scholarly journals Early mobilization as a new pathway to improve functional mobility of cardiac patients in High dependency Unit

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
RS Thakur ◽  
D Selvamani ◽  
S Matharsa ◽  
G Chacko ◽  
P Francis ◽  
...  
Keyword(s):  
Multidisciplinary Team ◽  
Early Mobilization ◽  
Functional Mobility ◽  
Flow Chart ◽  
High Dependency Unit ◽  
Staff Education ◽  
Early Mobility ◽  
High Dependency ◽  
Level 3 ◽  
Level 2

Abstract Funding Acknowledgements Non funded project Background Early mobilization as a multidisciplinary team approach in cardiac High Dependency Unit-B (HDU B) helps to reduce loss of muscle strength, decrease hospital length of stay, improve functional capacity, cognitive levels, enhances the quality of care, and helps to decrease the hospitals costs. Purpose Early mobilization means reducing the time of bed rest from admission to first activity. Based on this definition the project aimed to mobilize more than 95% of cardiac patients within 24 hours of admission by September 2019 in HDU B unit. Methods HDU B Initiated Early mobilization program as a part of Value improvement project (VIP). Experts from multidisciplinary team (MDT) worked together to improve the functional mobility of patients. A cross section survey was conducted to identify barriers for early mobility in the unit followed by analyzing barriers through Pareto chart.  An early mobility flow chart (Level1-Passive, Level 2-Active assisted, Level 3-Active) framed in order to standardize the practice of mobilizing patients in HDU B. New changes were tested by using methodology of Plan Do Study Act. Staff education, training given regarding the implementation of early mobility protocol. Patients with mobility level 1 and 2 were identified by nurses, requested for Physiotherapy referral by Physicians. Nursing staff education on mobility assessment given an easy access of data about mobility level of patients in handoff communication, which guided the staff to decide on the need of PT consultation for each patient. In coordination with MDT team referral were also given even during weekend for the patients with mobility level 2. To engage patient and family in the early mobility program a new concept of END PYJAMA PARALYSIS was introduced. Patients with mobility level 3 were identified and encouraged to wear their own dress and move outside their room under supervision.This concept aims to build confidence in patients making them feel that they are ready to go home. Results With support and co-operation of the MDT, this project became a highly successful project in VIP. Initially 50% of the patients has been mobilized when the program was introduced in the ward during March 2019 which increased gradually to 90% at the end of the month. After introducing the flow chart, there was increase in 93.3% by April 2019. In addition to Physio referral it went to 100% at the end April 2019. End pyjama paralysis and weekend physio referral sustained the 100% compliance to Early mobility till the end of July 2019. Active interventions of the team helped to early mobilize by 100% till the end of September 2019 and currently it is in sustainable phase. Conclusion Early mobilization in HDU-B brought significant change in the culture of mobilization. Commitment, cooperation of MDT, a structural system and End pyjamas paralysis program are key factors of the success for the program that promoted patient safety and prevented adverse events.

High dependency and intensive care

2016 ◽  
Author(s):  
Philip Barclay ◽  
Helen Scholefield
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Admission Rate ◽  
Severity Of Illness ◽  
Scoring Systems ◽  
Near Misses ◽  
High Dependency ◽  
Level 3 ◽  
Level 2 ◽  
In Pregnancy

The development of maternal critical care is essential in reducing morbidity and mortality due to a substandard level of care. The level of critical care should depend upon the patient’s severity of illness, not their physical location. Escalation to level 3 (intensive) care is uncommon in pregnancy, with a median admission rate of 2.7 per 1000 births, mainly due to hypertensive disorders of pregnancy and haemorrhage. Maternal ‘near misses’ occur more frequently, with 6.5 per 1000 births meeting Mantel’s criteria, of which 85% is due to major obstetric haemorrhage. The admission rate to maternal high dependency units (level 2 care) varies from 1% to 5%. Acute physiological scoring systems have been found to be reliable when applied to parturients receiving level 3 care but overestimate mortality. Maternal early warning scores have been derived from simplified versions of these systems, with allowance made for physiological changes seen in pregnancy. There are many different maternity scoring systems in use throughout England and Wales. All share the same principle that parameters should be recorded regularly during the hospital stay, with deviations from normal quantified, recorded, and acted upon. A chain of response is then required to ensure that suitably qualified staff, possessing appropriate critical care competencies, attend in a timely fashion. Appropriate resources must be available with equipment readily to hand and suitably trained staff so that invasive monitoring can be used. Clear admission criteria are required for level 2 care within the delivery suite and escalation to level 3, with suitable arrangements for transfer.

