19 Integrated Falls Prevention Pathways; the Benefits of Organisational Collaboration

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i1-i6
Author(s):  
E Tanks ◽  
A Michael
Keyword(s):  
Resource Sharing ◽  
Best Practice ◽  
Single Point ◽  
Admission Rate ◽  
Improve Patient Care ◽  
Quality Standard ◽  
Falls Prevention ◽  
Nice Guideline ◽  
Peak Rate ◽  
Use Of Resources

Abstract Introduction There is continuous increased demand on the NHS, while resources are finite. Developing pathways with Integration and streamlining of services is crucial to achieve good outcome and better use of resources. Falls service is a good example. In Dudley, three separate services existed for managing falls: a local authority team, a NHS therapy team and a Consultant-led Falls & Syncope clinic. We collaborated and reorganised the services to improve patient care and achieve better outcome. Methods We integrated services into one pathway, where patients are triaged to the relevant service based on clinical need via a Single Point of Access. One multifactorial assessment- based on NICE guideline CG161 and Quality Standard QS86- was developed, which is completed by all services (streams). This allows their assessment to be transferred to another stream if clinically indicated, saving repetition/duplication. An extensive training programme was delivered to up-skill staff across the pathway in completing areas of best practice (e.g. postural BP measurement, balance/mobility assessments, cognitive assessment, FRAX score, medication issues). Additionally we established a Falls MDT meeting with representation from all streams, to discuss complex cases, and developed a shared, electronic database to track patient journeys and monitor service outcomes. Results Falls admission rate decreased by 29.4% for patients 65 y and over and 25.2% for 80+. This equates to 433 fewer falls compared to peak rate; saving an estimated £3.4million. Also, hip fracture admission rate decreased by 19.2% for patients 65 y and over and 23.5% for 80+. This equates to 91 fewer hip fractures compared to peak rate; saving an estimated £1.3million. Much improved service collaboration and resource sharing. Conclusion A collaborative approach between organisations, utilising existing resources in a system that places patients at the heart of the service, improves patient experience and outcomes, alongside significant financial savings.

NICE Recommendations Relevant to Open Fractures

2020 ◽  
pp. 205-210
Keyword(s):  
Open Fracture ◽  
Quality Standard ◽  
Open Fractures ◽  
Significant Component ◽  
Nice Guideline ◽  
Complex Fractures

In 2016 the National Institute for Clinical and Care Excellence (NICE) published a suite of five trauma-related guidelines, including the Guideline on Complex Fractures NG37. A significant component of this guideline related specifically to open fractures, and each of the relevant recommendations is discussed. Following the publication of the complete trauma Suite of guidelines there was further work by NICE resulting in the formulation of just five Quality Standard Statements; one of these was specific to open fractures. The relevant recommendations from the NICE guideline NG37 and statement from the Quality Standard are presented is this chapter for easy reference. This also allows the concordance that exists between the text in the rest of this book, the Open Fracture BOAST and NICE to be better appreciated.

Towards appropriate nutritional prescribing: challenges and solutions

2019 ◽  
Vol 1 (11) ◽  
pp. 556-564 ◽  
Author(s):  
Rebecca Fisher
Keyword(s):  
Best Practice ◽  
Nutritional Supplements ◽  
Pricing Model ◽  
Adequate Knowledge ◽  
Use Of Resources ◽  
Product Pricing ◽  
Appropriate Prescribing ◽  
Public Health Message ◽  
The Right ◽  
The Cost

The appropriate prescribing of nutritional supplements is coming under increasing scrutiny due to rising costs, workforce challenges, and a product pricing model that does not meet the needs of the healthcare economy. Data show that, whilst the number of items being prescribed is marginally decreasing, the cost of these items is increasing, and the assumption that all patients discharged on nutritional borderline substances from hospital have been assessed by a dietitian cannot be made. Standards of communication are highly variable but, with increasing knowledge about best practice and digitalisation, improvements are being made. There is a disparity between adequate knowledge of nutrition, prescribing, and best use of resources to effectively manage patient-centred care and costs. A number of strategies are being trialled to improve education and the utilisation of the right workforce. The need for a clear public health message on the importance of maintaining weight in older age is essential to ensure nutritional borderline substances are appropriately used.

