Enhancing safety and delivery of oral chemotherapy utilizing lean methodology.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 266-266
Author(s):  
Debbie Fernandez ◽  
Kathy Hulen ◽  
Leigh Anne Scott ◽  
Kelsey Bambara ◽  
Gayle Creamer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Safety Data ◽  
Oral Chemotherapy ◽  
Multidisciplinary Teams ◽  
Safety Standards ◽  
Chemotherapy Agent ◽  
Safety Interventions ◽  
Long Term Impact ◽  
The Right

266 Background: An oral chemotherapy safety event prompted analysis of related workflows utilizing lean quality improvement methodology. This analysis identified high variation in prescription processing, lack of standardized safety checks, inefficient use of pharmacy time, and inadequate data collection. Our goal was to create an oral chemotherapy protocol that could ensure patients have the right oral chemotherapy agent, at the right dose, at the right time, with independent and efficient safety checks by nursing, pharmacy, and providers. Methods: Multidisciplinary teams participated in two kaizen workshops. utilizing lean methodology. Primary workshop objectives were (1) develop safety standards for oral chemotherapy similar to those for intravenous chemotherapy; (2) make workflows more efficient; and (3) have workflows that enable data collection and process control. The first workshop standardized oral chemotherapy prescription processing though a single workflow in the EMR. This enabled robust data collection and established a platform for safety interventions. The second workshop developed standardized safety checks for and integrated those into the EMR workflow. Given the rarity of serious safety events, a validation measurement was not feasible to track in 30-day PDCA cycles. Consequently, surrogate measures of utilization of the EMR prescribing algorithm and reduction of non-clinical pharmacy interventions were used to assess progress. Safety data were collected and correlated to surrogate outcomes for long-term impact assessment. Results: Interventions resulted in the following outcomes: 100% reduction in oral chemotherapy order defects reaching pharmacy; 97% improvement processing oral chemotherapy though a single EMR workflow; 23% reduction in oral chemotherapy processing time; In spite of a 51% increase in oral chemotherapy volume, no serious safety events have occurred in the last year. Conclusions: Comprehensive quality improvement in our oral chemotherapy process increased safety and efficiency while developing data collection systems for continuous improvement. Multidisciplinary workshops with key stakeholders using established lean methodology were critical to success.

Sustaining safety and delivery of oral chemotherapy utilizing lean methodology.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 218-218
Author(s):  
Marc Steven Hoffmann ◽  
Adam Neiberger ◽  
Gloria Solis ◽  
Marshall Johnson ◽  
Debbie Fernandez
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Safety Data ◽  
Production Method ◽  
Error Reduction ◽  
Oral Chemotherapy ◽  
Multidisciplinary Teams ◽  
Care Providers ◽  
Targeted Interventions ◽  
The Right

218 Background: An oral chemotherapy safety event in 2017 prompted analysis of related workflows utilizing lean quality improvement methodology. Three kaizen workshops utilizing lean methodology with primary objectives to 1) develop safety standards for oral chemotherapy as rigorous as those for intravenous chemotherapy; 2) improve efficiency; and 3) design workflows that enable data collection and process control were conducted. Since 2017, our goal has been to sustain developed workflows to ensure oral chemotherapy patients have the right oral chemotherapy agent, at the right dose, at the right time, with independent and efficient safety checks by all care providers. Methods: After multidisciplinary teams participated in three kaizen workshops to develop workflows, education plans were developed and results were incorporated into the lean management system. The lean production method of Training Within Industry (TWI) was used to train physician, nursing, and pharmacy teams to the workflows. Results were communicated to key stakeholders weekly to monitor progress on workflow creation, spread, and process metrics designed to signal defects in the workflow. When processes were deemed ‘out of control,’ clinical team members provided regular and targeted interventions. Safety data were collected and correlated to surrogate outcomes for long-term impact assessment. Results: Interventions resulted in the following outcomes: 62 consecutive weeks with 99% reduction in oral chemotherapy defects reaching pharmacy. 86 consecutive weeks with 51% error reduction processing oral chemotherapy though a single EMR workflow. 57 consecutive weeks with 62% error reduction processing oral chemotherapy though a single EMR workflow. No serious safety events have occurred since 2017. Conclusions: Comprehensive quality improvement in our oral chemotherapy process has resulted in sustained safety, efficiency, and a data collection to signal when process defects occur. Multidisciplinary teams utilizing established lean methodology were critical to success.

