Patient Booklet Research Articles

Improving the nursing quality of non-pharmacological interventions for elderly constipation patients in the hospital: a best practice implementation project.

Non-pharmacological interventions are the preferred treatment for constipation; however, health care professionals in clinical settings tend to focus more on pharmacological treatments. This best practice implementation project aimed to integrate the best evidence on non-pharmacological interventions for elderly patients with constipation in clinical care practice and to promote the use of non-pharmacological interventions for such patients in the hospital setting. This project is based on the JBI Evidence Implementation Framework, which follows three stages. The first stage involved a baseline audit using two audit criteria derived from the best available evidence. This audit evaluated current clinical scenarios, guided by the i-PARIHS framework. The second stage involved analyzing the results of the baseline audit, identifying barriers to compliance, and developing and implementing strategies to overcome those barriers. Strategies included nursing education, development of constipation information booklets for nurses and patients, establishment of a nursing workflow, and modification of the department environment. In the third stage, a follow-up audit was conducted to evaluate the implementation, using the same data collection indicators and methods as in the baseline audit. Sixty patients participated in the project. Compliance for Criterion 1 (patient education) increased from 0% to 60% (P < 0.001), while compliance for Criterion 2 (monitoring patients' bowel health) increased from 0% to 100% (p < 0.001). The results indicate that this evidence-based implementation project facilitated the application of non-pharmacological interventions for elderly patients with constipation. Nurses played a significant role in developing regular defecation habits in patients and monitoring their defecation. http://links.lww.com/IJEBH/A284.

Poor Adherence and Limited Treatment Support are Risk Factors for Second Line Treatment Failure among HIV Children Under 15 Years, 2022: A Case Control Study

Title: Poor adherence and limited treatment support are risk factors associated with second line treatment failure among children under 15 years at Victoria Chitepo provincial hospital, 2022: a case control study. Background: New HIV resistance mutations have been emerging and frequently changing. HIV positive people switching to third line have been increasing in Manicaland Province. Third line anti-retroviral therapy (ART) combinations are not always available. We sort to determine the factors associated with second line treatment failure among HIV positive patients. Methods: We conducted a 1:1 unmatched case-control study among 107 case-control pairs. A case was any HIV positive individual with treatment failure confirmed by 2 viral load of ≥1000 copies/ml while a control was any HIV positive individual with a viral load of &lt;1000/ml copies; on second line therapy at Victoria Chitepo Provincial Hospital (VCPH), in 2022. Systematic random sampling was used to select cases and controls from the line-list. Administered questionnaires were used to ascertain risk factors to second line treatment failure. Patient booklets were reviewed for demographic and clinical characteristics. Frequencies, means, medians and odds ratios were generated. Multivariate analysis and stratified analysis was performed to identify independent risk factors. Permission to proceed was sought from relevant authorities and all ethical considerations were observed. Results: Defaulting treatment (aOR=2.42, 95% CI: 1.03-5.93), missing a viral load test (aOR=5.52, 95% CI: 2.30-13.26) and being under 15 years of age (aOR=6.18, 95% CI: 1.46-26.20) were independent risk factors associated with second line treatment failure. Having a treatment support was an independent protective factor (aOR=0.30, 95% CI: 0.10-0.86). Conclusion: Poor adherence is the key drive to second line treatment failure. Good adherence is critical in children under 15 years. Treatment support promotes viral load suppression.

Safer Patients Empowered to Engage and Communicate about Health (SPEECH) in primary care: a feasibility study and process evaluation of an intervention for older people with multiple long-term conditions (multimorbidity)

