Ensuring patient safety: Physical health monitoring in rapid tranquillisation for aggression and violence of adult acute inpatients

2016 ◽  
Vol 33 (S1) ◽  
pp. S170-S171 ◽  
Author(s):  
R. Talukdar ◽  
M. Ludlam ◽  
L. Pout ◽  
N.P. Lekka
Keyword(s):  
Patient Safety ◽  
Physical Health ◽  
Health Monitoring ◽  
Improve Patient Safety ◽  
Further Education ◽  
Local Policy ◽  
Nice Guideline ◽  
Level Of Consciousness ◽  
Competing Interest ◽  
Monitoring Protocols

IntroductionIntramuscular (IM) medications used in rapid tranquillisation (RT) to manage violent/aggressive behaviour can cause serious physical side effects including sudden death, therefore comprehensive physical health monitoring is advised.ObjectivesTo assess whether physical health monitoring of patients who received IM medication for RT was completed as per the Aggression/Violence NICE-guideline based local Policy.MethodsAll patients that received IM benzodiazepines or antipsychotics for RT were identified amongst 822 discharges from February 2014 to February 2015. Demographics, diagnoses, non-pharmacological interventions, types/doses of medication, and associated seclusion/restraint episodes were recorded. Notes were examined to determine whether physical health monitoring protocols involving blood pressure, pulse, temperature, oxygen saturation, respiratory rate and level of consciousness were followed.ResultsThere were a total of 218 episodes where these medications were used, in which only 19 (8.8%) had any physical observations completed; only one case (0.5%) was completed fully as per the protocol. Of the cases that did not have observations taken, in 12 (5.5%) cases observations were attempted but the patient was too agitated/aggressive. A doctor was contacted in only 53 (24.3%) cases and an ECG was completed in 120 (55%) cases, of which only 11 were completed within 24 hours.ConclusionsThe results show poor compliance (or at least recording) with the guidance, demonstrating the need for further education of nursing and medical staff on the potential dangers of RT and for better physical health monitoring of patients on RT. To improve patient safety, staff training and well-timed recording of physical observations on electronic tablets will commence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Using junior doctors to improve patient care: Creating a clinic to monitor the physical health of patients prescribed clozapine

2017 ◽  
Vol 41 (S1) ◽  
pp. S383-S383 ◽  
Author(s):  
M. Tonkins ◽  
P. Hardy ◽  
S. Foster ◽  
S. Mullins
Keyword(s):  
Physical Health ◽  
Health Monitoring ◽  
Improve Patient Care ◽  
Full Blood Count ◽  
Junior Doctors ◽  
Data Set ◽  
Compliance Level ◽  
Current Cycle ◽  
Competing Interest ◽  
Community Team

IntroductionIn the United Kingdom, compliance with guidelines on physical health monitoring of patients prescribed clozapine is poor. Our community team established a ‘clozapine clinic’, led by junior doctors, to monitor the physical health of this population.AimsThe aims of this audit were:– to ascertain levels of compliance with guidelines on the physical health monitoring of patients taking clozapine;– to compare the current level of compliance with that prior to the establishment of the clinic.MethodsEleven standards were drawn from National Institute for Health and Care Excellence guidelines and the Maudsley Prescribing Guidelines in Psychiatry.Three audit cycles were conducted: two prior to the establishment of the clinic and one after. In each cycle, searches of patient records were conducted and blood results were reviewed. This was supplemented by telephone calls to general practitioners to ensure a complete data set.Analysis was conducted in Microsoft Excel™ and changes between the cycles were analysed using a two-tailed Z-score.ResultsEach audit cycle included 28–30 patients. In the current cycle compliance levels varied between 66% (annual ECG recording) and 100% (monthly full blood count). The average compliance level was 73% across all standards. This represents an overall improvement on previous audit cycles. Since the clinic was established there has been a statistically significant improvement in compliance with annual monitoring of weight (P = 0.147), body mass index (P = 0.0178), and ECG monitoring (P = 0.0244).ConclusionsImprovements in the care of a vulnerable population may be achieved through setting clear standards, regular audit, and harnessing the leadership and enthusiasm of junior doctors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Psychiatric Morbidity and Mortality Teaching Conference to Improve Patient Safety: Lessons Learned at the Massachusetts General Hospital

2017 ◽  
Vol 41 (S1) ◽  
pp. S298-S298 ◽  
Author(s):  
O. Freudenreich ◽  
F. Smith ◽  
J. Wozniak ◽  
M. Fava ◽  
J. Rosenbaum
Keyword(s):  
Patient Safety ◽  
General Hospital ◽  
Massachusetts General Hospital ◽  
Improve Patient Safety ◽  
Psychiatric Morbidity ◽  
The United States ◽  
Lessons Learned ◽  
Morbidity And Mortality ◽  
Competing Interest ◽  
Improve Hospital

