PROMOTING HEALTH LITERACY IN OUTPATIENT SPECIALTY CLINICS: NURSING EDUCATION TO ADDRESS NURSE SENSITIVE INDICATORS AND IMPROVE INTERDISCIPLINARY CARE COORDINATION.

Tanisha R. Davis, BSN, RN, CCRNUniversity of Pittsburgh

MSN-CNL

• Define health literacy• Discuss the scope of

the issue• Define nurse

sensitive indictors• Discuss current

literature findings• Discuss practice

implications• Discuss key

strategies to address improving health literacy and implementing NSIs in the Rainbow clinic

HEALTH LITERACY

The IOM defines health literacy as “the degree in which individuals have the capacity to obtain, process and understand basic health information and services to make appropriate health decisions.”

SCOPE OF THE ISSUE Half of adults in

United States lack proficiency in basic reading or math skills (above 8th grade level).

Adults over the age of 65, racial and ethnic minorities, and low income status are the most at risk for low health literacy

WHAT CAN WE DO? Health literacy is integral part of nursing

practice. It is an essential part of health

communication, patient engagement, patient empowerment and can have a significant impact on health outcomes

The VA is dedicated to promoting health literacy within the organization Krames online

WHAT ARE NURSE SENSITIVE INDICATORS ANYWAY????• It started with Flo…• Nurse sensitive indicators identify patterns in

the care process or within the structure of nursing that influence care outcomes.

• The IOM

NURSING FOUNDATIONAL PRINCIPLES AND GUIDELINES STATE

We have a responsibility to measure, evaluate, and improve practice.

The Code of Ethics for Nurses with Interpretative Statements states: “The nurse promotes, advocates for, and strives to

protect the health, safety, and rights of the patient.” Nursing: Scope & Standards of Practice, Standard

7 states: “The registered nurse systematically enhances the

quality and effectiveness of nursing practice.”

USING NSIS

Today, NSIs are used to gauge the quality of care an organization is providing.

When the data is analyzed over time, themes and trends emerge that inform our practice and drive organizational decision-making.

To get the most out of data, it needs to be shared with the staff driving the initiatives at the unit level

WHAT IS THE QUALITY IMPROVEMENT GOAL?

Educate the Rainbow Clinic staff on the importance of health literacy, educate on the current NSIs in ambulatory care and create a culture of nursing driven education and care coordination.

MEASURE/INDICATORVeterans with appointments in the Rainbow clinic

8E/W/N areas will be assessed utilizing a standardized triage process to address current Nurse Sensitive Indicators established by the ANA and AAACN Task force

• Medication Reconciliation• Controlling High Blood Pressure• Depression Assessment conducted• Pain assessment and follow-up• Hospital Re-admissions• Smoking Cessation• Patient Education

RATIONALE Performance Improvement to address

NSIs in Ambulatory care To educate staff on the importance of

health literacy Standardize the triage process to

include brief patient education To promote patient engagement,

improve patient adherence to treatment plan, identify at risk veterans and promote collaboration of care

PLAN AND TIMELINE October 6-16, 2015:

Develop a flip-book and poster board of easily understood and culturally competent patient education on current outpatient specialty clinic nurse sensitive indicators: pain management, medication reconciliation, controlling high blood pressure, depression assessment, patient education on top chronic conditions seen at clinic , patient teaching on how to navigate VA resources and patient follow up reminder to prevent hospital readmissions.

Standardize the Triage process to address current NSIs during patient check in

Pre-implementation test October 19-23, 2015:

Staff education Teaching satisfaction survey

October 26, 2015-December 5, 2015: Implementation of process within the Rainbow Clinic triage staff.

Dec 5-7, 2015: Evaluation of results Dec 8-10, 2015: Dissemination of results to stakeholders

DO• Standardize Triage Process• Educate staff on health literacy• Educate staff on NSIs• Incorporate utilizing existing standardized

templates to assess patient risk related to NSIs.

• Incorporate flip book brief patient education tool

• Develop bulletin board on our units NSIs• Collaborate with interdisciplinary team for

patient care management.

STUDY Anonymous staff pre and post

implementation test The pre and post implementation test will be

anonymous and compare equal staff levels e.g. HCT to HCT, LPN to LPN…

Observation of patient triage by VA staff Observation of triage staff will not include

names of staff members or patient identifiers

ACT

• Review Pre and Post testing• Review Observation Data• Encourage staff participation and

the development of NSI champions• Review / Revise standardized

interventions – ongoing• Share all data with stakeholders

PRACTICE IMPLICATIONS / SUSTAINING MEASURES Utilize outpatient ambulatory clinic staff to

the full scope of their practice Promote patient engagement in care Improve patient health literacy Staff education on NSIs Develop NSI champions within the staff to

keep health information up to date and promote staff education laterally and horizontally.

Promote nursing driven quality improvement projects within Rainbow staff to share at monthly unit PPC meetings

FUTURE IMPLICATIONS Open up time currently allotted to medication

reconciliation and patient teaching performed by providers, to address the patients current health issue in which they are seeking care for.

Work with CPRS support team to make sure existing templates for pain, patient education, depression screening, medication reconciliation and follow up procedures to prevent rea-admissions is added to Rainbow Clinic “note”

Nursing driven patient education and care coordination for high risk patients

ACKNOWLEDGEMENTS Myra Couch, manager Rainbow Clinic Melissa Taylor, associate chief of nursing

research, VA All staff of Rainbow Clinic Rose Hoffman, University of Pittsburgh

REFERENCES CDC. (2015). Gateway to Health Communication and Social marketing Practice. .

Accessed on October 4, 2015. Retrieved from: http://www.cdc.gov/healthcommunication/index.html

Erickson, J. (2011). Nursing-sensitive indicators paint vivid picture of organizational commitment . Accessed on October 4, 2015. Retrieved from: www.mghpcs.org/eed_portal/Documents/Caring_NSIs_0411.pdf

Health Resources and Services Administration. (2015) Health Literacy. Accessed on October 4, 2015. Retrieved from: http://www.hrsa.gov/publichealth/healthliteracy/

Institute of Medicine (2004). Health Literacy: A Prescription to end confusion. Accessed on October 4, 2015. Retrieved from: https://iom.nationalacademies.org/~/media/Files/Report%20Files/2004/Health-Literacy-A-Prescription-to-End-Confusion/healthliteracyfinal.pdf

National Institute of Health (2015). Clear Communication. http://www.nih.gov/clearcommunication/

Rennis, Lesley, et al. "Google it! urban community college students' use of the internet to obtain self-care and personal health information." College Student Journal 49.3 (2015): 414+. Academic OneFile. Web. 4 Oct. 2015.

Start, R., Martinez, K., Mastal, M., Battaglia, R. Matolack, A. (2015). Nursing-Sensitive Indicators in Ambulatory Care. Nursing Economic$/January-February. Vol 33 (1).

The Joint Commission. (2015). Facts about patient-centered communication. Retrieved 04 October 2015 from: http://www.jointcommission.org/facts_about_patient-centered_communications/

Office of Disease Prevention and Health Promotion. (2014). National Action Plan to Improve Health Literacy. U.S. Department of Health and Human Services. Accessed on 04 October, 2015. Retrieved from: https://www.healthypeople.gov/2020/tools-resources/evidence-based-resource/national-action-plan-improve-health-literacy