scholarly journals Strengthening Services for Most Vulnerable Children Through Quality Improvement Approaches in a Community Setting: The Case of Bagamoyo District, Tanzania

Author(s):  
Flora Pius Nyagawa
2021 ◽  
Author(s):  
Joy Ross ◽  
Stefan Rakowicz ◽  
Eva Trowers ◽  
Amrit Aujla ◽  
Amanda Rees ◽  
...  

2021 ◽  
Author(s):  
◽  
Jennifer Shaw

The goal of this project was to outline best practices regarding the organization of diabetes care and services in the community in relation to the local context of services in Squamish, BC, Canada to create a foundation for future quality improvement work. The theoretical framework of personcentered care is essential to chronic disease management and underpins this work. The methods include: 1) A narrative literature review consisting of a database search, and 2) A gap analysis consisting of local data and an environmental scan. The Chronic Care Model is an evidence-based integrated care framework used to organize the findings of the narrative literature review and the gap analysis and to frame the recommendations (Clement et al., 2018). Based on the findings, evidence-based recommendations were created specific to the context of diabetes care in Squamish, BC creating the opportunity for meaningful future quality improvement work.


BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S208-S208
Author(s):  
Peter McMurray

AimsTo provide awareness of safety concerns around use of alcohol hand sanitiser on a mental health ward, and to consider ways of improving how learning for a serious adverse incident in one trust can better be communicated to other trustsBackgroundDD a male patient with history of paranoid schizophrenia alongside historic illicit drug use and current alcohol dependency admitted detained to Bluestone hospital following bizarre behaviour at a wake. Had been non-compliant with medication. Transferred to PICU due to going AWOL and returning under influence of alcohol.2nd April overnight staff noted him to become over-sedated, presenting with slurred speech and appeared under influence of alcohol – transferred to A + E due to deteriorating GCS – was intubated, and transferred to ICU. Blood alcohol level was 373. Several empty bottles of hand sanitiser from dispensers on ward found in his room and he later disclosed he had accessed further alcohol hand sanitiser in sluice while washing clothesSAI learning outcomes from one healthcare trust in Northern Ireland not currently routinely shared with other trustsMethodLiterature review carried out to search for reports of similar incidents – 1 previous review article suggesting one death and 11 other major complications from consumption of alcohol hand sanitiser over 5 year period 2005-2009.Quality improvement steps implemented to address this riskWard policy was reviewed to ensure patients no longer had unsupervised access to wash clothesLiaised with Infection Control to assess the need for alcohol hand sanitiser to be available to patients given the ward is effectively a community settingIntoxication policy reviewed and education sessions on this provided to all medical and nursing staffRegional regular PICU staff update seminar launched for purpose of bringing PICU staff from across Northern Ireland together to share learning from SAIs and casesResultInfection control agreed alcohol hand sanitiser dispensers could be removed from wards and kept only in locked nursing office with use of visitors.Learning from this case shared with other trusts locally at newly launched regional PICU update seminarNo further incidents to dateConclusionPatient access to alcohol hand sanitisers found to be a significant safety risk in PICU settingFollowing implementation of quality improvement steps no further incidents of patients swallowing alcohol hand sanitiserImproved awareness of risk of alcohol intoxication on ward with nursing staff escalating concerns to on-call doctor more frequently


Sign in / Sign up

Export Citation Format

Share Document