Effects of Safety Zone Implementation on Perceptions of Safety and Well-being When Caring for COVID-19 Patients

Background In March 2020, the caseload of patients positive for COVID-19 in hospitals began increasing rapidly, creating fear and anxiety among health care workers and concern about supplies of personal protective equipment. Objectives To determine if implementing safety zones improves the perceptions of safety, well-being, workflow, and teamwork among hospital staff caring for patients during a pandemic. Methods A safety zone process was implemented to designate levels of contamination risk and appropriate activities for certain areas. Zones were designated as hot (highest risk), warm (moderate risk), or cold (lowest risk). Caregivers working in the safety zones were invited to complete a survey regarding their perceptions of safety, caregiver well-being, workflow, and teamwork. Each question was asked twice to obtain caregiver opinions for the periods before and after implementation of the zones. Results Significant improvements were seen in perceptions of caregiver safety (P < .001) and collaboration within a multidisciplinary staff (P < .001). Significant reductions in perceived staff fatigue (P = .03), perceived cross contamination (P < .001), anxiety (P < .001), and fear of exposure (P < .001) were also seen. Teamwork (P = .23) and workflow (P = .69) were not significantly affected. Conclusions Safety zone implementation improved caregivers’ perceptions of their safety, their well-being, and collaboration within the multidisciplinary staff but did not improve their perceptions of teamwork or workflow.

856. Barriers to PrEP Implementation among Patient-Facing Staff in Three Urban Clinics

Background PrEP implementation has lagged in the US. The role of multidisciplinary staff in PrEP rollout has been neglected. We sought to identify barriers to PrEP implementation among 3 urban federally qualified health centers (FQHCs) in Connecticut that provide HIV and PrEP services in order to inform development of staff training. Methods A link to an anonymous survey was emailed to patient-facing staff members or posted at the end of staff trainings October 2020-April 2021. The survey requested demographics, duration of employment, and using 4 and 5 point Likert scales, ascertained knowledge and beliefs toward PrEP based on established scales, and perceived individual and systemic barriers to PrEP uptake. Results Among 101 respondents, 40% were 36-54yo, 22% were male, 68% were non-prescribing clinicians, and median duration of employment was 6 years (IQR 2-14). Among 32 (31%) prescribers (physicians, PAs, APRNs), 97% felt comfortable discussing sexual risk with patients, though 15% were not familiar with PrEP efficacy and safety data, 28% responded that PrEP use would encourage risky behaviors, 34% were concerned about side effects, 53% responded that educational and behavioral interventions should be attempted prior to prescribing PrEP, and 59% identified lack of provider training as a barrier. Among 69 (68%) non-prescribers, barriers to PrEP uptake included: patients don’t ask for PrEP (43%), lack of insurance (47%), lack of clinic guidelines/protocol (42%), and staff time for counseling (31%). Conclusion Prescribers and non-prescribers identified distinct individual and systemic barriers to PrEP uptake at FQHCs. Among prescribers, uncertainty regarding indications for and safety of PrEP exist, which will be addressed with targeted training. Non-prescribers identified the need for patient outreach, financial assistance, and counseling as the top priorities. The input of clinic multidisciplinary team members is essential to addressing barriers to PrEP implementation. Disclosures Sheela Shenoi, MD, MPH, Merck (Other Financial or Material Support, SS’s spouse worked for Merck pharmaceuticals 1997-2007 and retains company stock in his retirement account. There is no conflict of interest, but it is included in the interest of full disclosure.)

Adapting services for autism: Recommendations from a specialist multidisciplinary perspective using freelisting

The guidance available for tailoring mental health services for autistic people is limited and dispersed. Practitioners attempting to appropriately adapt mental healthcare and therapy provision report low confidence and inconsistency in their approach. This study contributes to the guidance by providing a shortlist of usable and priority adaptations for diagnostic and therapy services as described by multidisciplinary staff members responsible for the design and delivery of a specialist autism service in the UK. Individual freelisting interviews were conducted with 15 staff, who were asked to list the ways that they adapt their practice individually, within therapy, and collectively as a service. Salience and cultural consensus analyses demonstrated the following agreed priority service adaptations: ensuring the suitability of the service environment with consideration of sensory demands, adapting communication, knowing individual gender identity preferences and minimising client uncertainty. Detailed examples are given for flexibly adapting therapy to individual needs to inform general and specialist services. The findings require replication and evaluation.

