Implementation of a standardized oral screening tool by paediatric cardiologists

2020 ◽  
Vol 30 (12) ◽  
pp. 1815-1820
Author(s):  
Shelley I. McCargar ◽  
Joanne Olsen ◽  
Robert J. Steelman ◽  
Jennifer H. Huang ◽  
Elizabeth A. Palmer ◽  
...  
Keyword(s):  
Screening Tool ◽  
Invasive Procedure ◽  
Audit And Feedback ◽  
Secondary Outcome ◽  
Chart Audit ◽  
Implementation Framework ◽  
Screening Guidelines ◽  
Targeted Interventions ◽  
Provider Adherence ◽  
Oral Screening

AbstractBackground:An examination of invasive procedure cancellations found that the lack of pre-procedural oral screening was a preventable cause, for children with congenital heart disease. The purpose of this study was to implement an oral screening tool within the paediatric cardiology clinic, with referral to paediatric dental providers for positive screens. The target population were children aged ≥6 months to <18 years old, being referred for cardiac procedures.Methods:The quality implementation framework method was used for this study design. The multi-modal intervention included education, audit and feedback, screening guidelines, environmental support, and interdisciplinary collaboration. Baseline rates for oral screenings were determined by retrospective chart audit from January 2018 to January 2019 (n = 211). Provider adherence to the oral screening tool was the outcome measure. Positive oral screens, resulting in referral to the paediatric dental clinic, were measured as a secondary outcome. Provider adherence rates were used as a process measure.Results:Data collected over 14 weeks showed a 29% increase in documentation of oral screenings prior to referral, as compared to the retrospective chart audit. During the study period, 13% of completed screenings were positive (n = 5). Provider compliance for the period was averaged at 70% adherence.Conclusion:A substantial increase in pre-procedural oral screenings by paediatric cardiologists was achieved using the quality implementation framework and targeted interventions.

Section 2: Evidence implementation projects using an evidence-based audit and feedback approach: the JBI Implementation Framework

2019 ◽  
Author(s):  
Zachary Munn ◽  
Alexa McArthur ◽  
Kylie Porritt ◽  
Lucylynn Lizarondo ◽  
Sandeep Moola ◽  
...  
Keyword(s):  
Audit And Feedback ◽  
Evidence Based ◽  
Implementation Framework

scholarly journals Maternal Bacteremia Caused by Staphylococcus Aureus With a Focus on Infective Endocarditis

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Morgan K Morelli ◽  
Michael P Veve ◽  
Mahmoud A Shorman
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Drug Use ◽  
Hospital Mortality ◽  
Injection Drug Use ◽  
Pregnant Patient ◽  
Infectious Complications ◽  
Injection Drug ◽  
Secondary Outcome ◽  
Targeted Interventions

Abstract Background Sepsis is an important cause of morbidity and mortality in the pregnant patient. Injection drug use in pregnant populations has led to increased cases of bacteremia and infective endocarditis (IE) due to Staphylococcus aureus. We describe all cases of S. aureus bacteremia and IE among admitted pregnant patients at our hospital over a 6-year period. Methods This was a retrospective review of pregnant patients hospitalized with S. aureus bacteremia between April 2013 and November 2019. Maternal in-hospital mortality and fetal in-hospital mortality were the primary outcomes measured; the secondary outcome was the rate of 6-month maternal readmission. Results Twenty-seven patients were included; 15 (56%) had IE. The median (interquartile range [IQR]) age was 29 (25–33) years; 22 (82%) patients had methicillin-resistant S. aureus. Infection onset occurred at a median (IQR) of 29 (23–34) weeks’ gestation. Twenty-three (85%) mothers reported active injection drug use, and 21 (78%) were hepatitis C seropositive. Fifteen (56%) mothers required intensive care unit (ICU) care. Twenty-two (81%) patients delivered 23 babies; of the remaining 5 mothers, 3 (11%) were lost to follow-up and 2 (7%) terminated pregnancy. Sixteen (73%) babies required neonatal ICU care, and 4/25 (16%) infants/fetuses died during hospitalization. One (4%) mother died during hospitalization, and 7/26 (27%) mothers were readmitted to the hospital within 6 months for infectious complications. Conclusions Injection drug use is a modifiable risk factor for S. aureus bacteremia in pregnancy. Fetal outcomes were poor, and mothers were frequently readmitted secondary to infection. Future targeted interventions are needed to curtail injection drug use in this population.

