scholarly journals Impact of a Delirium Screening Tool and Multifaceted Education on Nurses’ Knowledge of Delirium and Ability to Evaluate It Correctly

2012 ◽  
Vol 21 (1) ◽  
pp. e1-e11 ◽  
Author(s):  
Gail Gesin ◽  
Brittany B. Russell ◽  
Andrew P. Lin ◽  
H. James Norton ◽  
Susan L. Evans ◽  
...  
Keyword(s):  
Intensive Care ◽  
Education Program ◽  
Screening Tool ◽  
Phase 1 ◽  
Surgical Trauma ◽  
Phase 2 ◽  
Phase 3 ◽  
Didactic Lecture ◽  
The Impact ◽  
Nurses Knowledge

BackgroundThe impact of using a validated delirium screening tool and different levels of education on surgical-trauma intensive care unit (STICU) nurses’ knowledge about delirium is unclear.ObjectivesTo measure the impact of using the Intensive Care Delirium Screening Checklist (ICDSC), with or without a multi-faceted education program, on STICU nurses’ knowledge and perceptions of delirium and their ability to evaluate it correctly.MethodsThe knowledge and perceptions of subject nurses about delirium, and agreement between the independent assessments of delirium by the subject nurse and by a validated judge (who always used the ICDSC), were compared across 3 phases. Phase 1: No delirium screening tool and no education. Phase 2: ICDSC and minimal education (ie, ICDSC validation study only). Phase 3: ICDSC and multifaceted education (ie, pharmacist-led didactic lecture, Web-based module, and nurse-led bedside training).ResultsNurses’ knowledge (mean [SD] score out of 10 points) was similar (P = .08) in phase 1 (6.1 [1.4]) and phase 2 (6.5 [1.4]) but was greater (P = .001) in phase 3 (8.2 [1.4]). Agreement between nurses and the validated judge in the assessment of delirium increased from phase 1 (κ = 0.40) to phase 2 (κ = 0.62) to phase 3 (κ = 0.74). Nurses perceived use of the ICDSC as improving their ability to recognize delirium.ConclusionsUse of a multifaceted education program improves both nurses’ knowledge about delirium and their perceptions about its recognition. Implementation of the ICDSC improves the ability of STICU nurses to evaluate delirium correctly.

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 < 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.

scholarly journals 137. Impact of Antimicrobial Stewardship Interventions on Post-Elective Caesarean Antibiotic Prophylaxis and Surgical Site Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S182-S182
Author(s):  
Xue Fen Valerie Seah ◽  
Yue Ling Rina Ong ◽  
Wei Ming Cedric Poh ◽  
Shahul Hameed Mohamed Siraj ◽  
Kai-Qian Kam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Prophylaxis ◽  
Patient Outcomes ◽  
Phase 1 ◽  
Surgical Site Infections ◽  
Phase 2 ◽  
Oral Antibiotics ◽  
Post Intervention ◽  
Phase 3 ◽  
The Impact

Abstract Background Antimicrobial stewardship programs (ASP) aim to improve appropriate antimicrobial use. Post-operative antibiotics are generally not necessary, especially those without surgical site infections risk factors (e.g. obesity). Few studies have described the impact of ASP interventions on patient outcomes especially in unique populations such as obstetrics. This study aims to evaluate the impact of ASP interventions on post-elective caesarean (eLSCS) oral antibiotic prophylaxis use and patient outcomes including SSI rates. Methods This pre-post quasi-experimental study was conducted over 9 months (2 months pre- and 7 months post-intervention) in all women admitted for eLSCS in our institution. Interventions included eLSCS surgical prophylaxis guideline dissemination, where a single antibiotic dose within 60 minutes before skin incision was recommended. Post-eLSCS oral antibiotics was actively discouraged in those without SSI risk factors. This was followed by ASP intervention notes (phase 1) for 3 months, and an additional phone call to the ward team for the next 7 months (phase 2). Phase 3 (next 6 months) constituted speaking to the operating consultant. The primary outcome was post-operative oral antibiotics prescription rates. Secondary outcomes included rates of 30-day post-operative SSI. Results A total of 1751 women was reviewed. Appropriateness of pre-operative antibiotic prophylaxis was 98% in our institution. There were 244 women pre-intervention, 274 in post-intervention phase 1, 658 in phase 2 and 575 in phase 3. Pre-intervention post-eLSCS antibiotic prescribing rates was 82% (200), which reduced significantly post-intervention to 54% (148) in phase 1, 50% (331) in phase 2 and 39% (226) in phase 3 (p< 0.001). There was no significant difference in patients who developed post-operative SSI pre-post intervention (0.8%, 2 of 242 vs. 1.9%, 28 of 1479, p=0.420) and among who received post-operative oral antibiotics compared to those without (1.9%, 17 of 905 vs. 1.5%, 13 of 846, p=0.582). Conclusion ASP interventions can reduce post-eLSCS antibiotic prophylaxis rates without adversely impacting patient safety. Disclosures All Authors: No reported disclosures

