scholarly journals Therapeutic duplication on the general surgical wards

2021 ◽  
Vol 10 (3) ◽  
pp. e001363
Author(s):  
Isabelle Huynh ◽  
Tania Rajendran
Keyword(s):  
Safety Net ◽  
Electronic Prescribing ◽  
Patient Harm ◽  
Surgical Team ◽  
Improvement Project ◽  
Patient Documentation ◽  
Original Number ◽  
Therapeutic Duplication ◽  
Medication Chart ◽  
Rule Out

Therapeutic duplication is the practice of prescribing multiple medications for the same indication or purpose without a clear distinction of when one agent should be administered over another. This is a problem that occurs frequently, especially on electronic prescribing records (EPR) as the medication chart is not always reviewed before prescribing. The aim of this Quality Improvement Project (QIP) was to reduce therapeutic duplication to 0% through educating the general surgical team. Prescriptions of all general surgical patients in the surgical wards were reviewed daily for a month. EPR was used to check if there were any duplications or identical class of drug prescribed. Patient documentation was thoroughly checked to rule out if the duplication was intentional. Following this, if duplication was still unclear, the relevant teams would be contacted for clarification. Any unintentional error was removed, and data was collected. The QIP results were presented to the local general surgical meeting and our fellow colleagues were educated on the importance of safe prescribing and on how to prevent prescribing errors. The baseline of therapeutic duplications on the general surgical wards was 9% prior to our first cycle. Following the presentation of data and educating the surgical team at the surgical meeting, the number of errors seemingly reduced, however, there was a jump to 22% of therapeutic duplication on a particular Friday which brought the average of therapeutic duplication to 8.77%. The team was reminded again about the importance of correct prescribing and after the second cycle, the number of errors reduced to 5.29%. For the third audit cycle, the team was presented with the reaudited data and following this, the number of errors dropped down to 3.12%. Therapeutic duplication should never occur as this could cause a risk to patient harm. Through educating the surgical team and reminding our team regularly, the average number of errors reduced by more than half of the original number. In our hospital, the main source of safety net is through pharmacists and nurses, however as shown, this is not enough to prevent all therapeutic errors. A more sustainable intervention such as an alert on EPR prior to prescribing may be required to maintain a low therapeutic duplication average and prevent patient harm.

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.

584 Maintaining Success in Patient Safety and Quality Metrics Through Teamwork and Contextual Modification

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S133-S134
Author(s):  
Mini Thomas ◽  
Aemilio W Ha ◽  
Victor C Joe ◽  
Theresa L Chin ◽  
Nicole O Bernal
Keyword(s):  
Best Practices ◽  
Patient Care ◽  
Quality Metrics ◽  
Team Work ◽  
The Other ◽  
Patient Harm ◽  
Improvement Project ◽  
Quality Metric ◽  
Hospital Leadership ◽  
Burn Unit