scholarly journals Patient safety initiatives in obstetrics: a rapid review

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020170 ◽  
Author(s):  
Jesmin Antony ◽  
Wasifa Zarin ◽  
Ba’ Pham ◽  
Vera Nincic ◽  
Roberta Cardoso ◽  
...  
Keyword(s):  
Patient Safety ◽  
Healthcare Providers ◽  
Audit And Feedback ◽  
Rapid Review ◽  
Secondary Outcome ◽  
Provider Education ◽  
Eligibility Criteria ◽  
Clinician Education ◽  
Study Selection ◽  
Safety Outcomes

ObjectivesThis review was commissioned by WHO, South Africa-Country office because of an exponential increase in medical litigation claims related to patient safety in obstetrical care in the country. A rapid review was conducted to examine the effectiveness of quality improvement (QI) strategies on maternal and newborn patient safety outcomes, risk of litigation and burden of associated costs.DesignA rapid review of the literature was conducted to provide decision-makers with timely evidence. Medical and legal databases (eg, MEDLINE, Embase, LexisNexis Academic, etc) and reference lists of relevant studies were searched. Two reviewers independently performed study selection, abstracted data and appraised risk of bias. Results were summarised narratively.InterventionsWe included randomised clinical trials (RCTs) of QI strategies targeting health systems (eg, team changes) and healthcare providers (eg, clinician education) to improve the safety of women and their newborns. Eligible studies were limited to trials published in English between 2004 and 2015.Primary and secondary outcome measuresRCTs reporting on patient safety outcomes (eg, stillbirths, mortality and caesarean sections), litigation claims and associated costs were included.ResultsThe search yielded 4793 citations, of which 10 RCTs met our eligibility criteria and provided information on over 500 000 participants. The results are presented by QI strategy, which varied from one study to another. Studies including provider education alone (one RCT), provider education in combination with audit and feedback (two RCTs) or clinician reminders (one RCT), as well as provider education with patient education and audit and feedback (one RCT), reported some improvements to patient safety outcomes. None of the studies reported on litigation claims or the associated costs.ConclusionsOur results suggest that provider education and other QI strategy combinations targeting healthcare providers may improve the safety of women and their newborns during childbirth.

scholarly journals Place-specific factors associated with adverse maternal and perinatal outcomes in Southern Mozambique: a retrospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024042 ◽  
Author(s):  
Prestige Tatenda Makanga ◽  
Charfudin Sacoor ◽  
Nadine Schuurman ◽  
Tang Lee ◽  
Faustino Carlos Vilanculo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Maternal Health ◽  
Family Support ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Reproductive Age ◽  
Secondary Outcome ◽  
Baseline Phase ◽  
Targeted Interventions

ObjectivesTo identify and measure the place-specific determinants that are associated with adverse maternal and perinatal outcomes in the southern region of Mozambique.DesignRetrospective cohort study. Choice of variables informed by literature and Delphi consensus.SettingStudy conducted during the baseline phase of a community level intervention for pre-eclampsia that was led by community health workers.ParticipantsA household census identified 50 493 households that were home to 80 483 women of reproductive age (age 12–49 years). Of these women, 14 617 had been pregnant in the 12 months prior to the census, of which 9172 (61.6%) had completed their pregnancies.Primary and secondary outcome measuresA combined fetal, maternal and neonatal outcome was calculated for all women with completed pregnancies.ResultsA total of six variables were statistically significant (p≤0.05) in explaining the combined outcome. These included: geographic isolation, flood proneness, access to an improved latrine, average age of reproductive age woman, family support and fertility rates. The performance of the ordinary least squares model was an adjusted R2=0.69. Three of the variables (isolation, latrine score and family support) showed significant geographic variability in their effect on rates of adverse outcome. Accounting for this modest non-stationary effect through geographically weighted regression increased the adjusted R2 to 0.71.ConclusionsThe community exploration was successful in identifying context-specific determinants of maternal health. The results highlight the need for designing targeted interventions that address the place-specific social determinants of maternal health in the study area. The geographic process of identifying and measuring these determinants, therefore, has implications for multisectoral collaboration.Trial registration numberNCT01911494.

