scholarly journals 64 Improving the Monitoring and Awareness of Fluid Balance on A Hip Fracture Ward

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
H Pickles ◽  
V Addy
Keyword(s):  
Quality Improvement ◽  
Hip Fracture ◽  
Fluid Balance ◽  
Medical Staff ◽  
Balance Training ◽  
Quality Improvement Project ◽  
Ward Staff ◽  
Post Intervention ◽  
Improvement Project

Abstract Introduction Fluid balance charts are frequently incomplete and inaccurate. At present our Trust does not offer fluid balance training to all ward staff. In addition, drinks given to patients by visitors are not usually documented on the fluid balance charts. The goals of this quality improvement project were therefore to: Methods Using the PDSA model a questionnaire was given to ward staff as a scoping exercise to identify the deficiencies in fluid balance education prior to the intervention and fluid balance charts were analyzed. The intervention involved: Results Pre-intervention questionnaires demonstrated that 31% of staff asked were not clear on the meaning of fluid balance and 88% felt that more fluid balance awareness was needed on the ward. In addition, 7/8 randomly selected fluid balance charts were incorrectly completed. Post intervention 87% understood the meaning of “fluid balance” monitoring and 7/8 fluid balance charts were correctly completed. Conclusion The intervention educated all ward staff and improved the accuracy of fluid balance monitoring. It also provided information and guidance to non-medical staff and visitors regarding fluid balance monitoring. Following the success of the project the intervention is being rolled out across the Trust alongside education sessions for staff.

scholarly journals Examining trainee awareness of dermatoses and dermatological assessments during acute admissions (A quality improvement project)

2018 ◽  
Vol 17 (3) ◽  
pp. 137-143
Author(s):  
Priya Patel ◽  
◽  
Natalie King ◽  
Keyword(s):  
Quality Improvement ◽  
Elderly Patients ◽  
Skin Care ◽  
Quality Improvement Project ◽  
Psychological Consequences ◽  
Post Intervention ◽  
Improvement Project ◽  
Care Bundles ◽  
Trust Hospital ◽  
Acute Admissions

Studies demonstrate 67% of elderly patients can have dermatoses, which could result in functional and psychological consequences. Elderly presentations are further complicated by comorbidities and polypharmacy. This combined with limited dermatology training at undergraduate and postgraduate levels creates diagnostic challenges. This project investigated dermatology assessments by trainees using the Trust’s acute medical admissions proforma. 100 proforma were reviewed for skin assessments alongside nursing skin care bundles. Subsequently, a skin survey was conducted amongst trainees evaluating knowledge and confidence when diagnosing and managing common dermatoses. Successively, a dermatology teaching series was delivered. Post-intervention the above were reassessed, demonstrating improvements in most areas. The dermatology teaching series will continue alongside a Trust hospital guideline to sustain improvements in dermatological care on admission.

scholarly journals 55 Quality Improvement Project to Assess How Informed Patients are About do not Attempt Cardiopulmonary (DNACPR) Decisions?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i14-i17
Author(s):  
P Jayasuriya ◽  
Y Amanullah ◽  
A Kumar ◽  
C Hookey
Keyword(s):  
Quality Improvement ◽  
Medical Staff ◽  
Quality Improvement Project ◽  
Next Of Kin ◽  
Geriatric Ward ◽  
Improvement Project ◽  
Information Leaflets ◽  
Journal Clubs ◽  
Weekly Journal

Abstract Introduction Despite growing evidence regarding DNACPR decisions, there is a paucity of information given to patients regarding resuscitation decisions. The main aim of this quality improvement project was to assess and improve patients’ and their relatives’ understanding about DNACPR decisions. Intervention We initially surveyed 30 inpatients or their next-of-kin (if the patient lacked capacity) in a geriatric ward who had DNACPR decisions in place. Although, 86% knew the implications of a DNACPR decision, only 50% knew that a DNACPR decision would not limit them from receiving other treatment. 66% reported that the information given by the healthcare professional is “too little”. 35 questionnaires were also given to doctors of all grades to assess their practice of DNACPR discussions and barriers for discussion. Majority (95%) of doctors knew what should be included in a DNACPR discussion. Medical staff not considering DNACPR discussions during assessment, medical staff not comfortable to make the DNACPR decision and the fear of distressing the patient are the three main issues that were highlighted as barriers. 17% of doctors reported that they would have attended a cardiac arrest at least on 2-5 occasions for a patient when resuscitation was futile. We presented this data and educated doctors on effective DNACPR discussions using video demonstrations in weekly journal clubs. All doctors were informed to distribute DNACPR Improvement After the intervention, only 80% understood the DNACPR discussion. 76% knew that DNACPR does not limit them from receiving other treatment. 73% reported that this was not stressful and 76% were satisfied with the discussion and reported that their questions were answered adequately. 11 out of 30 patients had received the information leaflets and all found it useful. Discussion Although after the intervention the percentage who understood the DNACPR decision had reduced compared to the initial audit, there was a 20% improvement in who knew that DNACPR decisions did not limit other treatment. We hope to extend this study by carrying out training sessions for doctors to improve the quality of these conversations and thereby enhance adherence to expected practice in DNACPR decision making.

