scholarly journals Outcomes of a National, Cross-Sector Antimicrobial Stewardship Training Initiative for Pharmacists in England

Pharmacy ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 165
Author(s):  
Vincent Ng ◽  
Diane Ashiru-Oredope ◽  
Helena Rosado ◽  
Beth Ward
Keyword(s):  
Quality Improvement ◽  
Workforce Development ◽  
Behaviour Change ◽  
Antimicrobial Stewardship ◽  
Outcome Data ◽  
Improvement Project ◽  
Training Initiative ◽  
Survey Responses ◽  
The Impact

(1) Background: Pharmacists play a pivotal role in tackling Antimicrobial resistance through antimicrobial stewardship (AMS) and are well placed to lead behaviour change interventions across the healthcare system; (2) Methods: A cross-sector AMS training initiative for pharmacists was implemented across England, with three cohorts between 2019–2021. Each cohort took part in an introductory workshop, followed- by a workplace-based quality improvement project supported by peer-assisted learning sessions. Completion of training was determined by an end of training assessment after three to four months. Outcome data and learner survey results were collated, anonymised, and analysed by the training provider. (3) Results: In total, 118 pharmacists participated in the introductory workshop, 70% of these subsequently undertook an improvement project, and 48% engaged workplace stakeholders in the process. Interventions were designed by 57% of learners and 18% completed a at least one Plan-Do-Study-Act cycle. Approximately a quarter of learners met the requirements for a Certificate of Completion. Knowledge quiz scores were obtained from 115 learners pre-training and 28 learners post-training. Paired t-tests conducted for 28 learners showed a statistically significant improvement in mean score from 67.7% to 81.1% (p < 0.0001). Sixty-two learner survey responses were received during the training and 21 follow-up survey responses 6 to 12 months post training. Of the 21 responses to the follow-up survey, ongoing quality improvement work and improvement outcomes were reported by nine and six learners, respectively. (4) Conclusions: The delivery of workplace-based training at scale can be challenging, however this study demonstrates that coupling learning with workplace implementation and peer support can promote behaviour change in learners. Further study into the impact of providing pharmacists across sectors and geographies with access to this type of training will help inform ongoing workforce development interventions.

scholarly journals Evaluating the impact of a nationally recognised training programme that aims to raise the awareness and challenge attitudes of personality disorder in multi-agency partners

2014 ◽  
Vol 9 (2) ◽  
pp. 89-100 ◽  
Author(s):  
Gary Lamph ◽  
Cameron Latham ◽  
Debra Smith ◽  
Andrew Brown ◽  
Joanne Doyle ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Service Evaluation ◽  
Outcome Data ◽  
Content Type ◽  
Training Initiative ◽  
The Future ◽  
The Impact ◽  
Positive Results ◽  
Roll Out

Purpose – An innovative training initiative to raise the awareness of personality disorder and enable more effective working with people with personality disorder who come into contact with the wider multi-agency system has been developed. For the purpose of the training initiative the nationally recognised Knowledge and Understanding Framework (KUF, awareness-level programme) has been employed. An overview of the comprehensive multi-agency training initiative will be outlined with reporting and discussion of the outcome data provided within this paper. The paper aims to discuss these issues. Design/methodology/approach – This paper outlines the development and outcomes of a service evaluation study. The utilised outcome measures were carried out at pre-, post- and three-month follow-up measures. The Personality Disorder-Knowledge Attitude and Skills Questionnaire was utilised on the recommendation of the central team. Additionally a Visual Analogue Scale was developed for the purpose of this study was also employed. Findings – Data findings are positive particularly when comparing pre- and post-results and the pre- and follow-up results. There appears to be an apparent peak in results post-training which could be attributed to the fact that knowledge and understanding is recent and fresh in the delegates mind, however positive results are still reported at follow-up there does appear to be decline in results and durability of the effect when three-month follow-up is compared against the post-training results. Research limitations/implications – Follow-up was at three months, which is a relatively short-time span post-training it would be of great interest to see in the future if the decline in the three areas continues. If this was followed up and if this pattern continued this could provide us with evidence to support the development of refresher courses. In the future, due to the multi-agency design of this service evaluation, comparisons of the different sectors, agencies and occupations involved, could also be explored further to establish what multi-agency areas the training has had the most effect and impact. Practical implications – High levels of demand from multi-agencies to receive training in personality disorder is reported. Our findings and experience provide evidence that multi-agencies partners from a variety of professional backgrounds can effectively work in partnership with people with lived experience to effectively deliver the KUF training. Social implications – This innovative roll-out of KUF training provides evidence that with a little investment, a comprehensive multi-agency roll-out of KUF is achievable and can provide statistically significant positive results displaying the effectiveness and change brought about via the KUF training. Originality/value – The originality of this sustainable and low-cost approach to educating the wider system is reported in this paper. This has lead to the strategy receiving national recognition winning a nursing times award in 2011 and a model of innovative practice nationally.

