Standardized Patient Education Research Articles

The standardised cancer booklet and beyond: Patient perspectives on patient education for breast cancer care

Objective: This qualitative study engaged with breast cancer patients to create a standardised cancer education booklet. This paper identifies lessons from that engagement process, showing how patients experienced their cancer education and how they were able to ensure their concerns and priorities were included in the standardised patient education booklet. Method: In semi-structured focus groups and interviews, patients reviewed the print materials they had received and a draft standardised booklet. Discussions were then analysed thematically through comparison and interpretive coding. Results: Patient education needs to provide key information on breast cancer and its treatment while also providing the kind of educational support that can strengthen patient capacity to take decisions, feel a sense of control, and move through the journey with optimism and courage. Conclusion: Patient education, including standardised materials, can reflect patient autonomy and empowerment if patients are engaged in developing educational materials in a broad, inclusive and sustained way.

NLN/Jeffries Simulation Framework for Simulated Participant Methodology

The integration of human role players into simulation education is at an all-time high. In 2017, the Association of Standardized Patient Educators released the Standards of Best Practice with the intention of complementing the International Nurses Association for Clinical Simulation and Learning Standards of Best Practicesm: Simulation. As the popularity of human role players in simulation rises, it is imperative to wrap the andragogy with a theoretical framework to ensure simulation-based education (SBE) is maximized for safety, psychological fidelity, and educational outcomes.This article suggests a modification of the NLN Jeffries Theory into SBE, where human role players and simulated participants are integrated. The identified components of Jeffries Theory, context, background, design, educational practices, simulation experience, and outcomes remain unchanged from the original. The suggested adaptations within each component are also discussed. This modification can be referenced to establish, evaluate, and/or modify simulated participant education programs.

A standardized patient education class as a vehicle to improving shared decision-making and increasing access to breast reconstruction

Shared decision-making is a key component of patient-centered care and has been shown to improve patient satisfaction and quality of life. Herein, we study the impact of a standardized patient education class for prospective breast reconstruction patients on clinic efficiency, access to care, and perception on shared decision-making. The number of new patient consultations per clinic, as well as average duration of the first individual clinic encounter, was compared before and after the introduction of a standardized education class given by the senior author to all new breast reconstruction patients. To evaluate patients' perception of shared decision-making, the 9-item Shared Decision-Making Questionnaire (SDM-Q9) and the Satisfaction with Information scale of the BREAST-Q Reconstruction Module were electronically distributed among the patients and compared between the two groups. Introduction of the patient education class was associated with a significant reduction in the duration of new patient encounters compared to historic controls (31.8 min vs. 53.5 min, p<0.01) along with permitting a 43% increase in new patient visits. No differences in self-perceived patient education and autonomy were seen between class participants and historic controls in the SDM-Q9 scores (p = 0.58) and BREAST-Q scores (p = 0.14). The introducing a standardized patient education class translated into a significant reduction in the duration of individual new patient encounters, thereby increasing patient access to care, while maintaining high-quality standards of self-perceived patient education and shared decision-making.

Learning in 360 Degrees: A Pilot Study on the Use of Virtual Reality for Radiation Therapy Patient Education

BackgroundPatient education for external beam radiation therapy (EBRT) is traditionally delivered in verbal and/or written form, which may not provide a full picture of the complex, technical aspects of treatment. The purpose of this pilot study was to create and evaluate a prototype 360-degree virtual reality (VR) video outlining the technical aspects of EBRT to the pelvis as a supplement to traditional education methods. Materials and MethodsA prototype VR video was filmed to simulate the delivery of one fraction of image-guided EBRT to the pelvis. Patients having a radical course of image-guided EBRT to the pelvis were approached while on active treatment to participate in focus groups evaluating the prototype VR video. Focus group discussions were recorded, transcribed, and subjected to thematic analysis. ResultsAll patients were accrued from a single academic cancer centre in a large metropolitan area. In total, seven patients were enrolled to participate in the focus groups. Thematic analysis revealed 71% of participants felt the traditional patient education met their needs. However, 86% mentioned the education did not fully capture the treatment experience. Participants identified potential benefits of VR could include an increased understanding of the treatment process, specifically the spatial and acoustic aspects of treatment, as well as the potential to reduce anxiety in new patients. Timing was also important, with 86% of participants recommending VR video viewing before the first day of treatment. Participants provided feedback such as including two-dimensional elements in the VR video and other changes which could potentially make the viewing experience more realistic. ConclusionsTraditional teaching methods are seen as satisfactory by patients at our institution, but it is recognized that there is a gap in current education methods. An immersive VR education tool has the potential to enhance standard patient education, increasing understanding of treatment and decreasing anxiety.