Abstract Introduction Hospitals constantly invest heavily in improving patient quality and safety metrics. Oftentimes, success is achievable for a single parameter but becomes challenging to achieve in all quality metrics. Our Burn Unit aimed for overarching principles of teamwork and contextual modification to obtain outstanding quality metrics in all six areas of patient quality. This quality improvement project aimed at reducing patient harms related to CLABSI, CAUTI, VTE, C.Diff, Falls, and HAPI. Methods Hospital leadership launched a dashboard of all six patient harm areas that is updated and reported daily during the leadership huddle. Apart from ensuring best practices for each quality metric, Burn Unit focused on teamwork and contextual modifications. Team work: Utilizing engaged multidisciplinary team, apparent cause analysis of identified cases helped in detecting fallibilities. Additionally, proactive actions were implemented for high risk patients by routine audits and discussions during daily rounds. Frequent reminders, appreciations, and celebration of success were also helpful strategies. Contextual modification: Unit and population specific interventions were actively sought for each quality metric. For HAPI, delineating existing burns or skin conditions from that of hospital acquired pressure injury helped to eliminate false positives. Identification and modification of patient care environment was vital in reducing the number of falls. Chlorhexidine gluconate bathing of burn wounds reduced the bioburden to help decrease CAUTI/CLABSIs. Results Burn Unit events related to CLABSI, CAUTI, VTE, C.Diff, Falls, and HAPI were compared to other ICUs, Step down, Telemetry, and Med-Surg units. The BICU was below national benchmarks for all six quality indicators and had outstanding success within the hospital. Our last patient harm was 328 days ago compared to the other 11 units which averaged 32 days. In the non-ICU units, Falls were the most frequent patient harm compared to CLABSI or CAUTIS for the ICUs. In Comparing to previous year, in 2019, BICU progressed in CAUTI, Falls, and HAPI while sustaining 2018 excellence in the other three areas. Conclusions Quality metrics can be simultaneously achieved by strengthening team work and contextual modifications beyond following best practices and protocols. Applicability of Research to Practice Quality metrics can be simultaneously achieved by strengthening team work and contextual modifications beyond following best practices and protocols. Strong teamwork from engaged staff and contextual modifications should be intertwined with scientific evidences for obtaining quality metrics in patient care.

scholarly journals Attempted Development of a Clinical Decision-making Model to Assist in Femoral Neck Stress Fracture Screening in Military Trainees

2020 ◽  
Author(s):  
Justin S Zimmerman ◽  
Gail D. Deyle ◽  
Mark E Lester ◽  
Jamie B Morris ◽  
Christopher S Allen
Keyword(s):  
Femoral Neck ◽  
Process Improvement ◽  
Roc Curve ◽  
Groin Pain ◽  
Clinical Decision ◽  
Clinical Usefulness ◽  
Trial Registration ◽  
Advanced Imaging ◽  
Improvement Project ◽  
Rule Out

Abstract Background: Femoral neck stress fractures (FNSF) are serious injuries prevalent throughout the military, particularly within the initial entry training (IET) population. Delay in diagnosis and management can lead to complications secondary to fracture progression and displacement. Effective screening and identification of FNSF can reduce patient risk, mitigate costs associated with treatment, and prevent the potential medical discharge of IET personnel. There is currently no validated testing to assist in decisions for ordering advanced imaging to rule out FNSF. Military healthcare providers, therefore, must rely on advanced imaging of patients with hip region complaints to rule out suspected FNSF resulting in potential MRI over utilization. The purpose of this project was to determine if a clinical decision model can be developed from clinical findings to assist clinicians in deciding when magnetic resonance imaging (MRI) is warranted for FNSF screening in IET personnel with hip or groin pain. Methods: This was a prospective observational cross-sectional cohort process improvement project. We screened all IET Soldiers presenting to a medical clinic with hip or groin pain and evaluated 18 clinical variables. The reference standard was a FNSF diagnosed using fast-sequence MRI. Statistical analyses included correlation, receiver operating characteristic (ROC) curve assessments, and regression.Results: Final statistical analysis included 184 IET Soldiers, of which 49 had a FNSF. Frequency analysis observed the highest occurrence of FNSF in non-Hispanic white females. Ten subjective and physical examination variables had a weak correlation to positive MRI findings for FNSF. Regression analysis revealed six variables with positive MRI outcome predictive abilities; however, small to medium effect sizes, low ability to account for MRI outcome variance, and poor estimated sensitivity on ROC curve analysis limit this regression model’s clinical usefulness utilizing the identified variables. Conclusions: The regression models evaluating the clinical variables within this project failed to demonstrate adequate predictability and clinical usefulness when screening for the high-risk injury FNSF in an IET population. Clinicians should maintain a low threshold for ordering an MRI to screen for FNSF in this population. Clinicians also cannot rely on subject-reported pain locations or objective testing as definitive assessment signs to distinguish between IET Soldiers with and without a FNSF.Trial Registration: This study was deemed as a process improvement project by the Brooke Army Medical Center Institutional Review Board on 7 August 2017. A trial registration was not needed.

