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?

[SmilingBluEyes]

hmmm wow I am sorry to read that. There is no easy answer for you, then. To "punish" those not doing this properly won't help, either. Maybe you could poll the nurses in your particular hospital and ask THEM why it's not being done?

[UM Review RN, ASN, RN]

Deb, thanks for the suggestion, but we're actually well beyond that stage. A process team did look at this and came up with a solution. The solution isn't being used. And since it's a widespread issue, meaning across the nation, I thought this time we'd start with a general "feel" of what staff nurses are thinking with regard to the whole process in general.

Then, once again, I'd have to go with the possibility that the root of this problem is, as with others, a staffing issue.

We are just too busy, too overwhelmed with paperwork and patient load. I've run across charts many times that had no charting done, for one or two shifts.

So I have to ask--did the Process Improvement Committee take a hard look at the rest of the chart?

How are nurse to patient ratios? On paper and in reality?

Do all of your nurses, like the nurses on my unit, get out on time because they do not take their 30-minute breaks. Do they write down that they missed break and therefore are not paid for working during it?

On your visits to all of the units, do the nurses look stressed out and harrassed or are they calm, relaxed, and look like they have all the time in the world?

Insofar as all charting goes, is there any discrepancy between what the hospital policy says must be done as opposed to what the BON says must be done?

These are easy questions to ask, but very difficult to answer with a fresh look and a truthful eye.

I know if I have a choice, I'd rather be taking care of patients. I figured out that I see each patient for about 15 minutes per shift (about 2 to 2 1/2 hours total, including admits, more if someone's crashing), and the entire remainder of the time, I spend checking charts, correcting charts, and doing my own charting.

My priorities are:

1. Patient care.

2. Making sure that ordered tests, treatments and medications are ordered correctly, have been completed correctly, and a copy of the reports wind up in the correct spot in the chart, from the entire day's past activity.

3. My own charting.

Three times in the past week, trying to get just my job done, I got out of work without a lunch break and one hour past my time.

One of the things I missed after one horrible night was the Patient Education Teaching. I had circled all the points I covered--and then something must've interrupted me before I signed them off.

But nobody wants to hear that the root of a multitude of problems is staffing, and if even the phrase "staffing problem" is said aloud or mentioned as a primary problem to anyone that matters, we target ourselves to look "inefficient" or "slow."

We floor nurses feel that we just get more and more paperwork piled onto us, yet no increase in staff to help us handle the load.

We repeat: We did not become nurses to spend half our lives doing clerical tasks; we became nurses so that we could be interacting with our patients.

Please don't take this personally, Susie, but apparently you're the only one who seems interested in the truth, so there ya have it.

FWIW, I know every single one of the nurses who I work with do try to get the Education sheet completed in a timely manner.

But how important is it?

Honestly, in the past month, we've had no less than THREE new charting forms to chart on, each one more complicated than the last, each one touted as "easy" and each one requiring several steps and involving more people in different departments, than the last.

Oh, and they WILL call us at home to come back in to complete those forms. :angryfire

The people who make up these forms need to get a serious grip on what it is that nurses do and how much we can do in one shift.

Peace,

~Angie

[Q.]

Angie,

Don't worry, I didn't take your post personally. In fact, I smiled because you called me "Susie" which actually is my name, spelled correctly. (Well, actually its Susan but my friends/family call me Susie). :)

I hear you. Loud and clear. And yes I am interested in the truth. I honestly believe it could be staffing that is the bulk of the issue but at the same time, I cringe when I hear that because in the big scheme of things there's nothing I can do about that piece. My role is to focus on one area of patient care - that being patient education. Sure, I can come up with reasons why it's not being done to standard, and very well cite staffing as the reason, but ultimately I don't have the power to change the staffing mix or ratio. And what's left is patient education that is incomplete or not done, and then administrators look to me and say that basically, the ONE thing I'm responsible for in the organization - patient ed, the ONE thing - is messed up and reprehensible. And we have JCAHO coming and our numbers better improve. And it's my fault.

No, I'm not complaining, I love my job. I love influencing patient outcomes from a different angle. But when part of your success in your job relies on the performance of others, it becomes a challenge.

And I don't want to add more paperwork or charting. But sometimes, as things become more complex or as regulatory agencies or state requirements change, hospitals are fearful of not showing compliance and design new forms to prove that they do this or that.

It's such a tangled web: staff nurses hate the additional paperwork that they have to complete; administrators/educators/managers needing to show evidence to accreditation bodies that we DO do the things they ask for - if only there could be some harmony.

[UM Review RN, ASN, RN]

...And I don't want to add more paperwork or charting. But sometimes, as things become more complex or as regulatory agencies or state requirements change, hospitals are fearful of not showing compliance and design new forms to prove that they do this or that.

It's such a tangled web: staff nurses hate the additional paperwork that they have to complete; administrators/educators/managers needing to show evidence to accreditation bodies that we DO do the things they ask for - if only there could be some harmony.

Thanks, it's nice to know that you understand.

[fergus51]

Whenever our hospital implements some improvement issue, we have a few "superusers" on each shift and tons of advertising reminding the nurses to implemnent the change, with some recognition for those that consistently do it right. Also, the dreaded "a" word comes up (audit!). Some of our stuff has to be done or the computer will not let us d/c the patient. Nothing works as well as that.