Quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia

Abstract Background Despite well-defined recommendations, prolonged fasting times for clear fluids and solids are still common before elective surgery in adults. Extended fasting times may lead to discomfort, thirst, hunger and physiological dysfunctions. Previous studies have shown that prolonged fasting times are frequently caused by patients being misinformed as well as inadequate implementation of the current guidelines by medical staff. This study aimed to explore how long elective surgery patients fast in a German secondary care hospital before and after the introduction of an educational note for patients and re-training for the medical staff. Methods A total of 1002 patients were enrolled in this prospective, non-randomised interventional study. According to the power calculation, in the first part of the study actual fasting times for clear fluids and solids were documented in 502 consecutive patients, verbally instructed as usual regarding the recommended fasting times for clear fluids (2 h) and solids (6 h). Subsequently, we implemented additionally to the verbal instruction a written educational note for the patients, including the recommended fasting times. Furthermore, the medical staff was re-trained regarding the fasting times using emails, newsletters and employee meetings. Thereafter, another 500 patients were included in the study. We hypothesised, that after these quality improvement procedures, actual fasting times for clear fluids and solids would be more accurate on time. Results Actual fasting times for clear fluids were in the median 11.3 (interquartile range 6.8–14.3; range 1.5–25.5) h pre-intervention, and were significantly reduced to 5.0 (3.0–7.2; 1.5–19.8) h after the intervention (median difference (95%CI) − 5.5 (− 6.0 to − 5.0) h). The actual fasting times for solids also decreased significantly, but only from 14.5 (12.1–17.2; 5.4–48.0) h to 14.0 (12.0–16.3; 5.4–32.0) h after the interventions (median difference (95%CI) − 0.52 (− 1.0 to − 0.07) h). Conclusions The study showed considerably extended actual fasting times in elective adult surgical patients, which were significantly reduced by simple educational/training interventions. However, the actual fasting times still remained considerably longer than defined in recommended guidelines, meaning further process optimisations like obligatory fluid intake in the early morning are necessary to improve patient comfort and safety in future. Trial registration German registry of clinical studies (DRKS-ID: DRKS 00020530, retrospectively registered).

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P64 Improving surgical consent – a quality improvement project to enhance the consenting process

BJS Open ◽

10.1093/bjsopen/zrab032.063 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Manu Shrivastava ◽

J Brown ◽

L Sun ◽

Rajini Rajagopal ◽

Manu Shrivastava

Keyword(s):

Quality Improvement ◽

Endoscopic Sinus Surgery ◽

Elective Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Quality Improvement Project ◽

Sinus Surgery ◽

Improvement Project ◽

Consent Forms ◽

Educational Meeting ◽

Patient Interviews

Abstract Introduction RCS guidelines on consent, recently updated, encourage a dialogue where all risks material to that patient are discussed and are clear. An audit was performed to assess whether practice at Oxford Hospitals is compliant with these guidelines – that all patients for elective surgery are consented prior to admission. Method Thirty-two undergoing elective Functional Endoscopic Sinus Surgery (FESS), Tonsillectomy and Septoplasty were interviewed in May-June 2019. Baseline data were presented at a local educational meeting, along with education on the recent changes to the RCS guidelines. Repeat audit took place in August-September 2020. Results All 32 patients were consented as per RCS guidelines and understood the reason for their surgery, but only 31% could explain the risks, and 56% could explain alternative options. Twenty (63%) consent forms were easily legible on randomised heuristic assessment. After education and change in department practice, understanding of the operation was much improved (80-100%). One outcome was to create pre-filled consent forms for common ENT operations. Conclusions Whilst RCS policy on completing consent prior to admission is being achieved, patient interviews suggest a lack of understanding of the operation. Standardised consent forms have the potential to enhance this understanding, as well as saving time.

