scholarly journals Leveraging the Outpatient Pharmacy to Reduce Medication Waste in Pediatric Asthma Hospitalizations

2019 ◽  
Vol 15 (01) ◽  
pp. 28-34
Keyword(s):  
Quality Improvement ◽  
Asthma Exacerbation ◽  
Outcome Measure ◽  
Insurance Coverage ◽  
Secondary Outcome ◽  
Inpatient Cost ◽  
Secondary Outcome Measure ◽  
Improvement Project ◽  
Medication Waste ◽  
Discharge Medication

BACKGROUND AND OBJECTIVE: Previous local quality improvement focused on discharging patients with inhaled corticosteroids (ICS) “in-hand” decreased healthcare reutilization after hospitalization for an asthma exacerbation. However, as a result of these new processes, some patients admitted for an asthma exacerbation received more than one ICS inhaler during their admission, contributing to medication waste and potential patient confusion regarding their discharge medication regimen. We sought to decrease this waste. METHODS: We conducted a quality improvement project to reduce the prescribing of multiple ICS inhalers to patients at a large academic children’s hospital. Our primary outcome measure was the monthly percentage of patients admitted with an asthma exacerbation who were administered more than one ICS inhaler. A secondary outcome measure evaluated the reliability of the new process of using the hospital-based outpatient pharmacy to supply ICS “in-hand” and verify insurance coverage. After the process map review, we hypothesized a delay in the initial ICS treatment decision would allow for both a finalized discharge medication plan and a standardized process to verify outpatient insurance coverage. | RESULTS: The mean percentage of patients receiving more than one ICS inhaler decreased from our baseline of 7.4% to 0.7%. Verification of outpatient prescription insurance coverage via the outpatient pharmacy increased from 0.7% to 50%. The average inpatient cost (average wholesale price) for ICS decreased by 62% to $90.25. CONCLUSIONS: Our process change to use the outpatient pharmacy to dispense and verify insurance coverage for ICS medication was associated with a reduction in medication waste during admission for an asthma exacerbation.

scholarly journals Effectiveness of an audit programme for dyslipidaemia management in a primary care setting in Macau: a quality improvement study

2020 ◽  
Vol 8 (1) ◽  
pp. e000222 ◽  
Author(s):  
In Wong ◽  
See Fai Tse ◽  
Chau Sha Kwok
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Statin Therapy ◽  
Health Center ◽  
Care Setting ◽  
Primary Care Setting ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Patient Records

ObjectiveThe objective of this study was to test the effectiveness of an audit programme for dyslipidaemia management in a primary care setting in Macau.DesignA quality improvement study based on an evaluation of a before-after intervention trial was conducted in 2017–2018. Interventions comprising feedback from an audit, general practitioner (GP) training via interactive workshops and one-on-one case discussions were implemented. The primary outcome measure was the proportion of patients with reasonable management of dyslipidaemia, and the secondary outcome measure was the proportion of patients with low-density lipoprotein cholesterol (LDL-C) meeting the target recommended by the Adult Treatment Panel III guidelines.SettingThis study was conducted at the Sao Lourenco Health Center, one of the health centres in the Macau primary care system; this centre provides primary care services to one-tenth of the residents of Macau.ParticipantsAll GPs who worked in the Sao Lourenco Health Center participated in the study. We systematically reviewed 100 patient records from each participating physician’s patient list. In total, 1200 and 1100 patient records were reviewed before and after the intervention, respectively.ResultsAt baseline, 390 (43.5%) patients were eligible for statin therapy, while 411 (47.7%) patients were eligible for statin therapy in the reaudit group (p=0.08). After intervention, the proportion of patients with reasonable management of dyslipidaemia increased from 83.9% to 88.5% (p=0.005), and the proportion of eligible patients with LDL-C levels meeting the target increased from 55.1% to 65% (p=0.004).ConclusionsThe audits and feedback significantly improved dyslipidaemia management in the Macau primary care setting.

