Fresh Approaches to Fresh Approaches to Patient Education Patient Education

Susan Savastuk MEd, BSNSusan Savastuk MEd, BSNStroke Program CoordinatorStroke Program Coordinator

Neuroscience InstituteNeuroscience InstituteBloomington HospitalBloomington Hospital

Bloomington, INBloomington, IN

1

OBJECTIVESOBJECTIVES

• Discuss the Joint Commission measurement for patient stroke education

• Review education initiatives and tools to increase compliance

2

ASA Policy Statement Recommendations ASA Policy Statement Recommendations for the establishment of stroke systems of for the establishment of stroke systems of care suggest that a stroke system should: care suggest that a stroke system should:

• Develop support tools to assist patients in long-term adherence to stroke prevention.

• Develop multiple education strategies along with health literacy targets appropriate to the education levels of the targeted population

Stroke March 20053

Joint Commission Performance Measure: Joint Commission Performance Measure: Stroke EducationStroke Education

Data Elements Five essentials of stroke education

Stroke Education Materials

Exclusions

Concerns

Data Sources Where stroke education can be documented

4

Education Data ElementsEducation Data Elements

• Personalized Risk Factors for Stroke

• Warning Signs and Symptoms of Stroke

• Activation of Emergency Medical Services

• Follow up after Discharge

• Medications Prescribed at Discharge

5

Educational MaterialsEducational Materials

• DVD, CD, Video, brochures, personalized teaching sheets can be used– Content of these items needs to be described

within your documentation

• Documentation can occur any time during admission

• JC recommends that stroke education

occurs throughout the hospital admission

6

Education Requirement ExclusionsEducation Requirement Exclusions

• If patient is “Comfort Measures Only”– Does NOT include “DNR” status– Does include patients with Hospice Referrals, etc.

• Patients being Discharged to Inpatient Rehab, Nursing Home, Long Term Acute Care (this is new for Jan 2010 JC submissions)

• Patients admitted for Elective Carotid Endarterectomies

7

Things That Impede the Education ProcessThings That Impede the Education Process

• If patients or family refuse education

• Patient has severe cognitive impairment, AND there is no family or caregiver available.

These instances must be documentedThese instances must be documented

8

Where to DocumentWhere to Document

• Med Reconciliation sheet signed by MD, Nurse, and Patient

• Pathway/ Care Plans

• DC Instruction Sheet

• Nurse’s Note documentation

• MD documentation (i.e. DC Summary)

9

Bloomington Hospital Stroke Bloomington Hospital Stroke Education Tools and InitiativesEducation Tools and Initiatives

10

Quality Improvement InitiativesQuality Improvement Initiatives

• Discussions with stroke unit staff

• Mentoring

• Identify “Stroke Champions”

• Modifications to pathway and order sets

• Daily rounds

• Bi-weekly interdisciplinary rounds

11

Ischemic Stroke Ischemic Stroke

OrdersOrders

Added Pathway Added Pathway to Admission to Admission

ordersorders

12

Stroke PathwayStroke Pathway

Added Added Reminder on Reminder on

PathwayPathway

13

14

Day of Day of Discharge Discharge Check ListCheck List

15

TIA Admission TIA Admission Orders and Orders and

PathwayPathway

16

Stroke Stroke Discharge Discharge

OrdersOrders

17

18

19

0%10%20%30%40%50%60%70%80%90%

100%

Percentage

2007 2008 2009

Measurement of Stroke Education and Pathway Use 2007-2009

Education Provided

Pathway Use

20