271 Introducing a ‘Do Not Attempt CPR’ and ‘Treatment Escalation Plan’ Form to Improve Patient Care and Decision Making

Abstract Background The HSE National Consent Policy recommends health care professionals ‘develop specific mechanisms for the documentation and dissemination of decisions relating to resuscitation’. We also felt a need to promote a move away from a unidimensional CPR focus more towards documentation of appropriate and inappropriate care for the individual patient. Methods In December 2018 we conducted a baseline study of the quality of documentation of patient resuscitation and escalation plans in our hospital. We reviewed the charts of patients on 4 wards on a single day. Results Of 80 patients, 19 had some documentation regarding a CPR discussion. Of those 19 one had been determined at time of an arrest call and one at the time of a deterioration. Only 13 of 19 had some documentation of a discussion surrounding the decision. Only 5 had any documentation of the reasoning behind the decision. Conclusion Other hospitals in our hospital group had implemented a `Do Not Attempt CPR' and Treatment Escalation Plan form in the last year. With their permission we used their form as a template to develop a form for use across our hospital .This form is to be readily accessible in an emergency and out of hours, and contains quality information regarding the goals of care for an individual patient. The form is a single page, easily identifiable with a red border and filed inside the front cover of the chart. We have had the form approved by our Lead Clinicians forum and Hospital’s Resus Committee. To promote the successful introduction of the form we have conducted education sessions across the departments of Medicine, Surgery, Anaesthesia and Obstetrics and Gynaecology. The form has is currently being printed and will be implemented in the coming weeks. We will be closely liaising with users and reviewing its use following implementation.

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Analytical Methods for the Determination of Sartans in Pharmaceutical Formulations and Biological Fluids: A Review

Current Analytical Chemistry ◽

10.2174/1573411014666181114091850 ◽

2020 ◽

Vol 16 (3) ◽

pp. 208-222

Author(s):

Miglena Smerikarova ◽

Stanislav Bozhanov ◽

Vania Maslarska

Keyword(s):

Biological Fluids ◽

Pharmaceutical Preparations ◽

Improve Patient Care ◽

Pharmaceutical Formulations ◽

Treatment Of Hypertension ◽

Therapeutic Doses ◽

Reliable Methods ◽

Improve Patient

Background: Sartans are mostly used as a part of combination with additional medicines in the therapy of essencial hypertension. Preferred combinations are ARB and thiazide diuretics (Hydrochlorothiazide (HCT) and Chlorthalidone (CHL)) or ARB and calcium antagonists. The number of sartans mostly prescribed by specialists is only seven - Candesartan (CDS), Eprosartan (EPS), Irbesartan (IBS), Losartan (LOS), Olmesartan (OMS), Telmisartan (TMS) and Valsartan (VLS). Methods: The widespread use of sartans in the treatment of hypertension requires reliable methods of analysis. Bulk drugs and pharmaceutical preparations should be analyzed to ensure the quality of the medicinal products reaching patients. On the other hand, the analysis of drugs in biological fluids aims to trace and improve patient care by adjusting the therapeutic doses of drugs. According to our knowledge, a review devoted to the analysis of sartans was published in 2014. Results: Spectral methods are widely used in the analysis of bulk drugs and pharmaceutical dosage forms due to their relatively simple procedures, low reagent and sample consumption, speed, precision and accuracy combined with accessibility and comparatively low cost of common apparatus. Many papers for determination of sartans in bulk drugs and pharmaceutical preparations based on liquid chromatographic techniques were published in the available literature. Among these methods, HPLC takes the leading place but UPLC and HPTLC are also present. Conclusion: The widespread use of sartans in the treatment of hypertension requires reliable methods of analysis. Bulk drugs and pharmaceutical preparations should be analyzed to ensure the quality of the medicinal products reaching patients. On the other hand, the analysis of drugs in biological fluids aims to trace and improve patient care by adjusting the therapeutic doses of drugs. Since 2014, many articles have been published on the sartans analysis and this provoked our interest to summarize the latest applications in the analysis of sartans in pharmaceutical formulations and biological media. Articles published from 2014 to 2018 are covered.