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The Clinical Nurse Specialist Role and its Relevance to Vascular Access: A Canadian Perspective

Journal of the Association for Vascular Access ◽

10.2309/java-d-21-00014 ◽

2021 ◽

Vol 26 (3) ◽

pp. 25-30

Author(s):

Andrea Raynak ◽

Brianne Wood

Keyword(s):

Quality Improvement ◽

Clinical Outcomes ◽

Vascular Access ◽

Organizational Outcomes ◽

Clinical Nurse Specialist ◽

Nurse Specialist ◽

Care Hospital ◽

Improvement Project ◽

Clinical Nurse ◽

The Impact

Highlights Abstract Purpose: The purpose of this quality improvement study was to examine the impact of a Vascular Access Clinical Nurse Specialist (VA-CNS) on patient and organizational outcomes. Description of the Project/Program: The VA-CNS role was created and implemented at an acute care hospital in Thunder Bay, Ontario, Canada. The VA-CNS collected data on clinical activities and interventions performed from April 1 to March 29, 2019. The dataset and its associated qualitative clinical outcomes were analyzed using deductive content analysis. Furthermore, a cost analysis was performed by the hospital accountant on these clinical outcomes. Outcome: Over a 1-year period, there were 547 patients protected from an unwarranted peripherally inserted central catheter (PICC) insertion among 302 patient consultations for the VA-CNS. A total of 322 ultrasound-guided peripheral intravenous catheters were inserted and 45 PICC insertions completed at the bedside. The cost associated with the 547 patients not receiving a PICC line result in an estimated savings of $113,301. The VA-CNS role demonstrated a positive payback of $417,525 to the organization. Conclusion: The results of this quality improvement project have demonstrated the positive impacts of the VACNS on patient and organizational outcomes. This role may be of benefit and worth its adoption for other health systems with similar patient populations.

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An Interdisciplinary Clinical Approach for Workplace Violence Prevention and Injury Reduction in the General Hospital Setting: S.A.F.E. Response

Journal of the American Psychiatric Nurses Association ◽

10.1177/1078390318788944 ◽

2018 ◽

Vol 25 (4) ◽

pp. 280-288

Author(s):

Barbara E. Lakatos ◽

Monique T. Mitchell ◽

Reza Askari ◽

Mary Lou Etheredge ◽

Karen Hopcia ◽

...

Keyword(s):

Quality Improvement ◽

Nursing Staff ◽

Workplace Violence ◽

Hospital Setting ◽

Incidence Rates ◽

Health Concern ◽

Clinical Approach ◽

Educational Training ◽

Private Industry ◽

Improvement Project

BACKGROUND: Workplace violence is a major public health concern. According to the U.S. Bureau of Labor Statistics, from 2002 to 2013, incidents of serious workplace violence (those requiring days off) were four times more common in health care than in private industry. AIMS: An interprofessional committee developed, implemented, and evaluated a quality improvement project from 2012 to 2016 to reduce workplace violence and prevent staff injury. The initiative termed S.A.F.E. Response stands for Spot a threat, Assess the risk, Formulate a safe response, Evaluate the outcome. METHOD: An institutional review board–approved quality improvement survey was implemented and evaluated. The data were analyzed using descriptive statistics. An interprofessional committee developed and implemented a comprehensive program to prevent injury, which included (a) a mandatory eLearning educational training, (b) a S.A.F.E. Response with standardized interventions for the clinical conditions affecting safety, and (c) a clinical debriefing process. A reduction in nursing staff assault incidence rates was identified as a success. RESULTS: Nursing staff injury rates decreased an average of 40%. CONCLUSIONS: A reduction in nursing staff assault incidence rates was notable. Clinicians equipped with knowledge, skills, and resources can identify and defuse unsafe situations to prevent violence. This clinical approach shifts the focus from crisis intervention to crisis prevention, which reduces injury.

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Winged Metal Needles versus Plastic Winged and Nonwinged Cannulae for Subcutaneous Infusions in Palliative Care: A Quality Improvement Project To Enhance Patient Care and Medical Staff Safety in a Singaporean Hospital

Journal of Palliative Medicine ◽

10.1089/jpm.2015.0085 ◽

2016 ◽

Vol 19 (3) ◽

pp. 318-322 ◽

Cited By ~ 1

Author(s):

Shirlyn Hui-Shan Neo ◽

Mansha Hari Khemlani ◽

Lai Kiow Sim ◽

Angeline Soek Tian Seah

Keyword(s):

Palliative Care ◽

Quality Improvement ◽

Patient Care ◽

Medical Staff ◽

Quality Improvement Project ◽

Improvement Project ◽

Enhance Patient Care

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55 Quality Improvement Project to Assess How Informed Patients are About do not Attempt Cardiopulmonary (DNACPR) Decisions?

