Stolk-Vos Aline C, van der Steen Jolet Je, Drossaert Constance Hc, Braakman-Jansen Annemarie, Zijlmans Bart Lm, Kranenburg Leonieke W, de Korne Dirk F
Rotterdam Ophthalmic Institute, Rotterdam, Netherlands.
Section Health Services, Management and Organisation, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
JMIR Perioper Med. 2018 Jul 16;1(2):e3. doi: 10.2196/periop.9463.
Surgery holds high risk for iatrogenic patient harm. Correct and sufficient communication and information during the surgical process is a root solution for preventing patient harm. Information technology may substantially contribute to engaging patients in this process.
To explore the feasibility of a digital patient-led checklist for cataract surgery, we evaluated the experiences of patients and nurses who have used this novel tool with a focus on use, appreciation, and impact.
A multidisciplinary team, including cataract surgeons, nurses, pharmacists and administrative representatives developed a 19-item digital patient-led checklist for cataract patients who underwent surgery in an ambulatory setting. This "EYEpad" checklist was distributed to patients and their companions during their hospital visit via an application on a tablet. It contained necessary information the patient should have received before or during the surgical preparation (8 items), before anesthesia (2 items), and before discharge (9 items). Patients and their companions were invited to actively indicate the information they received, or information discussed with them, by ticking on the EYEpad. Our qualitative research design included semi-structured individual interviews with 17 patients and a focus group involving 6 nurses. The transcripts were analyzed by 2 independent coders using both deductive and inductive coding.
All but one of the 17 patients used the EYEpad, occasionally assisted by his or her companion (usually the partner). In several cases, the checklist was completed by the companion. Most patients felt positively about the usability of the EYEpad. Yet, for most of the patients, it was not clear why they received the checklist. Only 4 of them indicated that they understood that the EYEpad was used to determine if there were sufficient and correct information discussed or checked by the nurses. Although most nurses agreed the EYEpad was easy to use and could be a useful tool for improving patient engagement for improving safety, they felt that not all elderly patients were willing or capable of using it and it interfered with the existing surgical process. They also anticipated the need to spend more time explaining the purpose and use of the EYEpad.
Our results showed that a digital patient-led checklist is a potentially valid way to increase patient participation in safety improvement efforts, even among elderly patients. It also illustrates the crucial role nurses play in the implementation and diffusion of technological innovations. Increased patient participation will only improve safety when both healthcare workers and patients feel empowered to share responsibility and balance their power.
手术对患者造成医源性伤害的风险很高。手术过程中正确且充分的沟通与信息提供是预防患者伤害的根本解决办法。信息技术可能在促使患者参与这一过程中发挥重要作用。
为探讨白内障手术数字患者主导检查表的可行性，我们评估了使用这一新型工具的患者和护士的体验，重点关注其使用情况、满意度及影响。
一个多学科团队，包括白内障外科医生、护士、药剂师和行政代表，为在门诊环境中接受手术的白内障患者制定了一份包含19项内容的数字患者主导检查表。这份“EYEpad”检查表在患者就诊期间通过平板电脑上的应用程序分发给患者及其陪同人员。它包含患者在手术准备前或过程中应已收到的必要信息（8项）、麻醉前的信息（2项）以及出院前的信息（9项）。患者及其陪同人员被邀请通过在EYEpad上打勾来积极表明他们收到的信息或与他们讨论过的信息。我们的定性研究设计包括对17名患者进行半结构化个人访谈以及对6名护士进行焦点小组访谈。两位独立编码员使用演绎和归纳编码对访谈记录进行分析。
17名患者中除1人外都使用了EYEpad，偶尔由其陪同人员（通常是伴侣）协助。在某些情况下，检查表由陪同人员完成。大多数患者对EYEpad的易用性持积极态度。然而，对于大多数患者来说，不清楚为何收到这份检查表。只有4人表示他们明白EYEpad用于确定护士是否讨论或核对了足够且正确的信息。尽管大多数护士同意EYEpad易于使用，并且可能是提高患者参与度以改善安全性的有用工具，但他们觉得并非所有老年患者都愿意或有能力使用它，而且它干扰了现有的手术流程。他们还预计需要花费更多时间解释EYEpad的目的和用途。
我们的结果表明，数字患者主导检查表是增加患者参与安全改进工作的一种潜在有效方式，即使在老年患者中也是如此。它还说明了护士在技术创新的实施和推广中所起的关键作用。只有当医护人员和患者都感到有能力分担责任并平衡权力时，增加患者参与度才会提高安全性。