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Insulin Bolus Calculator in a Pediatric Hospital

Applied Clinical Informatics ◽

10.4338/aci-2016-11-ra-0187 ◽

2017 ◽

Vol 08 (02) ◽

pp. 529-540 ◽

Cited By ~ 3

Author(s):

Mohammad Ateya ◽

Ranjit Aiyagari ◽

Colleen Moran ◽

Kanakadurga Singer

Keyword(s):

User Satisfaction ◽

Bolus Dose ◽

Improve Patient Care ◽

Severe Hypoglycemia ◽

Pediatric Hospital ◽

User Perceptions ◽

Hospital Safety ◽

Survey Responses ◽

Improve Patient

Summary Background: Insulin dosing in hospitalized pediatric patients is challenging and requires dosing to be matched with the specific clinical and nutritional circumstances. We implemented a customized subcutaneous insulin bolus dose calculator tool integrated with the electronic health record to improve patient care. Here we describe this tool, its utilization and safety, and assess user satisfaction and perceptions of the tool. Methods: Blood glucose results for all patients who received insulin with and without the calculator tool were compared to assess safety. To assess user perceptions and satisfaction, a survey was sent to all identified users who interacted with the tool during the period from May 2015 to the end of November 2015. Survey responses were summarized, mean user satisfaction calculated, and correlation of Likert scale items with overall satisfaction assessed. Results: Hypoglycemia rates (2.2% and 2.9%, p = 0.17) and severe hypoglycemia rates (0.04% and 0.1%, p = 0.21) were similar for the groups that received insulin with and without the calculator tool. Overall satisfaction for all survey respondents was high (4.05, SD = 0.83). Physicians indicated a slightly higher satisfaction than nurses (4.33 versus 3.94, p = 0.04). User agreement with improvement of quality of care showed the highest correlation with overall satisfaction (r = 0.80, 95% CI 0.7 –0.87). Conclusion: Implementation of an insulin calculator tool streamlined ordering and administration of insulin in a pediatric academic institution while maintaining patient safety. Users indicated high overall satisfaction with the tool. Citation: Ateya MB, Aiyagari R, Moran C, Singer K. .:Insulin bolus calculator in a pediatric hospital: Safety and user perceptions. Appl Clin Inform 2017; 8: 529–540 https://doi.org/10.4338/ACI-2016-11-RA-0187

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Links Between Perceptions and Practices in Patient Education: A Systematic Review

Health Education & Behavior ◽

10.1177/1090198119868273 ◽

2019 ◽

Vol 46 (6) ◽

pp. 1001-1011 ◽

Cited By ~ 1

Author(s):

Sandrine Roussel ◽

Mariane Frenay

Keyword(s):

Systematic Review ◽

Health Care ◽

Patient Education ◽

Health Care Professionals ◽

Quality Criteria ◽

World Health ◽

Health Organization ◽

The Individual ◽

Meta Analyses

Background. Two decades after “patient education” was defined by the World Health Organization, its integration in health care practices remains a challenge. Perceptions might shed light on these implementation difficulties. This systematic review aims to investigate links between perceptions and patient education practices among health care professionals, paying particular attention to the quality of practices in order to highlight any associated perception. Method. PubMed, PsycINFO, and Scopus were searched using the following search terms: “perceptions,” “patient education,” “health care professionals,” and “professional practices.” PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used. Results. Twenty studies were included. Overall findings supported the existence of links between some perceptions and practices. Links were either correlational or “causal” (generally in a single direction: perceptions affecting practices). Four types of perceptions (perceptions of the task including patient education, perceptions about the patient, perceptions of oneself as a health care professional, and perceptions of the context) were identified as being linked with educational practices. Links can although be mediated by other factors. Results concerning links should, however, be considered with caution as practices were mostly assessed by prevalence measurements, were self-reported and concerned exclusively individual education. When analyzing the quality of practices, the two retained studies highlighted their changing nature and the central role of perceptions with respect to the individual patient. Conclusions. This literature review led us to specify the quality criteria for further research: covering the entire spectrum of patient education, operationalizing variables, exploring specific practices, measuring the quality of practices, developing designs that facilitate causation findings, and considering a bidirectional perspective.