scholarly journals GEM Centre: Completion report for Phase 2 funding, 2017–2020

2021 ◽  
Author(s):  
Keyword(s):  
Global Education ◽  
Phase 1 ◽  
Lessons Learned ◽  
Foreign Affairs ◽  
Phase 2 ◽  
Phase 3 ◽  
Monitoring Centre ◽  
Australian Council ◽  
The Impact ◽  
Further Development

In 2014, the Australian Council for Educational Research (ACER) and the Australian Government’s Department of Foreign Affairs and Trade (DFAT) established a partnership under the Global Education Monitoring Centre. Since then, there have been two funding periods: Phase 1 from 2014–2017 and Phase 2 from 2017–2020. Phase 3 will cover 2020–2023. This report documents the completion of Phase 2 funding and describes the shared priorities of DFAT and ACER through the GEM Centre, followed by the objectives and key outcomes of the work program during this period. The outcomes and lessons learned, together with findings from the GEM Centre mid-term review (MTR) in 2019,1 are reflected against the impact and sustainability of the ACER–DFAT partnership. The MTR validated the overall success of the GEM Centre and identified areas for further development, specifically to improve the effectiveness of the partnership. This report concludes with a brief outlook on how these developments will be addressed under Phase 3 of the GEM Centre.

scholarly journals Pharmaceutical interventions in medications prescribed for administration via enteral tubes in a teaching hospital

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Carolina Justus Buhrer Ferreira Neto ◽  
Caroline Koga Plodek ◽  
Franciny Kossemba Soares ◽  
Rayza Assis de Andrade ◽  
Fernanda Teleginski ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Inpatient Treatment ◽  
Phase 1 ◽  
Phase 2 ◽  
Phase 3 ◽  
Standard Procedures ◽  
Unit Dose ◽  
Microsoft Office ◽  
The Impact ◽  
Pharmaceutical Interventions

Abstract Objective: to analyze the impact of guidelines regarding errors in medications prescribed for administration through enteral tubes. Method: quantitative study, in three phases, undertaken in internal medicine, neurology and an intensive care unit in a general teaching hospital. In Phase 1, the following was undertaken: a protocol for dilution and unit-dose repackaging and administration for 294 medications via enteral tubes; a decision flowchart; operational-standard procedures for dilution and unit-dose repackaging of oral pharmaceutical forms and for administration of medications through enteral tubes. In phase 2, errors in 872 medications prescribed through enteral tubes, in 293 prescriptions for patients receiving inpatient treatment between March and June, were investigated. This was followed by training of the teams in relation to the guidelines established. In Phase 3, pharmaceutical errors and interventions in 945 medications prescribed through enteral tubes, in 292 prescriptions of patients receiving inpatient treatment between August and September, were investigated prospectively. The data collected, in a structured questionnaire, were compiled in the Microsoft Office Excel(r) program, and frequencies were calculated. Results: 786 errors were observed, 63.9% (502) in Phase 2, and 36.1% (284) in Phase 3. In Phase 3, a reduction was ascertained in the frequency of prescription of medications delivered via enteral tubes, medications which were contraindicated, and those for which information was not available. Conclusion: guidelines and pharmaceutical interventions were determined in the prevention of errors involving medications delivered through enteral tubes.

scholarly journals Eight-Year Experience of Antimicrobial Stewardship Program and the Trend of Carbapenem Use at a Tertiary Acute-Care Hospital in Japan—The Impact of Postprescription Review and Feedback

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Tsubasa Akazawa ◽  
Yoshiki Kusama ◽  
Haruhisa Fukuda ◽  
Kayoko Hayakawa ◽  
Satoshi Kutsuna ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Phase 1 ◽  
Cost Savings ◽  
Care Hospital ◽  
Antimicrobial Stewardship Program ◽  
Phase 2 ◽  
Phase 3 ◽  
Car Use ◽  
Stewardship Program ◽  
The Impact

