Quantifying Patient Reported and Documented Compliance with Adjuncts to Venous Thromboembolism Prophylaxis

Objectives: 1. Measure patient compliance with pharmacologic, mechanical and ambulatory prophylactic measures. 2. Evaluate for agreement between nursing documentation and patient reported compliance with mechanical and ambulatory prophylactic measures.https://jdc.jefferson.edu/patientsafetyposters/1042/thumbnail.jp

Factors Affecting Patient Compliance to The National Health Insurance Referal System in Medan, North Sumatera

Background: Referal system is a critical element of the national health insurance (JKN) scheme that is managed by the Managing Body of Social Insurance (BPJS). An effective referral system ensures a close relationship between all levels of the health system and helps to ensure people receive the best possible care closest to home. It also assists in making cost-effective use of hospitals and primary health care services. Support to health centres and outreach services by experienced staff from the hospital or district health office helps build capacity and enhance access to better quality care. To date, however, the referal system had not been implemented as expected. This study aimed to analyze factors affecting patient compliance with the national health insurance referal system at Royal Prima Hospital, Medan, North Sumatera. Subjects and Methods: This was a cross sectional study conducted at Royal Prima Hospital, Medan, North Sumatera. A sample of 164 BPJS patients were selected for this study. The dependent variable was compliance with the referal system of JKN. The independent variables was accomodation. The data were collected by questionnaire and analyzed by a logistic regression model. Results: Patient compliance with the referal system of JKN was associated with accomodation cost incurred by the patient and the attending family member. Conclusion: Patient compliance with the referal system of JKN is associated with accomodation cost incurred by the patient and the attending family member. Keywords: referal system, primary care, hospital, compliance, patients, national health insuranc

Ward round documentation in a major trauma centre: can we improve patient safety?

Our objective was to improve documentation and patient safety in a major trauma centre. A retrospective audit was undertaken in March 2014. Ward round entries for each orthopaedic patients on three dates were assessed against standards and analysed. The audit was repeated in April 2014, and again in August 2014. Thorough documentation is paramount in a major trauma centre. It forms a useful record of the patients hospital stay, is a legal document and is highlighted in national guidelines. It provides a basis for good handover, ensuring continuation of care and maintaining patient safety. Resultant poor compliance with Royal College guidelines in the initial audit led to the production of a new electronic based note keeping system. A meeting was held with all staff prior to introduction. Our initial results gained 75 entries, and none showed full compliance. Mean compliance per entry was 59% (0-81%). The second attempt gained 90 entries, with 30 from the weekend. Mean compliance per entry 97%. Third attempt received 61 entries, with 27 from the weekend. Mean compliance was 96%, meaning that the improvement was being maintained. Recent distressing reports regarding patient highlighted the importance of patient. Our initial audit proved there were many areas lacking in our documentation and improvement was necessary. Prior to introducing electronic systems, the implemented change has produced improvement in documentation, and provides a useful handover tool for staff

Compliance, normality, and the patient on peritoneal dialysis

Monitoring and enhancing patient compliance with peritoneal dialysis (PD) is a recurring and problematic theme in the renal literature. A growing body of literature also argues that a failure to understand the patient's perspective of compliance may be contributing to these problems. The aim of this study was to understand the concept of compliance with PD from the patient's perspective. Using the case study approach recommended by Stake (1995), five patients on PD consented to in-depth interviews that explored the meaning of compliance in the context of PD treatment and lifestyle regimens recommended by health professionals. Participants also discussed factors that influenced their choices to follow, disregard, or refine these regimens. Results indicate that health professionals acting in alignment with individual patient needs and wishes, and demonstrating an awareness of the constraints under which patients operate and the strengths they bring to their treatment, may be the most significant issues to consider with respect to definitions of PD compliance and the development of related compliance interventions. Aspects of compliance that promoted relative normality were also important to the participants in this study and tended to result in greater concordance with health professionals' advice

Patient perceptions of physician empathy, satisfaction with physician, interpersonal trust, and compliance

Objectives: This study was designed to investigate psychometric properties of the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and to examine correlations between its scores and measures of overall satisfaction with physicians, personal trust, and indicators of patient compliance. Methods: Research participants included 535 out-patients (between 18-75 years old, 66% female). A survey was mailed to participants which included the JSPPPE (5-item), a scale for measuring overall satisfaction with the primary care physician (10-item), and demographic questions. Patients were also asked about compliance with their physician\u27s recommendation for preventive tests (colonoscopy, mammogram, and PSA for age and gender appropriate patients). Results: Factor analysis of the JSPPPE resulted in one prominent component. Corrected item-total score correlations ranged from .88 to .94. Correlation between scores of the JSPPPE and scores on the patient satisfaction scale was 0.93. Scores of the JSPPPE were highly correlated with measures of physician-patient trust (r \u3e.73). Higher scores of the JSPPPE were significantly associated with physicians\u27 recommendations for preventive tests (colonoscopy, mammogram, and PSA) and with compliance rates which were \u3e .80). Cronbach\u27s coefficient alpha for the JSPPPE ranged from .97 to .99 for the total sample and for patients in different gender and age groups. Conclusions: Empirical evidence supported the psychometrics of the JSPPPE, and confirmed significant links with patients\u27 satisfaction with their physicians, interpersonal trust, and compliance with physicians\u27 recommendations. Availability of this psychometrically sound instrument will facilitate empirical research on empathy in patient care in different countries

