Record keeping for outpatient IV sedation assessment in Oral Surgery - An audit of compliance with national guidelines before and after the introduction of a pro-forma

2014 ◽  
Vol 52 (8) ◽  
pp. e77
Author(s):  
Richard Carr ◽  
David Heads ◽  
Tim Milton
Keyword(s):  
Oral Surgery ◽  
National Guidelines ◽  
Record Keeping ◽  
Before And After ◽  
Pro Forma

scholarly journals Inappropriate Azithromycin Use in Nine Primary-Care Clinics Before and After Implementation of Provider Guidance in the EMR

2020 ◽  
Vol 41 (S1) ◽  
pp. s292-s293
Author(s):  
Alexandria May ◽  
Allison Hester ◽  
Kristi Quairoli ◽  
Sheetal Kandiah
Keyword(s):  
Primary Care ◽  
Retrospective Chart Review ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
National Guidelines ◽  
Targeted Interventions ◽  
Primary Care Clinics ◽  
Before And After ◽  
Upper Respiratory ◽  
Tract Infections

Background: According to the CDC Core Elements of Outpatient Stewardship, the first step in optimizing outpatient antibiotic use the identification of high-priority conditions in which antibiotics are commonly used inappropriately. Azithromycin is a broad-spectrum antimicrobial commonly used inappropriately in clinical practice for nonspecific upper respiratory infections (URIs). In 2017, a medication use evaluation at Grady Health System (GHS) revealed that 81.4% of outpatient azithromycin prescriptions were inappropriate. In an attempt to optimize outpatient azithromycin prescribing at GHS, a tool was designed to direct the prescriber toward evidence-based therapy; it was implemented in the electronic medical record (EMR) in January 2019. Objective: We evaluated the effect of this tool on the rate of inappropriate azithromycin prescribing, with the goal of identifying where interventions to improve prescribing are most needed and to measure progress. Methods: This retrospective chart review of adult patients prescribed oral azithromycin was conducted in 9 primary care clinics at GHS between February 1, 2019, and April 30, 2019, to compare data with that already collected over a 6-month period in 2017 before implementation of the antibiotic prescribing guidance tool. The primary outcome of this study was the change in the rate of inappropriate azithromycin prescribing before and after guidance tool implementation. Appropriateness was based on GHS internal guidelines and national guidelines. Inappropriate prescriptions were classified as inappropriate indication, unnecessary prescription, excessive or insufficient treatment duration, and/or incorrect drug. Results: Of the 560 azithromycin prescriptions identified during the study period, 263 prescriptions were included in the analysis. Overall, 181 (68.8%) of azithromycin prescriptions were considered inappropriate, representing a 12.4% reduction in the primary composite outcome of inappropriate azithromycin prescriptions. Bronchitis and unspecified upper respiratory tract infections (URI) were the most common indications where azithromycin was considered inappropriate. Attending physicians prescribed more inappropriate azithromycin prescriptions (78.1%) than resident physicians (37.0%) or midlevel providers (37.0%). Also, 76% of azithromycin prescriptions from nonacademic clinics were considered inappropriate, compared with 46% from academic clinics. Conclusions: Implementation of a provider guidance tool in the EMR lead to a reduction in the percentage of inappropriate outpatient azithromycin prescriptions. Future targeted interventions and stewardship initiatives are needed to achieve the stewardship program’s goal of reducing inappropriate outpatient azithromycin prescriptions by 20% by 1 year after implementation.Funding: NoneDisclosures: None

scholarly journals Effect of educational intervention on the appropriate use of oral antimicrobials in oral and maxillofacial surgery: a retrospective secondary data analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Junya Kusumoto ◽  
Atsushi Uda ◽  
Takeshi Kimura ◽  
Shungo Furudoi ◽  
Ryosuke Yoshii ◽  
...  
Keyword(s):  
Educational Intervention ◽  
Oral Surgery ◽  
Maxillofacial Surgery ◽  
Antibiotic Use ◽  
Oral And Maxillofacial Surgery ◽  
Third Generation ◽  
Oral Antibiotics ◽  
Appropriate Use ◽  
Before And After ◽  
Third Generation Cephalosporins