BackgroundOlder people with multiple long-term conditions (multimorbidity) (MLTC-M) experience difficulties accessing and interacting with health and care services. Breakdowns in communication between patients and staff can threaten patient safety. To improve communication and reduce risks to patient safety in primary care, we developed an intervention: Safer Patients Empowered to Engage and Communicate about Health (SPEECH). SPEECH comprises a booklet for patients and an associated guide for staff. The booklet is designed to provide patients with information about staff and services, skills to prepare and explain, and confidence to speak up and ask.MethodsA single-arm mixed methods feasibility study with embedded process evaluation. General practices in the North West of England were recruited. Participating practices invited patients aged 65+ with MLTC-M who had an appointment scheduled during the study period. Patients were asked to complete questionnaires at baseline and follow-up (four to eight weeks after being sent the patient booklet), including the Consultation and Relational Empathy measure, Empowerment Scale, Multimorbidity Treatment Burden Questionnaire, and Primary Care Patient Measure of Safety. Staff completed questionnaires at the end of the study period. A sub-sample of patients and staff were interviewed about the study processes and intervention. Patients and the public were involved in all aspects of the study, from generation of the initial idea to interpretation of findings.ResultsOur target of four general practices were recruited within 50 days of the study information being sent out. A fifth practice was recruited later to boost patient recruitment. We received expressions of interest from 55 patients (approx. 12% of those invited). Our target of 40 patient participants completed baseline questionnaires and were sent the SPEECH booklet. Of these, 38 (95%) completed follow-up. Patients found the intervention and study processes acceptable, and staff found the intervention acceptable and feasible to deliver.ConclusionsOur findings suggest the intervention is acceptable, and it would be feasible to deliver a trial to assess effectiveness. Prior to further evaluation, study processes and the intervention will be updated to incorporate suggestions from participants.Trial registrationThe study was registered on the ISRCTN registry (ISRCTN13196605: https://doi.org/10.1186/ISRCTN13196605).

Validation of a speech therapy guidelines booklet for dysphagic cancer patients

RESUMO Objetivo: validar conteúdo e aparência de uma cartilha de orientações fonoaudiológicas sobre disfagia para pacientes adultos oncológicos disfágicos. Métodos: trata-se de um estudo metodológico de abordagem mista, desenvolvido para a validação de uma cartilha de orientações. A validação da cartilha, quanto ao conteúdo, foi feita por cinco juízes especialistas e, quanto à aparência, por onze juízes não especialistas. Para a validação utilizou-se o Índice de Validade de Conteúdo para cada item, bem como para todos os itens juntos. Resultados: os juízes especialistas atribuíram valor acima de 80% e de 92,20% para a escala geral de análise. E os juízes não especialistas atribuíram valores acima de 90,9% e de 98,0%, também para a escala geral, sendo considerados excelentes. Conclusão: a cartilha de orientações proposta foi validada segundo conteúdo e aparência. Acredita-se que o referido material possa contribuir para a compreensão do processo saúde-doença, promover o autocuidado e despertar o interesse de outros profissionais da área da saúde para o desenvolvimento de tecnologias educativas em busca de melhores condições de saúde para a população destinada.

Evaluation of Physician Knowledge of Safety and Safe Use Information for Intravitreal Aflibercept Injection in Europe: A Second Survey of Physicians Following Dissemination of Updated Risk-Minimization Materials.

Materials have been distributed in the European Union to inform physicians on the safe use of intravitreal aflibercept (IVT-AFL) as part of the risk-minimization plan for IVT-AFL. We aimed to measure physician knowledge and understanding of key safety information for IVT-AFL. The current study was a follow-up cross-sectional survey ('wave 2') to an earlier survey ('wave 1') examining the effectiveness of the IVT-AFL educational materials by assessing physician knowledge of the key safety information. Based on wave 1 results, the educational materials were revised to focus more on items of key concern (e.g.,use in women of childbearing potential, procedural information); physicians in France, Germany, Italy, Spain, and the UK completed a questionnaire to evaluate their knowledge of key safety information in the revised educational materials. Among 454 physician respondents (of 4715 invited; response rate 9.6%), most reported having received the IVT-AFL Summary of Product Characteristics (SmPC; 89%) and Prescriber Guide (82%). More than half reported receiving the Injection Procedure Video (54%) and Patient Booklet (65%). The highest percentage of correct answers was observed for questions concerning procedural steps, the most important risks, and safe use as emphasized by the educational materials and the SmPC. Physician knowledge and understanding of safe use of IVT-AFL, including for questions that prompted revisions to the educational materials, suggests the need to reconsider methods for developing educational materials to follow best practices (e.g., focusing on only key messages and pretesting with end users).

