Teaching Tool for Hepatic Encephalopathy

Discussion

The goal of producing a PEM that is both readable and suitable was

achieved via a specific process that produced a measurable result.

Based on high rate of 30-day hospital readmissions for heart failure

and other chronic illnesses where self-care is a crucial component,

communication-related roadblocks to patient adherence to medical

advice for these conditions must be addressed.

30-Day hospital readmission rates

Use new HE patient education tool for outpatient interactions

and discharge teaching after hospital stays and E.D. visits

Commit to assuring that all Mayo Clinic PEMs are both

readable and suitable for their target audiences

Test existing Mayo Clinic PEMs and amend or replace as

needed

Recommendations

Bajaj, J., Sanyal, A., Bell, D., Gilles, H., & Heuman, M.

(2010). Predictors of the recurrence of hepatic encephalopathy

in lactulose-treated patients. Alimentary Pharmacology &

Therapeutics, 31, 1012-1017.

http://dx.doi.org/10.1111/j.1365-2036.2010.04257.x

Doak, C., Doak, L., & Root, J. (1996). Teaching patients with

low literacy skills (2nd ed.). Philadelphia, PA: J.B. Lippincott.

Free text readability consensus calculator. (n.d.). Retrieved

April 10, 2014, from

http://www.readabilityformulas.com/free-readability-formula-

tests.php

Jacobson, K., Cucchi, P., & Morton, F. (n.d.). Clear and

effective patient communication (K. McMorris, Ed.).

Retrieved from

http://lvnj.org/sites/default/files/images/Emory_Communicati

onsManual.pdf

Neyhart, C. (2008). Education of patients pre and post-

transplant: Improving outcomes by overcoming the barriers.

Nephrology Nursing Journal, 35. Pp. 409-410.

Ryan, L., Logsdon, M., McGill, S., Stikes, R., Senior, B.,

Helinger, B., Small, B., Winders Davis, D. (2014). Evaluation

of printed health education materials for use by low-education

families. Journal of Nursing Scholarship, 46(4), 1-11.

http://dx.doi.org/10.1111/jnu.12076

Stossel, L., Segar, N., Gliatto, P., Fallar, R., & Karani, R.

(2011). Readability of patient education materials available at

the point of care. Journal of General Internal Medicine, 27(9),

1165-1170. http://dx.doi.org/10.1007/s11606-012-2046-0

References

Research shows that up to half of the hospital admissions for

patients with hepatic encephalopathy (HE) were due to lack of

adherence to their medical advice

The average US resident reads at an 8th grade level, and the

average Medicare beneficiary reads at a 5th grade level

According to Joint Commission standards (PC.6.30), patients

are to receive education and training “specific to the patient’s

abilities”

Patient education materials (PEMs) are best received when

they are:

o Readable— easy to read and holds the reader's inter

o Suitable—fitting and useful for the audience and the

subject matter

Research consistently demonstrates that there is a poor

correlation between readability of PEMs and the intended

population

Healthcare providers and systems continue to develop and use

PEMs that are not appropriate for many of the patients and

families that they serve

At present there is no Mayo Clinic enterprise-wide PEM

specifically designed for HE patients & their caregivers

There are very few PEMs available anywhere for HE patients

& their caregivers

Those that are available are not readable and/or suitable for

the intended recipients

Background

Review research on HE

Identify content priorities for new teaching tool

Review research on designing PEMs that are both

readable and suitable for the target audience

Design tool that is both readable and suitable for the

target audience

Design survey to obtain feedback from MCF

professional staff involved with HE patients

Compile results and adjust tool as needed

Test new tool against existing HE-related PEMs for

readability and suitability

Goals

Implementation steps

• Review the literature

• Contact potential end users for input & support

• Prepare initial draft of teaching tool with focus on

suitability

• Obtain feedback from potential end users

• Edit document for suitability

• Test and edit document for readability

• Prepare PowerPoint as facsimile of brochure

Collaborative efforts

• Clinical Nurse Educator as mentor

• Pre-liver transplant nurse group--brief roundtable

discussion

• Reviewer input from above, plus MCF Hospital

Transplant Unit Education Committee, and a liver

transplant ARNP

Evaluation methods

• survey created and sent to reviewers

• teaching tool, existing HE-related PEMs tested for

readability and suitability

Implementation

Results

© 2014 Mayo Foundation for Medical Education and Research

David S. Cox, RN, BSN

Division of Nursing

Mayo Clinic, Jacksonville, FL

Testing of 3 HE-related PEMs for

Readability and Suitability

American Liver Foundation brochure scored well on readability

(SMOG formula: grade 6.5) but only fair on suitability (55%

SAM score)

Medline Plus info sheet scored poorly on both readability

(SMOG formula: grade 14.5) and suitability (5.5% SAM score)

Newly-created HE teaching tool scored well on both readability

(SMOG formula: grade 6.1) and suitability (100% SAM score).

Teaching Tool for Hepatic Encephalopathy

Out of the hospital,

but not out of the woods