Quality Improvement Approach to Increase Inpatient Pediatric Secondhand Smoke Exposure Screening

2021 ◽  
Author(s):  
Christine Studenmund ◽  
Jazzmin Williams ◽  
Antonio Hernandez ◽  
Elda Young ◽  
Ying Ying Hui ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Secondhand Smoke ◽  
Outcome Measure ◽  
Resource Distribution ◽  
Safety Net ◽  
Smoke Exposure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Secondhand Smoke Exposure ◽  
Positive Screen

BACKGROUND: Secondhand smoke exposure (SHSe) is highly prevalent among children and has numerous adverse health effects. Consistent screening for SHSe is an essential first step to helping families break the toxic cycle of smoking. METHODS: With this quality improvement project, we evaluated a SHSe screening and cessation resource distribution protocol in a general pediatrics inpatient unit of a safety-net hospital. Our primary outcome measure was the percent of admissions screened for SHSe, with a goal of increasing our documented rate of SHSe screening from 0% to 70% within 6 months of implementation. Our secondary outcome measure was the percent of those who screened positive for SHSe who were offered smoking cessation resources. Process measures included tracking nurse confidence in screening and compliance with new workflow training. Balancing measures were nurse satisfaction and brevity of screening. RESULTS: From May 1, 2019, to April 30, 2020, nurses screened 97.2% of the 394 patients admitted to the pediatric unit for SHSe. Of the patients screened, 15.7% were exposed to cigarettes or other tobacco products, 5.6% to e-cigarettes, and 6.5% to marijuana. Nurses documented offering “Quit Kits” with cessation materials to 45 caregivers (72.6% of positive screen results) and offering 33 referrals to the California Smokers' Helpline (53.2% of positive screen results). CONCLUSION: In this project, we successfully implemented a screening protocol for SHSe to tobacco, e-cigarettes, and marijuana and a workflow for cessation resource distribution in an inpatient pediatric setting that far exceeded goals. Requiring minimal maintenance and using just a simple paper-based format, the workflow could be adopted at other institutions.

Team sugar: Blood glucose screening in acute lymphoblastic leukemia patients during induction.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 57-57
Author(s):  
Mary C. Shapiro ◽  
Titilope Adenike Ishola ◽  
Paibel Ixia Aguayo-Hiraldo ◽  
Daniel Landi ◽  
Kiranmye Reddy ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Acute Lymphoblastic Leukemia ◽  
Insulin Therapy ◽  
Outcome Measure ◽  
Lymphoblastic Leukemia ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Improvement Project ◽  
Pdsa Cycle ◽  
Leukemia Data

57 Background: Pediatric acute lymphoblastic leukemia (ALL) protocols currently include steroids during induction therapy, which may lead to hyperglycemia. Published pediatric and adult leukemia data demonstrate increased rates of infection and mortality associated with hyperglycemia. Presently, there are no accepted recommendations for how to track blood glucose (BG) levels, so hyperglycemia may go undetected. A random review of 20 patients diagnosed with ALL during a 4-month period in 2014 at Texas Children’s Cancer Center (TXCCC) demonstrated that only 40% had BG checked throughout induction. The SMART aim of this quality improvement project was to increase BG screening rates to > 95% during first week of treatment and induction days 8, 15, 22 and 29 for patients with newly diagnosed ALL at TXCCC in a 15-month period. Methods: PDSA cycle 1 involved sticker reminders on treatment roadmaps by days that required a BG check. PDSA cycle 2 entailed reminder flyers in patient care areas and no further roadmap stickers. Primary outcome measure was the percentage of successful occurrences for BG checks on days 8, 15, 22, 29. Secondary outcome measure was the percentage of patients who needed insulin therapy. Results: TXCCC had 97 new ALL patients during March 2015 to May 2016. Providers obtained 333 of 372 possible BG checks (90%) on days 8, 15, 22, 29. Thirty-nine percent of patients developed hyperglycemia ≥ 200 mg/dL. Eighteen percent patients required insulin therapy. Eighty-nine percent of patients had their peak blood glucose by day 8, and 82% of patients who required insulin were started on insulin prior to day 8. Conclusions: We improved hyperglycemia screening rates for TXCCC ALL patients in induction from 40% to 90% by implementing reminder processes for providers. The roadmap stickers were replaced with reminder flyers for sustainability. Because the peak BG was reached by 89% of patients by day 8 of therapy, our efforts are now being directed at improving screening and interventions prior to day 8. Our goal is to standardize BG screening and hyperglycemia intervention algorithms to decrease both the time-to-initiation for insulin and readmission rate for symptomatic hyperglycemia for ALL patients at TXCCC.