PP98 Phelan-McDermid syndrome: Methodology For Creating A Patient Adapted Version Of A Clinical Practice Guideline

IntroductionPhelan-McDermid syndrome (PMS) is a chromosomal disorder caused by the loss of the end of chromosome 22, that is manifested as a neurodevelopmental disorder. Providing an adapted version of a guideline was seen as essential, as currently, there are no such booklets based on an international guideline for PMS patients, families and caregivers. The European Reference Networks (ERN) Guidelines programme results from a call for proposals funded (DG SANTE/2018/B3/030) for the development of Clinical Practice Guidelines (CPG) and Clinical Decision Tools in the area of rare diseases. Based on this European consortium, the purpose of this study is to describe how two Spanish HTA agencies, OSTEBA-BIOEF (Basque Office for Health Technology Assessment) and AETSA (Andalusian Health Quality Assessment Department) methodologically support the ERN-ITHACA (Rare malformation syndromes and rare intellectual and neurodevelopmental disorders) in the development of a comprehensive patient booklet based on a CPG to be used as an adjunct in the management of PMS syndrome that will be published in 2023.MethodsA preliminary booklet was created by HTA agencies using the new European guideline for PMS and a Dutch guideline. The booklet structure is an adaptation based on a European Commission template with the guidance of the methodological Handbook#11.ResultsThrough a comprehensive adaptation, following the PMS guideline and the Handbook #11, a booklet is developed for the PMS patients. Composed by 28 pages in DIN A5 format were introduction, diagnosis, treatment, pregnancy, do’s, supportive care, social networks (including a QR code) and a glossary are included. The selection of a symbol, colors at a chromatic level, a typography and graphical elements as illustrations were created as a corporate identity. Clinical experts and patient representatives that have participated in the creation of the guideline will assess and validate the booklet.ConclusionsCollaboration between agencies, clinicians and patients is critical to obtain evidence-based products adapted to the needs of patients and people involved in their care.

Development and description of a theory-driven, evidence-based, complex intervention to improve adherence to treatment for tuberculosis in the UK: the IMPACT study

ABSTRACT Background Tuberculosis (TB) has a significant treatment burden for patients, requiring at least six months of anti-TB treatment (ATT) with multiple medicines. Ensuring good adherence to ATT is central to global TB strategies, including those in high-income, low-TB incidence (HILI) settings. For adherence interventions to be successful and deliverable, they need to address the personal and environmental factors influencing patient and provider behaviour. Purpose This paper describes the application of theory and research evidence to inform the design process of the IMPACT manualised intervention to support ATT adherence for adults with TB disease in the United Kingdom (UK). It also provides a full description of the resulting intervention. Methods We synthesised findings from our formative research (qualitative and quantitative scoping reviews and patient and carer interviews) and supplemented these with clinic observations, a literature review, and healthcare provider interviews. Findings were mapped to the guiding theoretical framework (Perceptions and Practicalities Approach) which was operationalised to design the intervention components and content. An Intervention Development Group (IDG) of relevant stakeholders were consulted to adapt the intervention to local clinical settings. Results The pragmatic, deliverable components and content for the IMPACT intervention included: (1) an enhanced, structured, risk assessment to systematically identify risk factors for non-adherence plus locally-adapted guidance to mitigate these; and (2) patient educational materials (an animated video and interactive patient booklet) about TB and its treatment, to communicate the need for treatment and address common concerns. Conclusions Using a theory– and evidence– based approach incorporating stakeholder input, we have developed a multi-component, pragmatic, manualised intervention, which addresses patients’ personal barriers to adherence within local service resources to improve adherence to ATT within UK TB services.

Development of the ‘ACT now & check-it-out’ intervention to support patient-initiated follow up for Head and Neck cancer patients

ObjectiveCurrent Head and Neck cancer (HNC) follow-up models are considered sub-optimal at detecting recurrences. We describe the development of a patient-initiated follow up (PIFU) trial intervention support package, to support HNC patients to engage in PIFU self-care behaviors. MethodsAn intervention mapping approach, informed by evidence synthesis, theory and stakeholder consultation, guided intervention development. Data sources included a patient survey (n = 144), patient interviews (n = 30), 7 workshops with patients (n = 25) and caregivers (n = 3) and 5 workshops with health professionals (n = 21). ResultsThe intervention (‘ACT now & check-it-out’) comprises an education and support session with a health professional and an app and/or a booklet for patients. The main targets for change in patient self-care behaviors were: assessing what is normal for them; regularly checking for symptom changes; prompt help-seeking for persistent/new symptoms; self-management of fear of recurrence; engaging with the intervention over time. ConclusionsWe have developed an evidence, person and theory-based intervention to support PIFU self-care behaviors in HNC patients. Practice implicationsA trial is underway to assess the effectiveness and cost-effectiveness of the intervention. If successful, this intervention could be adapted for patients with other cancers or diseases, which is important given the recent shift towards PIFU pathways.

