#10GG Posters - Patient as Educators/Patient Safety
10GG01 (617)
Date of Presentation: Wednesday, 28 August 2019
Time of Session: 0830-1015
Location of Presentation: Hall/Foyer F, Level 0
Patients as educators: Endocrine senior residents (SRs) in the management of Type 1 Diabetes Mellitus (T1DM)
AUTHOR(S):
Cherng Jye Seow, Tan Tock Seng Hospital, Singapore (Presenter)
ABSTRACT
Background: Management of T1DM is extremely complex but emphasis in the local Endocrine training curriculum is lacking. There is concern SRs may be ill equipped to manage patients confidently.
Summary of Work: A survey was sent to 19 SRs assessing their experience and confidence in managing T1DM, their confidence level in interpreting technological tools used in T1DM management and their views on the role of a structured T1DM education module in the local curriculum. The SRs were subsequently rostered to attend T1DM patients’ education workshops as a pilot trial and their knowledge and confidence level reassessed.
Summary of Results: More than 80% of SRs have only managed <10 T1DM patients. 64.7% of trainees were very or somewhat unconfident in managing T1DM, and this increased to 88.2% and 82.4% in relation to T1DM patients who exercise and who were pregnant respectively. Most trainees had minimal experience managing patients on continuous glucose monitoring or insulin pumps, and were unfamiliar with interpreting an ambulatory glucose profile. Many felt that the management of T1DM was not adequately taught in the local curriculum and that a structured T1DM education program would be beneficial. SRs were then rotated to attend T1DM patients’ education workshops which were held regularly in our hospital. There are a total of 4 workshops, focusing on different aspects such as learning how to carbohydrate count, troubleshooting problems, exercising safely and coping with burnout. The patients and caregivers shared their challenges and the SRs acted as facilitators and tried to troubleshoot problems with the diabetes consultant as moderators. Feedback from the SRs were positive, that the knowledge garnered were very practical and they enjoyed this modality of learning much more than didactic teaching. Confidence level also increased.
Discussion and Conclusions: Results from our pilot study revealed that patients as educators work in the management of an extremely complex condition such as T1DM.
Take-home Messages: Greater emphasis should be placed on T1DM management in the local Endocrine curriculum and patients as educators is an effective way in improving knowledge in this field. #10GG Posters - Patient as Educators/Patient Safety
10GG02 (1084)
Date of Presentation: Wednesday, 28 August 2019
Time of Session: 0830-1015
Location of Presentation: Hall/Foyer F, Level 0
Patient Inputs Beneficial in Evaluating a Resident’s Communication Skill During the Residency Training
AUTHOR(S):
Jiratha Budkaew, Khon Kaen Medical Education Center, Khon Kaen Hospital, Thailand (Presenter)
ABSTRACT
Background: The patient’s experience reflects physician interpersonal and communication skills. Our objective was to evaluate the Family Medicine (FM) residents by using a patient assessment tool for communication skills during a home visit.
Summary of Work: We conducted a field test in the primary care settings affiliated with Khon Kaen Hospital. The evaluation was made using the 11-item self-administered tool (Cronbach’s alpha = 0.87) to identify communication skills of FM residents during the home visit. The skills were rated by community nurses, pharmacists, patients and themselves. Resident reflections on patients’ feedback were collected and analyzed.
Summary of Results: Fourteen residents, 28 patients, 4 community nurses, and 2 pharmacists participated in the field test. The average satisfaction scores by patients, colleagues, and self-assessment were 72.3%, 70.2%, and 72.3%, respectively. Treating patients with respect (71.2%), a cordial greeting (70.5%), and encouraging questions (69.8%) were a top three item rated by patients, colleagues, and self-assessment. Involving patient in decision making was the lowest rated item by patients, whereas expressing empathy was the lowest rated by colleagues and self-assessment. The overall percentage of items scored as satisfaction was significantly varied based on the training year (P=0.035, test for trend). Residents mostly reflected that patient assessment was beneficial for their learning and practicing communication skills and patients’ feedback enhanced their confidence in these skills.
Discussion and Conclusions: The patient could help to assess residents’ communication skills concurring with healthcare providers and resident’s self-assessment.