scholarly journals Reducing Unplanned Medical Oncology Readmissions by Improving Outpatient Care Transitions: A Process Improvement Project at the Cleveland Clinic

2016 ◽  
Vol 12 (5) ◽  
pp. e594-e602 ◽  
Author(s):  
Alberto J. Montero ◽  
James Stevenson ◽  
Amy E. Guthrie ◽  
Carolyn Best ◽  
Lindsey Martin Goodman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Outpatient Care ◽  
Medical Oncology ◽  
Care Transitions ◽  
Cleveland Clinic ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Phone Calls ◽  
The Impact

Purpose: Reducing 30-day unplanned hospital readmissions is a national policy priority. We examined the impact of a quality improvement project focused on reducing oncology readmissions among patients with cancer who were admitted to palliative and general medical oncology services at the Cleveland Clinic. Methods: Baseline rates of readmissions were gathered during the period from January 2013 to April 2014. A quality improvement project designed to improve outpatient care transitions was initiated during the period leading to April 1, 2014, including: (1) provider education, (2) postdischarge nursing phone calls within 48 hours, and (3) postdischarge provider follow-up appointments within 5 business days. Nursing callback components included symptom management, education, medication review/compliance, and follow-up appointment reminder. Results: During the baseline period, there were 2,638 admissions and 722 unplanned 30-day readmissions for an overall readmission rate of 27.4%. Callbacks and 5-day follow-up appointment monitoring revealed a mean monthly compliance of 72% and 78%, respectively, improving over time during the study period. Readmission rates declined by 4.5% to 22.9% (P < .01; relative risk reduction, 18%) during the study period. The mean direct cost of one readmission was $10,884, suggesting an annualized cost savings of $1.04 million with the observed reduction in unplanned readmissions. Conclusion: Modest readmission reductions can be achieved through better systematic transitions to outpatient care (including follow-up calls and early provider visits), thereby leading to a reduction in use of inpatient resources. These data suggest that efforts focused on improving outpatient care transition were effective in reducing unplanned oncology readmissions.

The virtual ear, nose and throat follow-up clinic: a 10-year quality improvement project

2022 ◽  
Vol 28 (1) ◽  
pp. 16-20
Author(s):  
Simon Morris ◽  
Tanvi Agarwal ◽  
Daniel Leopard ◽  
Rhodri Costello ◽  
Steven Backhouse
Keyword(s):  
Quality Improvement ◽  
Decision Process ◽  
Cost Savings ◽  
Outcome Data ◽  
Improvement Project ◽  
Service Demand ◽  
Patient Decision ◽  
Nose And Throat ◽  
Virtual Clinic

Background/Aims Ear, nose and throat services have seen one of the greatest increases in service demand over the last 6 years. This study aimed to determine if a virtual clinic system could reduce the volume of patients who need to be seen in person in an ear, nose and throat outpatient clinic. Methods Clinical outcome data for one consultant's team in a single ear, nose and throat department between 2009–19 were analysed. Data were prospectively collected on all patients who used the virtual clinic in this 10-year period and the outcomes analysed. Results A total of 3071 patients entered the virtual clinic during the 10-year period. Of these, 61% were discharged from the clinic via virtual follow-up and 39% required an in-person review appointment. On average, 187 patients per year did not have to attend an in-person follow-up appointment, with estimated cost savings of £27 000 per year. Conclusions The virtual ear, nose and throat clinic service has clear benefits for patients and services, delivering healthcare without unnecessary in-person appointments through a shared, clinician–patient decision process.

scholarly journals An evaluation of the implementation of quality improvement (QI) in primary care dentistry: a multi-method approach