Abstract Background In Japan, oral third-generation cephalosporins with broad-spectrum activity are commonly prescribed in the practices of dentistry and oral surgery. However, there are few reports on the appropriate use of antibiotics in the field of oral surgery. This study aimed to evaluate the appropriateness of antibiotic use before and after an educational intervention in the Department of Oral and Maxillofacial Surgery, Kobe University Hospital. Methods The use of oral antibiotics was investigated among inpatients and outpatients before and after an educational intervention conducted by the antimicrobial stewardship team. Additionally, the frequency of surgical site infection after the surgical removal of an impacted third mandibular molar under general anesthesia and the prevalence of adverse effects of the prescribed antibiotics were comparatively evaluated between 2013 and 2018. Results After the educational intervention, a remarkable reduction was noted in the prescription of oral third-generation cephalosporins, but increased use of penicillins was noted among outpatients. There was reduced use of macrolides and quinolones in outpatients. Although a similar trend was seen for inpatients, the use of quinolones increased in this population. Despite the change in the pattern of antibiotic prescription, inpatients who underwent mandibular third molar extraction between 2013 and 2018 did not show a significant increase in the prevalence of surgical site infections (6.2% vs. 1.8%, p = .336) and adverse effects of drugs (2.1% vs. 0%, p = .466). Conclusions This study suggests that the judicious use of oral antibiotics is possible through conscious and habitual practice of appropriate antibiotic use. However, further investigation is required to develop measures for appropriate use of oral antibiotics.

scholarly journals Dental anxiety in patients undergoing oral surgery and its effects on blood pressure and heart rate

2020 ◽  
Vol 9 (8) ◽  
pp. e316985536
Author(s):  
Jaqueline Oliveira Barreto ◽  
Julliana Cariry Palhano Freire ◽  
Arthur Willian de Lima Brasil ◽  
Cristian Statkievicz ◽  
Francisley Ávila Souza ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Oral Surgery ◽  
Dental Anxiety ◽  
Waiting Room ◽  
Demographic Questionnaire ◽  
Significant Difference ◽  
Before And After ◽  
Evaluation Anxiety

Objective: To assess dental anxiety in patients undergoing oral surgery, as well as its impact on blood pressure and heart rate. Material and Methods: A total of 233 patients answered a socio-demographic questionnaire and another one based on the Corah dental anxiety scale. Blood pressure and heart rate were assessed at three moments while: patients were in the waiting room, immediately before and after the procedure. Results: This study revealed a prevalence of anxiety of 77.3%. There was a statistically significant difference in mean systolic blood pressure and heart rate at the three moments of the evaluation. Anxiety was prevalent in the sample and was observed from the time in the waiting room until the time when local anesthesia was performed, causing variations in systolic blood pressure and heart rate, anxiety levels decreased after the end of the service. In conclusion, we observed that oral surgery is directly related to increased anxiety, and anxiety is mainly related to the change in heart rate.

scholarly journals Implementation of physical examination pro forma – a complete audit cycle

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S104-S104
Author(s):  
Deshwinder Singh Sidhu ◽  
Guy Molyneux
Keyword(s):  
Mental Health ◽  
Physical Examination ◽  
Physical Health ◽  
Medical Records ◽  
Psychiatric Ward ◽  
City Hospital ◽  
National Guidelines ◽  
Mandatory Requirement ◽  
Audit Cycle ◽  
Pro Forma

