Patient Education Process Research Articles

Prognostic factors for mortality in patients with bullous pemphigoid: a meta-analysis

Bullous pemphigoid (BP) is a chronic debilitating autoimmune blistering disease that frequently occurs in the elderly population. Previous studies have suggested a high morbidity and mortality associated with BP. However, relatively few studies have investigated prognostic factors of BP mortality, and they showed considerably various results. This meta-analysis aimed to quantitatively assess the association between several potential prognostic factors and risk of mortality in bullous pemphigoid. A comprehensive search was performed using Pubmed, Embase, and Cochrane Library. Cohort studies that assessed prognostic factors of BP mortality were included. Random-effects model was utilized to calculate the pooled hazard ratio (HR). Publication bias was evaluated qualitatively by constructing a funnel plot and quantitatively by conducting Egger’s test. 14 studies were included comprising 2499 patients. Combined HRs suggested that advanced age (HR 1.63, 95% CI 1.34–1.97), presence of circulating antibodies (HR 1.77, 95% CI 1.20–2.62), concomitant dementia (HR 2.01, 95% CI 1.22–3.33), and concomitant stroke (HR 1.86, 95% CI 1.29–2.67) have an unfavorable impact on patient survival. Gender, disease extent, mucosal involvement, and indirect immunofluorescence result were not shown to be linked to mortality by our analysis. This study indicated that BP patients with older age, circulating antibodies, dementia, and stroke are at greater risk of mortality. Clinicians should be aware of this association and utilize this information in patient education and treatment process.

Standardized symptom screening: Cancer Care Ontario's expanded prostate cancer index composite for clinical practice (EPIC-CP) provincial implementation approach.

100 Background: Cancer Care Ontario endorses patient reported outcome measures to improve outcomes and experience for nearly 14 million Ontarians. The EPIC-CP tool, validated to screen/monitor symptoms and side-effects in men with localized prostate cancer, was selected to improve patient and provider experience, and facilitate symptom management. Two pilots tested EPIC-CPs feasibility and acceptability. Subsequent recommendations include: province-wide implementation, improving technological privacy, patient and provider education and communication processes. This abstract will describe the provincial strategy for implementation of EPIC-CP. Methods: The implementation approach involved stakeholder-driven practices based on Kotter’s organizational process framework. Clinical, technical, administrative and patient stakeholder representatives from 14 cancer centres formed working groups to create a climate for change, to engage centres to strategize locally, to implement and sustain change and to address the challenges identified by the EPIC-CP pilot. Results: The final pilot ended in June 2015, and executive endorsement for EPIC-CP provincial implementation in March 2016. A schedule for multi-site phased implementation was informed by stakeholder consultations and began in Oct 2016. Technological privacy improvements were informed by 95 representatives creating a multidisciplinary team tasked with provincial oversight, development of EMR guidelines and IT solutions. Five patient and five clinical educational guides were designed to assist in symptom management, each focusing on one domain of EPIC-CP. Creation of the guides drew on the clinical and scientific expertise among 12 clinicians of varying disciplines in collaboration with four patients. This team assisted in enhancing communication processes by designing 21 training materials, including FAQs and narrated guides, accessible on a central communications hub. Conclusions: Results indicate that this framework-based, stakeholder-driven approach was successful and could be applied to other wide-scale implementations of symptom management tools.

Providing consistent patient education across the continuum of cancer care.

187 Background: The need for consistent patient education across Cancer Care Services was identified while planning for the Fred and Pamela Buffett Cancer Center. Work began in November 2015 to validate if education provided by multiple providers in various settings was consistent and delivered a clear message to patients. A plan was developed to provide consistent education across the care continuum with the goal of enhancing patient experience, improving staff workflow and defining expectations for patient education. Methods: A survey to assess the current state of education was conducted. Participants in the survey included multidisciplinary team members from inpatient and ambulatory care settings. Five questions were asked about education consistency. Comments about the current and future state of education were encouraged. An audit of educational materials was completed and outdated resources eliminated. Results: 456 surveys were sent with 154 surveys completed (34% return rate). Five major themes emerged (documentation, role expectation, resource standardization/availability, handoff between departments and disciplines, and assessment of individual learning needs). The documentation in Electronic Medical Record was inconsistent and unable to easily assess learner progress. Role expectation was poorly defined with no consistent approach to education delivery. Resource standardization/availability had varying availability of education materials and staff unaware of resources. Handoff between departments and disciplines had inconsistent documentation and no established process to identify needs and barriers related to successful handoffs. Assessment of individual learning needs had unknown compliance in completing the Learning Questionnaire. A team was assembled to address the themes. A process map of patient education was created starting at the initial encounter through end of treatment. Staff was educated on their role, available resources, and documentation expectations. Conclusions: Conducting an evaluation of the patient education process allows for identification of improvement opportunities. This reduces patient confusion and increases trust. Patient satisfaction scores related to education have increased. This work enhanced the patient experience and helped prepare for a smooth transition of patient education initiatives into our new cancer center.

