scholarly journals Bowel monitoring in psychiatry of old age: a quality improvement project

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S180-S180
Author(s):  
Alistair Cowie ◽  
Stephanie Sloan ◽  
Cara McDonald
Keyword(s):  
Quality Improvement ◽  
Psychiatric Symptoms ◽  
Bowel Perforation ◽  
Bowel Function ◽  
Bowel Habit ◽  
Care Centre ◽  
Staff Education ◽  
Improvement Project ◽  
Normal Bowel ◽  
Pdsa Cycle

AimsThis project aims to ensure all patients in the dementia ward 1 in Kingsway Care Centre, Dundee have daily bowel monitoring and achieve a normal bowel habit. The hypothesis is that patients are inadequately screened and substantial undiagnosed constipation exists.BackgroundConstipation has a prevalence of 16-50% among individuals over 65 years old in the community. Psychiatric illnesses are known risk factors with older psychiatric patients 3-6 times more likely to be constipated. Untreated constipation may progress to serious complications such as bowel obstruction and bowel perforation. Delirium, often mislabelled as worsening psychiatric symptoms, also may occur leading to additional psychotropic medications being prescribed, further worsening the constipation.MethodAll patients in Ward 1, Kingsway Care Centre Dundee over 4 months were included, amounting to 25 patients. Data were gathered from stool charts weekly. Quality improvement framework was followed with two plan-do-study-act (PDSA) cycles completed. Normal bowel function was assessed against ROME IV constipation criteria and less than 75% of Bristol stool type 6 or 7 due to the risk of overflow diarrhoea and laxative overuse. In the first PDSA cycle, stool charts were modified to account for patients independently mobilising to the bathroom and daily documentation even if bowel movements were uncertain. The second PDSA cycle introduced a sticker on charts folder to “ask the patient” along with a staff education leaflet on the complications of constipation. Data were anonymised and analysed with run charts using Microsoft Excel.ResultAt baselines, 50% of patients had a stool chart. This increased to 90% in cycle 1, 100% in cycle 2. 28% of patients had any stools documented at baselines. This increased to 31% in cycle 1, 59% in cycle 2. At baselines, 0% of patients had a normal bowel habit. This maintained at 0% in cycle 1 but increased to 13% in cycle 2. No serious complications were found in patients assisted with toileting. However, 34% of independently mobile patients developed serious complications.ConclusionPoor documentation existed in all patients, particularly those independently mobile. Independently mobile patients were particularly at risk of serious complications of constipation compared to assisted patients. Introduction of new stool charts in the first PDSA cycle resulted in increased documentation but limited benefit for identification of constipation. The second PDSA cycle, targeting staff education and compliance, showed an increase in identification of constipation indicating limited staff knowledge as a key barrier to improvement in patients’ bowel habit.

scholarly journals ‘CPR for Feet’ care bundle to improve foot assessment in inpatient diabetes

2018 ◽  
Vol 7 (3) ◽  
pp. e000196 ◽  
Author(s):  
Rhea O’Regan ◽  
Ross MacDonald ◽  
James G Boyle ◽  
Katherine A Hughes ◽  
Joyce McKenzie
Keyword(s):  
Quality Improvement ◽  
Nursing Staff ◽  
Quality Improvement Project ◽  
Care Bundle ◽  
Staff Education ◽  
Pressure Relief ◽  
Improvement Project ◽  
The Third ◽  
Inpatient Diabetes ◽  
Pdsa Cycle

AimsThe Scottish Inpatient Diabetes Foot Audit conducted in 2013 revealed that 57% of inpatients had not had their feet checked on admission, 60% of those at risk did not have pressure relief in place and 2.4% developed a new foot lesion. In response, the Scottish Diabetes Foot Action Group launched the ‘CPR for Feet’ campaign. The aim of this project was to raise awareness of the ‘Check, Protect and Refer’ (CPR) campaign as well as improve the assessment and management of inpatients with diabetes.MethodsA quality improvement project underpinned by Plan-Do-Study-Act (PDSA) methodology was undertaken. The first and second cycles focused on staff education and the implementation of a ‘CPR for Feet’ assessment checklist using campaign guidelines, training manuals and modules. The third and fourth cycles focused on staff feedback and the implementation of a ‘CPR for Feet’ care bundle.ResultsBaseline measurements revealed 28% of patients had evidence of foot assessment. Medical and nursing staff reported to be largely unaware of the ‘CPR for Feet’ campaign (13%). Fifty-two per cent of inpatients with diabetes had their feet assessed and managed correctly following the second PDSA cycle. After completion of the third and fourth PDSA this number improved further to 72% and all staff reported to be aware of the campaign.ConclusionsThe introduction of a ‘CPR for Feet’ care bundle improved the assessment of inpatients with diabetes.

