Research for Patient Benefit

A service user/nurse collaborative had submitted an outline grant application with the full submission to be completed by 21 May 2010.

The collaborative nursing and service user study aims to

Elucidate patients' experiences of MRSA screening and also experiences of decolonisation treatment for those who are MRSA positive;

Investigate staff perceptions of MRSA screening;

Identify what interventions and information will improve the screening process and compliance with decolonisation treatment;

Devise, pilot and evaluate a MRSA screening toolkit collaboratively with staff and SURF input to include effective patient information materials, patient-focused staff training materials to improve the provision of information and a patient assessment tool to identify and assist individuals who may require support with decolonisation treatment;

Identify a set of patient reported experience measures to support NHS hospitals in evaluating the patient experience of screening for MRSA and undertaking decolonisation treatment.

A discussion on the submission took place Maria Cann believed this work was essential and should link in to the work of the NHS Institute for Innovation and Improvement, they were conducting workshops with service users and infection prevention specialists from across the NHS to develop a toolkit for staff to assist pre-operative assessment staff with having conversations with patients on the need for MRSA screening and what happens after the screening.  MRSA Action UK advocates post discharge screening to keep a check on bacterial colonisation, since hospital environments are more likely to give patients an encounter with micro-organisms, to include MRSA, due to the high usage of antibiotics and large numbers of vulnerable susceptible patients who are hospitalised.

MRSA Action UK knows that the patient experience shows that joined-up working is needed with the primary care setting, to include domiciliary and social care, particularly with the trend toward aiming for speedier discharge from hospital.  Support is needed prior to and on discharge from hospital.  Decolonisation treatment prior to surgery needs to be conducted effectively for the treatment to work, and vulnerable people are not always equipped to do this effectively.

We believe patient reported experience measures should identify:

Whether the surgery was elective or emergency;

Whether the result was positive or negative;

If they were negative were they still worried and was any further advice given, if so what advice, ie leaflet, referral to pharmacist, other agency;

Where the screening took place - the GP practice; out-patient clinic; hospital, or at home

Who informed the patient of the result?

How they were informed - by letter and a leaflet, whether this included an opportunity for further discussion; face-to-face, whether this was the consultant, GP or other professional; an outside body; whether this was discussed with multiple agencies, why did they choose to go elsewhere for information?  Was the information useful?  Were they worried by any of the information, and were the professionals able to allay their concerns?

For elective patients:  If they were MRSA positive were they given a choice of where to receive the decolonisation treatment?  Would they have preferred to be given a choice, ie at home or in hospital?  Did they believe they were well enough to perform the decolonisation regime at home?  Did they know of the support they could receive through Social Services?

Was the treatment documented in their care plan, and was an integrated care pathway for MRSA included in the care plan?

Recommendations will be made to the NHS based on the toolkit and patient reported experience measures developed and evaluated during the project.  It was agreed to supply supporting information to demonstrate the need for further work to supply information on screening and its impact on patients.