A Multidisciplinary Evaluation of Staphylococcus aureus Screening, Decolonization and Patient Adherence to Pre-Operative Decolonization Procedures

BackgroundColonization with Staphylococcus aureus (SA) increases the risk of surgical site infection (SSI) and de-colonization reduces this risk depending on level of patient adherence. Our VA facility’s participation in a multi-site study to identify the best strategies for implementing peri-operative SA de-colonization provided an opportunity to examine the reliability of existing internal processes. The objectives of this single-site study were to asses self-reported patient adherence, and barriers to recommended de-colonization procedures, as well as to examine if current patient educational materials were sufficient.MethodsA survey measuring self-reported adherence and barriers to recommended de-colonization procedures was administered by telephone. A process map of the patient education process was employed to identify key frontline staff who were asked to review existing patient education materials and procedures. A new patient education tool was then developed with their input and input from an expert in patient education.Results34 patients responded to the telephone interview. Self-reported de-colonization adherence was 100%. 32% of patients reported high levels of social/economic deprivation and only 32% reported using medication reminders, suggesting some risk of non-adherence. Process mapping revealed that patient education was delivered through a combination of face-to-face training and printed materials. Review of the printed materials identified a number of opportunities for improvement. The newly developed patient education tool was rewritten at a 7th grade reading level and revised to include: (1) more concrete information on the benefits of SA de-colonization; (2) visual aides to enhance performance of different de-colonization tasks; and (3) a tracking log to facilitate adherence to each of the recommended de-colonization tasks.ConclusionWe identified many opportunities to improve the education of patients undergoing SA de-colonization prior to high-risk surgery at our VA. Further work will need to be done to determine whether these changes positively impacted patient adherence to recommended de-colonization procedures and whether this translates into improved patient outcomes.Disclosures M. Schweizer, B Braun: Speaker at a course, Travel reimbursement to teach course

Providing patient information and education in practice: the role of the health librarian.

In this article, guest writer Ivana Truccolo presents an overview of her work at the Scientific and Patient Library of a Cancer Comprehensive Centre in Italy coordinating the patient education process. She discusses the historical evolution of the concept of patient education and how this has run alongside the role of the health librarian in the provision of consumer health information. Details are provided about various patient education programmes in place at the Centre. In particular, various activities are discussed including patient education classes, the development of patient education handouts and a narrative medicine programme which includes a literary competition. The article concludes with a specific outline of the role the health librarian can play in the provision of consumer health information and patient education. H.S.

Educational strategies and challenges in peritoneal dialysis: a qualitative study of renal nurses' experiences.

The aim of the study was to explore renal nurses' experiences, strategies and challenges with regard to the patient education process in peritoneal dialysis. Patient education in peritoneal dialysis is essential to developing a successful home-based peritoneal dialysis program. In this area research is scarce and there is a particular lack of focus on the perspective of the renal nurse. Qualitative design formed by thematic qualitative text analysis. Five group interviews (n=20) were used to explore the challenges peritoneal dialysis nurses face and the training strategies they use. The interviews were analyzed with thematic qualitative content analysis using deductive and inductive subcategory application. The findings revealed the education barriers perceived by nurses that patients may face. They also showed that using assessment tools is important in peritoneal dialysis patient education, as is developing strategies to promote patient self-management. There is a need for a deeper understanding of affective learning objectives, and existing teaching activities and materials should be revised to incorporate the patient's perspective. Patients usually begin having questions about peritoneal dialysis when they return home and are described as feeling overwhelmed. Adapting existing conditions is considered a major challenge for patients and nurses. The results provided useful insights into the best approaches to educating peritoneal dialysis patients and served to raise awareness of challenges experienced by renal nurses. Findings underline the need for nosogogy - an approach of teaching adults (andragogy) with a chronic disease. Flexibility and cooperation are competencies that renal nurses must possess. Still psychomotor skills dominate peritoneal dialysis patient training, there is a need of both a deeper understanding of affective learning objectives and the accurate use of (self-)assessment tools, particularly for health literacy.

