Antibiotic prescribing on an Elderly Care ward: closing the audit loop

2011 ◽  
Vol 63 (6) ◽  
pp. e5-e6
Author(s):  
Pamela Sarkar ◽  
Sani Aliyu ◽  
Margaret Gillham
Keyword(s):  
Elderly Care ◽  
Antibiotic Prescribing ◽  
Care Ward

74 Improving Handover Between Doctors and Nurses on An Elderly Care Ward

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
K Suseeharan ◽  
T Vedutla
Keyword(s):  
High Risk ◽  
Patient Care ◽  
Positive Impact ◽  
Elderly Care ◽  
Task Completion ◽  
Risk Area ◽  
High Risk Area ◽  
Staff Members ◽  
Care Ward ◽  
Doctors And Nurses

Abstract Background The Royal College of Physician guidelines (2011) identified handover as a “high risk step” in patient care, especially in recent times within the NHS where shift patterns lead to more disjointed care with a high reliance on effective handover by all staff members. Introduction At Cannock Chase hospital, Fairoak ward is an elderly care rehabilitation ward where there is a large multi-disciplinary team. While working on the ward as doctors we noticed that handover between the MDT was poor. Anecdotal evidence from both doctors and nurses felt that this was a high risk area in need of improvement. Aim to improve handover between doctors and nurses on this elderly care ward. Method To measure the quality of current handover practice we did a questionnaire. A total of 12 questionnaires were completed which showed that 92% of staff felt that handover on the ward was very poor and 50% preferred both written and verbal handover. We measured the number of tasks verbally handed over between doctors and nurses over 3 days. On average 65% of the tasks were completed. We then made the below interventions and re-audited to see if there was any improvement. Interventions over 3 week period: Results Questionnaire: Measuring task completion after interventions; Conclusion This project has made a positive change qualitatively and quantitatively to the ward handover practice. Staff satisfaction regarding handover has improved and the number of “handed over” tasks completed daily has significantly improved. The written handover sheet had poor utilisation by staff but in 4 months we are going to re-audit and trial the handover sheet again to further improve service delivery. We hope this improvement will have a positive impact on patient care on this elderly care ward.

scholarly journals Nosocomial or not? A combined epidemiological and genomic investigation to understand hospital-acquired COVID-19 infection on an elderly care ward

2021 ◽  
Vol 3 (3) ◽  
pp. 100165
Author(s):  
R.D. Wenlock ◽  
M. Tausan ◽  
R. Mann ◽  
W. Garr ◽  
R. Preston ◽  
...  
Keyword(s):  
Elderly Care ◽  
Hospital Acquired ◽  
Care Ward

scholarly journals Multifaceted antibiotic stewardship intervention using a participatory-action-research approach to improve antibiotic prescribing for urinary tract infections in frail elderly (ImpresU): study protocol for a European qualitative study followed by a pragmatic cluster randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052552
Author(s):  
Esther A R Hartman ◽  
Wim G Groen ◽  
Silje Rebekka Heltveit-Olsen ◽  
Morten Lindbaek ◽  
Sigurd Hoye ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Frail Elderly ◽  
Controlled Trial ◽  
Elderly Care ◽  
Cluster Randomised Controlled Trial ◽  
Antibiotic Use ◽  
Research Approach ◽  
Antibiotic Prescribing ◽  
Action Research Approach ◽  
Tract Infections

IntroductionAlmost 60% of antibiotics in frail elderly are prescribed for alleged urinary tract infections (UTIs). A substantial part of this comprises prescriptions in case of non-specific symptoms or asymptomatic bacteriuria, for which the latest guidelines promote restrictiveness with antibiotics. We aim to reduce inappropriate antibiotic use for UTIs through an antibiotic stewardship intervention (ASI) that encourages to prescribe according to these guidelines. To develop an effective ASI, we first need a better understanding of the complex decision-making process concerning suspected UTIs in frail elderly. Moreover, the implementation approach requires tailoring to the heterogeneous elderly care setting.Methods and analysisFirst, we conduct a qualitative study to explore factors contributing to antibiotic prescribing for UTIs in frail elderly, using semi-structured interviews with general practitioners, nursing staff, patients and informal caregivers. Next, we perform a pragmatic cluster randomised controlled trial in elderly care organisations. A multifaceted ASI is implemented in the intervention group; the control group receives care as usual. The ASI is centred around a decision tool that promotes restrictive antibiotic use, supported by a toolbox with educational materials. For the implementation, we use a modified participatory-action-research approach, guided by the results of the qualitative study. The primary outcome is the number of antibiotic prescriptions for suspected UTIs. We aim to recruit 34 clusters with in total 680 frail elderly residents ≥70 years. Data collection takes place during a 5-month baseline period and a 7-month follow-up period. Finally, we perform a process evaluation. The study has been delayed for 6 months due to COVID-19 and is expected to end in July 2021.Ethics and disseminationEthical approvals and/or waivers were obtained from the ethical committees in Poland, the Netherlands, Norway and Sweden. The results will be disseminated through publication in peer-reviewed journals and conference presentations.Trial registration numberNCT03970356.

