scholarly journals The Impact of COVID-19 on Levels of Adherence to the Completion of Nursing Records for Inpatients in Isolation

2021 ◽  
Vol 18 (21) ◽  
pp. 11262
Author(s):  
Mercedes Fernández-Castro ◽  
José-María Jiménez ◽  
Belén Martín-Gil ◽  
María-Fé Muñoz-Moreno ◽  
María-José Castro ◽  
...  
Keyword(s):  
Social Vulnerability ◽  
Structural Changes ◽  
Phase 1 ◽  
Phase 2 ◽  
Hospitalised Patients ◽  
Scale Scores ◽  
The Mean ◽  
Two Phases ◽  
Clinical Records ◽  
The Impact

The COVID-19 pandemic has led to an increased workload for nurses and organisational and structural changes, which have been necessary to meet the needs of inpatients in isolation. Aim: To describe the impact of the COVID-19 pandemic on levels of adherence to the completion of nursing records that document the risk of developing pressure ulcers, falling, and social vulnerability among hospitalised patients in isolation. Methods: Observational pre-post comparison study. Comparison between nursing records (the Braden, Downton, and Gijón scales) belonging to 1205 inpatients took place in two phases. Phase 1: 568 patients admitted in February 2020, prior to the COVID-19 pandemic, vs. phase 2: 637 patients hospitalised with COVID-19 in March–April 2020, during the peak of the first wave of the pandemic. This research adheres to the STROBE guidelines for the reporting of observational studies. Results: The degree of completion of the Braden, Downton, and Gijón scales decreased significantly in phase 2 vs. phase 1 (p < 0.001). The mean Downton and Gijón scale scores for patients admitted in phase 1 were higher compared to those of patients admitted in phase 2 (p < 0.001). The mean Braden scale score in phase 2 was higher than in phase 1 (p < 0.05). Conclusion: During the COVID-19 pandemic, there was a decrease in the completion of nursing records in the clinical records of patients in isolation. The levels of risk of developing PUs, falling, and social vulnerability of patients admitted to hospital were lower during the first wave of the pandemic.

Risk reduction in a cancer chemotherapy production unit: Contribution of an automated drug dispensing system

2020 ◽  
pp. 107815522094106
Author(s):  
Jean-Marie Ouedraogo ◽  
Soumaya El Baraka ◽  
Casimir Adade Adade ◽  
Joseph Sitsopeh ◽  
Abou Sessouma ◽  
...  
Keyword(s):  
Production Process ◽  
Cancer Chemotherapy ◽  
Failure Modes ◽  
Phase 1 ◽  
Production Unit ◽  
Phase 2 ◽  
Risk Minimization ◽  
Drug Dispensing ◽  
Two Phases ◽  
The Impact

Objective The purpose of our study was to evaluate the contribution of an automated drug dispensing system in securing cancer chemotherapy production process at the pharmacy of the National Institute of Oncology in Rabat. Methods The failure modes and effects analysis method was applied to the chemotherapy production process in two phases: Phase 1, using an open shelf for storage then phase 2, using an automated drug dispensing system. The failure modes were defined and their criticality indexes was calculated on the basis of the likelihood of occurrence, the potential severity for the patients and/or the impact on the process and the detection probability. The criticality indexes of the two phases were prioritized and compared. Results We identified 35 failure modes for phase 1 and 37 for phase 2. The sum of criticality indexes was 5957 and 4586, respectively, for phase 1 and phase 2, corresponding to a criticality reduction of −23%. The greatest improvements concerned that the needed drug is missing during the picking, storage of potential expired drugs, and double compounding. Conclusion Our study highlighted the contribution of automated drug dispensing system in risk minimization. The use of automated drug dispensing system is a part of security improvement in chemotherapy production unit.

scholarly journals 786. Diagnostic stewardship of C difficile PCR testing with two step algorithm- A rural community hospital experience

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S437-S438
Author(s):  
Raghavendra Tirupathi ◽  
Ruth Freshman ◽  
Norma Montoy ◽  
Melissa Gross
Keyword(s):  
Phase 1 ◽  
Antibiotic Use ◽  
Step Test ◽  
Phase 2 ◽  
Stewardship Program ◽  
Risk Adjustment Model ◽  
Step Algorithm ◽  
Two Phases ◽  
The Impact ◽  
Test Ordering

