Volume 24
Number 21
October 18, 2013
Hospital of the University of Pennsylvania
Do Patients Really Understand? Inadequate health literacy is a significant concern in today’s healthcare environment. Indeed, more than one-third of Americans don’t understand the basic medical information that’s needed to make informed health-care decisions. This knowledge gap can have serious repercussions: poor medication adherence, increased mortality, and increased hospital readmissions and trips to the ER. Individuals with inadequate health literacy can be found throughout the United States. The problem doesn’t necessarily have anything to do with a lack of education. Even highly educated individuals can have difficulty understanding health information. “We need to change how staff teach so that patients can learn to care for themselves,” said Carolyn Cutilli, PhD-c, MSN, director of Patient and Family Education for UPHS. “It is important for the staff to put themselves in the patient’s shoes and explain concepts in very simple terms.” Several resources are available on the Intranet to help staff meet the health literacy needs of patients (see sidebar on page 3). In addition, courses are offered on Knowledge Link to increase staff awareness of health literacy and provide tools to improve patients’ understanding, such as the “teach-back” approach (have the patients explain instructions in their own words). Some clinical areas, though, have taken the challenge to the next level. With a focus on reducing heart failure readmissions, the staff on Silverstein 10 and the cardiac intermediate care unit (CICU) have developed their own tools to ensure that these patients not only understand what their providers are telling them but remember it as well.
INSIDE Did You Get Your Flu Vaccine?.......2 10 Steps to Healthier Babies......3 OncoLink Brown Bag Chat.......4 A Thumbs Up from Founders 12!..............................4 Advance Directives: The Voice of the Patient............4
`` Desiree Crompton, BSN, RN, PCCN, reviews one of the medication cards with heart failure patient Tom Andreas.
Keeping Patients in the Know One tool that all of Silverstein 10’s patients receive – the “Cardiac Surgery Journey” welcome sheet -- describes every step of their progress as an inpatient, from arrival at the hospital to surgery to recovery in the CICU and on Silverstein 10, and, ultimately, discharge. “At each step, the sheet describes what needs to be done to continue onto the next,” said Tanya Johnson-Coleman MHA, Ed. In creating the map, “we tried to answer questions that patients always ask, especially what needs to happen before they’re discharged. I think it helps to alleviate the stress and anxiety patients have from not knowing.” The staff also created medication cards – as well as a Penn Heart Vascular Medication Reference Guide -- to help patients better understand their medications, including why they’re taken and potential side effects. The ring of cards is placed by the patient’s bed for easy access, but staff nurses review meds as well, focusing on one medication each day. There is also an in-unit “class” for patients and families which focuses on medications, procedures and problems they might encounter after discharge. The challenge to increase health literacy is also being tackled by Penn’s Center for Innovation. Adam Lang, Innovation manager, and his team explored how improved discharge instructions could better (Continued on page 2)
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Did You Get Your
Flu Va
The UPHS employee flu campaign is well underway. If you have not yet received a flu vaccine, you can get one at a flu vaccine clinic on the Ravdin Mezzanine at the following times:
Friday, October 18, from noon to midnight Monday through Wednesday, October 21-23, from 1:30 am to 7 pm Additional times and locations of the Flu Vaccine Clinics are posted on the Intranet at http://uphsxnet.uphs.upenn. edu/occupationalmedicine. To ensure minimal waiting times and rapid documentation, bar-coded vaccine consent forms are available to employees `` Tracy Clark-Hornbaker, RN, BSN, of Occupational Medicine, helps Gemma Oetzel, RN, BSN, of Trauma, stay healthy this winter with a flu vaccine.
Do Patients Really Understand? (continued from page 1) prepare heart failure patients to take care of themselves once they got home from the hospital. The original instructions, he said, “were four to five pages of all text with no prioritization of information. The advice at the end was the same for every patient, regardless of diagnosis.” In creating a new prototype design, the team “organized and prioritized the information and kept it to one sheet,” said Matt Vandertuyn, Innovation Experience designer. “The information is easier to understand and the design is much more visually appealing.” Although the design is still in the development stage, it has received positive feedback from both patients and nurses.
follow-up.The nurse can also do a video chat to the patient’s tablet, picking up on signs of shortness of breath. The pilot starts next month. These efforts — and many others in use throughout the hospital — will not only keep our patients healthy but also have a financial impact. One section of the HCAHPS survey, which measures patients’ perception of their hospital experience, focuses on communications between doctors and nurses and their patients. The results are tied to a hospital’s payment from the CMS (Centers for Medicare and Medicaid Services). The Joint
Commission also has multiple criteria for patient and family education. Said Lynn Washington, RN, Cardiovascular nurse navigator and leader in HUP’s Patient and Family Education Committee, “We have to do a better job at assessing patients’ comprehension of what is important for them to know and what will motivate the behavior changes needed to improve their health and make more informed choices.
