Steffenino Giuseppe, Aimar Federica, Bogetti Mariachiara, Dutto Maria Stefania, Dutto Monica, Lice Giulietta, Mogna Aldo, Tomatis Marilena, Conte Laura
Laboratorio di Emodinamica, A.O. S. Croce e Carle, Cuneo.
Ital Heart J Suppl. 2005 Jan;6(1):35-41.
A new patient consent form has recently been adopted in our Institution, with a uniformly written text to be used for all medical procedures and interventions. It is accompanied by a separate information sheet, explaining both the details and the risk/benefit profile for each specific procedure/intervention. It should be given to the patient as early as possible after the procedure/intervention is planned. Testing the effectiveness of this new information policy has been included into the quality assurance goals by our nursing staff.
From mid April to mid June 2004 a questionnaire was administered to all patients who had undergone an elective cardiac interventional procedure. The timing, manner and perceived completeness of the information received by patients was investigated by 14 yes/no or multiple choice questions. A goal of <5% deviation from a 100% standard was set for all indicators.
Two hundred and thirty-eight valid questionnaires were obtained out of 308 consecutive procedures. Seven patients (3%) refused the questionnaire. The response rate was >90% for each question. Seventy-eight patients (33%) had a history of cardiac interventional procedures. The information sheet had been received before the procedure in 93% of cases, and this had happened in the ward in 58% of cases; the procedure had been performed at least 1 hour after receipt of the information sheet in 83% of cases. Twenty-seven patients (13%) stated they had not read the information sheet, in most cases (92%) because they felt they already knew enough. Among patients who had read the information sheet, 99% deemed it could be easily understood. Difficulties in asking questions were reported by 6% of patients. When questions had been asked, the nursing staff was addressed in 42% of cases, and the answers were rated as clear in 98% of cases. The consent form was not read at all by 13% of patients, due to alleged lack of time, and was not read completely by another 15%; 98% of those who had read it, however, found it was fairly understandable.
The effectiveness of our new patient information policy seems to approach our quality goals, and is liable to further improvement. The nursing staff of the cardiac catheterization unit is involved in the patient information process, and has full competence to study this issue.
我们机构最近采用了一种新的患者同意书,其文本统一,适用于所有医疗程序和干预措施。同时还附有一份单独的信息表,解释每种特定程序/干预措施的详细情况以及风险/益处概况。应在计划进行程序/干预措施后尽早将其交给患者。我们的护理人员已将测试这一新信息政策的有效性纳入质量保证目标。
2004年4月中旬至6月中旬,对所有接受择期心脏介入手术的患者进行了问卷调查。通过14个是/否或多项选择题,调查患者接收信息的时间、方式以及对信息完整性的感知。为所有指标设定的目标是与100%的标准偏差<5%。
在308例连续手术中,共获得238份有效问卷。7名患者(3%)拒绝填写问卷。每个问题的回答率均>90%。78名患者(33%)有心脏介入手术史。93%的病例在手术前收到了信息表,其中58%是在病房收到的;83%的病例在收到信息表至少1小时后进行了手术。27名患者(13%)表示未阅读信息表,大多数情况(92%)是因为他们觉得自己已经了解得足够多了。在阅读了信息表的患者中,99%认为其易于理解。6%的患者报告在提问时有困难。当提出问题时,42%的情况是向护理人员咨询,98%的回答被认为清晰明了。13%的患者根本没有阅读同意书,原因是据称时间不够,另有%的患者没有完整阅读;然而,98%阅读过同意书的患者认为其相当易懂。
我们新的患者信息政策的有效性似乎接近我们的质量目标,并且有进一步改进的空间。心脏导管室的护理人员参与了患者信息告知过程,并且完全有能力研究这个问题。