Abstract Background An estimated 15% of hospitalized patients are asymptomatic carriers of C. diff. Inappropriate testing can lead to over diagnosis, treatment, isolation & substantial financial penalties. Ours is a rural 310 bed hospital with nurse driven C. diff test ordering protocol. Due to inadvertent test ordering, we had an uptick in the HO-CDI incidence with rates as high as 0.94 per 1000 patient days in 2017. In order to streamline testing, we initiated an infection preventionist(IP) led diagnostic stewardship program which was implemented in two phases in 2017-2019 Methods The phase 1 involved daily review by IPs regarding the legitimacy of PCR order for minimum 3 loose stools in 24 hours, use of laxatives, presence of symptoms.There were concerns nationally that then CDI risk adjustment model from NHSN in 2017 does not optimally account for the impact of specific CDI testing methods used by individual hospitals on CDI SIRs. Hence, in Jan 2018 NHSN’s MDRO/CDI Protocol stated “Results of the final test that are placed in the patient’s medical record should be used to determine whether event meets the CDI LabID defn”.This led to phase 2 in mar 2019 which involved two step testing which started with C diff PCR assay with positive test reflexed to the toxin A/B assay. Results During the first phase, and a full year of the protocol in 2018, the number of completed PCR tests decreased to 626 (compared to 940 PCR tests in 2016) with an 34% decrease. In the year following implementation of the Diagnostic Stewardship, HO CDI decreased from 60 in 2017 to 43 events in 2018 with a reduction of 28%. Subsequently, HO CDI further decreased in 2019 to 28 with a reduction of 35%. Since the start of the project in 2017, HO CDI have decreased 54% in total. The reduction in 314 C diff PCR tests in the first year[2017-2018] led to a savings of $8300 in lab supplies. No readmissions with C difficile infection documented within 30 days on patients who did not meet the criterion for testing. Significant decrease in the usage of C difficile antibiotics. After the start of the two step test, we have seen a precipitous drop in our HO-CDI rates to less than 0.3 per 1000 pt days by the end of 2019. Quarterly comparison of HO CDI incidence for 2017-2020 HO CDI incidence before and following phase 1 and phase 2 interventions C. difficile antibiotic use trends during intervention period Conclusion IP run diagnostic stewardship programs with two step tests are highly successful in streamlining testing and in discriminating infection from colonization Disclosures All Authors: No reported disclosures

Abstract T P4: Impact of Extended IV rt-PA Time Window and Immediate Endovascular Therapy on the Outcome in Patients with Major Artery Occlusion

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Hiroshi Yamagami ◽  
Mikito Hayakawa ◽  
Masatoshi Koga ◽  
Shoichiro Sato ◽  
Tomoyuki Ohara ◽  
...  
Keyword(s):  
Time Window ◽  
Phase 1 ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Phase 2 ◽  
Total Period ◽  
Nihss Score ◽  
Poor Outcome ◽  
Two Phases ◽  
The Impact

Background and Purpose: In Japan, indication of intravenous recombinant tissue plasminogen activator (IV rt-PA) therapy for acute ischemic stroke (AIS) has been extended to 4.5 hours after the onset from Aug, 2012. Additionally, we have modified our institutional strategy of endovascular treatment (EVT) to start immediately after IV rt-PA in patients with occlusions of internal carotid artery (ICA), proximal portion of middle cerebral artery (MCA), or basilar artery (BA) from Oct, 2012. This study aimed to clarify the impact of these changes on the outcome in patients with major artery occlusion. Methods: We investigated the AIS patients with ICA, MCA or BA occlusion admitted to our hospital within 24 hours after the onset. They were divided into two phases according to admission date: phase 1 (Oct, 2011 to Sept, 2012) or phase 2 (Oct, 2012 to Apr, 2013). Backgrounds, treatments, and outcomes were compared between two phases. Favorable outcomes were defined as modified Rankin Scale (mRS) ≦2 or equal to premorbid mRS, and poor outcome as mRS 5 or 6 at 90 days after the onset. Results: Among 248 patients (130 men, 76.1±12.4 years old, National Institute of Health Stroke Scale [NIHSS] score on admission: median 18 [IQR 11-24]), 152 patients were admitted in phase 1 and 96 in phase 2. Age, sex, onset to admission time, stroke subtype, and sites of occluded arteries were similar in two phases, while NIHSS score on admission was higher in phase 1 than 2 (median 19 vs 17, P=0.046). Compared to phase 1, IV rt-PA (36.8 vs 44.8%), EVT (12.5 vs 26.0%), and either reperfusion therapy (42.8 vs 54.2%) were more frequently performed, and door to IV rt-PA time (71 vs 61min.) and door to EVT time (148 vs 127min.) were shorter in phase 2. The rate of favorable outcome significantly increased (27.0 vs 40.6%, P=0.027) and that of poor outcome decreased (44.1 vs 30.2%, P=0.033) in phase 2. With multivariate analysis in total period, reperfusion therapy was associated to favorable outcomes (OR 2.24, 95% CI 1.05-4.80) and inversely associated with poor outcome (OR 0.29, 95%CI 0.13-0.64). Conclusions: Increased frequency of reperfusion therapy by extended IV rt-PA time window and rapid EVT may contribute to the improvement of outcome in AIS patients with major artery occlusion.