“I often tell my patients, ‘If you didn’t understand, it’s because I didn’t do my job.’”
A High-Tech Approach Another initiative will use a high-tech approach to help keep patients with heart failure from being readmitted. As part of a pilot program on Founders 10 and 11, each of these patients will receive a computer tablet at discharge which has a special AirCare app. At home, the patient will receive and respond to a daily checklist customized by his or her bedside nurse. For example, one list item might say “I took my Lasix today.” All responses will automatically be classified into three risk categories: red (high), yellow (medium) and green (low). The patient’s nurse will check the AirCare website daily to see if any patients are at high risk, requiring
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`` A pilot program providing heart failure patients with computer tablets at discharge allows nurses to do follow-up with patients through Skype.
accine?
and faculty directly. To access your barcoded form, click on ‘2013 Flu Campaign Information’ under ‘What’s Hot’ on the Intranet.
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STEPS TO HEALTHIER BABIES
New this year, employees who submit their completed flu bar-coded consent form by November 1 will be entered into the raffle and eligible to win prizes. The UPHS Influenza Vaccine Policy is unchanged from last year. Contact your HR generalist for any questions about the policy.
`` A ribbon cutting signified the installation of the 10 Steps to Successful Breastfeeding footprints in all of HUP’s Women’s Health patient care units.
HUP’s Health Literacy Resources: To access patient and family education resources, go to the Intranet home page and click on ‘Patient and Family Education’ on the left column. Then, click on HUP. On that page you will find: TOOLKITS FOR PROFESSIONALS —
Guidance on preparing patient and family education materials. TIGR —
On-demand patient education videos. EDUCATION LINKS —
Additional information to help patients learn more (eg, LEP or Non-English educational resources). INSTRUCTION SHEETS —
Written educational sheets for patients (eg, preventing falls). You can find additional resources at Mosby’s Nursing Skills (on the right column of HUP nursing page). Click on Patient Education tab. Patients can also find health information through their myPennMedicine account.
Last year, HUP was selected to participate in Best Fed Beginnings, a national effort to improve breastfeeding rates in states where rates are currently the lowest. Since that time, the staff on Labor & Delivery has been moving full steam ahead to raise its breastfeeding rates and, ultimately, achieve BabyFriendly status. This designation is given to hospitals that promote excellence in maternal-infant feeding practices. Their efforts so far have paid off. Since the initiative started, the unit’s rates for breastfeeding exclusivity (meaning no formula supplements) have more than doubled, from 20 percent to an average of 50 over the past few months! “I think of lot of the increase is due to bringing awareness to our patients through education,” said Jessica Lazzeri, MSN, nurse manager of Women’s Health. “Plus, the Baby-Friendly initiative is generating a lot of excitement!” Educating the unit’s nursing staff also contributed to the increase. All nurses are receiving 20 hours of breastfeeding education and many have gone on to become certified breastfeeding counselors. “Education helps nurses understand why breastfeeding is important and how they can be more supportive to our patients,” she said. “It also empowers them in their teaching, providing a consistent message to the moms.” The importance of breastfeeding came more into the public eye in January 2011, when Surgeon General Regina M. Benjamin, MD, released a Call to Action to support breastfeeding. In addition, reporting “exclusivity in breastfeeding” rates is now a
requirement of the Joint Commission. And it’s easy to understand why. Breast-fed infants have fewer infections and allergies than those on a supplement. And it benefits moms as well, with a lower risk of breast and ovarian cancer, osteoporosis, and cardiovascular disease. Lazzeri said their goal is to obtain the Baby Friendly designation by September 2014. Some of the other criteria they’re working on include increasing rooming in (the baby stays in the mom’s room 24/7), promoting skin-to-skin contact between baby and mom immediately after delivery, and educating the parents on the appropriate use of pacifiers. In honor of World Breastfeeding Week, the unit held a small celebration, recognizing how far they’ve come in doing what’s best for the babies. “The key to success,” said Michael Posencheg, MD, ICN medical director, “is changing our culture to think of mom and baby together as one, a unit.” “We are striving to meet the needs of moms and babies,” added Deborah Driscoll, MD, chair of OB/GYN. “It is my pleasure to watch the program grow.”