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Combined Regenerative Approach for a Complex Lower Extremity Wound: A Case Report

WOUNDS A Compendium of Clinical Research and Practice ◽

10.25270/wnds/2021.e3438 ◽

2021 ◽

Vol 33 (5) ◽

pp. E34-E38

Author(s):

Pedro Piccinini ◽

Mariana de Sousa Rebelato ◽

Marwan Masri ◽

Carlos Uebel ◽

Rubem Stümpfle ◽

...

Keyword(s):

Negative Pressure Wound Therapy ◽

Improve Patient Care ◽

Acellular Dermal Matrix ◽

Dermal Matrix ◽

Plantar Ulcer ◽

Regenerative Approach ◽

Lower Extremity Wound ◽

Acellular Dermal ◽

Improve Patient

More than 400 million patients worldwide are affected by diabetes; over their lifetime, at least 25% will develop foot ulcers that often result in high rates of nonhealing wounds and amputation. The authors present the case of a 43-year-old female patient with multiple comorbidities who presented with a large (8 cm x 4 cm), noninfected, hindfoot plantar ulcer that extended down to the bone and calcaneus. Over 2 weeks, the patient was successfully treated using a combination of an acellular dermal matrix, nanofat grafting, and negative pressure wound therapy, lessening the effects of the ulcer on the patient’s quality of life and achieving limb salvage. Utilizing the regenerative procedures described herein may improve patient care and decrease costs.

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Know the score: management of patients with a new diagnosis of acute pulmonary embolism

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0345 ◽

2020 ◽

Vol 81 (11) ◽

pp. 1-4

Author(s):

D'Marieanne Koomson ◽

Neil Smith ◽

Simon McPherson ◽

Vivek Srivastava

Keyword(s):

Patient Outcome ◽

Pulmonary Embolism ◽

Quality Of Care ◽

Patient Care ◽

Acute Pulmonary Embolism ◽

Improve Patient Care ◽

Confidential Enquiry ◽

New Diagnosis ◽

Improve Patient

The National Confidential Enquiry into Patient Outcome and Death review into the quality of care provided to UK patients with a new diagnosis of acute pulmonary embolism highlights both clinical and organisational changes that should be made to improve patient care and outcomes.

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Obstetrics and Gynaecology as a Career Choice among Medical Students in North Central Nigeria

Journal of BioMedical Research and Clinical Practice ◽

10.46912/jbrcp.66 ◽

2018 ◽

Vol 1 (3) ◽

pp. 207-210

Author(s):

M T Maanongun ◽

A A Ornguze ◽

S K Hembah-Hilekaan ◽

A O Ojabo

Keyword(s):

