859 Improving Accuracy of Admission Notes Over A Four-Year Period Within an Orthopaedic Trauma Ward: A Four-Cycle Audit

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C McCann ◽  
S Mackenzie ◽  
T White
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Royal College ◽  
Further Education ◽  
Patient Records ◽  
Orthopaedic Trauma ◽  
Contact Number ◽  
Audit Cycle ◽  
Improving Accuracy

Abstract Background Accurate medical notes are essential for effective patient care and safety. The Royal College of Surgeons (RCS) set forth guidelines for standards of documentation. Lack of awareness of these standards can result in inaccurate documentation, compromising patient safety. Method Four prospective audits of admission documents for orthopaedic inpatients were completed, each 1 year apart. For each cycle, 50 admission documents were assessed to determine compliance with the RCS standards. Interventions were carried out between each audit cycle in the following order: educational posters, change from handwritten to online admission forms and optimisation of the online proforma. Results Initially, only two criteria showed above 95% compliance. Implementing educational posters produced significant improvement in one criterion: ‘note signed’ (60% to 96%, p < 0.05). Moving admission documents online improved ‘date stamp’ (66% to 100%, P < 0.05) and ‘contact number’ (0% to 34%, p < 0.05), but decreased documentation of ‘time recorded’ (18% to 0%, p < 0.05) and ‘name and grade’ (74% to 26%, p < 0.05). Further education and modification to the admissions proforma improved documentation of all criteria to over 95%. Conclusions Early cycles of this audit highlighted poor standards of documentation in admission records. Changing to online patient records significantly changed documentation standards. These were further improved with educational measures.

scholarly journals 367 Improving Handover Documentation in Surgical Inpatients Using Weekend Handover Stickers

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C Boyle ◽  
S Chien ◽  
A McCallum
Keyword(s):  
Patient Safety ◽  
Antibiotic Therapy ◽  
Royal College ◽  
Clinical Information ◽  
Relevant Information ◽  
Clinical Situation ◽  
Clinical Governance ◽  
Surgical Patients ◽  
Blood Tests ◽  
Audit Cycle

Abstract Introduction Transfer to the care to the oncoming team is the point at which inpatients are most vulnerable. Effective handover is vital to protect patient safety and clinical governance. The Royal College of Surgery (RCS) Safe Handover guidelines highlight relevant information required for comprehensive handover. This QI project aimed to determine if implementation of weekend handover stickers in surgical patients’ notes improved handover documentation. Method A retrospective records-based audit of patients admitted under general surgery over a 4-week period was performed. Standards were set using the RCS guidelines to determine if sufficient weekend handover was documented. We designed weekend handover stickers to be inserted in notes based on guidelines. A re-audit cycle over a 4-week period was performed to determine if the intervention improved handover documentation. Results 119 patients were in the initial audit. 125 patients were in the re-audit. Documented handover in the notes improved from 43.7% to 89.6% after intervention. Documentation of the following clinical information also improved: clinical situation (43.7% to 92.0%); co-morbidities (14.3% to 89.6%); current issues (71.4% to 94.4%); weekend blood tests (32.8% to 92.0%); antibiotic therapy (21.8% to 92.0%). Conclusions Weekend handover stickers resulted in a significant improvement in handover documentation improving patient safety.

scholarly journals 1248 “Passing the Surgical Torch”- A Review of Appropriate Surgical Handover Protocol on The Acute Surgical Take

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Shaladi ◽  
K Marshall ◽  
R Fernandes
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Royal College ◽  
Patient Management ◽  
Management Plan ◽  
Clinical State ◽  
Time Data ◽  
Imaging Results ◽  
Resuscitation Status

