What you need to know • Thinking of quality improvement (QI) as a principle-based approach to change provides greater clarity about (a) the contribution QI offers to staff and patients, (b) how to differentiate it from other approaches, (c) the benefits of using QI together with other change approaches
BackgroundPatient safety is at the core of the General Medical Council (GMC) standards for undergraduate medical education. It is recognised that patient safety and human factors’ education is necessary for doctors to practice safely. Teaching patient safety to medical students is difficult. Institutions must develop expertise and build curricula while students must also be able to see the subject as relevant to future practice. Consequently graduates may lack confidence in this area.MethodWe used gamification (the application of game design principles to education) to create a patient safety simulation for medical students using game elements. Gamification builds motivation and engagement, whilst developing teamwork and communication. We designed an escape room—a team-based game where learners solve a series of clinical and communication-based tasks in order to treat a fictional patient while avoiding ‘clinician error’. This is followed up with an after action review where students reflect on their experience and identify learning points.OutcomeStudents praised the session’s interactivity and rated it highly for gaining new knowledge and skills and for increasing confidence to apply patient safety concepts to future work.ConclusionOur findings are in line with existing evidence demonstrating the success of experiential learning interventions for teaching patient safety to medical students. Where the escape room has potential to add value is the use of game elements to engage learners with the experience being recreated despite its simplicity as a simulation. More thorough evaluation of larger pilots is recommended to continue exploring the effectiveness of escape rooms as a teaching method.
Quality problem or issueA patient survey found significantly fewer patients reported they had self-administered their medicines while in hospital (20% of 100 patients) than reported that they would like to (44% of 100). We aimed to make self-administration more easily available to patients who wanted it.Initial assessmentWe conducted a failure, modes and effects analysis, collected baseline data on four wards and carried out observations.Choice of solutionOur initial assessment suggested that the main areas we should focus on were raising patient awareness of self-administration, changing the patient assessment process and creating a storage solution for medicines being self-administered. We developed new patient information leaflets and posters and a doctor’s assessment form using Plan–Do–Study–Act cycles. We developed initial designs for a storage solution.ImplementationWe piloted the new materials on three wards; the fourth withdrew due to staff shortages.EvaluationFollowing collection of baseline data, we continued to collect weekly data. We found that the proportion of patients who wished to self-administer who reported that they were able to do so, significantly increased from 41% (of 155 patients) to 66% (of 118 patients) during the study, despite a period when the hospital was over capacity.Lessons learnedRaising and maintaining healthcare professionals’ awareness of self-administration can greatly increase the proportion of patients who wish to self-administer who actually do so. Healthcare professionals prefer multi-disciplinary input into the assessment process.
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