An education resource for human papillomavirus oropharyngeal cancer patients: think-aloud interviews

PurposeThe human papillomavirus (HPV) is well recognised as a factor in developing oropharyngeal cancer (OPC). A booklet for HPV-OPC patients aimed to deliver evidence-based messages in everyday language, in a way to minimise negative psychological impacts on patients. Our study explored the suitability of the booklet for use.MethodsParticipants were recruited through social media and interviewed via Zoom. Participants were shown the booklet and a think-aloud method elicited real-time reactions to the content. Responses were analysed for each section and coded as either for or against for content, with other responses thematically analysed using NVivo.ResultsThe sample comprised 24 participants: patients (n = 19) who completed treatment for HPV-OPC and partners of survivors of HPV-OPC (n = 5). All participants found the booklet useful, and most wished the resource had been available previously. Some indicated the information was new to them. The majority agreed the booklet would be best delivered by their specialist at point of diagnosis and would be a useful resource for friends and family. Most participants gave feedback on improvements to the booklet in terms of comprehension and design. Overall, participants found the content easy to understand. Most participants found that it helped to reduce shame and stigma associated with HPV as a sexually transmitted infection.ConclusionAn evidence-based booklet for HPV-OPC patients and their partners is acceptable. Implementation may be feasible in routine clinical practice, specifically at time of diagnosis. Adapting the content will help optimise the efficacy of the booklet in facilitating communication between all stakeholders.

Construction and validation of an educational booklet for patients in the postoperative period of cardiac surgery: a methodological study.

to construct and validate an educational booklet for self-care of patients in the postoperative period of cardiac surgery. methodological study, including bibliographic survey, construction of the booklet and validation with judges and the target audience. For validation with judges, the Health Educational Content Validation Instrument was used, and with the target audience, an instrument was used with questions related to organization, writing style, appearance and motivation. To analyze the judges' answers, the content validation index was used. the booklet was prepared with 14 topics. The content validation index among the eight judges was 1 and the concordance index among the ten patients was above 80%. The final version of the material was made available in printed format. the educational booklet was developed and validated by judges and the target audience, serving as an educational support tool for self-care of patients in the postoperative period of cardiac surgery.

Development of a Communication Instrument to Address Sexuality in COPD: COSY.

Sexuality, an important aspect of quality of life, is often overlooked in COPD. Our aim was to develop an instrument that facilitates communication and counseling on sexuality in persons living with chronic obstructive pulmonary disease (COPD). We searched for publications on sexuality in COPD focusing on communication about sexuality and tools to support such communication. We also performed a survey asking 25 patients and 36 health care professionals (HCPs) about their attitudes, experiences, barriers, and facilitators when talking about sexuality. We set up a project expert team of HCPs and 3 persons with COPD. In a half-day workshop, the team discussed the results of the literature review and the survey as a basis for the contents, the "when and how" to address communication about sexuality, and the design of the communication instrument. The survey showed that although patients and HCPs wanted to talk about sexuality, it rarely happened due to communication barriers, lack of self-confidence, and misconceptions on both sides. In review rounds of the expert team, feedback on the drafts was collected and integrated into the final version of the communication instrument: COmmunication about SexualitY in COPD (COSY). The COSY instrument resulted in 4 tools: a communication leaflet, an application guide, a pictorial representation of the spectrum of intimacy for HCPs, and a comprehensible, picturized information booklet for patients. Addressing sexuality in persons living with COPD should not be neglected. The COSY instrument could help to start and shape communication and consultations about sexuality and a more holistic consideration of quality of life.