Differential impact of on-site or telepharmacy in the intensive care unit: a controlled before–after study

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Joao Gabriel Rosa Ramos ◽  
Sandra Cristina Hernandes ◽  
Talita Teles Teixeira Pereira ◽  
Shana Oliveira ◽  
Denis de Melo Soares ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Phase 1 ◽  
Phase 2 ◽  
Differential Impact ◽  
Scarce Resources ◽  
Clinical Pharmacists ◽  
Versus Phase ◽  
Quasi Experimental ◽  
The Impact

Abstract Background Clinical pharmacists have an important role in the intensive care unit (ICU) team but are scarce resources. Our aim was to evaluate the impact of on-site pharmacists on medical prescriptions in the ICU. Methods This is a retrospective, quasi-experimental, controlled before-after study in two ICUs. Interventions by pharmacists were evaluated in phase 1 (February to November 2016) and phase 2 (February to May 2017) in ICU A (intervention) and ICU B (control). In phase 1, both ICUs had a telepharmacy service in which medical prescriptions were evaluated and interventions were made remotely. In phase 2, an on-site pharmacist was implemented in ICU A, but not in ICU B. We compared the number of interventions that were accepted in phase 1 versus phase 2. Results During the study period, 8797/9603 (91.6%) prescriptions were evaluated, and 935 (10.6%) needed intervention. In phase 2, there was an increase in the proportion of interventions that were accepted by the physician in comparison to phase 1 (93.9% versus 76.8%, P &lt; 0.001) in ICU A, but there was no change in ICU B (75.2% versus 73.9%, P = 0.845). Conclusion An on-site pharmacist in the ICU was associated with an increase in the proportion of interventions that were accepted by physicians.

Psychiatry Transcript Annotation: Process Study and Improvements

2021 ◽  
Vol 10 (1) ◽  
pp. 71-75
Author(s):  
Srinivasan Sridhar ◽  
Nazmul Kazi ◽  
Indika Kahanda ◽  
Bernadette McCrory
Keyword(s):  
Mental Health ◽  
Work Experience ◽  
Phase 1 ◽  
Kappa Statistics ◽  
Phase 2 ◽  
Rater Reliability ◽  
Standard Data ◽  
Annotation Process ◽  
Data Collection Process ◽  
Two Phases

Background: The demand for psychiatry is increasing each year. Limited research has been performed to improve psychiatrist work experience and reduce daily workload using computational methods. There is currently no validated tool or procedure for the mental health transcript annotation process for generating “gold-standard” data. The purpose of this paper was to determine the annotation process for mental health transcripts and how it can be improved to acquire more reliable results considering human factors elements. Method: Three expert clinicians were recruited in this study to evaluate the transcripts. The clinicians were asked to fully annotate two transcripts. An additional five subjects were recruited randomly (aged between 20-40) for this pilot study, which was divided into two phases, phase 1 (annotation without training) and phase 2 (annotation with training) of five transcripts. Kappa statistics were used to measure the inter-rater reliability and accuracy between subjects. Results: The inter-rater reliability between expert clinicians for two transcripts were 0.26 (CI 0.19 to 0.33) and 0.49 (CI 0.42 to 0.57), respectively. In the pilot testing phases, the mean inter-rater reliability between subjects was higher in phase 2 with training transcript (k= 0.35 (CI 0.052 to 0.625)) than in phase 1 without training transcript (k= 0.29 (CI 0.128 to 0.451)). After training, the accuracy percentage among subjects was significantly higher in transcript A (p=0.04) than transcript B (p=0.10). Conclusion: This study focused on understanding the annotation process for mental health transcripts, which will be applied in training machine learning models. Through this exploratory study, the research found appropriate categorical labels that should be included for transcripts annotation, and the importance of training the subjects. Contributions of this case study will help the psychiatric clinicians and researchers in implementing the recommended data collection process to develop a more accurate artificial intelligence model for fully- or semi-automated transcript annotation.

