Nursing students use of teach-back to improve patients' knowledge and satisfaction: A quality improvement project

BackgroundNurses provide education on medications to hospitalized patients and this intervention is measured by patient's satisfaction on the Hospital Consumer Assessment of Healthcare Providers and Systems Survey [HCAHPS] (Center for Medicare & Medicaid Services[CMS], 2008).PurposeNursing students implement the teach-back method in a quality improvement project to improve patients' knowledge of medications and satisfaction on the HCAHPS survey. Specific aim 1: increase nursing students use of teach-back from the current state of 0% to 80% of their patient encounters; Specific aim 2: ensure that 80% of the patients approached can state the name, purpose and side effects of their current medications; Specific aim 3: have 80% of the patients satisfied with their medication teaching.MethodsThe Model for Improvement framework from the Institute for Healthcare Improvement was used (Ogrinc et al., 2012). Process and outcome measures and Plan-Do-Study-Act cycles were analyzed.ResultsSenior nursing students used teach back on 82.9%% of their patient encounters. Of the N = 55 patients who received the intervention, 58.2% could state the name and purpose, and 50.9% knew the side effects of their medications. HCAHPS survey responses did not achieve the benchmarks of 77.2% and 52.3% for “always” responses for medication education questions. However, patient satisfaction was measured at 96.4% with the One Minute Evaluation (Appendix A) by nursing students following the intervention.ConclusionIntegrating QI into the clinical environment is a method to not only increase patient outcomes but also exposes students to the methods of QI. Although the intervention did not meet the benchmark for patient satisfaction in “Communication about Medicines” category as measured by HCAHPS survey results, the teach-back method was an effective evidence-based tool for improving patient knowledge of medications.     

Providing Equitable Postpartum Breastfeeding Support at an Urban Academic Hospital

ObjectiveTo equitably increase exclusive breastfeeding at hospital discharge among obstetrician/gynecologist resident service clients by 20% over 8 weeks.DesignThis quality improvement project used a plan–do–study–act format to implement interventions with patients and staff based on the Baby-Friendly Hospital Initiative. Run charts were used to evaluate intervention effects over time according to Institute for Healthcare Improvement criteria, and outcome data informed tests of change for subsequent cycles.Setting/Local ProblemPostpartum clients of an obstetrician/gynecologist resident service were found to be less likely to exclusively breastfeed compared to the hospital average (7% vs. 34%) at baseline. A baseline resident client survey (n = 20) showed that 75% believed it best to give human milk plus formula.ParticipantsOf 186 postpartum participants, 65% identified as breastfeeding at the time of birth (53% of Hispanic participants [n = 99], 52% of non-Hispanic Black participants [n = 44], and 73% of non-Hispanic White participants [n = 33]).Interventions/MeasuresThe World Health Organization’s revised Implementation Guidance for the Baby-Friendly Hospital Initiative provided the basis for all interventions, which included a prenatal infant feeding plan, postpartum educational video with teach-back, cue-based feeding log, breastfeeding education guidelines for postpartum nurses, and team engagement via huddles. Measures assessed whether each intervention met the intended goals.ResultsRates of exclusive breastfeeding at hospital discharge were 7% at baseline and 13% after implementation. Rates of exclusive breastfeeding among Black clients were 0% at baseline and 16% after implementation. Clients demonstrated Baby-Friendly knowledge (teach-back average, 89%) but continued to supplement with formula, most often related to supply concerns (65%).ConclusionIntentionally equitable implementation of the Baby-Friendly steps may ameliorate racial disparities in breastfeeding during the early postpartum period. Preparing families to exclusively breastfeed should begin prenatally.     

Alternatives to opioids for pain management in the emergency department decreases opioid usage and maintains patient satisfaction

Objective

The objective of this study was to assess opioid use in an emergency department following the development and implementation of an alternative to opioids (ALTO)-first approach to pain management. The study also assessed how implementation affected patient satisfaction scores.