scholarly journals 182 Improving Handovers from A Neurosurgical High Dependency Unit to Ward Teams

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Faderani ◽  
A Mohamed ◽  
P Stewart
Keyword(s):  
Quality Of Care ◽  
Continuity Of Care ◽  
Multidisciplinary Team ◽  
High Dependency Unit ◽  
Effective Management ◽  
High Dependency ◽  
Raising Awareness ◽  
Delayed Discharges

Abstract Introduction A good handover is fundamental in providing continuity of care within a multidisciplinary team, allowing for safe and effective management of patients. Method Handovers between the neurosurgical high dependency unit and the ward team were prospectively evaluated as patients were stepped down over a 6-week period. The handover rate and consequences of poor handovers (missed investigations, referrals, or delayed discharges) were documented. After 6-weeks, handover proforma was introduced and the rates were recalculated. Results In the initial 6-week period, 36 patients were transferred, with only 2(5.6%) appropriately handed-over. Consequently, 9(26%) patients had delayed scans, 5(15%) missed referrals, and 24(71%) delayed discharges. In the 6-week period following the introduction of the proforma, a total of 28 patients were transferred, with 19(67.8%) documented handovers. Consequently, 1(3.5%) patient had a scan delay, 0 missed referrals and only 2(7%) patients had delayed discharges. Conclusions By raising awareness of handovers and introducing a proforma, we improved documented handovers by 62.3% whilst reducing the rate of missed investigations, referrals, and delayed discharges by over 90%. This project highlights how small, simple, and easy to enforce changes can lead to significant improvements in the quality of care provided to patients.

scholarly journals 248 Improving Handovers from A Neurosurgical High Dependency Unit to Ward Teams

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Faderani ◽  
A Mohamed ◽  
P Stewart
Keyword(s):  
Quality Of Care ◽  
Continuity Of Care ◽  
Multidisciplinary Team ◽  
High Dependency Unit ◽  
Effective Management ◽  
High Dependency ◽  
Raising Awareness ◽  
Delayed Discharges

Abstract Introduction A good handover is fundamental in providing continuity of care within a multidisciplinary team, allowing for safe and effective management of patients. Method Handovers between the neurosurgical high dependency unit and the ward team were prospectively evaluated as patients were stepped down over a 6-week period. The handover rate and consequences of poor handovers (missed investigations, referrals, or delayed discharges) were documented. After 6-weeks, handover proforma was introduced and the rates were recalculated. Results In the initial 6-week period, 36 patients were transferred, with only 2(5.6%) appropriately handed-over. Consequently, 9(26%) patients had delayed scans, 5(15%) missed referrals, and 24(71%) delayed discharges. In the 6-week period following the introduction of the proforma, a total of 28 patients were transferred, with 19(67.8%) documented handovers. Consequently, 1(3.5%) patient had a scan delay, 0 missed referrals and only 2(7%) patients had delayed discharges. Conclusions By raising awareness of handovers and introducing a proforma, we improved documented handovers by 62.3% whilst reducing the rate of missed investigations, referrals, and delayed discharges by over 90%. This project highlights how small, simple, and easy to enforce changes can lead to significant improvements in the quality of care provided to patients.

ASSESSING PHARMACEUTICAL CARE NEEDS OF PAEDIATRIC IN-PATIENTS: A TEAM BASED APPROACH

2016 ◽  
Vol 101 (9) ◽  
pp. e2.34-e2 ◽  
Author(s):  
Adele Mott ◽  
Susan Kafka ◽  
Adam Sutherland
Keyword(s):  
Pharmaceutical Care ◽  
Clinical Supervision ◽  
Assessment Tools ◽  
Medication History ◽  
Patient Acuity ◽  
Care Plans ◽  
High Dependency ◽  
Level 3 ◽  
Level 1 ◽  
Level 2

