Lean Six Sigma Redesign of a Process for Healthcare Mandatory Education in Basic Life Support—A Pilot Study

Healthcare staff are required to undertake mandatory training programs to ensure they maintain key clinical competencies. This study was conducted in a private hospital in Ireland, where the processes for accessing mandatory training were found to be highly complex and non-user friendly, resulting in missed training opportunities, specific training license expiration, and underutilized training slots which resulted in lost time for both the trainers and trainees. A pilot study was undertaken to review the process for accessing mandatory training with a focus on the mandatory training program of Basic Life Support (BLS). This was chosen due to its importance in patient resuscitation and its requirement in the hospital achieving Joint Commission International (JCI) accreditation. A pre- and post-team-based intervention design was used with Lean Six Sigma (LSS) methodology employed to redesign the process of booking, scheduling, and delivery of BLS training leading to staff individual BLS certification for a period of two years. The redesign of the BLS training program resulted in a new blended delivery method, and the initiation of a pilot project led to a 50% increase in the volume of BLS classes and a time saving of 154 h 30 min for staff and 48 h 14 min for BLS instructors. The success of the BLS process access pilot has functioned as a platform for the redesign of other mandatory education programs and will be of interest to hospitals with mandatory training requirements that are already facing healthcare challenges and demands on staff time.

423. Implementation of a Hierarchy of Controls in a Mobile Health Unit to Safely Care for Inpatients with COVID-19 during Healthcare System Surge

Background In April 2021, Sunnybrook Health Sciences Centre opened a Mobile Health Unit (MHU, i.e. medical tents) under the direction of the Ontario Ministry of Health and Long Term Care in response to a surge in hospitalized patients with COVID-19 during wave three of the pandemic. Providing care to patients in non-conventional spaces is not new, however, experience in safely caring for COVID-19 patients in these settings is lacking. Our aim is to describe the implementation of our MHU and associated outcomes of these COVID-19 patients. Methods A multidisciplinary clinical and operations team was created to plan, execute and operate a safe environment for COVID-19 patients and healthcare workers within the MHU. Patient selection was restricted to patients with COVID-19 who were clinically recovering from severe COVID-19 pneumonia. Ventilation was optimized with air flow directed away from patient areas, velocity reduced to below 0.25 meters per second, and air exchanges of 24-28 per hour. All healthcare workers working in the MHU were offered COVID-19 vaccine and required to complete mandatory education if they declined (vaccination rate of 87% was achieved among dedicated staff). Universal masking and eye protection was used throughout the MHU with designated areas for donning and doffing personal protective equipment. Results In total, 32 patients with COVID-19 were managed in the MHU between 26 April and 21 May, 2021. Table 1 provides the summary of patient characteristics. All patients had a median of one-day of transmission-based precautions remaining in their course and were infected with Alpha variant with exception of one patient with the Gamma variant. Among those patients with genotyping available, all were infected with SARS-CoV-2 carrying the N501Y mutation. Four of the 32 patients required transfer to the main hospital for medical indication while the others were discharged home or to rehabilitation. None of the healthcare workers who worked within the MHU developed COVID-19 infection. Conclusion We safely cared for patients recovering from COVID-19 infection in an MHU to support system healthcare capacity. Our experience, including the specific hierarchy of controls implemented, may be helpful for future pandemic planning. Disclosures All Authors: No reported disclosures

“We should at least have basic survival skills, right?”: young males support mandatory food skills education

PurposeThis study explored young males' suggestions for food skills education in three domains: food selection and planning, food preparation and food safety and storage. It also solicited young males' perspectives on mandatory food skills education.Design/methodology/approachThis descriptive qualitative study employed a semi-structured interview guide. A one-page list of food skills was provided to each participant to form a consistent basis for the interviews. Data were analyzed using the constant comparative method.FindingsForty-four young men aged 17 to 35 participated in the study. Thirty-seven supported mandatory education for food skills. Gender stereotypes around food skills were identified as a barrier to young males enrolling in elective food skills courses. When asked how food skills should be taught, the two main strategies mentioned were “online” and “hands-on.” Most participants identified skills in the food preparation domain as essential to include in the curriculum, although some recognized the importance of incorporating skills from all three domains.Practical implicationsUnderstanding important characteristics of effective food skills education for young males may increase their participation in school, virtual and community-based food skills education. Curricular content should consider young males' interests and baseline competencies and emphasize practical hands-on skills. Mandatory food skills education in secondary schools for all genders represents a comprehensive solution.Originality/valueThis study is among the first to report young males' opinions on crucial components of, and methods for, effective food skills education for this population.

Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study

Background Many studies have compared quality of life of post-intensive care syndrome (PICS) patients with age-matched population-based controls. Many studies on PICS used the 36-item Short Form (SF-36) health survey questionnaire version 2, but lack the data for SF-36 values before and after intensive care unit (ICU) admission. Thus, clinically important changes in the parameters of SF-36 are unknown. Therefore, we determined the frequency of co-occurrence of PICS impairments at 6 months after ICU admission. We also evaluated the changes in SF-36 subscales and interpreted the patients’ subjective significance of impairment. Methods A prospective, multicenter, observational cohort study was conducted in 16 ICUs across 14 hospitals in Japan. Adult ICU patients expected to receive mechanical ventilation for > 48 h were enrolled, and their 6-month outcome was assessed using the questionnaires. PICS definition was based on the physical status, indicated by the change in SF-36 physical component score (PCS) ≥ 10 points; mental status, indicated by the change in SF-36 mental component score (MCS) ≥ 10 points; and cognitive function, indicated by the worsening of Short-Memory Questionnaire (SMQ) score and SMQ score at 6 months < 40. Multivariate logistic regression model was used to identify the factors associated with PICS occurrence. The patients’ subjective significance of physical and mental symptoms was assessed using the 7-scale Global Assessment Rating to evaluate minimal clinically important difference (MCID). Results Among 192 patients, 48 (25%) died at 6 months. Among the survivors at 6 months, 96 patients responded to the questionnaire; ≥ 1 PICS impairment occurred in 61 (63.5%) patients, and ≥ 2 occurred in 17 (17.8%) patients. Physical, mental, and cognitive impairments occurred in 32.3%, 14.6% and 37.5% patients, respectively. Population with only mandatory education was associated with PICS occurrence (odds ratio: 4.0, 95% CI 1.1–18.8, P = 0.029). The MCID of PCS and MCS scores was 6.5 and 8.0, respectively. Conclusions Among the survivors who received mechanical ventilation, 64% had PICS at 6 months; co-occurrence of PICS impairments occurred in 20%. PICS was associated with population with only mandatory education. Future studies elucidating the MCID of SF-36 scores among ICU patients and standardizing the PICS definition are required. Trial registration UMIN000034072.

Prevalence of post intensive care syndrome among Japanese intensive care unit patients: A prospective, multicenter, observational J-PICS study

Background Many studies have compared quality of life of post-intensive care syndrome (PICS) patients with age-matched population-based controls. Many studies on PICS used the 36-item Short Form (SF-36) health survey questionnaire version 2 but lack the data for SF-36 values before and after intensive care unit (ICU) admission. Thus, clinically important changes in the parameters of SF-36 are unknown. Therefore, we determined the frequency of co-occurrence of PICS impairments at 6 months after ICU admission. We also evaluated the changes in SF-36 subscales and interpreted the patients’ subjective significance of impairment.Methods A prospective, multicenter, observational cohort study was conducted in 16 ICUs across 14 hospitals in Japan. Adult ICU patients expected to receive mechanical ventilation for >48 hours were enrolled, and their 6-month outcome was assessed using the questionnaires. PICS definition was based on the physical status, indicated by the change in SF-36 physical component score (PCS) ≥10 points; mental status, indicated by the change in SF-36 mental component score (MCS) ≥10 points; and cognitive function, indicated by the worsening of Short-Memory Questionnaire (SMQ) score and SMQ score at 6 months <40. Multivariate logistic regression model was used to identify the factors associated with PICS occurrence. The patients’ subjective significance of physical and mental symptoms was assessed using the 7-scale Global Assessment Rating to evaluate minimal clinically important difference (MCID).Results Among 192 patients, 48 (25%) died at 6 months. Among the survivors at 6 months, 96 patients responded to the questionnaire; ≥1 PICS impairment occurred in 61 (63.5%) patients, and ≥2 occurred in 17 (17.8%) patients. Physical, mental, and cognitive impairments occurred in 32.3%, 14.6%, and 37.5% patients, respectively. Population with only mandatory education was associated with PICS occurrence (odds ratio: 4.0, 95% confidence interval: 1.1–18.8, P=0.029). The MCID of PCS and MCS scores was 6.5 and 8.0, respectively.Conclusions Among the survivors who received mechanical ventilation, 64% had PICS at 6 months; co-occurrence of PICS impairments occurred in 20%. PICS was associated with population with only mandatory education. Future studies elucidating the MCID of SF-36 scores among ICU patients and standardizing the PICS definition are required. Trial registration UMIN000034072

