scholarly journals Audit on nursing notes in a psychiatry in-patient setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S189-S189
Author(s):  
Kavinda Gunathillaka ◽  
Mariam Timbo ◽  
Stephen Ginn
Keyword(s):  
Physical Health ◽  
Mental State ◽  
Fold Increase ◽  
Assessment Instrument ◽  
Average Score ◽  
Personal Care ◽  
Post Intervention ◽  
Staff Members ◽  
Retrospective Audit ◽  
Audit Cycle

AimsWe aimed to assess the accessibility and informativeness of the content of daily nursing notes through an audit, and improve deficiencies identified.BackgroundNursing notes are an important source of observation findings, of in-ward psychiatry patients.There can be variations in the quality of the notes as well as information contained within.A basic level of clarity and information within all notes will be helpful in using these to inform the management of patients.MethodAn audit was carried-out in a ward treating working-age patients for psychiatric illnesses.Setting standards - standard required of a daily progress note was decided after discussion in multi-disciplinary team meeting (MDT). Clear language and information on; mental-state, medication, meals, physical health, personal care, activities, risks and use of leave, were identified as requirements.Retrospective audit - First audit cycle was carried-out by assessing the notes two weeks retrospectively. The assessment instrument used a qualitative measurement of the readability of the notes as well as quantitative assessment of the contents.Intervention - The standards set during the MDT, as well as a suggested format for recording notes, were communicated to the staff through email. Follow-up meetings with individual staff members and MDT, to evaluate staff satisfaction and new suggestions to improve the format were held. Difficulties staff encountered when implementing the format were discussed and resolved.Second audit cycle - Following implementation of the intervention, the notes were again assessed using the same instrument.ConclusionDifficulty in accessing information from the notes was noted in the first audit cycle. The average score for accessibility of information when scored on Likert scale + 3 to -3, was 1. Use of language scored 2 on average. On the second audit cycle, accessibility had increased to 3 on average while language score remained 2.Quantitative measurement was done for presence of information on; mental state, medication, meals, physical health, personal care, activities, risks and use of time away from ward. All of these parameters showed an increase in the post-intervention second audit cycle. Information on taking meals, medication, and physical health was present 100% of the time in the second cycle. Most improvement was in information on personal care which showed a five-fold increase, from 17% to 89%In conclusion, standard for nursing notes arrived via discussion and consensus in MDT, has been successful in improving the accessibility and information within nursing notes.

scholarly journals Improving TB infection control in a regional hospital in the Eastern Cape, South Africa

2019 ◽  
Vol 8 (1) ◽  
pp. bmjoq-2018-000347 ◽  
Author(s):  
Ilsa Louisa Haeusler ◽  
Felicity Knights ◽  
Vishaal George ◽  
Andy Parrish
Keyword(s):  
South Africa ◽  
Eastern Cape ◽  
Post Intervention ◽  
Hospital Policy ◽  
Staff Members ◽  
Root Cause ◽  
Number Of Patients ◽  
Service Training ◽  
Education And Awareness ◽  
Awareness Raising

This quality improvement (QI) work was carried out in Cecilia Makiwane Hospital (CMH), a regional public hospital in the Eastern Cape, South Africa (SA). SA has among the highest incidence of tuberculosis (TB) in the world and this is a leading cause of death in SA. Nosocomial infection is an important source of TB transmission. Adherence to TB infection prevention control (IPC) measures in the medical inpatient department was suboptimal at CMH. The overall aim of this QI project was to make sustainable improvements in TB IPC. A multidisciplinary team was formed to undertake a root cause analysis and develop a strategy for change. The main barriers to adherence to IPC measures were limited knowledge of IPC methods and stigma associated with TB. Specifically, the project aimed to increase the number of: ‘airborne precaution’ signs placed above patients’ beds, patients correctly isolated and patients wearing surgical face masks. Four Plan-Do-Study-Act cycles were used. The strategy for change involved education and awareness-raising in different formats, including formal in-service training delivered to nurses and doctors, a hospital-wide TB awareness week with engaging activities and competitions, and a World TB Day provincial solidarity march. Data on adherence to the three IPC measures were collected over an 8-month period. Pre-intervention (October 2016), a mean of 2% of patients wore face masks, 22% were correctly isolated and 12% had an airborne precaution sign. Post-intervention (May 2017), the compliance improved to 17%, 50% and 25%, respectively. There was a large variation in compliance to each measure. Improvement was greatest in the number of patients correctly isolated. We learnt it is important to work with, not in parallel to, existing teams or structures during QI work. On-the-ground training of nurses and clinicians should be undertaken alongside engagement of senior staff members and managers. This improves the chance of change being adopted into hospital policy.

