scholarly journals 56 Quality Improvement Project on the Bowel Charts in An Elderly Care Ward in Basildon University Hospital

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i14-i17
Author(s):  
R A Hakim ◽  
M Ali ◽  
I Wijenyake
Keyword(s):  
Elderly Care ◽  
Oral Intake ◽  
University Hospital ◽  
Improvement Project ◽  
Memory Problems ◽  
Sustained Change ◽  
Initial Survey ◽  
Care Ward ◽  
Measurable Change

Abstract Background To improve the rate of documentation on bowel charts on an elderly care ward with a significant percentage of patients suffering from dementia. Importance As a junior doctor working on an elderly care ward with patients who often had memory problems and were unable to recall their bowel patterns, it was extremely challenging to establish whether a particular patient has constipation or diarrhoea. Constipation in an elderly patient can lead to multiple complications like urinary retention, intestinal obstruction and often decreased oral intake. Methods An audit was carried out to see the rate of completion of the Bowel charts on the ward. Only about 23% of the bowel charts on the ward were complete in the initial survey. Then interventions were introduced in steps and three more audits were done. At each step, we were able to show how the interventions introduced changed the degree of completion of the bowel charts. Outcome We have seen a marked improvement of 37% since the start of the project 5 months ago. From 23% to 60% completion of bowel charts. There appeared to be a sustained change only falling short at the weekends (due to staffing issues) Overall awareness had increased vastly. We were able to make a measurable change and improvement in the quality of care provided.

14 Rational Prescribing in the Frail Elderly Population: A Quality Improvement Project to Reduce Inappropriate Prescribing Using STOPP-Frail Criteria

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
J Brooke ◽  
R Darnell ◽  
M Boltova ◽  
N Hashemi
Keyword(s):  
Quality Improvement ◽  
Elderly Care ◽  
Inappropriate Prescribing ◽  
Drug Effects ◽  
The Elderly ◽  
Quality Improvement Project ◽  
University Hospital ◽  
Lipid Lowering ◽  
Adverse Drug Effects ◽  
Improvement Project

Abstract Introduction 2.5 million people in the UK are aged over 80 and up to 50% can be considered frail. Complex co-morbidities and polypharmacy are linked with adverse drug effects and negative outcomes. NICE recommends a medication review yearly, and a hospital admission provides an opportunity for this. STOPP-Frail is a screening tool designed to highlight medications that could be reduced/stopped with a view to improving quality of life. We conducted a quality improvement project to quantify levels of inappropriate prescribing at Croydon University Hospital (CUH), with a view to de-prescribing and reducing adverse drug effects. Methods A retrospective analysis was carried out on the Elderly Care wards at CUH. Data was collected from 60 consecutive patients discharged from 1st November 2018, utilising electronic Cerner records. Recorded medication on admission and discharge, noting any amendments in accordance with the STOPP-Frail criteria. Results Data collected from 60 patients; one exclusion for not meeting STOPP-Frail criteria (n=59). Median age 86 years (69 to 103 years). Mean number of medications on admission 7.42 (1 to 15). 93.2% patients had polypharmacy (defined as ≥ 4 medications). Mean number of medications on discharge 8.22; an increase of 0.8/patient. 19.4% admission medications met STOPP-Frail criteria for inappropriate prescriptions. Only 18.8% of these were reduced or stopped during admission. Gastrointestinal and cardiovascular medications were most commonly inappropriately prescribed (n=27 and 24 respectively). Most common medications not amended were lipid-lowering therapies (n=21) and proton-pump inhibitors (n= 20). Conclusions The opportunity to rationalise medication in the frailest patients admitted to CUH is missed in over 80% of cases. STOPP-Frail provides clear guidance to aid clinicians in reducing inappropriate prescribing. An educational programme is in place to highlight medication rationalisation and guide clinicians in the use of the STOPP-Frail tool. This includes doctors’ induction, departmental teaching, posters and computer flash cards.

scholarly journals Improving the documentation quality of point-of-care ultrasound scans in the emergency department

2020 ◽  
Vol 9 (1) ◽  
pp. e000636
Author(s):  
Shadman Aziz ◽  
James Bottomley ◽  
Vasant Mohandas ◽  
Arif Ahmad ◽  
Gemma Morelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Royal College ◽  
Point Of Care ◽  
University Hospital ◽  
Point Of Care Ultrasound ◽  
Core Element ◽  
Improvement Project ◽  
Documentation Quality ◽  
Minimum Requirements