Improving the quality of the consenting and education process for patients starting on oral oncology medications.

82 Background: Oral oncology medication prescribing is on the rise nationwide. Given that these medications are self-administered, drug compliance is a concern. Appropriate patient education directly impacts drug adherence. Prior to the process improvement initiative in our community based medical oncology clinic, implied consent was obtained while educating patients on side effects and written informed consent was documented 0% of the time. This creates a patient safety and risk management problem. Methods: Our clinic implemented a new process for consenting and educating patients starting on new oral oncology medications from April – October 2015. The plan/do/study/act performance improvement technique was utilized. A new consent form was created for oral oncology medications meeting ASCO/ONS safety standards. The consent and education packets were placed centrally in the office and coincided with an initiative to improve consenting for IV chemotherapy. Providers were in-serviced to contact the nurse prior to patients exiting clinic to initiate the new prescription and begin the patient education process. Reminder checklists were placed in exam rooms to trigger the provider to communicate with nursing staff. Outcome measures included data on the percent of patients with written informed consent in health record and percent of patients with patient education handouts in health record prior to drug start. Data on percent of patients for whom the provider notified nurse prior to end of clinic visit were collected as a balance measure. Results: Over a 6 month period, 101 consecutive patients initiated on oral oncology drugs were included in the data analysis. The baseline mean improved from 0% to 75% for obtaining written informed consent (p chart, 3 sigma). The baseline mean improved from 37% to 80% for documenting patient education in health record prior to oral oncology medication start (p chart, 3 sigma). Conclusions: There was significant improvement in obtaining written informed consent and providing patient education prior to oral oncology drug start after implementation of new clinic processes.

SELF-MANAGEMENT EXPERIENCES IN PERSONS LIVING WITH DIABETES MELLITUS TYPE 2

Diabetes mellitus (DM) is a progressive disease which has the potential of negatively affecting virtually all the systems of the body, causing debilitating and life-threatening complications if blood glucose levels are not controlled. A high level of self-management is required in order to control blood glucose levels and prevent or delay the onset of complications which may have severe physical, psychological and financial implications for the individuals and their families.  As no research on the experiences of persons living with the condition was previously conducted in Nelson Mandela Bay, South Africa, a qualitative, descriptive, exploratory and contextual study was conducted between January and April 2009. Nineteen participants from both the private and public health care sectors were recruited making use of purposive sampling. The following themes emerged from the data collection: persons living with DM experience a wide range of emotions on initial diagnosis; gradually they experience an acceptance and acknowledgment of their condition; persons living with DM have definite opinions on the concept of self-management; persons living with DM acknowledge both positive and negative factors which influence self-management and expressed views on how professional nurses can assist them in achieving self-management. Recommendations included allowing persons living with DM to take a leading role in decisions regarding management of their condition. They should make periodic reinforcements of their lifestyle modifications as part of an ongoing patient education process. Qualified Diabetes Nurse Educators should be employed at health care facilities, both in the public and private sector. Finally, specialized courses covering all areas of management of DM should be more readily available to health care workers.

Patient Education Process in Oncologic Context: What, Why, and by Whom?