Establishing scald prevention measures in UK maternity units from takeaway drinks.

To identify policies on the consumption of hot drinks by patients and visitors on all perinatal and postnatal wards in the United Kingdom, and to seek the opinions of members of the wider burns MDT as to whether standardised patient education or regulation of hot drinks around newborn babies is required. All maternity units with postnatal wards across the United Kingdom were surveyed to establish availability of hot drinks on site and whether these were permitted on postnatal wards around infants. An online questionnaire was distributed to members of the British Burn Association to ascertain opinions on hot drinks policies. Hot takeaway drinks were permitted around newborn infants in 194 of surveyed postnatal wards and were only banned by two units. The online survey received 49 responses from different members of the British Burn Association. Thirty responders (61%) supported a takeaway hot drink ban, while those against the policy would alternatively encourage patient education, dedicated drinking areas and introduction of safety measures. Almost every postnatal unit in the UK has access to hot drink retailers on site allowing parents and visitors to bring them into close contact with babies. With varying local regulations, this poses potentially serious consequences during feeding or carrying. We propose a standardised antenatal education be made available, together with standardised designated areas on wards for parents and visitors to consume hot drinks away from infants.

Hemşirelik Öğrencilerine Verilen Standart Hasta Eğitiminin, Ameliyat Sonrası Bakım Yönetimine Etkisi

Hemşirelik Öğrencilerine Verilen Standart Hasta Eğitiminin, Ameliyat Sonrası Bakım Yönetimine Etkisi

Reducing contamination of midstream urine samples through standardized collection processes: a best practice implementation project.

The objective of this project is to decrease the rates of midstream urine sample contamination through standardization of evidence-based techniques among nurses. Urinary tract infection is a prevalent health problem worldwide. The diagnosis and treatment of urinary tract infection depend on a thorough physical examination and the results of an uncontaminated midstream specimen of urine. However, improper techniques used in the collection often cause sample contamination, leading to delayed diagnosis and the use of inappropriate antibiotics for treatment. As nurses are at the forefront of care delivery, they are involved in reducing the rates of midstream urine sample contamination. Thus, the use of an evidence-based approach to standardize collection of midstream urine culture is crucial for the provision of higher-quality patient care. Education sessions were delivered to the nurses and an evidence-informed standardized patient education leaflet was crafted by the project team for implementation. With a sample size of 30 nurses and patients, the project took place in a 21-bed adult surgical ward in a hospital in Singapore. The JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) programs were used to implement the evidence-based project. The project was implemented in three phases from October 2018 to January 2019. A standardized audit tool devised from JBI PACES was used for the audits in this project. The rates of midstream urine specimen contamination and the knowledge of nurses were also monitored. The baseline audit revealed that the nursing staff required educational sessions to improve their knowledge of midstream urine sample collection. Aside from criteria 1,3 and 4, the remaining criteria achieved compliance of more than 80%. The criteria below 80% compliance became the main focus of the project interventions. At follow-up cycle 1, all criteria achieved at least 80% compliance except criteria 4 and 5, which achieved 73% and 69% compliance, respectively. At the three-month post implementation audit, all criteria achieved a compliance rate of at least 80%. Fisher's exact test was carried out, and statistical significance of the results was achieved (p < 0.001) when compared to baseline audit. The rates of midstream urine specimen contamination also significantly decreased from 40% at the baseline audit to 20% at the third-month post implementation audit. Nurses' knowledge markedly improved as measured by the three-question quiz. This evidence-based implementation project highlights the effectiveness of the JBI PACES and GRiP processes for initiating best practice within a nursing environment. The use of JBI best-practice recommendations to standardize methods for midstream urine specimen collection effectively reduced the rates of midstream urine contamination.

