Abstract TP327: Are We Really That Noncompliant? Identifying Barriers to Documenting Patient Education
Background/Purpose: Patient education impacts stroke recovery and prevention. Certification as a Joint Commission Primary Stroke Center (JC PSC) requires consistent performance in patient education. Prior to instituting a new electronic medical record (EMR) in March 2011 our hospital maintained compliance with this measure at or above 93%. We have experienced difficulty returning to this level for unclear reasons. We sought to identify factors contributing to a decrease in performance.
Methods: The institution’s Get with the Guidelines Stroke database was reviewed from July 2010 to June 2012. Institutional and departmental changes occurring during months of low compliance were explored. A Project RN was hired to focus on data abstraction and patient education.
Results: Prior to March 2011 compliance was 93-100%, at which time it dropped to 68%. April 2011 to June 2012 the range was 76-100% with 9 months less than 90%. Only three months during that time were 93% or better. The initial decrease in compliance was clearly attributable to the EMR which lacks previously available “hard stops” for education. Continued compliance of less than 90% was multifactorial. An average census increase of 16.8% per month from 2010 to 2012 was identified. In addition, there were staffing changes within the stroke center during months of low performance. Absence of a nurse practitioner on the inpatient unit had a negative impact. Patients in the stroke unit had better documentation of education than those on other units. Improved compliance coincided with preparation for a JC PSC site visit and completion of the Project RN’s orientation.
Conclusions: Consistent achievement of stroke education at 93% or better can be reached, but is challenging in a frequently changing environment. We believe our patients are getting stroke-specific education, but documentation has declined due to the EMR, changes in staff, and growing census. Identifying these barriers has allowed the development of a PI plan with a goal of consistent compliance of 93% or better. This plan includes revision of the Project RN responsibilities and scheduling patient education sessions more frequently. Another NP is being recruited, and investigation into better use of the available features of the EMR is underway.
- © 2012 by American Heart Association, Inc.