1. ENDOSCOPY PATIENT EDUCATION Yvonne Pumphrey, RN, SCNI, CGRN UMMC Endoscopy Patient and Endoscopy Education Coordinator

2. Objectives Review Health Literacy Facts Discuss Guidelines for Clear Communication Discuss Endoscopy Patient Education

3. Health Literacy Health Literacy is defined as the ability to read, understand and effectively use health care information Health Literacy is defined as the ability to read, understand and effectively use health care information Research has shown that literacy skills are a stronger predictor of a patient’s health status than: Research has shown that literacy skills are a stronger predictor of a patient’s health status than:  Age  Education Level  Employment  Income  Race  Ethnicity

4. Patients with Low Health Literacy Are Less Likely ■ To seek medical care ■ To comply with prescribed treatments and follow up ■ To take medications properly ■ To keep appointments ■ To complete medical forms correctly ■ To admit they don’t understand

5. Patient’s With Low Health Literacy Are More Likely To require hospitalization To require hospitalization ↑ hospital length of stay ↑ hospital length of stay ↑ mortality ↑ mortality ↑ hospitalizations ↑ annual health care costs ↑ hospitalizations ↑ annual health care costs  4 times higher than for patient’s with higher health literacy skills

6. Assessing for Health Literacy Skills in Endoscopy Patients Begin with first encounter and establish Begin with first encounter and establish  Primary language  If patient read and understood pre procedure instructions  Review of medications including patient’s understanding of usage  Ask if the patient knows what procedure they are having and why

7. TEACHING PATIENTS TO ASK 3 EVERY TIME THEY TEACHING PATIENTS TO ASK 3 EVERY TIME THEY TALK TO THEIR DOCTOR, NURSE OR PHARMACIST TALK TO THEIR DOCTOR, NURSE OR PHARMACIST 1. WHAT IS MY MAIN PROBLEM ? PROBLEM ? 2. WHAT DO I NEED 2. WHAT DO I NEED TO DO ? TO DO ? 3. WHY IS IT IMPORTANT FOR IMPORTANT FOR ME TO DO THIS ? ME TO DO THIS ? ASK ME 3 is an educational program provided by the ASK ME 3 is an educational program provided by the Partnership for Clear Health Communication at the Partnership for Clear Health Communication at the National Patient Safety Foundation National Patient Safety Foundation ASK ME THREE

9. Health Literate Organization Meets Needs of All MultiLingual Creates Easy to Use Materials Design Team Includes Patients to be Served Clearly Explains Health Care Coverage Includes Patient’s Out of Pocket Expense for Services

10. CLEAR COMMUNICATION WITH PATIENTS Ask for and use correct pronunciation of patient’s name Ask for and use correct pronunciation of patient’s name Encourage patients to bring a list of their current medications and health concerns Encourage patients to bring a list of their current medications and health concerns Use short words and sentences Use short words and sentences Explain all medical terminology in layman’s terms Explain all medical terminology in layman’s terms

11. Non-Verbal Communication ■Use direct eye contact ■Nodding indicates that you are listening to the patient ■Use affirmative statements, then confirm your understanding with patient’s ■Don’t interrupt the patient, allow them to finish their statement

12. Health Literacy Facts Almost 9 out of 10 adults in the US have some level of difficulty understanding the health information that is common in hospitals, medical offices, media, and communities Almost 9 out of 10 adults in the US have some level of difficulty understanding the health information that is common in hospitals, medical offices, media, and communities The average adult in the US reads at an 8 th grade level, although 20% of our population read at the 5 th grade level or lower. (may include elderly, those with chronic disease, uneducated, and recent immigrants) The average adult in the US reads at an 8 th grade level, although 20% of our population read at the 5 th grade level or lower. (may include elderly, those with chronic disease, uneducated, and recent immigrants) Medical terminology is most often written at an 11 th or 12 th grade level creating the gap for low health literacy Medical terminology is most often written at an 11 th or 12 th grade level creating the gap for low health literacy

13. Unit Level Education  Pre Procedure Phone Call  Review of Instructions  Npo Status  Adult Accompaniment if Sedation or Anesthesia to be used to be used  Specific Prep Instructions  Review of Medications  Sleep Apnea and Use of CPAP  Review Directions to Facility and Endoscopy Unit  Review Procedure Time and Expected Time of Arrival

