scholarly journals 554 - Evaluation of CPR Decisions on an Older Adult Psychiatric Ward, A Quality Improvement Project

2021 ◽  
Vol 33 (S1) ◽  
pp. 95-95
Author(s):  
L Bennett ◽  
M McKinlay ◽  
A Prasanna
Keyword(s):  
Older Adult ◽  
Patient Outcomes ◽  
Hospital Admissions ◽  
Psychiatric Ward ◽  
Inclusion Criteria ◽  
National Guidelines ◽  
Education Session ◽  
Improvement Project ◽  
Psychiatric Setting

BackgroundThe National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) stated that CPR status must be considered and recorded for all acute hospital admissions. Compliance with this recommendation and with Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) form documentation in an inpatient psychiatric hospital was assessed. Multidisciplinary team (MDT) opinions surrounding DNACPR were also explored with an aim to educate staff, improving frequency and quality of future discussions.Research ObjectiveEnsure patient suitability for CPR is discussed at admission, that discussions are documented and forms completed in line with Trust policy and national guidelines.MethodResuscitation Council UK guidelines were used as a standard, namely recommendations for clear and full documentation of CPR decisions triggered by a new admission to hospital. A retrospective study of admissions to the older adult psychiatric ward over a four-month period was carried out, identifying 25 patients fulfilling the inclusion criteria. Demographics and CPR consideration at the initial consultant ward round were documented. Completed DNACPR forms were audited for compliance with Trust guidance. Following data collection, 14 staff interviews using standardised questions were completed to gauge understanding of DNACPR. Answers were analysed and education was identified as key. Bite-sized teaching for MDT staff on DNACPR was carried out and response to the intervention assessed using these same standardised questions.Preliminary Results of the Ongoing Study1 patient out of 25 had a CPR discussion documented from their initial consultant review. 12% had documentation of DNACPR consideration throughout the entirety of admission. The 1 DNACPR form subsequently completed had 91% compliance with Trust policy. Qualitative results from staff interviews were insightful with 50% knowing where DNACPR forms werekept, 29% feeling confident discussing DNACPR and 93% feeling able to contribute to team decisions.Following a bite-sized education session these figures increased to 100% having awareness and confidence discussing CPR suitability.ConclusionDNACPR considerations are infrequent and staff interviews suggest this may be due to lack of confidence and knowledge surrounding CPR. Bite-sized education may play a significant role in informing the MDT and ensuring vital DNACPR considerations are not forgotten about in the psychiatric setting.

Improvement of time to develop treatment plan at a specialized sarcoma center.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 127-127 ◽  
Author(s):  
Adriana Chavez ◽  
Prachee Singh ◽  
Jaime Anderson ◽  
Andrea Aleman ◽  
Colleen Jernigan ◽  
...  
Keyword(s):  
Decision Making ◽  
Median Time ◽  
Patient Outcomes ◽  
Process Improvement ◽  
Treatment Plan ◽  
Rapid Development ◽  
Insufficient Data ◽  
Improvement Project ◽  
Imaging Results

127 Background: Treatment of new patients at the MD Anderson Sarcoma Medical Oncology Clinic can take up to 1 to 2 weeks from their initial consultation depending on the information available for review. Treatment delays can result in poor patient outcomes, adversely affecting the quality of care provided. There are numerous processes involved in the development of a treatment plan that could be improved to reduce the time to finalization of treatment plan. Methods: We undertook a quality improvement project involving key clinic and administrative team members. We performed detailed process mapping and developed a cause and effect diagram to identify and prioritize opportunities for improvement. We measured the time in hours from the patient’s initial appointment to finalization of a treatment plan. Baseline data (before process improvement implementation) was collected retrospectively through chart review. Post-implementation data was collected prospectively. For process improvement, we focused on two deficiencies that were regarded as the key causes of delay to develop a finalized treatment plan (1) insufficient data for decision making at the time of new patient visit, and (2) delays in obtaining diagnostic imaging. Results: Due to insufficient data for decision-making available at the time of initial consultation, the median time to develop a treatment plan is 72 hours. After initiating process improvement, the median time to develop a treatment plan decreased to approximately 7 hours. Conclusions: Improving the quality of data available for the medical oncologist prior to initial consultation greatly enhances the rapid development of finalized treatment plan. Availability of an early treatment plan improves patient outcomes, diminishes patient anxiety, and decreases the costs incurred by the patient awaiting a treatment plan at a specialized oncology clinic.