Medical Students ◽

Health Care Professionals ◽

Career Choices ◽

State University ◽

Undergraduate Medical Students ◽

Career Interest ◽

North Central ◽

Obstetrics And Gynaecology ◽

Self Administered Questionnaire

The availability of various health care professionals including obstetricians and gynaecologist is dependent on career interest of present undergraduate medical students. We sought to identify obstetrics and gynaecology and other career choices among medical students in Makurdi, Nigeria and what affect these choices. Clinical students in the College of Medicine, Benue State University, Makurdi Nigeria completed a pre-validated, self-administered questionnaire on nature and reasons of career choices, the assessment and suggestions on ways of improving the training of students in obstetrics and gynaecology. A total of 185 clinical students were eligible and 182(98.4%) participated in the study. The average age of the students was 27.0 ±3.2 years with a range of 21-40 years. There were 143(78.6%) males and 39(21.4 females). Overall, the most preferred specialty amongst the students was surgery 51(28.0%), followed by internal medicine 29(15.9%) with obstetrics and gynaecology and paediatrics having 20(11.0%) each. The commonest factors influencing their choices were natural interest and personal convenience. Others included possibility of getting a job, financial gains and personal aptitude. One hundred and fifty eight (86.8%) reported that obstetrics and gynaecology was important and interesting, others felt that it was important but either uninteresting or boring. Most students suggested that there should be improvement in the quality of teaching 71 (39%), more bedside teaching 55(30.2%) and practical sessions 48(26.4%). Conclusion: Obstetrics and gynaecology was the 3rd most popular career among students. The commonest factors for choosing obstetrics and gynaecology included natural interest and personal convenience. Though most students considered obstetrics and gynaecology as interesting, a good number felt the teaching and practical sessions need improvement.

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Improving the quality of healthcare data through information design

Information Design Journal ◽

10.1075/idj.23.1.11noe ◽

2017 ◽

Vol 23 (1) ◽

pp. 104-122 ◽

Cited By ~ 1

Author(s):

Guillermina Noël ◽

Janet Joy ◽

Carmen Dyck

Keyword(s):

Patient Care ◽

Healthcare Providers ◽

Improve Patient Care ◽

Quality Of Healthcare ◽

Healthcare Data ◽

Advantages And Disadvantages ◽

Quality Of Patient Care ◽

Improve Patient ◽

Insight Into

Improving the quality of patient care, generally referred to as Quality Improvement (QI), is a constant mission of healthcare. Although QI initiatives take many forms, these typically involve collecting data to measure whether changes to procedures have been made as planned, and whether those changes have achieved the expected outcomes. In principle, such data are used to measure the success of a QI initiative and make further changes if needed. In practice, however, many QI data reports provide only limited insight into changes that could improve patient care. Redesigning standard approaches to QI data can help close the gap between current norms and the potential of QI data to improve patient care. This paper describes our study of QI data needs among healthcare providers and managers at Vancouver Coastal Health, a regional health system in Canada. We present an overview of challenges faced by healthcare providers around QI data collection and visualization, and illustrate the advantages and disadvantages of different visualizations. At present, user– centred and evidence–based design is practically unknown in healthcare QI, and thus offers an important new contribution.

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It's a Non-Dialysis Day… Do You Know How Your Patient Is Doing? A Case for Research into Interdialytic Activity

Blood Purification ◽

10.1159/000369430 ◽

2015 ◽

Vol 39 (1-3) ◽

pp. 74-83 ◽

Cited By ~ 6

Author(s):

Melissa Mendoza ◽

Maggie Han ◽

Anna Meyring-Wösten ◽

Kenneth Wilund ◽

Peter Kotanko

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Standard Method ◽

Healthcare Workers ◽

Improve Patient Care ◽

Know How ◽

Tracking Devices ◽

The Relationship ◽

Improve Patient

Hemodialysis (HD) patients are less active than their healthy counterparts; this is associated with higher mortality. Healthcare workers observe their patients only during HD, which accounts for about 7% of the week. Knowing more about what occurs in between sessions, particularly with respect to physical activity, may improve patient care and prognosis. Yet without a standard method to measure interdialytic activity, it is difficult to compare the effect of interventions. However, it is unclear how interdialytic activity can be accurately measured. Since activity associated with quality of life is multi-dimensional, objective and subjective tools should be used in conjunction. While commercially available tracking devices can be seamlessly incorporated into everyday life and can increase awareness of user's activity, their validation is needed in the HD population. Fertile topics for research should include the relationship between objective and subjective measures in HD patients, and the investigation of physical activity in non-ambulatory HD patients.

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