Patient Safety & Quality Improvement

 Improving sick day management among patients and families with Type 1 Diabetes

Hannah Geddie: Hilary Swanson: Tristan Hall: Jenny Merla: Karen McAssey

Introduction:
Sick day management is a critical part of Type 1 Diabetes (T1DM) education. Complications such as hypoglycemia and ketosis are more likely to occur during illness. Sick day management is challenging for families, requiring specific calculations and knowledge that is infrequently used. Interactive educational tools may help families manage diabetes during illness.

Objectives:
1.) To develop an educational intervention on sick day management for T1DM.
2.) To evaluate the impact of the intervention on patient satisfaction, knowledge, and behavior.

Methods:
To develop our intervention, we reviewed the literature and assessed patient knowledge using a standardized diabetes knowledge assessment tool. Our content is based on the 2019 Ontario Pediatric Diabetes Network provincial guidelines. Our study population includes children aged 0-18 with T1DM at McMaster Children’s Hospital, diagnosed for >/ = 1 year.

Intervention:
First visit: Patients will be consented at their initial clinic visit. Our intervention consists of a 15 minute teaching session targeting common knowledge gaps with teach back moments. A standardized checklist will ensure consistency.

We will provide patients with an illness management algorithm on paper and online using the IBM Watson Assistant Chatbot. An illness scenario will be used to assess baseline knowledge. Patients will also complete a baseline behavioral questionnaire.

3 Month Follow up: We will assess patient satisfaction with the intervention via questionnaire

6 and 12 month Follow up: We will reassess behavior change via patient questionnaire and repeat knowledge assessment. We will also complete a chart review of phone calls to the diabetes team,  emergency department visits and DKA episodes. We will compare data with the 12 months prior to our intervention.

Discussion:
Our knowledge pretests indicated that basic knowledge of sick day management is high. Specific gaps included whether to check for ketones with a normal blood sugar and how to dose rapid insulin at meals. Our intervention aims to address these specific knowledge gaps and focus on the practical application of knowledge towards illness management decisions.

Our next steps are to pilot our intervention with diabetes patients at regular clinic visits.  We plan to launch our intervention, complete data collection and analysis by end of 2020.

How Professional Identities Affect Speaking Up Behaviours in Residents

Al-Hadhrami, Sumaiya; Ngo, Quang

Introduction
Critical patient safety errors are often a result of problems in communication.  A breakdown in communication amongst a team of healthcare workers leads to patient morbidity and mortality.  Part of that communication barrier has been the inability to “speak up.”  The ability to “speak up” has been defined by Okuyama et al as “the raising of concerns by health care professionals for the benefit of patient safety and care quality upon recognizing or becoming aware of the risky or deficient actions of others within healthcare teams in the hospital environment."
Much research has been done to examine the factors that both serve as barriers and enablers for healthcare professionals (HCP) to speak up but few studies have examined medical residents specifically.  Nursing literature has shown that a deeper connection to their own professional identity may enable individuals to act in accordance to their professions values.  Understanding how professional identity factors drive medical learners to speak up can inform medical educators on how to bridge the gap between knowing what is right to doing what is right by designing more deliberate interventions that encourage professional identity formation (PIF).

Working from the conceptual framework of PIF, we seek to explore the phenomenon of residents who speak up in the clinical setting and how PIF influences speaking up behaviours in senior residents in hospital based specialities.  We hypothesize that pre-existing identities are more likely to influence speaking up behaviours whereas medical socialization is more likely to influence silencing behaviours.

Methods
We propose a qualitative phenomenology study of senior medical residents who have had an experience of speaking up in a hospital based clinical setting, using focus groups and purposive sampling.  An focus group guide has been developed focusing on issues pertaining to the experience of speaking up, the context and prior experiences.  This has also been informed by PIF theory as proposed by Cruess et al.  Our analysis will be done using a grounded theory approach with constant comparative analysis with open coding done on the initial 3 focus groups.  This coding schema will then be used to inform the analysis of subsequent focus groups until thematic sufficiency is achieved.

Results and Conclusion
This project is being reviewed by REB and we anticipate data collection to be complete in May, 2020.