Poster 117: Pain Assessment Survey (PAS) for Assessing Physical Pain in Post-Cerebrovascular Accident (CVA) Patients Post Intervention: Quality Improvement Project

PM&R ◽  
2017 ◽  
Vol 9 ◽  
pp. S172-S172
Author(s):  
Kirill Alekseyev ◽  
Nikhil Verma ◽  
Swathy Sreekumar ◽  
Amarin Suriyakhamhaengwongse ◽  
Malcolm Lakdawala ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pain Assessment ◽  
Cerebrovascular Accident ◽  
Quality Improvement Project ◽  
Physical Pain ◽  
Post Intervention ◽  
Improvement Project ◽  
Assessment Survey

scholarly journals Education and training as key drivers for improving the quality of fluid balance charts: findings from a quality improvement project

2021 ◽  
Vol 10 (3) ◽  
pp. e001137
Author(s):  
Alpha Madu ◽  
Harshini Asogan ◽  
Ajmal Raoof
Keyword(s):  
Quality Improvement ◽  
Nursing Staff ◽  
Fluid Balance ◽  
Poor Quality ◽  
Quality Improvement Project ◽  
Hydration Status ◽  
Improvement Project ◽  
Cost Efficient ◽  
Competency Assessments

Reviewing fluid balance charts is a simple and effective method of assessing and monitoring the hydration status of patients. Several articles report that these charts are often either inaccurately or incompletely filled thereby limiting their usefulness in clinical practice. We had a similar experience in our practice at Kettering General Hospital and conducted a quality improvement project with a goal to increase the number of charts that were completely and accurately filled by a minimum of 50% in a 1-month period and to reassess the sustainability of this improvement after 6 months. Data from baseline measurements showed that only 25% of the charts in the ward had accurate measurements, 20% had correct daily totals and 14% had complete records of all intakes and losses. We collected feedback from nursing staff in the ward on what challenges they faced in using these charts and how best to support them. Corroborated by evidence from the literature, we discovered that inadequate training was a major factor responsible for the poor quality of documentation in these charts. Using simultaneous plan–do–study–act cycles, we designed and delivered personalised teaching on fluid balance chart documentation to the nursing staff. Subsequent data showed remarkable improvements in all the parameters we assessed. For instance, the proportion of charts with accurate measurements increased by 55% and those with complete entries by 122%. Unfortunately, we were unable to demonstrate sustainability of these improvements as our second set of data collection coincided with the SARS-CoV-2 outbreak. In this project, we were able to demonstrate that simple and cost-efficient measures such as adequate training of nursing staff could remarkably improve the quality of fluid balance charts used in our hospitals. We suggest that this training should be included as part of the regular competency assessments for nurses and other healthcare staff.

scholarly journals A quality improvement project on nicotine replacement therapy in Shannon Clinic (Northern Ireland)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S211-S211
Author(s):  
Eileen Moss
Keyword(s):  
Quality Improvement ◽  
Northern Ireland ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Medical Staff ◽  
Quality Improvement Project ◽  
Clinical Environment ◽  
Nicotine Replacement ◽  
Improvement Project ◽  
Different Types

AimsThe aims of this quality improvement project were to determine if Nicotine Replacement Therapy was being prescribed correctly in Shannon Clinic in Northern Ireland and also to improve the rates of correct prescribing of Nicotine Replacement Therapy in the aforementioned unit.BackgroundThere are several different types of Nicotine Replacement Therapy currently available. Shannon Clinic is a smoke-free clinical environment therefore patients who smoke are offered Nicotine Replacement Therapy on admission. When I was working at Shannon Clinic I became aware that there was no clear guidance available to medical staff on the wards regarding prescribing Nicotine Replacement Therapy and therefore I decided to carry out this quality improvement project.MethodAn audit of drug charts was done on the patients who were under the care of the consultant that I worked with. In total nine drug charts were included in the audit. After the audit was complete, I produced a poster to show how to correctly prescribe Nicotine Replacement Therapy. A copy of this poster was placed on each ward in Shannon Clinic. After a period of time the drug charts were re-audited to see if there had been an improvement in the rates of correct prescribing of Nicotine Replacement Therapy.ResultIn total, 22% of the drug charts which were included in the audit had Nicotine Replacement Therapy prescribed incorrectly on them. After the inclusion of a poster outlining how to prescribe Nicotine correctly on each ward in Shannon Clinic, 0% of drug charts had Nicotine Replacement Therapy prescribed incorrectly on them. This was an improvement of 22%.ConclusionThis quality improvement project was successful at reducing the rates of incorrect Nicotine Replacement Therapy in Shannon Clinic. In the future it is my hope that this quality improvement project should lead to the correct prescribing of Nicotine Replacement Therapy for all patients in Shannon Clinic. It should also lead to an increased awareness regarding the different types of Nicotine Replacement Therapy for medical staff working in this clinical unit.