Construction and validation of an educational booklet for patients in the postoperative period of cardiac surgery: a methodological study

RESUMO Objetivo: construir e validar uma cartilha educativa para o autocuidado de pacientes no pós-operatório de cirurgia cardíaca. Métodos: estudo metodológico, incluindo levantamento bibliográfico, construção da cartilha e validação com juízes e com o público-alvo. Para validação com juízes, utilizou-se o Instrumento de Validação de Conteúdo Educativo em saúde e com o público-alvo utilizou-se um instrumento com questões relacionadas à organização, estilo da escrita, aparência e motivação. Para análise das respostas dos juízes foi utilizado o índice de validação de conteúdo. Resultados: a cartilha foi elaborada com 14 tópicos. O índice de validação de conteúdo entre os oito juízes foi de 1 e o índice de concordância entre os dez pacientes acima de 80%. A versão final do material foi disponibilizada no formato impresso. Conclusão: a cartilha educativa foi desenvolvida e validada por juízes e público-alvo, servindo como uma ferramenta educativa de apoio para o autocuidado de pacientes no pós-operatório de cirurgia cardíaca.

Use of a Patient Booklet to Enhance Adherence to Prophylactic Exercises by Patients Undergoing Chemoradiation Therapy for Head and Neck Cancer

Use of a Patient Booklet to Enhance Adherence to Prophylactic Exercises by Patients Undergoing Chemoradiation Therapy for Head and Neck Cancer

Impacts of Educational Interventions with Support of Mobile App versus Booklet for Patients with Hypertension and Metabolic Syndrome: A Secondary Data Analysis.

Background: Hypertension comorbid with metabolic syndrome could increase the development of adverse cardiovascular events. Educational interventions were effective to improve outcomes in patients. Methods: This was a secondary data analysis of participants with hypertension. The original randomized controlled trial aimed to examine the effect of app and booklet versus control among individuals diagnosed with metabolic syndrome living in the community. A 30-min health education was provided to each participant. In addition to the education, the app group received a mobile app while the booklet group received a booklet. Data were collected at baseline, week 4, week 12, and week 24. Intention-to-treat principle was followed, and generalized estimating equations was employed for data analysis. Results: A total of 118 participants with hypertension and metabolic syndrome were extracted from the three-arm trial data. The sample size was 36, 42, and 40 in the app group, booklet group, and control group, respectively. Compared to the control group, the app group showed a significant reduction on body weight and waist circumference at week 24, while the total exercise and self-efficacy for exercise were increased at week 12 and week 24 but no significant findings were observed in the booklet group. Conclusions: The educational intervention supported with app was superior to the booklet support on the outcomes of body weight, waist circumference, total exercise, and self-efficacy for exercise among patients with hypertension and metabolic syndrome in the community.

Construction of an educational booklet for people with asthma

Aim: To report the development of an educational booklet for adult patients with asthma. Methods: Experience report on the development of an educational booklet, from March to July 2019, considering four main steps: i) survey of topics necessary for an adequate management of asthma, ii) literature review, iii) elaboration of the educational booklet in dialogue format and iv) review and printing of the material. Results: The educational booklet entitled “Tenho asma, e agora? (I have asthma, what now?)” contains 32 pages and 11 topics that address the concept of the disease, triggering factors, use of medications and inhaler devices, symptoms and action plan in case of an exacerbation. The development of this educational technology required the team to review the literature based on scientific evidence, interdisciplinary articulation, creativity and active listening until reaching the final product. Conclusion: The construction of educational booklets should value clinical practice, users' doubts and identifiable language among users. Educational booklets contribute to better health outcomes.

Sexual and Emotional Health after Allogeneic Hematopoietic Cell Transplantation: A Comprehensive Review and Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC).

A person’s sexual and emotional life is greatly impacted after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This topic is not addressed very much by patients and caregivers. Physical, endocrine and genital chronic graft versus host disease (cGVHD)-related disorders are multiple and intertwined with psychological disorders. The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) has issued recommendations for a better gynecological monitoring of female recipients after allo-HCT. A patient booklet was also offered to patients in the form of questions and answers to facilitate discussions between patients and caregivers and to improve the management of sexual and emotional life after transplant.