A Quality Improvement Initiative to Improve Feeding and Growth of Infants With Cleft Lip and/or Palate

2018 ◽  
Vol 55 (9) ◽  
pp. 1218-1224 ◽  
Author(s):  
Adriane L. Baylis ◽  
Gregory D. Pearson ◽  
Courtney Hall ◽  
Lauren L. Madhoun ◽  
Caitlin Cummings ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Care Delivery ◽  
Academic Medical Center ◽  
Secondary Outcome ◽  
Quality Improvement Initiative ◽  
Secondary Outcome Measure ◽  
Targeted Interventions ◽  
Growth Outcomes

Objective: The purpose of this quality improvement initiative was to improve feeding and growth outcomes in infants with cleft lip and/or palate (CL/P). Design: Institute for Healthcare Improvement quality improvement model. Setting: Large pediatric academic medical center in the Midwestern United States. Participants: One hundred forty-five infants with nonsyndromic CL/P ages 0 to 12 months. Interventions: Key drivers included (1) caregiver education and resources, (2) care coordination and flow, and (3) provider education and training. Interventions were designed around these themes and included targeting improved team communication, increased social work consultations, patient tracking, staff education, improved access to feeding equipment, and the launch of a new cleft palate feeding team. Main Outcome Measure(s): The primary outcome measure was the percentage of new patients with CL/P who met criteria for failure to thrive (FTT) per month. The secondary outcome measure was the frequency of hospitalization for infants with CL/P with a primary reason for admission of feeding difficulties or FTT. Results: The institutional FTT rate for infants with CL/P decreased from 17% to 7% ( P < .003). The frequency of hospitalization for FTT improved from once every 30 days to once every 118 days. Conclusions: Targeted interventions aimed at improving feeding efficiency and effectiveness, as well as changes in care delivery models, can reliably promote improvements in feeding and growth outcomes for infants with CL/P, even with psychosocial risk factors present.

Improving Psychosocial Risk Assessment and Service Provision for Craniofacial Team Patients: A Quality Improvement Project

2021 ◽  
pp. 105566562110430
Author(s):  
Canice E. Crerand ◽  
Meghan O’Brien ◽  
Hillary M. Kapa ◽  
Ari N. Rabkin ◽  
Amanda Smith ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Quality Improvement ◽  
Service Provision ◽  
Academic Medical Center ◽  
Psychosocial Risk ◽  
Secondary Outcome ◽  
Risk Screening ◽  
Improvement Project ◽  
Psychosocial Services ◽  
Psychosocial Risk Assessment