A equipe de enfermagem militar como instrutores em saúde operacional

Atualmente o profissional de enfermagem tem função ativa no Atendimento Pré Hospitalar. Na Força Aérea Brasileira estes profissionais compõe a equipe multidisciplinar no atendimento assistencial, bem como, tem importante função como agente educador, durante as instruções como no Curso de Adaptação em Saúde Ocupacional, ministrado anualmente aos novos Oficiais de saúde durante o curso de formação. Objetivo: Descrever a atuação da equipe de enfermagem, como instrutores em Saúde Operacional e contribuir com a formação multiprofissional na área de Atendimento Pré Hospitalar. Método: Relato de experiência. Resultados: Constatou-se que a atuação da enfermagem como componente de uma equipe multidisciplinar possibilita ampliação de conhecimento dos instrutores através das atividades práticas simuladas. Conclusão: Demonstrou-se que a atuação do profissional de enfermagem, contribuiu para melhor interação em equipe e ainda com a familiarização dos alunos no curso, fatores estes que contribuem com qualidade e segurança do cuidado prestado e ampliação do espaço de atuação.Descritores: Enfermagem, Saúde Militar, Ensino, Emergências em Desastres. The military nursing staff as operational health instructorsAbstract: Currently, the nursing professional has an active role in Pre-Hospital Care. In the context of the Brazilian Air Force, such professionals make up the multidisciplinary team in assistance, as well as having an important role as educational agents, during instructions like in the Occupational Health Adaptation Course, given annually to new health officers during the formation course. Objective: To describe the nursing performance in the multidisciplinary staff during the instruction of the Adaptation Course in Operational Health. Method: Experience report. Results: It was found that the performance of nursing as a component of a multidisciplinary staff enables the expansion of knowledge of instructors through simulated practical activities. Conclusion: It has been shown that the performance of the nursing professional contributed to a better team interaction and also to get the students familiarized in the course, factors which contribute to the quality and safety of the care provided and the expansion of the performance space.Descriptors: Nursing, Military Health, Teaching, Disaster Emergencies. El equipo militar de enfermería como instructores operacionales de saludResumen: Actualmente, el profesional de enfermería tiene un papel activo en la atención prehospitalaria. En la Fuerza Aérea Brasileña, estos profesionales conforman el equipo multidisciplinario de asistencia, además de tener un papel importante como agente educativo, durante las instrucciones como en el Curso de Adaptación en Salud Ocupacional, que se imparte anualmente a los nuevos oficiales de salud durante el curso de capacitación. Objetivo: describir el desempeño del equipo de enfermería como instructores en salud operativa y contribuir a la capacitación multiprofesional en el área de atención prehospitalaria. Método: informe de experiencia. Resultados: Se encontró que el desempeño de la enfermería como componente de un equipo multidisciplinario permite la expansión del conocimiento de los instructores a través de actividades prácticas simuladas. Conclusión: se demostró que el desempeño del profesional de enfermería contribuyó a una mejor interacción del equipo y también a familiarizar a los estudiantes en el curso, factores que contribuyen a la calidad y seguridad de la atención brindada y la expansión del espacio de desempeño.Descriptores: Enfermería, Salud Militar, Enseñanza, Emergencias de Desastres.