scholarly journals Nutrition Standards For Infants and Young Children can be Implemented by Family Child Care Home Providers

2021 ◽  
Vol 8 ◽  
pp. 2333794X2198955
Author(s):  
Lorrene D. Ritchie ◽  
Victoria Keeton ◽  
Danielle L. Lee ◽  
Klara Gurzo ◽  
Elyse Homel Vitale ◽  
...  
Keyword(s):  
Child Care ◽  
Educational Intervention ◽  
Care Home ◽  
Family Child Care ◽  
Average Score ◽  
Post Intervention ◽  
Convenience Sample ◽  
Nutrition Standards ◽  
Infants And Young Children ◽  
Provider Surveys

The study evaluated an educational intervention with family child care home (FCCH) providers to implement nutrition standards. A convenience sample of licensed California FCCH providers (n = 30) attended a 2-hour, in-person group training in English or Spanish on nutrition standards for infants and children aged 1 to 5 years. Provider surveys and researcher observations during meals/snacks were conducted pre- and 3 months post-intervention. Providers rated the training as excellent (average score of 4.9 on a scale of 1-5). Adherence, assessed by survey and observation and compared over time using paired t-tests, increased from an average of 36% pre-intervention to 44% post-intervention ( P = .06) of providers (n = 12) for infant standards and from 59% to 68% ( P < .001) of providers (n = 30) for child standards. One-third (39%) of providers rated infant standards and 19% of providers rated child standards as difficult to implement. Nutrition standards can be implemented by FCCH providers after an educational intervention; a larger study is warranted with a representative group of providers.

scholarly journals 241 Remotely Delivered Yoga Nidra for Insomnia and Anxiety during COVID-19

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A96-A96
Author(s):  
Erica Sharpe ◽  
Matthew Butler ◽  
Doug Hanes ◽  
Ryan Bradley
Keyword(s):  
Adult Population ◽  
Sleep Onset ◽  
Severity Index ◽  
Index Score ◽  
Average Score ◽  
Sleep Onset Latency ◽  
Post Intervention ◽  
Natural Medicine ◽  
National University ◽  
Yoga Nidra

Abstract Introduction Insomnia and related anxiety affect 30 - 50% of the US adult population. These conditions often coexist, and contribute to increased mortality from depression, heart disease, and stroke. The current COVID-19 pandemic has heightened anxiety and sleeplessness, and 53% of US adults report the pandemic has affected their mental health. There is a need for research into therapies for anxiety and insomnia that can be delivered remotely for increased accessibility to reach more individuals in need. Methods To contribute to this need, we examined the effects of remotely delivered Yoga Nidra (translated to mean “yogic sleep”), a guided meditation practice, on anxiety and sleep. The practice was delivered in real-time before bed, or asynchronously via an online REDCap-based platform, once per week for 16-weeks from April to July (during the early months of the COVID-19 pandemic). Results Seventy-four individuals joined the study, of whom 71% reported subthreshold insomnia (Insomnia Severity Index score of 14 ± 4), and 74% reported anxiety (Generalized Anxiety Disorder Index score of 10 ± 5). Seventy-one (96%) participants accessed the asynchronous recordings. Remote delivery of this practice proved very feasible, with no adverse events reported, and although we provided no monetary compensation, 50% of our sample still completed a post-intervention survey. Further, 52% of n=25 respondents who completed both pre- and post-intervention sleep surveys reported decreased sleep onset latency (SOL) the following day, with a mean decrease of 10 minutes (95% CI = −19.0, −0.5) for all respondents, and strongest change (−34 min; p=.017) measured for those who reported SOL between 30-120 min at baseline. Overall state anxiety was decreased by 41% for n=32 respondents who completed pre-post State Trait Anxiety Index (STAI) surveys surrounding a single practice (average score of 47 ± 11 before practice vs. 27 ± 8 after practice, p&lt;.0001). Conclusion Remotely delivered Yoga Nidra is feasible to deliver, and demonstrates potential benefits for anxiety and insomnia, warranting additional research. Support (if any) This work was supported by the R90 BRIDG grant at the Helfgott Research Institute at the National University of Natural Medicine.