scholarly journals 56 Quality Improvement Project on the Bowel Charts in An Elderly Care Ward in Basildon University Hospital

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i14-i17
Author(s):  
R A Hakim ◽  
M Ali ◽  
I Wijenyake
Keyword(s):  
Elderly Care ◽  
Oral Intake ◽  
University Hospital ◽  
Improvement Project ◽  
Memory Problems ◽  
Sustained Change ◽  
Initial Survey ◽  
Care Ward ◽  
Measurable Change

Abstract Background To improve the rate of documentation on bowel charts on an elderly care ward with a significant percentage of patients suffering from dementia. Importance As a junior doctor working on an elderly care ward with patients who often had memory problems and were unable to recall their bowel patterns, it was extremely challenging to establish whether a particular patient has constipation or diarrhoea. Constipation in an elderly patient can lead to multiple complications like urinary retention, intestinal obstruction and often decreased oral intake. Methods An audit was carried out to see the rate of completion of the Bowel charts on the ward. Only about 23% of the bowel charts on the ward were complete in the initial survey. Then interventions were introduced in steps and three more audits were done. At each step, we were able to show how the interventions introduced changed the degree of completion of the bowel charts. Outcome We have seen a marked improvement of 37% since the start of the project 5 months ago. From 23% to 60% completion of bowel charts. There appeared to be a sustained change only falling short at the weekends (due to staffing issues) Overall awareness had increased vastly. We were able to make a measurable change and improvement in the quality of care provided.

scholarly journals What is an admission? A standardised approach to classifying inpatient episode data from multiple jurisdictions

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Sarah Rees ◽  
Ashley Akbari ◽  
Huw Collins ◽  
Amanda Marchant ◽  
Daniel Thayer ◽  
...  
Keyword(s):  
Data Quality ◽  
Elderly Care ◽  
Discharge Destination ◽  
Inpatient Episode ◽  
Subsequent Episode ◽  
Episodes Of Care ◽  
The Uk ◽  
Care Ward ◽  
Clinical Meaningfulness

IntroductionInpatient datasets in the UK are primarily organised by episodes (periods of care under an individual consultant), while researchers often want to measure admissions (periods of stay in hospital). We developed a standardized method for identifying admissions in inpatient data, while accounting for differences between the four UK nations. Objectives and ApproachAll UK inpatient datasets include date variables, permitting chronological sequencing of episodes. They include flags describing whether an episode is a transfer of care, although structures and definitions differ. Data quality is variable leading to concurrent and overlapping episodes, duplication and “orphan” or “childless” transfer episodes, where no originating or destination episode can be identified. Our objective was to define a method for classifying individual episodes into a continuous period of stay in hospital, which would be consistently applicable to the analysis of inpatient datasets of all four UK nations, while prioritising clinical meaningfulness. Three permutations were considered. ResultsFor each permutation, episodes for an individual were linked when they related to the same individual and met the following criteria: Zero or one day gap between episode end and subsequent episode start Evidence of transfer according to admission method or discharge destination variables Episode overlapping or completely nested within another episode Permutations: a and b a only a and c Permutation three was adopted, as it was felt to be the most clinically meaningful approach, was not dependent on accurate recording of transfers and captured nested or overlapping episodes, which may occur for example when a patient is in a long-stay psychiatric or elderly care ward but requires care from a different specialty. Importantly it permitted consistent analysis of episodes across all UK nations. Conclusion/ImplicationsThe output of this work provides a useful guide for the classification of inpatient episodes into more clinically meaningful periods of care, and is applicable to the inpatient datasets of all four UK nations. It describes important issues to consider when classifying episodes of care, particularly relating to data quality.

scholarly journals Taste thresholds of patients in an NHS elderly care ward

2010 ◽  
Vol 69 (OCE6) ◽  
Author(s):  
S. Behrman ◽  
K. Lau ◽  
M. A. Gosney ◽  
O. B. Kennedy ◽  
L. Methven
Keyword(s):  
Elderly Care ◽  
Care Ward ◽  
Taste Thresholds
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