Information needs assessment and development of information booklet for patients with cancer receiving chemotherapy: A cross-sectional analysis

Background: Patients with cancer require a wide variety of information during their illness. Identifying their need for information and providing education are vital responsibilities of nurses and physicians.Objectives: We aimed to assess the information needs of patients with cancer receiving chemotherapy. We then aimed to develop and validate an information booklet, based on the needs assessment.Materials and Methods: This study was conducted among patients with cancer visiting the day care center for chemotherapy at the Shirdi Saibaba Cancer Hospital and Research Center, Kasturba Medical College, a tertiary cancer center in Manipal, India. The information needs of the patients were assessed through a questionnaire. The chemotherapy information module developed was then given to five subject experts for validation.Results: Between Dec 2018 and Feb 2019, we enrolled 245 patients in the study. Of these, 108 (44.1%) expressed a desperate need for information, 136 (55.5%) had a preferred need for information, and 1 (0.4%) did not require any information. The information considered as the absolute need to know by over half (52.7%) the participants was regarding the disease (severity, recurrence, malignancy, and effect on the body), followed by the side-effects of chemotherapy and their management (49%) and psychological support (45.3%).Conclusion: Patients with cancer have the desire to be well informed about their disease, treatment, and side-effects. Education sessions can be planned to improve the chemotherapy-related knowledge of patients with cancer. Regular appraisal of the need for information among patients with cancer is critical, considering the changing needs of the health-care seekers. (Clinical Trials Registry-India number CTRI/2018/11/016378)

The effect of nutrition counseling on nutritional status for breast cancer patients in dr. Sardjito Hospital, Indonesia

Background: Nutrition counseling in breast cancer (BC) patients show long-term adherence to a dietary pattern and effects on nutritional status and quality of life (QOL).Objective : We evaluated the effects of nutrition counseling for nutrients intake dan nutritional status improvement among breast cancer patients.Material and Methods: This research was conducted in a Pre-experimental design; one group pretest-postest design was conducted on 45 BC patients who underwent radiotherapy for five weeks in the Radiotherapy Unit, dr. Sardjito Hospital, Indonesia. Nutrition counseling was demonstrated by trained fieldworkers to 45 participants using a nutrition booklet for BC patients and a food model as an intervention technique. Continuous nutrition counseling was given three times: weeks 1, 3, and 5 of radiotherapy. We examined anthropometry, biochemical, physical, dietary, and Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire to obtain nutritional status.Results: Most of the participants had a body mass index (BMI) ≥25 kg/m2 (62.2%). After the participants were receiving nutrition counseling, there were increases in intake of energy, protein, carbohydrate, vitamin A, vitamin C, and vitamin E amounted 124.54 kcal, 8.12 g (p=0.01), 5.84 g, 234.43 mg, 0.042 mg, and 0.44 mg, respectively. Intake of fruits and vegetables improved on the first, third, and fifth week (1.44, 2.36, and 4.03 portion/day, respectively) (p=0.001). Handgrip strength (HGS) showed slight improvement (p=0.081). However, HGS ameliorated from 15.85 kgs in the early to 16.97 kgs in the end stage of therapy. Bodyweight decreased 0.28 kg; however, there are no changes in PG-SGA score, hemoglobin (Hb), and albumin levels.Conclusion: Nutrition counseling improves patients’ nutrition intake despite there is no significant alteration in nutritional status. In addition, nutrition counseling for breast cancer patients during radiotherapy is essential to maintain and improve nutrient intake and nutritional status. In the long-term period, it might be affected to improve quality of life.

Enhanced Recovery After Surgery at Howard County General Hospital: A Multidisciplinary and Collaborative Initiative

<h3>Background Information</h3> In the traditional model, patient care in the hospital is delivered in silos by different providers which hinders the delivery of optimal patient care. Enhanced Recovery after Surgery (ERAS) pathway is a new standardized, multidisciplinary, and collaborative quality initiative that is evidence-based associated with better outcomes to surgical patients. With the continuous challenge posed by reimbursements, Howard County General Hospital (HCGH) needs to implement efficient and cost effective initiative that improves patient care and patient experience to support the Johns Hopkins Innovation 2023 strategic plan –" Improve the quality and affordability of healthcare"; hence the birth of ERAS at HCGH. <h3>Objectives of Project</h3> Implement a standardized, patient centered protocol at HCGH to facilitate optimal recovery of patients undergoing surgery or procedure which integrates the pre-operative, intra- operative, post-operative, and post-discharge phases of care to reduce hospital length of stay (LOS); improves patient care and outcomes; and improve patient/family experience and satisfaction by getting the patient back to normal preoperative function faster. <h3>Process of Implementation</h3> On January 2016, a multidisciplinary ERAS Committee was developed and tasked to create ERAS pre-op order set and protocol; ERAS resource booklet for patients; get the buy-in; disseminate information; and educate the different stakeholders. On April 2016, ERAS was implemented on colorectal, followed by GYN and Orthopedic cases. On February 2019, ERAS was expanded to all surgical patients to support "ERAS for ALL." The NPO Guidelines and the Posting Sheet were also revised to reflect carbohydrate loading 2 hours before surgery. <h3>Statement of Successful Practice</h3> The success of the initiative is dependent upon highly committed and collaborative multidisciplinary teams. HCGH colorectal data from NSQIP has shown 1.3 days reduction in LOS and 1 day earlier transition into oral pain medication from January 2015 to February 2017 due to more tolerable post-operative pain. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> ERAS at HCGH strongly promotes multidisciplinary collaboration and the use of evidence-based and best practices to deliver optimal care to patients. Education of providers and patients; monitoring of protocol compliance, including barriers; and the collection of outcomes data are imperative to the initiative's success. Improved outcomes, decreased LOS, and improved patient/family satisfaction have strongly encouraged perianesthesia nurses' commitment and participation.

