Nursing Annual Report 2015 - East Tennessee Children's Hospital
Rainbow Clinic Staff Education
1. PROMOTING HEALTH LITERACY
IN OUTPATIENT SPECIALTY CLINICS:
NURSING EDUCATION TO ADDRESS
NURSE SENSITIVE INDICATORS
AND IMPROVE INTERDISCIPLINARY
CARE COORDINATION.
Tanisha R. Davis, BSN, RN, CCRN
University of Pittsburgh
MSN-CNL
2. • Define health literacy
• Discuss the scope of
the issue
• Define nurse sensitive
indictors
• Discuss current
literature findings
• Discuss practice
implications
• Discuss key strategies
to address improving
health literacy and
implementing NSIs in
the Rainbow clinic
3. HEALTH LITERACY
The IOM defines health literacy as “the
degree in which individuals have the
capacity to obtain, process and understand
basic health information and services to
make appropriate health decisions.”
4. SCOPE OF THE ISSUE
Half of adults in
United States lack
proficiency in basic
reading or math
skills (above 8th
grade level).
Adults over the age
of 65, racial and
ethnic minorities,
and low income
status are the most
at risk for low health
literacy
5.
6. WHAT CAN WE DO?
Health literacy is integral part of nursing practice.
It is an essential part of health communication,
patient engagement, patient empowerment and can
have a significant impact on health outcomes
The VA is dedicated to promoting health literacy
within the organization
Krames online
7. WHAT ARE NURSE SENSITIVE INDICATORS
ANYWAY????
• It started with Flo…
• Nurse sensitive indicators identify patterns in the
care process or within the structure of nursing that
influence care outcomes.
• The IOM
8. NURSING FOUNDATIONAL PRINCIPLES AND
GUIDELINES STATE
We have a responsibility to measure, evaluate, and
improve practice.
The Code of Ethics for Nurses with Interpretative
Statements states:
“The nurse promotes, advocates for, and strives to protect the
health, safety, and rights of the patient.”
Nursing: Scope & Standards of Practice, Standard 7
states:
“The registered nurse systematically enhances the quality and
effectiveness of nursing practice.”
9. USING NSIS
Today, NSIs are used to gauge the quality of care
an organization is providing.
When the data is analyzed over time, themes and
trends emerge that inform our practice and drive
organizational decision-making.
To get the most out of data, it needs to be shared
with the staff driving the initiatives at the unit level
10. WHAT IS THE QUALITY IMPROVEMENT GOAL?
Educate the Rainbow Clinic staff on the importance
of health literacy, educate on the current NSIs in
ambulatory care and create a culture of nursing
driven education and care coordination.
11. MEASURE/INDICATOR
Veterans with appointments in the Rainbow clinic 8E/W/N
areas will be assessed utilizing a standardized triage
process to address current Nurse Sensitive Indicators
established by the ANA and AAACN Task force
• Medication Reconciliation
• Controlling High Blood Pressure
• Depression Assessment conducted
• Pain assessment and follow-up
• Hospital Re-admissions
• Smoking Cessation
• Patient Education
12. RATIONALE
Performance Improvement to address NSIs
in Ambulatory care
To educate staff on the importance of health
literacy
Standardize the triage process to include
brief patient education
To promote patient engagement, improve
patient adherence to treatment plan, identify
at risk veterans and promote collaboration
of care
13. PLAN AND TIMELINE
October 6-16, 2015:
Develop a flip-book and poster board of easily understood and
culturally competent patient education on current outpatient specialty
clinic nurse sensitive indicators: pain management, medication
reconciliation, controlling high blood pressure, depression
assessment, patient education on top chronic conditions seen at
clinic , patient teaching on how to navigate VA resources and patient
follow up reminder to prevent hospital readmissions.
Standardize the Triage process to address current NSIs during
patient check in
Pre-implementation test
October 19-23, 2015:
Staff education
Teaching satisfaction survey
October 26, 2015-December 5, 2015:
Implementation of process within the Rainbow Clinic triage staff.
Dec 5-7, 2015: Evaluation of results
Dec 8-10, 2015: Dissemination of results to stakeholders
14. DO
• Standardize Triage Process
• Educate staff on health literacy
• Educate staff on NSIs
• Incorporate utilizing existing standardized
templates to assess patient risk related to NSIs.
• Incorporate flip book brief patient education tool
• Develop bulletin board on our units NSIs
• Collaborate with interdisciplinary team for patient
care management.
15. STUDY
Anonymous staff pre and post implementation test
The pre and post implementation test will be
anonymous and compare equal staff levels e.g. HCT to
HCT, LPN to LPN…
Observation of patient triage by VA staff
Observation of triage staff will not include names of
staff members or patient identifiers
16. ACT
• Review Pre and Post testing
• Review Observation Data
• Encourage staff participation and the
development of NSI champions
• Review / Revise standardized
interventions – ongoing
• Share all data with stakeholders
17. PRACTICE IMPLICATIONS / SUSTAINING
MEASURES
Utilize outpatient ambulatory clinic staff to the
full scope of their practice
Promote patient engagement in care
Improve patient health literacy
Staff education on NSIs
Develop NSI champions within the staff to keep
health information up to date and promote staff
education laterally and horizontally.
