By Tara Boyd
Educating and empowering patients to actively participate in their care helps reduce a patient's risk of hospital acquired infections. Creating an open dialogue, however, can be a challenge in today's healthcare. So how can hospitals improve their patient education programs and help patients become empowered and active in their treatment?
First, hospitals need to understand what accreditation standards require of hospitals. The Joint Commission established certain standards to protect patients' rights and assist hospitals in patient education. These standards, while broad, provide the framework for healthcare providers to establish patient education practices.
"It's general enough that it can cover any case scenario that you've got," says Emi Datuin-Pal, RN, BSN, MSHSA, MBA, associate project director at the Joint Commission.
One of the Joint Commission's general standards for patient education requires the hospital to provide patient education and training based on the patient's needs, Datuin-Pal says. This includes conducting a learning needs assessment and then administers training to the patient based on the assessment. The standard provides examples of what hospitals should train patients on, including basic health practices and safety.
Start with the basics.
Healthcare providers first and foremost should make sure patients are doing the simplest infection control methods and doing them well, says Patricia McGaffigan, RN, MS, the interim president of the National Patient Safety Foundation. This includes making sure people thoroughly wash their hands with soap and water for a thorough amount of time instead of just running their hands under water.
"Even things like not sneezing into your hands but into your elbow - these are pretty basic but critical types of things patients can do in order to reduce the risk of spreading any type of infection," says McGaffigan.
In addition, let patients know that they should be asking their healthcare providers if they washed their own hands, McGaffigan says. Patients have the right to ask, especially when sinks and sanitation stations are located outside their room, where they cannot see if the healthcare provider thoroughly washed his or her hands. Placing sanitation stations or hand sanitizer within sight of the patient can help reassure the patient that their healthcare providers are taking steps to minimize the risk of infection, according to McGaffigan.
Make the patient comfortable.
The general standard on patient education also requires that the hospital provide the patient with education on how to communicate concerns about patient safety issues, Datuin-Pal says.
Patients may feel cautious or apprehensive about asking questions because they do not want to be considered a tough patient, but encouraging them to speak up can go a long way in preventing infections, McGaffigan says.
Healthcare providers can help ease some of that apprehension by routinely asking patients if they have any questions or concerns they want to discuss, McGaffigan says. By asking them first you open a whole new line of communication, making the patient more willing to come forward if he or she notices a change.
"It is very difficult for the patient to have the courage to speak up unless they are invited to speak up by the system," McGaffigan added. When patients do speak up thank them for raising a concern even if it leads to nothing. Once again this will help them feel more at ease and comfortable bringing up issues in the future.
Encourage patients to also have an advocate—either a family member or someone else—who can help look out for potential risks. These advocates can also look out for variations in practice and may notice changes in the patient before healthcare providers see a difference.
"Very often the patient is not only reluctant to speak up but they're not feeling well or they may have trouble communicating for a variety of reasons, so that third party is vital," according to McGaffigan.
Help the patient become an active participant.
Talk to the patient about what he or she can do to optimize care, instead of focusing solely on what the healthcare provider is going to do for the patient, McGaffigan says. "Patients want to be involved in their care. They want to be an active participant. And family members want to be involved in any way they can," McGaffigan adds.
Encourage the patient to ask questions regarding his or her treatment. Urinary tract infections and central line infections are common in hospitals and can be costly to the patient. When it comes to certain things like catheters assure patients that they can ask doctors and nurses, "Is it essential for my care?" McGaffigan explains. Educating the patient on these practices may reduce the risk of infection by eliminating a potential threat.
Let patients know what their care should look like as well.
"A lot of bad things in healthcare happen because of the variation in practice," McGaffigan says. "If we can encourage patients to know what to expect then they can identify a variation in practice that is exposing them to a potential risk."
Educate the patient on what dressings or catheters need to be changed on a daily basis and what the process looks like. Showing the patient what to expect and what techniques help prevent infections empowers him or her to look out for potential risks when shifts change and someone else begins changing his or her dressings.
The Joint Commission, in addition to their standards, recognizes the importance of healthcare providers encouraging their patients to speak up and ask about their care, according to Datuin-Pal.
To assist in the process, the Joint Commission launched the national Speak Up campaign in 2002, and since then hospitals and other healthcare providers have been using the brochures and videos to help patients understand their right to speak up. The brochures and videos provide easy-to-understand information on certain issues that healthcare providers may find lacking in their own patient education programs.
"Five Things You Can Do To Prevent Infection," one of the Speak Up brochures, provides patients with the information needed to help them remember proper infection control, including proper hand washing techniques and information on vaccinations. "Know Your Rights" also gives patients critical information on understanding their rights in the healthcare setting. It includes more information on selecting an advocate, questions for patients to ask to optimize care and what patients have the right to know about their care. When patients understand their rights they will feel more comfortable opening up about concerns with their care. These brochures should be placed in waiting rooms or other areas of the hospital, easily accessible to patients and their families.
The Joint Commission provides all of the Speak Up videos and brochures for free on their website, http://www.jointcommission.org/speakup.aspx.
Don't forget about high-risk patients.
Hospitals need to improve their patient education and infection control training with high risk patients, McGaffigan says.
"There are a number of patients out there who have diabetes, and if there are significant changes in their blood sugar that can increase their chances of infection, whether they are in the hospital or not," McGaffigan says.
For patients at a higher risk of infection, such as those who are diabetic, overweight or smokers, healthcare providers need to discuss how these issues heighten their risk for infection. Patients in the intensive care unit are also considered high risk. Healthcare providers should encourage ICU patients to get up and out of bed, McGaffigan says.
"A lot of people think 'I'm in the ICU. I can't get up. I can't get out of bed,'" McGaffigan explains. "The irony of it is getting them out of bed is and should be a routine practice in the prevention of infection."
In certain cases, alerting high risk patients to the heightened risk of infection can lead to proactive measures to prevent infection. Inform patients of their risk and work with them to lower the risk whenever possible.
Understand the patient's rights to education.
The Joint Commission purposely does not call for a specific format in patient education, but they provide certain requirements healthcare providers need to understand.
According to Joint Commission standards, the patient possesses the right to receive information in a manner in which the patient understands. In certain cases the hospital may need to provide interpreting or translation services to accommodate the patient's communication needs. These needs should be determined during the initial learning needs assessment.
Making sure that healthcare providers record all patient safety and infection control education helps the entire healthcare team stay informed about the patient's care and alerts them to what still needs to be discussed with the patient.
Patient education is an ongoing process, Datuin-Pal says. There is no set time frame or format for providing education, but it should be considered part of the patient's daily care. As treatment proceeds or becomes modified patients need to remain informed about the care being provided.
Hospitals should make patient safety and education a key concern at every level, from the top administration down, McGaffigan says, adding, "If we were able to minimize hospital acquired infections alone in a manner where we have engagement from the staff and from the patient and families, we could be reducing risk and cost substantially, let alone the mortality rate."
Tara Boyd is a writer for ICT.