Take-home Messages: The patient could be a good asset for evaluating communication skills and facilitating residency training. #10GG Posters - Patient as Educators/Patient Safety
10GG03 (78) Date of Presentation: Wednesday, 28 August 2019 Time of Session: 0830-1015 Location of Presentation: Hall/Foyer F, Level 0
“My patients are not educational menus”: The effect of using student reflective narratives to observe dignity and respect for patients’ rights in clinical education
AUTHOR(S): Hoda Ahmari Tehran, Qom University of Medical Sciences, Iran (Presenter) Ahmad Kachoie, Qom University of Medical Sciences, Iran Mahdi Ghassabi Chorsi, Iran University of Medical Sciences, Iran Saeed Madani, Qom University of Medical Sciences, Iran
ABSTRACT
Background: Research show that stress in medical students leads to burnout and loss of respect for patients’ rights. These declines in mood and malpractice worsen in the internship period. On the other hand, literature reviews have addressed the importance of reflective practice in the education. This study investigates the effect of using student reflective narratives to observe dignity and respect for patients’ rights in clinical education Summary of Work: A mixed method research based on reflective learning theories( Gibbs reflective model)was conducted during 12 months using 48 intern students.In a quasi-experimental study, these students were randomly categorized as either intervention or control. Only in intervention groups, Students were allowed to talk to the patients and ask them if they have properly respected the patients’ right and dignity. Then, students were to reflect on their performances. In the first week, a pretest was conducted in both groups. Intervention group received reflective education and reflection writing in the second and the third week. And in the last week a post-test was conducted among both groups. To explore students perception of effectiveness of reflecting on their performance, a qualitative content analysis was conducted which included 12 semi-structured interviews and 144 reflection notes. Summary of Results: Mean scores of students’ performance of respect for patient in experimental group was improved significantly in post-test (12.32±1.21) compared to pretest (9.85±1.39) (p<0/05). Independent t- test implied that the difference of post test scores in two groups was significant (P=0.01). Of Interviews, four main themes emerged: improving empathy and understanding the feelings of patients, paying attention to the patients’ humanistic dimensions, respecting the autonomy and rights of the patients, and promoting interpersonal communication skills. Discussion and Conclusions: This study showed the emotional effects of reflective narrative writing interventions on medical students for observing dignity and respect for patients rights. It is recommended to use students’ Reflective Narratives in this area. Take-home Messages: Using real patients in various settings is an invaluable part of learning the art of medicine, as it enables students to apply learning to the real world. However, We must not forget that patients are human beings with feeling and their rights and dignity should be respected. #10GG Posters - Patient as Educators/Patient Safety
10GG04 (708) Date of Presentation: Wednesday, 28 August 2019 Time of Session: 0830-1015 Location of Presentation: Hall/Foyer F, Level 0
Students’ Learning Outcomes of Patient-Centered Home Care facilitated by Village Health Volunteer as Educator
AUTHOR(S): Chanat Kanchit, Medical Education Center, Ratchaburi Hospital, Thailand (Presenter) Sudarat Wijitsetthakul, Medical Education Center, Ratchaburi Hospital, Thailand Sirote Srimahadthai, Medical Education Center, Ratchaburi Hospital, Thailand Anon Sathapornsathid, Medical Education Center, Ratchaburi Hospital, Thailand
ABSTRACT
Background: Patient-Centered Home Care (PCHC) is a comprehensive care approached by multidisciplinary team including family physician, nurse practitioner, physical therapist and village health volunteer (VHV). The VHVs are also the patients obtain high health literacy, so they can facilitate medical students for PCHC as educators. This study aims to evaluate the student’s learning outcomes of PCHC facilitated by VHV. Summary of Work: This study was conducted for the total of 32 fourth-year medical students in November and December 2018 at Family Medicine department, Medical Education Center, Ratchaburi Hospital, Thailand. Four students per group approached PCHC facilitated by VHV as educator for once a week by two months. All VHV were patients with non-communicable diseases treated by Family physicians in Ratchaburi Hospital and were trained to care the patients in community with PCHC program. Student’s learning outcomes regarding three domains of knowledge, attitude and skill toward PCHC were determined by 12 multiple-choice questions in summative evaluation, questionnaire with 5-point Likert scale and home care rubrics respectively. Reliability of assessment tools including attitude and skill were 0.813 and 0.876, respectively. Summary of Results: A total of 32 medical students participated in PCHC facilitated by VHV. All students passed in minimal passing level of knowledge and skill with the percent scores of 70.3±10.6 and 86.9±7.9, respectively. Attitude toward understanding PCHC was improved from the percent scores of 56.9±14.5 to 78.1±9.3 (p<0.001). Discussion and Conclusions: Patient, role of VHV, as educator could promote medical student’s learning outcomes because of high health literacy; the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. However, they could facilitate the students to approach good PCHC. The strengths of this program were inter-professional education and effective learning. In case of none VHV in some country, the caregiver or care-manager can take the role of educator. Take-home Messages: The patient can be a good educator. They were provided medical knowledge, patient-centered attitude and home care skill by medical educator, and transfer all of integrated knowledge, attitude and skill with their experiences absolutely to medical students. #10GG Posters - Patient as Educators/Patient Safety
10GG05 (2125) Date of Presentation: Wednesday, 28 August 2019 Time of Session: 0830-1015 Location of Presentation: Hall/Foyer F, Level 0
National Advance Care Planning Educational Workshop for Healthcare Professionals in Taiwan: Using Learning Science with 3 Levels of Course Design
AUTHOR(S): Wei-Min Chu, Department of Emergency Medicine, Taichung Veterans General Hospital, Taiwan (Presenter) Wei-Chun Lin, Department of Oncology, Chi Mei Medical Center, Liouying, Taiwan Shih-Chun Ho, Palliative Care Center, Chi Mei Medical Center, Taiwan Yi-Yin Lin, Hospice Foundation of Taiwan, Taiwan Chao-Huei Chen, Center for Faculty Development, Taichung Veterans General Hospital, Taiwan
ABSTRACT
