scholarly journals 1126 Improving Hand Trauma Clerking Using an Electronic Proforma: A Full Cycle Clinical Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Luck ◽  
K Spiteri ◽  
A Lim ◽  
J Moledina ◽  
R Adlard
Keyword(s):  
Nurse Practitioners ◽  
Service Evaluation ◽  
Standards Of Care ◽  
Free Text ◽  
Hand Trauma ◽  
Improvement Project ◽  
Documentation Quality ◽  
Surgical Trainees ◽  
Data Points ◽  
Loop 2

Abstract Aim The BSSH standards of care in hand trauma emphasise the importance of accurate and comprehensive documentation. This quality improvement project aimed to evaluate whether an electronic proforma could improve documentation rates in hand trauma. Method This prospective, closed-loop audit involved two cycles of seven consecutive days. Outcomes were evaluated against BSSH standards of care using 15 data points. Pre-audit, a bespoke proforma was piloted in the hand trauma clinic and revised following feedback. In the first cycle (‘Loop 1’), documentation in the hand trauma clinic was compared with that of the acute take, where clinicians were still using free text. The second cycle (‘Loop 2’) compared documentation pre- and post-introduction of the proforma within the acute take setting. Categorical data were interrogated using the χ2 test with significance set at p < 0.05. Results 122 patients were included in the Loop 1 dataset. Free text clerking quality varied between clinician groups (e.g., surgical trainees significantly outperformed advanced nurse practitioners in 5/15 data points); however, some data points were universally poorly documented. 99 patients were included in the Loop 2 dataset. There was excellent uptake of the proforma in both acute take (95%) and hand trauma clinic (100%) settings. Statistically significant improvements were seen in 11/15 data points following the introduction of the proforma. Conclusions This project demonstrates that the introduction of a hand trauma clerking proforma led to significant improvements in documentation quality. The proforma has now been developed into a Trust-wide ClinDoc which brings additional benefits in terms of research, audit and service evaluation.

450 Retrospective Analysis of Surgical Clerk-Ins Within the Acute Receiving Unit: A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Lee ◽  
A MacLeod ◽  
A Bradley
Keyword(s):  
Royal Infirmary ◽  
Improvement Project ◽  
Out Of Hours ◽  
Emergency Admissions ◽  
Vte Prophylaxis ◽  
Care Services ◽  
Documentation Quality ◽  
Patient Documentation ◽  
Patient Handovers

Abstract Introduction Accurate patient documentation at the ARU is vital to patient safety and ensuring smooth handovers to secondary care services. Because the nature of surgical treatment requires frequent patient handovers, and this increases the risk of miscommunication, we aimed to assess the quality of surgical clerk-ins and identify areas for improvement. Method Emergency admissions at the Dumfries Galloway Royal Infirmary were audited, looking at documentation quality under various clerk-in sections. Data was analysed before presentation to clinical governance. Results When 46 patient clerk-ins were examined, venous thromboembolism (VTE) prophylaxis plans were performed in only 24% of admissions - less than 1 in 4 patients. Comparing out-of-hours and in-hours patient documentation, much higher omission rates were identified in the out-of-hours documentation: in systemic enquiry (42 vs 100%) and family history (31% vs 66%). Conclusions These results brought to attention the effect of hospital admission timing on patient documentation quality, and the lack of VTE prophylaxis planning. In surgery, these plans are key to minimising risk of avoidable thromboembolic complications. A departmental meeting was convened to stress the importance of accurate and comprehensive clerk-ins to ARU doctors. Future audits could explore the factors influencing documentation quality for out-of-hours admissions, and ways to address these issues.