Abstract Aim Effective handover between shifts is vital to protect patient safety. The Royal College of Surgeons has detailed the necessary information needed for each patient at handover. We aimed to assess compliance with this handover protocol. Method Weekday surgical handover was reviewed over an 8-week period of time. Data was collected on documentation of diagnosis, up to investigations/bloods, clinical state of patient, management plan and resuscitation status/ceiling of care and COVID status. Results 210 patients were reviewed. Of these, a clear diagnosis was documented for 152 patients. Up to date imaging results if applicable was documented in 111 of 153 patients. Up to date bloods were included in 140 of 210 patients. COVID status was only noted in 31 of 210 patients and DNAR status in only 24. After re-audit of 197 a clear diagnosis was seen in 183 patients, COVID status was documented in 170 patients and DNAR status in 169. Conclusions Surgical handover is hugely crucial for provision of patient care. Following clear guidance from the royal college of surgeons, better compliance with handover was noted, including a critical improvement in COVID and DNAR status.

Clinical Cybersecurity Training Through Novel High Fidelity Simulations (Preprint)

2018 ◽  
Author(s):  
Christian Dameff ◽  
Jordan Selzer ◽  
Jonathan Fisher ◽  
James Killeen ◽  
Jeffrey Tully
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Medical Devices ◽  
Healthcare Systems ◽  
High Fidelity ◽  
Protected Health Information ◽  
Patient Harm ◽  
Security Vulnerabilities ◽  
Clinical Simulations ◽  
Medical Infrastructure

BACKGROUND Cybersecurity risks in healthcare systems have traditionally been measured in data breaches of protected health information but compromised medical devices and critical medical infrastructure raises questions about the risks of disrupted patient care. The increasing prevalence of these connected medical devices and systems implies that these risks are growing. OBJECTIVE This paper details the development and execution of three novel high fidelity clinical simulations designed to teach clinicians to recognize, treat, and prevent patient harm from vulnerable medical devices. METHODS Clinical simulations were developed which incorporated patient care scenarios with hacked medical devices based on previously researched security vulnerabilities. RESULTS Clinician participants universally failed to recognize the etiology of their patient’s pathology as being the result of a compromised device. CONCLUSIONS Simulation can be a useful tool in educating clinicians in this new, critically important patient safety space.

TEACHING THE TEACHERS—WHAT EDUCATION AND TRAINING NEEDS ARISE AMONG TEACHERS THROUGH THE USE OF SIMULATION IN THE EDUCATION OF EMS PERSONNEL IN THE GERMAN HEALTH CARE SYSTEM

2015 ◽  
Vol 1 (1) ◽  
pp. 41.3-41
Author(s):  
Michael Wessels ◽  
Manuel Geuen
Keyword(s):  
Patient Safety ◽  
Emergency Services ◽  
Teaching Method ◽  
Medical Personnel ◽  
Further Education ◽  
Teaching Staff ◽  
Transfer Of Knowledge ◽  
Performance Skills ◽  
Intensive Training ◽  
Emergency Services Personnel

Background & PurposeThe professional qualifications of paramedics in the emergency services are not uniform at the federal level across Germany. Federalism leads to a considerable heterogeneity of regional regulations and curricula for training at the state-approved emergency services School. This results in an uneven transfer of knowledge of action skills, scientific findings as well as inconsistent application of appropriate teaching methods. Finally, this culminates in an inconsistent qualification of EMS personnel.To illustrate the needs of teachers in simulation in training and continuing education of EMS personnel.MethodsBased on a systematic literature review and expert interviews on training and further education of non-medical personnel in emergency care simulation was analysed as a teaching method from an educational perspective. For a standardized carrying out of the interviews a unified interview guide was used. The statements of the experts were analysed with the software MAXQDA.ResultsThrough simulation, in conjunction with debriefings an outstanding benefit for the direct learning from mistakes is made possible, both in the whole group as well as in the setting of reality (train where you work). This supports a long-needed culture of errors in emergency service as well as improving patient safety in emergency response. This requires intensive training of the teaching staff in pedagogy and technology. Further research needs were identified for potential fields of application of simulation in the training of EMS personnel.ConclusionsSimulation provides for the training of emergency services personnel, particularly in view of the new profession of emergency paramedics (Notfallsanitäter) and their advanced performance skills extensive opportunities. With the help of simulation abilities and skills as well as inter-professional teamwork can be taught and improved individualized. In fact, simulation contributes to improving patient safety and guideline- based care of emergency patients.

