we all have to agree… that our shared goal is to improve health outcomes. This may not be as easy as it sounds, since some of us believe our real goal is to stay financially solvent, make money, or not kill anyone today.

Ask any manager. There are only three sure things in life: death, taxes, and no documentation of patient education.

Why is documentation of patient education such a problem? Because

1. Health care team members agree it's not important to document what is taught, so peers don't hold one another accountable.
2. Managers agree it's not important to document what is taught, so they only hold staff accountable for documentation of patient education when accrediting agencies are due to visit.
3. It really isn't necessary.

Think about it. Healthcare professionals save lives. As we rush patients through our doors, we look only at the short-term goals: diagnosis and treatment of acute conditions (even if it's an acute flare of a chronic disease). It doesn't matter what you teach a patient, what videos he watches, or what handouts you give him. We just have to treat the immediate concern.

But if we want our patients to survive and thrive after they leave the hospital or clinic, and not come back as often, we have to teach them how to best take care of themselves. If we want to improve health outcomes we have to involve patients in their own care. That's the whole point of providing patient education. It becomes even more important with chronic diseases and complex health problems… the patients that cost the most to treat. So what we teach doesn't matter. What matters is if our patients understand how to take care of themselves, and if they can do it.

So first, we all have to agree (doctors, nurses, other direct care providers, managers, and administrators) that our shared goal is to improve health outcomes. This may not be as easy as it sounds, since some of us believe our real goal is to stay financially solvent, make money, or not kill anyone today.

Then we all have to understand that, unless the patient knows what to do when he leaves our direct care, we won't effectively improve health outcomes.

Here are some ways to to make that happen:

• Direct care providers need to assess every patient, to find out what he knows and can do for himself, and what he needs to learn. What skills does he have? What skills does he need? Does he know how to recognize health problems, and know how to respond?
• Next, recognize that we can't make the patient do something he doesn't want to do. Direct care providers need to establish shared goals with the patient and family, and collaboratively set patient education priorities. What are his health goals? How can we help him reach them? Another name for this is patient-centered care.
• Then, members of the health care team have to work together, across the continuum of care, to support the patient in learning self-care skills, and applying them. By collaborating, we improve the efficiency and effectiveness of patient education. When we know where the last caregiver left off in teaching, we know what to review, and what to teach next.

The best way for team members to share the status of patient education is through documentation. Documentation isn't a task to be completed. It's a means of communication that helps us work together efficiently toward the same goal.

Documentation isn't a task to be completed. It's a means of communication that helps us work together efficiently toward the same goal.

We don't have to document what we taught, because if the learner didn't get it, it doesn't matter. We do need to share our assessments (such as literacy skills, sensory deficits, and expressed learning needs) so the next caregiver doesn't have to rediscover what we already found out. We also need to share our evaluations of understanding, so the next caregiver knows the status of teaching, knows what to review, and what to teach next.

There's a movement toward evidence-based practice, using interventions that measurably change health outcomes. Managers and administrators need to understand that the only way to get long-term changes in health outcomes is if the patient follows through on the treatments we provide. Just handing someone a prescription, no matter how perfect that drug is for that patient, means nothing if it is not filled and taken. Just showing someone a video doesn't mean he'll change his behaviors. Teaching tools don't teach; people do. If we want our patients to change their behaviors, we have to take the time to talk to them, and tailor our teaching to meet individual needs. Teaching tools help to initiate or reinforce that conversation.

And the only way to know if learning took place, and self-care skills can be applied, is to evaluate understanding. This is done through having the patient teach the information back to you in his own words, or demonstrate the skill correctly.

Managers need to hold members of the health care team accountable for communicating with one another the status of patient education, just as they expect vital signs and changes in health status to be communicated. Every direct care provider's job description should include responsibility for patient education. It needs to be evaluated in every annual performance review. Make a person's raise dependent on sharing the status of patient education through documentation.

To fix the problem of lack of documentation of patient education, focus on the shared goal: improved health outcomes. How do we best reach that goal? By making sure the patient knows how to take care of himself. What can managers do to ensure this? Hold direct care providers responsible for collaborating to efficiently and effectively promote self-care skills.

When patient education is a meaningful intervention used by every member of the health care team, documentation naturally follows. The team needs evidence that their attention to patient education improves health outcomes and satisfaction scores. This will increase motivation to teach better. Once motivated, doctors, nurses, team members of other disciplines, and managers will begin to hold one another accountable for the provision of quality patient education. Administrators will provide support, because evidence shows it contributes to the organization's ability to meet its goals.

© (2005) Fran London, MS, RN