Holistic Nurse Practitioner Care Including Promotion of Shared Decision-Making

2021 ◽  
pp. 089801012110627
Author(s):  
Elizabeth Kinchen
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Medical Condition ◽  
Holistic Care ◽  
Special Focus ◽  
Free Text ◽  
Shared Decision ◽  
Convenience Sample

The purpose of this quantitative, descriptive, exploratory study was to gauge the degree to which nurse practitioners (NPs) incorporate holistic nursing values in their care, with a special focus on shared decision-making (SDM), using the Nurse Practitioner Holistic Caring Instrument (NPHCI), an investigator-developed scale. A single open-ended question inviting free-text comment was also included, soliciting participants’ views on the holistic attributes of their care. A convenience sample of NPs ( n = 573) was recruited from a southeastern U.S. state Board of Nursing's (BON) publicly available list of licensed NPs. Results suggest that NPs do indeed perceive their care to be holistic, and that they routinely incorporate elements of SDM in their care. Highest scores were accorded to listening, taking time to talk to patients, knowledge of physical condition, soliciting patient input in care decisions, considering how other areas of a patient's life may affect their medical condition, and attention to “what matters most” to the patient. Age, gender, level of education, practice specialty, and location were also associated with inclusion of holistic care. Free-text responses revealed that NPs value holistic care and desire to practice holistically, but identify “lack of time” to incorporate or practice holistic care as a barrier.

scholarly journals Preliminary investigation into the identification and management of catatonia in patients admitted to adult inpatient units

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S336-S336
Author(s):  
Joanna Moore ◽  
Amy Kunicki ◽  
Georgina Latcham ◽  
Eleanor Perkins ◽  
Emma Vaccari
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Mental State ◽  
Rating Scale ◽  
Statistical Significance ◽  
Preliminary Investigation ◽  
Psychiatric Inpatients ◽  
Service Evaluation ◽  
Improvement Project ◽  
Adult Inpatient ◽  
Inpatient Units

AimsThe prevalence of catatonia is considered to be approximately 10% in psychiatric inpatients. Clinical experience suggests a lower documented prevalence. This could cause longer admissions and complications, such as Neuroleptic Malignant Syndrome (NMS). We carried out a service evaluation to investigate the recognition and management of catatonia on inpatient units in Southern Health Foundation Trust (SHFT). We reviewed the local documented prevalence of catatonia, treatment offered and prevalence of complications.MethodWe retrospectively reviewed the electronic records of 95 consecutive admissions to four adult inpatient units in SHFT, starting on 1st August 2020. We reviewed notes for the admission to establish whether catatonia was suspected and identified. We applied the screening questions from the Bush-Francis Catatonia Rating Scale (BFCRS) to the documented mental state examinations (MSE) prior to, and shortly after, admission. We also recorded the prescriptions issued during the first 72 hours of admission, and whether patients developed neuroleptic malignant syndrome (NMS), serotonin syndrome or required admission to a general hospital during admission.ResultCatatonia was documented as a possibility for 2 patients (2.1%). One showed possible posturing and stupor, while there were no documented symptoms for the other. In both cases the possibility was discounted by the clinical team. Twelve patients (12.6%) showed one or more possible or confirmed signs of catatonia. Eleven of these were prescribed regular antipsychotic medication on admission, but only 3 were prescribed regular benzodiazepines. NMS was more likely to be suspected in patients with a BFCRS of 1 or more compared with those with a score of 0, with an odds ratio of 8.1 (95% CI [1.03-64.0], Fisher's exact test = 7.79, p = .076).ConclusionCatatonia is likely under-recognised and under-treated locally among psychiatric inpatients. Although only approaching statistical significance, the higher rate of suspected NMS in patients showing possible catatonia is noteworthy and needs further investigation. Regular benzodiazepines were not frequently prescribed in this group, while antipsychotics, prescribed in all of these patients, can precipitate NMS. Alternatively, this finding could reflect the overlap in clinical presentation between NMS and catatonia. Data collection was limited by the frequent use of “remote clerking”, in the context of the COVID-19 pandemic. Additionally, the quality of mental state examinations was often not sufficient to draw any conclusions on the possible presence or absence of catatonic symptoms. This project has highlighted practice in need of improvement, which will be further prospectively investigated and improved via a Quality Improvement Project.

scholarly journals Remote psychotropic medication advice for general practitioners: a quality improvement project