scholarly journals 179 Evaluating a Clinical Pharmacist Service in a Residential Care Unit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Claire Kavanagh ◽  
Eimear O'Dwyer ◽  
Róisín Purcell ◽  
Niamh McMahon ◽  
Morgan Crowe ◽  
...  
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Patient Outcomes ◽  
Residential Care ◽  
Clinical Pharmacist ◽  
Comparative Evaluation ◽  
Positive Impact ◽  
Standard Of Care ◽  
Pharmacist Interventions ◽  
Medication Reviews

Abstract Background This study assessed the pharmacist role in an 80 bed residential care unit by: Quantifying the number and type of pharmacist interventions made and their acceptance rate.Assessing impact of pharmacist interventions on patient care.Assessing staff attitudes towards the clinical pharmacist service. Methods This was a non-blinded, non-comparative evaluation of the existing clinical pharmacist service in the unit. All residents were included. All pharmacist interventions over a 10-week period were recorded, then graded according to the Eadon scale1 by a consultant gerontologist and an experienced pharmacist to assess their impact on patient care. Results There were 615 pharmacist interventions. The most common interventions were: Drug Therapy Review, 34% (n=209) Technical Prescription, 26.5% (n=163) Administration, 15.3% (n=94) Drug Interaction, 10.4% (n=64) Medication Reconciliation, 8.5% (n=52) 98% (n=596) of interventions were rated as having significance to patient care, of which: 48.4% (n=298) and 41.8% (n=257) of the interventions rated as ‘significant and resulting in an improvement in the standard of care’1% (n=6) and 0.5% (n=3) rated as ‘very significant and preventing harm’. There was a statistically significant agreement between the evaluators, κw = 0.231 (95% CI, 0.156 to 0.307), p < .0005. The strength of agreement was fair. Of interventions requiring acceptance by medical team (n=335), 89.9% (n=301) were accepted. 95% (n=36) of staff who responded agreed or strongly agreed that improved patient safety resulted from the pharmacist’s involvement in multidisciplinary medication reviews. Over 92% (n=35) agreed or strongly agreed that their experience of the pharmacist was positive. Conclusion The pharmacist has an important role in our residential care unit. Their involvement in the medicines optimisation process positively impacts patient outcomes and prevents harm. Staff perceived a positive impact of the clinical pharmacist service provided on patient care and patient safety.

scholarly journals Physical activity counselling in Ireland: a survey of doctors’ knowledge, attitudes and self-reported practice

2019 ◽  
Vol 5 (1) ◽  
pp. e000572 ◽  
Author(s):  
Sarah O'Brien ◽  
Lucia Prihodova ◽  
Mairéad Heffron ◽  
Peter Wright
Keyword(s):  
Physical Activity ◽  
General Practitioners ◽  
Royal College ◽  
Patient Preference ◽  
Online Survey ◽  
Response Rate ◽  
Further Education ◽  
Pharmaceutical Intervention ◽  
And Training ◽  
Do So

ObjectivePhysical activity (PA) counselling has been shown to raise awareness of the importance of PA and to increase the rate of PA engagement among patients. While much attention has been paid to examining the knowledge, attitudes and practice of general practitioners in relation to PA counselling, there is less literature examining such issues in hospital-based doctors in Ireland and further afield. This study aimed to explore doctors’ PA counselling practices and to analyse how this related to their level of PA knowledge, training and attitudes.MethodsAn invitation to participate in an online survey was sent to 4692 members of the Royal College of Physicians of Ireland who were listed as having an address in Ireland. Descriptive and explorative analyses of the data were performed using IBM SPSS V.22.0.ResultsA total of 595 valid responses were included (response rate 12.7%; 42.7% male, 42.6±12.1 years). The majority reported enquiring about PA levels (88.0%) and providing PA counselling (86.4%) in at least some of their patients. Doctors who saw it as their role and those who felt more effective/confident in providing PA counselling were significantly more likely to do so. A perceived lack of patient interest in PA and patient preference for pharmaceutical intervention were significant barriers to undertaking PA counselling.ConclusionThis study demonstrates the need for further education and training in PA counselling in Ireland with a particular focus on improving the attitudes and self-efficacy of doctors in this area at both undergraduate and postgraduate levels.

