Good companies - Positive Deviance Initiative
Good companies - Positive Deviance Initiative
Good companies - Positive Deviance Initiative
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check if patients were in fact purchasing the medicines. This verification served<br />
to cross-check the patients recollection. The initial phone calls were quite<br />
revealing. There was an instance where one patient, a gentleman on a blood<br />
thinner, was asked if he was taking his medication every other day. He said, of<br />
course. On probing by the nurse, the patient reveals that he was taking the<br />
medicine every Monday, Wednesday, and Friday. But what about on the<br />
weekend, the nurse responded. To which the man replied, weekends don’t count,<br />
it’s only every other day – by which he understood every other weekday, but not<br />
on weekends! Instead of taking the medication on average 15 times a month, he<br />
was taking it approximately 12 times a month or 80% of the required dosage. Dr.<br />
Cusano mentions another instance in which a patient had instructions on a<br />
discharge sheet “Take Q6H” as instructions for a specific pain medication. The<br />
patient did not read the label on the pill bottle, but assumed that Q6H on the<br />
discharge sheet meant to take the medication “six times” a day. (Cusano, 2005a)<br />
Jerry and Monique Sternin made six visits to the hospital between October and<br />
May. Facilitators spent between 85-100 hours on the intervention, not to mention<br />
the numerous hours spent by nurses making calls, as well as staff meetings and<br />
work sessions. And it was important for the staff to take the time. While everyone<br />
in the hospital understood the problem of medication reconciliation, there was<br />
poor awareness of the extent of the problem and its severity. Criticality of the<br />
issue promotes change, and the personal involvement of the nurses in the calling<br />
and in the overall intervention helped to raise awareness in the hospital: “Yes, we<br />
do have a problem here!”<br />
While there wasn’t a project plan as such, the timeline for the bulk of the<br />
intervention has been reconstructed by Ms. Potrepka. This timeline is not all<br />
inclusive, but does capture the major milestones along the way.<br />
R.M. Saco p. 38