1. Section Editor(s): Carolyn, Viall Donohue MSN, RN, NE-BC

Article Content

It would seem that not a day goes by that we do not hear of either some new regulation or requirement in the delivery and documentation of patient care. The stipulations for demonstrating quality and patient safety that impact reimbursement in healthcare can seem overwhelming. As nurses strive to meet the patient care needs and the documentation of that care, they also have to balance the cost-effectiveness and productivity measures that are necessary to run any business. In reviewing these issues and any deficiencies that are noted, the common theme is "we need to educate the staff." This is easier said than done because this is not a simple task that only takes a one-step process to accomplish.


This month's issue is focused on the pediatric patient care population and their needs in the home care setting, although some of the articles definitely present concepts that spread across patient populations. Identifying and maintaining the competencies of staff caring for children is difficult for many home care providers. Because children represent a smaller population in the healthcare system, no pun intended, the number of staff with experience and competence in their care are also unavailable or underrepresented in the healthcare community. Children located in more rural settings may also pose a unique challenge for many home care providers because their needs may be more complex and challenging to the provider to be able to provide the necessary skill set in the community. Failure to provide the level of care can clearly jeopardize the patient's health and safety. In addition, the ability to comply with regulatory requirements on documentation, staff orientation, training, and competence are all at risk from reimbursement, safety, and accreditation perspectives. All of these issues are addressed in educational initiatives, which may not be successful in the improvement of compliance to the standards.


Healthcare providers in the acute care and outpatient settings are organizing their work around the increasing number of quality and performance standards from the payors and accrediting organizations. The meaningful use criteria for use of an electronic medical record are impacting hospitals and the providers in the outpatient settings. The criteria include many performance criteria and outcomes for patient populations with chronic diseases, such as diabetes.


The Centers for Medicare and Medicaid Services (CMS) have developed core measures for measuring quality patient care that organizations must meet to ensure appropriate reimbursement. In pediatrics, the core measure that impacts the continuity of care of asthma patients includes the patient education plan to ensure appropriate rehospitalization. The ongoing need to coordinate the care of the patients across the continuum is increasingly being integrated into the reimbursement mechanisms of government and private payors.


Staff education on new requirements in care of patients and the measurement of their care is necessary. We frequently have to respond quickly to these demands and put together bullet points, learning modules, and other stopgap measures to get information to staff. The best approach to these educational needs is to have an advance plan as soon as the required criteria is known or defined. Leadership is needed to support staff without it seeming punitive. In our efforts to get information to them and expecting their compliance, it may come across in a punitive or negative manner. Clear expectations and facilitating learning using adult learning principles will promote learning. Using a creative approach to providing education and easily accessible references and resources will also help staff to assimilate this information into their practices. Putting together a distinct plan on how staff are educated on important initiatives and then measuring the effectiveness of that teaching within a reasonable time frame can assist in measurement. We need to share these approaches to staff education to help us all be successful in meeting the documentation criteria, the tools, and strategies that we employ to deliver care.


So the next time someone says to you, "We need to educate the staff," solicit their ideas on what is needed and what would be most effective. Find out how others are handling the issue because we are all in the same boat-and maybe someone can throw a life preserver your way.