1. Fresh Approaches to Patient Education Kari Bottemiller, RN, CNS Mayo Clinic April 8, 2010

2. Barriers Electronic Medical Record Electronic Medical Record Needing consistent documentation from a large number of nurses Needing consistent documentation from a large number of nurses Strict requirements Strict requirements Time for documentation Time for documentation Competing demands/priorities on the nurses time Competing demands/priorities on the nurses time Nurse awareness of requirements Nurse awareness of requirements Confusion in documentation requirements Confusion in documentation requirements Dismissal location, patients ability to learn and availability of family Dismissal location, patients ability to learn and availability of family

3. What do we do? Standard Stroke Education Standard Stroke Education All patients receive stroke education packet All patients receive stroke education packet Various materials (12 items) including stroke prevention, smoking cessation, psychosocial materials, nutrition, caregiver information, disease process, hypertension, Stroke DVD Various materials (12 items) including stroke prevention, smoking cessation, psychosocial materials, nutrition, caregiver information, disease process, hypertension, Stroke DVD Documentation of individual risk factors educated on (e-code) Documentation of individual risk factors educated on (e-code) Documentation of Stroke booklet in packet- with review of warning signs/symptoms, how to activate EMS and risk factors Documentation of Stroke booklet in packet- with review of warning signs/symptoms, how to activate EMS and risk factors Review and documentation of hospital dismissal summary for med education and follow up instructions Review and documentation of hospital dismissal summary for med education and follow up instructions

4. Order Stroke Education Plan part A & B 1 2 3 4

8. Individualize patient specific risk factors and press f12 to save

9. Finalized education with ecode

10. What have we done to increase compliance? Baseline data showed 12% compliance with stroke education (3 rd qtr 2006) Baseline data showed 12% compliance with stroke education (3 rd qtr 2006) EMR issues, education was occurring but not documented, addressing off floor stroke patients EMR issues, education was occurring but not documented, addressing off floor stroke patients

11. Education Improvement Plans 1:1 nursing education with staff to cover requirements 1:1 nursing education with staff to cover requirements Development of E-code to assist with charting Development of E-code to assist with charting Presentations at unit team days and specialty practice committees Presentations at unit team days and specialty practice committees Added stroke education to plan of care on admission Added stroke education to plan of care on admission Stroke CNS to provide off floor patient education Stroke CNS to provide off floor patient education Increased compliance to 57% (1QTR2007) Increased compliance to 57% (1QTR2007)

12. Education Improvement Plans Ongoing 1:1 feedback, discussion at unit practice committees Ongoing 1:1 feedback, discussion at unit practice committees ICU adding stroke ed order plans on admission ICU adding stroke ed order plans on admission Pilot role of stroke practice coordinator on stroke unit Pilot role of stroke practice coordinator on stroke unit One role was to provide education One role was to provide education Compliance increased to 84% (Aug 2007) Compliance increased to 84% (Aug 2007) Further analysis, showed gaps with hemorrhagic patients on surgical floor Further analysis, showed gaps with hemorrhagic patients on surgical floor CNS addresses on a daily basis CNS addresses on a daily basis

13. Jan 2008- the measure changed! Caused a dip in results Caused a dip in results Risk factor education compliance at 100%, but missing meds and follow up due to documentation practices (again) Risk factor education compliance at 100%, but missing meds and follow up due to documentation practices (again) Re-education with staff on new requirements Re-education with staff on new requirements

14. Current Practice Ongoing reinforcement continually required Ongoing reinforcement continually required New functionality to EMR coming to assist with education placed in plan of care New functionality to EMR coming to assist with education placed in plan of care Communication between CNS and practice coordinator to assess completion Communication between CNS and practice coordinator to assess completion Current compliance 90% (range 88-98%) Current compliance 90% (range 88-98%) Typically missing only portions of education Typically missing only portions of education

15. Stroke Education Class Implemented Feb 2009 Implemented Feb 2009 Created for patients and families of stroke patients Created for patients and families of stroke patients Content developed with multidisciplinary team and department of patient education Content developed with multidisciplinary team and department of patient education Open to the public and other units Open to the public and other units Tuesdays and Sundays from 4-5pm on 2Dom Tuesdays and Sundays from 4-5pm on 2Dom

16. Printed Materials

17. Recognizing Stroke and Stroke Prevention Video DVD DVD VOD VOD

18. Questions ?