scholarly journals Quality improvement primer part 2: executing a quality improvement project in the emergency department

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 532-538 ◽  
Author(s):  
Lucas B. Chartier ◽  
Antonia S. Stang ◽  
Samuel Vaillancourt ◽  
Amy H. Y. Cheng
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Quality Improvement ◽  
Improvement Project ◽  
Emergency Department Setting ◽  
Pdsa Cycle ◽  
Time To Antibiotics ◽  
Final Article

ABSTRACTThe topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement. We will review what makes a good aim statement, the various categories of measures that can be tracked during a QI project, and the relative merits and challenges of potential change concepts and ideas. We will also present the Model for Improvement’s rapid-cycle change methodology, the Plan-Do-Study-Act (PDSA) cycle. The final article in this series will focus on the evaluation and sustainability of QI projects.

scholarly journals Implementing the Patient Health Questionnaire Modified for Adolescents to improve screening for depression among adolescents in a Federally Qualified Health Centre

2020 ◽  
Vol 9 (4) ◽  
pp. e000751
Author(s):  
Mohamed Mansour ◽  
Dharshana Krishnaprasadh ◽  
Janice Lichtenberger ◽  
Jonathan Teitelbaum
Keyword(s):  
Quality Improvement ◽  
Adolescent Depression ◽  
Quality Improvement Project ◽  
Patient Health Questionnaire ◽  
Depression Symptoms ◽  
Health Questionnaire ◽  
Screening Rate ◽  
Improvement Project ◽  
Pdsa Cycle ◽  
Patient Health

BackgroundDepression, which is a serious medical illness, is prevalent worldwide and it negatively impacts the adolescent lifestyle. Adolescent depression is associated with adverse emotional and functional outcomes and suboptimal physical health. Over the last decade, it has been found that approximately 9% of teenagers meet the criteria for depression at any given time, and one in five teenagers have a history of depression during adolescence. Ninety per cent of paediatricians believe that recognition of child and adolescent depression is their responsibility; however, it has been reported that 46% lacked confidence that they could recognise depression.MethodsIn this study, adolescents between 12 and 17 years of age were screened during their well-child visits using the Patient Health Questionnaire Modified for Adolescents. A score of 10 or higher warrants a referral to a social worker and psychiatrist. The goals of this quality improvement project were to implement a standardised questionnaire and to improve the screening, diagnosis and treatment of depression in children from 12 to 17 years of age.ResultsIt was found that the adolescent depression screening rate significantly improved within 6 months of implementing this quality improvement project. The screening rate improved to 50% by mid-cycle (Plan-Do-Study-Act (PDSA) cycle 3) and up to 70% at the end of the 6-month period (PDSA cycle 5). Improvement was noted among all providers, across all age groups, and in both male and female patients by the end of the study period.ConclusionStandardised screening tests with a scoring system help providers to identify and monitor depression symptoms using a common language, especially in the outpatient clinical setting where the patient may be seen by different providers.

Improving time to initiation of bone modifying agents in patients with newly diagnosed multiple myeloma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6528-6528
Author(s):  
Nathaniel Rosko ◽  
Sarah Lee ◽  
Christy Joy Samaras ◽  
Alex V. Mejia ◽  
Faiz Anwer ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Quality Improvement ◽  
Cleveland Clinic ◽  
Institutional Care ◽  
Baseline Data ◽  
Physician Education ◽  
Newly Diagnosed ◽  
Improvement Project ◽  
Pdsa Cycle ◽  
Time To Initiation