Background: In Jan 2019, Taiwan has officially approved Patient Autonomy Law (PAL) which allows all citizens in Taiwan to make advance decision (AD) for 5 critical conditions. According to the law, all citizens wish to make an AD must go through official advance care planning (ACP), which will be held by certified healthcare professionals (HCP). Thus, several national ACP educational program were arranged to train future ACP professionals. Our ACP educational program was designed based on learning science that made participants learning by going through three levels: encoding, consolidation and retrieval. Summary of Work: The course was designed as 4-hours workshop and the concept was 3 levels of structure, including the first level Encoding (1 hour): Introduction of PAL and ACP with making practices by given specific situation in small groups; The second level Consolidation (1 hour): Practicing self ACP by pairs of two to fill the full AD form and to understand the difficulty of choices. The third level Retrieval (2 hours): Situational role-play in large groups, some participants would be appointed as HCP, others would be appointed as patient and family. They went through the simulational ACP process and completed patient’s AD. Summary of Results: In 2018, 14 courses were held. Totally 1247 HCP completed training, including 263 physicians, 641 nurses, 243 social workers, 79 psychologist and 21 other professionals. We collected all participants’ feedback after each course. The average score of course design assessment was 97.3%; The average score of program content assessment was 98.0%; And the average score of teacher assessment was 96.8%. Discussion and Conclusions: The key elements for a successful ACP educational workshop are: 1. Level by level course design based on learning science. 2. Using different grouping method ( either small group or large group) to fulfill the goal of learning. 3. Teacher’s experience in problem solving, guidance and fast response during teaching. Take-home Messages: 3 levels of course design based on learning theory helped HCP learn more efficiently and with more competency in future ACP. We believe that learning theory could also be applied to different aspect of medical educational workshop in the future. #10GG Posters - Patient as Educators/Patient Safety
10GG06 (422) Date of Presentation: Wednesday, 28 August 2019 Time of Session: 00830-1015 Location of Presentation: Hall/Foyer F, Level 0
Entrustable procedural skill teaching to improve patient safety
AUTHOR(S):
Adisak Tantiworawit, ChiangMai University, Thailand (Presenter) Parichat Salee, ChiangMai University, Thailand Atikun Limsukon, ChiangMai University, Thailand Pattraporn Tajarernmuang, ChiangMai University, Thailand Nuntana Kasitanon, ChiangMai University, Thailand Chalerm Liwsrisakun, ChiangMai University, Thailand
ABSTRACT
Background: Insertion of a central venous catheter (CVC) is a procedure which may cause morbidity in patients. Our hospital has experienced a high complication rate. The method of teaching this procedure was reviewed and updated with a key aim being patient safety. This skill development has been termed the entrustable approach. Summary of Work: The model of apprenticeship teaching by a senior resident was changed to a systematic approach involving 3 steps. Step 1: Resident completed a course of self-study followed by a video demonstration. This step aimed to encourage the learner to self-assess, review the basic concepts, consider indication-contraindication and complications. Step 2: A procedural work shop. The residents attended a group workshop in the clinical skill center. An experienced teacher shared best practice of the CVC procedure using a manikin to demonstrate, explain and model the different steps. This was followed by a group discussion. After discussion the residents carried out the procedure on the manikin. Step 3: Clinical practice under supervision. The residents practiced CVC insertion on a patient under supervision. The final step is critical in ensuring the learner is entrusted by the teacher to perform this procedure safety. Summary of Results: Student not only learnt the procedural skills, but also the showed increased awareness of the concept of patient safety. There was a 100% pass rate by the residents in step 1 and 2 however only 86% of residents passed step 3. In the final step the issue of patient safety was the most concerning. Following the implementation of this sharing best practice teaching method the complication rate has decreased by 57% in the department. Discussion and Conclusions: The widely used concept of “See One, Do One, Teach One” to enable the acquisition of procedural skills needs to be reconsidered and in many cases discarded. We have demonstrated a method for effective procedural skill teaching using CVC insertion. Various teaching methods can be used to promote effective learning, the methods being appropriate to all learner styles. Take-home Messages: This entrustable systematic teaching method not only promotes learner success but also results in improved patient safety. #10GG Posters - Patient as Educators/Patient Safety
10GG07 (2998) Date of Presentation: Wednesday, 28 August 2019 Time of Session: 00830-1015 Location of Presentation: Hall/Foyer F, Level 0
Continuous Improvement of Patient Safety and Teamwork Through In Situ Simulation Training in Cardiopulmonary Resuscitation
AUTHOR(S): Wan Ting Wu, Taipei Hospital, Taiwan (Presenter) Hsing Chien Wu, Taipei Hospital, Taiwan Jiin-Chyr Hsu, Taipei Hospital, Taiwan Ping-Hsun Yu, Taipei Hospital, Taiwan Li Zhen Tsai, Taipei Hospital, Taiwan
ABSTRACT
Background: Cardiopulmonary resuscitation (CPR) is one of the complex and time-critical endeavors in the hospital. CPR requires seamless coordination; even one-minute CPR delay or a tiny flaw could be fatal. In order to perform effective rescues, professionals suggested that healthcare providers consistently take CPR training. Experts have indicated that teamwork and leadership training can enhance rescue performances by reducing human errors. In situ simulation is a physically integrated into the clinical environment, provides a method to improve reliability and safety in high-risk areas. Summary of Work: In order to continuously monitor the quality of simulation training, we revised the training program last year. After the pre-test of instruction, the research introduces first aid situation simulation trainging, including watching videos, discussion and debrief. Our training program includes team training and Advanced Cardiac Life Support. The team training program was modified from China Airlines and TeamSTEPPS aterials. The training program was designed based on a simulation scenario of CPR clinical adverse event. 7 sessions of training were conducted in May to December, 2017, and 9 sessions of training were conducted in March to December, 2018. At the end of each training session, a score of the participants’ overall performance was be given by the instructors. Summary of Results: The results indicate that the overall performance of the participants was improved, with an increse of 45.85 %from the first session (56.45%) to the last one (86.12%). Moreover, most participants demonstrated positive attitude toward the training with the scores of satisfaction increased from 85% to 94%. Lastly, positive gains were also found in teamwork climate(56.4% to 73.5%), safety climate (64.1% to 65.7%), job satisfaction (62.7% to 64.6%). Discussion and Conclusions: Successful CPR relies both on skilled individual rescuers and effective teamwork. In situ simulation provides a learning opportunity for acontrolled clinical practice without putting patients or others at risk. This approach may help improve the effectiveness and impact of the training programs. In the future, teamwork concepts should be introduced to healthcare professionals. We will continue to monitor and analyze the outcomes. We suggest early implementation of team technique to improve safety climate and care quality.