A national survey of publicly funded chronic pain management services in Ireland

Background Chronic pain management services have historically been under-resourced in Ireland. There is no agreed model of care for chronic pain management services in Ireland. Previous studies have assessed the extent of services in Ireland without examining waiting times for access to services. Aims This study aimed to quantify the extent of, geographical distribution of and waiting times for access to publicly funded chronic pain management services in Ireland. Methods Using the British Pain Society’s Core Standards for Pain Management Services in the UK (2015) and International Association for the Study of Pain (IASP) recommendations, a questionnaire was devised. Publically funded departments in Ireland were contacted and questionnaires completed. Waiting list data was publicly available and obtained from the National Treatment Purchase Fund website. Results There was a 100% response rate. Sixteen publicly funded chronic pain management services were identified. There are 27 chronic pain management consultants (16.6 whole time equivalents (WTE)) practicing chronic pain management, amounting to 0.55 specialists (0.34 WTEs)/100,000 of the population. There are 21 WTE for non-consultant hospital doctors (NCHDs), 26.5 WTEs for nursing, 8 WTEs for physiotherapy and 6.2 WTEs for psychology, nationally. A percentage of 93.75% of departments (n = 15) provide interventional therapies, 37.5% (n = 6) provide advanced neuromodulation and 43.75% (n = 7) are managing intrathecal pump therapies. There are five pain management programmes nationally. As of January 2020, ~ 25% patients on waiting lists for outpatient appointments were waiting > 18 months, with ~ 17% patients on waiting lists for interventional treatments waiting > 12 months. Conclusions Shortage of multidisciplinary staff is of particular concern for Irish services. Patient access is limited as evidenced by significant waiting lists. In order to improve access to care and bring services in line with international recommendations, increased resources are needed.

Establishing safety huddles on a general adult acute psychiatric ward: staff's views and relation with restrictive practice

AimsTo establish Safety Huddles (SH) on an acute general adult psychiatric ward, exploring links to restrictive practice. Additionally, to obtain multidisciplinary staff feedback on SH's impact on their workload/wellbeing and on patient care, and to identify barriers in implementation.Background: A SH is a multidisciplinary daily briefing focused on patients most at risk, held at a fixed time and place, lasting max 5-10 minutes. Effective SH involve agreed actions, are informed by multidisciplinary staff feedback of data and provide the opportunity to appreciate and celebrate success in reducing harm. SH are a valuable team building activity, promoting situational awareness and helping with prioritising daily tasks.MethodSH were introduced on September 2020. Templates were developed to prompt staff how to facilitate. Staff were encouraged to identify key goals and reflect on issues in the last and next 24 hours. Each participant was allocated a role, e.g. record keeping or dissemination of information. In December 2020, records of incidence of restrictive practice (numbers of restraints, seclusions and rapid tranquilisations) were obtained for the periods June-August 2020 and September-November 2020. Additionally, staff feedback was obtained through a short anonymous Survey Monkey questionnaire. It explored whether SH had an effect on patient care and staff's workload/wellbeing, and possible barriers to implementation.ResultComparing the two 3-month periods before and after SH implementation, restraint episodes were reduced from 47 to 21, seclusion episodes from 19 to 2, and rapid tranquilisation episodes from 10 to 3. Nine staff members responded to the feedback questionnaire. All believed SH had a positive impact on patient care, or had the potential to do so. Staff reported SH gave them insight into incidents, made them feel safer and prepared for the day, played a part in reducing restrictive practice, and empowered staff from all professional backgrounds by giving them a voice. Low or late participation, cancellation of SH because of clinical activity, and vague questions in the meeting template were identified as barriers in implementation.ConclusionAcute psychiatric wards regularly face challenges of high clinical activity, low staffing levels, bed pressures, and high-risk patient cohorts. SH contributed to reducing restrictive practice and creating a safer and more positive work environment. It is important to ensure SH are taking place daily, using an appropriate template to guide staff who may be new to facilitating. Accordingly, the impact on restrictive practice, patient care and staff wellbeing can be sustained long-term.

Regulatory, scientific, and ethical issues arising from institutional activity in one of the 90 Italian Research Ethics Committees

Background This paper highlights the issues that one of the 90 Italian Research Ethics Committees (RECs) might encounter during the approval phase of a clinical trial to identify corrective and preventive actions for promoting a more efficient review process and ensuring review quality. Publications on the subject from Italy and the rest of Europe are limited; encouraging constructive debate can improve RECs’ service to the subject of the clinical trial. Methods We retrospectively reviewed a cohort of 822 clinical trial protocols, initially reviewed by REC, from June 2014 to December 2018. Data collected for each protocol were type of trial, sample size, use of placebo, number and kind of revisions requested by the REC before approval, and time taken for approval. Data for each protocol were collected by a trained clinical research assistant using the REC’s files and electronic archives. Results Almost 45% of the reviewed studies (374/822) required clarifications, significant changes to the documentation, or minor changes before final approval. Conclusions Preventive measures are needed to reduce the number of requested corrections and thus also the time required for approval, while maintaining review quality. All critical points and proposals presented in this paper require harmonization through updates to European regulations, as regulatory harmonization produces better compliance with rules and reduces the number of changes required before the trials’ final approval. Such updates include the development of standardized formats for informed consent, the verification of any evidence in favor of using off-label treatments over placebo as comparators, using multidisciplinary staff in clinical trials with children and adolescents, improving the legal definition of RECs to assign responsibilities and ensure independence, and providing guidance for RECs to engage clinical research assistants in internal audits.