6528 Background: Current ASCO and IMWG guidelines recommend that all patients (pts) on active anti-myeloma therapy receive concurrent supportive care treatment with a bone modifying agent (BMA) to decrease the risk of skeletal related events (SRE). Unfortunately, recent data shows only 51% of Medicare pts with myeloma received a BMA within 90 days of first chemotherapy. We implemented a quality improvement project to identify the average time to BMA initiation at all Cleveland Clinic affiliated sites, with the primary goal to improve time to initiation of BMA in newly diagnosed multiple myeloma (NDMM) pts by 4 weeks at Cleveland Clinic Main Campus (MC). Methods: Barriers with BMA initiation were identified using quality improvement tools developed at the ASCO Quality Training Program. The first PDSA cycle was implemented between September 2018 – January 2019 with an emphasis on education. This included review of updated guidelines, literature review of risks and toxicities associated with BMAs, and strategies for choosing BMA based on pt factors. Baseline data on time to start BMA and data to evaluate impact of PDSA intervention was completed via chart review. Results: 161 NDMM pts were evaluated between 2015 to 2018 at all sites. The average time difference between the start of anti-myeloma therapy and the start date of a BMA in NDMM pts was 10.5 weeks. Subset analysis based on whether pts were treated at MC vs affiliate sites was 10.6 weeks vs 9.1 weeks, respectively. During the first PDSA cycle, 14 NDMM pts were treated at MC. 86% (12/14) pts were treated with a BMA. The average time between cycle 1 day 1 of first line treatment and first dose BMA was 4.3 weeks (range 4-12 weeks). Conclusions: With increased physician education and awareness of internal baseline data, we achieved our initial goal and observed a significant improvement in time to initiation of BMA from 10.5 weeks to 4.3 weeks. Obstacles regarding effective communication with patients on the benefit of BMAs as well as need for dental clearance were barriers identified early on. We plan to incorporate BMA guidelines in our institutional care path with the goal to decrease time to initiation at all affiliated practices. Further mechanisms to ensure reinforcement of BMA initiation in NDMM patients is warranted to maintain therapeutic benefit.

Using Lean methodology to improve the time to antibiotics in oncology patients on chemotherapy who present to the ED with neutropenic fever.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 31-31
Author(s):  
Brian J. Byrne ◽  
Frederick Bailey ◽  
Pat Montanaro ◽  
Patricia Anne DeFusco
Keyword(s):  
Quality Improvement ◽  
Substantial Improvement ◽  
Neutropenic Fever ◽  
Medical Emergency ◽  
Antibiotic Administration ◽  
Improvement Project ◽  
The Third ◽  
Pdsa Cycle ◽  
Time To Antibiotics ◽  
American Society

31 Background: Neutropenic fever is a medical emergency. Delays in treatment can lead to increase in morbidity, mortality, and increase length of stay. The American Society of Clinical Oncology currently recommends that antibiotics be prescribed within 60 minutes of triage. Literature review shows through a multidisciplinary effort involving the ED, lab, oncology, and pharmacy significant improvement in time to antibiotics can be achieved. Since many patients with neutropenic fever present with sepsis, these guidelines also will need to be followed. Methods: Three PDSA cycles were conducted. The first involved education of the ED staff on the importance of treating neutropenic fever and using the correct antibiotic. The second PDSA cycle involved the laboratory and the calling of critical white counts and low neutrophil counts. The third PDSA involves patient education on the importance of temperature monitoring and reporting they are on chemotherapy to ED staff. Results: Baseline data show only 33% of patients receive the correct antibiotic and the average time to administration is 3 hours and 41 minutes. Results of the quality improvement project show a substantial improvement in time to antibiotic administration to 1 hour 58 minutes and an increase in the percentage of patients who receive the correct antibiotic. The time from the specimen received in the lab until critical called also improved from 1 hour 14 minutes to 18.5 minutes. Conclusions: This quality improvement led to a significant improvement in time to correct antibiotics, but several additional steps need to be taken to meet ASCO guidelines. [Table: see text]

scholarly journals A quality improvement project to increase patient feedback in the psychotherapy department, Tavistock Clinic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S170-S171
Author(s):  
Avgoustina Almyroudi ◽  
Alan Baban ◽  
Sukhjit Sidhu
Keyword(s):  
Quality Improvement ◽  
Online Survey ◽  
Response Rate ◽  
Feedback System ◽  
Response Rates ◽  
Improvement Project ◽  
Complex Needs ◽  
The Core ◽  
Patient Feedback ◽  
Pdsa Cycle