#10GG Posters - Patient as Educators/Patient Safety
10GG08 (3041) Date of Presentation: Wednesday, 28 August 2019 Time of Session: 00830-1015 Location of Presentation: Hall/Foyer F, Level 0
Quality and Patient Safety Linked to Healthcare across Middle-Eastern and Asian Countries: A Systematic Review
AUTHOR(S): Maha Hameed, AlFaisal University, Saudi Arabia (Presenter) Anam Yousuf, AlFaisal University, Saudi Arabia Sara Ahmed, AlFaisal University, Saudi Arabia Chowsan Safa, AlFaisal University, Saudi Arabia Noora Rameez, AlFaisal University, Saudi Arabia Amal Saadallah, King Faisal Specialist & Research Centre, Saudi Arabia
ABSTRACT
Background: A paucity in literature regarding comprehensive reviews of healthcare quality and safety status has been noted. The aim of this systematic review is to evaluate this status amongst Middle-Eastern and Asian countries. Summary of Work: A systematic research of itemized healthcare services was done including Middle- Eastern and Asian countries. Google and PubMed database were used, with 208 scholarly publications filtered according to government and international collaboration, patient involvement, adverse events/compliance/medical errors, and category focus on which of healthcare professionals focused on. Summary of Results: 10 out of 15 Middle Eastern and 4 out of 6 Asian countries had governmental involvement, while 10 out 15 Middle-Eastern and 5 out of 6 Asian countries had international organization collaboration. 5 out of 15 Middle Eastern, and 5 out of 6 Asian countries included patients’ involvement. 11 out of 15 Middle Eastern, and 5 out of 6 Asian countries reported adverse effects. 12 out of 15 Middle Eastern countries involved more nurses/nursing students, while 5 out of 6 Asian countries involved residents/physicians more. Discussion and Conclusions: Bahrain had higher governmental involvement while the countries Egypt, UAE and high-risk countries Syria and Yemen had focus by international organizations. Iran is the Middle-Eastern country having most influence in patient safety culture, reporting the most adverse effects, patient and healthcare professionals involvement. More than half the Asian countries displayed governmental or international contributions, Singapore being most for governmental. Meanwhile, Vietnam was the only Asian country that did not involve international organizations collaboration. Take-home Messages: More attention is needed towards patient and healthcare professionals involvement in healthcare quality and safety amongst Middle-Eastern and Asian countries. #10GG Posters - Patient as Educators/Patient Safety
10GG09 (3379) Date of Presentation: Wednesday, 28 August 2019 Time of Session: 00830-1015 Location of Presentation: Hall/Foyer F, Level 0
Learning-needs focused hands-on workshops on Chest Drain insertion and post- insertion Chest Drain management: How we improved the identified patient safety issues in our hospital
AUTHOR(S):
Catherine Russell, University Hospital Ayr, NHS Ayrshire and Arran, UK (Presenter) Anur Guhan, University Hospital Ayr, NHS Ayrshire and Arran, UK Sagara Dissanayaka, University Hospital Ayr, NHS Ayrshire and Arran, UK
ABSTRACT
Background: Intercostal Chest Drain Insertions (ICD-I) are the most invasive medical clinical procedures. After the NPSA (2007) alerted ICD-I associated morbidity and mortality, NHS organisations made concerted efforts to improve ICD-I training for medical trainees in simulated setting. Subsequent practical training remains opportunistic. In our practice, we noticed: a) Patient selection for ICD-I is often sub-optimal b) Much of the complications and morbidity occurs post-ICD-I and c) Junior doctors (JD) have limited knowledge and confidence in managing chest drains post-ICD-I. We set out to understand the range of ICD- I and post-ICD-I management (P-ICD-I-M) skills in our hospital, with a view to organising hands-on workshops to address any learning needs identified. We share our experience. Summary of Work: Doctors of all grades and specialities at the University Hospital Ayr were invited to complete an anonymous on-line survey: https://goo.gl/forms/c3CHq1YRn2Ua1sDs2 The results informed the programme design of five 4-hour hands-on ICD-I and post-ICD-I management workshops delivered to JD between June and December 2017. Accordingly, focus of the workshops was weighted towards decision making (patient selection and P-ICD-I-M). We assessed our effectiveness through a) Participants’ feedback and evaluation b) By repeating the on-line survey and c) By auditing case note documentation of ICD-I’s in the 12 months following the workshops. Summary of Results: Workshop evaluation: 100% of participants rated the workshop as Excellent overall. 60 responses to the online survey were received. Post course improvement in patient selection (from 48.3% to 95%) and P-ICD-I-M (21.6% to 85%) was demonstrated. Audit: 19 patients had 20 drains. Valid indications for chest drains were recorded in all cases. P-ICD-I-M was also well documented with clear management plans in 90% of cases. Discussion and Conclusions: Often technical skills’ training of ICD-I, overlooks development of the arguably more important cognitive skills of optimal ICD-I patient selection and safe P-ICD-I-M. Take-home Messages: Our hands-on workshops addressed the identified lacunae in knowledgebase, receiving very satisfactory feedback and evaluation with demonstrably improved change in behaviour, contributing to increased patient safety. #10GG Posters - Patient as Educators/Patient Safety