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S212-S213
Author(s):  
Emily Rackley ◽  
Rosemary King
Keyword(s):  
Confidence Interval ◽  
General Practitioners ◽  
Nurse Practitioners ◽  
Psychotropic Medication ◽  
Response Rate ◽  
Psychotropic Medications ◽  
Improvement Project ◽  
Email Address ◽  
Initial Survey ◽  
Relative Change

AimsOur first aim was to first find out how confident general practitioners were about referring in to the Gloucester Recovery Team and managing psychotropic medications. Our second aim was to then improve general practitioner's self-rated scores of confidence in managing psychotropic medication whilst also improving general practitioner's satisfaction with waiting times for patient's referred to the Gloucester Recovery Team.MethodWe planned to introduce an email address for GPs to use to seek medication and diagnostic advice for patients known to and not known to the Recovery Team. We initially introduced this for the ‘Team 2’ catchment area consisting of five practices within Gloucester. These were then read and replied to by the Team 2 consultant, Dr Ikram, as appropriate. A further survey was then sent out.. These results provided both quantitative ordinal data through a likert scale, which was then transformed into binomial data, such as those scoring ‘extremely confident’ ‘very confident’ ‘somewhat confident’ vs ‘not so confident’ and ‘not confident at all’ which is then compared using relative risk.ResultOur response rate for our initial survey was 8 general practitioners, and for our follow-up survey 1 general practitioner and 2 nurse prescribers. Confidence in continuing psychotropic medications increased from 7 out of the 8 (78%) stating somewhat confident to extremely confident to 3 out of the 3 (100%) after the introduction of the email; a relative change of 1.14 (95% confidence interval 0.87-1.48 p = 0.318). Confidence in initiating psychotropic medications increased from 4 out of the 8 (50%) stating somewhat confident to extremely confident to 2 out of the 3 (66%) after the introduction of the email; a relative change of 1.33 (95% confidence interval 0.46-3.84 p = 0.594).ConclusionAnalysing the qualitative data showed the email address was used for a variety of requests and advice including: 1) A capacity assessment, 2) Initiating medications for depression and anxiety, 3) Medications during pregnancy, 4) Medication for those with Intellectual Disability, 5) Switching medication, 6) Medications for poor sleep and 7) Mood stabilising medication.This change appeared to be well received, however the response rate was very low which makes full analysis difficult. We also included nurse practitioners working in primary mental health in our second survey, whereas the initial survey was only sent to GPs. This initiative was also only started for 5 of the GP practices within Gloucester, and there may be a different knowledge base/confidence amongst the other practices.

A collaborative program for advanced practice in trauma/critical care nursing

1996 ◽  
Vol 16 (2) ◽  
pp. 120-127 ◽  
Author(s):  
V Keough ◽  
J Jennrich ◽  
K Holm ◽  
W Marshall
Keyword(s):  
Critical Care ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Practice Nurse ◽  
Tertiary Care ◽  
Standards Of Care ◽  
Advanced Practice ◽  
Advanced Practice Nurse ◽  
Care Nurse

The students and faculty enrolled in the first TNP class have set a standard for future TNPs: a rigorous course of education with advanced practice and scholarship within an advanced practice collaborative model. Because of the increasingly number of trauma victims and the highly specialized care they require, nurses must come forward and provide quality care. The TNPs and their faculty must promote further recognition of the TNP role, become leaders in the field of acute care, and continue to develop and maintain collaborative relationship with physicians in support of advanced practice nursing in many areas of tertiary care. The first three graduates of the trauma/critical care practitioner class are now employed in advanced practice roles and are applying their education within trauma/critical care settings. Two of the students are trauma nurse practitioners in a community hospital, and one is a critical care nurse practitioner in a university hospital. Currently, there is an acute care nurse practitioner certification examination that is appropriate for nurses in the field of trauma/critical care. Co-sponsored by the AACN Certification Corporation and the American Nurses Credentialing Center, this examination is offered twice a year, in June and October. AACN is active in supporting and promoting the TNP role and, in conjunction with the American Nurses Association, has developed new standards of care and scope of practice to include this expanded role for the advanced practice nurse. The future for this exciting and demanding role looks bright for the advanced practice nurse interested in the care of the acutely ill patient. The time is right for this collaboration between nurses and physicians.

