scholarly journals Impact of a multifaceted and multidisciplinary intervention on pain, agitation and delirium management in an intensive care unit: an experience of a Canadian community hospital in conducting a quality improvement project

2021 ◽  
Vol 10 (4) ◽  
pp. e001305
Author(s):  
Zechen Ma ◽  
Mercedes Camargo Penuela ◽  
Madelyn Law ◽  
Divya Joshi ◽  
Han-Oh Chung ◽  
...  
Keyword(s):  
Intensive Care ◽  
Quality Improvement ◽  
Patient Outcomes ◽  
Community Hospital ◽  
Audit And Feedback ◽  
Post Intervention ◽  
Multidisciplinary Intervention ◽  
Improvement Project ◽  
Educational Modules ◽  
The Impact

BackgroundClinical guidelines suggest that routine assessment, treatment, and prevention of pain, agitation, and delirium (PAD) is essential to improving patient outcomes as delirium is associated with increased mortality and morbidity. Despite the well-established improvements on patient outcomes, adherence to PAD guidelines is poor in community intensive care units (ICU). This quality improvement (QI) project aims to evaluate the impact of a multifaceted and multidisciplinary intervention on PAD management in a Canadian community ICU and to describe the experience of a Canadian community hospital in conducting a QI project.MethodsA ten-member PAD advisory committee was formed to develop and implement the intervention. The intervention consisted of a multidisciplinary rounds script, poster, interviews, visual reminders, educational modules, pamphlet and video. The 4-week intervention targeted nurses, family members, physicians, and the multidisciplinary team. An uncontrolled, before-and-after study methodology was used. Adherence to PAD assessment guidelines by nurses was measured over a 6-week pre-intervention and over a 6-week post-intervention periods.ResultsData on 430 and 406 patient-days (PD) were available for analysis during the pre- and post- intervention periods, respectively. The intervention did not improve the proportion of PD with guideline compliance to the assessment of pain (23.4% vs. 22.4%, p=0.80), agitation (42.9% vs. 38.9%, p=0.28), nor delirium (35.2% vs. 29.6%, p=0.10) by nurses.DiscussionThe implementation of a multifaceted and multidisciplinary intervention on PAD assessment did not result in significant improvements in guideline adherence in a community ICU. Barriers to knowledge translation are apparent at multiple levels including the personal level (low completion rates on educational modules), interventional level (under-collection of data), and organisational level (coinciding with hospital accreditation education). Our next steps include reintroduction of education modules using organisation approved platforms, updating existing ICU policy, updating admission order sets, and conducting audit and feedback.

scholarly journals Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians

2016 ◽  
Vol 8 (2) ◽  
pp. 197-201 ◽  
Author(s):  
Kathleen Broderick-Forsgren ◽  
Wynn G Hunter ◽  
Ryan D Schulteis ◽  
Wen-Wei Liu ◽  
Joel C Boggan ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Audit And Feedback ◽  
Quality Improvement Initiative ◽  
Clinical Learning Environment ◽  
Improvement Project ◽  
Business Card ◽  
Quality Patient Care ◽  
White Board ◽  
White Boards ◽  
The Impact

ABSTRACT  Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program.Background  This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools—business cards and white boards—to improve provider identification.Objective  This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use.Methods  We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P < .01) and slightly improved business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P < .05 for all), but had no effect on photograph recognition.Results  Our educational intervention improved white board use, but did not result in improved patient ability to recognize physicians. Pooled data of business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools.Conclusions

Reducing delays in the transfer of patients from psychiatric intensive care units (PICU) to acute inpatient services: a quality improvement project

2021 ◽  
Author(s):  
Alexander Challinor ◽  
Emily Lewis ◽  
Andrew Mitchell ◽  
Debbie Williams
Keyword(s):  
Intensive Care ◽  
Quality Improvement ◽  
Intensive Care Units ◽  
Quality Improvement Project ◽  
Traffic Light ◽  
Improvement Project ◽  
Transfer Of Care ◽  
Delayed Discharge ◽  
Open Wards ◽  
The Impact