A point-of-care ultrasound scan (POCUS) is a core element of the Royal College of Emergency Medicine (RCEM) specialty training curriculum. However, POCUS documentation quality can be poor, especially in the time-pressured environment of the emergency department (ED). A survey of 10 junior ED clinicians at the Princess Royal University Hospital (PRUH) found that total POCUS documentation was as low as 38% in some examinations.This quality improvement project aimed to increase the coverage and quality of POCUS documentation in the ED. This was done by using a plan-do-study-act (PDSA) regime to improve the quality of POCUS documentation from the original baseline to 80%. There were three discreet PDSA cycles and the interventions included improving education and training about POCUS documentation and the introduction of an original proforma, which incorporated six minimum requirements for POCUS documentation as per the joint RCEM and Royal College of Radiologists (RCR) guidelines for POCUS documentation (patient details, indications, findings, conclusions, signature and date).The project team audited the quality of all documented scans in the resuscitation department of the PRUH against the RCEM/RCR guidelines at baseline and following three discrete PDSA cycles. This was done over an 8-week period, spanning 696 attendances to the resuscitation area of the ED and 42 documented POCUS examinations.Quality recording of the six RCEM/RCR elements of POCUS documentation was poor at baseline but improved following three successful PDSA cycles. There was a demonstrated improvement in five of six documentation elements: patient details on POCUS documentation increased from 53.3% to the 66.7%, indication from 60.0% to 66.7%, conclusion from 13.0% to 83.0%, signature from 86.7% to 100.0% and date from 46.7% to 66.7%.These results suggest that the introduction of a proforma and a vigorous education strategy are effective ways to improve the quality of documentation of ED POCUS.

scholarly journals 130 Quality improvement project – improving the quality of care for homeless patients presenting to the homerton university hospital emergency department 2019-20

2020 ◽  
Vol 37 (12) ◽  
pp. 833.1-833
Author(s):  
Phoebe Leung ◽  
Jane Chambers ◽  
Amber Morris ◽  
Kobbina Arthur ◽  
Fenella Prowse ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Social History ◽  
Quality Improvement Project ◽  
University Hospital ◽  
History Taking ◽  
Improvement Project ◽  
Legal Duty

Aims/Objectives/BackgroundHomelessness is on the rise in the UK. The problem identified specific to homeless patient care was clinician understanding of the homeless person’s social needs to form an adequate discharge plan as well as completing their legal duty to refer such patients to the local housing authority.Methods/DesignThis quality improvement project (QIP) aimed to reduce the reattendance rate of homeless patients presenting to the Homerton University Hospital (HUH) Emergency Department (ED) by 20% from November 2019 to April 2020. This would be done by improving social history taking, signposting of patients to appropriate resources, and performing the legal duty to refer. Using the PDSA cycle method, interventions included a week of presentations to inform clinicians of the process measures; an advertising campaign; and a defined flowchart process for the duty to refer.Results/ConclusionsThe QIP yielded the following results in terms of median baselines: social history taking 60% to 88%, signposting to resources 30% to 67%, and duty to refer 0 to 41%. There was no change to the outcome measure of reattendance rate, maintained at 40% throughout the project and hence the QIP did not meet its SMART aim.However this may have been the result of the decision to cut short data collection time due to the unprecedented COVID-19 pandemic which saw overall reduction in ED patient attendance. Most street homeless persons were put up in temporary hotels in the government funded scheme ‘Everybody In’, lockdown meant the hidden homeless should stay indoors, and a ban on court evictions has been extended until 23 August 2020.Nonetheless, work to improve quality of care continued with a new pathway for safe discharge of homeless patients with suspected COVID-19. Planning ahead for post pandemic times has brought about a new standard operating procedure, which will ensure sustainability of the QIP.

Acceptance of a Pharmacy-Based, Physician-Edited Hospital Pharmacy and Therapeutics Committee Newsletter

1992 ◽  
Vol 26 (7-8) ◽  
pp. 886-889 ◽  
Author(s):  
David J. Ritchie ◽  
Robert F. Manchester ◽  
Michael W. Rich ◽  
Mary M. Rockwell ◽  
Paul M. Stein
Keyword(s):  
Drug Class ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Perceived Usefulness ◽  
New Drugs ◽  
University Hospital ◽  
Care Hospital ◽  
Survey Results ◽  
Initial Survey