scholarly journals MP09: Canadian Community Utilization of Stroke Prevention Pilot Study-Emergency Department (C-CUSP ED)

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S68 ◽  
Author(s):  
R. Parkash ◽  
K. Magee ◽  
M. McMullen ◽  
M.B. Clory ◽  
M. D’Astous ◽  
...  
Keyword(s):  
Stroke Prevention ◽  
Phase 1 ◽  
Retrospective Chart Review ◽  
Phase 2 ◽  
Phase 3 ◽  
Three Phase ◽  
Rigorous Study ◽  
The Mean ◽  
Prior Risk

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia affecting 1-2% of the population. Oral anticoagulation (OAC) reduces stroke risk by 60-80% in AF patients, but only 50% of indicated patients receive OAC. Many patients present to the ED with AF due to arrhythmia symptoms, however; lack of OAC prescription in the ED has been identified as a significant gap in the care of AF patients. Methods: This was a multi-center, pragmatic, three-phase before-after study, in three Canadian sites. Patients who presented to the ED with electrocardiographically (ECG) documented, nonvalvular AF and were discharged home were included. Phase 1 was a retrospective chart review to determine OAC prescription of AF patients in each ED; Phase 2 was a low-intensity knowledge translation intervention where a simple OAC-prescription tool for ED physicians with subsequent short-term OAC prescription was used, as well as an AF patient education package and a letter to family physicians; phase 3 incorporated Phase 2 interventions, but added immediate follow-up in a community AF clinic. The primary outcome of the study was the rate of new OAC prescriptions at ED discharge in AF patients who were OAC eligible and were not on OAC at presentation. Results: A total of 632 patients were included from June, 2015-November, 2016. ED census ranged from 30000-68000 annual visits. Mean age was 71±15, 67±12, 67±13 years, respectively. 47.5% were women, most responsible ED diagnosis was AF in 75.8%. The mean CHA2DS2-VASc score was 2.6±1.8, with no difference amongst groups. There were 266 patients eligible for OAC and were not on this at presentation. In this group, the prescription of new OAC was 15.8% in Phase 1 as compared to 54% and 47%, in Phases 2 and 3, respectively. After adjustment for center, components of the CHA2DS2-VASc score, prior risk of bleeding and most responsible ED diagnosis, the odds ratio for new OAC prescription was 8.0 (95%CI (3.5,18.3) p&lt;0.001) for Phase 3 vs 1, and 10.0 (95%CI (4.4,22.9) p&lt;0.001), for Phase 2 vs 1). No difference in OAC prescription was seen between Phases 2 and 3. Conclusion: Use of a simple OAC-prescription tool was associated with an increase in new OAC prescription in the ED for eligible patients with AF. Further testing in a rigorous study design to assess the effect of this practice on stroke prevention in the AF patients who present to the ED is indicated.

scholarly journals Removal of organic matter from pre-treated domestic sewage in anaerobic biological reactor by a combined system of electrolytic and biological aerobic treatment

2019 ◽  
Vol 14 (4) ◽  
pp. 1
Author(s):  
Ariela Araujo Fonseca ◽  
Yovanka Pérez Ginoris ◽  
Norma Mendes Pinheiro Gontijo ◽  
Marco Antonio Almeida de Souza
Keyword(s):  
Organic Matter ◽  
Electric Current ◽  
Phase 1 ◽  
Zooplankton Community ◽  
Batch Reactors ◽  
Phase 2 ◽  
Combined System ◽  
Organic Matter Removal ◽  
Electrolytic Process ◽  
Two Phases