AimsTo pilot a novel approach to providing pharmaceutical care to paediatric inpatients using structured referral and assessment tools. Using standardised referral criteria to ensure patients are assessed by appropriately skilled pharmacists.MethodThree wards of varying acuity and specialism were selected in a tertiary children's hospital in England - General Paediatric Ward (GPW), High Dependency Unit (HDU) and Haematology/Oncology Ward (HOW). The project ran for three months.Three levels of pharmacist were involved: Band 8 (“Level 3”), Paediatric Band 7 (“Level 2”) and rotational band 6/7 (“Level 1”). All patients were initially triaged by an appropriate pharmacist using criteria: Early Warning Scores (EWS), reason for admission, Level 1 Medicines Reconciliation. Patients were then graded according to level of acuity: Level 1: EWS 0–2 AND no significant medication history; Level 2: EWS 2–4 OR significant medication history; level 3: EWS >4.After initial triage patients were handed over using SBAR1 in a structured group “huddle”, and acuity levels validated. Pharmaceutical care plans were formulated and patients allocated to appropriate pharmacists.On the GPW patients were triaged by a level 3 pharmacist (“Refer Down”) for the first 2 weeks. On review of data generated and acuity levels triage was changed to be carried out by a level 1 pharmacist (“Refer Up.”) In the HDU and HOW the Refer Down system was used. All patients in the pilot were reassessed and acuity re-evaluated daily ensuring appropriate pharmacist review.Data was collected on initial acuity level and any change in level following the huddle; (1) to identify those patients in need of a higher level of pharmaceutical input; (2) to identify the level of pharmacist most appropriate to a given clinical area.Results245 patients were assessed. 148 (83%) patients on GPW were triaged as level 1. Using a “refer down” model there was no change in patient acuity. Using “refer up” only 5 patients were reclassified to a higher level of care post-huddle.18 (64%) patients in HOW were triaged as level 3. Eight patients were reduced to level 2 after the huddle. 53% of patients were classified as level 2 post-huddle. There were very few level 1 patients in HOW. PHDU demonstrated similar demographics, though with more level 1 patients.ConclusionThis study demonstrates the potential benefits of a team based approach in optimising pharmaceutical care by directing patients to the most appropriate pharmacist. The huddle facilitates clinical supervision of patients and pharmacists. There may be benefits in efficiency using this system in a resource-constrained environment. This study does not present longitudinal changes in acuity. More research is needed.

Exercise as early mobilization in patients using vasoactive drugs

2020 ◽  
Vol 19 (4) ◽  
pp. 301
Author(s):  
Amanda Mariano Morais ◽  
Daiane Naiara Da Penha ◽  
Danila Gonçalves Costa ◽  
Vanessa Beatriz Aparecida Fontes Schweling ◽  
Jaqueline Aparecida Almeida Spadari ◽  
...  
Keyword(s):  
Intensive Care ◽  
Cardiovascular Response ◽  
Ventilatory Support ◽  
Early Mobilization ◽  
Scientific Basis ◽  
Routine Practice ◽  
Vasoactive Drugs ◽  
Early Ambulation ◽  
Early Mobility ◽  
The Face

Introduction: The functional benefits of Early Mobilization (EM) capable of minimizing limitations and deformities in the face of immobility are clear, but there are many barriers to conduct EM as a routine practice in the Intensive Care Unit (ICU), including the use of vasoactive drugs (VAD), since it is directly related to weakness acquired in the ICU, in addition to the resistance of the multidisciplinary team to mobilize the patient using VAD. Objective: The objective of this literature review is to raise a scientific basis in the management of critically ill patients using DVAs for EM in the ICU. Methods: It is an integrative review of the literature, with research in the databases: PEDro, Pubmed, Lilacs, with articles published between 2011 and 2018, in Portuguese and English, using the terms: vasoactive drugs, early mobility, exercise in UCI, vasopressor and its equivalents in Portuguese. Results: Nine studies were included that analyzed the EM intervention in patients using VAD, with or without ventilatory support. There was no homogeneous treatment among the researched works, varying between exercises in bed and outside, with passive and / or active action. However, regardless of the conduct, there was an improvement in the cardiovascular response without relevant changes regarding the use of VAD. Conclusion: EM is not contraindicated for patients in the ICU with the use of VAD, and it was shown to be effective and safe without promoting relevant hemodynamic and cardiorespiratory changes, which would determine its absolute contraindication.Keywords: vasodilator agents, early ambulation, intensive care units, physical therapy specialty.