To improve psychosocial risk assessment and service provision for children with craniofacial conditions presenting for annual interdisciplinary team visits. Institute for Healthcare quality improvement model. U.S. pediatric academic medical center. Caregivers of children ages 0-17 years with craniofacial conditions presenting for 1692 team visits between August 2017 and July 2019. Key drivers included: (1) standardizing pre-visit triage processes; (2) administering the Psychosocial Assessment Tool-Craniofacial Version (PAT-CV); (3) utilizing PAT-CV scores in real time to add patients to psychosocial provider schedules; and (4) family education. Interventions included improving patient screening, increasing PAT-CV completion rate, altering clinic flow, providing patient and parent education about psychosocial services, and altering team member roles to fully integrate PAT-CV administration and scoring in the clinic. The primary outcome was the percentage of patients identified for psychosocial consultations via nurse triage, PAT-CV score, family or provider request who completed consultations. The secondary outcome was the percentage of patients completing needed psychosocial consultations based on elevated PAT-CV scores. Use of the PAT-CV resulted in an increase in the percentage of patients with elevated psychosocial risk who received a psychosocial consultation from 86.7% to 93.4%. The percentage of children receiving psychosocial consultation at their annual team visit due to elevated PAT-CV scores increased from 72% to 90%. Integrating a validated psychosocial risk screening instrument can improve risk identification and psychosocial consultation completion. A combination of risk screening approaches may be indicated to identify patients in need of psychosocial services.

scholarly journals Success of trabeculectomy surgery in relation to cataract surgery: 5-year outcomes

2018 ◽  
Vol 103 (10) ◽  
pp. 1395-1400 ◽  
Author(s):  
Rashmi G Mathew ◽  
Sahar Parvizi ◽  
Ian E Murdoch
Keyword(s):  
Cataract Surgery ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Risk Of Failure ◽  
Increased Risk ◽  
Significant Difference ◽  
Measure Change ◽  
Group 2

AimsTo compare success proportions at 5 years in three surgical groups: group 1, trabeculectomy alone; group 2, trabeculectomy followed by cataract surgery within 2 years; and group 3, trabeculectomy performed on a pseudophakic eye.MethodsA retrospective cohort study. 194 eyes of 194 patients were identified with at least 5 years’ follow-up post trabeculectomy (N=85, 60 and 49 in groups 1, 2 and 3, respectively).Main outcome measures1. Primary outcome measure: intraocular pressure (IOP) at 5 years post-trabeculectomy surgery, 2.Secondary outcome measure: change in visual acuity at 5 years.ResultsAt 5 years, the mean IOP (SD) was 12.9 (3.5), 12.5 (4.8) and 12.7 (4.8) mm Hg in groups 1, 2 and 3, respectively. Overall success was almost identical, 58%, 57% and 59% in groups 1, 2 and 3, respectively. There was no significant difference between the groups in terms of percentage IOP reduction, number of medications, proportion restarting medication and reoperation rates at 5 years. Logistic regression for an outcome of failure showed men to be at increased risk of failure OR 1.97 (95% CI 1.10 to 3.52, p=0.02). Nearly 80% of patients retained or improved their vision following their initial trabeculectomy.ConclusionsThe sequence in which surgery is carried out does not appear to affect trabeculectomy function at 5 years, success being similar to trabeculectomy alone. In our study, men may be at increased risk of failure.

scholarly journals Determinants of Sports Injury in Young Female Swedish Competitive Figure Skaters

2021 ◽  
Vol 3 ◽  
Author(s):  
Moa Jederström ◽  
Sara Agnafors ◽  
Christina Ekegren ◽  
Kristina Fagher ◽  
Håkan Gauffin ◽  
...  
Keyword(s):  
Outcome Measure ◽  
Sports Injury ◽  
Young Female ◽  
Older Age ◽  
Point Prevalence ◽  
Severe Injury ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Multiple Model ◽  
Figure Skaters