Mandatory pharmacist-led education session for patients seeking medical cannabis

Objective: The primary objectives of this pre-post session study, was to evaluate the impact of a pharmacist-led education session on the perceived benefits and safety of cannabis among patients with chronic pain, as well as determine the influence of pharmacist education on the selection of safer cannabis products and dosage forms for medical use among patients. Methods: A retrospective analysis of completed pre-post session questionnaires was conducted among chronic pain patients attending a mandatory education session led by a pharmacist, prior to being authorized cannabis in clinic. All questionnaire data was analyzed using SPSS v. 25. Demographic and sample characteristics were reviewed using univariate analyses. Chi-Square tests were employed to determine if the group-based education significantly affected knowledge, perception of efficacy and safety of cannabis. Results: Of the 260 session participants, 203 completed pre-post session questionnaires. After the session, a majority of current cannabis users (33.8%) and cannabis naïve/past users (56.9%) reported they would use a low THC product in the future, and a majority of current users (54.5%) would use a high CBD product in the future. After education, participants were more likely to report cannabis as having the potential for addiction (chi-square =42.6, p <0.0001) and harm (chi-square =34.0, p <0.0001). Conclusions: Pharmacist counselling and education has the potential to influence patient selection and use of cannabis, from more harmful to safer products, as well as moderate the potential perceived benefits of use.

MODERN PARENTS’ PERCEPTIONS OF DEMANDS, ENCOURAGEMENT, AND PUNISHMENT AS COMPONENTS OF CHILD REARING

Statement of the problem. Solving the problem of psychological and pedagogical support of parents requires studying the request for psychological assistance from their side. In our opinion, this can be done by studying the social perceptions of modern parents about various aspects of the phenomenon of parenthood. The purpose of the article is to describe the semantic core of modern parents’ ideas about encouragement, punishment, and requirements as components of raising children in the family. Materials and methods. The research methodology is presented by the concept of social representations by S. Moscovici, as well as synthesized research in the field of social representations by Russian and foreign scientists (K.A. Abulkhanova-Slavskaya, G.M. Andreeva, E.Y. Artemyeva, M.I. Volovikova, T.P. Yemelyanova,L.G. Pochebut, J.K. Abrik, P. Verges, D. Jodle). Research results. The analysis of the results shows that the semantic core is the idea that the main task and responsibility of parents is to educate the child, and for this they can use methods of encouragement and punishment, moreover, they have the right to control and punish the child. The main tasks of different methods of education (requirements, prohibitions, punishments, incentives) is maintaining the authority of parents, taking care of the child’s safety, encouraging good behavior, good learning, and obedience of the child. These ideas tend to the traditional Russian understanding of the parent as an educator. Along with this, there is an appearance of ideas about non-mandatory education, the need to develop an educational strategy, and the need to avoid child-centered behavior. Conclusion. The results of the study allow us to make a request for the content of psychological and pedagogical support for parents within the educational system and psychological assistance services. Knowledge of modern parenting’s social concepts of parenting methods allows parents to develop education that is appropriate to their characteristics and needs.

Geriatric Dentistry Curriculum in Six Continents

The purpose of this study was to examine the presence of geriatric dentistry (GD) in the curricula of worldwide dental schools, and to identify and compare their curriculum content. Eighty-three dental schools (16.4% response rate), from 24 countries, in six continents, completed a 25-item online questionnaire, to assess their GD curriculum, and were included in the study. GD was a mandatory course in 56 dental schools (67.5%), an independent subject in 14 schools (16.9%), and was taught as a series of lectures in 31 schools (37.4%). Clinically, 56 dental schools (67.5%) had some form of mandatory education in GD. The type of school, location and method of presentation were not associated with greater interest in expanding their curriculum in GD (p = 0.256, p = 0.276, and p = 0.919, respectively, using the Chi-square test). We found GD is a curriculum requirement in most of the surveyed dental schools and is becoming more common among dental school curricula. This survey is the first study to present data from dental schools from all continents, using a web-based survey which is a resourceful, less-expensive tool to gather data.