Smith Radford, Cross Katie
Northern Devon Healthcare NHS Trust, United Kingdom.
BMJ Qual Improv Rep. 2016 Apr 7;5(1). doi: 10.1136/bmjquality.u209588.w3959. eCollection 2016.
An appendicectomy is one of the most common operations performed in North Devon District Hospital (NDDH) with over 200 carried out between 2013 to 2014. Despite this, a patient information leaflet (PIL) about appendicectomy is unavailable, which is compromising standards of care and uncompliant with Trust policy. This project aimed to establish levels of written information offered to patients undergoing an appendicectomy, develop a PIL, and assess its impact on the provision of written information using Plan-Do-Study-Act (PDSA) methodology. Case notes of patients operated on between January 2013 to October 2014 were randomly sampled at baseline. The primary outcome measure was whether written information was offered, retrospectively determined by reviewing the medical record. A PIL was then designed following a standard protocol, published on NDDH's website and distributed onto surgical wards. Posters were displayed in staff rooms to encourage use of the PIL for PDSA cycle 1. An article further promoting the PIL was written for the wards monthly newsletter and a local presentation was delivered for PDSA cycle 2. Patients views about the PIL were assessed prospectively using a questionnaire. The primary outcome was measured at 10 weeks following PDSA cycle 1 and at 5 months following PDSA cycle 2. 17% (5/30) of patients were offered written information at baseline. Following PDSA cycle 1, this rose substantially to 53% (8/15) but rates fell to 46% (7/15) following PDSA cycle 2. 89% of patients (8/9) surveyed agreed or strongly agreed that the PIL was helpful. This project indicates that provision of written information is poor despite it being highly valued by patients. The first ever Trust appendicectomy PIL has been established which substantially improved provision of written information after 10 weeks. However, continued education of staff is essential to embed good practice over the long term.
阑尾切除术是北德文郡区医院(NDDH)最常见的手术之一,2013年至2014年间实施了200多例。尽管如此,目前仍没有关于阑尾切除术的患者信息手册(PIL),这影响了护理标准,也不符合信托政策。本项目旨在确定为接受阑尾切除术的患者提供的书面信息水平,制定一份患者信息手册,并使用计划-执行-研究-行动(PDSA)方法评估其对书面信息提供情况的影响。在基线时,随机抽取了2013年1月至2014年10月期间接受手术的患者的病历。主要结局指标是是否提供了书面信息,通过查阅病历进行回顾性确定。然后按照标准方案设计了一份患者信息手册,发布在NDDH的网站上,并分发给外科病房。在员工休息室张贴海报,鼓励在PDSA循环1中使用该手册。为病房月度通讯撰写了一篇进一步推广该手册的文章,并在PDSA循环2中进行了一次本地展示。使用问卷前瞻性评估患者对该手册的看法。在PDSA循环1后10周和PDSA循环2后5个月测量主要结局指标。基线时,17%(5/30)的患者获得了书面信息。在PDSA循环1之后,这一比例大幅上升至53%(8/15),但在PDSA循环2之后降至46%(7/15)。89%的受访患者(8/9)同意或强烈同意该手册很有帮助。该项目表明,尽管患者高度重视书面信息的提供,但实际情况却很差。首个信托阑尾切除术患者信息手册已经制定,10周后书面信息的提供情况有了显著改善。然而,长期持续开展员工教育对于将良好做法深入人心至关重要。