scholarly journals 1181 Thoracic Outlet Syndrome - A Miss(Ed) Diagnosis-Delayed Diagnosis Of Thoracic Outlet Syndrome Is Common And Leads To Poorer Functional Outcomes

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Suresh ◽  
G Kaneta ◽  
A Wignakumar ◽  
S Choksy ◽  
S Sinha ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Thoracic Outlet Syndrome ◽  
Delayed Diagnosis ◽  
Initial Presentation ◽  
Shoulder Injury ◽  
Post Intervention ◽  
Vascular Surgeon ◽  
Delivery Of Care ◽  
Retrospective Audit ◽  
Adequate Care

Abstract Thoracic outlet syndrome was first defined by Peet in 1956 as “compression of the neurovascular structures in the interscalene triangle corresponding to the possible etiology of the symptoms”.1 Diagnosis of TOCS still remains controversial due to lack of clear referral pathways and our study aims to create one to prevent adverse treatment outcomes. Method A retrospective audit in a single vascular centre over a 11-year period correlating time of onset of symptoms to delivery of care and post intervention benefits Results Total of 50 patients were analysed during the study. 30 percent of the patients analysed were noted to be referred to a vascular surgeon 3 years post the initial presentation of symptoms. 60 percent were noted to be referred between 6-2.5 years post initial presentation. Remaining 10 percent were noted to be referred in less than 6 years. It was noted that patients belonging to the group Acohort were noted to have recurrence of symptoms, albeit minor post intervention and treatment of TOCS. Whereas recurrence was noted to be nil/ reduced in the patients intervened in less than 2 years from onset of symptoms. Furthermore, the study also noted that more than 50 percent patients with neurogenic/ venous TOCS had a history of preceeding trauma/ shoulder injury and were noted to be not investigated for TOCS. Conclusions Our study lends evidence that delayed diagnosis of thoracic outlet syndrome is common and leads to poorer functional and treatment outcomes. Hence a diagnostic pathway must be proposed and implemented at primary care which caters to diagnosis of TOCS, to avoid delays in delivery of adequate care and treatment.

scholarly journals Use of Ethylmethylhydroxypyridine in Patients Presenting with Myocardial Infarction: Antiischemic, Antidepressant, Anxiolytic Effects

2016 ◽  
pp. 67-74
Author(s):  
Maryna Dolzhenko ◽  
Olena Popovich ◽  
Oksana Shershnyova ◽  
Oleksandr Nudchenko ◽  
Kardo Faradzh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Mental State ◽  
Cardiac Arrhythmias ◽  
Average Score ◽  
Control Group ◽  
Basic Therapy ◽  
Coronary Syndrome ◽  
St Segment

The objective: to evaluate the efficiency of ethylmethylhydroxypyridine (Mexiprim, STADA Arzneimittel AG, Germany) in patients presenting with myocardial infarction at hospital and outpatient stage. Patients and methods. The study included 59 patients with coronary artery disease, acute coronary syndrome with ST1segment elevation in the first day of admission to the ICU, AH, 3-stage, 2 degrees, HF. To all patients basic therapy according to current ESH/ESC guidelines was prescribed. To 39 patients additionally intravenous infusion of 200 mg of mexiprim o.d. for 10 days, followed by 125 mg per os three times a day for next 60 days was administered. Another 20 patients presented control group and received only basic therapy. The study design included: 24-hour Holter monitoring to estimate the dynamics of changes in the ST segment, cardiac arrhythmias and heart rate variability, evaluation by the scale of Beck, Hamilton scale for the assessment of anxiety (HARS) and depression (HDRS), the common blood and urine tests, biochemical blood analysis, evaluation of therapeutic tolerability conducted before treatment and 60 days after treatment. Surveys on a scale SAN, assessment of cognitive impairment on the MMSE scale were performed on the 60th day of treatment. Efficiency criteria were: a 50% reduction of cardiac arrhythmias, a decrease in ischemia, a decrease by 50% or more from baseline average score by HARS, HDRS scales, dynamics of the mental state questionnaire and less than 9 points on a scale of depression, reducing in SAN scale score. Results. In pаtients of mexiprim group significant reduction of depression scores by 62% were observed. According to the dynamics of the mental state questionnaire patients of mexiprim group reported feeling better, that is, reduction of score by 45% . According to the Hamilton scale for the assessment of anxiety (HARS), in particular mental anxiety – decrease in the total score of 65%, somatic anxiety – by 35.5%, and a total of 50% were revealed. In the group of patients receiving additionally intravenous Mexiprim for 10 days significantly reduced the number of single and group PACs, as well as single and multiple PVCs, not only in comparison with these parameters before the treatment, but also in comparison with the control group. In patients treated with Mexiprim no evidence of residual ischaemia were noted, but in the control group statistically significant segment depression ST remained. Heart rate variability was not significantly changed in the control group, but increased in patients who received Mexiprim. Conclusion. Use of Mexiprim in patients with myocardial infarction reduces ST segment depression, amount of ventricular and supraventricular arrhythmias, improved heart rate variability, and the state of anxiety and depression.