Use Of Prothrombin Complex Concentrates In Warfarin Anticoagulation Reversal In The Emergency Department: A Quality Improvement Study Of Administration Delays

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4824-4824
Author(s):  
Simon Bordeleau ◽  
Daniele Marceau ◽  
Julien Poitras ◽  
Patrick Archambeault ◽  
Carolle Breton
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Action Plan ◽  
Blood Bank ◽  
Audit And Feedback ◽  
Chart Audit ◽  
Improvement Project ◽  
Administration Time ◽  
The Mean ◽  
Timely Administration

Introduction In some bleeding situations, quick reversal of warfarin anticoagulation is important. In the event of a major life-threatening bleeding event, the anticoagulation reversal delay can have an impact on mortality. This study aimed to improve the administration delay when using Prothrombin Complex Concentrate (PCC) for the emergent reversal of warfarin anticoagulation in the emergency department. Methods An audit and feedback quality improvement project was conducted in three phases: a retrospective audit phase, an analysis and feedback phase and prospective evaluation phase. The charts of all eligible patients in a single Emergency Department (ED) in Québec, Canada, who received 4-factor PCC since the introduction of this product in 2009 until October 31, 2011 were retrospectively audited with pre-planned evaluation criteria. The administration delay of PCC was calculated from the time of prescription to the time of administration. After this retrospective chart audit, we determined where improvements could be attained, gave feedback to the ED and the blood bank, and we created an action plan to ensure the timely administration of PCC. The action plan was then implemented in practice to reduce the administration delay. Finally, a six-month prospective evaluation study was conducted to determine if our action plan was followed and improved the administration delays. Results Seventy-seven charts were reviewed in the retrospective chart audit. The mean administration delay was 73.6 minutes (STD [34.1]) with a median of 70.0 minutes (25-75% IQR [45.0-95.0]). We found that this delay was principally due to the following barriers that prevented timely administration of PCCs: communication problems between the ED and the blood bank and reconstitution and delivery inefficiencies. In order to address these barriers, we developed an action plan that involved the following elements: a flowchart to remind all clinicians how to order PCCs and a new delivery method from the blood bank to the ED. During the 6 months following the implementation of our action plan, 39 patients received PCCs and the mean administration time decreased to 33.2 minutes (STD [14.2]) (p<.0001) with a median of 30.0 minutes (25-75% IQR [24.3-38.8]). Conclusion This audit and feedback quality improvement project involving the development and the implementation of an action plan comprising of a flowchart and a new delivery process reduced the administration time of PCC by more than half. Future studies to measure the impact of implementing a similar audit and feedback process involving an action plan in other centers should be conducted before this type of improvement process is implemented on wider scale. Disclosures: No relevant conflicts of interest to declare.

scholarly journals 30. Implementation of the PEN-FAST Penicillin Allergy Screening Tool in the Emergency Department During Medication Reconciliation

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S137-S138
Author(s):  
Satwinder Sony Kaur ◽  
David T Adams ◽  
Brittany Parker
Keyword(s):  
Emergency Department ◽  
Screening Tool ◽  
Healthcare Providers ◽  
Low Risk ◽  
Penicillin Allergy ◽  
Secondary Outcome ◽  
Beta Lactam ◽  
Decision Tool ◽  
Allergy Test ◽  
Risk Patients

Abstract Background The purpose of this study is to implement the PEN-FAST Penicillin Allergy Screening Tool in the emergency department to identify low risk patients with inappropriate penicillin-related allergies to transition them to a beta-lactam. Newly published, validated, penicillin allergy clinician decision tool (PEN-FAST) allows healthcare providers to identify low risk penicillin allergies with a negative predictive value of 96%. This quick, five question clinical decision tool allows healthcare providers and antimicrobial stewardship programs to identify patients who would also test negative if a formal penicillin allergy test was performed, making the process to confidently identify inappropriately labeled penicillin-related allergies more efficient. Methods During routine medication reconciliations, pharmacists will identify patients who have a documented penicillin-related allergy in the EMR and use the PEN-FAST screening tool. Patients meeting inclusion criteria will have their penicillin-related allergy updated in the EMR based upon their assessed risk of very low, low, moderate, or high. The primary outcomes for this study are the percentage of patients screened that were classified as “very low and low risk” and percentage penicillin-related allergies updated. The secondary outcomes are the percentage of patients that required antibiotic therapy (post-allergy update) that were transitioned to a beta-lactam, inpatient broad-spectrum antibiotic usage before and after allergy update, and time spent interviewing each patient. Results A total of 59 patients were interviewed using the PEN-FAST Tool. The results for the primary outcomes indicate 92% (n=54) of patient allergies updated in the EMR, 24% (n=13) of patients classified as “very low risk” and 34% (n=18) of patients classified as “low risk”. Results for the secondary outcome showed out of the 36 patients that were on non-beta lactams during allergy update, 72% (n=26) of those patients were transitioned to a beta-lactam. The average time to complete the PEN-FAST Tool was 4.2 minutes. Conclusion The results of this study support the use of the PEN-FAST Tool in efficiently updating patient’s allergies in the EMR and identifying low risk patients who may be eligible for beta-lactam therapy. Disclosures All Authors: No reported disclosures