Quality Improvement in the Care of Patients with Asplenia: Focus on Diminishing Risk of Infection

IntroductionAsplenia, the absence of normal spleen function, may be congenital or acquired (Rubin & Schaffner 2014). The spleen plays an important role in immune response, particularly in the filtration of encapsulated bacteria (Brown et al. 1981). Asplenia renders patients with this condition at risk of life threatening bacterial infections (Winkelstein 1977). Overwhelming post-splenectomy infection (OPSI) has a mortality rate of 50% (Bisharat et al. 2001). In an observational study conducted over 4 years, 72 cases of potentially preventable OPSI were reported in patients aged 3 months to 87 years (Waghorn 2001). In this study, 74% of patients were not prescribed antibiotics (neither prophylactic nor for treatment use), 69% had not received the pneumococcal vaccination and only 1 of 77 individuals was issued a medical alert card for asplenia.The objective of our study was to enhance recognition and understanding of asplenia as well as to promote appropriate preventative measures for infection for people with asplenia at St. Michael's Hospital in Toronto, Canada.MethodsA prospective quality improvement study was conducted over one year in the hematology clinics at St. Michael's Hospital. An interdisciplinary team of stakeholders were engaged and provided strategies to enhance the medical management of patients with asplenia. A medical alert card and educational booklet for patients with asplenia were developed. The medical alert card was used to record vaccination status and educate the patient to present immediately to medical attention at the onset of fever. The booklet described the importance of immunization and the symptoms indicating the onset of a potentially life-threatening infection. It also outlined vaccination schedules and management of fever for patients with asplenia. The booklet was directed towards both patients and clinicians.We administered a baseline questionnaire to patients with asplenia who presented to the hematology clinic. The questionnaire measured patients' understanding of asplenia. Following the questionnaire, the medical alert the card and booklet were distributed to the patients with asplenia. A follow-up questionnaire was completed by the patient at their next presentation. The primary outcomes included change in number of patients aware of their: condition, vaccination record; appropriate fever management; and prescribed antibiotic. Secondary outcomes included: change in vaccination rates and patient satisfaction.This initiative was formally reviewed and approved by Quality Improvement authorities at St. Michael's Hospital.ResultsThirty patients with asplenia completed the baseline questionnaire. Sixty-seven percent of patients had an unknown or incomplete vaccination record, 82% were unaware that fever requires immediate medical attention and 100% were unaware of a prescribed antibiotic in the event of fever if more than 2 hours away from medical attention. Of the 30 patients with asplenia who received the medical alert card and booklet, 20 (67%) have completed the follow-up questionnaire. 17/20 (85%) were informed regarding their vaccination status and 15/20 (75%) were either completely vaccinated or were taking measures to become appropriately vaccinated. 15/20 (75%) demonstrated an improved understanding of appropriate fever management.ConclusionsThe implementation of a personalized medical alert card and booklet is associated with improved awareness and understanding of asplenia and its consequences. We anticipate these preventative measures will empower patients to facilitate their safe medical care. Given the successful outcomes and apparent need, we are extending this intervention to other areas of St. Michael's Hospital and beyond. [Display omitted] DisclosuresSholzberg:Shire: Honoraria, Research Funding; CSL Behring: Honoraria, Research Funding; Octapharma: Honoraria, Research Funding; NovoNordisk: Honoraria.