scholarly journals Implementation of physical examination pro forma – a complete audit cycle

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S104-S104
Author(s):  
Deshwinder Singh Sidhu ◽  
Guy Molyneux
Keyword(s):  
Mental Health ◽  
Physical Examination ◽  
Physical Health ◽  
Medical Records ◽  
Psychiatric Ward ◽  
City Hospital ◽  
National Guidelines ◽  
Mandatory Requirement ◽  
Audit Cycle ◽  
Pro Forma

AimsAim of this audit is to achieve and maintain 100% compliance in physical examination on admission.BackgroundConducting physical examination on admission is a mandatory requirement and is monitored by the Mental Health Commission during yearly inspections. A report published by Inspectorate of the Mental Health Commission recently in 2019 identifies a gap in physical health monitoring. We conducted a complete audit cycle in an inner city hospital psychiatric ward to monitor compliance with physical examination on admission.MethodWe based the audit on Judgment Support Framework (JSF) version 5 standards. A retrospective review of all of the patient's medical records was carried out. 13 medical records were reviewed in the first cycle. The results of the first cycle were presented to the Multi Disciplinary Team (MDT) members, including the Non-Consultant Hospital Doctors (NCHD). Physical health policy was reviewed, in consultation with the committee and Clinical Director, a Physical Examination pro-forma (colour coded) was developed and implemented. It was based on the National Guidelines and the JSF ver.5. All members of the MDT and NCHDs were briefed on the pro forma introduced. A repeat audit cycle was conducted of all patients admitted after first audit cycle. Data were collected using a simple audit tool indicating if physical examination was conducted or refused.ResultA total of 22 medical records were audited. 13 medical records in the first cycle indicted only 3 patients had physical examination on admission. However, prior to admission a total of six patients had physical exam in the Emergency Department (ED). Upon implementation of the pro forma, 9 medical records of all patients admitted post-first cycle were audited. A total of 7 patients had physical examination on admission to the ward. Two patients refused physical examination and this was clearly documented. One patient had physical examination completed in ED. All newly admitted patients had physical examination completed or the reason why it wasn't completed documented clearly.ConclusionPhysical examination pro forma was successfully implemented, raising current compliance to a 100%, with a significant improvement from 23% compliance in the first cycle. Existing pro forma is helpful as a reminder to NCHDs. Colour coding of pro forma improves accessibility and distinguishability during the process of admission and auditing. Physical examination pro forma will be audited every 6 monthly.

Compliance with the Data Protection Acts in a psychiatric department: a complete audit cycle

2014 ◽  
Vol 31 (2) ◽  
pp. 125-130
Author(s):  
A. Hassab Errasoul ◽  
M. Cannon ◽  
D. Cotter
Keyword(s):  
Data Protection ◽  
Working Hours ◽  
Educational Interventions ◽  
Hospital Data ◽  
Staff Members ◽  
Before And After ◽  
Audit Cycle ◽  
Collection Practices ◽  
Psychiatric Department ◽  
The Impact

Aim1) to assess compliance with the Data Protection Acts (DPA) by a Department of Psychiatry in a general hospital, 2) to implement measures that are likely to maximize compliance with the hospital data protection policy, 3) to close the audit cycle by assessing the impact of such measures on departmental compliance with the DPA over five months period.MethodAn individual, anonymised staff questionnaire on data collection practices, procedure of disclosure of data to third parties and previous training on DPA was used to collect information from the department staff. The premises were inspected at different times over a week period using structured checklist. Default points were recorded during each inspection. Post-audit interventions included a mixture of educational interventions and practical solutions. A re-audited took place five months later using the same method.ResultsThe baseline audit demonstrated significant lack of compliance with the DPA among staff members and lack of staff training on the DPA. Following the interventions, staff awareness of the requirements of the act rose which in turn lead to better adherence to recommend practices in data handling and to mean default points dropped significantly. Management of manual files appears to constitute the biggest problem in this audit. Daytime breaks were found to pose higher risk to stored data compared with before and after working hours.ConclusionsA combination of educational and practical interventions including training of staff on the DPA results in overall improvement in compliance and reduction in default points. However, management of manual (physical) data proves to be more difficult and hence will need more input.