Reducing complexity: explaining inborn errors of metabolism and their treatment to children and adolescents

BackgroundInborn errors of metabolism (IEM) are a group of rare, heterogeneous and complex genetic conditions. Clinically, IEM often affect the central nervous system and other organs. Some carry the risk of progression and / or potentially life-threatening crises. Many patients have to adhere to lifelong dietary or drug treatment.The complexity of IEM makes it difficult for patients and caregivers to understand their pathophysiology, inheritance and therapy rationale. Especially patients reaching adolescence may have only limited knowledge of their condition since medical care has often entirely been handled by their parents. Knowledge about disease and treatment, however, constitute pillars of self-responsible disease management. Not many standardized patient education materials on IEM are available and their comprehensibility has not been systematically investigated.MethodsWe developed and tested patient education materials for school-aged children and adolescents with IEM. Informative texts and illustrations in paper form and as videos were developed by an international network of metabolic care professionals together with a graphic artist and experts for easy-to-read language. The materials were presented in standardized single or group training sessions to 111 individuals; first, to 74 healthy children and adolescents (recruited via public schools) and consecutively to 37 paediatric patients with IEM (phenylketonuria, galactosemia, urea cycle defects, lysosomal storage disorders) from six metabolic centres. Knowledge-gain was assessed by pre- and post-testing.ResultsKnowledge-gain was significant in healthy children and adolescents as well as in patients (p < .001, r =. -77 /. -70). Effect sizes were large in both groups (r = -.77 / -.70). This result was independent from family language and teacher-rated concentration or cognitive capacity in healthy children.ConclusionThe newly developed patient education materials are a powerful tool to improve disease- and treatment-related knowledge. They facilitate communication between the medical team and children and adolescents with IEM and their caregivers.

STANDART HASTA İLE EĞİTİMİN PROFESYONEL DEĞERLERE ETKİSİ

<div><!--block-->Objective: This study aims to investigate the changes in professional values through a structured training program and standardized patient practices.&nbsp;<br><br>Method: The study was conducted with 346 3rd year medical students during the 2016-2017 academic year. Attitudes towards professionalism were assessed by using the “Professionalism” scale developed by The Penn State College of Medicine. The scale was applied to all of the students before the training (pretest) and after the training was completed (post-test).&nbsp;<br><br>Results: The mean scores of the pre-test and post-test, respectively, were 17.5±1.8-18.1±1.9 for accountability; 16.34±2.117.0±1.6 for enrichment; 12.5±1.3-13.0±2.1 for equity; 19.6±1.720.7±1.5 for honor and integrity; 8.4±1.2-13.5±2.1 for altruism; 11.9±1.2-13.4±1.1 for duty; and 5.51±0.6-5.92±0.9 for respect (p&lt;0.05). When the mean scores of the students were compared based on gender, the scores of the female students were found to be higher than those of the male students in all sub dimensions (p&lt;0.05).&nbsp;<br><br>Conclusion: Professional values are important concepts which are complex, difficult-to-measure and affected by multiple factors. An increase was observed in the professionalism scores of the students after the standard patient education practice. This increase was found to be significantly higher among the female students than among the male students.</div>

The Effect of an App for Day-to-Day Postoperative Care Education on Patients With Total Knee Replacement: Randomized Controlled Trial.