Quality improvement in hospitals: barriers and facilitators

2017 ◽  
Vol 30 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Dick E. Zoutman ◽  
B. Douglas Ford
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Patient Care ◽  
Acute Care ◽  
Medical Staff ◽  
Acute Care Hospitals ◽  
Content Type ◽  
Active Involvement ◽  
Staff Engagement ◽  
Positive Impacts

Purpose The purpose of this paper is to examine quality improvement (QI) initiatives in acute care hospitals, the factors associated with success, and the impacts on patient care and safety. Design/methodology/approach An extensive online survey was completed by senior managers responsible for QI. The survey assessed QI project types, QI methods, staff engagement, and barriers and factors in the success of QI initiatives. Findings The response rate was 37 percent, 46 surveys were completed from 125 acute care hospitals. QI initiatives had positive impacts on patient safety and care. Staff in all hospitals reported conducting past or present hand-hygiene QI projects and C. difficile and surgical site infection were the next most frequent foci. Hospital staff not having time and problems with staff prioritizing QI with other duties were identified as important QI barriers. All respondents reported hospital leadership support, data utilization and internal champions as important QI facilitators. Multiple regression models identified nurses’ active involvement and medical staff engagement in QI with improved patient care and physicians’ active involvement and medical staff engagement with greater patient safety. Practical implications There is the need to study how best to support and encourage physicians and nurses to become more engaged in QI. Originality/value QI initiatives were shown to have positive impacts on patient safety and patient care and barriers and facilitating factors were identified. The results indicated patient care and safety would benefit from increased physician and nurse engagement in QI initiatives.

The process of sourcing and preparing electronic health records data to implement a machine-learning algorithm for early identification of maternal cardiovascular risk (Preprint)

2021 ◽  
Author(s):  
Nawar Shara ◽  
Kelley M. Anderson ◽  
Noor Falah ◽  
Maryam F. Ahmad ◽  
Darya Tavazoei ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cardiovascular Risk ◽  
Electronic Health Records ◽  
Patient Care ◽  
Early Identification ◽  
Health Data ◽  
Patient Specific ◽  
Patient Records ◽  
Health Records ◽  
Electronic Health

BACKGROUND Healthcare data are fragmenting as patients seek care from diverse sources. Consequently, patient care is negatively impacted by disparate health records. Machine learning (ML) offers a disruptive force in its ability to inform and improve patient care and outcomes [6]. However, the differences that exist in each individual’s health records, combined with the lack of health-data standards, in addition to systemic issues that render the data unreliable and that fail to create a single view of each patient, create challenges for ML. While these problems exist throughout healthcare, they are especially prevalent within maternal health, and exacerbate the maternal morbidity and mortality (MMM) crisis in the United States. OBJECTIVE Maternal patient records were extracted from the electronic health records (EHRs) of a large tertiary healthcare system and made into patient-specific, complete datasets through a systematic method so that a machine-learning-based (ML-based) risk-assessment algorithm could effectively identify maternal cardiovascular risk prior to evidence of diagnosis or intervention within the patient’s record. METHODS We outline the effort that was required to define the specifications of the computational systems, the dataset, and access to relevant systems, while ensuring data security, privacy laws, and policies were met. Data acquisition included the concatenation, anonymization, and normalization of health data across multiple EHRs in preparation for its use by a proprietary risk-stratification algorithm designed to establish patient-specific baselines to identify and establish cardiovascular risk based on deviations from the patient’s baselines to inform early interventions. RESULTS Patient records can be made actionable for the goal of effectively employing machine learning (ML), specifically to identify cardiovascular risk in pregnant patients. CONCLUSIONS Upon acquiring data, including the concatenation, anonymization, and normalization of said data across multiple EHRs, the use of a machine-learning-based (ML-based) tool can provide early identification of cardiovascular risk in pregnant patients. CLINICALTRIAL N/A

scholarly journals Adjustment of oxygen use by means of pulse oximetry: an important tool for patient safety

