scholarly journals Time for change in practice of in-patient oxygen therapy: a period-limited, multidimensional approach to improve oxygen prescription compliance: quality improvement project at Hamad General Hospital, Qatar

2021 ◽  
Vol 10 (4) ◽  
pp. e001574
Author(s):  
Samman Rose ◽  
Sundus Sardar ◽  
Sreethish Sasi ◽  
Dabia Hamad S H Al Mohanadi ◽  
Ahmed Ali A A Al-Mohammed ◽  
...  
Keyword(s):  
Quality Improvement ◽  
General Hospital ◽  
Oxygen Therapy ◽  
Poor Compliance ◽  
Target Range ◽  
Small Scale ◽  
British Thoracic Society ◽  
Electronic Prescription ◽  
Improvement Project ◽  
Prescription Practice

Prescription of oxygen therapy has traditionally poor compliance across the globe and mostly given to patients on verbal orders leading to under or overuse. The British Thoracic Society (BTS) guidelines (2017) recommend that oxygen therapy must be prescribed. Our study aimed to assess the prescription practice of oxygen therapy for patients admitted to acute medical assessment unit and general medical wards at Hamad General Hospital, Qatar and to achieve 80% compliance of valid oxygen therapy prescription implementing the quality improvement model against the BTS guidelines.The prescription practice of oxygen therapy was audited between April 2019 and August 2019. Using a Plan, Do, Study, Act (PDSA) model of improvement and multiple interventions was performed in the eight PDSA cycles, including (1) educational sessions for residents/fellows/nurses, (2) introduction of electronic prescription, (3) emails, posters/flyers, (4) nurse-led reminders and (5) re-enforced teaching for new residents. Data were then collected using a questionnaire assessing electronic prescriptions and documentation. Our baseline study regarding oxygen therapy showed limited awareness of BTS guidelines regarding the documentation of initiation and further adjustment of oxygen therapy. There was a lack of compliance with oxygen prescription; none of the patients had a valid prescription on our computer-based prescription (Cerner). The duration, target range and indications of Oxygen therapy were documented in 25% (18/72), 45.8% (33/72) and 42% (30/72) patients, respectively. Oxygen was initiated by communication order only. In a total of 16 weeks period, the repeated PDSA cycles showed significant improvement in safe oxygen prescription practices. Following intervention, oxygen electronic prescription, documentation of indications for oxygen therapy, target oxygen saturation and wean-off plan improved to 93%, 85%, 86 % and 80 %, respectively.We concluded that poor compliance to oxygen therapy Orders is a universal issue, which can be successfully managed using small-scale PDSA cycles to ensure sustained improvement through multidimensional interventions, continuous reinforcement and frequent reassessments.

Barriers to receipt of novel oral oncolytics: A single-institution quality improvement investigation

2019 ◽  
Vol 26 (2) ◽  
pp. 279-285
Author(s):  
Ann A Wang ◽  
Christopher Tapia ◽  
Yasin Bhanji ◽  
Christopher Campbell ◽  
Daniel Larsen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Care Center ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Wait Times ◽  
Prescription Data ◽  
Electronic Prescription ◽  
Improvement Project ◽  
Pharmacy Claims ◽  
Oral Oncolytics

Introduction Novel oral oncolytic agents have become the standard of care and first-line therapies for many malignancies. However, issues impacting access to these drugs are not well explored. As part of a quality improvement project in a large tertiary academic institution, we aim to identify potential barriers that delay treatment for patients who are prescribed novel oral oncolytics. Methods This was a retrospective review of adults who were newly prescribed a novel oral oncolytic for Food and Drug Administration-approved indications at a single tertiary care center. Patients were identified via electronic prescription data (e-Scribe). Demographics, insurance information, and prescription dates were extracted from the electronic medical record and pharmacy claims data. Statistical analyses were performed to determine whether time-to-receipt was associated with insurance category, pharmacy transfers, cost assistance, and drug prescribed. Results Of the 270 successfully filled prescriptions, the mean time-to-receipt was 7.3 ± 10.3 days (range: 0–109 days). Patients with Medicare experienced longer time-to-receipt (9.1 ± 13.1 days) compared to patients with commercial insurance (4.4 ± 3.3). Uninsured patients experienced the longest time-to-receipt (15.7 ± 7.8 days) overall. Pharmacy transfers and cost assistance programs were also significantly associated with longer time-to-receipt. Ten prescriptions remained unfilled 90 days after the study period and were considered abandoned. Conclusion Insurance has a significant effect on the time-to-receipt of newly prescribed novel oral oncolytics. Pharmacy transfers and applying for cost assistance are also associated with longer wait times for patients. Our retrospective analysis identifies areas of improvement for future interventions to reduce wait times for patients receiving novel oral oncolytics.