Limited effect of patient and disease characteristics on compliance with hospital antimicrobial guidelines

Objective: Physicians frequently deviate from guidelines that promote prudent use of antimicrobials. We explored to what extent patient and disease characteristics were associated with compliance with guideline recommendations for three common infections. Methods: In a 1-year prospective observational study, 1,125 antimicrobial prescriptions were analysed for compliance with university hospital guidelines. Results: Compliance varied significantly between and within the groups of infections studied. Compliance was much higher for lower respiratory tract infections (LRTIs; 79%) than for sepsis (53%) and urinary tract infections (UTIs; 40%). Only predisposing illnesses and active malignancies were associated with more compliant prescribing, whereas alcohol/ intravenous drug abuse and serum creatinine levels > 130 mu mol/l were associated with less compliant prescribing. Availability of culture results had no impact on compliance with guidelines for sepsis but was associated with more compliance in UTIs and less in LRTIs. Narrowing initial broad-spectrum antimicrobial therapy to cultured pathogens was seldom practised. Most noncompliant prescribing concerned a too broad spectrum of activity when compared with guideline-recommended therapy. Conclusion: Patient characteristics had only a limited impact on compliant prescribing for a variety of reasons. Physicians seemed to practise defensive prescribing behaviour, favouring treatment success in current patients over loss of effectiveness due to resistance in future patients

Where do hands go? An audit of sequential hand-touch events on a hospital ward

Reservoirs of pathogens could establish themselves at forgotten sites on a ward, posing a continued risk for transmission to patients via unwashed hands. To track potential spread of organisms between surfaces and patients, and to gaina greater understanding into transmission pathways of pathogens during patient care. Hand-touch activities were audited covertly for 40 30 min sessions during summer and winter, and included hand hygiene on entry; contact with near-patient sites; patient contact; contact with clinical equipment; hand hygiene on exit; and contact with sites outside the room. There were 104 entries overall: 77 clinical staff (59 nurses; 18 doctors), 21 domestic staff, one pharmacist and five relatives. Hand-hygiene compliance among clinical staff before and after entry was 25% (38/154), with higher compliance during 20 summer periods [47%; 95% confidence interval (CI): 35.6e58.8] than during 20 winter periods (7%; 95% CI: 3.2e14.4; P < 0.0001). More than half of the staff (58%; 45/77) touched the patient. Staff were more likely to clean their hands prior to contact with a patient [odds ratio (OR): 3.44; 95% CI: 0.94e16.0); P ¼ 0.059] and sites beside the patient (OR: 6.76; 95% CI: 1.40e65.77; P ¼ 0.0067). Nearly half (48%; 37/77) handled patient notes and 25% touched the bed. Most frequently handled equipment inside the room were intravenous drip (30%) and blood pressure stand (13%), and computer (26%), notes trolley (23%) and telephone (21%) outside the room. Hand-hygiene compliance remains poor during covert observation; understanding the most frequent interactions between hands and surfaces could target sites for cleaning

Hand washing Compliance - Is It A Reality?

Background: Transmission of microorganisms from the hands of health care workers is the main source of cross-infection in hospitals and can be prevented by hand washing. The aim of this study was to identify predictors of noncompliance with hand washing during routine patient care. Materials And Methods: This is an observational study. The participants in the study were Health Care Workers (HCWs). Doctors, nurses and ward aides working in different wards of the hospital who were observed for compliance with hand washing. Results: In 270 observed opportunities for hand washing, average compliance was 63.3%. Noncompliance was highest among doctors followed by nurses. Ward aides were most compliant. Conclusions: Compliance with hand washing was moderate. Variation across the hospital ward and type of HCW suggests that targeted educational programs may be useful. Noncompliance suggests that understaffing may decrease quality of patient care

Impact of neonatal intensive care bed configuration on rates of late-onset bacterial sepsis and methicillin-resistant Staphylococcus aureus colonization

OBJECTIVES: Infections cause significant morbidity and mortality in neonatal intensive care units (NICUs). The association between nursery design and nosocomial infections has not been delineated. We hypothesized that rates of colonization by methicillin-resistant Staphylococcus aureus (MRSA), late-onset sepsis, and mortality are reduced in single-patient rooms. DESIGN: Retrospective cohort study. SETTING: NICU in a tertiary referral center. METHODS: Our NICU is organized into single-patient and open-unit rooms. Clinical datasets including bed location and microbiology results were examined over a 29-month period. Differences in outcomes between bed configurations were determined by Chi-square and Cox regression. PATIENTS: All NICU patients. RESULTS: Among 1823 patients representing 55,166 patient-days, single-patient and open-unit models had similar incidences of MRSA colonization and MRSA colonization-free survival times. Average daily census was associated with MRSA colonization rates only in single-patient rooms (hazard ratio 1.31, p=0.039), while hand hygiene compliance on room entry and exit was associated with lower colonization rates independent of bed configuration (hazard ratios 0.834 and 0.719 per 1% higher compliance, respectively). Late-onset sepsis rates were similar in single-patient and open-unit models as were sepsis-free survival and the combined outcome of sepsis or death. After controlling for demographic, clinical and unit-based variables, multivariate Cox regression demonstrated that bed configuration had no effect on MRSA colonization, late-onset sepsis, or mortality. CONCLUSIONS: MRSA colonization rate was impacted by hand hygiene compliance, regardless of room configuration, while average daily census only affected infants in single-patient rooms. Single-patient rooms did not reduce the rates of MRSA colonization, late-onset sepsis or death