Biological processes are the most widespread methods for wastewater treatment. However, they are limited in their ability to degrade toxic and refractory pollutants, contaminants that electrochemical processes can remove. Therefore, this research explored the possibility of treating sewage by an anaerobic biological process followed by an aerobic system integrated to an electrolytic process. Three sequential batch reactors were operated in an automated way. Each of three reactors represented a process: aerobic biological treatment (BR); electrolytic treatment (ER); and a combination of both, the bio electrolytic reactor (BER). Two phases were ran with different electrodes: (Phase 1) stainless steel and (Phase 2) graphite. The electric current was varied from 0.001 to 0.100 A. COD, TS, SS, turbidity, and the zooplankton community were monitored. The highest organic matter removal efficiencies were 86%, 79% and 87% for BR, ER and BER, respectively. The best weekly BER efficiencies for COD removal were 90% and 98%, with current densities of 0.27 A/m2 (Phase 1) and 0.05 A/m2 (Phase 2). The main conclusions about bio electrolytic process were: (1) it did not achieve organic matter removal high enough to justify its application; (2) inert electrodes are the more indicated; and (3) the zooplankton community was affected by the electric current.

scholarly journals Developing a realist theory of psychosocial rehabilitation: the Clubhouse model

2021 ◽  
Author(s):  
Christina Mutschler ◽  
Jen Rouse ◽  
Kelly McShane ◽  
Criss Habal-Brosek
Keyword(s):  
Phase 1 ◽  
Psychosocial Rehabilitation ◽  
Theory Development ◽  
Realist Evaluation ◽  
Self Determination ◽  
Phase 2 ◽  
Two Phase ◽  
Realist Theory ◽  
Clubhouse Model ◽  
Two Phases

Background Psychosocial rehabilitation is a service that supports recovery from mental illness by providing opportunities for skill development, self-determination, and social interaction. One type of psychosocial rehabilitation is the Clubhouse model. The purpose of the current project was to create, test, and refine a realist theory of psychosocial rehabilitation at Progress Place, an accredited Clubhouse. Method Realist evaluation is a theory driven evaluation that uncovers contexts, mechanisms, and outcomes, in order to develop a theory as to how a program works. The current study involved two phases, encompassing four steps: Phase 1 included (1) initial theory development and (2) initial theory refinement; and Phase 2 included (3) theory testing and (4) refinement. Results The data from this two-phase approach identified three demi-regularities of recovery comprised of specific mechanisms and outcomes: the Restorative demi-regularity, the Reaffirming demi-regularity, and the Re-engaging demi-regularity. The theory derived from these demi-regularities suggests that there are various mechanisms that produce outcomes of recovery from the psychosocial rehabilitation perspective, and as such, it is necessary that programs promote a multifaceted, holistic perspective on recovery. Conclusions The realist evaluation identified that Progress Place promotes recovery for members. Additional research on the Clubhouse model should be conducted to further validate that the model initiates change and promotes recovery outcomes.

scholarly journals Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) – a programme of research to facilitate recognition of stroke by emergency medical dispatchers

2014 ◽  
Vol 2 (1) ◽  
pp. 1-124 ◽  
Author(s):  
Caroline L Watkins ◽  
Stephanie P Jones ◽  
Michael J Leathley ◽  
Gary A Ford ◽  
Tom Quinn ◽  
...  
Keyword(s):  
Phase 1 ◽  
Research Programme ◽  
Online Training ◽  
Final Diagnosis ◽  
Phase 2 ◽  
The Public ◽  
Training Package ◽  
Emergency Medical ◽  
Emergency Medical Dispatchers ◽  
The Impact

