# Presentation: 137392

## PCC Patient Education Protocols

- Why won’t they just write it down?

## Why do we educate patients?

## Patients do what they perceive as important.

**Notes:**
I would like it if they would do what I think is important, but that’s just not the way the world works.

## What is the Task of patient education?

## The task of patient education is to bring the patient to an understanding of his or her disease process and its management as important.

**Notes:**
I was once told that if you want someone to remember  something you should say it more than once.  Since I believe that this point is very important...

## The task of patient education is to bring the patient to an understanding of his or her disease process and its management as important.

## Do providers understand this concept?

**Notes:**
What do you think?  I think that mostly they do understand this if they don’t, it’s up to you to help them understand it.

## Do providers educate patients?

**Notes:**
Having been in a lot of exam rooms with a lot of different doctors I can tell you that almost all providers educate their patients..

## WHY WON’T THEY JUST WRITE IT DOWN?!!

## I discussed with Ms. Jones that her obesity puts her at increased risk for diabetes, heart disease, gallstones, back and knee problems, and infertility.  I discussed the relationship among obesity, caloric intake and exercise.  I explained that she likely has a genetic predisposition to obesity and that she will have to work harder to lose weight.  I explained that she could lose weight through a plan including regular exercise and dietary  modification/restriction.  I advised her to talk to a physician before she began any diet, especially fad diets.  I emphasized the importance of good hygiene.  We discussed some components of a healthy eating plan including regular meal times, eliminating  or limiting snack foods and fatty foods, reducing sodium consumption and adding more fresh fruits and vegetables and fiber to the diet.  We discussed that the most healthy fluid for the body is water and that colas and alcohol contain many hidden calories.  We discussed that healthy eating plans begin at the grocery store and discussed techniques for shopping for a healthier body.  

## WHY WON’T THEY JUST WRITE IT DOWN?!!

## TIME

**Notes:**
If it takes more time to write it down than it does to do it, it won’t get written down.

## So, what’s the answer?

**Notes:**
One answer is....

## PCC Patient Education Protocols

**Notes:**
How many of you are familiar with PCC pt et protocols?  Have any of you been using them at your site?

## What are Pt. Ed. Protocols?

- 4-part mnemonics that are a short-cut for documenting patient/family education encounters.
- They are entered in the Patient Education Section of the PCC.
- They result in an entry on the health summary for future reference.

**Notes:**
Getting the education encounter to the health summary allows for more complete education over time, both from provider to provider and from one visit to another.

## What are the 4 parts?

- Disease state, condition or system being addressed.
- Specific education topic
- Level of patient/family understanding of the material
- Initials of the provider who did the education

**Notes:**
Let’s discuss each one in detail.

## 1st letter condition, system, or disease process

- BT - Baby Bottle Tooth Decay
- BH - Behavioral Health
- BF - Breast-feeding
- CVA - Cerebrovascular Disease
- CD - Chemical Dependency
- CHN - Child Health Newborn
- CHI - Child Health Infant
- CHT - Child Health Toddler
- CHP - Child Health Preschool
- CHS - Child Health School Age
- CHA - Child Health Adolescent
- CDC - Communicable Diseases

- CAD - Coronary Artery Disease
- DM - Diabetes Mellitus
- DP - Disease Process
- DV - Domestic Violence
- LIP - Dyslipidemia
- DYS - Dysrhythmia
- FP - Family Planning
- GER - Gastroesophageal Reflux Disease
- GL - Glaucoma
- HTN - Hypertension

**Notes:**
There are a lot of these because we educate patients about a wide variety of disease states, conditions and systems.  I can assure you that this list is still not complete.  There are still many topics that are not included.  You can see that we have codes for ....

- IM - Immunizations
- INJ - Injuries
- M - Medications
- MH - Men’s Health
- ND - Neurologic Disorder
- OBS - Obesity
- OC - Ocular Condition
- ODM - Ocular Diabetes Mellitus
- OM - Otitis Media
- PVD - Peripheral Vascular Disease

- PN - Prenatal
- PP - Postpartum
- PL - Pulmonary
- RD - Rheumatic Disease
- STD - Sexually Transmitted Diseases
- SPE - Surgical Procedure and Endoscopy
- TO - Tobacco Use
- TB - Tuberculosis
- WL - Wellness
- WH - Women’s Health

**Notes:**
One of the things I hear the most is that providers will look at this list and close their minds by saying, I’m not going to memorize this list.  The good thing is that you don’t have to.

