Background: Urinary tract infections (UTIs) are common healthcare-associated infections. Evidenced-based practice (EBP) successes of catheter associated urinary tract infection (CAUTI) bundles has resulted in rates decreasing >50% in community-based nursing homes. The South Texas Community Living Center (CLC SA), our 42-bed long-term care and rehabilitation center, conducts routine infection prevention surveillance. During routine surveillance, the infection prevention team noticed an increase in UTI percentages and CAUTI rates. Thus, we sought to increase compliance with standard CAUTI bundles, and we implemented an intervention called the “bladder bundle.” Methods: A multidisciplinary team (ie, infection preventionist, clinical nurse leader, simulation director, educator, leadership and frontline staff champions) identified and evaluated practices through documentation of audits and safety rounds during April and May of 2017 (FY19 QTR 3). The comprehensive bladder bundle was initiated in June 2017, based on EBP interventions and included education for staff with audit and feedback. The team reviewed the literature and expanded the bladder bundle to include a comprehensive urinary note and oral hydration program for the veterans in addition to the standard CAUTI bundles (ie, minimize catheter use, use with appropriate indications, consider alternatives to catheters, proper insertion and securement). In May 2018, a facility-wide, hospital-wide initiative focused on a new urinary catheter insertion kit, insertion competencies and perineal care to improve outcomes. This initiative was added to our bladder bundle for CLC SA. Results: Before the intervention (FY16 Q3 to FY17 Q2), percentages of veterans with a UTI had increased to 4.65%, in FY17 Q3, this rate had increased to 11.76%. After the intervention (FY17 Q4 to FY19 Q3) the percentage dropped significantly to 0%, and this rate has now been sustained for 8 quarters. Our CLC SA has remained at zero harm and has no NHSN CAUTI has occurred since October 2017 (FY18Q1). The catheterization in bladder days has decreased from 162 days in FY14 to 49 in FY18, and for the first 2 quarters of FY19, there were only 25 days. For the last 8 quarters, documentation compliance has increased, as has use of BB interventions. Conclusions: The continuous improvement project targeted within the CLC SA, with education to staff, audit and feedback tools, and a comprehensive urinary note with the oral hydration program in combination with the standard CAUTI bundles, have improved veteran health outcomes and have expanded provider and nursing practices. The interprofessional team approach enhanced the success of this project. Funding: None Disclosures: None
Hypothesis It was hypothesized that Veterans scheduled to undergo Coronary Artery Bypass Graft surgery (CABG) would benefit by participating in a high-fidelity simulation pre-operative educational intervention. The following research question was addressed: What is the influence of a high-fidelity pre-operative CABG simulation education intervention, compared to usual CABG education, on Veteran knowledge, satisfaction, anxiety, and length of stay? Methods An experimental pretest posttest design was selected to evaluate the influence of a high-fidelity simulation patient education intervention on learner knowledge, satisfaction, anxiety and length of stay in Veterans undergoing CABG surgery. Prior to education a pretest knowledge quiz (KQ), the State-Trait Anxiety Inventory (STAI), and demographics data were collected. The control group received VA established, usual CABG pre-operative education at the bedside or in a clinic setting. The intervention group education was in a setting resembling an ICU environment. Participants entered the simulated ICU environment with the high-fidelity simulator in an ICU bed with monitor, ventilator, endotracheal tube, chest tube, sternal and leg dressings, arterial line, SWAN catheter, IV’s, IV pumps, pace maker, Foley catheter, compression boots, and restraints in place. The posttest KQ, State-Anxiety Inventory and satisfaction instrument data were collected immediately after each session. Results Twenty veterans scheduled for CABG surgery consented to participate. Pre-knowledge results demonstrated no difference in groups before educational intervention (t (18) = 0.50, p = .63). However, post-knowledge quiz scores of the high-fidelity intervention group were significantly higher than for the usual control education group (t (10.25) = 7.09, p = .0001, d=3.19). There was no significant difference in State anxiety before the educational training session, (t (18) = 0.73, p = .47). After the sessions a difference in scores revealed a significant reduction in State anxiety for Veterans in the high-fidelity intervention group in comparison to the usual control group, (t (18) = -2.61, p = .02, d=1.17). There was no significant difference in the LOS between the two groups, (t (18) = .79, p = .44). Veterans in the high-fidelity intervention group reported being significantly more satisfied with their educational intervention than the usual control group, (t (9.24) = 2.66, p = .03, d=1.20). Conclusion The findings suggest high-fidelity simulation intervention is an effective educational tool for use with Veterans scheduled to undergo CABG surgery. In conclusion, there was no significant improvement in LOS in Veterans in either educational group. However, use of a high-fidelity simulation education intervention experience revealed a significant increase in Veteran knowledge and satisfaction compared to the control usual pre-CABG education sessions. Veterans also had a significant decrease in state anxiety scores in the intervention simulation education group over the control usual pre-CABG groups. The positive results of this study demonstrate the use of high-fidelity simulation education is a useful option to advancing teaching methods available in improving overall patient experiences. The technology savvy patients of today may be seeking more than the traditional face-to-face verbal interactions with healthcare providers. References 1. U.S. Department of Health and Human Services. (2011). National Heart, Lung and Blood Institute. Washington DC. Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/hs/. Accessed January 20, 2014. 2. The Joint Commission. Comprehensive accreditation manual for hospitals. Oak Book Terrace, IL: Author; 2006. 3. Hahn CA, Fish LJ, Dunn RH, Halperin EC. Prospective trial of a video educational tool for radiation oncology patients. American Journal of Clinical Oncology 2005; 28(6): 609–612. 4. Harless WG, Zier MA, Harless MG, Duncan RC, Braun MA, Willey S, Warren RD. Evaluation of virtual dialogue method for breast cancer patient education. Patient Education and Counseling 2005; 76:189–195. 5. Kolb D. Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall 1984. 6. Mikulaninec CE. Effects of mailed preoperative instructions on learning and anxiety. Patient Education and Counseling 1987; 10: 253–265. 7. Brunges M, Avigne G. Music therapy for reducing surgical anxiety. AORN Journal 2003; 78: 816–818. 8. Pignay-Demaria V, Lesperance F, Demaria RG, Frasure-Smithe, N, Perrault LP. Depression and anxiety and outcomes of coronary artery bypass surgery. Annals of Thoracic Surgery 2003; 75: 314–321. 9. Shuldham CM. Pre-operative education for the patient having coronary artery bypass surgery. Patient Education and Counseling 2001; 43(2): 129–137. Disclosures None
