[Experiences of health care providers with the implementation of medication schemes on paper]

BACKGROUND

Medication management demands information exchange between healthcare professionals of intra- and transmural care.

AIM

The goal of this study is to determine if a paper medication overview improves the information exchange between healthcare professionals of primary and secondary care in the South Eastern part of Limburg.

METHODS

A paper medication overview was implemented in this region. A pre and post survey were used to gather healthcare professionals opinions about the potential of the paper medication overview. The expectations, experiences and the use of the medication overview were gathered.

RESULTS

The most important barriers are the time investment of healthcare professionals and patient involvement. A paper medication overview appears to be mostly used to reduce medication errors. Few healthcare professionals see potential in the paper medication overview as a tool to improve communication. An electronic medication overview yields more possibilities as well for intramural care as for transmural care.

CONCLUSION

A paper medication overview is perceived as a tool to reduce medication errors. Although it is very time consuming to keep the paper medication overview up-to date, it yields a lot of possibilities to improve information exchange between different kinds of healthcare professionals. Patient involvement is crucial to establish the flow of healthcare information.

ENT one day surgery: critical analysis with the HFMEA method

OBJECTIVES

Research shows that 51.4% of adverse events in hospitals occur in surgery and that 3-22% of surgical patients experience adverse events. The risk may be even higher when turnover is high and when patients are children, as is often the case in ear, nose and throat surgery. This quality project therefore started in response to requests from physicians in two hospitals in the Flemish part of Belgium. The aim of this study is to use the Healthcare Failure Mode & Effect Analysis method to evaluate the process flow for ear, nose and throat patients, and to redesign the process to enhance patient safety.

METHODOLOGY

In two One Day Clinics, processes were prospectively analysed using the Healthcare Failure Mode & Effect Analysis method.

RESULTS

Similar potential failures were reported in both hospitals. The major failure mode was linked to the absence of an active identity check throughout the process. The process was therefore redesigned by implementing a surgical safety checklist and an active identity check protocol. Although the Healthcare Failure Mode & Effect Analysis is a time-consuming method, this systematic approach by a multidisciplinary team has been found to be useful in detecting failure modes that need immediate safety responses. The involvement of all disciplines and an open safety culture during the procedure were the most important conditions.

CONCLUSIONS

The Healthcare Failure Mode & Effect Analysis is a useful instrument for detecting the failure modes in this care process.

Effect of a tailored behavior change program on a composite lifestyle change score: a randomized controlled trial

To evaluate the effect of a tailored behavior change program on a composite lifestyle change score. A randomized controlled trial conducted in Belgium in 2007-08 with 314 participants allocated to a control and an intervention condition. The intervention was a tailored behavior change program (web-based and individual coaching). The dose of the coaching was chosen by the participants and registered. Outcome measures were weight, saturated fat intake, fruit and vegetable intake, physical activity, smoking status and a composite lifestyle change score. Mann-Whitney U-tests, Kruskal-Wallis tests, t-tests and one-way analyses of variance were used to compare the study conditions and three intervention dose groups (no/low, medium and high intervention dose). There were no significant differences between the study conditions or between the intervention dose groups for the individual lifestyle factors. The composite lifestyle change score was significantly higher in the high intervention dose group compared with the no/low intervention dose group (P = 0.009). The composite lifestyle change score was positively related to the intervention dose, while the individual lifestyle factors were not. Behavior change programs that target multiple lifestyle factors could be evaluated by using a composite lifestyle change score taking into account the intervention dose.

Current primary care practice in the diagnosis and management of patients with suspected venous thromboembolism and prescription of initiation dose of enoxaparin

AIM

Ambulatory care of patients with deep vein thrombosis (DVT) has been well validated but limited data exist on the diagnostic and therapeutic management of venous thromboembolism (VTE) in primary care.

METHODS

A cross-sectional survey on the clinical conditions for the initiation of once daily (OD) enoxaparin and on the diagnostic and therapeutic strategy of VTE in ambulatory patients using a single-visit questionnaire to be filled out by the general practitioner (GP).

RESULTS

Of the 4522 included patients, 2164 (48%) were started on therapeutic OD enoxaparin for confirmed or suspected proximal DVT, 464 (10%) for distal DVT, 493 (11%) for pulmonary embolism (PE), and 742 (16%) for superficial venous thrombosis (SVT). Further indications included bridging of oral anticoagulation in 173 patients (4%), atrial fibrillation in 77 patients (2%) and prevention of VTE in 78 patients (2%). Enoxaparin was initiated on the basis of clinical probability before objective confirmation in 17%, 33%, 53% and 69% of patients with a diagnosis of PE, proximal DVT, distal DVT and SVT, respectively. No objective testing was planned for 3%, 9%, 18% and 41% of patients in these respective categories. Patients were referred to specialist care in 88%, 49%, 42% and 21% of patients with PE, proximal DVT, distal DVT and SVT, respectively.

CONCLUSION

Therapeutic OD enoxaparin is prescribed in primary care for the whole clinical spectrum of VTE. However, the diagnostic work-up is unsatisfactory to suboptimal in a substantial proportion of these patients.