Patients with cancer move between institutions and settings and have different knowledge expectations during their illness trajectory. To provide individually tailored, timely, and relevant education, healthcare professionals should collaborate in the patient education process. This study aimed to describe procedures used by healthcare professionals involved in cancer management when assessing knowledge expectations, cognitive resources, and comprehension of adult patients with cancer during and after education in various phases of their illness trajectory. Intraprofessional and interprofessional collaboration concerning the patient education process is described. Eleven focus group interviews were conducted for nurses (n = 42) and physicians (n = 23) involved in cancer care from four healthcare organizations: a private occupational health care and three hospital settings. Interview data were analyzed with inductive content analysis. In the assessment of the knowledge expectations, cognitive resources, and comprehension of a patient with cancer, both the nurses and physicians first applied objective assessment methods and then used dialogue with the patient. No validated instruments were used by either group. Among nurses, educational content was based on the patient's possible or actual problems in everyday life during cancer management, whereas the physicians focused on the patient's rights to information and informed consent for treatment. The patient education process was often incompletely documented into patient records and not always utilized interprofessionally or between care units. In oncology services, there is a gap between research evidence utilization and the patient education process. Patients should be involved in the planning, implementation, and evaluation of their education and be informed about the division of responsibilities in patient education between different professional groups. This would allow patients to participate more extensively in the decision making concerning their own treatments. To ensure effective interprofessional patient education for individual patients, improvement in information exchange among members of the cancer care team is needed.

Impact of variability in adherence to HIV antiretroviral therapy on the immunovirological response and mortality.

BackgroundSeveral previous studies have shown relationships between adherence to HIV antiretroviral therapy (ART) and the viral load, the CD4 cell count, or mortality. However, the impact of variability in adherence to ART on the immunovirological response does not seem to have been investigated yet.MethodsMonthly adherence data (November 1999 to April 2009) from 317 HIV-1 infected patients enrolled in the Senegalese ART initiative were analyzed. Latent-class trajectory models were used to build typical trajectories for the average adherence and the standardized variance of adherence. The relationship between the standardized variance of adherence and each of the change in CD4 cell count, the change in viral load, and mortality were investigated using, respectively, a mixed linear regression, a mixed logistic regression, and a Cox model with time-dependent covariates. All the models were adjusted on the average adherence.ResultsThree latent trajectories for the average adherence and three for the standardized variance of adherence were identified. The increase in CD4 cell count and the increase in the percentage of undetectable viral loads were negatively associated with the standardized variance of adherence but positively associated with the average adherence. The risk of death decreased significantly with the increase in the average adherence but increased significantly with the increase of the standardized variance of adherence.ConclusionsThe impacts of the level and the variability of adherence on the immunovirological response and survival justify the inclusion of these aspects into the process of patient education: adherence should be both high and constant.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2288-15-10) contains supplementary material, which is available to authorized users.

The effectiveness of orthopedic patient education in improving patient outcomes: a systematic review protocol.

The objective of this review is to identify the effectiveness of patient education for orthopedic surgery patients. More specifically, the objectives are to identify the effectiveness of patient education on:length of staysatisfactionpain levelcost of carefunctional abilitiesknowledgeanxietyquality of life in orthopedic settings. Patient education is an essential part of practice for all healthcare professionals. In the orthopedic setting, effective patient education contributes to positive patient outcomes. Patient education is critical to ensure that patients receive appropriate information to assist in the pre-admission, peri-operative treatment and rehabilitation process for the patient. The process of patient education is essentially one where the patient comes to understand his or her physical condition and self-care using the experience and guidance of the multidisciplinary team.With an effective and well-structured patient education program, the cost benefit for health care provider and patient includes a shortened length of stay, and reduced cost of care. According to Huang et al. a simplified pre-operative education program reduced the length of stay and cost of care. Similarly, Jones et al. found that length of stay of a patient who received pre-operative education was reduced. In that study, the mean length of stay was significantly reduced from seven days in patients who did not received pre-operative education to five days in patients who received pre-operative education. These results suggest that pre-operative education programs are an effective method in reducing the length of stay of orthopedic patients.Johansson et al. also described pre-operative education for orthopedic patients in a systematic review published in 2005. They discussed the effect of patient education on the orthopedic patient and found that knowledge, anxiety, pain, length of hospital stay, performance of exercise and mobilization, self-efficacy, patient compliance, adherence and empowerment were all improved as a result of patient education. While Johansson et al. included studies up to 2003, the proposed systematic review will include studies from 2003 to 2013.Kruzik also reported benefits of decreased length of stay, reduced pain medication requested post-operatively together with increased patient and family member satisfaction. Bastable reported benefits of patient education, including increased patient satisfaction, improved quality of life, enhanced continuity of care, decreased anxiety, fewer complications, promotion of adherence to the plan of care, maximized independence, and empowerment.Types of education involved in this systematic review are patient education, pre-operative education, and discharge education. Only one study discussed discharge education and the outcome from this review. The outcomes that have been discussed in this systematic review include length of stay, satisfaction, pain level,, 21 cost of care, functional abilities, knowledge, anxiety, and quality of life.Major outcomes discussed in these studies are length of stay, pain,, 21 functional abilities, and anxiety. Most of these studies found significant results of reduced length of stay on those patients who received patient education compared to patient who did not received any patient education or information. Studies support the positive outcomes around length of stay.Common orthopedic conditions that have been discussed are osteoarthritis with total arthroplasty either hip or knee or joint replacement. A study on spinal surgery patients and the effects of pre-operative education, which stated that although there are many studies on the effectiveness on patient education, there are missing data on spinal surgery. This study found that the implementation of patient education has positive impacts upon patient satisfaction especially in managing pain.This review will look specifically at the effectiveness of orthopedic patient education for length of stay, satisfaction, pain level, cost of care, functional ability, knowledge, anxiety, and quality of life.

