JCR Book Excerpt: The Joint Commission Guide to Patient and Family Education

The following excerpt comes from “Chapter Three: Explore the Link between Patient Safety and Patient Education”

The patient and family can play a vital role in making care safe by becoming an active, involved and informed member of the health care team. Improving patient safety requires continuous learning and the constant communication of information between organizations, health care staff, and patients and their families.

Patients and families must be given sufficient information to make decisions and to take responsibility for self-management activities related to their needs, as required under The Joint Commission “Provision of Care” (PC) standard PC.6.10 and “Ethics, Rights and Responsibilities” (RI) standard RI.2.30. Staff can educate patients and, as appropriate, their families to improve individual outcomes by promoting healthy behavior and appropriately involving patients in their care, treatment, and service decisions. Research shows that patients who take part in decisions about their health care are more likely to have better outcomes and experience fewer errors.(1) The Joint Commission incorporated this powerful concept into National Patient Safety Goal 13 for 2006.

Just as patients are entitled to appropriate education that meets their needs, organizations have the right to reasonable and responsible behavior on the part of patients and their families under Joint Commission standard RI.3.10. The responsibilities of the patient and the patient’s family include the following:

• Provide information—including accurate and complete patient history that includes care and services received, as well as perceived risks and any unexpected changes
• Ask questions—such as when treatment, care, expectations, or services are not understood
• Follow instructions and identify when unable (or even unwilling) to do so
• Accept consequences if the care, service, or treatment plan is not followed
• Follow the organization’s rules and regulations
• Show respect and consideration for staff and property as we well as for the organization’s other patrons
• Meet financial commitments

The typical time for this education is at admission, entry, registration, or intake and then as needed throughout the patient’s stay. Organizations may choose to inform the patient of his or her responsibilities verbally or in writing. During the assessment process, any questions regarding this education should be addressed. Any problems with the responsibilities must be identified during assessment so that appropriate education can be planned.

Staff can use several strategies to encourage the active involvement of patients and their families in health care:

• Educate patients on the fact that they have an important role to play in their own care. Convey to patients and their families that they have both the right and the responsibility to be aware of the care they are receiving, to understand it, and to take part in care decisions.
• Encourage patients and families to ask “why” questions over and over again until they get the answer they need.
Communicate openness to patients and family members, particularly when it comes to reporting safety concerns.
• Establish a way for patients and family members to report safety concerns and encourage them to do so. Educate them on what sorts of safety issues to report. Provide the forms to report these issues or include a question about safety on patient perception of care surveys.
• Treat patients and their families as your partners in the patient’s care. Tell them what staff know, avoid hiding things from them, and include them in decision making by giving them care and treatment options.
• Encourage patients to involve family members or significant others in their care. These individuals can act as an advocate for the patient in the health system and a back-up resource for information about the patient’s health history.
• Encourage each patient to be a “smart patient”.(2) Teach patients how to keep track of their health history using personal health journals and medication logs, explain health facts accurately, educate themselves on basic health issues and ask questions of care staff, and engage staff in active dialogue.
• Suggest to patients and their families that they write down their questions before they see their care practitioner.
• Use the teach-back method when providing education to patients and families to make sure they truly understand the information.
• Provide patients and their families with options for contacting staff after hours to discuss questions, issues, or concerns that they may have.
• Provide health and safety information in a variety of media such as posters, patient orientation pamphlets, or the organizations website.
• Direct patients and their family members to websites or other resource materials if they want further information

Encourage Patients to Speak Up and Ask Questions
The Joint Commission’s Speak Up™ campaign, launched in 2002 with the support of the Centers for Medicare & Medicaid Services, encourages patients to become active, involved, and informed participants of the health care team in an effort to reduce errors. The campaign provides a variety of resources for communicating basic safety information to patients and the community as a whole. For example, the most recent Speak Up initiative, “Planning Your Recovery,” provides tips to help people get the information they need and become actively involved in their recovery. Patients who understand and follow directions about follow-up care are more likely to heal faster and less likely to need rehospitalization. When discussing care issues with patients and families, ask them to speak up. Urge them to take the following actions:

• Bring up any questions or concerns with staff. Ask again if they do not understand an explanation.
• Pay attention to the care they are receiving. Make sure the right treatments and medications are provided by the right health care professionals.
• Educate themselves about their diagnosis, the medical tests they are undergoing, and the care plan
• Ask a trusted family member or friend to be an advocate
• Know what medications they take and why they take them
• Use a hospital, clinic, surgery center, or other type of health care organization that has undergone a rigorous on-site evaluation against established state-of-the-art quality and safety standards
• Participate in all decisions about their care

Staff can download the Speak Up brochure specific to their care setting—and a variety of other safety brochures— from The Joint Commission’s Web site (http://www.jointcommission.org) by clicking on the “Speak Up” link. The Partnership for Clear Health Communication™, a national, non-profit coalition of organizations working to build awareness and advance solutions to improve health literacy and positively impact health outcomes, launched the “Ask Me 3” initiative in May 2003.(3) Ask Me 3 is a quick, effective tool designed to improve health communication between patients and practitioners. Through patient and staff education materials developed by leading health literacy experts, the initiative promotes three simple but essential questions that patients should ask their practitioners in every health care interaction, and that practitioners should always encourage their patients to understand the answers to:(4)

1. What is my main problem?
2. What do I need to do?
3. Why is it important for me to do this?

Build a Safety Culture through Education
The National Patient Safety Foundation® (NPSF) raised a call to action for health care organizations at all levels to involve patients and families in systems and patient safety problems. Their 2002 “Patients and Families in Patient Safety: Nothing About Me, Without Me” white paper, a high-level road map for action, outlines how the Foundation will take a leading role in four key areas, including education. The NPSF urges that individual health care organizations establish interactive, interdisciplinary education that brings together patients and professionals. For example, education for the general public (including patients, families, and media) should include the following message topics:(5)

• Definition and principles of patient safety
• Frequency of medical error
• How to safeguard your own care and partner with your providers
• What to do if you experience a mistake or error

Alternatively, health care staff need to receive the message that the patient/family perspective is important and should be actively integrated into culture of an organization.

To achieve these goals, the NPSF urges health care organizations to incorporate patients and families into their systems and programs that create a culture of safety. An organization can foster a culture that values patient and family input by taking the following actions:(6)

• Create a patient and family advisory council.
• Conduct focus groups with patients/families.
• Set up support groups for patients/families who have experienced a medical error.
• Incorporate the patient/family perspective into an organization’s systems and operations.

The NPSF offers a consumer fact sheet that provides strategies for patients and families to help make health care safer. It is available at http://www.npsf.org/d ownload/ConsumerFactSheet.doc.

References

1. Joint Commission Resources: Patient-inclusive care: Encouraging patients to be active participants in their care.
Jt Comm Perspect Patient Safe 5:1-2, 8, Nov. 2005.
2. Roizen M.F., Oz M.C., Joint Commission Resources: You: The Smart Patient. New York: Free Press, 2006.
3. Partnership for Clear Health Communication: Ask Me 3: What Can Providers Do? http://www.askme3.org/PF CHC/what_can_provid.asp (accessed Aug. 4, 2006).
4. Partnership for Clear Health Communication: About the Partnership for Clear Health Communication. http://www.p4chc.org/abo ut-the-partnership.aspx (accessed Aug. 4, 2006).
5. National Patient Safety Foundation Patient and Family Advisory Council: National Agenda for Action: Patients and Families in Patient Safety: Nothing About Me Without Me. 2003. http://www.npsf.org/down load/AgendaFamilies.pdf (accessed May 9, 2006).

Source: The Joint Commission: The Joint Commission Guide to Patient and Family Education, Second Edition, 2007.
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