HEALTHCARE PROVIDERS MUST meet patient expectations of providing safe, high-quality care aimed at improving patient outcomes. This means that healthcare facilities should focus on improving information sharing, communication, and patient understanding regarding the administration of newly prescribed medication. Crucial to providing safe patient care, medication education is a measurable outcome reviewed on patient experience and hospital satisfaction surveys such as Hospital Consumer Assessment of Health Plans Survey, Press Ganey, and Survey of Healthcare Experiences of Patients (SHEP) data bases. Encouraging patient and family involvement in patient care has been identified by The Joint Commission as a critical safety strategy in preventing errors.1 A 2012 National Patient Safety Goal for healthcare workers was to provide, maintain, and communicate accurate medication information to improve patient outcomes. The VA Connecticut Healthcare System created a medication card program to enhance the quality of patient interactions and therapeutic alliances with professional teams in medication administration and education. This article reviews program implementation and results. Shuffle the deck Before creating our pilot project, we conducted a literature review examining the effectiveness and role of printed information on medications available to patients. The review revealed that most patients had concerns about the poor visual presentation and use of complex language in the medication information provided.2 In most cases, knowledge wasn't increased by the information provided. Patients weren't getting the information they wanted about: adverse reactions contraindications medication purpose how to take the medication properly.2 One study followed up with patients 2 to 6 weeks after discharge. During follow-up calls, researchers learned that only 55% of patients could name their discharge medications and less than 25% could describe adverse reactions or other information pertaining to their medication.3 In a 2011 qualitative study, patients felt that medication information was important only when a new medication was prescribed.4 In another study, educating patients and presenting them with a key-points fact sheet followed by discussion was more beneficial than the use of printed information alone.5 Many researchers agree that starting a new medication can lead to patient misunderstanding and possible adverse events.6,7 VA Connecticut's initial assessment of SHEP feedback scores related to questions addressing education about new medications and potential adverse reactions indicated that scores were below the benchmark expectations for our facility. To improve these scores, we decided to implement an evidence-based program that would present patients receiving new medications with a key-points fact sheet followed by discussion. We hoped this strategy would have a greater impact on patient outcomes than the use of written information alone.5 It's in the cards We first asked our patients, the veterans, what they'd like to know about medications or prescriptions. Responses included: “Just tell me what my medications are for in simple terms.” “I'd like to know what the medication is for (if it is new).” “Give me simple, easy-to-read and understandable paperwork.” “They printed information for me last time and it was a little small and hard to read.” Next, we identified inadequate medication education as a patient safety risk and earmarked it for a Plan, Do, Study, Act performance improvement project. The interprofessional team members selected for the project included clinical nurses, pharmacists, quality management personnel, a patient experience officer, physicians, nursing administrators, and the clinical nurse leader. The team also collaborated with a local healthcare facility, and a plan was initiated to develop medication information cards that would be given to veterans receiving new medications. At this time, our facility was working closely with the Planetree model for patient experience and Griffin Hospital in Derby, Conn. This hospital had a similar medication card concept and we collaborated with its pharmacy staff to determine the best practice for our veteran population. (For supplemental content, see VA Connecticut Healthcare System sample medication card on the Nursing2015 iPad app.) The medication cards provide basic information about the medication, including general classification, brand and generic names, indications, and adverse reactions. The program was piloted initially with two medication cards on two selected medical-surgical units. Education regarding the intervention was reviewed with all RNs and LPNs. The project plan required all nurses administering a new medication to provide the patient with the appropriate medication card, discuss the information on the card, and ask if the patient had any questions or would like more detailed information. Then subsequent staff members would ask the patient to “show me your medication card,” and ask if he or she had any questions about the new medication. This applied to nurses on each shift. They would follow up with the veterans even if they weren't the staff member who gave the original medication cards.Figure: Pre- and postimplementation scoresDealing a winner Before the pilot program was implemented, veteran national satisfaction survey questions regarding new medication education and medication education on adverse reactions composite scores (November 2011) were 61.8%. Postpilot medication card implementation data revealed scores increased to 80.2% (end of fiscal year 2012). The pilot was successful, allowing VA Connecticut to reach the benchmark measure. (See Pre- and postimplementation scores.) Fiscal Year 2014 quarter one composite scores were 85.3%. Positive outcome data from hospital surveys and patient experience scores have led VA Connecticut to implement medication card education in all acute care areas with over 15 medication categories, such as opioid analgesics. The staff can now provide the medication cards to veterans as part of regular education or review of current medication. Recently, we've included the medication card information in our computerized patient record system. This project has proven within our facility that medication education is crucial to providing safe patient care.