scholarly journals Midwives' evaluation of their role in crowdsourcing activities to improve the maternity experience: part 1

2019 ◽  
Vol 27 (6) ◽  
pp. 368-372 ◽  
Author(s):  
Sam Frewin ◽  
Sarah Church
Keyword(s):  
Quality Improvement ◽  
Maternity Care ◽  
Low Cost ◽  
Service Evaluation ◽  
Quality Improvement Project ◽  
Service Users ◽  
Improvement Project ◽  
Maternity Services ◽  
Creative Solutions ◽  
Evaluation Project

This is the first of two articles introducing crowdsourcing as a tool that offers creative solutions to address everyday challenges in maternity care. In this first article, crowdsourcing is defined and discussed, demonstrating how it can be used to discover many relatively low-cost ideas to improve maternity services. By engaging service users in crowdsourcing activities, quality improvement is shared and focused on issues that emerge from practice. This process has the potential to generate more innovative ways to improve maternity services and women's experiences of care. In the second article, the discussion will centre on a service evaluation project that studied midwives' involvement in a workshop as part of a quality improvement project.

scholarly journals Improving the working environment for the delivery of safe surgical care in the UK: a qualitative cross-sectional analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023476 ◽  
Author(s):  
Alice Baggaley ◽  
Lydia Robb ◽  
Simon Paterson-Brown ◽  
Richard J McGregor
Keyword(s):  
Nurse Practitioners ◽  
Surgical Care ◽  
Cross Sectional Study ◽  
Team Work ◽  
Working Environment ◽  
Free Text ◽  
Discussion Paper ◽  
Cross Sectional ◽  
Firm Structure ◽  
The Uk

ObjectivesThe aim of this study was to identify current problems and potential solutions to improve the working environment for the delivery of safe surgical care in the UK.DesignProspective, questionnaire-based cross-sectional study.Setting/participantsFollowing validation, an electronic questionnaire was distributed to postgraduate local education and training board distribution lists, the Royal College of Surgeons of Edinburgh (RCSEd) mailing lists and trainee organisations. This consisted of a single open-ended question inviting five open-ended responses. Throughout the 13-week study period, the survey was also published on a number of social media platforms.ResultsA total of 505 responders completed the survey, of which 35% were consultants, 30% foundation doctors, 17% specialty trainees, 11% specialty doctors, 5% core trainees and <1% surgical nurse practitioners. A total of 2238 free-text answers detailed specific actions to improve the working environment. These responses were individually coded and then grouped into nine categories (staff resources, non-staff resources, support, working conditions, communication and team work, systems improvement, patient centred, training and education, and miscellaneous).ConclusionsThe results of this study have identified a number of key areas that, if addressed, may improve the environment for the delivery of safer surgical care. Common themes that emerged across all grades included: increased front-line staff; a return to a ‘firm’ structure to improve team continuity; greater senior support; and improved hospital facilities to help staff rest and recuperate. While unlimited funding remains unrealistic, many of the suggestions could be implemented in a cost-neutral fashion and include insightful ideas for remodelling or restructuring the workforce to improve the efficiency of the surgical team. The findings of this study formed the basis of a set of recommendations published by the RCSEd as a discussion paper.

P85 The effectiveness of group physiotherapy interventions for hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD): a service evaluation project

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Dolcie M Paxton ◽  
Rachel Lewis ◽  
Shea Palmer ◽  
Emma M Clark
Keyword(s):  
Patient Education ◽  
Service Evaluation ◽  
Lifestyle Changes ◽  
Free Text ◽  
Relaxation Techniques ◽  
Ehlers Danlos Syndrome ◽  
Written Information ◽  
Physiotherapy Intervention ◽  
Lack Of Information ◽  
Multisystemic Disorders

