A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery: Qualitative Study

Aline C. Stolk-Vos (Corresponding Author), Jolet J.E. van der Steen, Constance H.C. Drossaert, Annemarie Braakman-Jansen, Bart LM Zijlmans, Leonieke W Kranenburg, Dirk F. De Korne

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Abstract

Background: Surgery holds high risk for iatrogenic patient harm. Correct and sufficient communication and information during the surgical process is a root solution for preventing patient harm. Information technology may substantially contribute to engaging patients in this process.

Objective: To explore the feasibility of a digital patient-led checklist for cataract surgery, we evaluated the experiences of patients and nurses who have used this novel tool with a focus on use, appreciation, and impact.

Methods: A multidisciplinary team, including cataract surgeons, nurses, pharmacists and administrative representatives developed a 19-item digital patient-led checklist for cataract patients who underwent surgery in an ambulatory setting. This “EYEpad” checklist was distributed to patients and their companions during their hospital visit via an application on a tablet. It contained necessary information the patient should have received before or during the surgical preparation (8 items), before anesthesia (2 items), and before discharge (9 items). Patients and their companions were invited to actively indicate the information they received, or information discussed with them, by ticking on the EYEpad. Our qualitative research design included semi-structured individual interviews with 17 patients and a focus group involving 6 nurses. The transcripts were analyzed by 2 independent coders using both deductive and inductive coding.

Results: All but one of the 17 patients used the EYEpad, occasionally assisted by his or her companion (usually the partner). In several cases, the checklist was completed by the companion. Most patients felt positively about the usability of the EYEpad. Yet, for most of the patients, it was not clear why they received the checklist. Only 4 of them indicated that they understood that the EYEpad was used to determine if there were sufficient and correct information discussed or checked by the nurses. Although most nurses agreed the EYEpad was easy to use and could be a useful tool for improving patient engagement for improving safety, they felt that not all elderly patients were willing or capable of using it and it interfered with the existing surgical process. They also anticipated the need to spend more time explaining the purpose and use of the EYEpad.

Conclusions: Our results showed that a digital patient-led checklist is a potentially valid way to increase patient participation in safety improvement efforts, even among elderly patients. It also illustrates the crucial role nurses play in the implementation and diffusion of technological innovations. Increased patient participation will only improve safety when both healthcare workers and patients feel empowered to share responsibility and balance their power.
Original languageEnglish
Article numbere3
JournalJMIR Perioperative Medicine
Volume1
Issue number2
Publication statusPublished - 16 Jul 2018

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Checklist
Cataract
Safety
Patient Participation
Nurses
Patient Harm
Diffusion of Innovation
Inventions
Nurse's Role
Qualitative Research
Focus Groups
Ambulatory Surgical Procedures
Pharmacists
Tablets

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Stolk-Vos, A. C., van der Steen, J. J. E., Drossaert, C. H. C., Braakman-Jansen, A., Zijlmans, B. LM., Kranenburg, L. W., & De Korne, D. F. (2018). A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery: Qualitative Study. JMIR Perioperative Medicine, 1(2), [e3].
Stolk-Vos, Aline C. ; van der Steen, Jolet J.E. ; Drossaert, Constance H.C. ; Braakman-Jansen, Annemarie ; Zijlmans, Bart LM ; Kranenburg, Leonieke W ; De Korne, Dirk F. / A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery : Qualitative Study. In: JMIR Perioperative Medicine. 2018 ; Vol. 1, No. 2.
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title = "A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery: Qualitative Study",
abstract = "Background: Surgery holds high risk for iatrogenic patient harm. Correct and sufficient communication and information during the surgical process is a root solution for preventing patient harm. Information technology may substantially contribute to engaging patients in this process.Objective: To explore the feasibility of a digital patient-led checklist for cataract surgery, we evaluated the experiences of patients and nurses who have used this novel tool with a focus on use, appreciation, and impact.Methods: A multidisciplinary team, including cataract surgeons, nurses, pharmacists and administrative representatives developed a 19-item digital patient-led checklist for cataract patients who underwent surgery in an ambulatory setting. This “EYEpad” checklist was distributed to patients and their companions during their hospital visit via an application on a tablet. It contained necessary information the patient should have received before or during the surgical preparation (8 items), before anesthesia (2 items), and before discharge (9 items). Patients and their companions were invited to actively indicate the information they received, or information discussed with them, by ticking on the EYEpad. Our qualitative research design included semi-structured individual interviews with 17 patients and a focus group involving 6 nurses. The transcripts were analyzed by 2 independent coders using both deductive and inductive coding.Results: All but one of the 17 patients used the EYEpad, occasionally assisted by his or her companion (usually the partner). In several cases, the checklist was completed by the companion. Most patients felt positively about the usability of the EYEpad. Yet, for most of the patients, it was not clear why they received the checklist. Only 4 of them indicated that they understood that the EYEpad was used to determine if there were sufficient and correct information discussed or checked by the nurses. Although most nurses agreed the EYEpad was easy to use and could be a useful tool for improving patient engagement for improving safety, they felt that not all elderly patients were willing or capable of using it and it interfered with the existing surgical process. They also anticipated the need to spend more time explaining the purpose and use of the EYEpad.Conclusions: Our results showed that a digital patient-led checklist is a potentially valid way to increase patient participation in safety improvement efforts, even among elderly patients. It also illustrates the crucial role nurses play in the implementation and diffusion of technological innovations. Increased patient participation will only improve safety when both healthcare workers and patients feel empowered to share responsibility and balance their power.",
author = "Stolk-Vos, {Aline C.} and {van der Steen}, {Jolet J.E.} and Drossaert, {Constance H.C.} and Annemarie Braakman-Jansen and Zijlmans, {Bart LM} and Kranenburg, {Leonieke W} and {De Korne}, {Dirk F.}",
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Stolk-Vos, AC, van der Steen, JJE, Drossaert, CHC, Braakman-Jansen, A, Zijlmans, BLM, Kranenburg, LW & De Korne, DF 2018, 'A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery: Qualitative Study' JMIR Perioperative Medicine, vol. 1, no. 2, e3.