BackgroundPatients who undergo primary Total Knee Replacement surgery (TKR) are often discharged within 1-3 days after surgery. With this relatively short length of hospital stay, a patient’s self-management is a crucial factor in optimizing the outcome of their treatment. In the case of TKR, self-management primarily involves adequate pain management, followed by physiotherapy exercises and daily self-care activities. Patients are educated on all these topics by hospital staff upon discharge from the hospital but often struggle to comprehend this information due to its quantity, complexity, and the passive mode of communication used to convey it.ObjectiveThis study primarily aims to determine whether actively educating TKR patients with timely, day-to-day postoperative care information through an app could lead to a decrease in their level of pain compared to those who only receive standard information about their recovery through the app. In addition, physical functioning, quality of life, ability to perform physiotherapy exercises and daily self-care activities, satisfaction with information, perceived involvement by the hospital, and health care consumption were also assessed.MethodsA multicenter randomized controlled trial was performed in five Dutch hospitals. In total, 213 patients who had undergone elective, primary, unilateral TKR participated. All patients had access to an app for their smartphone and tablet to guide them after discharge. The intervention group could unlock day-to-day information by entering a personal code. The control group only received weekly, basic information. Primary (level of pain) and secondary outcomes (physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption) were measured using self-reported online questionnaires. All outcomes were measured weekly in the four weeks after discharge, except for physical functioning and quality of life, which were measured at baseline and at four weeks after discharge. Data was analyzed using Student t tests, chi-square tests, and linear mixed models for repeated measures.ResultsIn total, 114 patients were enrolled in the intervention group (IG) and 99 in the control group (CG). Four weeks after discharge, patients in the IG performed significantly better than patients in the CG on all dimensions of pain: pain at rest (mean 3.45 vs mean 4.59; P=.001), pain during activity (mean 3.99 vs mean 5.08; P<.001) and pain at night (mean 4.18 vs mean 5.21; P=.003). Additionally, significant differences were demonstrated in favor of the intervention group for all secondary outcomes.ConclusionsIn the four weeks following TKR, the active and day-to-day education of patients via the app significantly decreased their level of pain and improved their physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption compared to standard patient education. Given the rising number of TKR patients and the increased emphasis on self-management, we suggest using an app with timely postoperative care education as a standard part of care.Trial RegistrationNetherlands Trial Register NTR7182; https://www.trialregister.nl/trial/6992

A standardized workflow to improve the consent process among patients initiating an oral anticancer drug.

259 Background: The American Society of Clinical Oncology and The Oncology Nursing Society’s guidelines recommend that consent be obtained and patient education provided prior to oral anticancer drug (OACD) initiation. The aim of this quality improvement project was to improve documentation rates of consent and education prior to OACD initiation in an outpatient breast oncology clinic. Methods: Plan-Do-Study-Act (PDSA) methodology was used to identify the root causes of inadequate OACD documentation; and to evaluate a standardized OACD workflow that included a multidisciplinary (physician, nurse practitioner [NP], and administrative staff) checklist on the disposition sheet and standardized patient education material, used in the Columbia University Irving Medical Center Breast Oncology Clinic. New OACD prescriptions were identified in the electronic health record (EHR) from 2/1/18-4/1/18 (pre-intervention) and 6/5/18-8/17/18 (post-intervention). Documentation of consent and education were evaluated by EHR review. Consent (yes/no) was determined by physician documentation in either the corresponding clinic note or scanned consent form, and education (yes/no) was determined by NP documentation in the education section of the clinic note. Documentation rates were compared pre- and post-intervention. Results: Pre-intervention, 19 patients received a new OACD, and 0 (0%) had documentation of consent or patient education. Root cause analysis revealed the driver of inadequate documentation was the inability to identify patients with a new OACD prescription at the time of their clinic visit. After implementation of the OACD workflow, 23 patients initiated a new OACD, 15 (65.0%) had documentation of consent and 7 (30.0%) had OACD education documented in the EHR. Conclusions: After the first PDSA cycle, documentation of consent and education improved from baseline. However, improvement in both metrics are still needed. Patient volume, staff changes, and the format of the OACD checklist may have limited the efficacy of this intervention. In the next PDSA cycle, the consent process will be linked to the required OACD pre-approval process to further increase OACD documentation.

