[How informed is patient consent to interventional cardiology procedures. A quality assurance survey by the nurses].

Giuseppe Steffenino, Federica Aimar, Mariachiara Bogetti, Maria Stefania Dutto, Monica Dutto, Giulietta Lice, Aldo Mogna, Marilena Tomatis, Laura Conte
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Abstract

Background: A new patient consent form has recently been adopted in our Institution, with a uniformly written text to be used for all medical procedures and interventions. It is accompanied by a separate information sheet, explaining both the details and the risk/benefit profile for each specific procedure/intervention. It should be given to the patient as early as possible after the procedure/intervention is planned. Testing the effectiveness of this new information policy has been included into the quality assurance goals by our nursing staff.

Methods: From mid April to mid June 2004 a questionnaire was administered to all patients who had undergone an elective cardiac interventional procedure. The timing, manner and perceived completeness of the information received by patients was investigated by 14 yes/no or multiple choice questions. A goal of <5% deviation from a 100% standard was set for all indicators.

Results: Two hundred and thirty-eight valid questionnaires were obtained out of 308 consecutive procedures. Seven patients (3%) refused the questionnaire. The response rate was >90% for each question. Seventy-eight patients (33%) had a history of cardiac interventional procedures. The information sheet had been received before the procedure in 93% of cases, and this had happened in the ward in 58% of cases; the procedure had been performed at least 1 hour after receipt of the information sheet in 83% of cases. Twenty-seven patients (13%) stated they had not read the information sheet, in most cases (92%) because they felt they already knew enough. Among patients who had read the information sheet, 99% deemed it could be easily understood. Difficulties in asking questions were reported by 6% of patients. When questions had been asked, the nursing staff was addressed in 42% of cases, and the answers were rated as clear in 98% of cases. The consent form was not read at all by 13% of patients, due to alleged lack of time, and was not read completely by another 15%; 98% of those who had read it, however, found it was fairly understandable.

Conclusions: The effectiveness of our new patient information policy seems to approach our quality goals, and is liable to further improvement. The nursing staff of the cardiac catheterization unit is involved in the patient information process, and has full competence to study this issue.

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患者对介入心脏病学手术的知情程度。由护士进行的质量保证调查。
背景:我们机构最近采用了一种新的患者同意书,其中有统一的书面文本用于所有医疗程序和干预措施。它附有一份单独的信息表,解释每个特定程序/干预的细节和风险/益处概况。应在计划手术/干预后尽早给予患者。测试这一新信息政策的有效性已被纳入我们护理人员的质量保证目标。方法:2004年4月中旬至6月中旬对所有择期心脏介入手术患者进行问卷调查。通过14道是/否或多项选择题来调查患者接受信息的时间、方式和感知完整性。结果目标:在308个连续程序中,获得有效问卷238份。7名患者(3%)拒绝填写问卷。每个问题的回复率都大于90%。78例患者(33%)有心脏介入手术史。93%的病例在手术前收到了信息单,58%的病例在病房内收到了信息单;在83%的病例中,该程序在收到信息表后至少1小时进行。27名患者(13%)表示他们没有阅读信息表,在大多数情况下(92%),因为他们觉得自己已经知道得够多了。在阅读过说明书的患者中,99%的人认为说明书很容易理解。6%的患者报告有提问困难。当被问及问题时,42%的病例得到了护理人员的回答,98%的病例的答案被评为清楚。13%的患者根本没有阅读同意书,因为他们声称没有时间,另有15%的患者没有完全阅读同意书;然而,98%读过这篇文章的人认为它是可以理解的。结论:我们的新患者信息政策的有效性似乎接近我们的质量目标,并有可能进一步提高。心导管病房的护理人员参与到患者的信息处理过程中,完全有能力研究这个问题。
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