Safety checklists have been identified as an effective intervention to improve patient safety across a variety of clinical settings, increasing compliance with guidelines and decreasing patient mortality and morbidity (Thomassen, Storesund, Søfteland, & Brattebø, 2014). The ‘rights’ of medication administration (for example, the right patient, right route of administration, right dose and so on) are retained and used by nurses as a mental safety checklist when administering medications in hospital. Additionally, hospital policies and procedures specify the requirement to adhere to checking for each ‘right’. In regard to supporting and promoting nurses’ adherence to correct checking procedures, engagement of patients (for example, patients proactively presenting their identification band for checking, stating their names, and/or reminding nurses of their allergies) has the potential to reduce medication errors. Patient participation in health care delivery is increasingly recognised as important to the success of service initiatives and the potential for such involvement to promote patient safety is also increasingly acknowledged (Ocloo & Matthews, 2016). There is evidence that patients can modify health professionals’ behaviour in regard to medication prescribing, patient referral and operating practices. Patient-mediated knowledge translation strategies are specifically targeted at patients with the aim of changing health professionals’ behaviour as a result of patient-health professional interaction (Stacey & Hill, 2013).
The aim of this study was to evaluate patients’ perceptions of their experience of engagement in medication administration following the introduction of a targeted knowledge translation patient engagement intervention.
Methods: A clustered randomised controlled study design was used. Study units for randomisation and intervention allocation were general medical wards within hospitals. The trial had two arms: intervention (knowledge translation patient engagement intervention) and control (monitoring usual practice). The intervention was randomised, within hospitals, at the ward level so that patients on one ward at each hospital received the intervention and one ward at each hospital acted as a control.
The intervention was co-developed with input from representatives of the organisation’s Consumer Advisory Committee and the Medication Safety Committee. The membership of the former committee is consumers, and consumers are also represented on the latter committee. The intervention comprised of a single-page brochure containing information about medication checking procedures and how patients can be engaged in the medication administration process. During a four-month intervention phase, research personnel distributed the brochure by hand to all patients who met the inclusion criteria within 72 hours of their admission to an intervention ward. The brochure remained with the patient for the duration of their inpatient stay. Patients in the control (usual practice) wards did not receive the brochure.
Patients discharged from both control and intervention wards during the 3-month intervention phase were surveyed using a suite of tools. The tools captured patients’: (1) perceived health confidence (using the My Health Confidence single-item measure (World Health Organisation, 2009), found to be an effective proxy for patient engagement); (2) perceptions of patient-clinician communication and their involvement in decision-making related to their care (using the Patients’ Perceived Involvement in Care Scale (M-PICS; Lerman et al., 1990); and (3) knowledge, skills and confidence for self-management (using the Patient Activation Measure (PAM®) Short Form (Hibbard, Mahoney, Stockard & Tusler, 2005)). Ethics approval to conduct this research was obtained from the university and the health service.
Results: A total of 54 surveys were returned from patients across both the control and intervention wards during the study. The response rate across the four wards ranged from 26.9% - 46.2%, with an overall response rate of 35.3%. When data for the two control and two intervention wards were combined, there were 27 participants in each group. The intervention appeared to have little impact on participants’ confidence, knowledge, and skills to manage their health problems, as measured by the PAM® and My Health Confidence tools, with no differences between the control and intervention groups. Similarly there was no difference between participants in the two groups with regards to the extent to which they found the information provided to them by doctors and nurses useful and easy to understand. Those in the intervention group, however, reported a statistically significantly greater tendency to seek out or share information with their health care provider (Intervention: M = 3.54, SD = 0.63; Control: M = 3.01, SD = 1.04; t (44) = 2.10, p = .042, η2 = 0.09) and also greater participation in decision-making about medical treatment (Intervention: M = 2.47, SD = 1.00; Control: M = 1.82, SD = 0.65; t (48) = 2.73, p = .009, η2 = 0.13).
Conclusion: The findings of this study indicate that implementation of a brochure containing information to enable and encourage patient engagement in their medication management has potential to influence patients to seek and share information and to have greater participation in decision-making about their care. The implementation of the brochure was brief, occurring over a 4-month period. This study has also enabled testing of the data collection systems and analysis process which will inform a larger study with an extended implementation phase.
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