A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery: Qualitative Study.
A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery: Qualitative Study.
复制标题
数字患者主导的医院清单，以提高白内障手术的安全性：定性研究。
DOI：
10.2196/periop.9463
复制
发表时间：
2018-07-16
影响因子：
--
通讯作者：
de Korne DF
中科院分区：
文献类型：
--
作者：
Stolk-Vos AC;van der Steen JJ;Drossaert CH;Braakman-Jansen A;Zijlmans BL;Kranenburg LW;de Korne DF
手术具有医源性患者伤害的高风险。在手术过程中，正确和充分的沟通和信息是防止患者伤害的根本解决方案。信息技术可以极大地促进患者参与这一过程。为了探索白内障手术患者主导的数字检查表的可行性，我们评估了使用这种新工具的患者和护士的经验，重点是使用、欣赏和影响。包括白内障外科医生、护士、药剂师和行政代表在内的多学科团队为在门诊接受手术的白内障患者制定了一份由患者主导的19项数字清单。该“EYEpad”检查表通过平板电脑上的应用程序分发给患者及其同伴。它包含了患者在术前或手术准备中（8项）、麻醉前（2项）和出院前（9项）应了解的必要信息。患者和他们的同伴被邀请积极地指出他们收到的信息，或与他们讨论的信息，通过点击EYEpad。我们的定性研究设计包括对17名患者的半结构化个人访谈和6名护士的焦点小组访谈。转录本由2个独立编码器分别使用演绎和归纳编码进行分析。17例患者中除1例外均使用EYEpad，偶尔由其伴侣（通常为伴侣）协助使用。在一些情况下，检查表是由同伴完成的。大多数患者对EYEpad的可用性持积极态度。然而，对于大多数患者来说，他们不清楚为什么会收到这份清单。只有4人表示了解EYEpad用于确定护士讨论或检查的信息是否足够和正确。虽然大多数护士都认为EYEpad易于使用，可以成为提高患者参与度和安全性的有用工具，但他们认为并非所有老年患者都愿意或有能力使用它，而且它会干扰现有的手术过程。他们还预计需要花更多的时间来解释EYEpad的目的和用途。我们的研究结果表明，数字化患者主导的检查表是增加患者参与安全改进工作的潜在有效方法，即使是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传播中发挥的关键作用。只有当医护人员和患者都感到有能力分担责任并平衡他们的权力时，增加患者的参与才能提高安全性。
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.