Results
Participants
All five selected project members agreed to participate in the
interview. Among the five project members were four nurses and one
quality manager. Two project members were interviewed in the same
session at their request. Of the 40 care professionals that work on the
neurology ward, 23 (57.5%) responded to the questionnaire. The majority
of the respondents were nurses (table 2).
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Reach
Of the five project members who were interviewed, two reported that all
targeted staff members were informed of the intervention. Two other
project members reported that at least all nurses were informed, but
that they were not sure whether all other care professionals were
informed. The other project member indicated that staff members who
exclusively work during weekends or vacation periods may not have been
informed of the CCWs and their use.
The results of the questionnaire
revealed that 20 (87.0%) and 21 (91.3%) of the care professionals who
participated in the survey reported to be informed of the use of
respectively the green and yellow wristbands, respectively. Two of the
nurses who participated in the survey reported not being informed of
either wristbands and one of the speech therapists reported not being
informed of the yellow wristband. The survey respondents were asked to
rate their satisfaction with the manner in which they were informed of
the CCWs. Of the survey respondents who were informed of the CCWs, 13
(65.0%) and 14 (66.6%) reported being (very) satisfied with how they
were informed of respectively the green and yellow wristband.
The
survey respondents were asked to rate the extent to which they agreed
with several statements related to the received information. The
majority of the respondents reported that their colleagues were aware of
the CCWs. Moreover, respondents generally appraised the information
received on the CCWs as clear (table 3).
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Performance according to
protocol
Results of the questionnaire showed that all 13 nurses who had reported
that they had been informed of the CCWs always perform the
water-swallowing test when admitting stroke patients. In addition, nine
of these nurses reported that in almost all cases patients are issued a
CCW after a fall incident and four reported that this happens in most
cases. During the interviews, two of the five project members indicated
encountering patients at the neurology ward who should have been wearing
a CCW but who had not been issued one. According to these project
members, nurses sometimes forget to issue the CCWs during hectic
periods, such as nightshifts and large transfers of patients. In the
questionnaire, the nurses who reported being aware of the CCWs were
asked to which extent all patients who need a CCW, as indicated by their
electronic health record, actually wear it. Nine of the 13 nurses who
were informed of the CCWs reported that almost all patients who need a
CCW wear one and four reported that most patients who need it wear one.
These nurses were also asked how
often they verify whether all patients who need a CCW wear it. Three
nurses indicated patients are inspected for wearing a CCW every day,
four indicated this is done almost every day, five indicated this is
done a few times a week, and one indicated not knowing how often this is
done.
All of the interviewed project
members reported that the sign holders were placed in every patient
room, as intended. The questionnaire revealed that five nurses always
provide the flyers to the patients with a CCW and/or their family, six
nurses provide them to the patients sometimes, and two nurses provide
them seldom or never to the patients. The nurses were also asked to what
extent they explain the use of the CCWs to patients and their families.
The majority of the nurses (n = 11) reported always explaining the use
of the CCWs to patients. One nurses reported explaining the use of the
CCWs to the patients in some cases and another reported explaining it
seldom or never. With regard to explaining the use of the CCWs to family
members, seven nurses reported always doing so, four nurses reported
doing so most of the times, one nurse reported doing so sometimes and
another reported doing so seldom or never.
During the interviews, the four project members who are nurses reported
being attentive to the special needs of patients with a CCW. Examples of
preventive measures they took for patients wearing green wristbands
included: employing motion sensors, putting on non-slip socks, putting
the beds in low position, and putting the bed’s side rails up. With
regard to the yellow wristband, the projected members mentioned a sign
that is hung on the beds of patients with a yellow wristband, to remind
staff and visitors to not provide food that poses a choking hazard.
Project members also reported that the location of patients with a
yellow wristband is mapped to aid the nutritionists in their
work. In the questionnaire,
respondents were asked to rate their level of agreement with several
statements related to the performance according to protocol (table 3).
The respondents generally reported being more careful when mobilizing
patients with a green wristband and when offering food and drink to
patients with a yellow wristband. However, respondents reported mixed
attitudes towards whether they treat patients with a CCW differently.
Compliance
During the interviews, all five project members indicated that patients
sometimes remove their CCWs during a state of deliriousness and that the
CCWs are sometimes covered by patients’ clothing. In the questionnaire,
the nurses were asked how often patients and family members refuse the
CCWs. Of the 13 nurses that were informed of the CCWs, three reported
the patients sometimes refuse the CCWs and 10 reported the patients
refuse them seldom or never. One nurse reported that family members
sometimes refuse the CCWs. The other nurses (n = 12) reported that
family seldom or never refuse the CCWs. Respondents were asked how often
they see patients (un- or intentionally) wear clothes over their CCWs.
Of the respondents who were informed of at least one of the CCWs (n =
21), eight indicated seeing patients wear clothes over their CCWs often,
five reported seeing this regularly, four reported seeing this
sometimes, and four reported seeing this seldom or never or not having
paid attention to it.
Opinion on the
intervention
In the questionnaire, respondents
were asked to express their opinion on the intervention by rating the
extent to which they agreed with several statements (table 3). For both
CCWs, approximately half of the respondents reported that they think
that CCWs help to improve quality of care. Only a minority of the
respondents reported that they think that patients find the CCWs
bothersome. The respondents reported mixed attitudes towards whether the
family of the patients find the CCWs useful. Respondents were asked to
rate their satisfaction with the CCWs as an aid. Of the respondents who
were informed of the CCWs, 11 (55.0%) and 14 (66.7%) reported being
(very) satisfied with respectively the green and yellow wristband as an
aid. All of the interviewed project members observed that patients and
family members generally are content with the CCWs.
In the interviews and questionnaire, we asked how the intervention could
be further improved. During the interviews, three project members
suggested implementing a third colour code that represents both the
green and yellow wristband to help make patients more comfortable. The
two other interviewed project members offered no suggestions for
improvement. The majority of the surveyed care professionals (n = 17,
74.0%) offered no suggestions for improvement. Two survey respondents
wrote that they would like the physiotherapists be more involved in
issuing the green wristbands. One survey respondent suggested organizing
a meeting for all the neurology ward’s staff members to establish more
clarity on the protocols of the intervention. Another respondent noted
that the issue of patients covering their CCWs warrants more attention.
Context
During the interviews, the project members were asked how contextual
factors could have affected the intervention. According to the project
members, the implementation of the intervention was postponed because
some staff members were concerned that labelling patients with CCWs
would violate their privacy. In addition, the project members noted
several factors that caused the implementation period to be busier than
usual. First, during the implementation period, the hospital was also
being accredited by the Netherlands Institute for Accreditation in
Healthcare. Second, because of undergoing renovation, the neurology ward
had to be temporarily move its activities to a different location in the
hospital. Finally, two project members were absent for some time due to
private reasons.