Patient / family education standards

The JCAHO Patient and Family Education (PF) standards provide direction for health care agencies seeking accreditation. JCAHO standards do not require any specific structure, such as an education department, a patient education committee, or nurses or other health care professionals hired as patient educators. The most important aspect of JCAHO patient and education standards is that health care facilitates are able to demonstrate how they carry out an educational philosophy that views education as an interactive process, in which both patients and health care professionals are learners.

JCAHO surveyors look for evidence of three major processes involved in patient education:

The hospital’s internal focus on education
Direct education of the patient and family
Evaluation of how well the education program achieves its goals.

As an example of how these processes can be carried out, the JCAHO describes a situation involving a 4-year-old child admitted to a pediatric intensive care unit (PICU) in a coma. The PICU staff establish two goals for patient and family teaching: 1) to reduce fear of equipment used in care; and 2) to promote family involvement in the patient’s care. While the child is in a coma, the staff direct their teaching efforts toward the parents. The staff assess the parents‘ level of knowledge about equipment used in an intensive care setting, and as the staff use the equipment, they explain how the equipment works and why they are using it for the child’s care. The staff also provides formal education via booklets about coma and what might be expected. As the child regains alertness, staff members teach her how to use hand signals and a cartoon chart to indicate her needs. These activities demonstrate the hospital’s internal focus on education and direct education of the patient and family. Lastly, the PICU assesses the effectiveness of the educational program as part of the unit’s ongoing measurement, assessment, and improvement efforts.

Table 2 summarizes current JCAHO Patient Education Standards.

Table 2

JCAHO Patient and Family
Education (PF) Standards

PF1-The patient’s learning needs, abilities, preferences, and readiness to learn are assessed.

PF 1.1-The assessment considers cultural and religious practices, emotional barriers, desire and motivation to learn, physical and cognitive limitations, language barriers, and financial implications of care choice.
PF 1.2-When called for by the patient’s age and length of stay, the hospital assesses and provides for patients‘ academic education needs.
PF 1.3-Patients are educated about the safe and effective use of medication, according to law and their needs.
PF 1.4–Patients are educated about the safe and effective use of medical equipment.
PF 1.5-Patients are educated about potential food-drug interactions, and provided counseling on nutrition and modified diets.
PF 1.6 -Patients are educated about rehab techniques to helpthem adapt or function more independently in their environment.
PF 1.7-Patients are taught that pain management is a part of treatment. (This standard is not yet scored for compliance, but will be in the future.)
PF 1.8-Patients are informed about access to additional resources in the community.
PF 1.9-Patients are informed about when and how to obtain any further treatment they may need.
PF 1.10-The hospital makes clear to patients and families what their responsibilities are regarding the patient’s ongoing health care needs and gives them the knowledge and skills they need to carry out their responsibilities.
PF 1.11-With due regard for privacy, hospital teaches and helps patients maintain good standards for personal hygiene and grooming, including bathing, brushing teeth, caring for hair and nails, and using the toilet.

PF 2-Patient education is interactive.

PF 3-When the hospital gives discharge instructions to the patient or family, it also provides these instructions to the organization or individual responsible for the patient’s continuing care.

P F4-The hospital plans, supports, and coordinates activities and resources for patient and family education.

PF 4.1-The hospital identifies and provides the educational resources required to achieve its educational objectives.
PF 4.2-The patient and family educational process is collaborative and interdisciplinary, as appropriate to the plan of care.

Source: Joint Commission on Accreditation of Healthcare Organizations. (1997-2000). Comprehensive Accreditation Manual for Hospital: The Official Handbook. Oakbrook Terrace, Ill.: JCAHO

Accreditation standards published by JACHO during the 1990s made patient and family education outcomes a high priority and a focus area for surveys. Meeting this requirement means that there is increased emphasis on patient education activities both within hospitals and coordination between hospitals and other post-hospitalization care providers. The JCAHO promotes the concept of patient-centered care and views patient and family education as a vital part of health care, including the patient as member of the health care team. Patient education is also seen by the JCAHO as central to processes for quality management. It is important for nurses and other health care professionals to recognize that health care organizations are expected to show evidence of patient learning outcomes, to focus on discharge and continuity of care, and to coordinate patient teaching across disciplines. Importantly, we as nurses must direct our attention to evaluating not what content and procedures we have taught, but what the patient and family can do as a result of our teaching efforts.

Table 3 describes examples of acceptable performance for patient and family education.

Table 3

JCAHO Examples of Acceptable
Performance for Patient,
Family Education

Examples of patient and family educational materials
Hospitalwide policies and procedures defining responsibilities for patient or family
Progress notes· Flowcharts
Referral and consultation notes
Interviews with clinical staff

Source: See Table 2.

Table 4 outlines the purposes of patient education, as published in the 1997 JCAHO Standards

Table 4

Purposes of Patient Education

To increase patient’s and family’s understanding of the patient’s health status, health care options, and consequences of options selected
To encourage patient, family participation in decision making about health care options
To increase the patient’s and family’s potential to follow the therapeutic health care plan
To maximize patient and family care skills· To increase the patient’s and family’s ability to cope with the patient’s health status and prognosis and outcome
To enhance the patient’s and family’s role in continuing care
To promote a healthy patient lifestyle

Source: See Table 2.

The growing need for patient teaching