Patient participation is limited. Background. More information is no solution PATIENT CHECKS HOSPITAL?

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1 PATIENT CHECKS HOSPITAL? Dirk de Korne PhD MSc - José Rekko RN - Lara Vankan MSc Fatma Unal RN - Claudia van Gaalen MSc - Koen van Overdam MD FEBOpht - Francis Hiddema MD 29 th ISQua-2489, Geneva - October 23, 2012 Background Patient participation is limited Correct and sufficient postsurgical patient information major safety issue Non-compliance / non-adherence to instructions reported as important barrier for right care at the right moment > However, many studies show role of patients as active participators in safety is limited: > well listening (Aujolat et al. 2007; Sharf 1988) > speaking up when concerned (McWilliams et al 1997; Paterson 2001) (Longtin et al, 2010; Samoocha et al. 2010) More information is no solution > More talking, more websites, more information is not a solution > 20% of Dutch patients more anxious after taking online health information (De Bruin et al. 2012) > Standardization and checklist-use in hospitals seems increasing, but still there is high variation between departments and lack of compliance (Haynes et al. 2009; Huis et al. 2012; Borchard et al. 2012; Levy et al. 2012) > None of the cases completely executed all items on the checklist, and the average number of checklist items performed in the observed cases was 4 of 13. (Levy et al. 2012) 1

Background Patient participation is limited Correct and sufficient postsurgical patient information major safety issue Non-compliance / non-adherence to instructions reported as important barrier for

2 Patient pathway as journey Patient Fear reduction Traveller Taxi service Planning system Critical check points Time out Crew Resource Management Black box Marking (De Korne et al. 2010) Het Oogziekenhuis Rotterdam Main intervention Research question > Give the patient your checklist > To which extend will a patient-led hospital exit checklist for retina patients result in less postoperative questions and improve patient safety? Methods > Mixed methods case study design > Between December 2011 en January 2012, 110 patients who underwent retinal surgery in the Rotterdam Eye Hospital (the Netherlands) received a 11-item checklist on the day of surgery. > Before and after use of the checklist, focus groups with nurses (2x5) and patients (1x12) were held to assess their views and experiences with the checklist. 2

result in less postoperative questions and improve patient safety?

3 The Rotterdam Eye Hospital Retina surgery vitrectomy > 145,000 outpatient visits (510 p/day) > 14,000 surgeries (50 p/day) > 2,000 retina surgeries > 4 OR s + 2 Daysurgery OR s > 9 beds > 93 % daycase > 50 % outside of Rotterdam > 26,000 emergency visits (70 p/day )(7/24) > 25 outpatient rooms > 400 employees > 30 ophthalmologists + 20 residents > Interior of ocular > Remove vitreous humour > Reposition retina with fluid > Potentially laser > Replace fluid with gas / air /oil From a staff-led checklist 11-item retina checklist > A checklist was constructed with a multidisciplinary retina team > Retinal surgeons > Surgical nurses > Ward nurses. > sub specialized Retinal nurses > Most necessary post-operative items that patients need to know at when exit the hospital > Printed on credit card size for nurse use > However: not used by nurses DOMAIN Physical safety Medication safety Post-op hospital contact Patient peer community ITEM 1. Posture advice 2. Eye protection 3. Activities of daily living (ADL) 4. Prescription checked 5. Eye drops administering 6. Medication reconciliation 7. Emergency 8. Complaints 9. Follow-up visit 10. Helpdesk 11. Retina patient forum. To a patient-led checklist On paper MyRetinaPad Checklist bij uw vertrek uit Het Oogziekenhuis Rotterdam > Patient receives checklist on day of surgery > During the exit interview before leaving the hospital, the patient uses the checklist to check with the nurse to which extend information on the issues mentioned has been delivered and understood. Als patient heeft u een regierol bij de behandeling aan uw ogen. Gebruik daarom deze checklijst om bij vertrek vast te stellen of u voldoende informatie heeft ontvangen. De volgende informatie heb ik gekregen en begrepen (kruis aan): Houdingsadvies (en eventueel hulpmiddel) Bescherming van het oog Leefregels (wat mag ik wel/niet doen) Druppelen (zelf druppelen of met hulp) Instructie voor gebruik van medicijnen (ook pijnstilling en evt. andere oogmedicijnen die ik al gebruik) Informatie over mogelijke klachten Wat te doen bij spoedgevallen Het recept dat ik voor de operatie al ontvangen heb is gecontroleerd Ik heb een brief over het retinaforum ontvangen Visitekaartje van de retina telefonische helpdesk Vervolgafspraak (dag na de operatie groepsvoorlichting en afspraak retinachirurg) Vragen die ik nog moet stellen voor ik het ziekenhuis verlaat: 3

humour > Reposition retina with fluid > Potentially laser > Replace fluid with gas / air /oil From a staff-led checklist 11-item retina checklist > A checklist was constructed with a

and as eyepad > From August 2012 on, patients who underwent retinal surgery in the Rotterdam Eye Hospital received a eyepad with the 11-item checklist on the day of surgery > Focus attention by being

4 and as eyepad > From August 2012 on, patients who underwent retinal surgery in the Rotterdam Eye Hospital received a eyepad with the 11-item checklist on the day of surgery > Focus attention by being actively involved and moving a cursor > Using of ipad for other things during day of surgery Non-checked items paper and eyepad checklist Medication safety Post-op hospital contact Physical safety AV=10.8% Nurse reported effects > Nurses indicate that they appreciate the checklist, however they prefer to use it by themselves and feel barriers to empower and inquire patients > Some nurses do not feel capable since they are not familiar with ipads and computers > Nurses indicate that patients and accompanies are more focussed during pre-op waiting 4

5 Patient reported effects Number of questions after retina surgery (per month, >0 days postop) > Patient stress that they trust the hospital and do not feel much incentivized to use the checklist paper based checklist eyepad checklist > Accompanying family members play an important role in the actual use of the checklist during pre and post operative process number of helpdesk retina questions > Open spaces on the checklist are mostly used to question the hospital on medication issues percentage of retina questions of total questions > Patient questions for additional apps, both informative, educational and fun 10 0 Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Discussion From participation to empowerment > Patient participation has been suggested as major intervention for improvement on quality and safety of health care > Both health care workers and patients need however to adjust their views and share responsibility and power > Patient em power ment > Who should facilitate? > Patient participation is a process of behaviour change, where active participation needs to be stimulated and rewarded > More advanced technology to stimulate active participation (f.e. integration with personal medical device) should be considered Look forward! Thank you > Dirk de Korne > d.dekorne@eyehospital.nl 5

questions > Open spaces on the checklist are mostly used to question the hospital on medication issues 30 20 percentage of retina questions of total questions > Patient questions for additional apps,

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