scholarly journals Meet your surgical team: The impact of a resident-led quality improvement project on patient satisfaction

2018 ◽  
Vol 216 (4) ◽  
pp. 793-799
Author(s):  
Rebecca Craig-Schapiro ◽  
Sandra R. DiBrito ◽  
Heidi N. Overton ◽  
James P. Taylor ◽  
Ryan B. Fransman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Quality Improvement Project ◽  
Surgical Team ◽  
Improvement Project ◽  
The Impact

Themes of Worry Among Psychiatric Inpatients That Persist Through Acute Hospitalization

2020 ◽  
pp. 107839032097376
Author(s):  
Pia Engstrom ◽  
Matthew Bolton ◽  
Cynthia Bautista ◽  
Todd Barnes
Keyword(s):  
Quality Improvement ◽  
Behavioral Health ◽  
Medical Center ◽  
Academic Medical Center ◽  
Psychiatric Inpatient ◽  
Safety Net ◽  
Health Staff ◽  
Improvement Project ◽  
Safety Net Hospital ◽  
Psychiatric Units

INTRODUCTION Problems that worry patients throughout hospitalization are complex and varied, but they fall within the scope of safe, effective, patient-centered care. To our knowledge, there is no evidence describing the problems that worry patients in inpatient psychiatric units. AIM The purpose of this quality improvement project was to describe common themes of worry experienced by individuals in psychiatric inpatient units in order to improve patient experience. METHOD This project took place at an urban, safety net hospital at an academic medical center in the northeastern United States between March and December 2019. All patients across five inpatient psychiatric units were offered the Combined Assessment of Psychiatric Environments (CAPE) survey as they approached the end of their stay. RESULTS A total of 1,800 patients took the survey. Of these patients, 36% (650/1,800) patients responded never/sometimes to “During my hospitalization, I found solutions to problems that worried me,” and 46% (297/650) patients provided a response to the follow-up question “What are the problems that worry you the most?” Common themes of worry for inpatient behavioral health patients include (a) life in the hospital, (b) self, and (c) outside life. CONCLUSION Each of these worry themes that emerged from this thematic analysis has implications for behavioral health staff who are preparing the psychiatric/behavioral health inpatient for discharge. These themes can also be used to focus on a variety of quality improvement initiatives to improve the patients experience while in an inpatient psychiatric/behavioral health unit.

scholarly journals Implementation and spread of a simple and effective way to improve the accuracy of medicines reconciliation on discharge: a hospital-based quality improvement project and success story

2019 ◽  
Vol 8 (3) ◽  
pp. e000363 ◽  
Author(s):  
Shady Botros ◽  
John Dunn
Keyword(s):  
Improve Patient Safety ◽  
Successful Implementation ◽  
Patient Harm ◽  
Success Story ◽  
Improvement Project ◽  
Medicines Reconciliation ◽  
Improvement Methodologies ◽  
The Right ◽  
Do The Right Thing ◽  
Improve Patient

BackgroundChanges are often made to medications at times of transitions in care. Inadequate reconciliation during admission, transfer and discharge causes medication errors and increases risks of patient harm. Despite well-established multidisciplinary medicines reconciliation (MR) processes at hospital admission, our MR process at discharge; however, was poor. The main errors included failure to recommence withheld medicines and lack of documentation explaining changes made to medications on discharge. Our objective was to develop an intervention that supports prescribers to follow a simple standardised MR process at discharge to reduce these errors.MethodsWorking closely as a multidisciplinary team, we used improvement methodologies to design and test a process that reliably directs prescribers in surgery to use the inpatient prescribing chart as well as the MR on admission form as sources to create accurate discharge prescriptions. The project was segmented into testing, implementation, spread and sustainability.ResultsThe tested intervention helped the accuracy of discharge prescriptions steadily and quickly improve from 45% to 96% in the pilot ward. Following the successful implementation and sustainability in two separate pilot wards, the intervention was spread to the remaining eight wards producing a similar improvement.ConclusionsTo improve patient safety, it is crucial to ensure that information about medicines is effectively communicated when care is transferred between teams. Although this can be challenging, we’ve shown that it can be done effectively and reliably if this responsibility is equally shared by healthcare professionals from all disciplines while being supported by safe systems that make it easy to do the right thing. Successfully implementing a standardised multidisciplinary MR process at discharge can also reduce the reliance on pharmacists therefore freeing them to undertake other clinical roles.