AimsAim of this audit is to achieve and maintain 100% compliance in physical examination on admission.BackgroundConducting physical examination on admission is a mandatory requirement and is monitored by the Mental Health Commission during yearly inspections. A report published by Inspectorate of the Mental Health Commission recently in 2019 identifies a gap in physical health monitoring. We conducted a complete audit cycle in an inner city hospital psychiatric ward to monitor compliance with physical examination on admission.MethodWe based the audit on Judgment Support Framework (JSF) version 5 standards. A retrospective review of all of the patient's medical records was carried out. 13 medical records were reviewed in the first cycle. The results of the first cycle were presented to the Multi Disciplinary Team (MDT) members, including the Non-Consultant Hospital Doctors (NCHD). Physical health policy was reviewed, in consultation with the committee and Clinical Director, a Physical Examination pro-forma (colour coded) was developed and implemented. It was based on the National Guidelines and the JSF ver.5. All members of the MDT and NCHDs were briefed on the pro forma introduced. A repeat audit cycle was conducted of all patients admitted after first audit cycle. Data were collected using a simple audit tool indicating if physical examination was conducted or refused.ResultA total of 22 medical records were audited. 13 medical records in the first cycle indicted only 3 patients had physical examination on admission. However, prior to admission a total of six patients had physical exam in the Emergency Department (ED). Upon implementation of the pro forma, 9 medical records of all patients admitted post-first cycle were audited. A total of 7 patients had physical examination on admission to the ward. Two patients refused physical examination and this was clearly documented. One patient had physical examination completed in ED. All newly admitted patients had physical examination completed or the reason why it wasn't completed documented clearly.ConclusionPhysical examination pro forma was successfully implemented, raising current compliance to a 100%, with a significant improvement from 23% compliance in the first cycle. Existing pro forma is helpful as a reminder to NCHDs. Colour coding of pro forma improves accessibility and distinguishability during the process of admission and auditing. Physical examination pro forma will be audited every 6 monthly.

scholarly journals Application of thrombin powder after tooth extraction in patients receiving anticoagulant therapy

2002 ◽  
Vol 59 (4) ◽  
pp. 389-392 ◽  
Author(s):  
Marjan Marjanovic
Keyword(s):  
Anticoagulant Therapy ◽  
Tooth Extraction ◽  
Oral Surgery ◽  
Risk Group ◽  
Oral Environment ◽  
Before And After

Patients with extreme hypocoagulation, which occurs either as an effect of some diseases with coagulation deficiency or because of the anticoagulant therapy (ACT), are a risk group for oral surgery. In the last decades decision to change or interrupt ACT before and after the procedure was abandoned and more often local hemostasis was being achieved by combining chemical and biological substances. The success of the surgical hemostasis and thrombin powder combination was tested on the group of 20 patients with ACT. The results were satisfactory despite thrombin powder solubility in the moist oral environment.

Scottish Intercollegiate Guidelines Network (SIGN) guidelines on tonsillectomy: a three cycle audit of clinical record keeping and adherence to national guidelines

2002 ◽  
Vol 116 (6) ◽  
pp. 453-454 ◽  
Author(s):  
Alun Williams ◽  
Patrick Lee ◽  
Alastair Kerr
Keyword(s):  
Sore Throat ◽  
Clinical Record ◽  
National Guidelines ◽  
Record Keeping ◽  
The Third ◽  
Progressive Improvement ◽  
Clinical Records ◽  
The Impact

Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the indication for tonsillectomy in the management of sore throat were published in January 1999. To determine adherence to these guidelines in our unit, clinical records were examined on admission for tonsillectomy. Three cohorts were analysed. The first listed prior to SIGN, the second after SIGN and the third after presentation of the results of cohorts 1 and 2. The records were examined for documentation of the number of attacks of tonsillitis in the preceding year. The first cohort revealed poor documentation of attacks of tonsillitis (30 per cent). Thesubsequent cohorts showed progressive improvement in record keeping (74 per cent and 96 per cent). The adherence to SIGN guidelines for those with adequate documentation also improved (75 per cent, 80 per cent, 93.5 per cent). The importance of adequate record keeping to enable audit of practice and the impact of national guidelines on practice are discussed.

WhatsApp guidelines – what guidelines? A literature review

2019 ◽  
Vol 25 (9) ◽  
pp. 524-529 ◽  
Author(s):  
Maurice Mars ◽  
Christopher Morris ◽  
Richard E Scott
Keyword(s):  
Clinical Practice ◽  
Ethical Issues ◽  
Instant Messaging ◽  
Healthcare Delivery ◽  
Modern Society ◽  
Professional Communication ◽  
Sensitive Information ◽  
Inclusion Criteria ◽  
National Guidelines ◽  
Record Keeping

