A retrospective study of complaint letters sent to a Swiss Emergency Department between 2009 and 2014.

OBJECTIVE: Patient complaints are a valuable resource for monitoring and improving patient safety and quality of care. The purpose of this study was to analyze the complaint letters received at a Swiss academic emergency department (ED) over six years. METHODS: A retrospective study of all complaint letters sent to a Swiss academic ED between 2009 and 2014 was conducted. The following data were extracted: epidemiology items, reasons for complaints, hospital responses, follow-up, and severity of the events mentioned in the complaints. All complaint letters related to adult patients evaluated in the ED between 2009 and 2014 were included and a qualitative evaluation was performed based on a systematic taxonomy. Context, patient characteristics, mode of resolution and clinical severity of the related adverse event were evaluated. RESULTS: A total number of 156 complaints were recorded, corresponding to an annual complaint rate of 5.5 to 8.8 per 10,000 visits. The complaints concerned mostly three domains (clinical care, management and patient or caregiver relationship) with a slight predominance for organisation and logistics (39%) compared with 31.4% for standard of care and 29.6% for communication/relational complaints. The majority of complaints were sent within one month of the ED visit. Most complaints were resolved with written apologies or explanations. The consequences of 73.5% of the events in question were considered minor or negligible, 19% moderate, and 6.5% major. Only 1% (two cases) was related to situations with catastrophic consequences. CONCLUSION: Complaint incidence in our ED was low and remained stable over the six-year observation period. Most of the complaints pertained to incidents that entailed negligible or minor consequences. As most complaints were due to inadequate communication, interventions targeting improvement of the doctor/patient communication are required.

Adherence therapy improves medication adherence and quality of life in people with Parkinson's disease: a randomised controlled trial.

BACKGROUND: Many factors are associated with medication non-adherence in Parkinson's disease (PD), including complex treatment regimens, mood disorders and impaired cognition. However, interventions to improve adherence which acknowledge such factors are lacking. A phase II randomised controlled trial was conducted investigating whether Adherence Therapy (AT) improves medication adherence and quality of life (QoL) compared with routine care (RC) in PD. METHODS: Eligible PD patients and their spouse/carers were randomised to intervention (RC plus AT) or control (RC alone). Primary outcomes were change in adherence (Morisky Medication Adherence Scale) and QoL (Parkinson's Disease Questionnaire-39) from baseline to week-12 follow up. Secondary outcomes were MDS-UPDRS (part I, II, IV), Beliefs about Medication Questionnaire (BMQ), EuroQol (EQ-5D) and the Caregiving Distress Scale. Blinded data were analysed using logistic and linear regression models based on the intention-to-treat principle. RESULTS: Seventy-six patients and 46 spouse/carers completed the study (intervention: n = 38 patients, n = 24 spouse/carers). At week-12 AT significantly improved adherence compared with RC (OR 8.2; 95% CI: 2.8, 24.3). Numbers needed to treat (NNT) were 2.2 (CI: 1.6, 3.9). Compared with RC, AT significantly improved PDQ-39 (-9.0 CI: -12.2, -5.8), BMQ general harm (-1.0 CI: -1.9, -0.2) and MDS-UPDRS part II (-4.8 CI: -8.1, -1.4). No significant interaction was observed between the presence of a spouse/carer and the effect of AT. CONCLUSION: Adherence Therapy improved self-reported adherence and QoL in a PD sample. The small NNT suggests AT may be cost-effective. A larger pragmatic trial to test the efficacy and cost-effectiveness of AT by multiple therapists is required.

Re-introducing skills teaching to nurse education: an action research project.

A skills teaching programme for first year nursing students is being developed as an action research project with the participation of lecturers, practitioners of three NHS trusts and first year students. All branches of nursing are equally represented. During the first part of the action research cycle the skills to be taught were decided upon using anonymous questionnaires and branch specific group interviews. The selected skills related to aspects of communication, observation, care planning and nursing activities as well as health care and information technology. The professional and personal development of students was also considered. All branches were able to agree on a common skills teaching programme. During this first part of the action research cycle concerns about the organizational possibility of teaching skills to an ever-increasing number of nursing students and the necessary participation of many lecturers were raised. Nevertheless, all participants emphasized the need to continue the project, requesting the development, implementation and evaluation of a new curriculum based on this research as soon as possible. This research demonstrates how small schools of nursing without the resources of large metropolitan-based medical schools and teaching hospitals can improve or design and implement skills teaching programmes for their students in a logical and research based fashion.

Preceptorship: the progression from student to staff nurse.

Preceptorship assists the development from learner to accountable staff nurse. Time has to be available for preceptorship to be successful. The learning objectives need to be relevant for the individual preceptee. Preceptors require considerable support for their role. Preceptees had difficulty adjusting to being staff nurses and experienced high levels of stress. Most progress was observed after a three month period, when ability and confidence levels had increased and stress levels decreased.

Role of nurses in promoting complementary therapies.

The decline in the caring aspects of medicine has made technology appear cold and inhuman and has turned medicine into a physical, restorative profession. Because practitioners are disillusioned by the shortcomings of scientific medicine, a desire to explore alternative approaches to health has appeared. Many complementary methods are similar to nursing in that they centre on the concept of holism. The lack of research in complementary methods and the need for legal regulation of their practitioners have a potential to discredit this area of health care. Nurses are among the most suitable professional groups to help complementary health care methods to attain their rightful place. The role of the nursing profession in this process will be seen as an indication of its standing as an independent research-based profession.