scholarly journals Standard operating procedure for the management and prevention of post-partum haemorrhage in a public general hospital in rural South India: a quality improvement project

2021 ◽  
Vol 8 (6) ◽  
pp. 2897
Author(s):  
Arkadeep Dhali ◽  
Christopher D'Souza ◽  
B. Rathna Roger
Keyword(s):  
Quality Improvement ◽  
General Hospital ◽  
Operating Procedure ◽  
Assessment Tool ◽  
Post Partum ◽  
Standard Operating Procedure ◽  
Quality Improvement Project ◽  
Maternity Ward ◽  
Improvement Project ◽  
Standard Operating

Background: The Obstetrician stationed in a Public General Hospital noticed that there were no standard guidelines nor any assessment tool for the management of post-partum hemorrhage (PPH). This developed the idea to prepare a standard protocol.Methods: Aiming to ensure prevention and proper management of PPH in the Maternity ward, a team was formed to perform a Quality improvement project (QIP). A Standard operating procedure (SOP) was formulated referring to the National Health Mission (NHM). Outcome indicators were defined. A series of interventions were implemented and assessed using Plan-Do-Study-Act (PDSA) cycles. The findings from the PDSA cycle of a previous intervention were used to implement change in the next intervention. The data was analysed to accept the change or to further modify it.Results: At the end of 3 months, percentage of patients with PPH reduced by 3%, percentage of patients diagnosed with PPH within the 1st hour increased by 50%, percentage of patients with PPH treated appropriately increased by 20% and percentage of patients requiring referral due to PPH decreased by 15%. Thus, at the end of 3 months there was significant improvement in the values of the outcome indicators.Conclusions: In the span of few months, we were able to implement an SOP and bring a significant improvement in the management of PPH in the maternity ward. 

scholarly journals Redesigning community care for safer staff and patient experiences: quality improvement project to improve safety and reduce incidents of violence and aggression in a community mental health team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S217-S218
Author(s):  
Sarah Saxena ◽  
Alberto Gutierrez Vozmediano ◽  
Katrina Walsh ◽  
Sarah Moodie ◽  
Rumbi Mapfumo
Keyword(s):  
Quality Improvement ◽  
Focus Groups ◽  
Multidisciplinary Approach ◽  
Care Pathway ◽  
Patient Discharge ◽  
Community Services ◽  
Small Scale ◽  
Discharge Process ◽  
Contributing Factors ◽  
Improvement Project

AimsViolent or aggressive incidents can be relatively common in community settings, and perhaps more difficult to manage than at inpatient wards due to the relative isolation and peripatetic delivery model, which can put staff at higher risk during incidents. Carshalton and Wallington Recovery Support team was identified as an outlier in the Trust and was invited to partake in a Safety Collaborative across South London Partnership.Stakeholders agreed on the aim of reducing incidents by 20% over 1 year by the end of 2020.MethodData about incidents were analysed and staff surveys conducted to evaluate violent events. Patient discharge was highlighted as a particular time of increased aggression. Involvement of patients and carers through patient focus groups and co-production was essential to elicit areas of improvement. These included staff confidence and awareness of existing guidelines. Additional secondary drivers were communication with patients, care pathway development, discharge process and multidisciplinary approach, which each had associated change ideas.The team identified change ideas that have been tested over one year using the Quality Improvement methodology of small-scale testing and PDSA. Example ideas tested include multidisciplinary Risk meetings, Safety huddle tool, Staff Safety training, co-produced Welcome and Discharge Packs with informed care pathways.ResultThere has been a 30% reduction in incidents by December 2020 across a total of 280 patients. Surveys have shown an increase in staff confidence and safety protocol awareness from 40% to 70% by October 2020. 100% of patients in focus groups found the Welcome and Discharge Packs helpful.ConclusionA structured improvement approach focused on staff safety and minimisation of known and potential contributing factors can lead to a reduction in incidents. Safety huddles and risk meetings allow a formal multidisciplinary approach to management of violence and aggression. Staff feel more reassured about safety policies in the trust, with better communication between senior management and colleagues to highlight risk and provide support. A culture of open discussion and transparency was implemented through provision of Welcome Packs including Care and Discharge Pathways details at point of entry to the service. Support was provided to patients with Discharge Packs including information about community services. This enabled a meaningful support model at the end of their recovery journey and an improved discharge process.The team is now working with additional teams and administrative and clerical staff to improve safety. We hope to replicate this approach in our Trust.

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