The GAP-ED Project: Improving Care for Elderly Patients Presenting to the Emergency Department

BackgroundOlder adults presenting to the emergency department (ED) represent a highly vulnerable patient population with complex conditions and multiple comorbidities. The introduction of a Geriatric and Palliative (GAP)-ED partnership may be an effective strategy to avoid unneeded admissions and improve outcomes for this population.ObjectivesThe primary objective was to decrease 30-day revisit and hospitalization rates in this population through identifying patients that could be safely sent home with connection to community resources. Secondary outcomes included achieving high patient and family satisfaction scores assessed through follow-up interviews.MethodsThe GAP-ED intervention included the placement of a Specialist in the ED to coordinate care for older adults presenting to the ED who were likely to be discharged home. Independent t-tests and chi-squared tests were used to assess for changes in outcomes between the intervention group and a blocked matched historical usual-care group.ResultsThere was no significant difference in 30-day ED revisits between the two groups, but there was a statistically significant reduction in hospital admissions from these 30-day revisits. Patient and family satisfaction with the presence of the GAP-ED Specialist was high.ConclusionThe implementation of a GAP-ED partnership and use of a GAP-ED Specialist is an effective means of reducing hospitalization in older adults revisiting the ED.     

Incorporating Hourly Rounding to Increase Emergency Department Patient Satisfaction: A Quality Improvement Approach

ProblemPatient satisfaction is an important factor that influences the perceived quality of care delivered. In an effort to meet patient expectations, a process improvement initiative involving hourly rounding was implemented to improve low patient satisfaction scores.MethodsThis project took place over 23 months and consisted of 4 phases (baseline, intervention I, break, and intervention II). During the intervention phases, self-reported hourly rounding was tracked on a daily basis. Compliance with rounding and patient satisfaction results were provided to staff during unit meetings and were displayed on a visual tracker board. Weekly 5-minute customer service training was provided to all staff. During the baseline and break phases, hourly rounding was not tracked. However, patient satisfaction data were still collected through the Interactive Customer Evaluation system. Three variables were measured using a 5-point Likert scale: overall patient satisfaction, patient perception of staff attitude, and whether the health care team answered all patient questions/concerns.ResultsHourly rounding compliance was 39% during intervention I and 51% during intervention II. Approximately 0.01% of patients submitted satisfaction data. From baseline to conclusion of intervention II, overall patient satisfaction increased from 52% to 73%; perception of staff attitude increased from 70% to 84%; and whether the health care team answered all patient questions/concerns increased from 63% to 81%.DiscussionThere is a positive relationship between hourly rounding and patient satisfaction scores. Despite low compliance with hourly rounding, patient satisfaction increased for all 3 variables measured. To achieve a change in culture with hourly rounding compliance, nurse managers must consistently monitor staff compliance with hourly rounding.     

Creating a Rapid Assessment Zone with Limited Emergency Department Capacity Decreases Patients Leaving Without Being Seen: A Quality Improvement Initiative

IntroductionPatients leaving the emergency department before treatment (left without being seen) result in increased risks to patients and loss of revenue to the hospital system. Rapid assessment zones, where patients can be quickly evaluated and treated, have the potential to improve ED throughput and decrease the rates of patients leaving without being seen. We sought to evaluate the impact of a rapid assessment zone on the rate of patients leaving without being seen.MethodsA pre- and post-quality improvement process was performed to examine the impact of implementing a rapid assessment zone process at an urban community hospital emergency department. Through a structured, multidisciplinary approach using the Plan, Do, Check, Act Deming Cycle of process improvement, the triage area was redesigned to include 8 rapid assessment rooms and shifted additional ED staff, including nurses and providers, into this space. Rates of patients who left without being seen, median arrival to provider times, and discharge length of stay between the pre- and postintervention periods were compared using parametric and nonparametric tests when appropriate.ResultsImplementation of the rapid assessment zone occurred February 1, 2021, with 42,115 ED visits eligible for analysis; 20,731 visits before implementation and 21,384 visits after implementation. All metrics improved from the 6 months before intervention to the 6 month after intervention: rate of patients who left without being seen (5.64% vs 2.55%; c² = 258.13; P < .01), median arrival to provider time in minutes (28 vs 11; P < .01), and median discharge length of stay in minutes (205 vs 163; P < .01).DiscussionThrough collaboration and an interdisciplinary team approach, leaders and staff developed and implemented a rapid assessment zone that reduced multiple throughput metrics.     