A Framework for Best Practice Health Promotion in Primary Health Care

2001 ◽  
Vol 7 (1) ◽  
pp. 101
Author(s):  
Meredith Swaby ◽  
Amanda Biesot
Keyword(s):  
Health Promotion ◽  
Workforce Development ◽  
Resource Sharing ◽  
Best Practice ◽  
Reference Group ◽  
Program Planning ◽  
Integrated Approach ◽  
Health Issues ◽  
Structural Framework ◽  
Working Groups

ISIS Primary Care provides health and welfare services to the municipalities of Brimbank, Hobsons Bay and Wyndham. An organisational commitment was made to establish an integrated approach to health promotion that would result in best practice health promotion within the community and in partnership with other agencies. To achieve this it was necessary to develop internal organisational skills and processes as well as formalise the relationships with agencies within the catchment. A "framework for best practice health promotion" was developed with a number of interrelated components occurring concurrently at several levels within the organisation and externally. This encompasses a structural framework with a Health Promotion Reference Group of key intersectoral stakeholders, as well as six Health Promotion Working Groups across the organisation each focussing on identified health issues. The strategic framework is a procedural document outlining processes for planning, implementation and evaluation of health promotion at an organisational level. The supporting framework includes detailed program planning and evaluation guidelines and workforce development. The implementation of this framework has resulted in a coordinated and sustainable approach to health promotion across the catchment with opportunities for successful partnerships, capacity building, resource sharing and increased program reach in meeting the perceived needs of the community.

35 Enhanced Service Through An Integrated New Model of Care in A Buckinghamshire Care Home

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i9-i10
Author(s):  
U Okoli ◽  
S Chimhau ◽  
B Nagyova ◽  
A Sahni ◽  
S Amin ◽  
...  
Keyword(s):  
Best Practice ◽  
Adverse Drug Events ◽  
Hospital Admissions ◽  
Care Home ◽  
Cost Savings ◽  
Care Homes ◽  
Multiple Chronic Conditions ◽  
Model Of Care ◽  
Nice Guideline ◽  
Care Plans

Abstract Introduction Care home residents often have multiple, chronic conditions and are receiving complex treatment regimes. Polypharmacy and medication errors are common. The frequency and quality of medication reviews is variable with limited general practice (GP) capacity to carry out comprehensive reviews. The initiative used a care home pharmacist, technician, geriatrician and GPs to tackle these issues on an individual and care home level. The objective being to ensure the safe and effective use of medicines for all care home residents. NICE guideline [NG56] recommends reducing pharmacological treatment burden for adults with multimorbidity at risk of adverse drug events such as unplanned hospital admissions. A study by Dilles et al1 found adverse drug reactions in 60% of residents. Methods A new interdisciplinary model of care was delivered in a 120 bedded Buckinghamshire care home. Clinical Commissioning Group pharmacist, general practitioners and pharmacy technician reviewed medication for all residents. The most complex individuals were reviewed by the geriatrician and if needed by other multidisciplinary team members specialist. Results Overall 115 medications were stopped for 109 residents, with 31 interventions to reduce falls risk and 19 interventions on medication at high risk2 of causing admission. Total cost savings on medicines optimisation, medicines waste and non-elective admission prevented was £35,211. Residents’ care plans were updated to reflect best practice standards. Conclusions Future direction of this project focuses on system wide improvements to promote interdisciplinary healthcare professionals work in care homes. The success of this integrated model of care has enabled recurrent funding of pharmacist by the local county council and an additional 42 geriatrician sessions into Buckinghamshire care homes. References 1. Dilles T, Vander Stichele R, Van Bortel L, Elseviers M. Journal of American Medical Directors Association 2013; 14: 371–6. 2. Pirmohamed M, et al. Br Med J 2004; 329: 15–9 61.

