Comprehensive Educational Programs
Building and Implementing a Comprehensive Educational Program
Lenore Blank RN MSN*
*Adapted from the Building and Implementing a Comprehensive Educational Program Chapter of the Glycemic Control Implementation Guide by Dave Wesorick, Cherri Lattimer, Nancy Skinner, Robert Rushakoff, Greg Maynard
Comprehensive education and counseling are the foundation for all heart failure management. A comprehensive educational program should involve educating the staff as well as the patients.
Staff Education
The role of education in quality improvement is complex. Educational efforts alone do not usually result in major changes in practice, as the other
sections of this resource room have made very clear. However, it would be unrealistic to believe that an institution could enact major changes in the attitudes, knowledge, and practices of its staff without some kind of information transfer. How much the success of a quality improvement effort depends on education is contingent on the complexity of the intervention. For example, if the goal of a quality improvement effort were simply to increase the number of patients with heart failure taking an ACE inhibitor, a simple electronic reminder system might be effective, which might not require any education beyond what is stated in the reminder. However, if the goal is to change practice in more substantial ways, particularly if the desired change depends on the acquisition of new knowledge, education takes on a more important role. When developing educational materials for use in a quality improvement project, a few rules should be kept in mind:
1. Direct educational efforts toward imparting both general and institution-specific knowledge, the former to support the initiative and the latter about the practical applications of the interventions (such as familiarity with an order set or institutional policy).
2. Define the target audience (and the objectives for them). Educating people about what they do not need to know is wasteful, but failing to educate even a few of those who do need to know can undermine the success of the project. Recognize that educational efforts often need to be directedtoward people from many professions and with different levels of training. Identify educational objectives that are both general and institution specific for each component of the audience.
3. Do not reinvent the wheel. In many cases, at least some of the necessary educational materials (especially the general knowledge part) may already exist.
4. Plan the delivery. Creating the educational materials is the easy part. The hard part is assuring that the content finds its way into the
knowledge baseof all the right people. If the project is small (eg, focused on only a single unit or service), this is less of an issue. But for bigger
projects (eg, spanning an entire institution), getting the message to everyone can be difficult. Easy access to training is a key factor. Usually, the most
cost effective way to accomplish broad-based training is Internet- or intranet-based learning modules, often augmented with hands-on or lecture
materials. However, even if the educational materials are widely accessible, it might still be difficult to make sure all key personnel participate. Some methods to optimize participation include:
- Make participation mandatory for important topics. Mandatory participation is fairly common among nursing, pharmacy, and ancillary staff and is usually well accepted. It is more difficult to mandate physician staff to participate in educational programs, particularly at institutions that use the open medical staff model, but it may be possible if the education is directed toward a discrete group whose leadership is committed to the project (eg, a residency program).
- Make the educational program as enjoyable as possible. Regardless of whether the training is mandatory, educational programs are more effective if they are concise, clear, case based, and interactive.
- Create other incentives for participating, if the education cannot be made mandatory. The incentives offered usually depend on the resources available. An example of a common incentive is offering an educational presentation as part of a program that includes a nice dinner. Hospitalist groups or other providers may get recognition or a competitive advantage for certification or full participation in training. CME, CEU, and Pharmacy educational credits may by valuable for many learners.
5. Evaluate and track the participation and performance of staff in the educational program and the impact of the educational program as a whole. Even the best educational module will have no effect on those not exposed to it. Keeping track of who has and has not been educated will allow the latter to be identified for special intervention. If the process is mandatory, the intervention might be disciplinary, but even for non-mandatory programs, the QI team might be able to come up with innovative ways of making sure that everyone is educated. For examples, members of the QI team could provide abbreviated, one-on-one education for noncompliant members of the target group (academic detailing). The worst-case scenario would be to post an educational module on the Internet and just assume that everyone has completed it. Modern Web-based learning modules allow evaluation of performance on questions as well as tracking participation.
In the future, hospitals might require completion of some educational modules as part of the credentialing process for its professionals. Many hospitals already use this type of online education for topics that are mandated by regulatory agencies (such as infection control or fire safety) because they can be tracked and reported. This mechanism is appealing from a QI standpoint, where the success of a project often hinges on the education of many, diverse people.
Now, how might this framework be applied in the context of a quality improvement project aimed at improving the management of heart failure patients?
Identify the Target Audience and the Learning Objectives
Inpatient heart failure management is a broad educational effort for nearly all nurses, pharmacists, and physicians.
Objectives for Physicians
From the ACC/AHA, with some additional items listed
Core knowledge for physicians, midlevel practitioners, and pharmacists
Practitioners should stay up-to-date on the current care practices to ensure they provide the best care for their patients. The following example documents were created to assist practitioners to provide adequate care:
Many online tools as guidelines and best practices for physicians and healthcare providers:
- ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. This full text report of the American College of Cardiology/American Heart Associate Task Force on Practice Guidelines (2001) was developed in collaboration with the International Society for Heart and Lung Transplantation. Endorsed by the Heart Failure Society of America. Visit the American Heart Associates' Heart Failure pages.
- “Heart Failure Practice Guidelines.” Originally published in The Journal of Cardiac Failure, 1999;5:357-382. Reprinted in Congestive Heart Failure, 2000;6:11-39. See it at: www.hfsa.org/hf_guidelines.asp.
- “Get With the Guidelines-Heart Failure” sponsored by the American Heart Association. Find out more by clicking on “Getting Started Online Course” at: www.americanheart.org/presenter.jhtml?identifier=3029030.
- Health Care Excel offers a template of stickers to attach to patient charts that outlines the national guidelines for Heart Failure care. Find it at: www.hce.org/Medicare/PDF_Documents/HF_stickers.pdf.
- Health Care Excel offers a wall poster that outlines the national guidelines for Heart Failure care. Find it at: www.hce.org/Medicare/PDF_Documents/small_HF_poster.pdf.
- Transitions to outpatient regimens
- Culture of safety issues
INSTITUTION SPECIFIC
The medicare quality improvement committee recommends the following hospital quality improvements for heart failure:
- Develop standing or preprinted orders consistent with guidelines for heart failure care (see below)
- Condense current science into quick reference tools for heart failure
- Create a quality improvement community with other area hospitals to improve care in your area
- Post data on performance measures in a common area of the hospital where staff can see them
- Develop performance measures for Board of Directors’ quality improvement activities
- Begin a program for senior leaders to learn care delivery by working closely with a unit at the hospital
- Make physician performance measures a criterion for admitting privileges
- Develop tools to track quality improvement activities or outcomes
- Develop a guideline tailored for a microsystem within the hospital
- Develop recognition programs to reward quality improvement activities and achievements
Interdisciplinary Patient/Family Education Record
View Interdisciplinary Patient/Family Education Record
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