10GG10 (2766) Date of Presentation: Wednesday, 28 August 2019 Time of Session: 00830-1015 Location of Presentation: Hall/Foyer F, Level 0
Simulation based education on chemotherapy medication safety of new graduated nurses
AUTHOR(S): Shu-Fen Chen, Taipei Medical University-Shuang Ho Hospital, Taiwan (Presenter) Tze-Fang Wang, National Yang-Ming University, Taiwan Mei-Hua Wang, National Taipei University Of Nursing And Health Sciences, Taiwan Wen-Ting Ho, Taipei Medical University-Shuang Ho Hospital, Taiwan Chia-Li Wu, Taipei Medical University-Shuang Ho Hospital, Taiwan
ABSTRACT
Background: Chemotherapy are high-risk drugs and even minor negligence may endanger patient safety. New graduated nurses lack experience in the administration of chemotherapy, which is an unfamiliar process, and easily to lead adverse drug events. Simulation-based education is learner-centered and emphasizes the interaction between learners and learning situations. Therefore, our aim is use simulation- based education to enhance the ability of new graduated nurses to administer chemotherapy medications and improve patient safety. Summary of Work: Application of simulation-based education includes skills, simulation, critique and debriefing (SSCD). (1) Technical exercises: Through videos, teaching and practice of delivery techniques. (2) Situational simulation: Key events that lead to alarm events in violation of patient safety are added to the situation, and the entire simulation learning process is recorded. (3) Learning critique: Observe peer performance and record whether the peer has performed important behavioral and safety procedures based on a critique form. (4) Debriefing: Teachers and students examine video content, discuss case focuses, patient safety principles, student performance, and the impact of negligent clinical work. Summary of Results: First, new graduated nurses learning chemotherapy medication safety behavior and were able to identify negligence in patient safety in situation simulations. Second, teaching and learning satisfaction was 95%. Third, there was a slight decline in the rate of adverse drug events. This requires long- term observation and future research. Discussion and Conclusions: Simulation-based education allows new graduated nurses to learn and develop relevant experience in a safe environment without having to worry about causing harm to real patients are very importance to nursing education. Application of situational simulation allows new graduated nurses can learn chemotherapy medications safety behaviors, enabling them to have impressive learning experiences. This learning approach enhances the ability of new graduated nurses to administer chemotherapy medications. Moreover, satisfaction with teaching and learning is improved, along with patient safety and nursing quality. Take-home Messages: Compared with traditional teaching strategies, situational simulation to provide learners with an experiential learning experience. This is an approach for learning how to do a procedure, which includes learning from mistakes and repeated practice, and is effective in improving patient safety. #10GG Posters - Patient as Educators/Patient Safety
10GG11 (1210)
Date of Presentation: Wednesday, 28 August 2019
Time of Session: 00830-1015
Location of Presentation: Hall/Foyer F, Level 0
Physician-Pharmacist Cooperation Workshop for Reducing Medication Errors
AUTHOR(S):
Sunee Chayangsu, Surin Medical Education Center, Suranaree University of Technology, Thailand (Presenter)
Chawalit Chayangsu, Surin Medical Education Center, Suranaree University of Technology, Thailand
Natenapa Triniti, Surin Hospital, Thailand
Pakarat Sangkla, Surin Medical Education Center, Suranaree University of Technology, Thailand
ABSTRACT
Background: Medication errors are common and most recognized by pharmacists. Learning with errors may increase physician self-awareness and improve patient safety. We conducted workshop with pharmacists to improve prescribing skills and develop interprofessional education to our institute.
Summary of Work: We set up workshop with three stations consisted of 1.Medication Reconciliation 2.Prescribing Errors and 3.Drug Use Evaluation (DUE) of antibiotics. A group included with physician, pharmacists, interns and 6th year medical students (externs) rotated in each stations every 30 minutes. The questionnaire was used to evaluate satisfaction and advantage scores of workshop.
Summary of Results: All questionnaires were responded with 28 interns and 30 externs. The mean of satisfaction and advantage scores were 4.50 and 4.62 with no one responded under score 3 (max score=5). Interns rated scores more than externs both. Interns satisfaction and advantage scores were 4.64(±0.49), 4.75(±0.44) compared with externs score 4.37(±0.72), 4.50(±0.51), p=0.095 and p=0.051 respectively. Most of participants agreed that all three aspects in stations were important and necessary. Some suggested feedback directly to physician and working with interprofessional staffs will improve medication errors.
Discussion and Conclusions: Interns and externs in our institute are satisfied with this activity and physician-pharmacist workshop has the advantage for them. Both scores of externs are lower than interns reflect that medication error may be far from them because most patients are treated directly by interns.