14. Unit Level Education  Begin Patient Education with Endoscopy Unit Orientation  Perform Intake Assessment  Explain Safety Precautions  Explain Pre, Intra and Post Procedure  Initiate Plan of Care with Patient’s Goals, Education Needs, and Interventions  Explain Anesthetics/Sedation Plan

15. Discharge and Follow Up Education Provide Discharge Instructions Written, Verbal, Multilingual Provide Discharge Instructions Written, Verbal, Multilingual To include : ■ Physician’s impressions and recommendations ■ Medication Reconciliation ■ Follow up treatments/appointment dates and time

16. Post Procedure Calls  Fever, Pain or Bleeding  Other Problems  Is a physician, physician’s assistant, or nurse practitioner call back necessary  Patient Satisfaction

17. Community Outreach Education Health Fairs Health Fairs Colon Cancer Awareness Colon Cancer Awareness Parish Nurse programs Parish Nurse programs County Homeless Education Support County Homeless Education Support Educational Fund Raisers Educational Fund Raisers GI Nurses and Associates Day GI Nurses and Associates Day

18. Founded in 1823 as one of the nation’s oldest academic medical centers. All physicians are faculty at the University of Maryland’s School of Medicine. The medical center treats over 32,000 inpatients and more than 300,000 outpatients each year. The Shock Trauma unit provides treatment for more than 7,500 patients yearly with greater than 97% survival rate. Founded in 1823 as one of the nation’s oldest academic medical centers. All physicians are faculty at the University of Maryland’s School of Medicine. The medical center treats over 32,000 inpatients and more than 300,000 outpatients each year. The Shock Trauma unit provides treatment for more than 7,500 patients yearly with greater than 97% survival rate. Magnet Designation Magnet Designation Leap Frog Top Hospital award for quality and safety from 2001-2011 Leap Frog Top Hospital award for quality and safety from 2001-2011 Listed Among Nation’s Top Hospitals by US News and World Report Listed Among Nation’s Top Hospitals by US News and World Report

19. UMMC Endoscopy Case Load – 75% Outpatient 25% Inpatient Apx 30 procedures daily Two Procedural Units Four procedure room / nine bed recovery unit with moderate sedation and anesthesia support Two procedure room/PACU unit with anesthesia support (SECU-surgical endoscopy care unit)

20. UMMC Endoscopy Clinical Staff : 13 Medical and Surgical Endoscopists 5 Hepatologists 17 Fellows /3 yr program 17 Nurses 16 Technicians

21. Endoscopy Procedures EGD Balloon Enteroscopy ERCP Endoscopic Ultrasound Capsule Endoscopy Bravo Cryotherapy Radio Frequency Ablation Laser Therapy Colonoscopy Flexible Sigmoidoscopy

22. Value of ABCGN Certification Study and Review: Stimulates your recall Increases your knowledge base Improves your organization and study skills Promotes networking with colleagues ABCGN Certification: Instills a professional sense of pride and accomplishment Validates your advanced knowledge, competence, and skills Improves patient care Improves patient satisfaction Improves job satisfaction Increases potential for higher salary and career advancement

23. References New Federal Policy Initiatives To Boost Health Literacy Can Help The Nation Move Beyond the Cycle of Costly Crisis Care (2012) www.health Literacy.Health.gov A Guide to Writing and Designing Easy to Use Health Websites www.health www.health Quick Guide to Health Literacy and Older Adults www.health www.health National Action Plan to Improve Health Literacy www.health National Patient Safety Foundation Partnership for Clear Health Communication www.AskMe3.org The Center for Healthcare Communication infor@communicatingWithPatients.com, www.Communicating WithPatients.com infor@communicatingWithPatients.com Institute of Medicine of the National Academies Roundtable on Health Literacy University of Maryland Health Sciences and Human Services Library The Newest Vital Sign: A Health Literacy Assessment Tool for Healthcare Providers, http://www.pfizerhealthliteracy.com/public-policy-researchers/NewestVitalSign.aspx http://www.pfizerhealthliteracy.com/public-policy-researchers/NewestVitalSign.aspx Improving Health Literacy http://www.plainlanguage.gov/populartopics/healthliteracy/index.cfm http://www.plainlanguage.gov/populartopics/healthliteracy/index.cfm University of Maryland Patient and Family Education Council Planning Your Patient’s care Delivery and Education 2008 University of Maryland Endoscopy Practices and Procedures 2012