A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery : Qualitative Study. / Stolk-Vos, Aline C. (Corresponding Author); van der Steen, Jolet J.E.; Drossaert, Constance H.C.; Braakman-Jansen, Annemarie; Zijlmans, Bart LM; Kranenburg, Leonieke W; De Korne, Dirk F.

In: JMIR Perioperative Medicine, Vol. 1, No. 2, e3, 16.07.2018.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery

T2 - Qualitative Study

AU - Stolk-Vos, Aline C.

AU - van der Steen, Jolet J.E.

AU - Drossaert, Constance H.C.

AU - Braakman-Jansen, Annemarie

AU - Zijlmans, Bart LM

AU - Kranenburg, Leonieke W

AU - De Korne, Dirk F.

PY - 2018/7/16

Y1 - 2018/7/16

N2 - Background: Surgery holds high risk for iatrogenic patient harm. Correct and sufficient communication and information during the surgical process is a root solution for preventing patient harm. Information technology may substantially contribute to engaging patients in this process.Objective: To explore the feasibility of a digital patient-led checklist for cataract surgery, we evaluated the experiences of patients and nurses who have used this novel tool with a focus on use, appreciation, and impact.Methods: A multidisciplinary team, including cataract surgeons, nurses, pharmacists and administrative representatives developed a 19-item digital patient-led checklist for cataract patients who underwent surgery in an ambulatory setting. This “EYEpad” checklist was distributed to patients and their companions during their hospital visit via an application on a tablet. It contained necessary information the patient should have received before or during the surgical preparation (8 items), before anesthesia (2 items), and before discharge (9 items). Patients and their companions were invited to actively indicate the information they received, or information discussed with them, by ticking on the EYEpad. Our qualitative research design included semi-structured individual interviews with 17 patients and a focus group involving 6 nurses. The transcripts were analyzed by 2 independent coders using both deductive and inductive coding.Results: All but one of the 17 patients used the EYEpad, occasionally assisted by his or her companion (usually the partner). In several cases, the checklist was completed by the companion. Most patients felt positively about the usability of the EYEpad. Yet, for most of the patients, it was not clear why they received the checklist. Only 4 of them indicated that they understood that the EYEpad was used to determine if there were sufficient and correct information discussed or checked by the nurses. Although most nurses agreed the EYEpad was easy to use and could be a useful tool for improving patient engagement for improving safety, they felt that not all elderly patients were willing or capable of using it and it interfered with the existing surgical process. They also anticipated the need to spend more time explaining the purpose and use of the EYEpad.Conclusions: Our results showed that a digital patient-led checklist is a potentially valid way to increase patient participation in safety improvement efforts, even among elderly patients. It also illustrates the crucial role nurses play in the implementation and diffusion of technological innovations. Increased patient participation will only improve safety when both healthcare workers and patients feel empowered to share responsibility and balance their power.

AB - Background: Surgery holds high risk for iatrogenic patient harm. Correct and sufficient communication and information during the surgical process is a root solution for preventing patient harm. Information technology may substantially contribute to engaging patients in this process.Objective: To explore the feasibility of a digital patient-led checklist for cataract surgery, we evaluated the experiences of patients and nurses who have used this novel tool with a focus on use, appreciation, and impact.Methods: A multidisciplinary team, including cataract surgeons, nurses, pharmacists and administrative representatives developed a 19-item digital patient-led checklist for cataract patients who underwent surgery in an ambulatory setting. This “EYEpad” checklist was distributed to patients and their companions during their hospital visit via an application on a tablet. It contained necessary information the patient should have received before or during the surgical preparation (8 items), before anesthesia (2 items), and before discharge (9 items). Patients and their companions were invited to actively indicate the information they received, or information discussed with them, by ticking on the EYEpad. Our qualitative research design included semi-structured individual interviews with 17 patients and a focus group involving 6 nurses. The transcripts were analyzed by 2 independent coders using both deductive and inductive coding.Results: All but one of the 17 patients used the EYEpad, occasionally assisted by his or her companion (usually the partner). In several cases, the checklist was completed by the companion. Most patients felt positively about the usability of the EYEpad. Yet, for most of the patients, it was not clear why they received the checklist. Only 4 of them indicated that they understood that the EYEpad was used to determine if there were sufficient and correct information discussed or checked by the nurses. Although most nurses agreed the EYEpad was easy to use and could be a useful tool for improving patient engagement for improving safety, they felt that not all elderly patients were willing or capable of using it and it interfered with the existing surgical process. They also anticipated the need to spend more time explaining the purpose and use of the EYEpad.Conclusions: Our results showed that a digital patient-led checklist is a potentially valid way to increase patient participation in safety improvement efforts, even among elderly patients. It also illustrates the crucial role nurses play in the implementation and diffusion of technological innovations. Increased patient participation will only improve safety when both healthcare workers and patients feel empowered to share responsibility and balance their power.

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JO - JMIR Perioperative Medicine

JF - JMIR Perioperative Medicine

SN - 2561-9128

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M1 - e3

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