A Scoping Review of the Evidence About the Nurses Improving Care for Healthsystem Elders (NICHE) Program

2019 ◽  
Author(s):  
Allison Squires ◽  
Komal Patel Murali ◽  
Sherry A Greenberg ◽  
Linda L Herrmann ◽  
Catherine O D’amico
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Quality Of Care ◽  
Work Environment ◽  
Older Adult ◽  
Patient Outcomes ◽  
Scoping Review ◽  
Adult Care ◽  
Program Adoption

Abstract Background and Objectives The Nurses Improving Care for Healthsystem Elders (NICHE) is a nurse-led education and consultation program designed to help health care organizations improve the quality of care for older adults. To conduct a scoping review of the evidence associated with the NICHE program to (a) understand how it influences patient outcomes through specialized care of the older adult and (b) provide an overview of implementation of the NICHE program across organizations as well as its impact on nursing professionals and the work environment. Research Design and Methods Six databases were searched to identify NICHE-related articles between January 1992 and April 2019. After critical appraisal, 43 articles were included. Results Four thematic categories were identified including specialized older adult care, geriatric resource nurse (GRN) model, work environment, and NICHE program adoption and refinement. Specialized older adult care, a key feature of NICHE programs, resulted in improved quality of care, patient safety, lower complications, and decreased length of stay. The GRN model emphasizes specialized geriatric care education and consultation. Improvements in the geriatric nurse work environment as measured by perceptions of the practice environment, quality of care, and aging-sensitive care delivery have been reported. NICHE program adoption and refinement focuses on the methods used to improve care, implementation and adoption of the NICHE program, and measuring its impact. Discussion and Implications The evidence about the NICHE program in caring for older adults is promising but more studies examining patient outcomes and the impact on health care professionals are needed.

scholarly journals Evaluating Caregiver Burden as a Predictive Factor for Patient Outcomes in Patients Receiving Anti-cancer Systemic Therapy at a Tertiary Institution in Cebu City

2021 ◽  
Author(s):  
Clarence Aaron Cheng Sy
Keyword(s):  
Quality Of Life ◽  
Educational Attainment ◽  
Patient Outcomes ◽  
Caregiver Burden ◽  
Systemic Therapy ◽  
Employment Status ◽  
Hospital Admissions ◽  
Self Care ◽  
Anti Cancer

Abstract Background: Though found to be a common occurrence in individuals caring for patients with debilitating illnesses such as cancer, caregiver burden remains underprioritized, and its relationship with patient outcomes is only sparingly described. Methodology: This cross-sectional, observational study included 50 patient-caregiver pairs receiving anti-cancer systemic therapy at a tertiary hospital in Cebu City. Sociodemographic and clinical characteristics were obtained. Patient quality of life was measured using the EQ-5D-5L Questionnaire, while caregiver burden was assessed with the Zarit Burden Interview. The association between caregiver burden and patient outcomes were examined using multivariate logistic regression models and bivariate analysis.Results: Patients included in the study were predominantly females, middle-aged to elderly, and in advanced stages of disease, whereas caregivers were mostly female, and younger in relation. The usual patient-caregiver relationships were spousal and parental. Educational attainment, employment status and income varied among caregivers, and were significantly associated with caregiver burden, as were patient age, a lung primary, and limitations in patient mobility, self-care and ability to perform usual activities. On the other hand, higher levels of caregiver burden were linked to quality of life impairment, increased anxiety or depression, and more frequent hospital admissions for patients.Discussion: The level of care in patients requiring continuous assistance often leads to an imbalance of care demands relative to the caregiver’s personal time and space, roles and resources, the latter being particularly relevant in the third-world setting where healthcare expenditure remains largely out-of-pocket. Patients likewise suffer from the burden they unwillingly impose on caregivers, with self-perceived burden contributing significantly to patient anxiety and depression, and influencing therapeutic choices in the direction of palliative care over curative therapy. Additionally, a higher level of caregiver burden was found to compromise the quality of care, and increase reliance on health systems, often leading to more frequent hospital admissions, perpetuating a vicious cycle of demand and burden.Conclusions: Financial standing, which can be influenced by educational attainment, employment status and income, was found to be significantly associated with caregiver burden. Patient-related factors such as age, a lung primary, and assistance requirement were also associated factors. Conversely, caregiver burden was found to influence patient quality of life via the impairment of mobility, self-care and ability to perform activities of daily living, and an increase in anxiety or depression. Higher levels of caregiver burden were also found to be associated with a higher frequency of hospital admissions for the patient.

