1. Hospital Policy, The Learner & Quality of Care: A Student-centred learning tool – a Pilot study
OE Abara, D Switzer, J Boucher, O Abara, L Beadow, D Boucher, N Noushi, R Schmidt
Richmond Hill Urology Practice and Prostate Institute
3. Background
•Policies in organizations why they exist, how they come to be
•Relevance of policy?
•Are they static?
•“Change is Constantly changing”
•Need to revise, review & develop policies in a vibrant organization
5. What is this?
•A NOSM Faculty/Learner project by Sensenbrenner LEG and Partners
•Health quality & patient safety improvement project
•Setting: Rural Hospitals in remote communities of Northeastern Ontario
•Pilot Project: The Sensenbrenner Hospital, Kapuskasing –Intravesical BCG Therapy review 1989-2014
6. Aims of Study/Project
• To address a request to change the current procedural policy related to intra-vesical BCG
•To allow the Learner to participate in reviewing, revising and/or developing hospital policy
•Enable the Learner acquire research experience and engage the community- “Give back”.
•Understand the impact and knowledge base
•An opportunity for inter-professional collaboration in a small hospital – student/faculty, nursing, administration, pharmacy etc.
7. Methods & Materials
•Literature review on Hospital and Health Policy – search engine : PubMed,Google Scholar
•Review of current intra-vesical BCG protocols in the various Hospitals in Northeastern Ontario
•Recommendations by Cancer Care Ontario
•Review of world literature on Intra-vesical BCG – indications, results, and complications
8. Cost Analysis of current method compared with proposed change
Current Method
Proposed Method
Materials
•Plastic syringe (60ml)
•14/16#Foley catheter
•Catheter tray
•Gloves
•Infusion bag Stand
•Infusion bag
•Drip set
•14/16#Foley Catheter
•Catheter tray
•Gloves
Administration
•Manual infusion with syringe
•Infusion by gravity from drip stand
Disposal
10% hypochloride into the patient toilet
10% hypochloride into the patient toilet
Cost of materials used
$5
$50
9. Opinions of Various Practitioners & Resources available in local hospitals
•Oncology Nurse
•Pharmacist
•Hospital Acquisition staff/logistics
•Impact on Hospital budget
10. Review of Practices in other Regions
•Regional Hospitals
•University Teaching Hospitals
•Community Hospitals
•Other – Cancer Care Ontario
11. Staff Perception Analysis
Current Method
Proposed Method
Oncology Nurse
Yes
No
Pharmacist
Yes
No
Housekeeping
Yes
No
Physician Assistant
Yes
No
12. Results
•Current protocol is safe; is practised in most hospitals in Ontario
•Student/Medical Learner actively participated in Literature search, review of Policy and procedure
•General satisfaction from all collaborators – their involvement, contributions, sharing information, etc.
•Student/Learner felt this was a way to give back to the community during their stay
13. Learner Perspectives on Participation in this project
•Welcome introduction to health policy, hospital policy – what they mean, how they come to be and consequences
•Excellent introduction and exercise in literature search
•Gained exposure to development and revision of hospital procedural policy
•Acquired experience and skills in collaborative
work in a rural hospital setting
14. Learner Perspectives on Participation in this Project
•Learn more about BCG therapy for treatment of bladder cancer
•Explore issues surrounding quality of life for bladder preservation therapies
•Interact with staff in the management of this special group of patients in a rural hospital community setting
•Social accountability aspect- “medical learner/faculty/ LEG and community working together”
15. What the Student has to say
•“I see this as an opportunity for me to give something tangible back to the community of Kapuskasing in return for the teaching and learning the patients and staff have shared with me.”
–Danica Switzer, 4th year medical student (NOSM)
16. How can this exercise impact quality of care of patients: Propositions? Thoughts? Hypotheses?
•Maintenance of up-to-date care
•Quality improvement – harnessing new information
•Collaborative care – resulting in learning from
one another
•Questioning present practices, reinforces and maintains good standard of care
•“Good policies well practiced result in healthy organization with good patient quality care.”
17. Possible Outcomes in the future of Learners
•May lead to better compliance
•Grow the habit of inter-professional collaboration in medical education and clinical practice
•Better educated, better equipped learners may result in better quality of care and health outcomes
18. Drawbacks/Challenges
•An uncommon phenomenon
•Health policy and hospital policy issues not high in the medical schools’ curriculum
•A pilot study; in the bigger picture this may not be a significant issue
•Not worth the time spent, as medical students already have a lot on their plates
19. Possibilities
•Great way to engage Learners & Faculty in small rural hospitals starved of personnel and time
•May lead to development of a teaching module in Hospital/Health policy for undergraduate and postgraduate medical education
•Multi-institutional and international collaborative exercise or study is most welcome and should be considered.
20. Acknowledgement
•President CEO, Administration, Staff of Sensenbrenner Hospital, Kapuskasing
• Local Education Group (LEG) Kapuskasing
•Medical Advisory Committee and Ethics Board
•Departments of Pharmacy & Health Records, Kapuskasing
21. References
•Shortt, S. et.al. A curriculum for the times: an experiment in teaching health policy to residents in family medicine. Canadian Medical Association Journal,157(11):1567- 9.1997.
•Greysen,S.et.al.Teaching health policy to residents-three year experience with a multi-specialty curriculum. Journal of General Internal Medicine,24(12):1322-6.2009.
•Patel,M.et.al.Advancing medical education by teaching health policy. New England Journal of Medicine, 364(8):695-7.2011.
•Morales,A.,Eidinger,D,and Bruce,A.W.: Intracavity bacillus Calmette-Guerin in the treatment of superficial bladder tumours.J.Urol.,166:180,1976.