scholarly journals Development and evaluation of a national gentamicin and vancomycin quality improvement programme

2020 ◽  
Vol 75 (7) ◽  
pp. 1998-2003 ◽  
Author(s):  
Yvonne Semple ◽  
Marion Bennie ◽  
Jacqueline Sneddon ◽  
Alison Cockburn ◽  
R Andrew Seaton ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Online Survey ◽  
Guideline Implementation ◽  
Mobile App ◽  
Multidisciplinary Teams ◽  
Point Prevalence Study ◽  
National Guidance ◽  
Improvement Programme ◽  
Long Term Impact

Abstract Background Scottish Antimicrobial Prescribing Group (SAPG) recommendations to reduce broad-spectrum antimicrobial use led to an increase in gentamicin and vancomycin prescribing. In 2009, SAPG introduced national guidance to standardize dosage regimens, reduce calculation errors and improve the monitoring of these antibiotics. Studies conducted in 2010 and 2011 identified limitations in guideline implementation. Objectives To develop, implement and assess the long-term impact of quality improvement (QI) resources to support gentamicin and vancomycin prescribing, administration and monitoring. Methods New resources, comprising revised guidelines, online and mobile app dose calculators, educational material and specialized prescribing and monitoring charts were developed in collaboration with antimicrobial specialists and implemented throughout Scotland during 2013–16. An online survey in 2017 evaluated the use of these resources and a before (2011) and after (2018) point prevalence study assessed their impact. Results All 12 boards who responded to the survey (80%) were using the guidance, electronic calculators and gentamicin prescription chart; 8 used a vancomycin chart. The percentage of patients who received the recommended gentamicin dose increased from 44% to 89% (OR 10.99, 95% CI = 6.37–18.95) between 2011 and 2018. For vancomycin, the correct loading dose increased from 50% to 85% (OR = 5.69, CI = 2.76–11.71) and the correct maintenance dose from 55% to 90% (OR = 7.17, CI = 3.01–17.07). Conclusions This study demonstrated improvements in the national prescribing of gentamicin and vancomycin through the development and coordinated implementation of a range of QI resources and engagement with local and national multidisciplinary teams.

Strategi Humas Partai Gerindra dalam Membangun Citra Partai pada Pemilu 2014

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Rialdo Rezeky ◽  
Muhammad Saefullah
Keyword(s):  
Data Collection ◽  
Public Relations ◽  
Media Relations ◽  
Executive Board ◽  
The Public ◽  
Community Or ◽  
The Subject ◽  
Main Components ◽  
The Right ◽  
Participatory Observation

The approach of this research is qualitative and descriptive. In this study those who become the subject of research is an informant (key figure). The subject of this study is divided into two main components, consisting of internal public and external public that is from the Board of the Central Executive Board of Gerindra Party, Party Cadres, Observers and Journalists. The object of this research is the behavior, activities and opinions of Gerindra Party Public Relation Team. In this study used data collection techniques with interviews, participatory observation, and triangulation of data. The results of this study indicate that the Public Relations Gerindra has implemented strategies through various public relations programs and establish good media relations with the reporters so that socialization goes well. So also with the evaluation that is done related to the strategy of the party. The success of Gerindra Party in maintaining the party’s image in Election 2014 as a result of the running of PR strategy and communication and sharing the right type of program according to the characteristics of the voting community or its constituents.Keywords: PR Strategy, Gerindra Party, Election 2014

scholarly journals Changing relationships: how does patient involvement transform professional identity? An ethnographic study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045520
Author(s):  
Marie-Pierre Codsi ◽  
Philippe Karazivan ◽  
Ghislaine Rouly ◽  
Marie Leclaire ◽  
Antoine Boivin
Keyword(s):  
Quality Improvement ◽  
Data Collection ◽  
Health Professionals ◽  
Clinical Care ◽  
Ethnographic Study ◽  
Structured Interviews ◽  
Administrative Team ◽  
Nurse Clinician ◽  
New Perspective ◽  
Relational Framework