A Challenge

This past February, at the Combined Sections Meeting (CSM) of the American Physical Therapy Association (APTA), the Editorial Board of the Journal of Physical Therapy Education led an exciting discussion on the development of an educational research agenda for the profession of physical therapy. It is the editors’ perspective that, just as is true for our clinical research colleagues, those engaged in educational research need to pursue research that results in the best evidence for policy makers. Research conducted with the best possible design and methodology can inform good educational decisions in many areas, including education for learners in the classroom and the clinic, across entry and post-professional education, patient education, curriculum development, and institutional processes for education. To this end, the editors have encouraged researchers to adopt strong research principles, including selection of appropriate design, use of standardized outcome measures, and collaboration to increase participant numbers. In addition, we have encouraged the consideration of mixed methods to explore educational questions. We have clearly stated that work that demonstrates equivalency between educational methods can be of value by providing educators with viable options. Researchers have responded by increasing the quantity and quality of current work. This work, however, is still being done in the absence of a contemporary, well-articulated education research agenda for the profession of physical therapy. While there are items related to educational research included in APTA's Clinical Research Agenda,1 they do not constitute a cohesive and organized agenda for the profession. The CSM session provided the opportunity for over 70 educational leaders to begin a discussion on what should be included. We asked all participants to identify items they wanted to see in a research agenda and then to work in groups to develop the top ranked items to include. The items developed at the meeting are shown in Table 1. They provide some excellent topics, all worthy of exploration, and we thank the participants for their careful thought on this issue. We challenge educational researchers to consider these important topics as they plan their own individual research agendas. Leaders from APTA, the Education Section, and the American Council of Academic Physical Therapy (ACAPT) were present at the meeting and indicated their desire to work to together to develop a formal agenda. In addition, leaders from the Foundation for Physical Therapy commented on the importance of a formal agenda to improve funding opportunities for educational research. While supportive, the conversation stopped short of a specific plan to make an education research agenda for the profession a reality. We challenge APTA, the Education Section, and ACAPT to make the development of an education research agenda a high priority, with rapid determination of the best process to use, and with completion of the process within the next year.

Reduction of emergency department utilization via access to outpatient cancer care.

128 Background: Emergency department (ED) utilization for non-emergent medical problems is an inefficient use of medical resources. During calendar year 2013, 224 RIH adult cancer patients presented to the RIH ED. Retrospective review indicated up to 50% of these ED visits were avoidable. Methods: This project was developed for the ASCO Quality Training Program. A multidisciplinary team was assembled to address ED utilization. Retrospective chart review of ED visits included time and reason for visit and primary tumor site. The team selected the Lung Cancer as the target group, developed a cause-and-effect analysis for ED visits, administered a patient survey, and implemented a series of Plan-Do-Study-Act (PDSA) cycles. The team implemented a patient education process of nurse sick-line symptom management and same-day sick visits at RIH CCC as well as developing a single-page patient “sick-line tool” with oncology nurse sick-line contact telephone numbers. A patient navigator introduced the sick-line tool at the first visit and its usage was reinforced at subsequent visits. Results: For RIH CCC lung cancer patients, a standardized symptom-control education process correlated with 30% decrease in ED visits for any presenting complaint (42 visits vs. 60 visits) and 32% decrease in ED visits with presenting complaint of pain (13 visits vs. 19 visits) during January/February 2014 compared to January/February 2013. We did not find significant differences between the proportion of ED visits during Cancer Center business hours, evenings, or weekends. Sick-line calls were found to increase by 53% during January 2014 compared to December 2013 with an additional 35% increase in February 2014. Conclusions: A standardized patient education process resulted in a significant decrease in ED visits, concurrent with an increase in outpatient sick-line utilization. This may reflect an improvement in efficiency of outpatient cancer patient care in a single-institution setting. Given other reports of increased ED utilization by lung cancer patients for similar presenting reasons, these improvements may be generalizable to other institutions.