Age and Ageing ◽

10.1093/ageing/afz186.09 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i14-i17

Author(s):

P Jayasuriya ◽

Y Amanullah ◽

A Kumar ◽

C Hookey

Keyword(s):

Quality Improvement ◽

Medical Staff ◽

Quality Improvement Project ◽

Next Of Kin ◽

Geriatric Ward ◽

Improvement Project ◽

Information Leaflets ◽

Journal Clubs ◽

Weekly Journal

Abstract Introduction Despite growing evidence regarding DNACPR decisions, there is a paucity of information given to patients regarding resuscitation decisions. The main aim of this quality improvement project was to assess and improve patients’ and their relatives’ understanding about DNACPR decisions. Intervention We initially surveyed 30 inpatients or their next-of-kin (if the patient lacked capacity) in a geriatric ward who had DNACPR decisions in place. Although, 86% knew the implications of a DNACPR decision, only 50% knew that a DNACPR decision would not limit them from receiving other treatment. 66% reported that the information given by the healthcare professional is “too little”. 35 questionnaires were also given to doctors of all grades to assess their practice of DNACPR discussions and barriers for discussion. Majority (95%) of doctors knew what should be included in a DNACPR discussion. Medical staff not considering DNACPR discussions during assessment, medical staff not comfortable to make the DNACPR decision and the fear of distressing the patient are the three main issues that were highlighted as barriers. 17% of doctors reported that they would have attended a cardiac arrest at least on 2-5 occasions for a patient when resuscitation was futile. We presented this data and educated doctors on effective DNACPR discussions using video demonstrations in weekly journal clubs. All doctors were informed to distribute DNACPR Improvement After the intervention, only 80% understood the DNACPR discussion. 76% knew that DNACPR does not limit them from receiving other treatment. 73% reported that this was not stressful and 76% were satisfied with the discussion and reported that their questions were answered adequately. 11 out of 30 patients had received the information leaflets and all found it useful. Discussion Although after the intervention the percentage who understood the DNACPR decision had reduced compared to the initial audit, there was a 20% improvement in who knew that DNACPR decisions did not limit other treatment. We hope to extend this study by carrying out training sessions for doctors to improve the quality of these conversations and thereby enhance adherence to expected practice in DNACPR decision making.

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357 Improving Surgical Consent – A Quality Improvement Project to Enhance the Consenting Process

British Journal of Surgery ◽

10.1093/bjs/znab134.412 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Shrivastava ◽

J Brown ◽

L Sun ◽

R Rajagopal

Keyword(s):

Quality Improvement ◽

Endoscopic Sinus Surgery ◽

Elective Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Quality Improvement Project ◽

Sinus Surgery ◽

Improvement Project ◽

Consent Forms ◽

Educational Meeting ◽

Patient Interviews

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A quality improvement project on nicotine replacement therapy in Shannon Clinic (Northern Ireland)

BJPsych Open ◽

10.1192/bjo.2021.564 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S211-S211

Author(s):

Eileen Moss

Keyword(s):

Quality Improvement ◽

Northern Ireland ◽

Replacement Therapy ◽

Nicotine Replacement Therapy ◽

Medical Staff ◽

Quality Improvement Project ◽

Clinical Environment ◽

Nicotine Replacement ◽

Improvement Project ◽

Different Types

AimsThe aims of this quality improvement project were to determine if Nicotine Replacement Therapy was being prescribed correctly in Shannon Clinic in Northern Ireland and also to improve the rates of correct prescribing of Nicotine Replacement Therapy in the aforementioned unit.BackgroundThere are several different types of Nicotine Replacement Therapy currently available. Shannon Clinic is a smoke-free clinical environment therefore patients who smoke are offered Nicotine Replacement Therapy on admission. When I was working at Shannon Clinic I became aware that there was no clear guidance available to medical staff on the wards regarding prescribing Nicotine Replacement Therapy and therefore I decided to carry out this quality improvement project.MethodAn audit of drug charts was done on the patients who were under the care of the consultant that I worked with. In total nine drug charts were included in the audit. After the audit was complete, I produced a poster to show how to correctly prescribe Nicotine Replacement Therapy. A copy of this poster was placed on each ward in Shannon Clinic. After a period of time the drug charts were re-audited to see if there had been an improvement in the rates of correct prescribing of Nicotine Replacement Therapy.ResultIn total, 22% of the drug charts which were included in the audit had Nicotine Replacement Therapy prescribed incorrectly on them. After the inclusion of a poster outlining how to prescribe Nicotine correctly on each ward in Shannon Clinic, 0% of drug charts had Nicotine Replacement Therapy prescribed incorrectly on them. This was an improvement of 22%.ConclusionThis quality improvement project was successful at reducing the rates of incorrect Nicotine Replacement Therapy in Shannon Clinic. In the future it is my hope that this quality improvement project should lead to the correct prescribing of Nicotine Replacement Therapy for all patients in Shannon Clinic. It should also lead to an increased awareness regarding the different types of Nicotine Replacement Therapy for medical staff working in this clinical unit.

