Development and Implementation of Patient Safety Checklists Before, During and After In-hospital Surgery
- Conditions
- Safety IssuesHealth LiteracySurgeryHealth EconomicsPatient SafetyComplication
- Interventions
- Other: Patient Safety Checklist
- Registration Number
- NCT03105713
- Lead Sponsor
- Haukeland University Hospital
- Brief Summary
Building on the Norwegian Patient Safety Program's target areas, the Patients' Surgical Checklist (PASC) will empower surgical patients to become more involved in their own safety and contribute to preventive safety measures. A safety checklist for patients to use has been developed and validated for use in surgical patients. In a Stepped Wedge Cluster RCT effects of patients using their own checklists to avoid preventable patient harm are examined. The project will re-use existing health and personal data collected from patient records and patient reported data as outcome measures. A consortium of all relevant stakeholders and users participate: two hospitals with seven surgical clusters, patient representatives, representatives of general practitioners, and interdisciplinary in-hospital professionals. The important project partners are information and communications technology companies (Helse-Vest IKT and CheckWare service delivery), general practitioners, and national and international research partners leading in the field of patient safety, implementation science and health economics.
- Detailed Description
The PASC consist of measures that enable patients to optimize their own health prior to surgery and for discharge from hospital. The checklist addresses risk areas as pre-operative information and preparations, post-operative information, and post-operative plans and follow-up. Pre-operative risk areas are contact information, medication safety, health status, optimizing health and nutritional status, dental status, comprehend critical information, preparation two weeks before surgery, communication with surgical ward, and discharge planning. Post-operative risk areas are prevention of complications, medication safety, activity restriction, and pain relief.
The checklist has been developed in cooperation with patients, patients' representatives, surgeons, general practitioners, ward doctors, nurses, pharmacists, clinical nutritionists, safety officers, hospital managers, information technology experts and the researchers. The intervention include paper and electronically versions of the checklist. Of eligible surgical wards, seven were randomly selected based on power calculation. All the invited wards agreed to participate. Surgical patients from these wards, in two Norwegian hospitals, will be invited to participate in the trial. Based on data from a validation and feasibility study of PASC, the power analysis suggest to include 38 patients per month (on average), per cluster over 20 months, as the lowest number of participants to detect a 5% (33.3% relative risk reduction). An intra-cluster-correlation at 0.05, and type I and type II error at 0.05 and 0.20, respectively, were assumed.
The outcomes of this study are primarily patient outcomes (morbidity and mortality). The study further assess outcomes on nutritional status (MST form), implementation (acceptability, appropriateness and feasibility survey), health economic (EQ-5D-3L) data, and health literacy (HLQ), from surveys and forms.
Based on power calculation, 350 questionnaires will be distributed in each arm of the trial (baseline and internvention).
Focus group interviews with content analysis will be applied to assess patients and health care personnel's experiences with patients' use of PASC.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 6191
Elective surgery.
- Age over 18 years.
- Able to use Norwegian language.
- Patients must have had surgery 2-4 weeks before inclusion for the focus group interviews.
- Must be cognitive able to use the checklist.
- Age under 18 years.
- Non-surgical procedures.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description Patient Safety Checklist Intervention Patient Safety Checklist The intervention to be administered is a patient safety checklist (two parts) for patients to be performed on paper or electronically: a) before admission to hospital, and b) under hospital stay (discharge)
- Primary Outcome Measures
Name Time Method Number of embolism associated with the hospital stay Up to 30 days Number of embolies
Number of infections Up to 30 days Numbers of infections
Number of mechanical implant complications Up to 30 days Number of mechanical implant complications
Number of re-operations Up to 30 days Number of re-operations
Number of complications associated with the participants surgery Up to 30 days Total numbers of complications
Number of complications within respiratory system Up to 30 days Number of respiratory complications
Number of complications within cardio-thoracic system Up to 30 days Number of cardio-thoracic complications
Number of nervous system complications Up to 30 days Number of nervous system complications
Volume of bleeding associated with operation Up to 30 days Volume of bleedings in mL
Number of re-admissions Up to 30 days Number of re-admissions
- Secondary Outcome Measures
Name Time Method Rate of patient scores on EQ5D Up to 3 months Mean scores of EQ5D
Rate of patient scores on Health Literacy Questionaire Up to 3 months post discharge Mean scores of HLQ and EQ5D surveys
Rates of Checklist Implementation Survey scores Up to 3 months post discharge Mean scores on checklist implementation survey
Number of deaths associated with surgery Up to 90 days Total numbers of deaths
Trial Locations
- Locations (2)
Haukeland University Hospital
🇳🇴Bergen, Norway
Førde Central Hospital
🇳🇴Førde, Norway