Implementation of an evidence-based education practice change for patients with cancer.

As oncology care continues to move toward delivery in the outpatient setting, oncology nurses must find ways to effectively educate patients about diagnosis, treatment, and symptom management. A cancer diagnosis induces high levels of anxiety, often affecting a patient's ability to retain information about his or her disease, treatment, and symptom management. Based on results from the ONS Foundation-supported Breast Cancer Care Quality Measures Set and Breast Cancer Survivorship Quality Measures Set, a community-based, multisite cancer center located in the midwestern United States embarked on a quality project in patient education. The purpose of this article is to describe a quality project that evolved from a review of the patient education process for patients with cancer in three medical oncology clinics to a pilot of a new model for patient education. The pilot identified gaps, developed and implemented evidence-based improvement strategies, and planned for evaluation of process and patient outcomes of this practice change. A pilot study to assess processes and workflows associated with a one-hour separate patient education visit was designed and initiated. Patients and oncology nurses have expressed satisfaction with standardized patient education. Although processes and workflows continue to be evaluated, a proposal was developed, submitted, and accepted by the institutional review board to evaluate patient-centered outcomes.

Variation in daily median respiratory rate identifies patients at higher risk of worsening HF in 30 days

Methods: Using the IOWA model, our EBP team reviewed the evidence and decided to implement the Teach Back to improve our patient education process. We participated on a multidisciplinary team to develop new patient education materials that used the HF Zone tool and a new book centered on 5 key messages for HF selfcare. Learning assessment and Teach back included nurses, nurse technicians and student nurses. Further hardwiring of the practice change included review of patient education as part of daily interdisciplinary rounds and charge nurse documentations reviews. Based on the success of the practice change, key EBP Teammembers participated in the pilot for a system-wide roll-out of Teach Back, serving as trainers and competency validators for their peers. Results: The practice change was measured by a nurse survey, clinical pathway documentation audits and follow-up call data as well as HF 30 day readmission data. These process improvements contributed to reducing LOS and HF readmission rate, enabling the Health System to avoid CMS penalties for two years in a row. A key reason for the success of this programwas the levels of staff buy-in. Staff initiated the EBP project and embraced the evidence to support their practice change. Conclusion: Post implementation, HF to HF 30 day readmission rates and LOS has decreased from 16% to 3% and 5.01 to 4.11 respectively. Readiness for discharge and instructions given increased from 85% to 89.8%, and 84.6% to 89.5% respectively. The use of evidence-based strategies is clearly making a difference in the quality of our patient education and thereby improving the clinical outcomes of our HF patients.

Iranian nurses and nursing students' attitudes on barriers and facilitators to patient education: A survey study

The aim of this study is to describe the attitudes of Iranian nurses and students on barriers and facilitators to patient education. In this descriptive quantitative study, 103 nurses and 84 nursing students in two teaching hospitals in an urban area of Iran responded to a questionnaire investigating their attitudes on patient education. Results showed that all nurses and the majority (87.3%) of the students mentioned that they performed patient education. Moreover, 95% and 63.3% of the nurses and students respectively accepted that patient education was one of their roles. The nurses stated that heavy workload, inadequate time and lack of educational facilities were main barriers to patient education. The students believed that lack of knowledge, lack of communication skills and heavy workload were main barriers to patient education from their perspectives. While Iranian nurses and nursing students had positive attitudes towards patient education, it could not guarantee the implementation of patient education. Therefore, the clarification of patient education activities and development of a patient education team with the support of healthcare settings' administrators can facilitate the process of patient education in the Iranian healthcare settings.