BackgroundRapid access to emergency stroke care can reduce death and disability by enabling immediate provision of interventions such as thrombolysis, physiological monitoring and stabilisation. One of the ways that access to services can be facilitated is through emergency medical service (EMS) dispatchers. The sensitivity of EMS dispatchers for identifying stroke is < 50%. Studies have shown that activation of the EMSs is the single most important factor in the rapid triage and treatment of acute stroke patients.ObjectivesTo facilitate recognition of stroke by emergency medical dispatchers (EMDs).DesignAn eight-phase mixed-methods study. Phase 1: a retrospective cohort study exploring stroke diagnosis. Phase 2: semi-structured interviews exploring public and EMS interactions. Phases 3 and 4: a content analysis of 999 calls exploring the interaction between the public and EMDs. Phases 5–7: development and implementation of stroke-specific online training (based on phases 1–4). Phase 8: an interrupted time series exploring the impact of the online training.SettingOne ambulance service and four hospitals.ParticipantsPatients arriving at hospital by ambulance with stroke suspected somewhere on the stroke pathway (phases 1 and 8). Patients arriving at hospital by ambulance with a final diagnosis of stroke (phase 2). Calls to the EMSs relating to phase 1 patients (phases 3 and 4). EMDs (phase 7).InterventionsStroke-specific online training package, designed to improve recognition of stroke for EMDs.Main outcome measuresPhase 1: symptoms indicative of a final and dispatch diagnosis of stroke. Phase 2: factors involved in the decision to call the EMSs when stroke is suspected. Phases 3 and 4: keywords used by the public when describing stroke and non-stroke symptoms to EMDs. Phase 8: proportion of patients with a final diagnosis of stroke correctly dispatched as stroke by EMDs.ResultsPhase 1: for patients with a final diagnosis of stroke, facial weakness and speech problems were significantly associated with an EMD code of stroke. Phase 2: four factors were identified – perceived seriousness; seeking and receiving lay or professional advice; caller’s description of symptoms and emotional response to symptoms. Phases 3 and 4: mention of ‘stroke’ or one or more Face Arm Speech Test (FAST) items is much more common in stroke compared with non-stroke calls. Consciousness level was often difficult for callers to determine and/or communicate. Phase 8: there was a significant difference (p = 0.003) in proportions correctly dispatched as stroke – before the training was implemented 58 out of 92 (63%); during implementation of training 42 out of 48 (88%); and after training implemented 47 out of 59 (80%).ConclusionsEMDs should be aware that callers are likely to describe loss of function (e.g. unable to grip) rather than symptoms (e.g. weakness) and that callers using the word ‘stroke’ or describing facial weakness, limb weakness or speech problems are likely to be calling about a stroke. Ambiguities and contradictions in dialogue about consciousness level arise during ambulance calls for suspected and confirmed stroke. The online training package improved recognition of stroke by EMDs. Recommendations for future research include testing the effectiveness of the Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) training package on the recognition of stroke across other EMSs in England; and exploring the impact of the early identification of stroke by call handlers on patient and process outcomes.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

scholarly journals Factors Influencing International Board Certified Lactation Consultants to Continue Advancing Practice Beyond Certification: A Multinational Study

2018 ◽  
Vol 7 (4) ◽  
pp. 227-237 ◽  
Author(s):  
Karolyn Vaughan ◽  
Anne McMurray ◽  
Mary Sidebotham ◽  
Jennifer Gamble
Keyword(s):  
Phase 1 ◽  
Demographic Data ◽  
Phase 2 ◽  
Online Questionnaire ◽  
Optimal Care ◽  
Lifelong Learners ◽  
Lactation Consultant ◽  
Qualitative Understanding ◽  
Lactation Consultants ◽  
Two Phases

Background:Certification as a lactation consultant is based on practitioners having achieved a standard of knowledge indicative of their competence to practice by passing a psychometric examination. The underpinning principle of recertification programs is to support clinicians to become lifelong learners by progressively enhancing and advancing their knowledge and skills in line with contemporary evidence. The aim of this study was to investigate the factors that influence International Board Certified Lactation Consultants (IBCLCs) to advance their practice.Method:A mixed-methods study was conducted in two phases. Phase 1 included focus groups, interviews, and participants’ demographic data. Phase 2 comprised of an online questionnaire to IBCLCs. This approach was designed to provide a comprehensive qualitative understanding of the IBCLCs’ experiences, which was then triangulated with quantitative data from a significantly larger population of IBCLCs in Phase 2.Results:The findings are described in themes and subthemes. Participants in phase 2 (n = 3,946) reported being intrinsically motivated (93.3%, n = 3,631) and committed to providing evidence-based guidance and optimal care to support breastfeeding mothers. They identified various sources of continuing education, although attendance at conferences, peer support, and reflective sessions were the most common approaches to enhancing knowledge. They recognized that it was through extension of knowledge that they were able to advance their practice.Conclusion:This article identifies strategies that the managers, educators, and certification bodies can adopt to support the IBCLCs in continuing to advance their practice, which will ultimately improve breastfeeding outcomes for mothers.

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