Aim: To investigate the delays in the transfer of care of patients from psychiatric intensive care units (PICU) to acute care inpatient wards.Background: Few studies have focused on the characteristics of patients requiring transfer from PICU or delays in transfer of care from PICU to inpatient beds. The efficient transfer of patients from a PICU is essential to provide a dynamic service, promote patient recovery, enable safe, timely discharges and reduce stay in unnecessarily restrictive settings.Method: A 3-month prospective study was performed on two PICUs (Brooklands and Willow), investigating delays to transfer from PICUs to open wards. Days and percentage of discharges was also examined.Following collection of the initial data cycle, Brooklands implemented a ‘traffic light’ tool to identify delays. Following implementation, the project was repeated one year later.Results: A total of 122 patients were analysed for delays in the transfer of care from PICU to acute open wards. Brooklands PICU demonstrated a prolonged delay to transfer of patients, prompting implementation of a delayed discharge tool, the ‘traffic-light’ system. Brooklands PICU subsequently demonstrated a statistically significant improvement in the days to transfer.Conclusions: This quality improvement project adds to the limited research base for delays in the transfer of PICU patients and is the first study to implement a delayed discharge tool within a PICU. Further research is required on the transfer of patients from PICUs, examining barriers for these delays and the impact of this on patients within PICU.

scholarly journals Post-discharge care following acute kidney injury: quality improvement in primary care

2020 ◽  
Vol 9 (4) ◽  
pp. e000891
Author(s):  
Susan J Howard ◽  
Rebecca Elvey ◽  
Julius Ohrnberger ◽  
Alex J Turner ◽  
Laura Anselmi ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Kidney Injury ◽  
Patient Safety ◽  
Quality Improvement ◽  
Health Outcomes ◽  
Kidney Injury ◽  
Audit And Feedback ◽  
Improvement Project ◽  
General Practices ◽  
The Impact

BackgroundOver the past decade, targeting acute kidney injury (AKI) has become a priority to improve patient safety and health outcomes. Illness complicated by AKI is common and is associated with adverse outcomes including high rates of unplanned hospital readmission. Through national patient safety directives, NHS England has mandated the implementation of an AKI clinical decision support system in hospitals. In order to improve care following AKI, hospitals have also been incentivised to improve discharge summaries and general practices are recommended to establish registers of people who have had an episode of illness complicated by AKI. However, to date, there is limited evidence surrounding the development and impact of interventions following AKI.DesignWe conducted a quality improvement project in primary care aiming to improve the management of patients following an episode of hospital care complicated by AKI. All 31 general practices within a single NHS Clinical Commissioning Group were incentivised by a locally commissioned service to engage in audit and feedback, education training and to develop an action plan at each practice to improve management of AKI.ResultsAKI coding in general practice increased from 28% of cases in 2015/2016 to 50% in 2017/2018. Coding of AKI was associated with significant improvements in downstream patient management in terms of conducting a medication review within 1 month of hospital discharge, monitoring kidney function within 3 months and providing written information about AKI to patients. However, there was no effect on unplanned hospitalisation and mortality.ConclusionThe findings suggest that the quality improvement intervention successfully engaged a primary care workforce in AKI-related care, but that a higher intensity intervention is likely to be required to improve health outcomes. Development of a real-time audit tool is necessary to better understand and minimise the impact of the high mortality rate following AKI.

scholarly journals 83. Staff Pharmacist-driven Prospective Audit and Feedback at a Community Hospital: Assessing an all Hands on Deck Approach to Antimicrobial Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S58-S59
Author(s):  
Casey J Dempsey ◽  
Natasha Weiner ◽  
Michele Riccardi ◽  
Kristin Linder
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Audit And Feedback ◽  
Small Community ◽  
Prospective Audit ◽  
Post Intervention ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback ◽  
The Impact ◽  
Feedback Program