Improvement in the quality of patient notes: A report of a closed loop audit quality improvement project at a neurosurgical department in Pakistan.

2020 ◽  
pp. 1-17
Author(s):  
Mohammad Ashraf ◽  
Syed Shahzad Hussain ◽  
Usman Ahmad Kamboh ◽  
Mehreen Mehboob ◽  
Saman Shahid ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Audit Quality ◽  
Wound Care ◽  
International Standards ◽  
Neurosurgical Department ◽  
Post Intervention ◽  
Improvement Project ◽  
Audit Cycle ◽  
Patient Note ◽  
Operative Notes

Abstract Objective: To identify the deficiencies in patient note record-taking with the aim of improving the quality to meet international standards. Methods: The prospective clinical quality improvement audit study was conducted at the department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore from January 219 to February 2020. The first audit cycle was carried out in July 2019, after data anonymisation, the notes from 1st January to 31st June were analysed in the first audit cycle against a hybrid proforma containing entries deemed essential in operative notes according to the guidelines of the Royal College of Surgeons of England. The guidelines were subsequently disseminated among postgraduate trainees using various methods. Post-intervention, randomly selected patient-notes from 1st August to 31st December 2019 were analysed in the second audit which was done in February 2020. The result of the two audits were compared to assess significance of association between the cycles for each categorical variable. Results: Of the 100 patient-notes audited, 50(50%) were part of each of the two cycles. Significant improvements (p<0.05) were seen between the two cycles in time of operation, pre-op status, post-op care: monitoring instruction, mobilisation, feeding instructions, wound care and position. There was 100% improvement in entries including name, age and sex, date of operation, elective/emergency, name of the procedure and name of operating surgeon and assistant, and the name of anaesthetist. Overall, marked improvement was observed in all parameters except in ‘use of antibiotic prophylaxes’. Conclusion: Regular audits are needed to monitor and improve, Continuous..

Improving patient-centered oral chemotherapy at an academic cancer center.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 212-212
Author(s):  
Charles Henry Lim ◽  
Jennifer Petronis ◽  
Sabrina Mellor ◽  
Monika K. Krzyzanowska
Keyword(s):  
Patient Education ◽  
Treatment Plan ◽  
Patient Survey ◽  
Satisfaction Score ◽  
Cancer Center ◽  
Average Score ◽  
Post Intervention ◽  
Care Plans ◽  
The Impact ◽  
Single Question

212 Background: Despite established standards for prescribing and monitoring oral anti-cancer medications (OAC) and validated tools supporting OAC patient education, substantial quality gaps remain. Methods: To identify local gaps in care for patients receiving OAC, we used a patient survey in the GI and Endocrine medical oncology clinic. Providers were also interviewed. The survey consisted of 23 questions addressing three domains (treatment plan (T) education, self-management (S) education and health team communication (C) as well as a single question overall satisfaction score. A composite average score encompassing all 23 questions was generated. Questions were derived from ASCO chemotherapy standards and validated patient communication instruments and scored on a 5-point Likert scale. Subsequently, individualized drug-specific written care plans guiding patient education were developed and tested in iterative PDSA cycles. The aim was to improve the composite average patient survey score by 10%. The same patient survey was used to assess the impact of the change ideas. Results: We collected 32 patient surveys, 21 pre- and 11 post-intervention. Baseline surveys indicated lowest scores in the C domain. Providers reported variation in education content and communication techniques used. Care plans with standardized content for 8 OAC agents were tested in simulated and clinic settings in a stepwise fashion, with implementation beginning in Feb 2018. Providers received training on integrating the care plans into clinic workflow. The composite average score for all 23 items improved from 4.18 to 4.29. The single question overall satisfaction score improved from 4.17 to 4.45. Improvement was noted across all 3 domains (T: 4.31 → 4.41, S: 4.26 → 4.36, C: 4.00 → 4.15). For balancing measures, provider teaching time per patient initially rose following implementation before returning to baseline. Conclusions: The intervention led to improvement in the patient experience when starting OAC. Standardized content and a framework guiding provider communication were key elements of the change ideas. To meet the study aim, further PDSA cycles integrating teach back methodology and proactive phone follow up are ongoing.

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