Nurse Practitioner Knowledge of and Experienced Barriers to High-Risk Colorectal Cancer Screenings

2016 ◽  
Vol 9 (2) ◽  
pp. 229-235
Author(s):  
Lecia Reardon
Keyword(s):  
Colorectal Cancer ◽  
High Risk ◽  
Health Outcomes ◽  
Nurse Practitioners ◽  
Practice Patterns ◽  
Screening Guidelines ◽  
Targeted Interventions ◽  
Crc Screening ◽  
Screening Barriers ◽  
Improve Health

Problem: Evidence supports earlier preventive colorectal cancer (CRC) screening for high-risk individuals. Awareness of high-risk factors and application to screening guidelines can enable nurse practitioners (NPs) to positively impact screening rates. Application of this knowledge can transform high-risk CRC screenings from tertiary CRC diagnosis to primary and secondary prevention to improve health outcomes. Purpose: To survey NP knowledge, perceived barriers, and current practice patterns in referring high-risk individuals for CRC screenings. Methods: A 16-question Qualtrics Internet survey designed, tested, and emailed to 2,155 primary care NPs in North Carolina. Results: One hundred eighty respondents (8.3%) completed the survey, with 57.5% (n = 104) rating themselves knowledgeable of high-risk CRC screening guidelines. Screening barriers included uninsured status, patient refusal, and lack of access. Aggregate practice screening pattern questions were related to self-perceived knowledge of high-risk CRC guidelines (χ2 = 4.1918, df = 1, p = .04). Conclusion: Over half (57.8%) of the respondents reporting knowledge of high-risk CRC guidelines had statistically significant relationship in aggregate practice patterns. Reduction of screening barriers using targeted interventions may improve health outcomes.

scholarly journals Cancer Screening Patterns and Concerns in Caregivers of Patients Undergoing Radiation Therapy

2016 ◽  
Vol 12 (4) ◽  
pp. e405-e412
Author(s):  
Jolinta Y. Lin ◽  
Tejan P. Diwanji ◽  
James W. Snider ◽  
Nancy Knight ◽  
William F. Regine
Keyword(s):  
Radiation Therapy ◽  
Cancer Screening ◽  
Radiation Oncology ◽  
Primary Care Physicians ◽  
Cancer Society ◽  
Screening Guidelines ◽  
The Public ◽  
Targeted Interventions ◽  
Patients With Cancer ◽  
American Urological Association

Purpose: Evolving cancer screening guidelines can confuse the public. Caregivers of patients undergoing radiation oncology may represent a promising outreach target for disseminating and clarifying screening information. We aimed to: (1) determine the incidence of cancer screening in this cohort, and (2) identify barriers to and deficiencies in screening. Methods: We distributed a 21-item survey on cancer screening history and related concerns to caregivers ≥ 18 years old at one urban and two suburban radiation oncology centers. Reported screening habits were compared with American Cancer Society/American Urological Association guidelines for breast, cervical, colon, and prostate cancer. Statistical analysis included Pearson χ2 tests. Results: A total of 209 caregivers (median age, 55.5 years; 146 women) were surveyed. Although 92% had primary care physicians (PCPs), only 58% reported being informed about recommended screening intervals. Participants ≤ 49 years old were less likely to report PCP discussion of cancer screening than older participants (41% and 66%, respectively; P = .006). Ninety-eight respondents (47%) had one or more screening concern(s). Among screening-eligible caregivers, 23 (18%) reported not undergoing regular colonoscopies. Fourteen women (13%) did not have Papanicolaou smears at recommended intervals, and 21 (18%) did not have annual mammograms. Six men (21%) did not undergo annual prostate screening. Decreased recommended screening with colonoscopy and mammography correlated with younger age. Conclusion: This survey of relatively unexplored caregivers identified cancer screening deficiencies and concerns that might be addressed by targeted interventions. With approximately 60% of patients with cancer receiving radiation therapy, advice in the radiation oncology setting could positively affect cancer screening behaviors in caregivers.

scholarly journals Smoking in social housing among adults in England, 2015-2020

2022 ◽  
Author(s):  
Sarah E Jackson ◽  
Hazel Cheeseman ◽  
Deborah Arnott ◽  
Robbie Titmarsh ◽  
Jamie Brown
Keyword(s):  
Social Housing ◽  
Smoking Prevalence ◽  
Smoking Status ◽  
High Risk Group ◽  
Housing Tenure ◽  
Secondary Outcome ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Targeted Interventions ◽  
Stop Smoking