ObjectivesTo understand identity tensions experienced by health professionals when patient partners join a quality improvement committee.DesignQualitative ethnographic study based on participatory observation.SettingAn interdisciplinary quality improvement committee of a Canadian urban academic family medicine clinic with little previous experience in patient partnership.ParticipantsTwo patient partners, seven health professionals (two family physicians, two residents, one pharmacist, one nurse clinician and one nurse practitioner) and three members of the administrative team.Data collectionData collection included compiled participatory observations, logbook notes and semi-structured interviews, collected between the summer of 2017 to the summer of 2019.Data analysisGhadiri’s identity threats theoretical framework was used to analyse qualitative material and to develop conceptualising categories, using QDA Miner software (V.5.0).ResultsAll professionals with a clinical care role and patient partners (n=9) accepted to participate in the ethnographic study and semi-structured interviews (RR=100%). Transforming the ‘caregiver–patient’ relationship into a ‘colleague–colleague’ relationship generated identity upheavals among professionals. Identity tensions included competing ideals of the ‘good professional’, challenges to the impermeability of the patient and professional categories, the interweaving of symbols associated with one or the other of these identities, and the inner balance between the roles of caregiver and colleague.ConclusionThis research provides a new perspective on understanding how working in partnership with patients transform health professionals’ identity. When they are called to work with patients outside of a simple therapeutic relationship, health professionals may feel tensions between their identity as caregivers and their identity as colleague. This allows us to better understand some underlying tensions elicited by the arrival of different patient engagement initiatives (eg, professionals’ resistance to working with patients, patients’ status and remuneration, professionals’ concerns toward patient ‘representativeness’). Partnership with patients imply the construction of a new relational framework, flexible and dynamic, that takes into account this coexistence of identities.

scholarly journals Fieldwork on epistemic authority markers: What we can learn from different types of data

2020 ◽  
Vol 54 (2) ◽  
pp. 405-445 ◽  
Author(s):  
Karolina Grzech
Keyword(s):  
Data Collection ◽  
Discourse Markers ◽  
Epistemic Modality ◽  
Linguistic Meaning ◽  
Epistemic Authority ◽  
Data Collection And Analysis ◽  
The Right To Know ◽  
Cognitive Study ◽  
The Right

AbstractEpistemicity in language encompasses various kinds of constructions and expressions that have to do with knowledge-related aspects of linguistic meaning (cf. Grzech, Karolina, Eva Schultze-Berndt and Henrik Bergqvist. 2020c. Knowing in interaction: an introduction. Folia Linguistica [this issue]). It includes some well-established categories, such as evidentiality and epistemic modality (Boye, Kasper. 2012. Epistemic meaning: A crosslinguistic and functional-cognitive study. Berlin: De Gruyter Mouton), but also categories that have been less well described to-date. In this paper, I focus on one such category: the marking of epistemic authority, i.e. the encoding of “the right to know or claim” (Stivers, Tanya, Lorenza Mondada & Jakob Steensig. 2011b. Knowledge, morality and affiliation in social interaction. In Stivers et al. 2011a). I explore how the marking of epistemic authority can be documented and analysed in the context of linguistic fieldwork. The discussion is based on a case study of Upper Napo Kichwa, a Quechuan language spoken in the Ecuadorian Amazon that exhibits a rich paradigm of epistemic discourse markers, encoding meanings related to epistemic authority and distribution of knowledge between discourse participants. I describe and appraise the methodology for epistemic fieldwork used in the Upper Napo Kichwa documentation and description project. I give a detailed account of the different tools and methods of data collection, showing their strengths and weaknesses. I also discuss the decisions made at the different stages of the project and their implications for data collection and analysis. In discussing these issues, I extrapolate from the case study, proposing practical solutions for fieldwork-based research on epistemic markers.