Improving outcomes for multi-drug-resistant tuberculosis in the Peruvian Amazon \u2013 a qualitative study exploring the experiences and perceptions of patients and healthcare professionals

BackgroundManagement for multi-drug-resistant tuberculosis (MDR-TB) is challenging and has poor patient outcomes. Peru has a high burden of MDR-TB. The Loreto region in the Peruvian Amazon is worst affected for reasons including high rates of poverty and poor healthcare access. Current evidence identifies factors that influence MDR-TB medication adherence, but there is limited understanding of the patient and healthcare professional (HCP) perspective, the HCP-patient relationship and other factors that influence outcomes. A qualitative investigation was conducted to explore and compare the experiences and perceptions of MDR-TB patients and their dedicated HCPs to inform future management strategies.MethodTwenty-six, semi-structured in-depth interviews were conducted with 15 MDR-TB patients and 11 HCPs who were purposively recruited from 4 of the worst affected districts of Iquitos (capital of the Loreto region). Field notes and transcripts of the two groups were analysed separately using thematic content analysis. Ethics approval was received from the Institutional Research Ethics Committee, Department of Health, Loreto, and the University of Birmingham Internal Research Ethics Committee.ResultsFour key themes influencing patient outcomes emerged in each participant group: personal patient factors, external factors, clinical factors, and the HCP-patient relationship. Personal factors included high standard patient and population knowledge and education, which can facilitate engagement with treatment by encouraging belief in evidence-based medicine, dispelling belief in natural medicines, health myths and stigma. External factors included the adverse effect of the financial impact of MDR-TB on patients and their families. An open, trusting and strong HCP-patient relationship emerged as a vitally important clinical factor influencing of patient outcomes. The results also provide valuable insight into the dynamic of the relationship and ways in which a good relationship can be fostered.ConclusionsThis study highlights the importance of financial support for patients, effective MDR-TB education and the role of the HCP-patient relationship. These findings add to the existing evidence base and provide insight into care improvements and policy changes that could improve outcomes if prioritised by local and national government.

Standardization of Education of Patients With Cancer in a Low- and Middle-Income Country: A Quality Improvement Project Using the Cancer and You Booklet.

PURPOSEThe Butaro Cancer Centre of Excellence is the first comprehensive referral cancer center in Rwanda and at its inception did not have a standardized patient education program. Partners in Health/Inshuti Mu Buzima and the Rwandan Ministry of Health conducted a quality improvement project to increase patient knowledge by implementing a standardized oncology education program using picture-based and culturally appropriate materials designed for patients with cancer in low- and middle-income countries.METHODSFour Rwandan nurses were trained to provide patient education using the Cancer and You education booklet created by Global Oncology. A pre- and post-test design was used to evaluate patients’ knowledge of cancer, treatment, and management of adverse effects. Nurses administered a posteducation questionnaire in Kinyarwanda to determine patients’ level of satisfaction with the education session and booklet. The four nurses were interviewed at the completion of the project for their feedback. A total of 40 oncology patients were included in the pilot project, of which 85% reported completing primary school or less.RESULTSOn average, participants improved 19% (95% CI, 13.9% to 24.1%; standard deviation, 16%) from pre- to postevaluation, demonstrating a significant increase in knowledge (P ≤ .001). Nearly all patients (97.5%) reported that they were either satisfied or very satisfied with the education program. Oncology nurses gave positive feedback, highlighting that it was helpful to have a standard tool for education with descriptive illustrations for those patients with low literacy.CONCLUSIONImplementation of a standardized patient education program demonstrated a statistically significant increase in patient knowledge and a high level of satisfaction among patients and nurses. The project serves as an example for other low- and middle-income countries looking to standardize oncology patient education.