回馈教育模式在永久性肠造口患者中的应用

目的:探讨回馈教育模式在永久性肠造口患者中的应用效果及对患者健康素养、自我护理能力、心理韧性的影响。方法:采用便利抽样法,选取2019年1—10月滨州医学院烟台附院胃肠外科收治的70例直肠癌术后永久性肠造口患者为研究对象,于患者入院、术前、术后、出院和造口门诊阶段实施回馈教育模式的造口宣教。干预前后分别采用健康素养调查表(HLMS)、自我护理能力测评表(ESCA)、心理韧性量表(CD-RISC)对患者的健康素养、自我护理能力、心理韧性进行评价。结果:干预后患者的HLMS信息获取能力、经济支持意愿、交流互动能力、改善健康意愿维度得分均高于干预前,干预前后比较差异有统计学意义(P<0.05)。干预后患者ESCA的自我护理技能、自我责任感、自我概念、健康知识水平维度得分高于干预前,干预前后比较差异有统计学意义(P<0.05)。干预后患者CD-RISC的坚韧性、力量性、乐观性维度得分高于干预前,干预前后比较差异有统计学意义(P<0.05)。结论:对永久性肠造口患者实施回馈教育,能提高患者的健康素养和自我护理能力,改善患者心理韧性。     

The Effect of Implementing Bar-Code Medication Administration in an Emergency Department on Medication Administration Errors and Nursing Satisfaction

IntroductionBar-code medication administration has been shown to reduce medication errors in inpatient settings with limited studies on its use in emergency departments. In addition, no studies have evaluated nursing satisfaction with implementing bar-code medication administration in an emergency department. This study was designed to determine the impact of implementing bar-code medication administration in an emergency department on medication errors and nursing satisfaction.MethodsThis is a before-and-after study, with no control group, of a bar-code medication administration intervention conducted in a community hospital emergency department. Direct observation was used to compare medication error rates before and 3 months after implementing bar-code medication administration. The Medication Administration System—Nurses Assessment of Satisfaction survey was used to assess the impact on nursing satisfaction before and 1 month after bar-code medication administration implementation.ResultsA total of 676 medication administrations were observed in the period before bar-code medication administration implementation and 656 after. The medication administration error rate preimplementation was 2.96% with “wrong dose” errors being the most common. After bar-code medication administration implementation, the medication administration error rate fell to 0.76%, a relative reduction of 74.2% (Fisher exact P < 0.01). The average (SD) Medication Administration System—Nurses Assessment of Satisfaction score preimplementation was 2.60 (0.75) and improved to 2.29 (0.66) (t = 2.00, P = 0.05) 1 month post implementation.DiscussionImplementing bar-code medication administration in a community emergency department was associated with a decrease in medication administration errors and an improvement in Medication Administration System—Nurses Assessment of Satisfaction scores. The results of this study suggest a benefit of bar-code medication administration in reducing medication administration errors and improved nursing satisfaction in the emergency department.     

Satisfaction levels with physical therapy in hospitalized patients

BackgroundPatient's satisfaction level is considered an indicator that interferes with interventions effectiveness. There is evidence from other health professionals that patients with higher satisfaction level recover faster. However, benefits toward physical therapy intervention is poorly known.ObjectiveTo measure the inpatient satisfaction level receiving physical therapy care and to evaluate which aspects of these treatments are flawed.MethodsPatients admitted to hospital were evaluated using MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) that scores from 1 to 5 (higher values indicate higher satisfaction) for each item. Patients clinical and demographic characteristics and the Global Perceived Effect (GPE) were also collected. Exploratory factor analysis was conducted.Results200 patients were evaluated (50.9 ± 18.81 years, 58% male). Most of MRPS items were above 4. The highest scoring item (4.75) was physical therapist's respect to the patient. The lowest scoring item (1.82) was in relation to physical therapy guidelines at hospital discharge. Mean MRPS total score and GPE were 46.09 ± 4.93 and 2.18 ± 1.18, respectively.ConclusionThe majority of patients are satisfied and showed improvement after physical therapy treatment. There is the need for advances and intervention in relation to physical therapy guidelines at hospital discharge. MRPS instrument proved to be appropriate to measure inpatient's satisfaction level with physical therapy care.     