Abstract Objective We implemented a stepwise antimicrobial stewardship program (ASP). This study evaluated the effect of each intervention and the overall economic impact on carbapenem (CAR) use. Method Carbapenem days of therapy (CAR-DOT) were calculated to assess the effect of each intervention, and antipseudomonal DOT were calculated to assess changes in use of broad-spectrum antibiotics. We carried out segmented regression analysis of studies with interrupted time series for 3 periods: Phase 1 (infectious disease [ID] consultation service only), Phase 2 (adding monitoring and e-mail feedback), and Phase 3 (adding postprescription review and feedback [PPRF] led by ID specialist doctors and pharmacists). We also estimated cost savings over the study period due to decreased CAR use. Results The median monthly CAR-DOT, per month per 100 patient-days, during Phase 1, Phase 2, and Phase 3 was 5.46, 3.69, and 2.78, respectively. The CAR-DOT decreased significantly immediately after the start of Phase 2, but a major decrease was not observed during this period. Although the immediate change was not apparent after Phase 3 started, CAR-DOT decreased significantly over this period. Furthermore, the monthly DOT of 3 alternative antipseudomonal agents also decreased significantly over the study period, but the incidence of antimicrobial resistance did not decrease. Cost savings over the study period, due to decreased CAR use, was estimated to be US $150 000. Conclusions Adding PPRF on the conventional ASP may accelerate antimicrobial stewardship. Our CAR stewardship program has had positive results, and implementation is ongoing.

scholarly journals A Small Nudge can make a Difference: Impact of Passive Feedback on Prescription Behavior

2016 ◽  
Vol 4 (1) ◽  
pp. 31-34
Author(s):  
DK Sharma
Keyword(s):  
Error Rate ◽  
Phase 1 ◽  
Audit And Feedback ◽  
Phase 2 ◽  
Phase 3 ◽  
Prescription Errors ◽  
The Impact ◽  
Prescription Behavior

ABSTRACT It is generally believed that big changes can be brought about by big interventions. Sometimes, small interventions also can show spectacular results. This case describes the impact of simple intervention, audit and feedback on change in the behavior of clinicians. In this case, the impact of simple intervention in the form of passive feedback has been documented. All the prescriptions received in pharmacy during the period of study were scrutinized for specific prescription errors. An overall error rate of 0.12% was observed in phase 1 of the study, which was reduced to 0.04% during phase 2 of the study after implementation of the intervention, which further dropped to zero during phase 3. It was concluded that a simple audit and feedback nudged the recipients of the feedback to modify their behavior. How to cite this article Tadia VK, Ahlawat R, Arya SK, Sharma DK. A Small Nudge can make a Difference: Impact of Passive Feedback on Prescription Behavior. Int J Res Foundation Hosp Health Adm 2016;4(1):31-34.

scholarly journals Centralized Ambulance Destination Determination: A Retrospective Data Analysis to Determine Impact on EMS System Distribution, Surge Events, and Diversion Status

2021 ◽  
Vol 22 (6) ◽  
pp. 1311-1316
Author(s):  
Gurvijay Bains ◽  
Amelia Breyre ◽  
Ryan Seymour ◽  
Juan Carlos Montoy ◽  
John Brown ◽  
...  
Keyword(s):  
Phase 1 ◽  
Geographical Area ◽  
Pilot Project ◽  
Baseline Period ◽  
System Level ◽  
Phase 2 ◽  
Phase 3 ◽  
Retrospective Data Analysis ◽  
Level Loading ◽  
The Impact

Introduction: Emergency medical services (EMS) systems can become impacted by sudden surges that can occur throughout the day, as well as by natural disasters and the current pandemic. Because of this, emergency department crowding and ambulance “bunching,” or surges in ambulance-transported patients at receiving hospitals, can have a detrimental effect on patient care and financial implications for an EMS system. The Centralized Ambulance Destination Determination (CAD-D) project was initially created as a pilot project to look at the impact of an active, online base hospital physician and paramedic supervisor to direct patient destination and distribution, as a way to improve ambulance distribution, decrease surges at hospitals, and decrease diversion status. Methods: The project was initiated March 17, 2020, with a six-week baseline period; it had three additional study phases where the CAD-D was recommended (Phase 1), mandatory (Phase 2), and modified (Phase 3), respectively. We used coefficients of variation (CV) statistical analysis to measure the relative variability between datasets (eg, CAD-D phases), with a lower variation showing better and more even distribution across the different hospitals. We used analysis of co-variability for the CV to determine whether level loading was improved systemwide across the three phases against the baseline period. The primary outcomes of this study were the following: to determine the impact of ambulance distribution across a geographical area by using the CV; to determine whether there was a decrease in surge rates at the busiest hospital in this area; and the effects on diversion. Results: We calculated the CV of all ratios and used them as a measure of EMS patient distribution among hospitals. Mean CV was lower in Phase 2 as compared to baseline (1.56 vs 0.80 P < 0.05), and to baseline and Phase 3 (1.56 vs. 0.93, P <0.05). A lower CV indicates better distribution across more hospitals, instead of the EMS transports bunching at a few hospitals. Furthermore, the proportion of surge events was shown to be lower between baseline and Phase 1 (1.43 vs 0.77, P <0.05), baseline and Phase 2 (1.43 vs. 0.33, P < 0.05), and baseline and Phase 3 (1.43 vs 0.42, P < 0.05). Diversion was shown to increase over the system as a whole, despite decreased diversion rates at the busiest hospital in the system. Conclusion: In this retrospective study, we found that ambulance distribution increased across the system with the implementation of CAD-D, leading to better level loading. The surge rates decreased at some of the most impacted hospitals, while the rates of hospitals going on diversion paradoxically increased overall. Specifically, the results of this study showed that there was an improvement when comparing the CAD-D implementation vs the baseline period for both the ambulance distribution across the system (level loading/CV), and for surge events at three of the busiest hospitals in the system.

