I read with interest the article on missed opportunities for preventive interventions when patients are in hospital. [1] When I was an ambulatory care fellow at the Veterans Affairs Medical Center in Salt Lake City, Utah, I was involved with a project from 1993 to 1995 designed to increase attention to preventive care in general internal medicine outpatient clinics.
The project involved 2 strategies: transfer of many activities to nursing staff through education and standing orders, and provision of patient-specific reminders.
Rates of documentation of 11 preventive interventions including patient education (smoking, alcohol, diet, exercise and seatbelt use), screening (blood pressure, occult blood screening in stool samples and cholesterol) and immunizations (influenza, pneumococcal and tetanus-diphtheria vaccines) were examined in patient charts. The documentation rates were measured at baseline, after education of and delegation to the nursing staff, and again after the additional use of manually generated patient-specific reminders. A single-page coloured "Health Maintenance Record" was included at the front of each chart for documentation and reminder purposes.
Overall documentation rates rose from 50% at baseline to 76% after delegation to nursing staff and to 97% after the additional use of reminders. The rate of documentation of patient education increased most dramatically, from 30% at baseline to 95% after nursing staff involvement and use of reminders. The respective increase in the rate of immunization documentation was from 69% to 98%.
Vicki Foerster, MD
Victoria, BC
References
- 1.↵