Educational intervention for patients with head and neck cancer in the discharge phase

PurposeThe consequences of head and neck cancer (HNC) treatment have great impact on patients' lives. Despite the importance of preparing patients for the period after discharge, patients frequently experience a lack of information. Aims of the study were to develop a nurse-led educational intervention to provide information during a discharge interview and to investigate the effects of the intervention on informational needs and satisfaction with information in HNC patients.MethodsA total of 48 patients participated in this quasi-experimental study. The control group (n = 26) received standard care, which included a short interview using the patients' discharge letter dictated by the nurse. The intervention group (n = 22) received the educational intervention, namely a discharge interview where trained nurses used a checklist to inform patients about: general information, wound-care, physical-social problems, work and finances. Effects associated with discharge interview were measured with the Patient Information Need Questionnaire (PINQ) and the Satisfaction with Cancer Information Profile.ResultsThe findings showed that patients need information concerning: illness, treatment, side-effects, physical fitness, impact on functioning, duration of recovery time and impact on quality of life. The educational intervention had no significant effect on the informational needs or the level of satisfaction with information.ConclusionsA nurse-led intervention to provide discharge information was developed however no effects on patient outcomes were found. Nurses need to use an instrument to assess the informational needs of patients prior to the discharge interview. The effects of the educational intervention need to be tested in a larger group of patients.     

The Effectiveness of Pictorial Discharge Advice Versus Standard Advice Following Discharge From the Emergency Department: A Systematic Review and Meta-Analysis

IntroductionFailure to provide adequate discharge advice to patients on leaving the emergency department can lead to poor understanding of and noncompliance with discharge instructions and consequently postdischarge complications or hospital readmissions. The use of pictographs to complement discharge advice has the potential to enhance patient recall and comprehension. The purpose of this paper was to determine the effectiveness of pictorial discharge advice compared with standard discharge advice in the emergency department.MethodsA systematic review and meta-analysis was conducted. CINAHL, MEDLINE, ASSIA, and EMBASE were searched from inception to March 1, 2020, combining terms related to the emergency room, pictogram, and randomized trials as appropriate. Randomized trials reporting on the use of pictorial discharge advice in the emergency department were eligible for inclusion. Outcome measures were comprehension, compliance with advice, satisfaction with advice and the ED visit, and reattendance rates. The Cochrane risk of bias tool was used to assess bias in the included studies.ResultsFour studies were identified as eligible and included in the review. Pictorial discharge advice improved comprehension, compliance, and patient satisfaction with the advice, but not satisfaction with the ED visit when compared with standard discharge advice. None of the included studies measured reattendance rates.DiscussionThe results of this systematic review support the use of pictorial discharge advice. However, few studies exist; none had a low risk of bias overall, and 3 were published over 12 years ago. This finding highlights a need for further research to inform evidence-based best practices on optimal methods for providing quality discharge advice in the emergency department.     

The Use of a Nurse-Initiated Pain Protocol in the Emergency Department for Patients with Musculoskeletal Injury: A Pre-Post Intervention Study

Background and Aim: As a common complaint of patients with traumatic injuries, pain remains undermanaged in emergency departments (EDs). Our aim was to evaluate the effects of a nurse-initiated pain management protocol in patients with musculoskeletal injuries in an ED in Iran.Material and MethodsThis pre-post intervention design study was conducted on 240 patients with orthopedic injuries selected through sequential sampling over two phases. The intervention consisted of case study sessions and the implementation of the nurse-initiated pain management protocol. The outcomes were assessed based on the Numeric Rating Scale (NRS) pain scores, the pain management satisfaction questionnaire, the nursing performance checklist and the waiting time evaluation form.ResultsThe mean pain intensity 30 and 60 min after triage and at discharge decreased significantly in the post-intervention group (p < .001). The patients' satisfaction with pain management (p < .01) and the nurses’ performance (p < .001) improved in the post-intervention group. Waiting time: there was a significant reduction in the post-intervention group from the end of triage by the nurse to the visit by the physician, and from patient’s arrival in ED to discharge or transferring, and also the time to initial analgesic.ConclusionsEducation based on case study and the implementation of the nurse-initiated pain management protocol resulted in a significant increase in multimodal analgesia administration and a reduction in pain intensity, an increase in patient satisfaction, an improvement in the triage nurses’ performance and the reduction of potential delays in pain management while maintaining the safety of patients with musculoskeletal trauma.     