scholarly journals Rodent eradication scaled up: clearing rats and mice from South Georgia

Oryx ◽  
2017 ◽  
Vol 53 (1) ◽  
pp. 27-35 ◽  
Author(s):  
A. R. Martin ◽  
M. G. Richardson
Keyword(s):  
Phase 1 ◽  
Phase 2 ◽  
Phase 3 ◽  
Island Populations ◽  
South Georgia ◽  
Passive Devices ◽  
Cavity Nesting ◽  
Rodent Eradication ◽  
Rats And Mice ◽  
The Impact

AbstractThe Subantarctic island of South Georgia lost most of its birds to predation by rodents introduced by people over 2 centuries. In 2011 a UK charity began to clear brown rats Rattus norvegicus and house mice Mus musculus from the 170 km long, 3,500 km2 island using helicopters to spread bait containing Brodifacoum as the active ingredient. South Georgia's larger glaciers were barriers to rodent movement, resulting in numerous independent sub-island populations. The eradication could therefore be spread over multiple seasons, giving time to evaluate results before recommencing, and also reducing the impact of non-target mortality across the island as a whole. Eradication success was achieved in the 128 km2 Phase 1 trial operation. Work in 2013 (Phase 2) and early 2015 (Phase 3) covered the remaining 940 km2 occupied by rodents. By July 2017, 28 months after baiting was concluded, there was no sign of surviving rodents, other than one apparently newly introduced by ship in October 2014. A survey using detection dogs and passive devices will search the Phase 2 and Phase 3 land for rodents in early 2018. Seven (of 30) species of breeding birds suffered losses from poisoning, but all populations appear to have recovered within 5 years. The endemic South Georgia pipit Anthus antarcticus was the first bird to breed in newly rat-free areas, but there were also signs that cavity-nesting seabirds were exploring scree habitat denied them for generations. Enhanced biosecurity measures on South Georgia are needed urgently to prevent rodents being reintroduced.

scholarly journals P095: Preparing emergency patients and providers study: Clinician and patient satisfaction with communication tool

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S98
Author(s):  
J. Nunn ◽  
D. Chiasson ◽  
C. Cassidy ◽  
S. MacPhee ◽  
B. Rose-Davis ◽  
...  
Keyword(s):  
Nova Scotia ◽  
Response Rate ◽  
Phase 1 ◽  
Descriptive Statistics ◽  
Phase 2 ◽  
Phase 3 ◽  
Item Questionnaire ◽  
Ed Visits ◽  
The Impact

