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Executive Summary
Patient safety is a challenge in many healthcare settings, including primary care (World Health Organization, 2017). Among other conditions, diabetes mellitus requires the consideration of patient safety (Haltbakk et al., 2019). In this proposal, a Doctor of Nursing Practice (DNP) project dedicated to the engagement of diabetic patients and their families in primary care will be considered.
The topic is significant because diabetes is becoming more widespread (Zimmet, Alberti, Magliano, & Bennett, 2016), but diabetes patient engagement is not focused on by the projects site. Given the potential positive outcomes of patient engagement, which are evidenced by recent systematic reviews (Kim et al., 2018; Park & Giap, 2020), it is reasonable to consider the introduction of a specific approach to patient and family engagement.
The project will consist of a pre-test post-test research, in which the guide by Smith et al. (2017) is going to be implemented to develop a tailored solution to diabetes patient and family engagement in a primary care office. The outcomes will include patient safety measures that are currently tracked by the clinic, as well as patient safety culture and patient engagement index, which are going to be evaluated with already existing and tested tools (Smith et al., 2017; Xu, Cheung, & Wong, 2018).
The participants will be the clinics staff and patients, which is why an IRB review will be required, as well as the protection of human subjects. The following PICOT is proposed: in diabetic patients and their family members (P), does the use of the Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families by Smith et al. (2017) (I) improve patient and family engagement and safety culture, as well as safety outcomes (O), as compared to the pre-intervention period (C), over eight weeks (T)?
Introduction
Patient safety (PS) remains a critical aspect of healthcare, which is brought to attention by all the relevant organizations, including the World Health Organization [WHO] (2017). The purpose of this paper is to propose a short, preliminary plan for a study dedicated to PS improvement with the help of patient and family engagement. The purpose of the proposed project is to implement and measure the outcomes of the implementation of a patient and family engagement guide by Smith et al. (2017) in a primary care setting for diabetic patients. This paper will state the problem, present the PICOT question, and discuss the details of the project, demonstrating that it is a feasible and important study that can help to improve practice.
Problem Statement and Significance of the Practice Problem
The challenge of ensuring PS is among the most important activities and principles of healthcare (WHO, 2017). PS refers to minimizing the preventable harm that can be caused during healthcare, and there are different approaches to securing it (Haltbakk et al., 2019; WHO, 2017). Since the proposed project takes place in a primary care office, the problem of PS in primary care is going to be considered. Specifically, the safety of diabetes patients is going to be discussed since, according to the sites decision-maker, diabetes mellitus is one of the most common conditions of the patients of the practicum site.
Internationally and nationally, the number of people with diabetes keeps growing; in 2015, at least 415 million people all over the world had the condition (Zimmet et al., 2016). The most recent National Diabetes Statistics Report states that at least 30 million people in the US have this disorder, and around 77% of them are diagnosed (National Center for Chronic Disease Prevention and Health Promotion, 2017).
One of the methods of enhancing PS is the engagement of patients and their families in ensuring it (Smith et al., 2017). However, patient engagement practices vary significantly across US healthcare providers (Herrin et al., 2016), which means that no level of engagement is guaranteed. The project site does not have any uniform guide for providers on how to engage diabetic patients. PS outcomes are being recorded, but no information about patient engagement is available. In the proposed project, patient engagement will be carried out with the help of a patient and family engagement guide by Smith et al. (2017), and the outcomes of this activity will be tested.
PICOT Question
In diabetic patients and their family members (P), does the use of the Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families by Smith et al. (2017) (I) improve patient and family engagement and safety culture, as well as safety outcomes (O), as compared to the pre-intervention period (C), over eight weeks (T)?
The PICOT question contains five elements. The population is experiencing an increasingly widespread condition with significant but largely preventable negative health outcomes (Zimmet et al., 2016), and it is a major part of the practicum sites practice. The intervention provides a solution to a problem that the practicum site does not fully address. PS outcomes are going to be measured with the help of existing data, but engagement and safety culture are going to be assessed with new surveys that the site does not routinely use (Smith et al., 2017; Xu, Cheung, & Wong, 2018). The comparison defines the type of research, which is a pre-test post-test study (Polit & Beck, 2017). Finally, the timeframe is relatively short, but it is justified by the needs of the practicum and its site.