Introduction: Although figure skating attracts several hundred thousand participants worldwide, there is little knowledge about physical health and sports injuries among young skaters. The present study aimed to describe the health status of a geographically defined Swedish population of licensed competitive figure skaters and to examine injury determinants.Methods: All licensed competitive skaters in the southeastern region of Sweden were in April 2019 invited to participate in a cross-sectional study using an online questionnaire. Multiple binary logistic regression was used for the examination of injury determinants. The primary outcome measure was the 1-year prevalence of a severe sports injury episode (time loss &gt;21 days). The secondary outcome measure was the point prevalence of an ongoing injury. The determinants analyzed were age, skating level, relative energy deficiency indicators, and training habits.Results: In total, 142 (36%) skaters participated, 137 (96%) girls [mean (SD) age: 12.9 (SD 3.0) years]. Participating boys (n = 5) were excluded from further analysis. The 1-year prevalence of a severe sports injury episode was 31%. The most common injury locations for these injuries were the knee (25%), ankle (20%), and hip/groin (15%). In the multiple model, having sustained a severe injury episode was associated with older age (OR 1.2, 95% CI 1.1–1.4; p = 0.002) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p = 0.014). The point prevalence of an ongoing injury episode was 19%. The most common locations were the knee (24%), ankle (24%), and foot (24%). Having an ongoing injury episode was associated with older age (OR 1.4, 95% CI 1.2–1.7; p &lt; 0.001) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p = 0.049).Conclusion: One-third of young female Swedish competitive figure skaters had sustained a severe injury episode during the past year, and a fifth reported an ongoing episode. Older age and an increased number of skipped meals per week were associated with a sports injury episode. Long-term monotonous physical loads with increasing intensity and insufficient energy intake appear to predispose for injury in young female figure skaters. Further examination of injury determinants among competitive figure skaters is highly warranted.

scholarly journals Assessing the practice of written referrals to neuroradiology and how this process can be improved and standardised

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S181-S182
Author(s):  
Fraser Currie ◽  
Rashi Negi ◽  
Hari Shanmugaratnam
Keyword(s):  
Quality Improvement ◽  
Scoring Systems ◽  
Quality Improvement Project ◽  
Cortical Atrophy ◽  
Secondary Outcome ◽  
Quality Improvement Initiative ◽  
Exclusion Criteria ◽  
Quality Of Information ◽  
Improvement Project

AimsThis quality improvement project aims to improve the quality of information provided in the referrals from the older adult psychiatry department to radiology when requesting neuroradiological imaging.The secondary outcome aims to standardise information on the referral proforma. We hypothesise that this improved referral proforma will lead to improved quality of reporting from the radiology department, which will form the second stage of this quality improvement project.A further area of interest of this exercise is to establish whether standardised radiological scoring systems are requested in the referral, as these can be utilised as a means to standardise reported information.MethodRetrospective electronic case analysis was performed on 50 consecutive radiology referrals for a period of 3 months from November 2019 to January 2020. Data were obtained from generic MRI and CT referral proforma and entered into a specifically designed data collection tool. Recorded were patient demographics, provisional diagnosis, modality of imaging, use of ACE-III cognitive score, radiological scoring systems, and inclusion and exclusion criteria.ResultResults from 50 referrals have shown: 60% were male, 40% female. Average patient age of 74, ranging from 49 to 95. 58% were referred for CT head with 42% for MRI head. More than half of referrals quoted the ACE-III score. 26% of referrals stated exclusion criteria such as space occupying lesions, haemorrhages or infarcts. 10% of referrals requested specific neuro-radiological scoring scales. Specific scales which were requested included GCA (global cortical atrophy), MTA scale (medial temporal atrophy), Koedam scale (evidence of parietal atrophy) and Fazekas (evidence of vascular changes). Only 80% of referrals included the patients GP details on the referral form.Conclusion1. This quality improvement initiative has highlighted that the current level of information in referring patient to radiology is variable and dependent on the referrer.2. All referrals should state exclusion criteria as per the NICE guidelines on neuroimaging in diagnosis of dementia.3. Preliminary evidence suggests that requesting specific radiological rating scales could improve the quality of information received in the imaging report. The second part of this quality improvement initiative will aim to explore the impact of requesting these scales routinely.

