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Health Literacy Projects 2012-2013 Year 3

Wake County Human Services is an integrated public health and social services agency serving those live, work, play and learn in Wake County NC. Health literacy is important to the organization as it continues to serve a growing and diverse population, delivers essential public health services and implements legislative mandates that impact public health practice as well as those of the Affordable Care Act.

An assessment of select aspects of health literacy is being conducted in the agency’s Public Health Division to identify client’s perceptions of their care in the public health clinics as well as an assessment of written program materials using the Suitability Assessment of Materials.

The results of these assessments will provide the organization with some information about the organizations health literacy strengths and areas for development. The desired outcome is a coordinated effort that moves the agency further toward being a “health literate” organization that empowers its clients not only to good health but success and self-sufficiency.

Association for Home and Hospice Care (AHHC)

To revise the Association for Home & Hospice Care of North Carolina’s (AHHC) two brochures, “A Professional’s Guide to Home Care & Hospice Referrals” and “A Consumer’s Guide to Home Care & Hospice Services by adding graphics and ensuring the reading level is below high school.

Health Literacy, Alzheimer ’s disease (AD) and Dementia education

In this project I will teach health literacy to Stress Free Home Care caregivers that have direct contact with clients affected by AD and Dementia. Applying Health Literacy principles across the organization will also improve communication with our client’s families about the disease process.

Most of our home care clientele has been diagnosed with some form of dementia. Families are informed of these diagnoses, the client is prescribed a medication ( Aricept, Namenda, Exelon patch) and then just sent home. Families are not informed at the doctor’s offices what the next steps are. That is when Stress Free is contacted when families are in distress on how to take care of a love one that has been diagnosed. Families are not educated on how to take care of the individual and what to expect with a loved one battling Alzheimer’s disease.

Specific topics will include:

  • How to react to behavior outburst
  • The disease process (stages)
  • Medications
  • What to say, what not to say!
  • How to handle situations (bathing, dressing, feeding)
  • The terminal nature of the illness
  • Just go with it…..
  • How to connect with a client that has been diagnosed.

Ultimately this project could evolve into a community synopsis workshop about Alzheimer’s Dementia Education to improve the public’s awareness of the disease.

School Nursing Project

As a school nurse I have seen the positive outcomes that result from using specific communication interventions in the school setting. Examples of these outcomes include students becoming health literate as evidenced by:

  • learning to access health care on their own,
  • framing health questions in the Ask-Me-Three format, and
  • successfully demonstrating understanding during Teach Back encounters.

Additionally, these EBP practices are helpful to non-English speaking parents and grandparents caring for grandchildren. In such,

My project outlines a plan to increase system wide buy-in for the need to standardize communication practices and includes: Universal Precautions, Ask-Me -Three and Teach Tack approach as the general standard for communication intervention in the health room setting.

UNC Transplant Clinic In the transplant clinic instructions are critically important to our patients. During a social worker evaluation, I often repeat information that patients have heard in orientation. Although the information was introduced initially in orientation, many patients appear as if it is their first discussion with a staff member. Clarification is vital when communicating with patients. It was necessary to clarify my instructions using teach-back. Most patients required clarification 3 to 4 times. Initially, the method felt condescending but most of the patients appreciated the method.

All patients receive handouts to read and share with their caregivers.

Teaching Health Literacy to SR-AHEC Nursing Staff

The current project is to expand health literacy training to the SR-AHEC nursing staff in the Family Medicine Clinic to improve communication, interaction, and comprehension between them and their patients.

Charlotte AHEC

Incorporate health lit principles throughout nursing continuing education workshops offered at Chalotte AHEC by education speakers and faculty and encouraging the inclusion of these principles into ongoing education content. Goal 50% of the nursing courses should have health lit in it. First step, surveys of instructors and participants to determine baseline awareness and readiness to change.

Emergency Room

Poor health literacy more visits to er higher readmission rates, higher mortality, affordable care act and value based purchasing considers the same things. Patient education including medication side effects are part of the score in HCAP. Project is to get staff to recognize those that have poor health literacy, and do something about it. Teach back and definition of health literacy. And the impact on patients. HCAP scores will be part of evaluation as will patient surveys. This fall a retrospective study to look at mortality rates and readmission rates. Also working on signage.

English as a Second Language in School Health

Nnursing staff rely heavily on our ESL staff to translate materials, talk in person or over the phone with parents to relay important medical information and gather information pertinent to the health needs of our students. We want to help our ESL staff understand the concept of health literacy, especially when there is a language barrier and to utilize the teach back method when providing health information to our families. We will standardize some of the information the nurses ask ESL staff to give to parents so they are simply translating information.

Randolph Hospital

Our health literacy project includes a team approach focusing on patient education in the acute care and home health settings by a variety of clinicians (respiratory care, physical therapy, speech pathology, and occupational therapy), but predominantly nurses. The cornerstone for the project is the development and delivery of a 2-hour didactic and interactive program developed for AACN credit hour approval.

