Fresh Approaches to Patient Education Kari Bottemiller, RN, CNS Mayo Clinic April 8, 2010.

Fresh Approaches to Fresh Approaches to Patient EducationPatient Education

Kari Bottemiller, RN, CNSKari Bottemiller, RN, CNS

Mayo ClinicMayo Clinic

April 8, 2010April 8, 2010

Barriers Barriers • Electronic Medical RecordElectronic Medical Record

• Needing consistent documentation from a large number Needing consistent documentation from a large number of nursesof nurses

• Strict requirementsStrict requirements

• Time for documentationTime for documentation

• Competing demands/priorities on the nurses timeCompeting demands/priorities on the nurses time

• Nurse awareness of requirementsNurse awareness of requirements

• Confusion in documentation requirementsConfusion in documentation requirements

• Dismissal location, patients ability to learn and Dismissal location, patients ability to learn and availability of familyavailability of family

What do we do?What do we do?• Standard Stroke EducationStandard Stroke Education

• All patients receive stroke education packetAll patients receive stroke education packet• Various materials (12 items) including stroke Various materials (12 items) including stroke

prevention, smoking cessation, psychosocial prevention, smoking cessation, psychosocial materials, nutrition, caregiver information, disease materials, nutrition, caregiver information, disease process, hypertension, Stroke DVD process, hypertension, Stroke DVD

• Documentation of individual risk factors educated on (e-Documentation of individual risk factors educated on (e-code)code)

• Documentation of Stroke booklet in packet- with review of Documentation of Stroke booklet in packet- with review of warning signs/symptoms, how to activate EMS and risk warning signs/symptoms, how to activate EMS and risk factorsfactors

• Review and documentation of hospital dismissal Review and documentation of hospital dismissal summary for med education and follow up instructionssummary for med education and follow up instructions

Order Stroke Education Plan part A & BOrder Stroke Education Plan part A & B

12 3

4

Individualize patient specific risk factors and press f12 to save

Finalized education with ecode

What have we done to increase What have we done to increase compliance?compliance?

• Baseline data showed 12% compliance Baseline data showed 12% compliance with stroke education (3with stroke education (3rdrd qtr 2006) qtr 2006)

• EMR issues, education was occurring EMR issues, education was occurring but not documented, addressing off but not documented, addressing off floor stroke patients floor stroke patients

Education Improvement PlansEducation Improvement Plans• 1:1 nursing education with staff to cover 1:1 nursing education with staff to cover

requirements requirements

• Development of E-code to assist with chartingDevelopment of E-code to assist with charting

• Presentations at unit team days and specialty Presentations at unit team days and specialty practice committeespractice committees

• Added stroke education to plan of care on Added stroke education to plan of care on admissionadmission

• Stroke CNS to provide off floor patient Stroke CNS to provide off floor patient educationeducation

• Increased compliance to 57% (1QTR2007)Increased compliance to 57% (1QTR2007)

Education Improvement PlansEducation Improvement Plans

• Ongoing 1:1 feedback, discussion at unit Ongoing 1:1 feedback, discussion at unit practice committeespractice committees

• ICU adding stroke ed order plans on admissionICU adding stroke ed order plans on admission

• Pilot role of stroke practice coordinator on Pilot role of stroke practice coordinator on stroke unitstroke unit

• One role was to provide educationOne role was to provide education• Compliance increased to 84% (Aug 2007)Compliance increased to 84% (Aug 2007)

• Further analysis, showed gaps with Further analysis, showed gaps with hemorrhagic patients on surgical floorhemorrhagic patients on surgical floor

• CNS addresses on a daily basisCNS addresses on a daily basis

Jan 2008- the measure changed!Jan 2008- the measure changed!

• Caused a dip in resultsCaused a dip in results

• Risk factor education compliance at Risk factor education compliance at 100%, but missing meds and follow 100%, but missing meds and follow up due to documentation practices up due to documentation practices (again)(again)

• Re-education with staff on new Re-education with staff on new requirements requirements

Current PracticeCurrent Practice

• Ongoing reinforcement continually Ongoing reinforcement continually requiredrequired

• New functionality to EMR coming to assist New functionality to EMR coming to assist with education placed in plan of carewith education placed in plan of care

• Communication between CNS and practice Communication between CNS and practice coordinator to assess completioncoordinator to assess completion

• Current compliance 90% (range 88-98%)Current compliance 90% (range 88-98%)• Typically missing only portions of Typically missing only portions of

educationeducation

Stroke Education ClassStroke Education Class

• Implemented Feb 2009Implemented Feb 2009

• Created for patients and families of Created for patients and families of stroke patientsstroke patients

• Content developed with Content developed with multidisciplinary team and department multidisciplinary team and department of patient educationof patient education

• Open to the public and other unitsOpen to the public and other units

• Tuesdays and Sundays from 4-5pm on Tuesdays and Sundays from 4-5pm on 2Dom2Dom

Printed MaterialsPrinted Materials

Recognizing Stroke and Stroke Recognizing Stroke and Stroke Prevention VideoPrevention Video

• DVDDVD

• VODVOD

QuestionsQuestions

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