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?
Have you asked them why they aren't doing it? Honestly - I know it isn't coming from you, but the daily teaching is something that happens while I'm giving care to a patient. It doesn't come from a hand out they likely won't even look at.
I'm too aware of patients who may not be literate enough to understand (and you would never guess just who these people may be), the waste of paper and ink for papers that will end up in the trash, and the "in one ear out the other" attitude of many patients when it comes to officialdom. I have found that they'll listen better if the teaching is impromptu and casual, while other things are being attended to.
Voicecare would solve a lot of this for you. Every report given on it it banked somewhere for............well, IDK the exact amt. of time but I've heard numbers as high as 3-5 years.
I don't get what you mean.
What I am saying is that every time someone casually tells you something like " oh so-and-so rang and wanted there head up higher" I am supposed to run and chart that as having "received a report" on a pt.
I really think the only way to do patient teaching right is to have a nurse dedicated to just that task. I worked in one hospital that had a "Discharge nurse" - not a case manager, on every unit. That nurse was responsible for making sure every patient was prepared for discharge.
Hospitals need to realize that complying with The Joint and providing excellent care are unrelated in that order. (i.e. if you provide excellent care, you will be compliant not the other way around).
Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.
I never cease to be a amazed at what documentation they keep coming up with. My workplace has a new one - report received on a pt. We are supposed to chart time of report, who from, what professional designation, why there was a transfer of care, what was reported on, and how long it took. If you were busy or on break and someone else did something for your pt(e.g. toileted, turned, gave a med, gave a drink,helped with a meal) you have to fill out this documention EACH TIME. Needless to say most people choose not to participate.
"Handing Off Care" is the term given by the Joint Commission. We started doing this in the PACU (2007) just before I hung up my critical care stethescope. The documentation had to include time report was given and to whom, how it was given (phone, direct contact, etc.), any untoward events, and level of pain. In the past, we did report by "exception;" now, report has to be given on every patient. Doesn't anyone know how to read anymore???
I was going to say our manager makes changes daily...........they go in one ear and out the other. People have told her, she has to include what we are going to stop doing in replacement with all these changes but she never does. So, the nurses prioritize and decide for themselves what to "be on board with" and what not to be.
Seriously? Yes.
I'd rather be on board with no pt. falls and pain managed than, well............w/e the flavor of the week obcession for management and administration is. Most days, safety and the most generic care is all there is time for.
We too seem to have an enormous number of changes to procedures and practice, on top of high turnover, sick pts and bat s**t crazy families. In the past 6 months we have started barcode med admin, new skin care protocol, UTI prevention protocol, something called "teach back", written report from ED, caring for valvuloplasties, more carotid stents, update in isolation precautions, new PICCs, new IV tubing dating and labeling, subbing bumex for lasix, and that's all I got off the top of my head.
I hope I teach or reinforce something every interaction, but documentation is low on my priority list, even if it's just a few clicks.
When the push was on for giving the dc med list, our compliance list was posted/emailed daily and we got a cake or something when we hit 98% for a month.
For the OP, change is tough; I've heard you have to do something 13 times before it becomes a habit. I would suggest using a incentive like a contest and ask the staff what would help.
It has been an expectation for years that they do this, we are only now starting to enforce it because no one was doing it previously. It is an expectation of their job, they need to make time to do it, especially while their is a task force in place to help them.
ETA: And yes the majority of them, on the majority of the days have time to do it. I work the floor as well and have been doing it since I started.
Are you management? You sure sound like managment. "Well, I get it done so obviously everyone else should get it done. What's you guys problem?"
I've taken care of patients who didn't get a bath in the last three days. Do you make sure your patients get their basic hygiene?
I've taken care of postop patients who haven't been ambulated. Do you make sure all your patients are ambulated?
I've taken care of patients who really need to just talk to someone. When's the last time you held your patient's hand?
I know my tone sounds harsh and I don't mean it that way. I'm just tired of being lectured by the higherups about what I'm not doing right, or if I'm doing it right, it needs to be done in a timelier fashion.
One day I had three patients on my med surge floor. That was the day everything got charted the "right" way, and all those stupid doorway rounding sheets got signed. So if you think I should do everything the "right" way, give me 3 patients. Otherwise, I'm going to do what I can, and my patient care is going to come first.