Introduction Instant messaging (IM) is pervasive in modern society, including healthcare. WhatsApp, the most cited IM application in healthcare, is used to share sensitive patient information between clinicians. Its use raises legal, regulatory and ethical concerns. Are there guidelines for the clinical use of WhatsApp? Can generic guidelines be developed for the use of IM, for one-to-one and one-to-many healthcare professional communication using WhatsApp as an example? Aim We aimed to investigate if there are guidelines for using WhatsApp in clinical practice. Method Nine electronic databases were searched in January 2019 for articles on WhatsApp in clinical service. Inclusion criteria: paper was in English, reported on WhatsApp use or potential use in clinical practice, addressed legal, regulatory or ethical issues and presented some form of guideline or guidance for WhatsApp use. Results In total, 590 unique articles were found and 167 titles and abstracts met the inclusion criteria. Twenty-one articles identified the need for general guidelines. Twelve articles provided some form of guidance for using WhatsApp. Issues addressed were confidentiality, identification and privacy (eight articles), security (seven), record keeping (four) and storage (three). Mandatory national guidelines for the use of IM for patient-sensitive information do not appear to exist, only advisories that counsel against its use. Conclusion The literature showed clinicians use IM because of its simplicity, timeliness and cost effectiveness. No suitable guidelines exist. Generic guidelines are required for the use of IM for healthcare delivery which can be adapted to local circumstance and messaging service used.

Work-up and treatment of prostate cancer before and after publication of the first national guidelines on prostate cancer care in Sweden

2018 ◽  
Vol 52 (4) ◽  
pp. 277-284 ◽  
Author(s):  
Hampus Nugin ◽  
Yasin Folkvaljon ◽  
Jan-Erik Damber ◽  
Jan Adolfsson ◽  
David Robinson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Care ◽  
National Guidelines ◽  
Before And After ◽  
Work Up

Prevalence and estimated trend in chemotherapy use near death from population-based studies on cancer patients: A systematic review and meta-analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6590-6590
Author(s):  
Pei-Chun Chou ◽  
Chen Hsiu Chen ◽  
Tsang-Wu Liu ◽  
Siew Tzuh Tang
Keyword(s):  
Cancer Patients ◽  
Meta Analysis ◽  
Population Based ◽  
Poor Quality ◽  
National Guidelines ◽  
Payment Reform ◽  
Effective Interventions ◽  
The Us ◽  
Before And After ◽  
The Impact

6590 Background: Chemotherapy (CMT) use near death, based on US national guidelines, is an indicator of aggressive treatment and poor quality of end-of-life (EOL) care. US law also decreased Medicare payments for outpatient CMT since 2005-2006. To evaluate the impact of US payment reform and guidelines on CMT use at EOL, we estimated and compared the overall prevalence of CMT use at EOL in the US and other countries as well as before and after 2007 in the US. Methods: Six databases were systematically searched to January 2017 for population-based studies of CMT use at EOL for patients in all cancer groups. Two reviewers independently extracted data.Overall CMT use prevalence was pooled by a random-effects model. Differences in prevalence of CMT use were compared by meta-regression between subgroups (US vs non-US countries; before and after 2007 in the US). Results: We identified 9 and 7 articles from the US and non-US countries, respectively. CMT was provided to 28.9% [95% confidence interval (CI) 26.2%-31.8%], 23.2% [95% CI 21.7%- 24.8%], 10.0% [95% CI 8.5%-11.8%], and 4.5% [95% CI 3.9%- 5.2%] of cancer patients in their last 6, 3, and 1 months as well as 14 days of life, respectively. CMT use in the last 6 months was more common in the US than in non-US countries (32.4% vs. 26.2%, p = 0.015) but similar to that of other countries in the last month (9.3% vs.11.2%, p = 0.179) and last 14 days (4.6% vs.5.6%, p = 0.683) of life. Prevalence of CMT use in the last 14 days of life in the US did not differ significantly before and after 2007 (5.1% vs. 5.2%, p = 0.967). Conclusions: Many cancer patients worldwide receive CMT at EOL, and the prevalence of CMT use in US patients’ last 14 days of life was virtually unchanged over time. Effective interventions should be developed and provided to offset the trend of continuing CMT use at EOL.

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