The Effects of a Novel Mindfulness-based Intervention on Nurses’ State Mindfulness and Patient Satisfaction in the Emergency Department

IntroductionThe objective of this study was to examine the effect of a novel mindfulness-based time-out intervention on state of mindfulness among emergency nurses and, accordingly, on patient satisfaction.MethodsA pre-post intervention design among nurses in the emergency department was used with a between-subjects factor of patients who were nested within each nurse. The study was conducted between January 2017 and June 2018 among 48 nurses in the emergency department of a public tertiary academic hospital. For each nurse, a consecutive sample of 20 patients who attended the emergency department was recruited (n = 1920 patients; 960 in each phase). The mindfulness-based time-out intervention was based on theoretical mindfulness principles and carried out every 4 hours with direct communication to the patient at their bedside. Nurses’ sociodemographic and professional characteristics and trait mindfulness were collected preintervention. Pre- and postintervention, data was collected on patients’ sociodemographic and satisfaction, nurses’ state mindfulness, and ED workload.ResultsAn increase in nurses’ state mindfulness and patients’ satisfaction was found after the mindfulness-based time-out intervention compared with before the intervention (4.35 [SD = 0.64] vs 4.03 [0.82], P < .001 and 4.03 [0.41] vs 3.16 [0.44], P < .001, respectively). A positive correlation was found between patients’ satisfaction and nurses’ state mindfulness (r = 0.29, P < .001). The findings also demonstrated that state mindfulness was higher among nurses, characterized by high trait mindfulness, after the mindfulness-based time-out intervention implementation.DiscussionBy adapting mindfulness principles to the dynamic environment of the emergency department, we showed that the mindfulness-based time-out intervention was associated with a significant improvement in state mindfulness and patient satisfaction. The findings elucidate the interrelation among several conceptualizations of mindfulness that are increasingly reported in the literature, namely trait and state mindfulness, and interventions to promote mindfulness.     

Association between patient-physician gender concordance and patient experience scores. Is there gender bias?

BackgroundPatient satisfaction, a commonly measured indicator of quality of care and patient experience, is often used in physician performance reviews and promotion decisions. Patient satisfaction surveys may introduce gender-related bias.ObjectiveExamine the effect of patient and physician gender concordance on patient satisfaction with emergency care.MethodsWe performed a cross-sectional analysis of electronic health record and Press Ganey patient satisfaction survey data of adult patients discharged from the emergency department (2015-2018). Logistic regression models were used to examine relationships between physician gender, patient gender, and physician-patient gender dyads. Binary outcomes included: perfect care provider score and perfect overall assessment score.ResultsFemale patients returned surveys more often (n=7 612; 61.55%) and accounted for more visits (n=232 024; 55.26%). Female patients had lower odds of perfect scores for provider score and overall assessment score (OR: 0.852, 95% CI: 0.790, 0.918; OR: 0.782, 95% CI: 0.723, 0.846). Female physicians had 1.102 (95% CI: 1.001, 1.213) times the odds of receiving a perfect provider score. Physician gender did not influence male patients’ odds of reporting a perfect care provider score (95% CI: 0.916, 1.158) whereas female patients treated by female physicians had 1.146 times the odds (95% CI: 1.019, 1.289) of a perfect provider score.ConclusionFemale patients prefer female emergency physicians but were less satisfied with their physician and emergency department visit overall. Over-representation of female patients on patient satisfaction surveys introduces bias. Patient satisfaction surveys should be deemphasized from physician compensation and promotion decisions.     