After the initial training observations of the performance of teach-back with actual patients was completed and turned in to the Patient Education Council for review. Follow-up includes: addition of program to RN orientation, poster-board presentation/contest during Nurse’s week, poster-board rotation through units, and a video to be produced in fall for presentation to senior leadership and nursing shared governance councils regarding teach-back use.

Health Literacy Project 2011-2012

A teach back demonstrations was incorporated into video content used in online education for Physical Therapists. Course was deployed March 7, 2013 and has enrolled 600 therapists to date. Health literacy concepts are also included in presentations on falls prevention given in the community.

UNC School of Nursing

The purpose of this pilot study was to develop and test the implementation of diabetes group visits into an established community-based clinic serving low-income, uninsured, ethnic minority men and women. To augment the education classes, literacy tested handouts were developed. One handout that was tested, revised and tested again included information on “How to Understand Cholesterol” as one goal of diabetes self-management. Using text at a third grade level and creating a colored handout that was visually informative was very important. We used red for high numbers, yellow for slightly high numbers, and green for normal numbers. This was repeated for total cholesterol, low-density lipoprotein (lousy cholesterol), high-density lipoprotein (happy cholesterol) and triglycerides. The feedback from patients, physicians, physician assistants, nurse practitioners and nurses were overwhelmingly positive. We are currently analyzing the data.

UNC School of Pharmacy

The purpose of this study was to develop a medication management form for older adults that identifies potentially inappropriate medications that they are using. The form is intended to improve patient-provider communication in the primary care setting. The form lists all the medications the patient is taking and highlights potentially inappropriate medications based on the Beers Criteria. The form also provides information concerning the patient’s total drug burden, calculated using the Drug Burden Index. The total drug burden is important because greater scores on this index are associated with an increased risk of falls in older adults. Four focus groups were conducted to obtain feedback regarding the content and layout of the form, using mock patient data.

Moses Cohen Hospital

Project summary: Improving patient safety at discharge; a health literacy approach.

Multiple studies have demonstrated that parents have difficulty safely administering liquid over the counter medications to children. As children are discharged from the hospital, we have an opportunity to discuss appropriate over the counter medication doses (particularly for acetaminophen and ibuprofen) and ensure patient understanding. A chart review completed in August of 2012 demonstrated that only 38% of children were discharged with an easily measurable dose and with appropriate written instructions for use. We are currently enrolling patients in a study examining the relationship of health literacy with understanding discharge instructions and demonstrating an appropriate dose of acetaminophen at discharge. Following baseline data collection, a pictographic tool will be introduced as part of the standard discharge instruction and we will measure the changes in parents’ ability to correctly measure liquid medication. Anticipated study completion is September 2013. In addition, I’m now teaching an annual seminar on health literacy in primary pediatrics.

Health Literacy Projects 2010-2011 Year 1

Communication Forms UNC Family Medicine

Developed a communication form for clinical care providers working in a home visit program for UNC Family Medicine. The project included three examples of the communication form- An Inspiration Form, Modified From, and Current Form.

Reducing Falls Risk in the Elderly through Primary Care Intervention

The project plan included combining medical intervention in the primary care setting through assessment and referral with customized patient education related to their specific risk factors for falling. The expected outcome included adopting falls prevention strategies to reduce falls risk factors to the individual. The project included redesigning the customized patient education content to incorporate health literacy components.

Reduction of No-show Rates

High no-show rates indicated a need for systems change need related to low-health literacy. No-shows were compounded of course by the current economic down turn. Her project included making over 50 phone calls to find out why patients were not showing up and included summaries of the responses she received. When patients understand the importance of follow up care no show rates will improve. The success of applying health literacy concepts to this systems problem would be improved no-show rates.

Medi 286 Geriatrics Elective

The purpose of this project was to incorporate an hour-long lecture on health literacy into the Medi 286 curriculum, which is an elective course that 1st and 2nd year medical students can take. The expected outcomes of the project are to increase awareness and understanding of health literacy and improve communication between medical students and their patients. The project focused on the need for health literacy in medical student curriculum.

A Continuing Education Standard: Health Literacy at Wake AHEC-

The purpose for this project was to incorporate health literacy throughout continuing education programs at Wake AHEC to educate AHEC Course Directors, Speakers, and Faculty on the benefits of using health literacy principles in their presentations to health care providers.

Health Literacy for the Nurse Aide

The purpose of the project was to introduce Nurse Aides, who have the most contact with the patients, to health literacy and to develop a “crash course” for NAs within an 8-county region. The expected outcomes included better communication between the patient and caregiver and between NAs and nurses, decreased medical errors, and increased job satisfaction.

The Patient’s Perspective: A UNCH Clinic Visit

The purpose of the project was to develop awareness of health literacy issues in clinic business support staff. It was easy for staff to get caught in the completion of tasks vs. the enhancement of the clinic visit and her project aimed to change the clinic culture and clinic operations.