IntroductionA morbidity and mortality (M&M) conference is a time-honored educational format in surgery and medicine to review bad patient outcomes and learn from mistakes made. However, despite the value of learning together as peers from difficult cases with unexpected outcomes, most psychiatric departments in the United States do not have an M&M conference. Several years ago, the department of psychiatry at Massachusetts's general hospital in Boston began a monthly M&M conference.ObjectivesDescribe our department's experience with the M&M format as an educational vehicle to teach patient safety and improve care in an increasingly complex care environment.AimsIntroduce the M&M format that we have developed at our department and obstacles encountered.MethodsWe reviewed the content of our four years of M&M conferences; the feedback received from participants after each conference; and changes introduced to improve the conference.ResultsOur department has successfully implemented and sustained a monthly psychiatric M&M conference that is well attended and valued. A critical decision was mandatory involvement of residents to prepare cases in conjunction with a dedicated faculty member. A structured presentation using a root cause analysis framework to guide the discussion in order to harness the wisdom of the group allows for a more comprehensive understanding of factors leading to bad outcomes, including systems-based problems.ConclusionsA psychiatric M&M conference can teach individual clinicians about patient safety. Developing a departmental mechanism to apply lessons learned in the conference to improve hospital systems is the next task.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Health screening audit – south Barnet PCMH pilot

2017 ◽  
Vol 41 (S1) ◽  
pp. S700-S700
Author(s):  
H. Rahmanian
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Health Monitoring ◽  
Mental Health Problems ◽  
Health Problems ◽  
Consultant Psychiatrist ◽  
Team Members ◽  
Team Meetings ◽  
Physical Health Problems ◽  
Competing Interest

Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement.AimsThe aim of this project was to improve the physical health monitoring for patients with mental health illness. The patients group was under the care of south Barnet primary care mental health pilot (SB PCMH Pilot). SB PCMH pilot is a multidisciplinary team that includes: consultant psychiatrist mental health nurse and psychologist.ResultsBetween November to December 2014, 60 patients were discharged from SB PCMHT and the electronic case notes of 38 of them who had an assessment/intervention by the service were reviewed. Results showed that 82% of the records verified that discussion and screening of physical health, smoking, drugs and alcohol had been completed. The data was discussed in team meetings with all team members. After thorough team discussions and brainstorming; the team agreed that an improvement in the process of monitoring was needed to work towards ensuring these matters are discussed with 100% patients and that this is accurately recorded. It was agreed to re-audit in 3 months.Re-auditA re-audit completed between January to April 2015 confirmed an improvement as 98% of patients seen for an assessment by SB PCMH pilot have had their annual health checks and appropriate health screenings discussed and recorded routinely.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Analisis Faktor Yang Berhubungan Dengan Penerapan Surgical Safety Checklist Di Kamar Operasi Rumah Sakit Kota Batam

2019 ◽  
Vol 4 (3) ◽  
pp. 456
Author(s):  
Endang Yuliati ◽  
Hema Malini ◽  
Sri Muharni
Keyword(s):  
Patient Safety ◽  
Operating Room ◽  
Work Experience ◽  
Improve Patient Safety ◽  
Standard Procedure ◽  
City Hospital ◽  
Chi Square ◽  
Cross Sectional ◽  
Surgical Safety Checklist ◽  
Surgical Safety

<p><em><em>The use of the Surgical Safety Checklist (SSC) is associated with improving patient care according to nursing process standards includes the quality of work of the operating room nurse team. The form of professionalism in the operating room is how the application of a surgical safety checklist as the standard procedure for patient safety in the operating room. This study aims to determine the relationship of characteristics, knowledge, and motivation of nurses in the application of the surgical safety checklist in the operating room of a Batam city hospital. This research is quantitative using an observational analytic research design. This study was conducted on 67 nurses who were taken by total sampling. This research was conducted in three Batam City Hospitals, with hospital accreditation at the same level. Data were analysed by univariate and bivariate using the chi-square test. The results of the study found that most nurses had education at diploma level, with a working period experiences of &gt; 6 months (82%); good knowledge (53.7%) with low motivation (57.7%). There is a relationship between education (p = 0.042); length of work experience (p = 0.010); knowledge (p = 0.002); and motivation (p = 0.05) with the application of SSC. It is expected that health services carry out SSC following the applicable SOPs in the Hospital so that it can reduce work accident rates and improve patient safety.</em></em></p><p><em><br /></em></p><p><em>Penerapan Surgical Safety Checklist (SSC) berhubungan langsung dengan kualitas asuhan keperawatan yang termasuk adalah bagaimana perawat menerapkan fungsi sebagai bagian dari kamar operasi. Bentuk profesionalisme ini menjadi standar bagaimana kemampuan perawat menerapakan SSC. Tujuan penelitian adalah mengetahui hubungan karakteristik perawat, pengetahuan dan motivasi dengan penerapan SSC di kamar operasi. Penelitian ini menggunakan desain kuantitatif Cross Sectional dengan jumlah sampel 67 orang perawat kamar operasi. Data dianalisa dengan distribusi frekuensi dan uji hubungan bivariat. Didapatkan penerapan SSC perawat kota Batam masih kurang baik, dengan faktor yang mempunyai hubungan adalah Pendidikan, pelatihan dan pengetahuan. Diharapkan perawat mampu menerapkan SSC sesuai dengan Standar pelaksanaan fungsi perawat dikamar operasi.</em></p>