2021 ◽  
Vol 10 (2) ◽  
pp. e000839
Author(s):  
Heather Cassie ◽  
Vinay Mistry ◽  
Laura Beaton ◽  
Irene Black ◽  
Janet E Clarkson ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Case Studies ◽  
Quality Care ◽  
Theoretical Domains Framework ◽  
Team Members ◽  
Knowledge And Skills ◽  
Scottish Government ◽  
The Impact

ObjectivesEnsuring that healthcare is patient-centred, safe and harm free is the cornerstone of the NHS. The Scottish Patient Safety Programme (SPSP) is a national initiative to support the provision of safe, high-quality care. SPSP promotes a coordinated approach to quality improvement (QI) in primary care by providing evidence-based methods, such as the Institute for Healthcare Improvement’s Breakthrough Series Collaborative methodology. These methods are relatively untested within dentistry. The aim of this study was to evaluate the impact to inform the development and implementation of improvement collaboratives as a means for QI in primary care dentistry.DesignA multimethod study underpinned by the Theoretical Domains Framework and the Kirkpatrick model. Quantitative data were collected using baseline and follow-up questionnaires, designed to explore beliefs and behaviours towards improving quality in practice. Qualitative data were gathered using interviews with dental team members and practice-based case studies.ResultsOne hundred and eleven dental team members completed the baseline questionnaire. Follow-up questionnaires were returned by 79 team members. Twelve practices, including two case studies, participated in evaluation interviews. Findings identified positive beliefs and increased knowledge and skills towards QI, as well as increased confidence about using QI methodologies in practice. Barriers included time, poor patient and team engagement, communication and leadership. Facilitators included team working, clear roles, strong leadership, training, peer support and visible benefits. Participants’ knowledge and skills were identified as an area for improvement.ConclusionsFindings demonstrate increased knowledge, skills and confidence in relation to QI methodology and highlight areas for improvement. This is an example of partnership working between the Scottish Government and NHSScotland towards a shared ambition to provide safe care to every patient. More work is required to evaluate the sustainability and transferability of improvement collaboratives as a means for QI in dentistry and wider primary care.

Use of a Structured Panel Process to Define Quality Metrics for Antimicrobial Stewardship Programs

2012 ◽  
Vol 33 (5) ◽  
pp. 500-506 ◽  
Author(s):  
Andrew M. Morris ◽  
Stacey Brener ◽  
Linda Dresser ◽  
Nick Daneman ◽  
Timothy H. Dellit ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Stewardship ◽  
Bloodstream Infections ◽  
The United States ◽  
Community Acquired Pneumonia ◽  
Public Reporting ◽  
Modified Delphi ◽  
Number Of Patients ◽  
Days Of Therapy ◽  
The Impact

Introduction.Antimicrobial stewardship programs are being implemented in health care to reduce inappropriate antimicrobial use, adverse events, Clostridium difficile infection, and antimicrobial resistance. There is no standardized approach to evaluate the impact of these programs.Objective.To use a structured panel process to define quality improvement metrics for evaluating antimicrobial stewardship programs in hospital settings that also have the potential to be used as part of public reporting efforts.Design.A multiphase modified Delphi technique.Setting.Paper-based survey supplemented with a 1-day consensus meeting.Participants.A 10-member expert panel from Canada and the United States was assembled to evaluate indicators for relevance, effectiveness, and the potential to aid quality improvement efforts.Results.There were a total of 5 final metrics selected by the panel: (1) days of therapy per 1000 patient-days; (2) number of patients with specific organisms that are drug resistant; (3) mortality related to antimicrobial-resistant organisms; (4) conservable days of therapy among patients with community-acquired pneumonia (CAP), skin and soft-tissue infections (SSTI), or sepsis and bloodstream infections (BSI); and (5) unplanned hospital readmission within 30 days after discharge from the hospital in which the most responsible diagnosis was one of CAP, SSTI, sepsis or BSI. The first and second indicators were also identified as useful for accountability purposes, such as public reporting.Conclusion.We have successfully identified 2 measures for public reporting purposes and 5 measures that can be used internally in healthcare settings as quality indicators. These indicators can be implemented across diverse healthcare systems to enable ongoing evaluation of antimicrobial stewardship programs and complement efforts for improved patient safety.

