Evaluating transitions of care of hospitalized medical patients to long-term care facilities: a retrospective review of venous thromboembolism prophylaxis.

Venous thromboembolism (VTE) is a significant but preventable cause of hospital-related morbidity and mortality. Prevention of in-hospital VTE, thus, has become a major quality improvement initiative within hospitals. However, addressing VTE prophylaxis rates and appropriateness on transition to other facilities has not been fully characterized to date. The authors of this study retrospectively evaluated VTE prophylaxis on transfer from medical inpatient settings to long-term care facilities. Analysis indicated that on transfer to other facilities, VTE prophylaxis recommendations were not routinely documented. Interfacility communication is crucial to ensure that appropriate prophylaxis recommendations are addressed during transitions of care. New processes evaluating VTE prophylaxis recommendations at the time of care transfer warrant further study.

Patients' Perceptions of a Game About Warfarin and Vitamin K: A Pilot Study.

BACKGROUND: Digital games to promote healthy behaviors are rapidly expanding in the healthcare industry. One area where health game can be useful is in educating patients about oral anticoagulants such as warfarin. The goal of this pilot study was to develop a game about warfarin and vitamin K interactions and evaluate its usability among adult patients receiving warfarin therapy. SUBJECTS AND METHODS: The game was developed by an interdisciplinary team. The content of the game was based on published evidence-based practice about anticoagulation education. Kolb's experiential learning theory served as the theoretical foundation of the game, which we developed in Flash and Actionscript 2(®) (Adobe Systems, San Jose, CA) programming and scripting languages, and it is playable on various platforms, including Windows and Macintosh, via Internet Explorer, Mozilla Firefox, and Safari Web browsers. Twenty patients were surveyed using a 7-point Likert scale to evaluate their experience on the Perceived Health Web Site Usability Questionnaire (PHWSUQ). The PHWSUQ measures satisfaction, ease of learning the site, and usefulness. Possible responses ranged from 1 (very unsatisfied) to 7 (very satisfied) and from strongly disagree (1) to strongly agree (7). RESULTS: The overall mean score on the PHWSUQ was 53.6 out of 70 (SD, 11.3), or 76.6 percent. The mean scores for "satisfaction," "ease of use," and "usefulness" subscales were 80.2 percent, 71.2 percent, and 77.4 percent, respectively. CONCLUSIONS: The findings suggest that patients were satisfied with the game, which indicates that adult patients on warfarin are open to game use as an educational tool to learn health information.

Computerisation of a paper-based intravenous insulin protocol reduces errors in a prospective crossover simulated tight glycaemic control study.

BACKGROUND: Paper-based continuous intravenous insulin protocols for tight glycaemic control (TGC) are typically complex, error-prone, time-consuming and burdensome. Little is known about the errors that occur as a result of misinterpretation and whether computerised protocols reduce errors. OBJECTIVE: To compare the errors resulting from protocol misinterpretation, time required to manage insulin infusions and nursing satisfaction between a computerised insulin protocol and a paper-based protocol. METHODS: In a crossover study, 62 ICU nurses completed 10 TGC simulated scenarios for the computerised and paper protocols. Scenarios evaluated three phases of insulin management: initiation, titration and transition. Scenarios response errors, time to completion and user satisfaction were examined. RESULTS: A total of 620 responses were recorded using both protocols. The computerised protocols were associated with higher user satisfaction, as well as: fewer errors in the titration (13 vs. 113 errors, p=.0001) and transition phases (9 vs. 23 errors, p=.001), fewer dosing errors, although not statistically significant (p=.096), in the initiation phase, and less time to complete in the titration phase (6 vs. 9.5 min, p=.0001). CONCLUSIONS: In a simulated environment, a computerised protocol for TGC resulted in significant insulin dosing error reduction, saved time and improved nurse satisfaction.