scholarly journals To resuscitate or not to resuscitate; a question for old age psychiatrists

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S21-S22
Author(s):  
Liam Embliss ◽  
Mohan Bhat
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Older Adult ◽  
Good Practice ◽  
Psychiatric Ward ◽  
Routine Practice ◽  
Physical And Mental Health ◽  
Resuscitation Orders ◽  
Number Of Patients

AimsThe inpatient population of an older adult psychiatric ward will include people with physical and mental health conditions which affect life span and quality of life. Patients may be frail, acutely unwell, or have terminal illnesses such as dementia. It is therefore essential that clinicians review resuscitation status as part of their routine practice. However, we are aware that advanced decision-making – to resuscitate or not to resuscitate – is not routine practice across older adult psychiatric wards in the UK. Our 2017 audit reflected this, demonstrating a very low rate of resuscitation decisions at NELFT.This re-audit aimed to measure the frequency and quality of resuscitation decisions on an older adult psychiatric ward. We expected improvements in these areas, subsequent to changes implemented from the initial audit. We also sought to identify which patient factors influenced clinicians’ decision-making on resuscitation.Please note, this audit was completed prior to the COVID-19 pandemic.MethodIn June 2017, an audit of 25 patients admitted to two older adult psychiatric acute wards was completed. In December 2019, a retrospective analysis of the last 25 admissions to one older adult ward was undertaken. Electronic patient notes and DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) orders were examined. The audit measured frequency of resuscitation decisions and quality of documentation against current standards. DNACPR orders were analysed and clinicians were interviewed to identify the reasons for such decisions.ResultThere was an increase in the number of patients for which resuscitation decisions were made, from 4% in 2017 to 40% (n = 10) in 2019. The majority of patients with a DNACPR decision (n = 8) had a diagnosis of dementia. Prospective quality of life, with this diagnosis, was the most frequent determinant of DNACPR decisions (n = 7). Qualitative analysis indicated that clinicians were more likely to consider a resuscitation decision for patients with an organic disorder rather than functional disorder.Adequate completion of DNACPR orders was seen in each case. Either the patient, a family member or carer was involved in every decision. The standard for recording decisions on the electronic patient record was not met.ConclusionIt is good practice to consider resuscitation decisions for patients admitted to older adult psychiatric wards. This re-audit found an improvement in frequency of resuscitation decisions and also revealed differences in decision-making for patients with organic and functional disorders. Implementation of further change is indicated; decision-making can be improved through reflection, teaching, changes to practice, and technologies.

scholarly journals 741 Restarting Elective Orthopaedic Surgery During The COVID-19 Pandemic: Experiences and Patient Outcomes

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Laurent ◽  
M Saleh ◽  
A Vusirikala ◽  
T Castillo ◽  
R Kuzhupilly ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Outcomes ◽  
Orthopaedic Surgery ◽  
Statistical Difference ◽  
National Guidelines ◽  
Superficial Wound Infection ◽  
Post Operative Period ◽  
Superficial Wound ◽  
Hospital Deaths