Standardized patient methodology in mainland China: a nationwide survey

BackgroundTo describe the current status of standardized patient (SP) practice in mainland China.MethodsWe conducted a nationwide survey in 2016. One hundred and eighty-three SP educators (SPEs) responded to the questionnaire, representing 80 medical centers from 25 provinces in mainland China. All of these centers were affiliated with China Standardized Patients Practice Teaching Guidance. In the survey, we assessed the methods of SPs’ recruitment, hourly wage, how SPs were used and challenges of SP role. We also compared these data among the 4 different regions in China.ResultsIn mainland China, the most frequent range of SPs’ age was between 30 and 40 years (24.8%). The SPs were usually recruited by recommendations from the SPEs or a current SP (43.8%), as well as advertising in the hospitals (43.8%). The mean hourly wage was US$12.60 for teaching activities and US$18.82 for medical examinations. The median frequency for training SPs was 12.9 times per year. The SPs were used in areas such as internal medicine (89.6%), surgery (79.2%) and pediatrics (56.3%). The most challenging parts for the SPs were to remember all of the key points of the cases (51.9%) and portraying the emotions of the case (51.9%). Almost half of the SPs reported that, when interacting with medical students, they had difficulty in providing feedback in consistent with students’ learning objectives. SPs’ gender, age, rewards and scenarios playing were different significantly among the 4 geographic regions in China (P < 0.05).ConclusionsThis survey provided the reliable data on the current situation of SP application in China. SP activities have had an encouraging progress but regional development imbalance.

Strategies for reducing grade 2 and 3 adverse events due to immunotherapy in a Spanish university hospital.

e18295 Background: To develop an improvement project, the Lung Cancer Unit of Ramón y Cajal Hospital (Madrid) analyzed 45 patients treated with immunotherapy in 2017 and detected that 55% presented moderate-to-severe Adverse Events (AEs). Consequently, a specialized team from Ramon y Cajal Hospital and the ECO Foundation proposed to identify improvement areas that reduce grade 2 (G2) and 3 (G3) AEs. ECO is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. Methods: The team used as an instrument the American Society of Clinical Oncology (ASCO) Quality Training Program (QTP). A data collection process was conducted before attending the first out of three sessions of the QTP with the revision of medical records from lung cancer patients. The goal for the final QTP session in June 2018 was to reduce G2 and G3 AEs by 25%, by standardizing patient education sessions using ASCO guidelines for the management of immune-related AEs. Results: The data collected showed that G2 and G3 AEs had an impact on quality of care, specifically a treatment delay in 31% of patients, unscheduled visits in 19%, serious complications in 11% and patient dissatisfaction with the reporting system. The team created a cause and effect diagram, in which the most relevant causes were inadequate patient knowledge and a lack of communication with patients between visits. A run chart of the percentage of G2 and G3 AEs during 2017 displayed that G2 AEs were higher during January and August; and G3 AEs in February and December. The team, including patient advocates, prioritized the implementation of these short-term measures for patients: improvement of education, education follow-up, satisfaction questionnaire development and AE knowledge test. By June 2018, the resulting value of the “(mean + range)/standard deviation” formula for AEs perceived knowledge in patients increased from 5.4 to 11.1 points, the same value for patients’ AEs knowledge increased from 7.3 to 13.8 points, the percentage of G2 AEs reduced in 5% and the percentage of G3 AEs maintained in 0%. Conclusions: This improvement approach indicates the need to continue further quality projects in healthcare. Broader participation of Spanish hospitals in improvement initiatives will enhance the goal of a quality-oriented health care system.

GLA:D\xae Back: implementation of group-based patient education integrated with exercises to support self-management of back pain - protocol for a hybrid effectiveness-implementation study