AimsA rigorous and systematic patient feedback system is important for identifying gaps, improving the quality of care and encouraging patient involvement in service delivery. In the Adult Complex Needs Service of the Tavistock Clinic, a tertiary psychotherapy centre, only 5% of patients have provided feedback when requested. This Quality Improvement (QI) project aimed at improving the return rates of the Experience of Service Questionnaire (ESQ) and the CORE Outcome Measure by 10% within a year.MethodThe QI methodology was used to help identify factors contributing to the low response rate, including views amongst stuff about how such feedback, and the method of its delivery, might affect a psychoanalytically-informed treatment. Previously these forms were posted or handed out in person. In the first Plan-Do-Study-Act (PDSA) cycle, the method of distribution was changed by sending out the questionnaires to patients electronically, using an online survey platform. In the second PDSA cycle, the CORE-34 questionnaire was replaced with a shorter version, the CORE-10. This was in order to test our hypothesis that a shorter questionnaire would result in an increase in the response rates.ResultIn the first cycle of change, 197 patients were emailed for both the CORE-34 and ESQ and a total return rate of 31% was achieved. This signified an increase of 26% in the response rate. Overall more ESQ forms were completed (35% uptake) compared to CORE-34 forms (28% uptake). In the second cycle 199 patients were emailed with the CORE-10 and ESQ forms. The response rate was 21% and 18% respectively. Although the response rates decreased slightly in the second PDSA cycle the results indicated that this method of distribution was capturing a greater range of patients who had not previously provided the service with this sort of feedback.ConclusionSending out the outcome measures electronically and adopting shorter versions of the CORE questionnaire increased the feedback response rate significantly, and provided the service with useful data as to patients' experience of their treatment journey here.

Improving communication lines: quality improvement project moving a department away from outdated paging

BMJ Leader ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 37-40
Author(s):  
Neil John Jones ◽  
Sachi Shah ◽  
Shibby Robati ◽  
Michael Thilagarajah
Keyword(s):  
Quality Improvement ◽  
Mobile Phone ◽  
Mobile Phones ◽  
Healthcare Professionals ◽  
District General Hospital ◽  
Junior Doctors ◽  
Improvement Project ◽  
Mobile Phone Technology ◽  
Pdsa Cycle ◽  
The Way

IntroductionPaging systems in Hospitals have been established for some time, but they are now outdated and unreliable. This opinion is shared by the UK government, which has given the NHS until 2021 to become free of these technologies. Given this new mandate, we wanted to implement a change in the way other Healthcare Professionals can contact Orthopaedic Senior House Officer Doctors (SHOs), at Darent Valley Hospital, a District General Hospital in Kent, England.MethodsUsing the Plan, Do, Study, Act (PDSA) cycle model for quality improvement projects, the authors demonstrate two successful cycles improving the way in which HCPs can establish communication with Orthopaedic Junior Doctors. PDSA cycle 1 introduced a ward doctor to be stationed on the orthopaedic wards and to carry a mobile phone. The mobile phone worked well, but there were limitations to having to stay on the wards. PDSA cycle 2 introduced mobile phones for all Orthopaedic Doctor Teams. Impact of changes made was measured using staff questionnaires distributed to a range of Healthcare Professionals.ResultsAfter PDSA Cycle 1, 100% of the 36 asked agreed that having a ward doctor had saved time in their day. 72% said they page an Orthopaedic Doctor zero to two times with no reply, compared with 9% before the change was implemented. After PDSA cycle 2, 100% of the 31 asked agreed that using mobile phones was an effective way of communicating with the Orthopaedic Doctors, and 90% said that, on average, they would spend less than 2 min trying to contact an Orthopaedic Doctor, compared with 33% after PDSA cycle 1 intervention.ConclusionThis cycle has clearly improved communication in our orthopaedic department. If used in the right way, mobile phone technology can surely improve our clinical environments.