Objectives: To analyse associations between living in social housing and smoking in England and evaluate progress toward reducing disparities in smoking prevalence among residents of social housing compared with other housing types. Design: Nationally-representative, cross-sectional survey between January 2015 and February 2020. Setting: England. Participants: 105,562 adults (≥16y). Primary and secondary outcome measures: Linear and logistic regression were used to analyse associations between living in social housing (vs. other housing types) and smoking status, cigarettes per day, time to first cigarette, exposure to smoking by others, motivation to stop smoking, quit attempts, and use of cessation support. Analyses adjusted for sex, age, social grade, region, and survey year. Results: Adults living in social housing had twice the odds of being a smoker (ORadj=2.17, 95%CI 2.08-2.27), and the decline in smoking prevalence between 2015 and 2020 was less pronounced in this high-risk group (-7%; ORadj=0.98, 95%CI 0.96-1.01) than among adults living in other housing types (-24%; ORadj=0.95, 95%CI 0.94-0.96; housing tenure*survey year interaction p=0.020). Smokers living in social housing were more addicted than those in other housing (smoking within 30 minutes of waking: ORadj=1.50, 95%CI 1.39-1.61), but were no less motivated to stop smoking (ORadj=1.06, 95%CI 0.96-1.17) and had higher odds of having made a serious attempt to quit in the past year (ORadj=1.16, 95%CI 1.07-1.25). Among smokers who had tried to quit, those living in social housing had higher odds of using evidence-based cessation support (ORadj=1.22, 95%CI 1.07-1.39) but lower odds of remaining abstinent (ORadj=0.63, 95%CI 0.52-0.76). Conclusions: There remain stark inequalities in smoking and quitting behaviour by housing tenure in England, with declines in prevalence stalling between 2015 and 2020 despite progress in the rest of the population. In the absence of targeted interventions to boost quitting among social housing residents, inequalities in health are likely to worsen.

scholarly journals Use of hemoglobin A1c to identify dysglycemia in cystic fibrosis

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250036
Author(s):  
Amy Darukhanavala ◽  
Filia Van Dessel ◽  
Jannifer Ho ◽  
Megan Hansen ◽  
Ted Kremer ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Glucose Tolerance ◽  
Hemoglobin A1c ◽  
Screening Tool ◽  
Normal Glucose Tolerance ◽  
Screening Methods ◽  
Oral Glucose ◽  
Screening Guidelines ◽  
Normal Glucose ◽  
The Impact

Background Cystic fibrosis (CF) leads to pancreatic endocrine dysfunction with progressive glycemic disturbance. Approximately 30%–50% of people with CF eventually develop CF–related diabetes (CFRD). Pre-CFRD states progress from indeterminant glycemia (INDET) to impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Screening guidelines recommend inconvenient annual 2-hour oral glucose tolerance tests (OGTTs), beginning at age 10 years. More efficient methods, such as hemoglobin A1C (HbA1c), have been evaluated, but only limited, relatively small studies have evaluated the association between HbA1c and pre-CFRD dysglycemic states. Objective To determine whether HbA1c is an appropriate screening tool for identifying patients with pre-CFRD dysglycemia to minimize the burden of annual OGTTs. Methods This retrospective review evaluated medical records data of all University of Massachusetts Memorial Health System CF patients with an HbA1c result within 90 days of an OGTT between 1997 and 2019. Exclusion criteria were uncertain CF diagnosis, other forms of diabetes, or incomplete OGTT. In total, 56 patients were included and categorized according to OGTT results (American Diabetes Association criteria): normal glucose tolerance, INDET, IFG, or IGT. Associations were evaluated between HbA1c and OGTT results and between HbA1c and pre-CFRD dysglycemic states. Results Mean HbA1c was not significantly different between patients with normal glucose tolerance and those in the INDET (p = 0.987), IFG (p = 0.690), and IGT (p = 0.874) groups. Analysis of variance confirmed the lack of association between HbA1c and glycemia, as mean HbA1c was not significantly different amongst the four categories (p = 0.250). Conclusion There is increasing awareness of the impact of pre-CFRD states, including reduced pulmonary function and nutritional status. Unfortunately, our results do not support using HbA1c as a screening tool for pre-CFRD dysglycemia, specifically INDET, IFG, and IGT. Further studies are warranted to evaluate more efficient screening methods to reduce the burden of annual OGTTs.

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