Actividades en el diseño e implementación de un módulo del SIGEP

This section details the research method adopted for phase 2 and covers the questionnaire and its development, the procedure for data collection and any inherent safety issues.

3.4.4.1 Questionnaire development

Development of the questionnaire took existing evidence into account. Firstly, the findings from phase 1, detailed in chapter 3 were used as a basis for the topic of questions. Then published literature relating to patient experiences of the discharge process, existing validated questionnaires on similar topics and the researcher’s background knowledge of the discharge process were all used to help generate the specific questions. Questions were also drawn from the National NHS Inpatient Survey,⁽⁹³⁾ which contains a section dedicated to discharge. Guidance was sought from the supervisory team during the development of the questionnaire.

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One of the objectives of this phase of the PoW was to build on knowledge of issues inherent in the discharge process that were identified in phase 1. Issues identified were from a managerial and operational perspective, whilst this second phase aimed to determine patients’ perspective of these issues. The NHS strives to be patient-centred, so it was important to explore the patients’ perspective of these findings. Only the issues from the phase 1 themes thought to be patient-facing have been investigated in this phase, so that patients would be familiar enough with the topic to be able to comment.

The following themes from phase 1 were explored with patients in phase 2:

• Planning for discharge

• Medication supply for discharge

• Post-discharge community pharmacy involvement

• Patient involvement

The questions were constructed and amended until the questionnaire was felt to contain enough detail to elicit the information required from respondents, without being too long. This was achieved by writing a rationale for each question to ensure they were aligned with the research objectives. The rationale can be seen in Appendix 14.

Care was taken to ensure questions were easy to understand and not ambiguous, to improve trustworthiness of the data yielded. Once finalised the questions were formatted and structured to make the questionnaire easy to follow. The questions were structured in a way that allowed patient responses to be easily quantified for analysis purposes. This included ensuring that the questions and answers could be entered into SPSS for quantitative data analysis.

The questionnaire was pre-tested by several members of the public known to the researcher. Each respondent read through the questions and gave constructive comments regarding the wording and understanding of the questions. Any changes were made to the questionnaire after consultation with the supervisory team. No major changes were required and therefore the approving REC did not need to be notified. The questionnaire was then piloted prior to data collection. See section 3.4.6 Phase 2 pilot for details.

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The final version of the questionnaire was divided into four sections:

• Part A – About you

• Part B – About your medicines during your stay in hospital

• Part C – About your discharge

• Part D – After your discharge from hospital

The questionnaire contained 20 questions, consisting of mainly closed questions with a tick-box format for ease of use by participants. A range of topics relating to different aspects of the discharge process from the patient’s perspective were covered. Individual demographic questions were asked initially, to collect data such as age, gender and whether the patient took any regular medication. Several questions required an open format for patients to elaborate on their responses. A copy of the final questionnaire can be seen in Appendix 15.

3.4.4.2 Procedure

On data collection days, the researcher visited the wards where patients would potentially be discharged from that day. The gatekeeper was asked for suitable patients to potentially participate and each was then approached by the researcher. The researcher continued to collect data for as long as was feasible within the study period, to obtain as large a sample size as possible. Patients were recruited from a range of clinical specialities to ensure a diverse sample of respondents with different medical conditions and backgrounds.

Patients may be reluctant to discuss sensitive issues, which could lead to misrepresentative data being collected. As the topic of discharge was not considered sensitive, this was not thought to be a serious threat to this study. Nevertheless, in order to reduce the risk of bias, the researcher ensured that respondents were aware that any answers they provided were confidential and anonymous. As the questionnaire was carried out at the patient’s bedside, there was a possibility of patients or the researcher being overheard. Most respondents completed the questionnaire themselves and no-one wanted to discuss any of the topics privately. Patient identifiable data was not collected during the study.

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Respondents completed the questionnaire with the researcher nearby to enable them to ask for support when completing the questionnaire. This helped to increase the diversity of the sample and generalisability of the findings, by allowing patients with reading or writing difficulties to participate. The researcher provided information about the study questionnaire directly to each respondent, to build rapport and encourage participation whilst minimising pressure. Building rapport, trust and openness with respondents enabled them to express their honest views, improving robustness of the study. Answers to questions were recorded on the pre-printed questionnaire handed to patients. The time taken to complete the questionnaire varied between 5–20 minutes depending on the individual.

3.4.4.3 Safety issues

Neither the researcher nor any of the respondents were put at risk or under any duress during data collection. The questionnaire was designed not to cause any discomfort or emotional stress to the respondents. In the event a patient had become upset during the study, the researcher’s experience of working as a hospital pharmacist and dealing with patients, allowed her to confidently resolve any issues that may have arisen. The researcher would have either discussed the issue with the patient or sought assistance from an appropriate member of ward staff. In the event that the researcher was unable to manage an issue, she would – where appropriate - remind the patient of the complaints procedure, as detailed in the PIL (Appendix 11). Questionnaires were conducted at the respondent’s bedside, minimising risk of physical harm to the patient.

The researcher was not involved in any of the respondents’ care so questions or concerns highlighted by patients were passed immediately to an appropriate member of staff involved in their care. If evidence of poor practice arose, for example a patient raising concerns to the researcher, the researcher would advise nursing or pharmacy staff responsible for that patient to ensure the patient received appropriate support.

Should any serious incidents have arisen, the researcher would have also reported them to the Chief Pharmacist and discussed them with the supervisory team.

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