Assignment Need Finding - Downs

Performance Gap Standardization of a Home Oxygen Education Teaching Module

We must do a better job of educating our patients and caregivers before they are discharged from the
hospital. Medicare alone, spends on average, $15 billion for hospital readmissions, and it is estimated
that 20% of all patients admitted for a hospital visit will be back for another admission within 30-days
(Reducing hospital admissions with enhanced patient education). New healthcare initiatives have been
implemented for certain disease processes which are punitive to healthcare institutions whose patients
are readmitted with the same diagnosis within 30-days.
At my hospital, the Respiratory Care Services department is piloting a new Home Oxygen Education
program, designed to educate caregivers about oxygen for their child, who is being discharged from the
Neonatal Intensive Care Unit. The training will provide very specific information and guidelines for
caregivers, so they will know when and by how much to increase or decrease the oxygen for their child.
This project will also involve regular follow up with a respiratory therapist after discharge. However, as
part of this process, a lack of a standardized education model has been identified as a performance gap
resulting in inconsistent delivery of information.
This need was identified both by the respiratory therapists who were responsible for the training and
reported this issue, as well as the therapist who is currently responsible for following up with caregivers
after they are home. In two different circumstances, the caregiver had no recall of pertinent
information covered in the training.
Caregiver distractions in the healthcare setting are a ubiquitous challenge as well. These distractions
derive from stress incurred by caregivers who are faced with discharge-related education from an array
of healthcare disciplines, as well as from the healthcare setting itself. These factors, among others, are
further driving the need for a standardized training product which is designed with these constraints in
the learning environment in mind.
Through conversations with the therapists in NICU, it was revealed that the consistency of teaching was
not satisfactory. In other words, one therapist may teach in one style, emphasizing some points, while
other therapists would teach in a different manner, emphasizing other points. The end result was a
breakdown in the transfer of information to caregivers, evidenced by the lack of caregiver recall during
follow-up interviews. This project, would involve two main educational strategies.
To cover more peripheral, yet required information, a video would be developed and made available to
caregivers on the hospital systems Care-Hub program (an electronic source for caregiver training
material). This information would cover oxygen safety, the proper use of a pulse-oximeter, and cleaning
instructions.
In addition, visual presentations (lots of pictures), designed for use with a tablet (perhaps an iPad) would
be developed with a focus on the clinical concepts felt to be most critical for recall by the caregivers.
The content of these core concepts will be related to the follow-up questions that will be asked during
follow-up questions when the caregivers are home. It would be important to emphasize visual
examples, and ensure that information was written at an appropriate grade level.

This proposed project will enable the therapist to pick up the iPad, and use it at the bedside for
discharge education. Each core concept, including main points, will be visually displayed on each slide,
thus allowing the therapist to simply swipe their way through each presentation, ensuring that all
points are made available to the caregiver.
Eventually, this tablet might contain several different presentations, enabling the therapist to easily
access pre-prepared discharge education on a number of topics, from home oxygen education, to
metered-dose-inhaler instruction, to asthma action plans.
Patients and caregivers, will often see many different therapists during their stay, so having preprepared slides, optimized for caregivers, is less stressful for the therapists, and more effective for
caregivers who are struggling to remember everything they are being told.
For the time being, the technology would consist of presentations contained in a tablet, which would be
placed in a central location for the respiratory therapist when discharge education is ordered. Each slide
would be designed to convey the information in a way that is visually pleasing, and in a format that
captures the salient points of the training.
In the future, I envision a program that will not only provide information to caregivers, but that will also
enable them to interact with the material, improving knowledge transfer.
Currently, home instructions are in paper form, and consists mostly of text, with a few simple images.
Therapists report that they do not like to read the information to the caregiver, and that they would
prefer pre-developed presentations over the actual paper forms.
Having pre-developed presentations, designed with caregivers in mind, would be an effective tool for
standardizing the way we provide our education, which will hopefully in turn, more successfully
empower caregivers at home and reduce hospital readmissions.

References
Reducing hospital admissions with enhanced patient education. (n.d.). Retrieved from
https://www.bu.edu/fammed/projectred/publications/news/krames_dec_final.pdf