TEACHING THE TEACHERS—WHAT EDUCATION AND TRAINING NEEDS ARISE AMONG TEACHERS THROUGH THE USE OF SIMULATION IN THE EDUCATION OF EMS PERSONNEL IN THE GERMAN HEALTH CARE SYSTEM

2015 ◽  
Vol 1 (1) ◽  
pp. 41.3-41
Author(s):  
Michael Wessels ◽  
Manuel Geuen
Keyword(s):  
Patient Safety ◽  
Emergency Services ◽  
Teaching Method ◽  
Medical Personnel ◽  
Further Education ◽  
Teaching Staff ◽  
Transfer Of Knowledge ◽  
Performance Skills ◽  
Intensive Training ◽  
Emergency Services Personnel

Background & PurposeThe professional qualifications of paramedics in the emergency services are not uniform at the federal level across Germany. Federalism leads to a considerable heterogeneity of regional regulations and curricula for training at the state-approved emergency services School. This results in an uneven transfer of knowledge of action skills, scientific findings as well as inconsistent application of appropriate teaching methods. Finally, this culminates in an inconsistent qualification of EMS personnel.To illustrate the needs of teachers in simulation in training and continuing education of EMS personnel.MethodsBased on a systematic literature review and expert interviews on training and further education of non-medical personnel in emergency care simulation was analysed as a teaching method from an educational perspective. For a standardized carrying out of the interviews a unified interview guide was used. The statements of the experts were analysed with the software MAXQDA.ResultsThrough simulation, in conjunction with debriefings an outstanding benefit for the direct learning from mistakes is made possible, both in the whole group as well as in the setting of reality (train where you work). This supports a long-needed culture of errors in emergency service as well as improving patient safety in emergency response. This requires intensive training of the teaching staff in pedagogy and technology. Further research needs were identified for potential fields of application of simulation in the training of EMS personnel.ConclusionsSimulation provides for the training of emergency services personnel, particularly in view of the new profession of emergency paramedics (Notfallsanitäter) and their advanced performance skills extensive opportunities. With the help of simulation abilities and skills as well as inter-professional teamwork can be taught and improved individualized. In fact, simulation contributes to improving patient safety and guideline- based care of emergency patients.

scholarly journals Writing’s on the wall: improving the WHO Surgical Safety Checklist

2021 ◽  
Vol 10 (1) ◽  
pp. e001086
Author(s):  
Claire Cushley ◽  
Tom Knight ◽  
Helen Murray ◽  
Lawrence Kidd
Keyword(s):  
Patient Safety ◽  
Online Survey ◽  
Improve Patient Safety ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Time Out ◽  
Mandatory Requirement ◽  
Who Checklist ◽  
Improve Patient ◽  
Theatre Team

Background and problemThe WHO Surgical Safety Checklist has been shown to improve patient safety as well as improving teamwork and communication in theatres. In 2009, it was made a mandatory requirement for all NHS hospitals in England and Wales. The WHO checklist is intended to be adapted to suit local settings and was modified for use in Gloucestershire Hospitals NHS Foundation Trust. In 2018, it was decided to review the use of the adapted WHO checklist and determine whether improvements in compliance and engagement could be achieved.AimThe aim was to achieve 90% compliance and engagement with the WHO Surgical Safety Checklist by April 2019.MethodsIn April 2018, a prospective observational audit and online survey took place. The results showed compliance for the ‘Sign In’ section of the checklist was 55% and for the ‘Time Out’ section was 91%. Engagement by the entire theatre team was measured at 58%. It was proposed to move from a paper checklist to a wall-mounted checklist, to review and refine the items in the checklist and to change the timing of ‘Time Out’ to ensure it was done immediately prior to knife-to-skin.ResultsFollowing its introduction in September 2018, the new wall-mounted checklist was reaudited. Compliance improved to 91% for ‘Sign In’ and to 94% for ‘Time Out’. Engagement by the entire theatre team was achieved 100% of the time. Feedback was collected, adjustments made and the new checklist was rolled out in stages across all theatres. A reaudit in December 2018 showed compliance improved further, to 99% with ‘Sign In’ and to 100% with ‘Time Out’. Engagement was maintained at 100%.ConclusionsThe aim of the project was met and exceeded. Since April 2019, the new checklist is being used across all theatres in the Trust.

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