BackgroundReassuring patient education and exercise therapy are widely recommended interventions for back pain in clinical guidelines. However, many patients are offered non-guideline endorsed options, and strategies for effective implementation of guideline-based care have not yet been developed. This protocol outlines the evaluation of a strategy for nationwide implementation of standardised patient education and exercise therapy for people with persistent or recurrent back pain in a hybrid implementation-effectiveness design. The strategy and the evaluation were planned using the framework of the Behaviour Change Wheel.MethodsThe main activity of the implementation strategy is a two-days course for physiotherapists and chiropractors in delivering patient education and exercise therapy that is aimed at supporting patient self-management. This comes with ready-to-use patient education materials and exercise programs. The clinical intervention is a group-based program consisting of two sessions of patient education and 8 weeks of supervised exercises. The program uses a cognitive-behavioural approach and the aim of the exercise component is to restore the patient’s ability and confidence to move freely. The implementation process is evaluated in a dynamic process monitoring the penetration, adoption and fidelity of the clinical intervention. The clinical intervention and potential effect mechanisms will be evaluated at the patient-level using measures of knowledge, skills, beliefs, performance, self-efficacy and success in self-management. The education of clinicians will be evaluated via clinician-level outcomes, including the Pain Attitudes and Beliefs Scale, the Practitioner Confidence Scale, and the Determinants of Implementation Behaviour Questionnaire. Effects at a national level will be investigated via data from national registries of health care utilisation and sick-leave.DiscussionThis implementation-effectiveness study is designed to evaluate the process of implementing an evidence-based intervention for back pain. It will inform the development of strategies for implementing evidence-based care for musculoskeletal pain conditions, it will enhance the understanding of mechanisms for developing patient self-management skills, and it will demonstrate the outcomes that are achievable in everyday clinical practice.Trial registrationClinicalTrials.gov NCT03570463. Registered 27 June 2018.

BMT Patient Education: Consistency and Understandability in a Complex Population; Creating a Standardized Patient Education Process for Blood and Marrow Transplant, a Single Institution Experience in an Academic Medical Center

Topic Significance & Study Purpose/Background/Rationale Blood and marrow transplant (BMT) patient care is complex, and patient education is paramount to improving outcomes [1]. Standardized patient education has shown to decrease length of stay and lower readmission rates [2]. Previous to this quality improvement project, patients reported inconsistent verbal and written education, and staff reported difficulty finding education documents. Content was outdated, multiple document versions existed in various locations, and materials were not evaluated for readability. The purpose of this project was to objectively curate the current catalog of patient education and increase use by nursing staff. Methods, Intervention, & Analysis A nursing-led committee was developed to review all current education. Those from open source websites or other non-peer reviewed sources were removed. Non-proprietary education was reviewed and new institution-specific material was developed using a standard template. The committee scored new education for actionability and understandability using a validated tool (PEMAT), modifying materials to maximize the score [3]. Scores for both measures can range from 0-100%, with 100% being ideal.3 All approved education was uploaded to an internal website, accessible by all staff. Findings & Interpretation An analysis of pre-intervention education showed 68 content contradictions. After the intervention, 37 pieces of new, standard education were approved.. The average PEMAT score of new education is 92% for both measures. On average patient education is accessed by staff 30 times daily. Discussion & Implications The development of a committee structure and validated assessment tool answered concerns from staff and patients about patient education. A shared website allows for centralized control of education.. The committee structure and review process can be used in other practices to organize and improve complex education delivered to cancer patients.

Strides Toward Improving Post-Hematopoietic Progenitor Stem Cell Transplant Vaccination Compliance

Topic Significance & Study Purpose/Background/Rationale Hematopoietic stem cell transplant (HCT) recipients are at risk for losing natural and acquired immunities, that can lead to post-HCT infectious complications. Post-HCT re-vaccination is considered a standard of care by FACT and NMDP. The current work is a quality improvement project to improve vaccination compliance. Programmatic deficiencies were identified and a Plan Do Study Act (PDSA) was implemented. Methods, Intervention, & Analysis A retrospective audit of recipient charts was performed for vaccination schedule completion and compliance by September 30, 2016. The audit is a snapshot of patients that have received vaccines at the scheduled intervals or completed the full vaccination schedule. Compliance was defined as completion of scheduled vaccination within 3 months of target date unless otherwise documented. Relapse, delayed, held for GVHD/immunosuppressant's or steroids, and refusal with proper documentation are considered complaint. Deceased patients within 3 months of target date were excluded. Overall compliance is defined as: at the 24-month landmark, which patients have received vaccinations at all landmarks based on the compliance guidelines. 21-months after implementing the PDSA, recipient charts were audited for vaccination schedule completion and compliance by June 30, 2018. Findings & Interpretation Identified deficiencies included an infrastructure that did not allow for vaccinations to be given in the same clinic as the patient's appointment with their transplant physician, lack of communication between the clinics, inconsistent orders and documentation, and a lack of knowledge with staff and patients. The PDSA interventions included a standardized vaccination order sheet, appointment identification, staff and patient education, reminder cards, and policy updates. After implementing the PDSA, the overall compliance has increased from 56.7% to 72% and overall completion has increased from 76% to 83.8% over a 21-month period. Discussion & Implications Vaccination compliance requires standardization of practices, effective communication, and adequate documentation when caring for post-transplant patients. Success of a post transplantation vaccination program requires unwavering commitment to provide support and oversight for effective vaccination strategies. Retrospective vaccination chart audits continue quarterly to achieve an 80% compliance rate.

