961 ROSE's Proforma: A Tool to Improve Quality and Safety of Surgical Handover

Abstract Aim Accurate and rigorous handover is paramount in surgery. Human factor can unfortunately affect handovers resulting unsafe for patients. The ROSE’S handover proforma is a structured methodology which has been created according to the RCSEng guidelines to facilitate communication ensuring an effective delivering of information concerning the care of surgical patients. Method ROSE is the acronym for REASON, OBSERVATION, SHIFT, ESCALATION and it is made of multiple subparts that cover the majority of the information that need to be shared between team members such as wound care, NEWS score, medications, diagnostic tests, assessments of lines (catheter, cannula, drain, CVC), social situation, deterioration, medical history as required by guidelines of RCSEng. The timing of 40 handovers has been recorded, of these 20 were performed by using the ROSE’s form. A questionnaire has been administered before and after the implementation of the Rose’s handover. Results The average time for handover a surgical patient increased from 1.07 to 3.26 minutes with ROSE’s form. The 82.14% of the staff who tried it thought that the form resulted easy to navigate, brief and complete in details. It is a safer practice for the 71.43% of the staff. The quality and the accuracy of the handover given was perceived as improved by the 96.46% of the staff that used it. Conclusions A structured surgical handover performed with a written form can be an easy and safe tool that can minimize human factor and technical errors especially out of hours. Clearly further research is needed; however, the preliminary results look encouraging.

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Understanding decisions about antibiotic prescribing in ICU: an application of the Necessity Concerns Framework

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-012479 ◽

2021 ◽

pp. bmjqs-2020-012479

Author(s):

Alyssa M Pandolfo ◽

Robert Horne ◽

Yogini Jani ◽

Tom W Reader ◽

Natalie Bidad ◽

...

Keyword(s):

Focus Groups ◽

Antibiotic Prescribing ◽

Negative Consequences ◽

Out Of Hours ◽

Team Members ◽

Clinical Vignettes ◽

Molecular Microbiology ◽

Semistructured Interviews ◽

Decision Making Processes ◽

The Individual

BackgroundAntibiotics are extensively prescribed in intensive care units (ICUs), yet little is known about how antibiotic-related decisions are made in this setting. We explored how beliefs, perceptions and contextual factors influenced ICU clinicians’ antibiotic prescribing.MethodsWe conducted 4 focus groups and 34 semistructured interviews with clinicians involved in antibiotic prescribing in four English ICUs. Focus groups explored factors influencing prescribing, whereas interviews examined decision-making processes using two clinical vignettes. Data were analysed using thematic analysis, applying the Necessity Concerns Framework.ResultsClinicians’ antibiotic decisions were influenced by their judgement of the necessity for prescribing/not prescribing, relative to their concerns about potential adverse consequences. Antibiotic necessity perceptions were strongly influenced by beliefs that antibiotics would protect patients from deterioration and themselves from the ethical and legal consequences of undertreatment. Clinicians also reported concerns about prescribing antibiotics. These generally centred on antimicrobial resistance; however, protecting the individual patient was prioritised over these societal concerns. Few participants identified antibiotic toxicity concerns as a key influencer. Clinical uncertainty often complicated balancing antibiotic necessity against concerns. Decisions to start or continue antibiotics often represented ‘erring on the side of caution’ as a protective response in uncertainty. This approach was reinforced by previous experiences of negative consequences (‘being burnt’) which motivated prescribing ‘just in case’ of an infection. Prescribing decisions were also context-dependent, exemplified by a lower perceived threshold to prescribe antibiotics out-of-hours, input from external team members and local prescribing norms.ConclusionEfforts to improve antibiotic stewardship should consider clinicians’ desire to protect with a prescription. Rapid molecular microbiology, with appropriate communication, may diminish clinicians’ fears of not prescribing or of using narrower-spectrum antibiotics.