Abstract Aim The COVID-19 pandemic resulted in postponing all non-urgent elective surgeries from April 2020. As we emerged from the first peak, restarting non-urgent services such as elective orthopaedic surgery was important for patients with chronic debilitating conditions. Our hospital successfully restarted orthopaedic surgery during the pandemic to help improve the quality of life of patients. This study describes the development of local protocols and pathways to allow for a safe restart of elective orthopaedic surgery in a COVID-19 free site. It presents the morbidity and mortality outcomes of those patients. Method This is a prospective cohort study evaluating all patients undergoing non-emergency orthopaedic procedures through a COVID-19 free pathway in a DGH from 18th May – 10th July 2020. 104 patients were identified, and their outcomes analysed during the 2 weeks following their surgery. Results No patients developed COVID-19 in the 2-weeks post-operative period. There were no ITU admissions or in-hospital deaths. 22(21.15%) out of 104 patients developed 23 complications within 2 weeks of surgery. These included: TIA, PE, AF, superficial wound infection, oozy wound and post-operative anaemia. They all made full recovery. There was no statistical difference in the development of complications for age (< 70; >70), gender, BMI, or ASA grades. Conclusions This study describes a roadmap to setting up a protocolised elective operating service for orthopaedic surgery. It has shown that standardised protocols in a COVID-19 free site, pre-operative COVID-19 testing and adherence to national guidelines on self-isolation prior to surgery can help prevent COVID-19 infection and its related risks post-operatively.

An Evaluation of Cognitive Behavioral Therapy for Insomnia: A Systematic Review and Application of Tolin’s Criteria for Empirically Supported Treatments

2019 ◽  
Author(s):  
Cassandra L. Boness ◽  
Rachel Hershenberg ◽  
Joanna Kaye ◽  
Margaret-Anne Mackintosh ◽  
Damion Grasso ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Empirically Supported Treatments ◽  
Inclusion Criteria ◽  
American Psychological ◽  
Strong Recommendation ◽  
Empirically Supported ◽  
High Quality Evidence

The American Psychological Association’s Society of Clinical Psychology recently adopted the “Tolin Criteria” to evaluate empirically supported treatments. These criteria better account for strength and quality of rapidly accumulating evidence bases for various treatments. Here we apply this framework to Cognitive Behavioral Therapy for Insomnia (CBT-I). Following procedures outlined by Tolin and colleagues (2015), Step 1 included an examination of quantitative systematic reviews; nine met inclusion criteria. Step 2 evaluated review quality and effect size data. We found high-quality evidence that CBT-I produces clinically and statistically significant effects on insomnia and other sleep-related outcomes. Based on the Tolin Criteria, the literature merits a “strong” recommendation for CBT-I. This report is a working model for subsequent applications of the Tolin Criteria.

Diabetes Discharge Planning and Transitions of Care: A Focused Review

2019 ◽  
Vol 15 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Robin L. Black ◽  
Courtney Duval
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Medication Management ◽  
Hospital Readmissions ◽  
The United States ◽  
Transitions Of Care ◽  
Discharge Process ◽  
The Impact ◽  
Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

Severe Sepsis Attributable to Community-Associated Methicillin-Resistant Staphylococcus aureus: An Emerging Fatal Problem

2007 ◽  
Vol 73 (7) ◽  
pp. 684-687 ◽  
Author(s):  
Eric T. Castaldo ◽  
Edmund Y. Yang
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Soft Tissues ◽  
Hospital Admissions ◽  
Primary Source ◽  
Necrotizing Pneumonia ◽  
Inclusion Criteria ◽  
Methicillin Resistant ◽  
Cardiorespiratory Failure ◽  
Source Of Infection

We observed a number of cases of sepsis from bacteremia in children from community-associated methicillin-resistant Staphylococcus aureus (MRSA), which led us to study its patterns of infection and outcome. A retrospective review identifying children admitted to our institution with blood culture-proven community-associated MRSA sepsis over a 2-year period was performed. The inclusion criteria were younger than 19 years old, two or more blood cultures for MRSA within 48 hours of admission, evidence of systemic inflammatory response syndrome, and no prior hospital admissions within 6 months. Eight patients were included; seven required mechanical ventilation. Vasopressors were required in seven patients. Four patients required extra-corporeal membrane oxygenation. Four patients had culture-proven septic arthritis or thrombophlebitis and three of these patients developed bilateral necrotizing pneumonia. Bilateral necrotizing pneumonia was identified in the other four patients, but the primary source of infection was never identified. The overall intact neurologic survival was 50 per cent. Children with severe community-associated MRSA sepsis can rapidly progress to cardiorespiratory failure. Mortality appears to be high, and children may benefit from a search of their soft tissues and joints to identify the source of infection to prevent embolic dissemination.

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