scholarly journals EP.TU.785Quality Improvement Project: Improving Oxygen therapy prescription in surgical inpatients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Mohammed Hamid ◽  
Laith Al-Saket ◽  
Arab Rawashdeh ◽  
Raman Sudarsanam
Keyword(s):  
Large City ◽  
Safety Net ◽  
British Thoracic Society ◽  
City Hospital ◽  
Improvement Project ◽  
Pdsa Cycle ◽  
Projection Analysis ◽  
The Mean ◽  
One Year ◽  
Hospital Inpatients

Abstract Aims The 2015, British Thoracic Society (BTS) Oxygen audit demonstrated that 42% of hospital inpatients were using Oxygen without a prescription. National and local standards state that Oxygen, as a drug, should be routinely prescribed and checked along with regular medications and VTE risk assessment. Our baseline audit conducted over a two month period on the surgical wards of a large city hospital revealed that 78% of patients were not being prescribed oxygen. We set a SMART aim to increase the percentage of surgical inpatients being prescribed oxygen by 20% each month. Methods We used the trust e-prescription software to record our data, with three-stage verification and subsequent senior analysis of data. The three primary drivers identified were factors intrinsic to the department: lack of standard awareness, education and safety-net to ensure sustainability. To tackle these in-turns, we designed three PDSA cycles: Departmental poster, seminar with induction material, and system checklist notification. Results Following our first PDSA cycle, the mean percentage increased from 22% to 60%. Using projection analysis, we anticipate this to increase to > 75% after the second PDSA cycle, and >95% after PDSA3, with 100% sustainability one year later. Conclusion Our results to-date show that practice standards have improved following our first PDSA cycle, indicating that awareness played an important role. We predict that education will play an equal role; and given the research supporting the implications of checklists, we forecast that this later element will be the ultimatum leading to 100% sustainability of patients receiving oxygen prescription.

scholarly journals Feasibility Study of Vietnam Fire and Disaster Prevention Agency Improvement Project through ODA Project I

2021 ◽  
Vol 35 (5) ◽  
pp. 100-105
Author(s):  
Jun-Yang Park ◽  
Yong-Taek Han
Keyword(s):  
Rapid Change ◽  
Safety Net ◽  
Master Plan ◽  
Disaster Prevention ◽  
Social Safety Net ◽  
Improvement Project ◽  
The Past ◽  
Institutional Aspects ◽  
Specific Implementation ◽  
Selection Of

By matching domestic ODA projects for specific implementation in accordance with the 2020 Fire and Disaster Prevention Agency Facility Infrastructure Master Plan and 2030 Vision, a social safety net construction project in Vietnam, its business feasibility was analyzed. Vietnam is undergoing rapid change and urbanization. As a result, demand in the firefighting sector is expected to increase rapidly. Because there are no domestic manufacturers of firefighting vehicles in Vietnam, the demand is largely satisfied through imports; however, the firefighting vehicles and additional devices provided through this ODA project should greatly contribute to the promotion of domestic exports. To represent the environmental factors that can cause fires in 58 provinces, the selection of project areas to support firefighting vehicles is based on population, jurisdictional area, population density, age of firefighting vehicles, number of firefighting targets, and number of firefighting vehicles in the past four years; the trend of reinforcement of firefighting vehicles and regional characteristics is determined. Twelve provinces in Vietnam were selected in the same way as the selected areas to support firefighting vehicles. This ODA project is expected to provide an opportunity to improve the legal and institutional aspects of the firefighting and disaster prevention field in Vietnam by applying domestic advanced firefighting force deployment standards.

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