OBJECTIVE: To assess the level of physician acceptance and perceived usefulness of a pharmacy-prepared, physician-edited pharmacy and therapeutics (P&T) committee newsletter. DESIGN: Two separate surveys conducted after 7 and 24 months of publication, respectively. SETTING: 500-bed, university-affiliated, tertiary-care hospital. MAIN OUTCOME MEASURES: The initial survey was mailed to physicians after 7 months of publication and they were requested to rate various aspects of the newsletter, including timeliness of articles, usefulness of articles, quality of writing and design, and overall value of the publication on a scale of 1–4: (1 = excellent, 2 = good, 3 = fair, 4 = poor). Physicians were also asked to rank different categories of articles (articles on new drugs, drug-class reviews, topical reviews, formulary news, and articles providing P&T committee information) and were encouraged to provide comments. A separate follow-up survey conducted at 24 months asked physicians to indicate whether they (1) regularly received the newsletter, (2) regularly read the newsletter, (3) found the information in the newsletter to be useful, and (4) desired to continue receiving the newsletter. RESULTS: Initial survey results yielded mean newsletter quality scores ranging from 1.54 to 1.66. Respondents preferred, in descending order, articles on new drugs, drug-class reviews, topical reviews, formulary news, and P&T committee information. The 24-month survey revealed that 96 percent of the physicians regularly receiving and reading the newsletter found the information useful and 97 percent felt that the newsletter should continue to be published. Favorable comments were also received from several prominent physicians. CONCLUSIONS: The results indicate strong physician acceptance of a pharmacy-prepared, physician-edited newsletter and provide information about the types of articles preferred by physicians in a university hospital setting.

scholarly journals Improving paper-based discharge process; a continuous full-cycle quality improvement project in low resource setting

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 324
Author(s):  
Ihab B Abdalrahman ◽  
Mohammed Elsanousi Huzaifa Mohammed ◽  
Abdelmohaymin A Abdalla ◽  
Sulaf Ibrahim Abdelaziz ◽  
Aboaagla Abdalbagi Ali ◽  
...  
Keyword(s):  
Discharge Summary ◽  
University Hospital ◽  
Practical Training ◽  
Discharge Process ◽  
Improvement Project ◽  
Resource Setting ◽  
Low Resource Setting ◽  
The Moment

Background: The moment of hospital discharge is a time for vulnerability for many patients and might jeopardize their safety. We found that the current structure of the discharge card at Soba University Hospital (SUH) does not improve the quality of the discharge summary. This hinders the delivery of valid, relevant and adequate health information and can negatively affect outpatient care.   Methods: We implemented a new discharge card design with structured headings at the Department of Medicine at Soba University Hospital from the beginning of March to April 15th, 2017.  This was coupled with educational sessions highlighting the problems that might occur if there were gaps in patient transition from inpatient to outpatient. Results: There was a significant improvement in documentation of the majority (>90%) of the items, including name, age, source of admission treating doctor, diagnosis and medication, but there was a drop in documentation of comorbidities. We also noticed that the new discharge summary format significantly improved the documentation of the majority of the headings (all P values were <0.001), yet, there was a drop in documentation of comorbidities and dates for follow up. Conclusions: Recording of paper-based health records like discharge summaries could be substantially improved by use of well-structured formats and practical training sessions. Improvement is a dynamic process. Some gaps might appear during execution, these need monitoring and continuous improvement to establish sustainability.

The effectiveness of a digital pelvic floor training program in thetreatment of urinary incontinence – a real-world evaluation (Preprint)

2019 ◽  
Author(s):  
Sabine Keim ◽  
Alexandra von Au ◽  
Lina Maria Matthies ◽  
Stephanie Wallwiener ◽  
Sarah Brugger ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Floor ◽  
University Hospital ◽  
First Line ◽  
First Line Therapy ◽  
A Value ◽  
Pelvic Floor Training ◽  
Significant Impairment ◽  
Pelvic Floor Weakness

BACKGROUND Background: Many women experience urinary incontinence (UI) during andafter pregnancy due to pelvic floor weakness. First-line therapy is conservative treatment, which nowadays can be facilitated by using digitalsolutions. OBJECTIVE The aim ofthe present study was to investigate the efficacy and effectiveness of pelvinain patients with existing UI. METHODS Methods: In the present observational study we analyzed the effectivenessof pelvina, a certified digital pelvic floor training course, in reducing UI symptoms by regularly applying “The Questionnaire for Urinary Incontinence Diagnosis” (QUID) and furthermore examining quality of life (QoL) by conducting the SF-6D. RESULTS Results: In this prospective study, 373 patients with a median age of 36 years (IQR 33 - 47 years) were included. At baseline the patients had a median QUID of 11 (IQR 11 - 15). During the course, incontinence improved significantly to a QUID of 5 (IQR 2 – 11; p<0.001). Additionally, the patients had also shown a significant impairment in their QoL at baseline with a value of 19 (IQR 16 - 22) in SF-6D. After completing the course, the QoL had risen to 24 (IQR 20 - 26). CONCLUSIONS Conclusion: Use of the certified digital pelvic floor course pelvinasignificantly reduces existing UI due to pelvic floor weakness over the timespan of the course. At the same time QoL is significantly improved. CLINICALTRIAL The present study was approved by the ethics committee of the Heidelberg University Hospital (S-392/2019)

scholarly journals 49 A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Sadiq ◽  
M Tahir ◽  
I Nur ◽  
S Elerian ◽  
A Malik
Keyword(s):  
Categorical Variables ◽  
Next Of Kin ◽  
Chi Square ◽  
Neck Of Femur ◽  
Improvement Project ◽  
Handover Process ◽  
Neck Of Femur Fracture ◽  
The Impact ◽  
Standard Operating Protocol