Take-home Messages: Interprofessional education as physician-pharmacist cooperation workshop may improve medication errors and patient safety. #10GG Posters - Patient as Educators/Patient Safety
10GG12 (785) Date of Presentation: Wednesday, 28 August 2019 Time of Session: 00830-1015 Location of Presentation: Hall/Foyer F, Level 0
Evaluation of a patient safety course for intensive medicine residents using the Kirkpatrick’s model
AUTHOR(S):
Carolina Ruiz, Pontificia Universidad Católica de Chile, Chile (Presenter) Magdalena Vera, Pontificia Universidad Católica de Chile, Chile Noskar Navarro, Pontificia Universidad Católica de Chile, Chile Nicolas Severino, Pontificia Universidad Católica de Chile, Chile
ABSTRACT
Background: Critically ill patients admitted to the Intensive Care Units (ICU) are especially vulnerable to adverse events. The severity of their medical condition, concomitant with the complexity of their management can result in treatment and procedure errors. Daily, 1.7 errors/patient have been described during the ICU stay, and a large part of them can cause significant harm to patients. Despite this, the teaching of patient safety (PS) is limited in many intensive medicine (IM) residency programs. During 2018 a pilot PS course was developed within the IM residency program of the Pontificia Universidad CatÓlica de Chile. This course was developed in 4 sessions by a team of multidisciplinary facilitators, stimulating active learning. The objective of our study was to evaluate this course using levels 1 and 2 of Kirkpatrick’s evaluation model. Summary of Work: To assess level 1 (satisfaction) an 11-statement survey was conducted after the first and last session. To evaluated level 2A (perception) an 8-statement survey was applied before and after the course. The results were described with percentages and the evolution of the responses was analyzed using the Fishers Test. A value p<0.05 was considered significant. Summary of Results: The 18 residents of the program participated in the course and answered the surveys. In the initial satisfaction and perception surveys 88% and 67% of the statements, respectively, were qualified with good scores. The results of both surveys improved after the course was finalized, but without statistical significance. Discussion and Conclusions: Other studies have also shown that it is difficult to improve the perception of PS in residents, even after developing learning programs. These results will help us to improve this course using different learning methodologies. Future intensivists should be experts in PS, so it is imperative to improve the perception that they have of this topic. In conclusions, levels 1 and 2A of Kirkpatrick’s model could be improved during a pilot course of PS. This learning activity should be optimized to generate an important change in the perception of PS. Take-home Messages: Learning programs of PS for residents have the challenge to positively stimulate the perception of this topic. #10GG Posters - Patient as Educators/Patient Safety
10GG13 (3259) Date of Presentation: Wednesday, 28 August 2019 Time of Session: 00830-1015 Location of Presentation: Hall/Foyer F, Level 0
Foundation doctors’ perceptions towards feedback on electronic prescribing errors: a mixed-methods, single-centre study
AUTHOR(S): Ann Chu, Imperial College London, UK (Presenter) Arika Kumar, UCL School of Pharmacy, UK Geraldine Depoorter, University of Leuven, Belgium Bryony Dean Franklin, Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare, UK Monsey McLeod, National Institute for Health Research Imperial Patient Safety Translational Research Centre, UK
ABSTRACT
Background: Medicines safety is a key component of patient safety. Reducing prescribing errors, especially by novice prescribers, is a core aspect of quality improvement in healthcare. The expansion of electronic prescribing (EP) in the NHS requires additional staff training and development. This study explores the views of UK-based Foundation doctors on the provision of feedback on electronic prescribing errors. Summary of Work: A mixed-methods study was conducted at a large NHS hospital Trust. Electronic prescribing in all inpatient areas has been active since 2016. Phase 1 was a questionnaire study (both online and paper) delivered to all Foundation doctors (n=89). Phase 2 was an interview study with volunteer participants from the same sample. Summary of Results: Phase 1: 25/89 submitted responses (28% response rate). Most respondents (23/25) believed feedback about prescribing errors was important. Clinically, they wanted information about their own EP errors and digitally, wanted better understanding of the EP system to prevent repeating errors. However, current feedback provision was lacking or informal. Foundation doctors were supportive of personalised, real-time, digitised feedback mechanisms, as well as learning from general prescribing errors. Phase 2: 12 participants took part in either a focus group (n=7) or an interview (n=5). Foundation doctors appraised draft error reporting templates for utility, layout and perceived impact on learning. They were receptive to receiving personalised EP data but varied in format preferences (e.g. graphs, case studies). Others highlighted the importance of multidisciplinary communication. Discussion and Conclusions: Overall, Foundation doctors would value feedback on their electronic prescribing. As novice prescribers, they are keen to learn from errors, develop their clinical prescribing skills and use the electronic interface effectively. Our findings can be used to facilitate development of personalised EP feedback. Further research is needed to examine how Foundation doctors would engage with personalised error reporting if this was implemented. Take-home Messages: Foundation doctors in this study recognise the importance of learning from feedback on electronic prescribing errors, both clinically and digitally. A range of tailored, user-centred options would be a positive strategy to enhance the value of patient safety information for novice prescribers. #10GG Posters - Patient as Educators/Patient Safety
10GG14 (2516)
Date of Presentation: Wednesday, 28 August 2019
Time of Session: 0830-1015
Location of Presentation: Hall/Foyer F, Level 0
How to increase proper and suitable competency in medical practice
AUTHOR(S):
Boonyarat Warachit, Ministry of Public Health, Thailand (Presenter)
Varavudh Sumawong, Faculty of Medicine, Thailand
ABSTRACT
Background: In medical practice,problem solving and decision making skills are very crucial, however these skills decrease despite practicing in both simulated and real patients.
Summary of Work: A survey from medical teachers about their opinions in information gathering, critical appraisal, decision making and communication skills in final year medical students was done. An assessment driven learning using long case examination with modified essay question (MEQ) was developed to improve their skills. Final year medical students would have history taking and physical examination with simulated patient for thirty minutes and another thirty minutes for MEQ in this case.
Summary of Results: Sixty seven percent from 112 medical teachers said that young doctors had more problems, thirty said it was not different. Sixty three percent agree that we should improve their skills despite most of them could pass national licensing examination. Both long case examination and MEQ are good for assessing clinical reasoning. All medical students satisfied with this formative assessment driven tool.
Discussion and Conclusions: Proper and suitable competency can developed using many teaching, learning and assessment tools. Both long case examination and MEQ are good for assessing clinical reasoning but low reliability except using more cases and time.
Take-home Messages: Decreasing suitable competency in future doctors resulting decreasing patient safety. #10GG Posters - Patient as Educators/Patient Safety
10GG15 (1160) Date of Presentation: Wednesday, 28 August 2019 Time of Session: 0830-1015 Location of Presentation: Hall/Foyer F, Level 0
What could be the potential barrier for medical students to speak up when they encounter medical error?