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Learning from Lean: a quality improvement project using a Lean-based improvement approach to improve discharge for patients with frailty in an acute care hospital

BMJ Open Quality ◽

10.1136/bmjoq-2021-001393 ◽

2021 ◽

Vol 10 (4) ◽

pp. e001393

Author(s):

Thomas James Rollinson ◽

Joy Furnival ◽

Sarah Goldberg ◽

Aklak Choudhury

Keyword(s):

Quality Improvement ◽

Acute Care Hospital ◽

Quality Improvement Project ◽

Value Stream Mapping ◽

Care Hospital ◽

Improvement Project ◽

National Initiative ◽

Improved Performance ◽

The Uk ◽

The Impact

A Lean-based improvement approach was used to complete a quality improvement project (QIP) focused on improving speed and quality of discharge of frail patients on two wards at a large teaching hospital in the UK. This was part of a national initiative to embed continuous improvement within the trust. The aim of the QIP was to improve the proportion of prenoon discharges to 33% of total patients discharged from the ward each day. An ‘improvement practice process’ followed, which included seven discrete workshops that took the QIP through four distinct phases—understand, design, deliver and sustain. Several improvement methods and tools were used, including value stream mapping and plan–do–study–act (PDSA) cycles. Ten PDSA cycles were implemented across the clinical areas, including improved planning and data collection of discharge, improved communication between nursing and medical staff, and earlier referrals to community hospitals for discharge. Improved performance was identified through the outcome metric prenoon discharges on both wards, with the average increasing from 8% to 24% on ward X and from 9% to 19% on ward Y, with no other significant change seen in other measures. Pettigrew et al’s context–content–process change model was used to structure the learning from the QIP, which included the impact of varying ward contexts, the format of conducting improvement with staff, the importance of organisational support, the need for qualitative measures, agreeing to an apposite aim and the power of involving service users. The original aim of 33% prenoon discharges was not achieved, yet there was clear learning from completing the QIP which could contribute to ongoing improvement work. This identified that the Lean-based improvement approach used was effective to some degree for improving discharge processes. Further focus is required on collecting qualitative data to identify the impact on staff, especially related to behaviour and culture change.

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TP5.2.14 A quality improvement project: Engaging and educating our thyroidectomy patients

British Journal of Surgery ◽

10.1093/bjs/znab362.019 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Adetayo Aderombi ◽

Yasmin Mahfouz ◽

Fiona Wu ◽

Kevin Beatson ◽

Ibrahim Ahmed

Keyword(s):

Quality Improvement ◽

Health Literacy ◽

Total Thyroidectomy ◽

Elective Surgery ◽

Quality Improvement Project ◽

Improvement Project ◽

Information Leaflets ◽

Operative Complications ◽

Improve Health ◽

Post Operative Complications

Abstract Aims Hypocalcaemia can occur in up to 30% of patients post-total thyroidectomy. Severe hypocalcaemia can lead to life-threatening tetany and seizures. As part of the consent process, risks are discussed typically face-to-face, often with the aid of anatomy illustrations. As tele-consultations become increasingly commonplace, patient-information leaflets (PILs) can be invaluable in enhancing informed consent, and empowering patients regarding their own care. We performed a quality improvement project to assess the feasibility and effects of distributing PILs following consultations to improve patients’ understanding of post-operative complications (specifically hypocalcaemia). Methods A retrospective review of post-total thyroidectomy patients was performed from January 2019 to January 2020. A telephone survey was conducted to assess each patient’s understanding of post-operative complications. As tele-consultations began to be utilised during the COVID-19 pandemic, we designed a simple PIL to distribute to patients awaiting elective total thyroidectomy aiming to improve health literacy. Following distribution of PILs, the survey was repeated to evaluate feasibility and effectiveness. Results Conclusions A simple and inexpensive intervention, PILs can be distributed to patients awaiting elective surgery to improve health literacy, and reduce potential patient harm.

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