## Pediatric Codes	

- BT - Baby Bottle Tooth Decay
- BF - Breast-feeding
- CHN through CHA
- CDC - Communicable Disease
- DP - Disease Process
- DV - Domestic Violence

- IM- Immunizations
- OBS - Obesity
- OM - Otitis Media
- PL - Pulmonary Disease
- TO - Tobacco Use

**Notes:**
This list can be broken down by specialty and made to be much more manageable.  We are planning to print cards for our providers by specialty so they don’t have to memorize a thing.

## OB/Gyn codes

- BF - Breast-feeding
- DM - Diabetes Mellitus
- DP - Disease Process
- DV - Domestic Violence
- FP - Family Planning
- OBS - Obesity
- PN - Prenatal

- PP - Postpartum
- STD - Sexually Transmitted Disease
- SPE - Surgical Procedure and Endoscopy
- WL - Wellness
- WH - Women’s Health

## Surgery Codes

- DM - Diabetes Mellitus
- DP - Disease Process
- GER - Gastroesophageal  Reflux
- INJ - Injuries
- OBS - Obesity

- PVD - Peripheral Vascular Disease
- SPE - Surgical Procedures and Endoscopy
- TO - Tobacco Use
- WL - Wellness

## Adult Medicine Codes

- BH - Behavioral Health
- CVA - Cerebrovascular Disease
- CD- Chemical Dependency
- CDC - Communicable Diseases
- CHF - Congestive Heart Failure
- CAD - Coronary Artery Disease
- DM - Diabetes Mellitus
- DP - Disease Process
- LIP - Dyslipidemia
- DYS - Dysrhythmia
- GER - Gastroesophageal Reflux Disease

- HTN - Hypertension
- MH - Men’s Health
- ND - Neurologic Disorder
- OBS - Obesity
- PVD - Peripheral Vascular Disease
- PL - Pulmonary Disease
- RD - Rheumatic Disease
- TO - Tobacco Use
- TB - Tuberculosis
- WL - Wellness
- WH - Women’s Health

**Notes:**
The adult medicine list is a bit longer because adults tend to have more disease states to deal with.  Still this is much easier than writing out a narrative of your education encounter.

## 2nd letter - specific topicSome common examples

- DP - Disease Process
- C - Complications
- LA - Lifestyle Adaptations
- M - Medications
- N - Nutrition
- FU - Follow up
- L - Patient Information Literature

- P - Prevention
- S - Safety
- TX - Treatment
- TE - Tests

**Notes:**
These mnemonics happen in nearly every section.  There are other 2nd letter mnemonics that occur only in one place.  For example, the mnemonic ON only occurs under the breast-feeding section and stands for Latch On.
We made every attempt to make these mnemonics easy to remember and to keep any single mnemonic with a single meaning every where it is found.

## 3rd letter - level of understanding

- G - Good
- F - Fair
- P - Poor
- R - Refused
- GP - Group

**Notes:**
It is very important to note that this is NOT how well the material was taught but how well it was UNDERSTOOD.  I  was once told that if you want someone to remember something you should say it more than once.  This is how well the material was understood not how well it was taught.  If the patient doesn’t understand (4 kids in the room) this is important for the next person coming along to know so they may repeat the material.

## 4th letter - initials of provider

## I discussed with Ms. Jones that her obesity puts her at increased risk for diabetes, heart disease, gallstones, back and knee problems, and infertility.  I discussed the relationship among obesity, caloric intake and exercise.  I explained that she likely has a genetic predisposition to obesity and that she will have to work harder to lose weight.  I explained that she could lose weight through a plan including regular exercise and dietary  modification/restriction.  I advised her to talk to a physician before she began any diet especially fad diets.  I emphasized the importance of good hygiene.  We discussed some components of a healthy eating plan including regular meal times, eliminating  or limiting snack foods and fatty foods, reducing sodium consumption and adding more fresh fruits and vegetables and fiber to the diet.  We discussed that the most healthy fluid for the body is water and that colas and alcohol contain many hidden calories.  We discussed that healthy eating plans begin at the grocery store and discussed techniques for shopping for a healthier body.