The Clinical Nurse Specialist Role and its Relevance to Vascular Access: A Canadian Perspective

2021 ◽  
Vol 26 (3) ◽  
pp. 25-30
Author(s):  
Andrea Raynak ◽  
Brianne Wood
Keyword(s):  
Quality Improvement ◽  
Clinical Outcomes ◽  
Vascular Access ◽  
Organizational Outcomes ◽  
Clinical Nurse Specialist ◽  
Nurse Specialist ◽  
Care Hospital ◽  
Improvement Project ◽  
Clinical Nurse ◽  
The Impact

Highlights Abstract Purpose: The purpose of this quality improvement study was to examine the impact of a Vascular Access Clinical Nurse Specialist (VA-CNS) on patient and organizational outcomes. Description of the Project/Program: The VA-CNS role was created and implemented at an acute care hospital in Thunder Bay, Ontario, Canada. The VA-CNS collected data on clinical activities and interventions performed from April 1 to March 29, 2019. The dataset and its associated qualitative clinical outcomes were analyzed using deductive content analysis. Furthermore, a cost analysis was performed by the hospital accountant on these clinical outcomes. Outcome: Over a 1-year period, there were 547 patients protected from an unwarranted peripherally inserted central catheter (PICC) insertion among 302 patient consultations for the VA-CNS. A total of 322 ultrasound-guided peripheral intravenous catheters were inserted and 45 PICC insertions completed at the bedside. The cost associated with the 547 patients not receiving a PICC line result in an estimated savings of $113,301. The VA-CNS role demonstrated a positive payback of $417,525 to the organization. Conclusion: The results of this quality improvement project have demonstrated the positive impacts of the VACNS on patient and organizational outcomes. This role may be of benefit and worth its adoption for other health systems with similar patient populations.

69. A Quality Improvement Project to Increase Larc Follow-Up for Adolescents and Young Adults

2020 ◽  
Vol 66 (2) ◽  
pp. S36
Author(s):  
Sarah Pitts ◽  
Carly Milliren ◽  
Grace Berg ◽  
Danielle McPeak ◽  
Amy DiVasta
Keyword(s):  
Young Adults ◽  
Quality Improvement ◽  
Quality Improvement Project ◽  
Adolescents And Young Adults ◽  
Improvement Project

scholarly journals 0707 “What We’Ve Got Here Is Failure To Communicate”: Apnea Patients And Their DME Suppliers

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A269-A269
Author(s):  
S Thapa ◽  
S Agrawal ◽  
M Kryger
Keyword(s):  
Quality Improvement ◽  
Sleep Apnea ◽  
Quality Improvement Project ◽  
Timely Manner ◽  
Improvement Project ◽  
Therapy Initiation ◽  
Obstructive Sleep ◽  
Key Factor ◽  
The Impact ◽  
The Relationship

Abstract Introduction Successful treatment of obstructive sleep apnea requires adherence to positive airway pressure (PAP) therapy. A key factor is the relationship between the DME provider and the patient so that treatment can be initiated and continued in a timely manner. Our quality improvement project aims to empower and enable patients towards active participation in their sleep apnea care. Our goal is to ultimately increase patients’ knowledge of their Durable Medical Equipment (DME) supplies company, and thus improve their treatment. The first step was to determine patients’ familiarity with their DME. Methods Forty-one patients with sleep apnea on PAP therapy volunteered to be questioned about their DME company during clinic visits at the Yale North Haven Sleep Center, Connecticut, starting November 2019. Patients were asked if they knew the name or the contact of their DME; whether they received adequate training on PAP therapy initiation; if they were receiving timely and correct PAP therapy supplies. They were asked to rate their satisfaction with the DME on a scale of 1 to 5; one being very dissatisfied and five being very satisfied. Results Only 12 out of 41 patients (29.3 percent) knew the names of their DME companies. The average satisfaction rating was 3 (neutral); 44% of patients were dissatisfied, or very dissatisfied with the performance of their DME. Detailed comments were mostly related to poor contact and communication with the DME. Conclusion Most apnea patients had difficulty identifying and contacting their DME. As the next step of this quality improvement project we plan to intervene to ensure that the patients have the name and contact information of their DME available and attached to their PAP machine equipment. We plan to repeat this questionnaire after this intervention to study the impact of this quality improvement project. Support None

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