scholarly journals Comparing Glioblastoma Surgery Decisions Between Teams Using Brain Maps of Tumor Locations, Biopsies, and Resections

2019 ◽  
pp. 1-12 ◽  
Author(s):  
Domenique M.J. Müller ◽  
Pierre A.J.T. Robe ◽  
Roelant S. Eijgelaar ◽  
Marnix G. Witte ◽  
Martin Visser ◽  
...  
Keyword(s):  
Tumor Location ◽  
Three Dimensions ◽  
Multidisciplinary Teams ◽  
Surgical Removal ◽  
Treatment Variation ◽  
Probability Maps ◽  
Resected Patient ◽  
The Right ◽  
Referral Bias ◽  
The Brain

Purpose The aim of glioblastoma surgery is to maximize the extent of resection while preserving functional integrity, which depends on the location within the brain. A standard to compare these decisions is lacking. We present a volumetric voxel-wise method for direct comparison between two multidisciplinary teams of glioblastoma surgery decisions throughout the brain. Methods Adults undergoing first-time glioblastoma surgery from 2012 to 2013 performed by two neuro-oncologic teams were included. Patients had had a diagnostic biopsy or resection. Preoperative tumors and postoperative residues were segmented on magnetic resonance imaging in three dimensions and registered to standard brain space. Voxel-wise probability maps of tumor location, biopsy, and resection were constructed for each team to compare patient referral bias, indication variation, and treatment variation. To evaluate the quality of care, subgroups of differentially resected brain regions were analyzed for survival and functional outcome. Results One team included 101 patients, and the other included 174; 91 tumors were biopsied, and 181 were resected. Patient characteristics were largely comparable between teams. Distributions of tumor locations were dissimilar, suggesting referral bias. Distributions of biopsies were similar, suggesting absence of indication variation. Differentially resected regions were identified in the anterior limb of the right internal capsule and the right caudate nucleus, indicating treatment variation. Patients with (n = 12) and without (n = 6) surgical removal in these regions had similar overall survival and similar permanent neurologic deficits. Conclusion Probability maps of tumor location, biopsy, and resection provide additional information that can inform surgical decision making across multidisciplinary teams for patients with glioblastoma.

Pengembangan Potensi Ekowisata Suku Sambori Bima Nusa Tenggara Barat Indonesia

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Zulharman Zulharman ◽  
Mochamad Noeryoko ◽  
Ibnu Khaldun
Keyword(s):  
Medicinal Plants ◽  
Data Collection ◽  
Natural Resources ◽  
Land Management ◽  
Research Method ◽  
Economic Conditions ◽  
Tourist Attraction ◽  
Cultural Life ◽  
Future Strategy ◽  
The Right

The objectives of this study were: a. Identifythe potential for ecotourism based on family medicinal plants (toga) that can be developed in Sambori Tribe b. Identify the right strategy for developingecotourism based on family medicinal plants (toga) in Sambori Tribe based on community and stakeholder perceptions. Research Methods:The research method used descriptive methods with survey and observation techniques. Data collection used purposive sampling, the data consisted of aspects of tourism products and markets, economic and business benefits from ecotourism activities and the socio-economic conditions of the community. Product aspects include the main potential of flora, namely toga plants, fauna, natural attractions and landscapes, amenities, accessibility and the socio-cultural life of the community. The market aspect consists of potential tourists in Sambori Tribe. Key informants (Stakeholders). In this study, thestrategy is not only subjective to the researcher, the researcher also involves the opinions of related experts to become respondents. Results and Discussion:  The results of the research that Sambori Tribe had a variety of toga plants with  the potential as a tourist attraction.Sambori Tribe has a diversity of flora and fauna potentials as well as a very suitable landscape potential as a tourist attraction. Conclusion: Sambor Tribe has the potential of flora and faund and the landscape.  The future strategy for developing ecotourism of Toga in Sambori Tribe includes optimizing the potential of toga plants in terms of cultivation, land management and processing potential of toga plants, developing high potential of biological natural resources, both flora and fauna, and natural panoramas

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