AUTHOR(S):
Chao-Chun Huang, Taipei Medical University Hospital, Taiwan (Presenter) Jen-Chieh Wu, Taipei Medical University Hospital, Taiwan Hui-Wen Chen, Taipei Medical University, Taiwan Yi-No Kang, Taipei Medical University Hospital, Taiwan
ABSTRACT
Background: Medical student plays an important role in preventing medical error and ensuring patient safety. “See something, say something” sounds not hard but it would be challenging for medical students to report potential medical error in a complex clinical situation. The aim of this study is to identify the potential barrier and factors affecting medical students to speak up when observing potential medical errors. Summary of Work: A cross-sectional study was conducted among 154 clerkship medical students. Barriers of reporting a potential medical error was assessed using a 10-item structured questionnaire with a 6 points Likert-scale. The content validity was obtained by our internal expert group including faculties from different units and disciplines. The tool was developed and modified based on AHRQ hospital survey on patient Safety culture and the local cultural environment. Summary of Results: Nearly 97% of medical students became unconfident when they observed a medical error made by a senior physician even when they are highly confident about essential knowledge and treatment protocol. 74% students considered that the senior physician was in charge so as medical students they do not need to speak up. 96.2% students felt great difficulties to speak up when there existed obvious hierarchy differences. The personality style of the senior practicing physician could affect medical student’s decision on whether to response or not. Medical students may not speak up if the senior physician who is known as stubborn (84.6%), strict (92.4%) and grumpy (88.6%). Gender and different disciplines are not significant factors affecting medical students to speak up in medical error. Discussion and Conclusions: Hierarchy differences is a potential barrier for most medical students to response to potential medical error. Their confidence level to reporting error may decrease if the medical error is made by senior physician. Our study found together with medical knowledge cultivation and teaching, there is a great need for in-depth communication skill training to build up the confidence and competence to respond to medical error scenario for medical students. Take-home Messages: Building up confidence, attitude and competence of teamwork is important for medical students to respond to medical error. #10GG Posters - Patient as Educators/Patient Safety
10GG16 (1201) Date of Presentation: Wednesday, 28 August 2019 Time of Session: 0830-1015 Location of Presentation: Hall/Foyer F, Level 0
Improving patient safety attitude of medical students using medical error simulation scenario training
AUTHOR(S): Yiting Hsu, Taipei Medical University Hospital, Taiwan (Presenter) Jen-Chieh Wu, Taipei Medical University Hospital, Taiwan Hui-Wen Chen, Taipei Medical University, Taiwan Yi-No Kang, Taipei Medical University Hospital, Taiwan
ABSTRACT
Background: Building up teamwork and patient safety attitude is important for medical students not only to develop positive learning outcome but also for ensure patient safety. Limited medical curriculum addressing how medical students could be an important role in patient safety network and effect of team training on improving patient safety attitude. The objective of this study is to determine the efficacy of a simulation course related to medical error on patient safety attitude among undergraduate medical students in Taiwan. Summary of Work: We designed a simulation course composing of one minor and one major medical error scenario, respectively, in medical clerkship rotation training. 154 students were enrolled in this study and divided into two groups. One group would encounter minor medical error scenario first, followed by debriefing session and then major medical error scenario. Another group started with major error scenario, debriefing session, and then minor medical error scenario. At baseline and upon completion the simulation course, students completed a 19-item structured team attitude questionnairs using 6-points Likert-scale developed based on TeamSTEPPS teamwork attitude questionnaire and AHRQ hospital survey. Content validity was obtained from internal expert group. We compared their attitude score before and after simulation course. Summary of Results: The average baseline team attitude score is 88.3 for our participants. There was no baseline attitude score difference between both groups (group one 88.0 vs. group two 88.6, P=0.54). After simulation scenario and debriefing session, the overall post training team attitude score improved to 89.8 (P=0.003). Group two has significant attitude score improved to 90.5 (P=0.017) and group one has trend of attitude score improved to 89.07 (P=0.081). Discussion and Conclusions: Students experience medical error simulation scenario with faculty lead debriefing session could help to improve their team attitude. It is a safe and controllable teaching intervention for students to learn how to respond timely and correctly to a medical error situation without harming real patient. The students’ impression of encountering medical error experience may affect their attitude improvement. Faculty could consider this factor when integrate and design simulation activity and debriefing session. Take-home Messages: Medical error simulation scenario with faculty lead debriefing could help students to develop their team attitude. #10GG Posters - Patient as Educators/Patient Safety
10GG17 (2273)
Date of Presentation: Wednesday, 28 August 2019
Time of Session: 0830-1015
Location of Presentation: Hall/Foyer F, Level 0
An interactive medication error and patient safety workshop for intern and medical students
AUTHOR(S):
Kanokrot Kovjiriyapan, Medical Education Center Phayao Hospital, Thailand (Presenter)
ABSTRACT
Background: Introducing medication error and patient safety topic to medical students is important. However, it is challenging on how this teaching should be done because medical staffs often felt difficult on apply in teaching.The aim of this study was to develop and evaluate a patient safety learning activity which designed to improve internship and medical students’ knowledge and problem-solving skills toward patient safety and medication error using inter-professional team.
Summary of Work: Internship, medical students, nurse students and pharmacists were invited to participate in the workshop. In the classroom, teachers implemented the team competition to promote teamwork, leadership and practice communication, and small group discussion for incidental report and improvement method to prevent medication error. Before and after workshop, intern and medical students’ perception of knowledge and clinical problem-solving skills toward patient safety and quality improvement and inter-professional skill was assessed. We also evaluated student satisfaction with the workshop.