A quasi-experimental study examining a nurse-led education program to improve knowledge, self-care, and reduce readmission for individuals with heart failure

Background: Heart failure affects more than 6 million Americans and an estimated 23 million people worldwide. Inadequate self-care is associated with readmissions and are identified as a marker for poor health outcomes. Nurse-led heart failure inpatient hospital education has been demonstrated to improve knowledge, self-care behaviors and in some studies to reduce 30-day readmissions.Aims/Objectives: To evaluate the impact of nurse-led heart failure patient education on knowledge, self-care behaviors, and all cause 30-day hospital readmission.Design: Quasi-experimental pre-test and post-test on a convenient sample on two cardiac units at a large urban facility in the North East region of the United States.Methods: An evidence-based standardized heart failure patient education program based on the American Colleges of Cardiology and American Heart Association guidelines was implemented with a telephone follow-up at 7, 30, and 90 days post-discharge. The duration of the study was from September 2015 to February 2016. A convenience sample of (N = 29) individuals diagnosed with heart failure was asked to complete Dutch Heart Failure Knowledge Scale and Self-care Heart Failure Index.Results: A significant difference was found in knowledge at 7 day (P ≤ .001) and 90 day (P ≤ .032), self-care maintenance at 7 day (P ≤ .000) and 30 day (P ≤ .000), self-care management at 7 day (P ≤ .001) and 30-day (P≤.013). A statistically significant difference was found in self-care confidence at 30-day (P ≤ .017) but not at 7 day follow-up call. A statistically significant improvement in 30-day readmission was not found (P ≥ .05).Conclusion: Findings suggest the importance of developing patient education programs that are focused on improving knowledge and self-care behaviors for heart failure patients. Nurses are uniquely qualified to implement such programs that can improve health outcomes and need to accommodate evidence-based recommendations to global practice settings.

A Simulation-Based Workshop to Improve Dermatologists' Communication Skills: A Pilot for Continuing Medical Education.

IntroductionCommunication skills influence the quality of health care and patient experience; both may affect provider reimbursement. There are few opportunities available for practicing physicians to receive direct feedback on communication in patient encounters. The purpose of this simulation-based patient encounter workshop was for dermatologists to practice and obtain feedback on their communication skills.MethodsIn March 2016, dermatologists participated in a workshop with four simulated patient encounters. Cases were developed based on a prior needs assessment. Standardized patient educators evaluated participants’ communication using the Master Interview Rating Scale and provided verbal feedback. Physicians rated the usefulness of the simulation and the feedback received through a survey upon workshop completion.ResultsOf the 170 physicians who registered, 103 participated in the simulation. The workshop was highly rated in meeting its three learning objectives (score of 4.5–4.6 out of a maximum score of 5). The lowest-rated communication skills were as follows: allowing the patient to share their narrative thread (3.1), summarizing the patient’s history from the provider (3.8), and assessing patient understanding (3.8).ConclusionsParticipants reported that this communication workshop effectively satisfied its learning objectives. Opportunities to practice and improve communication skills as part of continuing medical education will benefit the clinical experience of patients and physicians alike, and the workshop may be formatted to serve physicians of other specialties. The lowest-scoring communication areas identified in this study present an opportunity to develop a tailored curriculum for physician–patient communication in the future.