Promote nursing driven quality improvement
projects within Rainbow staff to share at
monthly unit PPC meetings
18. FUTURE IMPLICATIONS
Open up time currently allotted to medication
reconciliation and patient teaching performed by
providers, to address the patients current health
issue in which they are seeking care for.
Work with CPRS support team to make sure
existing templates for pain, patient education,
depression screening, medication reconciliation and
follow up procedures to prevent rea-admissions is
added to Rainbow Clinic “note”
Nursing driven patient education and care
coordination for high risk patients
19. ACKNOWLEDGEMENTS
Myra Couch, manager Rainbow Clinic
Melissa Taylor, associate chief of nursing research,
VA
All staff of Rainbow Clinic
Rose Hoffman, University of Pittsburgh
20. REFERENCES
CDC. (2015). Gateway to Health Communication and Social marketing Practice. . Accessed on
October 4, 2015. Retrieved from: http://www.cdc.gov/healthcommunication/index.html
Erickson, J. (2011). Nursing-sensitive indicators paint vivid picture of organizational
commitment . Accessed on October 4, 2015. Retrieved from:
www.mghpcs.org/eed_portal/Documents/Caring_NSIs_0411.pdf
Health Resources and Services Administration. (2015) Health Literacy. Accessed on October 4,
2015. Retrieved from: http://www.hrsa.gov/publichealth/healthliteracy/
Institute of Medicine (2004). Health Literacy: A Prescription to end confusion. Accessed on
October 4, 2015. Retrieved from:
https://iom.nationalacademies.org/~/media/Files/Report%20Files/2004/Health-Literacy-A-
Prescription-to-End-Confusion/healthliteracyfinal.pdf
National Institute of Health (2015). Clear Communication.
http://www.nih.gov/clearcommunication/
Rennis, Lesley, et al. "Google it! urban community college students' use of the internet to obtain
self-care and personal health information." College Student Journal 49.3 (2015): 414+.
Academic OneFile. Web. 4 Oct. 2015.
Start, R., Martinez, K., Mastal, M., Battaglia, R. Matolack, A. (2015). Nursing-Sensitive
Indicators in Ambulatory Care. Nursing Economic$/January-February. Vol 33 (1).
The Joint Commission. (2015). Facts about patient-centered communication. Retrieved 04
October 2015 from: http://www.jointcommission.org/facts_about_patient-
centered_communications/
Office of Disease Prevention and Health Promotion. (2014). National Action Plan to Improve
Health Literacy. U.S. Department of Health and Human Services. Accessed on 04 October,
2015. Retrieved from: https://www.healthypeople.gov/2020/tools-resources/evidence-based-
resource/national-action-plan-improve-health-literacy
Editor's Notes
Health literacy includes: print literacy, oral literacy, E-health literacy and numeracy (numbers, dosages…)
Approximately 90 million adults have trouble understanding health information. The Department of Health and Human Services recognizes that for adults over the age of 65, racial and ethnic minorities, and low income status, most health literacy access measures have remained unchanged or worsened over the last ten years.
Research shows that these groups are significantly affected by low health literacy rates and correspondingly, low health literacy rates have been associated with increased rates of hospital admission, increased healthcare expenditures, and poor health outcomes
Scenario #1
A pulmonary patient that has COPD and is a current smoker, uses home O2 therapy. The patient goes outside to smoke, goes up and down some stairs and becomes short of breath, so they increase their oxygen rate. Does the patient know that by increasing oxygen level in COPD that they can retain CO2, which may suppress their respiratory rate?
Scenario #2
A patient with hypertension can not get a ride to the pharmacy to refill their prescription blood pressure meds, so they just don’t take their meds for a few days. The next day the patient has rebound hypertension and a hypertensive crisis which causes a hemorrhagic stroke.
Scenario #3
After a recent heart attack subsequent heart cath, a veteran is prescribed Carvedilol (Coreg) and Lisinopril, but stops taking the medication because he has developed a dry cough and feels dizzy when he gets up from bed or chair.
No, not the Flo from the Progressive commercials….Florence Nightingale. Evaluating the quality of nursing practice began when Florence Nightingale identified nursing's role in health care quality and began to measure patient outcomes. She used statistical methods to generate reports correlating patient outcomes to environmental conditions.
Translation: Florence nightingale noticed that when the doctor washed his hands in between treating patients, the patients were less likely to die.
Centers for Medicare and Medicaid, the Patient Care Link, the National Quality Forum, National Data Quality Indicators and the Magnet Recognition Program benchmark, share and compare performance for an organization.
