Exploring patient participation in reducing health-care-related safety risks

Exploring patient participation in reducing health-care-related safety risks
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words, staff already anticipated the need to increase hand washing before patients were
actually instructed to question them about hand hygiene.
Patient participation in error prevention: wrong-site surgery
Schwappach’s review includes a study by DiGiovanni et al. (20) of a preoperative
instruction for surgical patients to clearly mark the extremity that was not to be
operated on to prevent wrong-site surgery. The study was conducted in a foot-and-ankle
clinic and 100 consecutive patients were observed. Of these, only 59% were compliant in
correctly marking the site.
After Schwappach’s review was published, Bergal et al. (11) presented a study in which 200
orthopaedic patients were instructed during their preoperative visit to mark the word “YES”
(using a standard blue marking pen) at the site of surgery before arriving at the preoperative
area on the day of their surgery. The purpose of the study was to evaluate factors affecting
patients’ compliance with site marking to see if this could provide a useful tool to prevent
wrong-site surgery. Of the 200 enrolled patients, 135 (68.2%) made a mark, 63 made no
mark and 2 were lost to follow up. Of the 135 patients who made a mark, 2 marked the
wrong site. Time between enrolment and surgery negatively affected compliance, and
compliant patients were younger and used English more often as their primary language.
Other patient characteristics, such as gender or level of education, were not related to
compliance. The authors conclude that “patient involvement in surgical site marking is
unreliable and may not help in decreasing the chances of wrong-site surgery” (11).
Patient participation in error prevention: other
Schwappach describes a study by Anthony et al. (21) in which a patient safety video was
shown to patients who visited the ambulatory surgical areas of a community hospital.
Patients’ knowledge and levels of comfort in talking to staff about safety had slightly
increased after watching the video. Two further studies in Schwappach’s review focused
on information campaigns targeted at patients in the United States (22) and Ontario,
Canada (23). Only the latter study evaluated the level of patient involvement in error
prevention, only after the introduction of the campaign, and only in convenience samples.
The campaign (“Your health – be involved”) included brochures, posters and a DVD for
hospital television. Hospitals implemented the campaign in various ways. The study showed
that 17% of patients involved had heard about the campaign and that 7 out of 15 reported
that they had changed their way of communicating with health care staff as a result.
Measuring patient experiences
Background
The IOM defines quality of care in terms of six core aspects: safety, effectiveness, patient
centredness, timeliness, efficiency and equity (24). There are two important sources of
information relating to these aspects of quality of care: registration of clinical data by
health care providers; and patients’ reports, collected through surveys.
Patients have specific experiential knowledge that is seen as being crucial for the
advancement of high-quality care. Patients know what it is like to live with a specific
disease and have much experience with health care providers and treatments.