Abstract Background Facilities with robust antimicrobial stewardship programs often have infectious disease (ID) pharmacists with devoted time to complete antimicrobial stewardship initiatives. Smaller facilities with limited resources or lacking ID pharmacists, may encounter challenges meeting antimicrobial stewardship regulatory requirements. The goal of this study is to assess the impact of a staff pharmacist-driven prospective audit and feedback program in a small community hospital. Methods A pre- and post-intervention study was performed to assess the primary outcome of days of therapy per 1,000 patient days (DOT) for targeted antimicrobials (ciprofloxacin, levofloxacin, piperacillin/tazobactam, cefepime, ceftazidime). Secondary outcomes were antibiotic expenditures and rates of Clostridioides difficile infection (CDI). Results Significant decreases in DOT were observed for piperacillin/tazobactam (29.88 vs. 9.25; p < 0.001), ciprofloxacin (23.22 vs. 9.97; p < 0.001), levofloxacin (11.2 vs. 5.07; p < 0.001) and overall antipseudomonal DOT (62.91 vs. 51.67; p < 0.001). There was no difference in ceftazidime DOT (8.75 vs. 6.47; p= 0.083) and an increase in cefepime DOT (20.47 vs. 34.35; p < 0.001). A trend towards decreased rates of CDI was seen (4.9/10,000 patient days vs. 2.64/10,000 patient days; p= 0.931). There were significant decreases in antibiotic expenditures for piperacillin/tazobactam ($52,498 vs. $10,937; p < 0.001), levofloxacin ($2,168 vs. $672; p < 0.001), ciprofloxacin ($6,700 vs. $1,954; p < 0.001). Lower expenditures for ceftazidime were seen ($9,952 vs. $7,457; p= 0.29). Cefepime expenditures increased ($25,638 vs. $40,097; p= 0.001). An overall decrease in the expenditure for the targeted antibiotics was seen ($95,715 vs. $62,837; p < 0.001). Conclusion Implementation of a staff pharmacist-driven prospective authorization and feedback program led to a significant decrease in DOT and antibiotic expenditures for several targeted antibiotics and a trend towards decreased rates of CDI. Despite increased DOT and expenditures for cefepime, there was an overall decrease amongst the targeted antibiotics. With proper implementation, staff pharmacists can significantly benefit antimicrobial stewardship initiatives. Disclosures All Authors: No reported disclosures

scholarly journals Quality Improvement Implementation and Maintenance of a Paediatric Early Warning System

2020 ◽  
Author(s):  
Heather P Duncan ◽  
Amber Oliver ◽  
Karl Emms ◽  
Yvonne Heward ◽  
Adrienne P Hudson
Keyword(s):  
Cardiac Arrest ◽  
Intensive Care ◽  
Quality Improvement ◽  
Action Research ◽  
Hospital Mortality ◽  
Early Warning ◽  
Human Interaction ◽  
Paediatric Intensive Care ◽  
Audit And Feedback ◽  
The Impact

Abstract Background: Paediatric Early Warning (PEW) systems have led to earlier identification and escalation of treatment with subsequent admission to Paediatric Intensive Care (PIC) in deteriorating children. The impact on reductions in cardiac arrest and mortality vary between the heterogeneous studies, showing both unchanged and reduced cardiac arrest, morbidity and mortality. Identifying and managing critical illness on wards is a complex and dynamic process involving technology, human interaction, cultural context and environment. We introduced a PEW system to reduce potentially avoidable cardiac arrest and death.Methods: We report an Implementation Science Quality Improvement (QI) natural experiment using the Medical Research Councils (MRC) Guidelines for Developing and Evaluating Complex Interventions, Action Research, Action Research Theory and methods. The aim of this program was to identify learning, refinement and improvement opportunities to reduce poor outcomes. The interventions were 1) developing an observation and monitoring policy to standardise practice and provide a template for optimal care, 2) standardized charting with an embedded PEW score, 3) clinical skills training, 4) clinical process audit and feedback and 5) outcome surveillance.The process measures were 1) timeliness and impact for unplanned Paediatric Intensive Care (PIC) admissions, 2) clinical assessment skills and 3) chart completion compliance. The outcome measures included 4) total and predictable cardiac arrests and 5) hospital mortality. Data collection started in 2004, the PEW system was implemented in 2008, and the outcomes were reported through 2018.Results: In our specialist children’s hospital, we completed six improvement cycles over 10 years. 1) Timely PIC admissions improved after implementation (39% to 92%). Patients with unplanned PIC admissions had significantly lower severity of illness and mortality but a longer length of stay. 2) Routine clinical observation accuracy improved (66 to 82%) following multimodal training. 3) Chart completion compliance improved (87 to 99%). In 2018, 2% of observations had missing or inaccurate parameters with a consequent inaccurate total PEW score. 4) The total cardiac arrest rate was significantly reduced (0.36 to 0.16 per 1000 admissions). The small numbers of predictable cardiac arrests showed a decreasing trend. 5) Hospital mortality was significantly reduced (3.46 to 2.24 per 1000 admissions). Outcomes improved approximately 18 months after implementation and have not changed significantly since 2010 despite increasing critical care resources in and out of PIC. The impact of the PEW system on these outcomes is possible but not conclusive.Conclusion: Implementation of the PEW system as a complex intervention using QI methods is associated with improved clinical skill accuracy, chart compliance and detection of deterioration associated with more timely unplanned PIC admissions. These improvements were associated with a significant reduction in cardiac arrest and mortality.

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