Seriously...

[LouisVRN]

So as part of a continuing process to improve patient satisfaction and fiscally beneficial as well we are implement a revised discharge plan (basically trying to get everyone to prepare for the patients discharge from arrival, anticipate any needs/barriers and get the correct departments on board in an effort to reduce a last minute scramble).

That being the case, we are trying to reinforce the need to do daily teaching with the patient daily regarding something...anythhing. We have a very simple, easy to use application that allows us to print pretty much anything you could think of that you'd want to educate the patient on (diet, procedure, test, medication, equipment). The staff has been educated to print the daily teaching sign give one copy to pt one copy to chart.

Because this discharge redesign is relatively new in implementation we have a specific team who has spent time daily on the units to offer assistance, answer questions.

So today during my audit, I found that 4/28 pts received daily education. SERIOUSLY?!? What do I have to do to get people on board with any changes?

I am so frustrated right now I could scream!

[LouisVRN, RN]

Okay, if you're going to accuse your coworkers of falsification you better be prepared to back that up. That's a serious charge which can lead to loss of license.

And regarding your patient who thought she was getting X when she actually got Y. Do you really think that her surgeon met with her in her pre-op consultation and misled her? Then misled her again when she signed the consent? And the surgeon colluded with the nurse who witnessed her consent signature? Do you think this really happened?

Imagine this scenerio, which is going to happen to you someday.

You:....and so after this fifteen minutes of verbal education and this five page printout about the sequential compression devices, you understand the need and purpose for them?

Patient: Yep!

You: Do you have any questions?

Patient: Nope!

--------------ten minutes later--------------------------------------

Patient's wife: What's them things on your legs?

Patient: I dunno.

Patient's wife: Well, why don't they tell us anything around here!

I understand that. I have multiple incidences of being able to support that, I would never accuse anyone of anything without having proof. When the documentation says one thing and yet the nurse and patient deny it was done, it should never be documented that it was done, even if you had the intention of doing it and "just got busy".

[LouisVRN, RN]

And FYI, OP, I know you know this, but a Nissen fundoplication is surgery for severe GERD -- it's a stomach wrap. It's quite possible that this patient had a huge hiatal hernia and this is why she had such horrible GERD, hence the Nissen. To a layperson, this might be "hernia surgery" -- it's not that far off track.

People don't always get everything right no matter what you tell them. In my stepdown days, I recall that I had JUST finished up doing 10-15 minutes of this patient's initial coumadin education for his brand new aortic valve, including patient's target INR, etc. I was finished and the staff surgeon walked into the room and started quizzing the patient, "What's your INR supposed to be?" (Good surgeon -- worried about the follow up care of his patient, IMA.) The guy couldn't remember what I had told him for a value not 5 minutes before.

It's real -- you might shake your head, but it is. Patients don't absorb it all, and even if they did, they might not follow directions. I think the point that you might be missing in all this is that we can only do so much. You can throw papers at these people until the cows come home, but in the end, all you might be doing is killing trees. Unless people really like reading (and I don't think it's the majority of the population that learns and retains information this way, but I'm not an education expert), you're not going to get through, which is the whole point, isn't it?

I understand this, the patient in question did not have a hiatal hernia.

I also think that for a majority of patient we may be killing a lot of trees for them to never reference the material again. However I would rather them have it just in case they get home and are like wait, is it the blue pill I'm supposed to take with food and then take the white one 2 hours later, or the other way around because God knows neither of them can be retained in the Rx bottle.

[nicetomeetyou]

make the material more easily accessible. or make it a part of the admission process.

[General E. Speaking, RN, RN]

Well said, Erik.

To the OP - you would show real leadership if you tried to figure out why people are not doing required education documentation. Really listen to them, and not dismiss their opinions. Then you could show real initiative by fixing what's wrong with the system. Because that's what's broken, not the nurses.

I agree with this. We have all heard, "If you didn't document, you didn't do it". When I was the Unit Educator of our Tele unit a lot of Quality Control issues were dropped into my lap. We are not computerized (which makes it even harder, I think). I was still a staff nurse when I was doing the educational stuff so everything I was implementing or trying to reinforce would affect me too.

As far as documenting education, it just wasn't getting done. I know our nurses were teaching. We teach things to our patients everyday- sometimes without even thinking about it. I had a meeting and told them that it wasn't an option NOT to chart education. It is a necessity and we needed to figure out a way to make it easier. I asked why they weren't documenting. What was the barrier? Aside from adding more nurses to the unit (we would all love to have 3 patients on the floor) what could I do to help them document?

What I found was that we used to keep the "education" sheet inside the actual chart so unless you actually had the chart in front of you, you had to remember to go back and do it. What I did was to move the education flow sheet to be kept with the current 24 hr nursing flow sheet and MAR. The night nurses would get the new 24 hr flow sheet and MAR ready for the dayshift and they would transfer the existing education sheet with it. Now it was not "out of site, out of mind". It was right there with the flow sheet which made it much easier to document a quick teaching moment.

As the educator, it was out of my power to add staffing or get rid of required documentation. I tried to find a way to make it a little easier to get the stuff done. More and more nurses were documenting on the form. It helped a great deal in increasing compliance.

Just a thought.

[CNL2B]

I had an alert and oriented pt, walkie-talkie very nice educated lady pod 2. When I was asking her about her surgery she kept telling me she had hernia surgery. She didn't, she had a fundoplication. To me this is important that she knows the surgery she had done. I throughout the night educated her on her procedure and why it was done, she seemed shocked to know she did not have her hernia reduced (and no it was not reduced during the fundoplication, I asked the surgeon).

I understand this, the patient in question did not have a hiatal hernia.

I thought you said she did, see above. Not sure what kind of hernia you were asking the MD about reducing in re: fundoplication surgery then. I must not be understanding what you said.

Anyway, off topic.