Project Implementation and Evaluation Plan
The Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families by Smith et al. (2017) is the intervention to be implemented. It allows developing individualized, customized approaches to ensuring PS through the engagement of patients and their families, which are absent at the practicum site. The intervention is evidence-based; it was created for the Agency for Healthcare Research and Quality, and it is a concerted effort of multiple healthcare specialists.
Additionally, as a patient engagement approach to PS, it is likely to be effective; numerous studies, including recent systematic reviews, suggest that this method helps to improve tracked safety outcomes (Kim et al., 2018; Park & Giap, 2020). It is also a tactic that is recommended by the WHO (2017). Therefore, patient engagement is a suitable, evidence-based approach, and the Guide is a reasonable method of its introduction.
The project will involve all the healthcare professionals who will be implementing the guide, as well as diabetes patients and their family members who will be visiting the office throughout the projects duration. As a result, human subjects will be involved, which means that their rights, autonomy, and safety will need to be protected with the help of an IRB review, informed consent, and a careful approach to managing the data (Polit & Beck, 2017). The IRB approval will be obtained by preparing a proposal and an IRB application, in which all the specifics of the study that are relevant for IRB will be discussed.
Regarding outcomes, the study will use diabetic PS measures as the primary outcomes and patient and family engagement and safety culture as the outcomes that are supposed to demonstrate the implementation progress. Patient engagement will be evaluated with the help of the Patient Engagement Index developed and tested by Xu et al. (2018) (Cronbachs alpha >0.7, weighted kappa>0.4). PS measures and PS culture will be assessed with the help of the guides embedded surveys, as well as the practicum sites PS outcome data (Smith et al., 2017). All the information will be accumulated before and after the Guides introduction, making the study a pre-test post-test research.
Conclusion
To summarize, the proposed project is feasible, and given the importance of addressing PS and diabetes, its implementation can yield positive outcomes.
References
Haltbakk, J., Graue, M., Harris, J., Kirkevold, M., Dunning, T., & Sigurdardottir, A. (2019). Integrative review: Patient safety among older people with diabetes in home care services. Journal of Advanced Nursing, 75(11), 2449-2460. Web.
Herrin, J., Harris, K., Kenward, K., Hines, S., Joshi, M., & Frosch, D. (2016). Patient and family engagement: A survey of US hospital practices. BMJ Quality & Safety, 25(3), 182-189. Web.
Kim, J. M., Suarez-Cuervo, C., Berger, Z., Lee, J., Gayleard, J., Rosenberg, C.,& Dy, S. (2018). Evaluation of patient and family engagement strategies to improve medication safety. The Patient Patient-Centered Outcomes Research, 11(2), 193-206. Web.
National Center for Chronic Disease Prevention and Health Promotion. (2017). National Diabetes Statistics Report, 2017. Web.
Park, M., & Giap, T. (2020). Patient and family engagement as a potential approach for improving patient safety: A systematic review. Journal of Advanced Nursing, 76(1), 62-80. Web.
Polit, D.F., & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Smith, K., Baker, K., Wesley, D., Zipperer, L., Clark, M. D., Hanneke, C. R.,& Goeschel, C. A. (2017). Guide to improving patient safety in primary care settings by engaging patients and families. Web.
World Health Organization. (2017). Patient safety: Making health care safer. Web.
Xu, R., Cheung, A., & Wong, E. (2018). Development and validation of an instrument to measure patient engagement in Hong Kong Special Administrative Region, China. Patient Preference and Adherence, 12, 1667-1675. Web.
Zimmet, P., Alberti, K., Magliano, D., & Bennett, P. (2016). Diabetes mellitus statistics on prevalence and mortality: Facts and fallacies. Nature Reviews Endocrinology, 12(10), 616-622. Web.
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