scholarly journals Optimising the measurement of blood glucose and cholesterol in patients who had an acute stroke: a quality improvement project

2021 ◽  
Vol 10 (2) ◽  
pp. e001237
Author(s):  
Ayesha Rehan Khan ◽  
Shruti Dorai ◽  
Yaseen Serry
Keyword(s):  
Quality Improvement ◽  
Blood Glucose ◽  
Acute Stroke ◽  
District General Hospital ◽  
Serum Glucose ◽  
Improvement Project ◽  
Blood Tests ◽  
Cholesterol Levels ◽  
Effective Interventions ◽  
Suspected Stroke

Hypercholesterolaemia and diabetes are established modifiable risk factors for cerebrovascular disease. A baseline audit carried out on an acute stroke ward at a District General Hospital in East Kent showed variability in blood tests being requested on admission for patients who had a suspected stroke, in particular serum glucose and cholesterol levels. Our aim was to ensure that at least 80% of patients admitted to the stroke ward with a suspected stroke had blood glucose and cholesterol levels measured on admission, over an 18-week period.The percentage of patients admitted with a suspected stroke on the ward who had the appropriate investigations requested on admission was measured weekly. Quality improvement methodology was used to formulate three interventions in the form of Plan-Do-Study-Act cycles: (1) an educational email sent to doctors regarding the assessment of patients who had a stroke and admission blood tests required; (2) adaptation of the ‘Stroke Admission Clerking Proforma’ to include a list of bloods to be requested; (3) production of an all-inclusive ‘Stroke Bloods Panel’ on the online system for requesting bloods.At baseline, an average of 30% and 34% of patients had glucose and cholesterol levels requested on admission, respectively. These results increased to 43% and 40% after the first intervention; 71% and 61% after the second intervention; and after the final intervention, on average, 82% and 85% of patients had glucose and cholesterol levels requested, respectively. We therefore achieved our aim of ensuring that more than 80% of patients who had an acute stroke had the appropriate blood tests requested on admission.The modified stroke proforma and the blood panel were the most effective interventions. The changes were implemented in an additional hospital within the same Trust. We anticipate greater compliance with Royal College of Physicians (RCP), National Institute for Health & Care Excellence (NICE) and Trust guidelines regarding appropriate and timely prescription of antidiabetic and cholesterol-lowering medications for secondary preventative measures.

A Successful Quality Improvement Project for Detection and Management of Acute Stroke in Hospitalized Patients

2020 ◽  
Vol 52 (4) ◽  
pp. 186-191
Author(s):  
Carol J. Droegemueller ◽  
Bhavani Kashyap ◽  
Roberta L. Huna Wagner ◽  
Hannah Shibeshi ◽  
Mitchell W. Clayton ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Hospitalized Patients ◽  
Quality Improvement Project ◽  
Improvement Project

scholarly journals Protecting patients from infection: Improving topical prophylaxis compliance on surgical wards

2019 ◽  
Vol 21 (2) ◽  
pp. 47-51
Author(s):  
Holly Slyne ◽  
Natalie Clews ◽  
Sid Beech ◽  
Elizabeth Smilie
Keyword(s):  
Quality Improvement ◽  
Infection Prevention ◽  
Communication Strategies ◽  
District General Hospital ◽  
Site Infection ◽  
Improvement Project ◽  
Medication Prescription ◽  
Improvement Plan ◽  
Number Of Patients ◽  
Improve Compliance

Background: At a medium-sized district general hospital in the heart of England, it was identified that compliance to the administration of topical prophylaxis on three general surgery wards had reduced to 23%, following implementation of an electronic medication prescription record. Therefore, a quality improvement project was commenced to improve this compliance to protect patients from meticillin-resistant Staphylococcus aureus (MRSA) colonisation and associated bacteraemia. Aim: To improve compliance of topical prophylaxis administration on three surgical wards to protect patients from infection. Method: Quality improvement plan – do – study – act (PDSA) cycles evaluated the effectiveness of four different strategies from baseline data which was 23% compliant in December 2016. These included teaching and communication strategies, prompts in medical notes, discontinuation of Mupirocin 2% nasal ointment as part of the topical prophylaxis regime and discontinuation of the topical wash lotion from requiring a prescription. Results: The compliance of prophylaxis administration increased consistently throughout from 23% in December 2016 to 92% in March 2018. Consequently, the number of patients that developed a MRSA colonisation on the three wards reduced by 54%, from 13 in the 12 months before the study to six in the 12 months after the study. Discussion: This study led to a change in the Trust MRSA Policy to better protect patients from infection, particularly surgical site infection and MRSA bacteraemia. It suggests that quality improvement methodology has a place in infection prevention practice.

scholarly journals A quality improvement project to reduce overutilization of blood tests in a teaching hospital

2019 ◽  
Vol 9 (3) ◽  
pp. 189-194
Author(s):  
Mohammad Almeqdadi ◽  
Hari Krishnan Nair ◽  
Jeoffrey Hill ◽  
Julian Sanchez-Cruz ◽  
Claudia Nader ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Teaching Hospital ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Blood Tests

‘HINTS’ AT THE FRONT DOOR: AN ACUTE STROKE SERVICE QUALITY IMPROVEMENT PROJECT

2019 ◽  
Vol 26 (6) ◽  
pp. 5-5
Author(s):  
Rebecca Rayner ◽  
Chit Hmu
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Hospital Setting ◽  
Medical Setting ◽  
Improvement Project ◽  
Stroke Service ◽  
Early Results ◽  
Bedside Test ◽  
Vestibular Pathology

Background/Aims Differential diagnosis of acute vertigo syndrome is challenging. In the acute medical setting, it is difficult to ascertain whether a person has definite peripheral vestibular pathology or a posterior circulation stroke. Mismanagement of these groups within our service is costly, with regards to correct medical input, MRI scan use and bed use within acute stroke services and the hospital setting. Research has demonstrated that the Head Impulse, Nystagmus, and Test of Skew (HINTS) test is efficacious, specific and sensitive in non-UK countries in determining if acute vertigo patients have dangerous (stroke) or benign (peripheral vestibular) pathology. It is not widely used in the UK. This may be due to well-known themes in implementation evidence such as cultural and clinician factors, as well as the lengthy time it takes to embed research into clinical settings. Methods We have started exploring, using Plan Do Study Act cycles, if the HINTS test can be successfully used in a large acute stroke service and the quality improvement effects this may have for patients (correct diagnosis, education/management and follow-up), financially to the Trust (efficient use of MRI scanning) and to the Stroke Pathway (effective bed use/acute medical management). Results Early results in round one of the quality improvement plan show that HINTS is a feasible bedside test to complete with 100% accuracy in the patients it was used on within the acute stroke pathway. This involved one stroke consultant and the patients' diagnosis with HINTS was assessed against routine follow-up MRI as appropriate. HINTS training has now been provided to all the stroke consultant and registrar team, A&E registrars and A&E advanced clinical practitioners, to senior physiotherapists in the acute stroke pathway and to the stroke alert nurses. Data gathering has commenced for round two, focusing further on bed use effects, as well as consideration of staff satisfaction with HINTS, and development of a recommended pathway for acute vertigo syndrome patients.

Sign in / Sign up

Export Citation Format

Share Document