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ONCOLINK’S NEXT BROWN BAG CHATS: OncoLink will be broadcasting two workshops on Friday, October 25, live from PPMC’s Philadelphia Heart Institute. These workshops are open to patients, caregivers, and health-care professionals. You can attend the sessions at PHI or watch the webinars:
TIME: NOON– 1:30 TOPIC: What cancer patients need to know about Medicare open enrollment
Learn about the terminology, out of pocket expenses, communicating with your insurance company and much more. If you are looking for ways to maximize your coverage and minimize your costs, this workshop is for you!
TIME: 2:00– 3:00 TOPIC: The impact of the Affordable Care Act for cancer patients: It’s a game changer!
Get a better understanding of the basics of the law, the types of plans offered and how they will be managed, how to compare costs and get coverage and debunk some of the common myths.
Helping People ALL THE TIME Congratulations to May’s winners of the Helping People All the Time raffle! Beauty Averion . . . . . . . . Ravdin 6 Trudy Bailey. . . . . . . . . . . Ravdin 6
To register, please call 215-662-8785. Social workers who attend both sessions can receive 3 CEUs. If you cannot attend in person, you can participate online. Go to oncolink.org/webchat to learn more.
A THUMBS UP FROM FOUNDERS 12!
Naomi Cutler. . . . . . . . . . . Founders 14 Pamela Garvin. . . . . . . . . Rhoads 7 Felicia Gooden. . . . . . . . . Founders 14 Barbara Jones. . . . . . . . . Ravdin 6 Quinn Kostman. . . . . . . . . Ravdin 6 Caren Levine. . . . . . . . . . . Radiology Daniel Lombardi. . . . . . . Ravdin 6 Jamie Moyer . . . . . . . . . . Founders 9 Anna Nguyen. . . . . . . . . . Founders 9 Natalie Nicolosi . . . . . . . Rhoads 7 Rebecca Panrock. . . . . . Founders 9 Nicole Pape. . . . . . . . . . . Ravdin 6 Sharlette Rowe. . . . . . . . Founders 9 Teresa Scott. . . . . . . . . . . Rhoads 7
Founders 12 was the first patient-care unit to go live with bar code medication administration. According to nurse manager Nicole Nolte, staff gave it a “thumbs up. They have all been positive and enthusiastic! I am so proud of them!”
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HUPdate
`` (Front row, l. to r): Nicole Nolte, Kelly Parrott, Madeline Martin, Carly Rosenblatt, Jenn Rocco, Marybeth O’Malley, and Robyn DiFilipo and (back row, l. to r.) Laura Arntsen, CJ Miller, and Joan Brower.
EDITORIAL STAFF
Advance Directives: The Voice of the Patient
Tara Skoglund Designer
An advance directive is a health-care power of attorney, living will, or a written combination of both. It provides a voice for patients when they cannot speak for themselves.
ADMINISTRATION
Sally Sapega Editor and Photographer
Susan E. Phillips Senior Vice President, Public Affairs
Obtaining a copy of the advance directive for the medical record is important because it tells health-care providers who the patient appointed to speak for him/her when he/she is unable to do so. Also, it outines the patient’s wishes and instructions if in a state of permanent unconsciousness or in an end-stage medical condition and unable to make decisions.
CONTACT HUPDATE AT: 3535 Market Street, Mezzanine Philadelphia, PA 19104
According to UPHS policy (“Advance Directives: Living Wills, Health Care Powers of Attorney, and Other Advance Health Care Directives”), if a patient has an advance directive and does not bring a copy, an “Incomplete Sign-In” form must be completed so that the patient can express his wishes if he so desires. The form will be used until a copy of the advance directive is brought in by the family.
HUPdate is published biweekly for HUP employees. Access HUPdate online at http://news.pennmedicine.org/inside/hupdate.
phone: 215.662.4488 fax: 215.349.8312 email: sally.sapega@uphs.upenn.edu