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Joint Consultation Clinic by Infectious Diseases Specialists and Podiatry team (ID-POD) Compliments the Care of Diabetic Patients with Foot Infections by Reducing Cost and Decreasing Outpatient Clinic Visits

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.776 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S328-S328

Author(s):

Pushpalatha Bangalore Lingegowda ◽

Say-Tat Ooi ◽

Jyoti Somani ◽

Chelsea Law ◽

Boon Kiak Yeo

Keyword(s):

Infectious Diseases ◽

Diabetic Foot ◽

Wound Care ◽

Cost Savings ◽

Outpatient Setting ◽

Multidisciplinary Teams ◽

Diabetic Patients ◽

Wound Debridement ◽

Diabetic Foot Infections ◽

Before And After

Abstract Background Management of diabetic foot infections (DFI) is challenging and involves multidisciplinary teams to improve outcomes (1). Appropriate wound care of patients with DFI plays an important role in successfully curing infections and promote wound healing. In Singapore, Infectious Diseases (ID) specialists help in the management of DFI by recommending appropriate antibiotics for infected wounds while wound debridement are managed by Podiatrists (POD). When patients are hospitalized multidisciplinary teams including Vascular Surgery review patients. In the outpatient setting patients have multiple appointments including ID and Endocrinology etc. The time spent and costs incurred by patients for traveling to multiple appointments is considerable. A joint ID-POD clinic was initiated to reduce the cost and inconvenience for patients. Methods A joint weekly clinic was initiated in October’16 and the data was analyzed upto May’17. Finance was involved in deriving costs. The service costs for consultations payable by patients before and after the initiation of the joint clinic were compared. Results First 6 months experience of initiating the joint ID-POD clinic is reported. 35 unique patients had a total of 88 visits. 1/third of the patients had more than 2 visits to the joint clinic. For each visit to the joint clinic the patient paid 25% less compared with having separate clinics. The hospital lowered the service cost for the new clinic by 11%. This was done by minimizing the time involvement of the ID physician. Conclusion Joint ID-POD clinic for managing diabetic patients with foot infections revealed several advantages. Hospital outpatient visits for each patient decreased by 50% for those requiring care of both ID and POD, without compromising care. With the consolidation of care each individual patient had a cost savings of 25% for the joint consultation. This joint clinic while making it convenient for patients has revealed significant cost savings to patients especially for those requiring multiple visits. We recommend hospitals with high prevalence of Diabetes and Diabetic foot infections to consider joint ID-POD clinics to reduce hassle and increase saving for patients. Disclosures All authors: No reported disclosures.

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Prospective, multidisciplinary recording of perioperative errors in cerebrovascular surgery: is error in the eye of the beholder?

Journal of Neurosurgery ◽

10.3171/2015.5.jns142458 ◽

2016 ◽

Vol 124 (6) ◽

pp. 1794-1804 ◽

Cited By ~ 5

Author(s):

Suzanne M. Michalak ◽

John D. Rolston ◽

Michael T. Lawton

Keyword(s):

Improve Patient Care ◽

Vital Role ◽

Team Members ◽

Operating Team ◽

Technical Errors ◽

Resident Surgeon ◽

Hospital Stays ◽

Using Data ◽

Prolonged Hospital ◽

Communication Errors

OBJECT Surgery requires careful coordination of multiple team members, each playing a vital role in mitigating errors. Previous studies have focused on eliciting errors from only the attending surgeon, likely missing events observed by other team members. METHODS Surveys were administered to the attending surgeon, resident surgeon, anesthesiologist, and nursing staff immediately following each of 31 cerebrovascular surgeries; participants were instructed to record any deviation from optimal course (DOC). DOCs were categorized and sorted by reporter and perioperative timing, then correlated with delays and outcome measures. RESULTS Errors were recorded in 93.5% of the 31 cases surveyed. The number of errors recorded per case ranged from 0 to 8, with an average of 3.1 ± 2.1 errors (± SD). Overall, technical errors were most common (24.5%), followed by communication (22.4%), management/judgment (16.0%), and equipment (11.7%). The resident surgeon reported the most errors (52.1%), followed by the circulating nurse (31.9%), the attending surgeon (26.6%), and the anesthesiologist (14.9%). The attending and resident surgeons were most likely to report technical errors (52% and 30.6%, respectively), while anesthesiologists and circulating nurses mostly reported anesthesia errors (36%) and communication errors (50%), respectively. The overlap in reported errors was 20.3%. If this study had used only the surveys completed by the attending surgeon, as in prior studies, 72% of equipment errors, 90% of anesthesia and communication errors, and 100% of nursing errors would have been missed. In addition, it would have been concluded that errors occurred in only 45.2% of cases (rather than 93.5%) and that errors resulting in a delay occurred in 3.2% of cases instead of the 74.2% calculated using data from 4 team members. Compiled results from all team members yielded significant correlations between technical DOCs and prolonged hospital stays and reported and actual delays (p = 0.001 and p = 0.028, respectively). CONCLUSIONS This study is the only of its kind to elicit error reporting from multiple members of the operating team, and it demonstrates error is truly in the eye of the beholder—the types and timing of perioperative errors vary based on whom you ask. The authors estimate that previous studies surveying only the attending physician missed up to 75% of perioperative errors. By finding significant correlations between technical DOCs and prolonged hospital stays and reported and actual delays, this study shows that these surveys provide relevant and useful information for improving clinical practice. Overall, the results of this study emphasize that research on medical error must include input from all members of the operating team; it is only by understanding every perspective that surgical staff can begin to efficiently prevent errors, improve patient care and safety, and decrease delays.