Improving time to start bone modifying agents in newly diagnosed multiple myeloma patients.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 65-65
Author(s):  
Sarah Lee ◽  
Nathaniel Rosko ◽  
Janice Reed ◽  
Mary Ann Karam ◽  
Beth Faiman ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Quality Improvement ◽  
Cleveland Clinic ◽  
Institutional Care ◽  
Therapeutic Benefit ◽  
Baseline Data ◽  
Physician Education ◽  
Newly Diagnosed ◽  
Improvement Project ◽  
Pdsa Cycle

65 Background: Current ASCO and IMWG guidelines recommend all patients (pts) on active myeloma therapy receive concurrent supportive care with a bone modifying agent (BMA) to decrease the risk of skeletal related events (SRE). Unfortunately, recent data shows only 51% of Medicare pts with myeloma received a BMA within 90 days of first chemotherapy. We implemented a quality improvement project to identify the average time to BMA initiation at all Cleveland Clinic affiliated sites, with the primary goal to improve time to start BMA in newly diagnosed multiple myeloma (NDMM) pts by 4 weeks at Cleveland Clinic Main Campus (MC). Methods: Barriers to start BMA were identified using quality improvement tools developed at ASCO Quality Training Program. The first PDSA cycle ran from Sept 2018–Jan 2019 with an emphasis on education. This included review of updated guidelines, literature review of risks and toxicities associated with BMAs, and strategies for choosing BMA based on pt factors. Baseline data on time to start BMA and data to evaluate impact of PDSA intervention was done by chart review. Results: 161 NDMM pts were evaluated from 2015–2018 at all sites. The average time difference between the start of myeloma therapy and the start date of BMA in NDMM pts was 10.5 weeks. Subset analysis based on whether pts were treated at MC vs affiliate site was 10.6 weeks vs 9.1 weeks, respectively. During the first PDSA cycle, 14 NDMM pts were treated at MC. 86% (12/14) pts were treated with BMA. The average time between cycle 1 day 1 of first line treatment and first dose BMA was 4.3 weeks (range 4-12 weeks). Conclusions: With increased physician education and awareness of internal baseline data, we achieved our initial goal and observed a significant improvement in time to start BMA from 10.5 weeks to 4.3 weeks. Obstacles regarding effective communication with patients on the benefit of BMAs as well as need for dental clearance were barriers identified early on. We plan to incorporate BMA guidelines in our institutional care path with the goal to decrease time to initiation at all affiliated practices. Further mechanisms to ensure reinforcement of BMA initiation in NDMM patients is warranted to maintain therapeutic benefit.

scholarly journals The development of a quality improvement project to improve infection prevention and management in patients with asplenia or hyposplenia

2020 ◽  
Vol 9 (3) ◽  
pp. e000770
Author(s):  
Natalya Elizabeth O'Neill ◽  
Jillian Baker ◽  
Richard Ward ◽  
Colleen Johnson ◽  
Linda Taggart ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Best Practice ◽  
Tertiary Care ◽  
Clinic Visit ◽  
Quality Improvement Project ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Improvement Project ◽  
Vaccination Rates ◽  
Fever Management

Asplenia and hyposplenia (a/hyposplenia) are associated with increased morbidity and mortality from complications including infection. The recommended measures to reduce the risks associated with infection include patient education, vaccination and early initiation of antibiotic therapy for fever. Despite these recommendations, there is poor adherence to best practice management of patients with asplenia or hyposplenia (PWA/H). We present the development methodology and pilot data of a quality improvement project that explored whether a programme involving a novel medical alert card together with a patient and healthcare provider educational booklet increased vaccination rates and improved awareness and understanding of the infectious implications of a/hyposplenia. Our aim was to increase the proportion of those appropriately vaccinated and the proportion of patients with proper understanding of fever management by twofold in 18 months. Questionnaires were used locally as a root-cause-analysis to confirm the need for education and evaluate the effectiveness of the programme, as well as patient satisfaction. An interdisciplinary team developed a toolkit composed of a medical alert card and booklet. The toolkit was distributed to PWA/H who presented for a haematology clinic visit at a tertiary care centre. A separate set of questionnaires was then used to evaluate satisfaction and obtain feedback from patients and practitioners receiving the toolkit for the first time. Changes suggested by patients and practitioners with unanimous agreement among study investigators were made to the toolkit. The pilot study showed an increase in vaccination rates and awareness of vaccination status and appropriate fever management. The majority of the patients and practitioners found the information provided by the toolkit helpful. Given these promising single-centre findings, the intervention is being extended to another tertiary care centre with a large red blood cell disorders programme to evaluate its generalisability. The next step will be to expand the scope to paediatric PWA/H.

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