Abstract Introduction Poor handover between shifts can result in patient harm. This study was designed to evaluate the impact of implementing a handover protocol on the quality of information exchanged in the trauma handover meetings in a UK hospital. Method A prospective single-centre observational study was performed at an NHS Trust. Ten consecutive weekday trauma meetings, involving 43 patients, were observed to identify poor practices in handover. This data was used in conjunction with the Royal College of Surgeons’ recommendations for effective handover (2007) to create and implement a standard operating protocol (SOP). Following its implementation, a further 8 consecutive meetings, involving a further 47 patients, were observed. The data was analysed using t-test for quantitative variables and chi-square or Fisher’s exact tests for categorical variables. Results An improvement was demonstrated in multiple aspects of trauma handover including past medical history, injury date, results, diagnosis, consent, mark, and starvation status (all p &lt; 0.001). Subgroup analyses showed that handover of neck-of-femur fracture patients including information on baseline mobility (p = 0.04), Nottingham-Hip-Fracture Score (p = 0.01), next-of-kin discussion (p = 0.075) and resuscitation status (p = 0.001) all improved following the intervention. Conclusions These results demonstrate that the implementation of a well-structured handover protocol can improve the transmission of critical information in trauma meetings.

74 Improving Handover Between Doctors and Nurses on An Elderly Care Ward

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
K Suseeharan ◽  
T Vedutla
Keyword(s):  
High Risk ◽  
Patient Care ◽  
Positive Impact ◽  
Elderly Care ◽  
Task Completion ◽  
Risk Area ◽  
High Risk Area ◽  
Staff Members ◽  
Care Ward ◽  
Doctors And Nurses

Abstract Background The Royal College of Physician guidelines (2011) identified handover as a “high risk step” in patient care, especially in recent times within the NHS where shift patterns lead to more disjointed care with a high reliance on effective handover by all staff members. Introduction At Cannock Chase hospital, Fairoak ward is an elderly care rehabilitation ward where there is a large multi-disciplinary team. While working on the ward as doctors we noticed that handover between the MDT was poor. Anecdotal evidence from both doctors and nurses felt that this was a high risk area in need of improvement. Aim to improve handover between doctors and nurses on this elderly care ward. Method To measure the quality of current handover practice we did a questionnaire. A total of 12 questionnaires were completed which showed that 92% of staff felt that handover on the ward was very poor and 50% preferred both written and verbal handover. We measured the number of tasks verbally handed over between doctors and nurses over 3 days. On average 65% of the tasks were completed. We then made the below interventions and re-audited to see if there was any improvement. Interventions over 3 week period: Results Questionnaire: Measuring task completion after interventions; Conclusion This project has made a positive change qualitatively and quantitatively to the ward handover practice. Staff satisfaction regarding handover has improved and the number of “handed over” tasks completed daily has significantly improved. The written handover sheet had poor utilisation by staff but in 4 months we are going to re-audit and trial the handover sheet again to further improve service delivery. We hope this improvement will have a positive impact on patient care on this elderly care ward.

scholarly journals Quality of life, symptoms and dietary habits in oncology outpatients with malnutrition: A cross-sectional study

2021 ◽  
Vol 38 (2) ◽  
Author(s):  
Mira Sonneborn-Papakostopoulos ◽  
Clara Dubois ◽  
Viktoria Mathies ◽  
Mara Heß ◽  
Nicole Erickson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
At Risk ◽  
Side Effects ◽  
Dietary Habits ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment ◽  
University Hospital ◽  
Cross Sectional ◽  
European Organization

AbstractCancer-related malnutrition has a high prevalence, reduces survival and increases side effects. The aim of this study was to assess oncology outpatients and risk of malnutrition. Reported symptoms and quality of life (QoL) in patients found to be at risk of malnutrition or malnourished were compared to patients without malnutrition. Using a standardized questionnaire, the European Organization for Research and Treatment of Cancer Questionnaire for Quality of Life and the Mini Nutritional Assessment (MNA), patients in an outpatient cancer clinic undergoing chemotherapy treatment at a German University Hospital were assessed for nutrition, risk of malnutrition and quality of life. Based on the MNA, 39 (45.9%) patients were categorized as malnourished or at risk for malnutrition. Loss of appetite (n = 37.6%, p < 0.001) and altered taste sensation (n = 30,3%, p < 0.001) were the symptoms most frequently associated with reduced food intake. Patients with risk of malnutrition scored lower on the global health status (n = 48.15%, p = 0.001). Side effects of cancer treatments lead to a higher risk of malnutrition and as a consequence lower QoL. These side effects should be addressed more efficiently in cancer care.

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