Introduction: Effective communication to develop a shared understanding of patient/caregiver (P/C) expectations is critical during emergency department (ED) encounters. However, there is limited research examining the use of communication tools of P/C expectations to improve communication in the ED. The objective of this study was to examine satisfaction with a patient expectations questionnaire, known as the PrEPP tool, and its impact on communication and management of patients in the ED. Methods: The PrEPP tool collected P/C expectations over 3 phases of the study. In phase1, the PrEPP tool was distributed to all P/Cs (CTAS score of 2 to 5) in four EDs in Nova Scotia. In phase 2 the PrEPP tool was refined to a 5-item questionnaire. In phase 3 the PrEPP tool was re-implemented over a six-month period. Follow-up surveys were distributed to P/Cs via email (phase 1, 3) and HCPs on iPads in the ED (phase 3) to determine the impact of the tool on communication and management of patients. Entries were compiled on a REDCap database and descriptive statistics were used to analyze responses related to satisfaction.The PrEPP tool collected P/C expectations over 3 phases of the study. In phase1, the PrEPP tool was distributed to all P/Cs (CTAS score of 2 to 5) in four EDs in Nova Scotia. In phase 2 the PrEPP tool was refined to a 5-item questionnaire. In phase 3 the PrEPP tool was re-implemented over a six-month period. Follow-up surveys were distributed to P/Cs via email (phase 1, 3) and HCPs on iPads in the ED (phase 3) to determine the impact of the tool on communication and management of patients. Entries were compiled on a REDCap database and descriptive statistics were used to analyze responses related to satisfaction. Results: In Phase 1, 11418 PrEPP tools and 147 surveys (29% response rate) were collected from January-June 2016. The majority of P/Cs found the PrEPP questionnaire easy to complete (95.9%) and felt HCPs met their expectations (87.1%). In Phase 3, 951 P/C (31.1% response rate) and 128 HCP surveys were collected. Of P/C respondents 45.9% felt PrEPP helped to communicate expectations, while 49.7% said that they would like to use it on future ED visits. The majority of P/C respondents (75.4%) indicated their expectations were met during their visit to the ED. Of those whose expectations were not met, 69% felt their expectations were not discussed. The majority of HCP respondents (90.4%) indicated they used the PrEPP tool at least sometimes. Also, 78.4% said it influenced patient communication and 42% indicated the tool influenced management of patients at least sometimes. Conclusion: Obtaining expectations early in the patient encounter may provide opportunities for improved communication in the ED. P/Cs found the PrEPP tool easy to use to communicate their expectations and HCPs felt it influenced communication and management of patients in the ED. Further qualitative thematic analysis is needed to explore how the PrEPP tool impacted ED visits.

scholarly journals A Mobile App, KhunLook, to Support Thai Parents and Caregivers With Child Health Supervision: Development, Validation, and Acceptability Study

10.2196/15116 ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. e15116
Author(s):  
Rosawan Areemit ◽  
Pagakrong Lumbiganon ◽  
Chanyut Suphakunpinyo ◽  
Arunee Jetsrisuparb ◽  
Sumitr Sutra ◽  
...  
Keyword(s):  
Child Health ◽  
Phase 1 ◽  
Growth Parameter ◽  
Mobile App ◽  
Ease Of Use ◽  
Phase 2 ◽  
Phase 3 ◽  
Web Based ◽  
Health Supervision ◽  
The Impact

Background In Thailand, children born in government hospitals receive a maternal and child health handbook (MCHH). However, when a new MCHH edition is released, those with the previous editions do not have access to the updated information. A mobile app is an appealing platform to fill this gap. We developed a mobile app called “KhunLook” as an interactive electronic MCHH intended to assist parents in child health supervision. Objective This study describes the user requirements and development of the KhunLook mobile app, validity of parents’ growth assessments, and parents’ evaluation of feasibility and acceptability of the app. Methods Phase 1 was a qualitative study using individual interviews. The interview data were used to revise the prototype. In phase 2, parents were randomly assigned to assess their children’s growth with the app or the MCHH. The outcomes were compared to those of the physician’s assessment, and congruence was determined. In phase 3, parents evaluated the feasibility and acceptability of the app in comparison to the MCHH through a web-based survey. Results Four health care providers and 8 parents participated in phase 1. Two themes were identified: (1) the mobile app potentially counters parents’ infrequent use of the MCHH with accuracy, attractiveness, convenience, and simplicity, and (2) health supervision needs to be standard, up-to-date, and understandable. KhunLook was publicly launched with a family page and 7 key features: growth and nutrition, development, immunizations, oral health, reminders for the next appointment, memories, and health advice. In phase 2, 56 parents participated in the growth parameter assessments; 34 were in the App group and 22 in the MCHH group. The outcomes of the growth parameter assessments between parents and physicians in both the App and MCHH groups were not significantly different. The congruence proportions were higher in the App group for weight and head circumference, but the differences were not statistically significant. In phase 3, 356 parents from all over Thailand participated in a web-based survey. Parents rated the app feasibility as “very easy to easy” to use at higher proportions than the MCHH in all health assessment domains (growth, development, and immunizations) and ease-of-use domains with statistical significance (P<.001). The KhunLook app received a significantly higher mean score (8.59/10) than the MCHH (7.6/10) (P<.001). Most parents (317/356, 89.0%) preferred the app over MCHH. Further, 93.5% (333/356) of the parents stated that they would continue to use the app and 96.9% (345/356) would recommend others to use it. Conclusions KhunLook, a Thai mobile app for child health supervision, was developed, validated for growth assessments, and was well accepted for ease-of-use by parents. Further studies should be conducted with a large scale of users, and the impact of this app on health behaviors and health outcomes must be evaluated.

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