March 2, 2009 Update:
Objective: To evaluate effectiveness of how we educate patients regarding abnormal PAP results.
Prior to merging Women’s Health(WH) Department with General Medicine Department to create Clinical Services, abnormal PAP results and education related to it was done by WH clinicians and nursing staff. Since merging the departments this information may be given by a larger group of nursing staff, no longer specifically WH nurses. To ensure the consistency, quality and effectiveness of relaying abnormal PAP information we would like to study the effectiveness of our teaching.
1. Completion with exit test of nurse education relating to counseling of abnormal PAP results 2. Patient survey will reveal the level of satisfaction by the patient with the education process.
3. Nurse documentation of the PAP counseling will contain essential elements relating to the description of the result, timing and importance of follow-up care and written information provided to the patient.
The goal is to evaluate the effectiveness of nursing education relating to abnormal PAP test results in patients who have been educated about the result and its implications. A survey is being developed to capture the patient’s perceptions of important aspects of the education provided by the nurse. The team will evaluate the responses to the surveys and make improvements to the process as indicated by the results.
March 2, 2009 Update
The December 2008 results of the patient survey and chart review are based on a small data set and clearly need to be studied further. However, they illuminate the need for changes in order to provide improved and complete documentation, to consistently provide written information, and to provide additional information to selected patients.
Electronic health record enhancements have been identified to facilitate the process of providing and documenting the counseling. A remeasurement will be made in April 2009.
March 2, 2010 update
1/6/10 Re-measurement of chart review was performed in December, 2009. It was not possible to repeat the patient survey for Fall 2009 due to preoccupation of staff dealing with H1N1 illness on campus.
Chart review was performed December/January 2009-2010 on 30 women who had abnormal PAP results from 8/20/09 -12/2/09 using the same documentation set that was felt essential for the initial assessment. The results (see PAP Chart Review 1/8/10 for actual data) are as follows:
1. Abnormal PAP results given by clinician or nurse- documented at rate of 30/30
2. Description of abnormality- documented at rate of 28/30
3. Recommended treatment- documented at rate of 30/30
4. Importance of follow up care- documented at rate of 25/30
5. Written information provided- documented at rate of 24/30
Analysis of chart review reveals that documentation remains generally complete but not as perfect as that recorded in the April, 2009 measurement. While patients are being provided their abnormal PAP results along with recommendations for treatment at 100 % perfect rates, there has been a slight lapse in recording of description of abnormality (28/30), importance of follow up care (25/30), and written information provided (24/30).
Many of the omissions in documentation are related to the fact that the clinician did not request to have some of the above points of information given to a patients for appropriate reasons related to ongoing care of cervical disease. Some patients may be in the process of follow up and have at a previous time been given detailed description of their cervical disease or written disease information.
- Elaine Hazi, Co-Leader
- Joanna Moyer, Co-Leader
- Agatha Glusko, Member
- Kathy Petroff, Member