To the OP, I can TRY to understand what you are feeling. But really, it's ANOTHER documentation added to nursing. Sometimes I wish I could just focus on my NURSING CARE. Too much of my time is spent "documenting" so I don't get written up....and every month management seems to come up with one more thing we should be documenting. I wish management would sometimes come and participate in bed side nursing, then they would see how silly all this triple documentation is....if i teach my patient something, it will end up in my notes and i will state "pt verbalized understanding".....too much responsibility put on the nurse for documentation..why not let pharmacy teach patient's about medication..they know more about it anyway..right..but no..it has to be the NURSE to do it!!! don't get me wrong..i love my job, i just hate the TRIPLE documentation!!!!
I agree with amiro 100%--and to all of the managers out there--your nurses aren't NOT documenting to get on your nerves or because they don't want to...it's because we simply don't have time. We know that all of this comes down from some accrediting board, and that we might loose the hospital if it's not documented that education was given every single day, or report was handed off on an hourly basis, etc. But the honest to GOD truth is that we are SO busy and all we really want to do is take care of our patients. YES we know that there are some super nurses out there that can do all of this, and YES we know that way back when in the land of glass syringes and metal bedpans nurses took care of 30 patients each and bathed them all alone and did all the vitals and sterilized their own syringes, etc. BUT we aren't those nurses either. And, if we are human enough to tell you that we have too much on our plate to take care of 6 acutely ill patients and document on them thoroughly and safely and smile while doing it, then please DO NOT continue to add things to our "honey do" list. Also, please do not take the brief moments of us peeing, drinking, scarfing down a granola bar, or calling to check on our sick kid as "having plenty of time to do it". Since the movement to computers, there is SO much double and triple documentation, it's disgusting, perhaps if you can fix that problem, we would have the time to document that we taught Sally not to take her Dig if her heart rate was below 60. But I'd be willing to bet that if you printed out hard copies of your computerized documentation--there's at least 2 places to document over 1/2 of your assessments and that's not necessary! So, OP--you fix our problems, and we'll fix yours!
Also, please do not take the brief moments of us peeing, drinking, scarfing down a granola bar, or calling to check on our sick kid as "having plenty of time to do it".
If we're not literally sweating blood, they think we're goldbricking.
Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.
In my experience with audits, I found that audits rarely capture information correctly. It could well be that more than 4 out of 28 are getting their daily education, it's the audit system that is flawed. If your new system requires that the pt education info is printed twice, with the second copy placed on the chart, and you are auditing by which charts have the print outs on them, your audit system probably won't work very well since many nurses won't print out that whole extra set for the chart since it is a pointless waste of paper, I know I wouldn't.
I'm still a student... but let me throw in my 2 cents worth:
In some facilities the nurses are so busy, they barely have time to do the mandatory documentation. They sit down for 2 seconds to document, and another call bell goes off. Do they REALLY have time to sit at the computer, ponder what their patients might like to learn today, print out the materials, and then sit with each patient 5-10 minutes to do teach-back and review ? If the nurse can only spare enough time to toss the handout at the pt as she runs out of the room, I would not call that pt education.
Add to that in both med-surge units I've done clinicals on, computers or printers were always having some sort of problem. One was a magnet hospital... but on any given day a few of the terminals wouldn't let you log on or would get stuck some random place. If I had to deal with the crappy technology on a 12 hour shift daily, I don't think I'd use my spare time to log into it again and attempt to print things.
I really have the utmost of respect (and sympathy) for these nurses who are working their butts off. So I guess I am a little biased. :)
I LOVE pt education. Don't get me wrong. But if you see high rate of noncompliance, odds are there is a valid reason your nurses aren't doing it. Can you take the time one day to quietly observe your nurses? Can you pull a few who are open with you aside, asking for some candid answers?
What I am saying is that every time someone casually tells you something like " oh so-and-so rang and wanted there head up higher" I am supposed to run and chart that as having "received a report" on a pt.
Oh. I was thinking about the forms you have to fill out when a pt. is transferred. Lots of stuff you described documenting that is on voice care (phone recorded shift/transfer reports). Time, date, everything. Ours even has a special section for transfer reports so it doesn't bump out a shift hand off report. All that stuff you document during a transfer on another sheet is already in there.
clemmm78, RN
440 Posts
Have you asked them why they aren't doing it? Honestly - I know it isn't coming from you, but the daily teaching is something that happens while I'm giving care to a patient. It doesn't come from a hand out they likely won't even look at.
I'm too aware of patients who may not be literate enough to understand (and you would never guess just who these people may be), the waste of paper and ink for papers that will end up in the trash, and the "in one ear out the other" attitude of many patients when it comes to officialdom. I have found that they'll listen better if the teaching is impromptu and casual, while other things are being attended to.