The Staff Views About Assessing Voices Questionnaire: Piloting a Novel Socratic Method of Evaluating and Training Multidisciplinary Staff's Cognitive Assessment of Patients' Distressing Voices

Cognitive features of auditory hallucinations (voices) have important clinical significance and their assessment is vital for cognitive behavior therapy to be more widely deployed by multidisciplinary staff. Using a new Socratic instrument—The Staff Views About Assessing Voices Questionnaire (SVAVQ)—we surveyed a community inpatient rehabilitation multidisciplinary workforce's (N = 50) assessment and attitude toward asking cognitive questions about patients' voices. We found that there were many clinically important gaps in what staff asked about in relation to cognitive features of voices. We identified a range of beliefs the staff hold that may prevent assessment of voice cognitive features. However, after attending the Socratic SVAVQ interview, 84% of staff said they planned to ask patients more questions about cognitive features of patients' voices. Research could now test if other psychosis services neglect the assessment of important cognitive features of patients' voices and if staff Socratic questioning improves their cognitive assessments.

The Healthy Pregnancy Service to Optimise Excess Gestational Weight Gain for Women with Obesity: A Qualitative Study of Health Professionals’ Perspectives

Maternal obesity is associated with health risks for women and their babies, exacerbated by excess gestational weight gain. We describe health professionals’ perspectives in the provision of a Healthy Pregnancy service designed to optimise healthy lifestyle and support recommended gestational weight gain for women with obesity. Semi-structured interviews were conducted with health professionals. Questions were based on the Theoretical Domains Framework (TDF) and deductive thematic analysis was performed. A total of 14 multidisciplinary staff were interviewed. Six themes were identified: 1. health professionals view themselves as part of a team; 2. health professionals reported having necessary skills; 3. experience generated confidence in discussing gestational weight gain; 4. gestational weight gain is considered of variable importance; 5. health professionals want women to be comfortable; 6. the environmental context and resources presented some barriers. Staff were supportive of the Healthy Pregnancy service and valued developing teamwork with staff and rapport with women. Most felt relatively comfortable discussing weight gain with women. Barriers included ability to navigate sensitive topics with women, limited awareness of the intervention among new staff, communication between teams, and waiting time for women. Barriers and enablers to the delivery of an integrated model of maternity care were identified. These findings should inform and improve implementation of service models integrating healthy lifestyle in the antenatal care of women with obesity.

Pneumonia and the role of dentistry on ICU Staff

Ventilator-associated pneumonia (VAP) is one ofthe most prevalent healthcare-associated infections (HAI) andcauses of death in intensive care units (ICUs), and studies haveshown its relation to oral health. Aim: To report the impact ofthe incorporation of dental professionals into multidisciplinaryICU staff on the incidence of VAP. Methods: A retrospectiveobservational study was carried out to collect and analyzehealth indicators of patients in the ICUs from 2011 to 2018 andto differentiate these indicators between the periods beforeand after the participation of dental staff in the ICU. This studywas approved by the Research Ethics Committee. Results:The average number of monthly ICU admissions was 105.89 ±169.72, and the discharge was 105.21 ± 168.96, with a monthlyaverage number of deaths within 24 h of 38.61 ± 62.27. Theaverage number of monthly HAI-related deaths decreasedfrom 2011 to 2018, followed by a reduction in cases of HAIper month. The average monthly number of HAIs relatedto mechanical ventilation (MV) decreased, and the samewas observed for the infection density of HAIs related to MV(p < 0.001). In multivariate analysis, there was a significantdecrease in the number of HAIs related to MV (p = 0.005).Conclusion: Although a reduction in the number of admissionsor complexity of cases was not observed in the study period,multidisciplinary staff practices were essential for controllingHAIs and the presence of dental professionals can assist in thecontrol of HAIs related to MV.