2010 ◽  
Vol 8 (4) ◽  
pp. 449-455 ◽  
Author(s):  
Telma de Almeida Busch Mendes ◽  
Paola Bruno de Araújo Andreoli ◽  
Leny Vieira Cavalheiro ◽  
Claudia Talerman ◽  
Claudia Laselva
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
Physical Therapy ◽  
Confidence Interval ◽  
Pulse Oximetry ◽  
Patient Care ◽  
Physical Therapists ◽  
Severe Damage ◽  
Margin Of Error

ABSTRACT Objective: To assess patient's level of oxygenation by means of pulse oximetry, avoiding hypoxia (that causes rapid and severe damage), hyperoxia, and waste. Methods: Calculations were made with a 7% margin of error and a 95% confidence interval. Physical therapists were instructed to check pulse oximetry of all patients with prescriptions for physical therapy, observing the scheduled number of procedures. Results: A total of 129 patients were evaluated. Hyperoxia predominated in the sectors in which the patient was constantly monitored and hypoxia in the sectors in which monitoring was not continuous. Conclusions: Professionals involved in patient care must be made aware of the importance of adjusting oxygen use and the risk that non-adjustment represents in terms of quality of care and patient safety.

scholarly journals IS PATIENT SAFETY AT THE HEART OF MEDICAL EDUCATION IN INDONESIA? REFLECTION ON THE IMPACT OF THE NATIONAL EXAMINATION

2019 ◽  
Vol 8 (3) ◽  
pp. 153
Author(s):  
Rachmadya Nur Hidayah
Keyword(s):  
Medical Education ◽  
Quality Assurance ◽  
Patient Safety ◽  
Focus Groups ◽  
Patient Care ◽  
Medical Schools ◽  
Theory Approach ◽  
High Stakes ◽  
Teachers And Students ◽  
The Impact

ABSTRACT Background: National examinations in Indonesia (UKMPPD) has been implemented since 2007 as a quality assurance method for medical graduates and medical schools. The impact of UKMPPD has been studied since then, where one of the consequences were related to how it affected medical education and curricula. This study explored the consequences of UKMPPD, focusing on how the students, teachers, and medical schools’ leaders relate the examination with patient care. This study aimed to explore the impact of UKMPPD on medical education, which focusing on the issue of patient safety. Methods: This study was part of a doctoral project, using a qualitative method with a modified grounded theory approach. The perspectives of multiple stakeholders on the impact of the UKMPPD were explored using interview and focus groups. Interviews were conducted with medical schools’ representatives (vice deans/ programme directors), while focus groups were conducted with teachers and students. A sampling framework was used by considering the characteristics of Indonesian medical schools based on region, accreditation status, and ownership (public/ private). Data was analysed using open coding and thematic framework as part of the iterative process. Results: The UKMPPD affected how the stakeholders viewed this high-stakes examination and the education delivered in their medical schools. One of the consequences revealed how stakeholders viewed the UKMPPD and its impact on patient care. Participants viewed the UKMPPD as a method of preparation for graduates’ real clinical practice. The lack of reference for patient safety as the impact of the UKMPPD in this study showed that there were missing links in how stakeholders perceived the examination as part of quality assurance in health care. Conclusion: The UKMPPD as a high-stakes examination has a powerful impact in changing educational policy and programmes in Indonesia. However, in Indonesia, the examination brought in the reflection on how the “patient” element was lacking from medical education. This research offers an insight on the concept of patient safety in Indonesia and how the stakeholders could approach the issue. Keywords: UKMPPD, national licensing examination, impact, competence, patient safety, curriculum 

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