Abstract Background HSD and hEDS are complex and multisystemic disorders of connective tissue with arthralgia and other musculoskeletal features being acknowledged in the 2017 diagnostic criteria. Physiotherapy is a core component of management but there is no clear consensus regarding its effectiveness. For the last 21/2 years we have run an NHS group-based physiotherapy intervention consisting of four sessions focussing on patient education, exercises and lifestyle advice. The aim of this medical student-led project was to evaluate this service by canvassing patients' opinions and experiences and asking them to propose ways of improving care. Methods The physiotherapy intervention is open to all adults diagnosed with HSD and hEDS by rheumatologists or physiotherapists. 90 patients were invited to attend, and eleven groups were run between July 2017 and February 2019. To evaluate the service, patients were asked to complete an anonymised questionnaire which contained Likert scales (poor, average, good, very good or excellent) for four areas: (1) information on hypermobility; (2) pace of sessions; (3) physiotherapist's knowledge; and (4) relevance. In addition, free-text boxes asked about the patients' experiences of the course (likes, dislikes and suggested changes for future courses), and lessons learnt (lifestyle changes implemented, and take-home messages from the course). Results were recorded and analysed for recurring themes. Results 43 patients attended all four classes and 40 questionnaires were completed and returned. 100% rated the information on hypermobility and physiotherapist's knowledge as good, very good or excellent. Similarly, 94% rated the pace of sessions, and 97% the relevance of sessions as good, very good or excellent. Analysis of the free-text fields revealed three major themes: meeting people; effectiveness of the course; and lack of written information. Patients found it particularly valuable to meet others with similar concerns and experiences. They felt able to support each other by sharing and learning together, making them feel more comfortable with their condition. In terms of effectiveness of the course, they valued the information delivered about the condition and fatigue management. Patients reported benefit from learning exercises and relaxation techniques that they have built into their daily routines. Some patients came to realise that they can be active without causing injury and therefore incorporated regular exercise into their lifestyle. All patients reported actively implementing advice provided throughout the course. However, there was a lack of written information: patients requested leaflets relevant to the contents of classes. They also highlighted lack of information about the widespread effects of HSD/hEDS that they could share with friends, family and work colleagues. Conclusion Patients particularly valued learning alongside others with the same condition, and many reported actively implementing advice provided. An important area for development was written patient education and a resource pack needs generating to improve this. Disclosures D.M. Paxton None. R. Lewis None. S. Palmer None. E.M. Clark None.

scholarly journals Minimum standards for reporting outcomes of surgery in urogynaecology

2020 ◽  
Author(s):  
Philip Toozs-Hobson ◽  
Fiona Bach ◽  
J. Oliver Daly ◽  
Niels Klarskov
Keyword(s):  
Minimum Data Set ◽  
Free Text ◽  
Traffic Light ◽  
Data Set ◽  
The Third ◽  
Minimum Standards ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Minimum Data ◽  
Data Points

Abstract Introduction and hypothesis The IUGA special interest group (SIG) identified a need for a minimum data set (MDS) to inform outcome measurements to be included and simplify data capture and standardise reporting for data collection systems. To define a minimum data set for urogynaecological surgical registries. Methods Existing registries provide an inventory of items. A modified Delphi approach was used to identify a MDS. At each stage reviewers ranked data points and used free text to comment. The rating used a scale of 0–10 at each review and a traffic light system rated the scores as desirable, highly desirable and mandatory. The scores were collated and reported back to clinicians prior to the further rounds. Outliers were highlighted and reviewers re-assessed prior to repeating the process. A comparison of the MDS was made with published outcomes. Results Reviewers were from the outcome SIG with emphasis on widespread representation. Fifteen clinicians from eight countries were involved. Four reviewers dissected the existing databases. Eighty data points were considered in four categories, background, preoperative, intraoperative and postoperative. Consensus was reached by the third round. Two points were added on review (date of surgery and urodynamics). Three background points, five preoperative points, seven intraoperative points and nine postoperative points were identified giving 24 minimum data points in the final recommendation. Conclusions An MDS has been developed for urogynaecological surgical registries. These should be mandatory points which then allow larger varying points to be assessed. These points correspond well to data points used in published papers from established databases.

Sign in / Sign up

Export Citation Format

Share Document