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Reducing Hospital-acquired Pressure Injuries Among Pediatric Patients Receiving ECMO: A Retrospective Study Examining Quality Improvement Outcomes

Wound Management & Prevention ◽

10.25270/wmp.2021.9.1424 ◽

2021 ◽

Vol 67 (9) ◽

pp. 14-24

Author(s):

Jordan Jackson ◽

Holly Kirkland-Kyhn ◽

Laura Kenny ◽

Alana Beres ◽

Stephanie Mateev

Keyword(s):

Quality Improvement ◽

Pediatric Patients ◽

Wound Care ◽

Occipital Region ◽

Provider Education ◽

Before And After ◽

Prevention Interventions ◽

Improvement Interventions ◽

Quality Improvement Interventions ◽

Hospital Acquired

BACKGROUND: Pediatric patients immobilized for certain procedures, such as extracorporeal membrane oxygenation (ECMO), are at high risk for developing hospital-acquired pressure injuries (HAPIs). PURPOSE: To evaluate the rate of HAPI occurrence in ECMO patients before and after implementation of prevention interventions. METHODS: Patients younger than 18 years of age who were placed on ECMO from January 2012 through March 2020 were identified, and patient data, including the development of a stage 3, 4, or unstageable pressure injuries, were abstracted. From August 2018 through December 2018, HAPI prevention interventions were implemented, which included targeted HAPI prevention and ECMO provider education, fluidized positioner provider education, and the addition of 2 wound care interventions for ECMO patients. RESULTS: Of the 120 ECMO patients identified, 5 (4.2%) developed a HAPI. All patients developed HAPI in the occipital region, and 1 patient developed an additional HAPI on their back. The median age of patients with HAPI was 1 month (interquartile range [IQR], 0.3–6.8 months). The median duration from ECMO cannulation to identification of HAPI was 9.5 days (IQR, 4.8–32.3 days). The median total run time was 4.9 days (IQR, 2.5-7.6 days): 8.5 days for patients who did develop a HAPI and 4.8 days for those who did not develop a HAPI (P = .02). The overall HAPI rate dropped from 4.8% of ECMO patients before quality improvement interventions to 0% of ECMO patients after quality improvement interventions. CONCLUSIONS: The development of stage 3, 4, or unstageable HAPIs in pediatric ECMO patients was low (4.2%) over the period studied (January 2012 through March 2020). As of the time of this writing, no HAPIs occurred after implementation of provider education in 2018.

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Pengaruh Terapi Murrotal Terhadap Penurunan Tingkat Nyeri dan Kecemasan Saat Perawatan Luka Pasien Ulkus Dm Di Rsud K.R.M.T. Wongsonegoro Semarang

Indonesian Journal of Nursing Research (IJNR) ◽

10.35473/ijnr.v1i2.177 ◽

2019 ◽

Vol 1 (2) ◽

Author(s):

Dyah Restuning Prihati ◽

Maulidta Karunianingtyas Wirawati

Keyword(s):