The importance of perioperative optimisation to facilitate safe regional anaesthesia and their improved outcomes in fracture neck of femur patients

2021 ◽  
pp. 175045892110640
Author(s):  
Benjamin Thomas Vincent Gowers ◽  
Michael Sean Greenhalgh ◽  
Kathryn Dyson ◽  
Karthikeyan P Iyengar ◽  
Vijay K Jain ◽  
...  
Keyword(s):  
Hip Fracture ◽  
General Anaesthesia ◽  
Regional Anaesthesia ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
General Anaesthetic ◽  
Secondary Outcome Measure ◽  
Neck Of Femur ◽  
One Year ◽  
To Receive

Background: Hip fractures are common presentations to orthopaedic departments, and their surgical management often results in blood transfusions. Compared with general anaesthesia, regional anaesthesia reduces the need for transfusions and mortality in the wider surgical population. Aims: In hip fracture patients, our primary outcome measure was to examine any relationship between anaesthetic modality and transfusion rates. The secondary outcome measure was to assess the relationship between anaesthetic modality and one-year mortality. Methods: A retrospective cohort study of 280 patients was carried out in 2017 and 2018. Data were collected from patient records, local transfusion laboratory and the national hip fracture database. Results: A total of 59.6% had regional and 40.4% general anaesthesia. Regional anaesthesia patients were younger with fewer comorbidities (p < .05). About 19.8% regional and 34.5% general anaesthesia patients received transfusions (odds ratio (OR) = 0.47, p < .05); 13.6% were taking anticoagulants and were less likely to receive a regional anaesthetic (31.6% versus 64%, OR = 0.26, p < .05). One-year mortality was 27% for regional and 37% for general anaesthetic patients (OR = 0.64, p = .09). Conclusion: Regional anaesthesia halved the risk of blood transfusion. Anticoagulated patients were 74% less likely to receive regional anaesthetics, but had no additional transfusion risk. With optimisation, a larger proportion of patients could have regional anaesthesia.

scholarly journals Impact of blood group on survival following critical illness: a single-centre retrospective observational study

2019 ◽  
Vol 6 (1) ◽  
pp. e000426
Author(s):  
Robert Slade ◽  
Raza Alikhan ◽  
Matt P Wise ◽  
Lam Germain ◽  
Simon Stanworth ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Blood Group ◽  
Outcome Measure ◽  
Tertiary Hospital ◽  
Current Data ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Transfusion Requirements ◽  
Significant Difference

BackgroundPredicting patient outcomes following critical illness is challenging. Recent evidence has suggested that patients with blood group AB are more likely to survive following major cardiac surgery, and this is associated with a reduced number of blood transfusions. However, there are no current data to indicate whether a patient’s blood group affects general intensive care outcomes.ObjectiveThe objective of this study was to determine if ABO blood group affects survival in intensive care. The primary outcome measure was 90-day mortality with a secondary outcome measure of the percentage of patients receiving a blood transfusion.DesignRetrospective analysis of electronically collected intensive care data, blood group and transfusion data.SettingGeneral intensive care unit (ICU) of a major tertiary hospital with both medical and surgical patients.PatientsAll patients admitted to ICU between 2006 and 2016 who had blood group data available.InterventionNone.Measurements and main results7340 patients were included in the study, blood group AB accounted for 3% (221), A 41% (3008), B 10.6% (775) and O 45.4% (3336). These values are similar to UK averages. Baseline characteristics between the groups were similar. Blood group AB had the greatest survival benefit (blood group AB 90-day survival estimate 76.75, 95% CI 72.89 to 80.61 with the overall estimate 72.07, 95% CI 71.31 to 72.82) (log-rank χ2 16.128, p=0.001). Transfusion requirements were similar in all groups with no significant difference between the percentages of patients transfused (AB 23.1%, A 21.5%, B 18.7%, O 19.9%, Pearson χ2 5.060 p=0.167).ConclusionAlthough this is primarily a hypothesis generating study, intensive care patients with blood group AB appeared to have a higher 90-day survival compared with other blood groups. There was no correlation between blood group and percentage of patients receiving transfusion.

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