical nurse educators at the bedside.
Summary Attachments/Hyperlinks/Evidences
SE6 01 BHU Screenshot
SE6 02 HH-400-2000-711 Patient and Family Education Policy
SE6 03 Roll-out Subcommittee Meeting Minutes 3/3/13
SE6 04 BHU Course Completion Report
Exhibit SE6a: Homestead Hospital Inpatient HCAHPS Top Box Percentile Rank on the Discharge Information Domain Question