Wound Care ◽

Stress Hormones ◽

Sample Selection ◽

Intervention Group ◽

Wilcoxon Test ◽

Control Group ◽

Measuring Instruments ◽

Diabetic Ulcer ◽

Before And After ◽

Quasi Experimental

Diabetic ulcer is caused by damage to the skin nerves due to reduced blood flow. Pain and anxiety when wound care begins when dressing and cleaning the wound. Murottal therapy is a distraction technique in the form of al-quran records, decreases stress hormones and provides a feeling of relaxation. The purpose of this study was to reduce the level of pain and anxiety during wound care in patients with DM ulcers after being given murrotal therapy in RSUD K.M.T. Wongsonegoro Semarang. The research method with quasi experimental pre-posttest control group. a sample of 17 people in the intervention group and 15 in the control group. Sample selection with total sampling. The murrottal listening intervention group played for 3 times for 15 minutes. Respondents were conducted pre and posttest with NRS pain measuring instruments and DASS anxiety. The results of the Wilcoxon test in the intervention group obtained p = 0,000, there were differences in the level of pain between before and after murotal therapy and p = 0.002 there was a difference in the level of anxiety between before and after murotal therapy. In the control group obtained p = 0.02, there were differences in the level of pain between before and after murotal therapy and the value of p = 1.00, there was no difference in the level of anxiety between before and after given murotal therapy. Conclusion: Murrotal therapy can reduce the level of pain and anxiety during wound care for DM ulcer patients.

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888. Improving outcomes with revised preoperative universal decolonization protocol

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1076 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S479-S479

Author(s):

Silvia I Gnass

Keyword(s):

Surgical Procedures ◽

Baseline Period ◽

Surgical Team ◽

Team Members ◽

Surgical Infection ◽

Before And After ◽

Trial Basis ◽

The Impact ◽

Before And After Study ◽

Patient Infection

Abstract Background In order to improve outcomes, including reduced surgical infection rate and costs, a revised universal preoperative decolonization protocol was implemented on a trial basis. Methods In a 12 month before and after study at a public teaching hospital in southern California, an alcohol based nasal antiseptic was introduced in place of nasal povidone iodine (PVI) for all surgical patients pre-operatively, paired with chlorhexidine (CHG) bathing which was already in place. All surgical procedures were included, the most common being cholecystectomy, cesarean section and hip fracture. The alcohol nasal antiseptic was selected to replace the PVI nasal antiseptic based on efficacy, staff preference and cost. At the same time, surgical team members began self-application of the alcohol nasal antiseptic each day prior to surgical procedures. This was not mandatory and compliance was not tracked, though informal feedback and observation revealed most surgical team members were applying the nasal antiseptic prior to cases daily. Results In comparison to the 6 month baseline period where there were 27 SSI in 1188 procedures, during the 6 month study period there were 10 SSI in 1253 procedures, representing a 63% reduction (p=.0162) for all types of procedures. We have observed a reduction of 17 SSIs in 2019, compared to the previous year, during the 6 months period. That means a saving of $589,420 during the same period. Conclusion Preoperative universal decolonization with alcohol based nasal antiseptic in place of nasal PVI, paired with CHG bathing, was effective in reducing SSI rate and associated costs. Further study is needed to measure and assess the impact of surgical team member nasal decolonization on patient infection risk and rate. Disclosures All Authors: No reported disclosures

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Changes in Self-Image Resulting from Migration

10.35853/ufh-rmp-2019-sp07 ◽

2019 ◽

pp. 286-293

Author(s):

Olga Zotova ◽

Elena Perelygina ◽

Sergey Mostikov

Keyword(s):

Social Interaction ◽

Host Country ◽

Dynamic Structure ◽

Social Situation ◽

Cultural Environment ◽

The Core ◽

Self Image ◽

The World ◽

Before And After ◽

Personality Construct

The perception of one’s own identity is one of the basic moments of a personality construct as they relate to how people act; perceive the world around and with what social they identify themselves. While immersed in an alien culture these perceptions transform. The authors aimed to examine differences in selfimages of the Russian-speaking emigrants before and after emigration. Our hypothesis implies significant differences in self-image upon immersing in another cultural environment. The objective we set resides in identifying aspects of selfimage exposed to transformations and the degree of these changes. For data accumulating before and after the process of international migration with a period of 14 months, we exploited M. Kuhn and T. McPartland’s test “Who am I?” The data demonstrated statistically significant differences in the respondents’ self –image in the course of adaptation. The results allow us to conclude that with a changing social situation self-perception also most alternations exhibit those aspects of selfimage through which the respondents interacted with a host-country population. We believe that self-image presents a hierarchically organized, complex, and dynamic structure with the core and the periphery. The components of self-image can rebuild itself in response to a situation of social interaction.