Assessing the State of Safe Medication Practices Using the ISMP Medication Safety Self Assessment® for Hospitals: 2000 and 2011

Since development of the Institute for Safe Medication Practices (ISMP) Medication Safety Self Assessment for Hospitals in 2000, hospitals have used the tool to assess medication safety practices and identify opportunities for improvement. The Assessment was updated in 2011 to create a new baseline of hospital medication safety efforts and determine if progress has been achieved in the interim. Hospitals in the United States were asked to voluntarily complete the 2011 Assessment and submit their data confidentially to ISMP from April to October 2011. The Assessment contained 270 items organized into 10 key elements and then further divided into 20 core characteristics. By October 2011, 1,310 hospitals had submitted data to ISMP for a response rate of 23% for all 5,786 hospitals. Scores in 2011 increased significantly from 2000. The largest percent improvements were in core characteristics related to communication of drug orders, patient education, and quality processes and risk management. Hospitals in 2011 scored lowest in areas related to patient information, staff competency and education, and drug information. Higher scores for the core characteristics related to the organizational culture and staff education about medication error prevention were associated with higher scores for the core characteristic associated with error detection, reporting, and analysis. Hospitals with a medication safety officer scored higher in all key elements than hospitals without. While substantial medication safety improvements have been achieved within the last decade, opportunities still exist to improve medication safety. Widespread adoption of key safety strategies will be more effective if influential groups work together and external forces provide the necessary pressure via regulations, standards, public policy, or incentives.

Doing Right by Our Patients When Things Go Wrong in the Ambulatory Setting

Since development of the Institute for Safe Medication Practices (ISMP) Medication Safety Self Assessment® for Hospitals in 2000, hospitals have used the tool to assess medication safety practices and identify opportunities for improvement. The Assessment was updated in 2011 to create a new baseline of hospital medication safety efforts and determine if progress has been achieved in the interim.Hospitals in the United States were asked to voluntarily complete the 2011 Assessment and submit their data confidentially to ISMP from April to October 2011. The Assessment contained 270 items organized into 10 key elements and then further divided into 20 core characteristics.By October 2011, 1,310 hospitals had submitted data to ISMP for a response rate of 23% for all 5,786 hospitals. Scores in 2011 increased significantly from 2000. The largest percent improvements were in core characteristics related to communication of drug orders, patient education, and quality processes and risk management. Hospitals in 2011 scored lowest in areas related to patient information, staff competency and education, and drug information. Higher scores for the core characteristics related to the organizational culture and staff education about medication error prevention were associated with higher scores for the core characteristic associated with error detection, reporting, and analysis. Hospitals with a medication safety officer scored higher in all key elements than hospitals without.While substantial medication safety improvements have been achieved within the last decade, opportunities still exist to improve medication safety. Widespread adoption of key safety strategies will be more effective if influential groups work together and external forces provide the necessary pressure via regulations, standards, public policy, or incentives.

The Forming Process of Patient Education on Basic Nursing Education : The Educational Transformation from the End of the World War to the 1990s

The Forming Process of Patient Education on Basic Nursing Education : The Educational Transformation from the End of the World War to the 1990s

Promoting Healthcare Safety And Quality By Assessing Anticoagulation Education Process

We conducted a baseline study of warfarin patient education process by (1) assessing a healthcare facility’s current compliance with the education requirements for anticoagulation therapy, (2) assessing how effectively warfarin education was being provided in terms of patient’s knowledge and (3) identifying areas where process improvements were warranted. The facility is an acute care teaching hospital and a Level I Trauma Center with a pharmacist-managed outpatient anticoagulation clinic. We collected data from patients concerning (1) six warfarin knowledge domains (drug-nutrition interactions, drug-drug interactions, monitoring, drug information, dosing and adverse effects), (2) whether or not patients received warfarin education upon discharge and which healthcare professional provided this education (physician, pharmacist, nurse), (3) duration of warfarin therapy, (4) self-rated knowledge of warfarin, and (5) various demographics. Study results indicated the need to implement improvements to the education process to ensure that warfarin education is consistently and routinely provided to all patients prior to being discharged on warfarin with particular attention given to patients sixty years of age and older. Education provided should focus on drug-nutrition and drug-drug interactions, which were found to be areas of highest knowledge deficit. Improvements to the process of providing warfarin education at our hospital may additionally include implementation of a protocol to identify patients requiring education, and a standardized educational program with a pharmacist- managed warfarin discharge counseling service.