scholarly journals Using quality improvement to standardise and enhance the use of the national early warning score (NEWS) in an old age psychiatry inpatient setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S38-S39
Author(s):  
Fraser MacNicoll ◽  
Mong Sun Tung ◽  
Brion McGowan
Keyword(s):  
Quality Improvement ◽  
Old Age ◽  
Quality Improvement Project ◽  
Assessment Process ◽  
Early Warning Score ◽  
Post Intervention ◽  
Improvement Project ◽  
Physical Deterioration ◽  
Increased Risk ◽  
Old Age Psychiatry

AimsWithin an inpatient old-age psychiatry setting, there is an increased risk of acute physical deterioration secondary to age, comorbidities and reduced physiological reserve. Numerous recent clinical incidents highlighted late recognition of physical deterioration within this population. We assessed the use of the NEWS, a system for scoring physiological measurements, in an old-age psychiatry ward and subsequently attempted to improve performance of obtaining physical health observations in this cohort of patients.MethodRetrospective pre- and post- quality improvement study in a twenty bed Old Age Psychiatry Ward in East Lothian Community Hospital, Haddington, Scotland. Data were collected from 12th October – 16th November, 2020 (pre- period) and from 16th November 2020 to 15th February, 2021 (post- period). The primary process measure was ensuring all patients had at least one full set of physical observations at least once a week, or more frequent as deemed clinically appropriate. Secondary measures included ensuring NEWS scores were accurately calculated and improved documentation. This was tracked using a run chart. Improvement activities focused on increased awareness, effective training, key stakeholder buy-in and reviewing trust policy.ResultThe percentage of NEWS documented for all patients at least once a week improved from a mean of 28.7% (31/108) in the 6 weeks prior to intervention, to a mean of 71.4% (125/175) in the following 13 weeks. The minimum required physical observations required to accurately calculate a NEWS improved from 51.6% (16/31) pre-intervention to 95.2% (119/125) post-intervention and NEWS being calculated correctly increased from 80.6% (25/31) to 96% (120/125). Documentation of a reason why physical observations were not taken increased from 2.5% (2/77) to 62% (31/50) pre- and post- intervention respectively.ConclusionThis quality improvement project highlighted that recording of physical observations and use of NEWS was inadequate in this setting, increasing the risk of a delay in identification of acute physical deterioration and thus increase morbidity and mortality. Introducing simple measures and standardising the NEWS assessment process, along with senior nursing and medical oversight, greatly enhanced acquiring and recording of physical observations and NEWS scores. This quality improvement project has shown that practical solutions and staff education can increase efficacy and are hoping further input can consolidate the gains achieved and lead to continued improvements.

Improvement in Herpes Zoster Vaccination in Patients with Rheumatoid Arthritis: A Quality Improvement Project

2016 ◽  
Vol 44 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Heena Sheth ◽  
Larry Moreland ◽  
Hilary Peterson ◽  
Rohit Aggarwal
Keyword(s):  
Rheumatoid Arthritis ◽  
Quality Improvement ◽  
Herpes Zoster ◽  
Immunosuppressive Therapy ◽  
Eligible Patient ◽  
Quality Improvement Project ◽  
Post Intervention ◽  
Improvement Project ◽  
Intervention Phase ◽  
Vaccination Rates

Objective.To improve herpes zoster (HZ) vaccination rates in high-risk patients with rheumatoid arthritis (RA) being treated with immunosuppressive therapy.Methods.This quality improvement project was based on the pre- and post-intervention design. The project targeted all patients with RA over the age of 60 years while being treated with immunosuppressive therapy (not with biologics) seen in 13 rheumatology outpatient clinics. The study period was from July 2012 to June 2013 for the pre-intervention and February 2014 to January 2015 for the post-intervention phase. The electronic best practice alert (BPA) for HZ vaccination was developed; it appeared on electronic medical records during registration and medication reconciliation of the eligible patient by the medical assistant. The BPA was designed to electronically identify patient eligibility and to enable the physician to order the vaccine or to document refusal or deferral reason. Education regarding vaccine guidelines, BPA, vaccination process, and feedback were crucial components of the project interventions. The vaccination rates were compared using the chi-square test.Results.We evaluated 1823 and 1554 eligible patients with RA during the pre-intervention and post-intervention phases, respectively. The HZ vaccination rates, reported as patients vaccinated among all eligible patients, improved significantly from the pre-intervention period of 10.1% (184/1823) to 51.7% (804/1554) during the intervention phase (p < 0.0001). The documentation rates (vaccine received, vaccine ordered, patient refusal, and deferral reasons) increased from 28% (510/1823) to 72.9% (1133/1554; p < 0.0001). The HZ infection rates decreased significantly from 2% to 0.3% (p = 0.002).Conclusion.Electronic identification of vaccine eligibility and BPA significantly improved HZ vaccination rates. The process required minimal modification of clinic work flow and did not burden the physician’s time, and has the potential for self-sustainability and generalizability.

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