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Knowledge convergence among pre-service mathematics teachers through online reciprocal peer feedback

Knowledge Management & E-Learning: An International Journal ◽

10.34105/j.kmel.2017.09.001 ◽

2017 ◽

pp. 1-18 ◽

Cited By ~ 1

Keyword(s):

High School Students ◽

Mathematics Teachers ◽

Concept Maps ◽

Peer Feedback ◽

School Students ◽

Team Members ◽

Knowledge Representations ◽

Before And After ◽

Knowledge Convergence ◽

Group Members

This research focused on pre-service mathematics teachers’ sharing of knowledge through reciprocal peer feedback. In this study, pre-service teachers were divided into groups of five and engaged in an online reciprocal peer feedback activity. Specifically, after creating an individual concept map indicating high school students’ possible solutions to an algebra problem, pre-service teachers shared their individual maps with team members and engaged in online discussion, commenting on the concept maps of other group members and responding to peers’ feedback. Similarities in team members’ knowledge representations before and after this peer feedback activity were compared in order to analyze their knowledge convergence. It was found that a team member’s knowledge was more likely to match that of other team members after the online reciprocal peer feedback activity. Qualitative analysis was also conducted in order to explore the possible influence of a team’s interaction process on members’ knowledge convergence. It was also found that, after engaging in this peer feedback process, pre-service teachers demonstrated greater improvement in their convergence of concepts relating to problem-solving strategies than in the concepts representing problem context and domains.

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Impact of Donation Physicians on Deceased Organ Donation: A Systematic Review

10.21203/rs.3.rs-200397/v1 ◽

2021 ◽

Author(s):

Janet E. Squires ◽

Laura D. Aloisio ◽

Wilmer John Santos ◽

Danielle Cho-Young ◽

Monica Taljaard ◽

...

Keyword(s):

Systematic Review ◽

Organ Donation ◽

Interrupted Time Series ◽

Deceased Donor ◽

Organ Donors ◽

Consent Rate ◽

Team Members ◽

Study Selection ◽

Before And After ◽

Deceased Organ Donation

Abstract Background: An emerging strategy to increase deceased organ donation is to use dedicated donation physicians to champion organ donation. We sought to conduct a systematic review of the effectiveness of donation physicians in improving organ donation outcomes.Methods: A systematic review was conducted following Cochrane principles. MEDLINE, Embase, and CINHAL databases were searched from inception to March 26, 2020. Quantitative studies examining the effects of donation physicians on all deceased organ donation outcomes were considered for inclusion. Review articles, editorials and opinion articles, and case studies were excluded. Study selection was completed independently by two team members; all discrepancies were resolved by consensus. Two team members independently extracted data from studies. Results: A total of 1,017 studies were screened, and 12 met inclusion criteria. Included studies were published between 1994 and 2019. Half used an interrupted time series design (n = 6; 50%), three (25%) were cohort studies, and three (25%) used a before-and-after study design. Outcomes (reported in greater than 50% of included articles) included consent/refusal rate (n = 8; 67%), number of potential donors (n = 7; 58%), and number of actual donors (n = 7; 58%). Across studies and design types, there was an increase in potential organ donors ranging from 8 to 143% (Mdn = 33%), an increase in actual organ donors from 15 to 113% (Mdn = 27%), an increase in donor consent rate from -3 to 258% (Mdn = 12%) and an increase in deceased donor transplants from 13 to 24% (Mdn = 19%) following the introduction of donation physicians.Conclusions: Donation physicians have the potential to significantly improve deceased organ donation. Further implementation and evaluation of donation physician programs is warranted. However, implementation should be undertaken with a clear plan for a methodologically rigorous evaluation of outcomes.

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The Assay of Factor VII in its Native and Activated Forms

10.1055/s-0039-1684635 ◽

1979 ◽

Author(s):

T.J. Snape ◽

D. Griffiths

Keyword(s):

Human Factor ◽

Factor Vii ◽

Before And After

The preparation and use for factor VII assay of an artificial human factor VII-deficient substrate plasma is reported. Results of factor VII assays carried out using this plasma as substrate were closely comparable with values obtained using congenitally deficient plasma.Neither of these assay systems distinguishes between factor VII in its native and activated forms. The activation state of factor VII in plasma and in a therapeutic factor VII concentrate has been investigated using an amidolytic assay (Seligsohn et al, 1978, Blood, 52, 978) and also by a method involving conventional assay before and after incubation with heparin (Godal et al, 1974, Thromb. Res., 5, 773). The results suggest that factor VII in the concentrate is unactivated and is stable with respect to attempts to activate it by cold activation in the presence of contact activators.

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