**Notes:**
So with that in mind, this

## OBS-C,LA,EX,N-G-MR

**Notes:**
Becomes this.  Please note in this example that the 4 sections of the code are separated by dashes and the topics of education are separated by comas.  Let’s look at specific topics that can be coded under obesity.

## OBS - Obesity

- DP - Disease Process
- C - Complications
- LA - Lifestyle adaptations
- N - Nutrition
- EX - Exercise
- FU - Follow up
- P - Prevention
- L - Patient information Literature

**Notes:**
Each of these specific education topics has a set of standards to go with it that can be used as an education guide.  It is not meant to be a lesson plan.  Care was given to make the standards be essentially the things that most providers are already saying when teaching these topics.

## How were these codes developed?	A multidisciplinary team consisting of 2 doctors, 6 nurses, a pharmacist and a dietician from across I.H.S. met and revised and added to existing codes that were initially developed out of the Tucson area under Liz Dickey’s direction.

**Notes:**
Ideas for new codes are encouraged.  If you have a topic you would like to see added please feel free to contact me either by e-mail, banyan, fax, or letter.  It would be appreciated if you would submit your ideas in as complete a form as possible.

## Who can use these codes

- Doctors
- Physician Assistants and Nurse Practitioners
- Nurses
- Pharmacists
- Respiratory Therapists
- Patient Educators
- Other health care providers

## Slide 31

## “That’s great, Dr. Ratzlaff, but the doctors at my service unit won’t do this!”

**Notes:**
I’ve heard that before so let’s address it right now.  What can you do to get providers interested in using these codes?

## Providers do what they perceive as important.

**Notes:**
It’s true.

## How to motivate people	

- Find out what they want.
- Find out who they are afraid of.
- Find out who they want to like them.
- Find out what they want to avoid.

**Notes:**
Let’s address each of these issues independently.

## Find out what they want

- Nearly all doctors want to get credit for what they do.
- They all know that they are educating their patients.
- If you show them that they can get recognized for this it will be a motivator.
- Send a list of people who have more than 50 documented education encounters to supervisors.

**Notes:**
This has worked pretty well at our facility.  You do what works well for you.

## Find out who they are afraid of

- Whether they will admit it or not, doctors are typically afraid of JCAHO and HCFA.
- Be sure they understand that this is the way I.H.S. has chosen to comply with the JCAHO requirement for patient and family education.
- If it isn’t documented it didn’t happen.

**Notes:**
If patient education isn’t documented, by JCAHO standards it didn’t happen.  The hospital might not get accredited and then HCFA won’t pay.

## Find out who they want to like them

- Most doctors want their patients to like them.
- Patients will like them more if the patient feels like the doctor cares about him/her.
- Written coordination of patient education makes it clear that the doctor is the leader of the health care team.

**Notes:**
When patient education is entered onto the PCC it will result in an entry on the health summary.  This will make consistent patient education possible.  Patients will notice this.

## Find out what they want to avoid

- Doctors want to avoid more writing in the chart than they are already doing.
- Since they can’t avoid the JCAHO requirement for documentation of patient education, help them understand that they can beat JCAHO’s game with a few simple letters on the PCC.

**Notes:**
Point out that writing these few letters is much less writing than JCAHO had in mind when they put this rule into effect.

## Slide 39

## I discussed with Ms. Jones the correct technique for obtaining peak flow measurements.  I further discussed the importance of doing twice daily peak flows and how this can prevent ER visits and hospitalizations.  We then discussed how the use of a spacer could result in improved delivery of her inhaled medicines.  I explained the proper use and care of a spacer.   We reviewed her current asthma medications including the name dose and timing of administration.  I reinforced which medicines are for quick relief and which ones are anti-inflammatory medicines.  We discussed that correct use of her medicines could result in improved life-style.  I reminded her to consult with her physician before using any over the counter medicines for asthma.

## PL-PF,SPA,M-G-MR