Historical text archives and prosopography: the COEL database system

1998 ◽  
Vol 10 (1-3) ◽  
pp. 57-72 ◽  
Author(s):  
K. S. B. Keats-Rohan
Keyword(s):  
Research Tool ◽  
Direct Access ◽  
Specific Situation ◽  
Core Data ◽  
Secondary Sources ◽  
The Core ◽  
Level 3 ◽  
Full Discussion ◽  
Available Information ◽  
Level 2

The COEL database and database software, a combined reference and research tool created by historians for historians, is presented here through Screenshots illustrating the underlying theoretical model and the specific situation to which that has been applied. The key emphases are upon data integrity, and the historian's role in interpreting and manipulating what is often contentious data. From a corpus of sources (Level 1) certain core data are extracted for separate treatment at an interpretive level (Level 3), based upon a master list of the core data (Level 2). The core data are interdependent: each record in Level 2 is of interest in itself; and it either could or should be associated with an(other) record(s) as a specific entity. Sometimes the sources are ambiguous and the association is contentious, necessitating a probabilty-coding approach. The entities created by the association process can then be treated at a commentary level, introducing material external to the database, whether primary or secondary sources. A full discussion of the difficulties is provided within a synthesis of available information on the core data. Direct access to the source texts is only ever a mouse click away. Fully query able, COEL is formidable look-up and research tool for users of all levels, who remain free to exercise an alternative judgement on the associations of the core data. In principle, there is no limit on the type of text or core data that could be handled in such a system.

EVALUASI PELATIHAN DI PT. PUPUK KUJANG CIKAMPEK

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Lania Muharsih ◽  
Ratih Saraswati
Keyword(s):  
Training Evaluation ◽  
Work Productivity ◽  
Learning Behavior ◽  
Level 3 ◽  
Level 1 ◽  
Four Levels ◽  
A Company ◽  
Level 2 ◽  
Evaluation Sheet ◽  
Assessment Factor

This study aims to determine the training evaluation at PT. Kujang Fertilizer. PT. Pupuk Kujang is a company engaged in the field of petrochemicals. Evaluation sheet of PT. Fertilizer Kujang is made based on Kirkpatrick's theory which consists of four levels of evaluation, namely reaction, learning, behavior, and results. At level 1, namely reaction, in the evaluation sheet is in accordance with the theory of Kirkpatrick, at level 2 that is learning should be held pretest and posttest but only made scale. At level 3, behavior, according to theory, but on assessment factor number 3, quantity and work productivity should not need to be included because they are included in level 4. At level 4, that is the result, here is still lacking to get a picture of the results of the training that has been carried out because only based on answers from superiors without evidence of any documents.   Keywords: Training Evaluation, Kirkpatrick Theory.    Penelitian ini bertujuan mengetahui evaluasi training di PT. Pupuk Kujang. PT. Pupuk Kujang merupakan perusahaan yang bergerak di bidang petrokimia. Lembar evaluasi PT. Pupuk Kujang dibuat berdasarkan teori Kirkpatrick yang terdiri dari empat level evaluasi, yaitu reaksi, learning, behavior, dan hasil. Pada level 1 yaitu reaksi, di lembar evaluasi tersebut sudah sesuai dengan teori dari Kirkpatrick, pada level 2 yaitu learning seharusnya diadakan pretest dan posttest namun hanya dibuatkan skala. Pada level 3 yaitu behavior, sudah sesuai teori namun pada faktor penilaian nomor 3 kuantitas dan produktivitas kerja semestinya tidak perlu dimasukkan karena sudah termasuk ke dalam level 4. Pada level 4 yaitu hasil, disini masih sangat kurang untuk mendapatkan gambaran hasil dari pelatihan yang sudah dilaksanakan karena hanya berdasarkan dari jawaban atasan tanpa bukti dokumen apapun.   Kata kunci: Evaluasi Pelatihan, Teori Kirkpatrick.

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