The role of perforators in chronic venous insufficiency

2010 ◽  
Vol 25 (1) ◽  
pp. 3-10 ◽  
Author(s):  
T F O'Donnell
Keyword(s):  
Best Practice ◽  
Improve Patient Care ◽  
Cost Effective ◽  
Wound Dressings ◽  
Evidence Based ◽  
Systematic Analysis ◽  
Consensus Document ◽  
Grade Method ◽  
Compression Bandages ◽  
Effective Manner

Thesis Venous ulcers (VU) consume considerable resources in healthcare systems, up to 1% of healthcare budgets in industrialized countries. Best practice guidelines (GLs) incorporate evidence-based diagnostic and therapeutic recommendations in a cost-effective manner and have been associated with improved and less costly outcomes for many diseases. Objectives To determine whether there are common elements in GLs for VU and their evidentiary strength. Methods A systematic analysis of GLs for VU that were identified through clinicaltrials.gov, a government-sponsored website, and from experts outside the USA. Results Ten of 12 GLs on VU (7 North America and 5 Europe) were evidence-based, with the majority using the GRADE method. Only two had been developed or updated within the last three years. Venous duplex and ankle ABIs were recommended in all. Debridement was suggested in two, while simple non-adherent wound dressings were favoured in nine, and hydrocolloid in two. Only one GL discussed a range of dressing options, dependent on the condition of the VU. High pressure multi-layer compression bandages were favoured in 10. Only two focused on the importance of improving ankle joint mobility. Conclusions While there are numerous evidence-based GLs for VU, the majority may lag recent developments in the field. There is consensus on the elements for dressings and compression among the various GLs, which should facilitate the development of a common consensus GL, similar to that for DVT/PE. To improve patient care and reduce wasted resources, it is imperative for specialty societies to develop this consensus document.

Falls Prevention Strategies among Inpatients in a University Hospital: a best practice implementation project

2017 ◽  
Author(s):  
Flávia de Oliveira Motta Maia ◽  
Diná Monteiro da Cruz ◽  
Gilceria Shimoda ◽  
Karina Sichieri ◽  
Luciana Inaba Senyer Iida
Keyword(s):  
Best Practice ◽  
Falls Prevention ◽  
University Hospital ◽  
Prevention Strategies ◽  
Implementation Project ◽  
Practice Implementation

scholarly journals Hypothesis Testing in High-Throughput Screening for Drug Discovery

2012 ◽  
Vol 17 (4) ◽  
pp. 519-529 ◽  
Author(s):  
Michael Prummer
Keyword(s):  
Drug Discovery ◽  
High Throughput ◽  
High Throughput Screening ◽  
Large Scale ◽  
Single Point ◽  
Error Rates ◽  
P Value ◽  
Distribution Analysis ◽  
Use Of Resources ◽  
Compound Screening

Following the success of small-molecule high-throughput screening (HTS) in drug discovery, other large-scale screening techniques are currently revolutionizing the biological sciences. Powerful new statistical tools have been developed to analyze the vast amounts of data in DNA chip studies, but have not yet found their way into compound screening. In HTS, characterization of single-point hit lists is often done only in retrospect after the results of confirmation experiments are available. However, for prioritization, for optimal use of resources, for quality control, and for comparison of screens it would be extremely valuable to predict the rates of false positives and false negatives directly from the primary screening results. Making full use of the available information about compounds and controls contained in HTS results and replicated pilot runs, the Z score and from it the p value can be estimated for each measurement. Based on this consideration, we have applied the concept of p-value distribution analysis (PVDA), which was originally developed for gene expression studies, to HTS data. PVDA allowed prediction of all relevant error rates as well as the rate of true inactives, and excellent agreement with confirmation experiments was found.

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