Teaching and Training
Now that you have read all about my frustration in reviewing clinical records regarding teaching, let me offer a few tips to ensure that your documentation of teaching and training is fully reimbursable.
- Document the NEED for teaching. For instance, if your patient has been diabetic for ten years and your notes states that you are teaching insulin administration, explain yourself. It could be that the patient only recently began insulin or that you observed the patient self injecting and determined that reteaching was necessary.
- Do not teach the unteachable. If you have a patient with dementia, document exactly who was taught. As we grow older, our families become larger. You can teach the ‘caregiver’ several times and each time a different person is present. If there are multiple caregivers it makes sense to teach multiple times. It does not make sense to teach the same thing repeatedly.
- Teach only what is necessary. I once read a chart where the nurse taught the patient signs and symptoms of an intracranial bleed which could result from Coumadin. The patient was informed to call the MD for sudden loss of consciousness or seizures. It might have been better to teach safe use of Coumadin to avoid the worst case scenario.
- Sometimes, the best teaching you can do is to tell the patient to take the yellow pill at bedtime. Always consider your patient’s ability to learn. An elderly patient with a fifth grade education probably will not be able to learn that Lasix causes electrolyte imbalances. They will be able to learn to always take their potassium if ordered and to always be present for lab appointments to make sure there are no serious side effects from the medication.
- If a patient is noncompliant, explore the reasons why. You can teach about low sodium diets until the cows come home but if the patient is dependent on someone else for meals, you may be teaching the wrong person. We all know that low budget foods often mean high fat and sodium but there are ways around financial constraints. It may mean that instead of teaching the patient low sodium diets, you change the focus to low sodium and low budget diets and assist the patient in identifying inexpensive alternatives to canned soups and ramen noodles.
Teaching is most of what we do in home health. It is certainly the most important skill that we offer but it also puts us at risk when medications and diets are documented as verbatim off of a printed text that has not been tailored to the patient’s individual needs.
Next week, I plan to write about teaching guides. If anyone has anything good, bad or indifferent to say about them, please email me or leave a comment.
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I feel your pain! I often wonder ‘what were they thinking?’ when doing QA reviews. Whenver I talk with a nurse about a questionable chart, there is always more to the story. So much good care can go undocumented or underdocumented. Why do we as nurses often have such a hard time quantifying what we do in home care? I think there’s a fundamental shift in thinking when you transition from the hospital to home care.
While training a group can be effective, my favorite moment is talking with a nurse or therapist about a Start of Care they performed and the aha! when they finally understand to score OASIS on safety not performance.
Excellent post on teaching – it reminds me of what a nurse from Medicare Medical Review told me about a case where both the patient and caregiver had dementia. She asked who the nurse was teaching – based on the documented dementia for both, she might as well have been teaching the dog! Makes you wonder sometimes…..