Summary of Results: Pre and post self- assessment were completed by 13 interns and 17 medical students. Interns’ mean score perception of knowledge, problem-solving skills and inter-professional skill improved from 3.53 to 4.4 (p< 0.05), 3.42 to 4.68 (p< 0.001), 3.43 to 4.79 (p< 0.001) respectively. Medical students’ mean score perception of knowledge, problem-solving skills and inter-professional skill also improved from 3.0 to 4.18 (p< 0.001), 3.08 to 4.28 (p< 0.001), 2.88 to 4.35 (p< 0.001)respectively.
Discussion and Conclusions: Interns and medical students’ perception of knowledge and problem-solving skills toward patient safety and medication error and inter-professional skill significantly increased from start to end of the workshop. The workshop was an appropriate method of patient safety and medication error education.They are highly satisfied with this workshop .
Take-home Messages: Integrating patient safety education into health science education is necessary and should implement in multidisciplinary early year of curriculum. #10GG Posters - Patient as Educators/Patient Safety
10GG18 (3063)
Date of Presentation: Wednesday, 28 August 2019
Time of Session: 0830-1015
Location of Presentation: Hall/Foyer F, Level 0
Human Factors Training: evaluating its impact on clinical practice
AUTHOR(S):
Aaron Braddy, National Heart and Lung Institute, Imperial College London, UK (Presenter)
Elizabeth Haxby, Royal Brompton & Harefield NHS Foundation Trust, UK
Jo Szram, Royal Brompton & Harefield NHS Foundation Trust, UK
Phil Higton, Terema Ltd, UK
ABSTRACT
Background: Human Factors (HF) is a social science which studies and attempts to optimise the interactions of humans, technology and the environment at work. HF offers ways to minimise and mitigate human frailties, so reducing medical error and its consequences. The past 15 years has seen a rise in awareness of HF in clinical practice and professional bodies have incorporated it into standards of practice and education for doctors and nurses. The result of these recommendations has seen the development of HF training courses. To date, only four studies have set out to evaluate HF training. At Royal Brompton & Harefield NHS Foundation Trust a training course in HF has been running since 2003, training approaching 1000 healthcare professionals. We aim to evaluate the impact of this training on participants clinical practice and ability to report clinical incidents.
Summary of Work: Each participant completes an end-of-course evaluation involving self-reflection where the participant makes promises to self i.e. how they plan to integrate the training received into practice. We will appraise these promises to look for common themes. They will also be reflected back to participants to evaluate how successfully they have been incorporated. We intend to evaluate clinical incident reports for their quality based on whether the participant has completed HF training.
Summary of Results: We will present data appraising the common themes resulting from HF training focussing on its impact on clinical practice. We will review the quality of clinical incident reporting and correlate it to HF training. This will provide an interesting insight into implementation into practice from both a self-reported and objective viewpoint.
Discussion and Conclusions: This is the largest conducted study appraising HF training and aims to look at its impact on clinical practice and clinical incident reporting.
Take-home Messages: 1) HF is a social science which studies and attempts to optimise the interactions of humans, technology and the environment at work which has been incorporated into standards of practice and education for doctors and nurses 2) This study aims to look at the impact of HF training on clinical practice and clinical incident reporting from both a self-reported and objective viewpoint. #10GG Posters - Patient as Educators/Patient Safety
10GG19 (670) Date of Presentation: Wednesday, 28 August 2019 Time of Session: 0830-1015 Location of Presentation: Hall/Foyer F, Level 0
Moving beyond written reflection: An assessment of postgraduate trainee reflective accounts
AUTHOR(S): Melanie D'Costa, University of Liverpool, UK (Presenter) Jeremy Brown, Edge Hill University, UK Gavin Cleary, Alder Hey Children’s Hospital, UK Graham Lamont, Alder Hey Children’s Hospital, UK Malcolm Semple, University of Liverpool, UK
ABSTRACT
Background: Reflection is considered fundamental in postgraduate medical training, as advised by the General Medical Council (GMC). In order to demonstrate engagement with this practice, compulsory written reflections are often used in work based assessment. Many clinicians remain reluctant to complete written reflections. Barriers include variable training and feedback practices, inconsistent role modelling and disparate ideas regarding the added value of formalised reflection. Some doctors appear to prefer traditional methods of evaluating errors, such as peer discussion or independent rumination. In 2018, the erroneous assumption that Hadiza Bawa-Garba’s e-portfolio reflections were used in criminal court proceedings caused fear amongst the UK Medical community, worsening the collective disengagement from reflection. Summary of Work: As part of the standard evaluation of medication errors at Alder Hey Children’s Hospital, the prescribers are invited to participate in a reflective exercise. The aims of this pilot study were (1) to determine the extent of engagement with optional reflective learning and (2) to assess the quality of these reflective reports. Ethical approval was sought from the University of Liverpool. Reflections submitted by trainee doctors across a two year period were graded using a previously published quality rubric. Ordinal scores from 0 to 6 were allocated according to the description of the event, justification of lessons learned and analysis of contributory factors. Summary of Results: Preliminary analysis indicates poor engagement with an approximate return rate of 30%. Thirty seven reflections from 2017 (n=16) and 2018 (n=21) were graded, with a mean score of 2.8 (standard error 0.22). Further analysis is planned to identify trends in engagement across different time periods and training levels. Discussion and Conclusions: This project supports previous work in reporting poor engagement with written reflection. Results will inform a future substantive study which aims to identify andragogical methods of reflection through exploratory interviews. Take-home Messages: Although written reflection is widely used within postgraduate medical assessment, quality and engagement can be substandard. Enhancing existing methods of authentic reflection may be preferred by doctors and promote triple loop learning, allowing for greater educational impact.