The Effect of Patient-Controlled Oral Analgesia for Acute Abdominal Pain after Discharge

BackgroundDuring hospitalization, patients who were admitted with acute abdominal pain must be prepared to care for themselves at home after discharge to continue established treatment, promote recovery, and avoid readmission.AimsOur aim was to investigate the quality of pain management after discharge, when patient-controlled oral analgesia was compared with standard care for patients admitted to hospital with acute abdominal pain. The primary outcome measures were pain intensity and patient perception of care. The secondary outcome measures were pain interference with activity, affective experiences, side effects, and use of analgesics.DesignA questionnaire study measuring the effect of an intervention on patient-controlled oral analgesics.SettingsAn emergency department and a surgical department in Denmark.ParticipantsPatients admitted to hospital with acute abdominal pain.MethodsA pre- and postintervention study was conducted in an emergency department and a surgical department with three subunits. Data were collected using a Danish modified Revised American Pain Society Patient Outcome Questionnaire with five subscales (scale 0-10) completed in weeks 1 and 4 after discharge.ResultsIn total, 117 patients were included. The median scores at week 1 and week 4 in the control and intervention groups were, respectively, 2/1 and 1/0 on the pain subscale (p = .11/.16), 3/0 and 3/0 on the activity subscale (p = .19/.80), 1/0 and 0/0 on the emotional subscale (p = .02/.72), 1/0 and 1/0 on the side effect subscale (p = .95/.99), and 8/5 and 7/7 on the patient perception subscale (p = .35/.49). There was no significant difference in the use of analgesics at week 1.ConclusionsPatient-controlled oral analgesia during the hospital stay did not improve the quality of pain management after discharge.     

Randomised controlled trial of a tailored information pack for patients undergoing surgery and treatment for rectal cancer

PurposeTo evaluate the effects of a tailored information package for rectal cancer patients on satisfaction with information, anxiety and depression and readjustment.MethodThe study used a randomised control trial method. Seventy six patients undergoing surgery and treatment for rectal cancer were randomly assigned to an intervention (n = 43) or control group (n = 33). The intervention group received an information pack tailored according to their treatment plan and preferred information. The control group received the information currently given to these patients. Satisfaction with information was measured using the Patient Satisfaction with Cancer Treatment Education (PSCaTE) scale, anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) and readjustment was measured using the Reintegration to Normal Living Index, at three time points.ResultsThere was a statistically significant difference between the intervention and control group on pre and post intervention scores with patients in the intervention group expressing a higher level of satisfaction with information than those in the control group at Times 2 and 3 (p = 0.00 for both). The intervention group also had a significantly lower anxiety score than the control group at Time 3 (p = 0.03). There was no difference between depression and readjustment scores in the two groups.ConclusionThe results support the hypothesis that a tailored information pack for patients with rectal cancer will positively affect satisfaction with information. These results will enhance the knowledge base surrounding the provision of tailored information to specific patient groups.     

Personalized Care Plans: Are They Effective in Decreasing ED Visits and Health Care Expenditure Among Adult Super-Utilizers?

ProblemSuper-utilizers comprise 4.5% to 8% of all ED patients, but account for 21% to 28% of all ED visits. Excessive use of the emergency department contributes to increased health care costs, recurrent and unnecessary ED workup, decreased emergency readiness, and reduced staff morale.MethodsThe impact of personalized care plan implementation was evaluated using a within-subjects pre-post design. The number of ED visits for each enrolled patient (N = 65) were analyzed before and after personalized care plan enrollment at 90, 180, and 365 days. A post-hoc analysis was completed for each ED visit that resulted in a disposition of discharge. Total and average charges from the ED visits were analyzed to determine the intervention’s effect on health care expenditure. Staff was anonymously surveyed to assess perceived efficacy and level of satisfaction with the intervention before completion of data collection.ResultsMedian ED visits had a statistically significant decrease over 90, 180, and 365 days. There was also a decrease in median, average, and total ED charges for all time points. ED staff perceived the personalized care plans to be an effective intervention and were satisfied with their implementation.DiscussionPersonalized care plans effectively decreased the number of ED visits, reduced health care expenditure, and were well-received by the staff.