Patient Education - Why Don't You Document?

[Q.]

I know this is an on-going issue not just in my facility, but in others across the US. I know it's an issue because Patient Education Coordinators and Specialists across the country all discuss this very, very important issue and it becomes our problem in a very big way.

I'd like to know why staff nurses find it difficult to document patient education, whether it's a paper chart form or electronic charting?

Nearly every time an audit is done, 80% of patient education is not documented. Many of these undocumented forms get inspected by JCAHO and CMS, and many others are publically reportable - in other words, our compliance scores are posted publically for people to view and then compare against other hospitals.

We, like other hospitals, scored horribly, and showed that only 20% of our patients recieved discharge teaching on cardiac disease. I know that most likely, education was given but it just wasn't documented. And as we all know, if it's not documented, it's not done.

The last time I staffed the floor was 4 years ago, so I'm not THAT far out of touch with patient care. I worked in an LDRP, and I did my patient teaching and simply documented such on our teaching sheet.

I've seen teaching sheets not filled out at all, or partially filled out, etc. What would make documentation for you easier?

[canoehead, BSN, RN]

If I documented all my education it would double my charting time, we are constantly teaching in the ER.

[Q.]

If I documented all my education it would double my charting time, we are constantly teaching in the ER.

I can appreciate that, but at the same time the lack of documentation of patient education increases our liability.

How does it look if a heart disease patient was seen in our facility and discharged without any evidence of teaching how to take care of himself, and then subsequently dies?

How does it look when a Medicare patient is discharged and then readmitted within 30 days with the same diagnosis; and now as a result the hospital is not reimbursed for that care because it's obvious we didn't do our job if the patient is readmitted again for the same thing?

Patient education is often shuffled down the list as least priority, but it really is as much of a priority as any treatments given.

[SmilingBluEyes]

Well, first, you are assuming we don't do this in your title----- but that is wrong, in some cases....... Most of us DO document education in MULTIPLE places, Suzy. I know where I work, the patient does not leave w/o an extensive list of teaching subjects that must be covered prior to going home. She signs that the teaching of each item is done/understood, as well.

We also chart electronically on their record the teaching done...as well in the newborn's chart the infant response to teaching of care of the parents. Like I said, multiple places where I work, this gets done. It's repetitive but important, obviously.

Sounds to me as if you have some things to change in your institution, Suzy, whether it be checklists where education is documented or inservices on the subject for staff failing to meet the standard. That is my opinion, anyhow. Good luck.

[SmilingBluEyes]

I also know when I was hospitalized (in a different hospital than where I work) there was a teaching sheet covering recovery from my procedure and medications, etc, that I had to sign. One copy went w/me, one in my chart.

Also when I went to the ED for my migraine, they had a teaching sheet I had to sign, as well. So I think many places have this well-covered actually. Maybe you could poll different hospitals to see what systems they have in place and maybe get examples, to adopt in YOURS. Making it easy for staff to document would be key, obviously.

[UM Review RN, ASN, RN]

We have a teaching sheet checklist that must be updated q72h. This is going to sound really weird, but it's my opinion that because of the LOCATION of the sheet in the chart, which is after the nurse's progress notes, it's getting skipped.

I suggest that you put the teaching flow sheet right after the nursing flow sheet and BEFORE the nursing progress notes.

Most of the time, I find myself charting the teaching within the nursing notes. Must be a hangover from the old narrative-style days.:chair:

[Q.]

I know it may seem like it's limited to my organization Deb because of your experiences, but based upon conversations with other patient educators across the nation, this is a widespread issue. The lack of documentation or incomplete documentation. Sure, it gets documented here and there but on average the compliance is usually less than 50%, which is unacceptable.

I do appreciate all the ideas on making the teaching sheet more user-friendly and in a place where it can't get forgotten.

[canoehead, BSN, RN]

I can appreciate that, but at the same time the lack of documentation of patient education increases our liability.

Probably a lot less than the lack of actual patient care would increase liability. If the nurses got time for breaks that would indicate the possibility of having time to document a little more.

[SmilingBluEyes]

Don't misunderstand me; I did not say it is limited to your organization. I would say it's widespread. But some places have done better at this than others. My hope is others will come along with ideas as a couple of us have, rather than simple justification as to why it is not done. I would imagine that is what you are after, right?

[Q.]

Probably a lot less than the lack of actual patient care would increase liability. If the nurses got time for breaks that would indicate the possibility of having time to document a little more.

I don't buy that at all.

Yes, I know staffing is hard and most of us are understaffed. Like I said, it was only 4 years ago that I staffed L&D and was mandated overtime nearly every week.

But at the same time, I'm choosing to work as nurse, in that particular organization, in that particular unit and on that particular floor, whatever the practices may be. The fact that I don't get regularly scheduled breaks does not justify not providing complete care to patients ~ and I'm not talking about the niceities that we wish we could do ~ backrubs, "being with" your patient, etc ~ I'm talking about something that not only are JCAHO and CMS mandates, but are publically reportable measures and liability issues in a BIG way.

The problem seems to be that staff nurses don't view patient education as important, but rather they view it as that "nice stuff" to do/document. It isn't - it's a CYA, and it might even prevent your patients from getting sicker, getting readmitted with complications, and further causing the staffing issues on your floor.

[SmilingBluEyes]

I agree wholeheartedly with you, Suzy. It is incredibly important.

[fergus51]

I think it's important, but I will tell you honestly I would not stay overtime off the clock to document non-essential teaching I did on a kid who will still be there another month. It can be done when I have time to do it, another shift if necessary (yes, I've come back and documented on a kid the following day). Not a great attitude perhaps, but some days are just too busy and documenting that I taught the parents about diaper changes isn't at the top of my list. I realize nurse educators would put these that at the top of their list, but they must realize that everyone has something they want me to do that they all think should be my first priority.

[talaxandra]

realize nurse educators would put these that at the top of their list, but they must realize that everyone has something they want me to do that they all think should be my first priority.

Awesome point