The Effects of Introducing a Mobile Application-Based Procedural Logbook on Trainee Compliance to a Central Venous Catheter Insertion Accreditation Program: Before-and-After Study (Preprint)

BACKGROUND To reduce complications associated with central venous catheter (CVC) insertions, local accreditation programs utilising a supervised procedural logbook are essential. To increase compliance with such a logbook, a mobile application (App) could provide the ideal platform for trainees in an adult intensive care unit (ICU). OBJECTIVE To compare trainee compliance with completion of a logbook as part of a CVC insertion accreditation program, before and after the introduction of an App-based logbook. METHODS A retrospective observational study of logbook data, before and after the introduction of a purpose-built, app-based, electronic logbook to complement an existing paper-based logbook. Carried out over a two-year period in the adult ICU of the John Hunter Hospital (JHH), Newcastle, NSW, Australia, participants were ICU trainee medical officers completing a CVC insertion accreditation program. The primary outcome was the proportion of all CVC insertions documented in patients’ electronic medical records (EMR) appearing as logbook entries. To assess logbook entry quality, we measured and compared the proportion of logbook entries that were approved by a supervisor and contained a supervisor’s signature for the before and after periods. We also analysed trainee participation before and after the intervention by comparing the total number of active logbook users, and the proportion of first-time users who logged 3 or more CVC insertions. RESULTS Of 2,987 CVC insertions documented in the EMR between April 7, 2019, and April 6, 2021, 2,161 (72%) were included and separated into cohorts before and after the app’s introduction. Following the introduction of the App-based logbook the percentage of CVC insertions appearing as logbook entries increased from 3.6% to 20.5% (P<.001). There was no difference in the proportion of supervisor approved entries containing a supervisor’s signature before and after the introduction of the app, with 76.3% and 83.2% respectively (P=.31). Following the introduction of the App there was an increase in the percentage of active logbook users from 15.1% to 62.4% (P<.001). Adherence to one’s logbook was similar in both groups with 75% of first-time users in the before group and 79.5% in the after group going on to log at least 3 or more CVCs during their time working in ICU. CONCLUSIONS The addition of an electronic, mobile, app-based logbook to a pre-existing paper-based logbook, was associated with a higher rate of logbook compliance in trainee doctors undertaking an accreditation program for CVC insertion in ICU.

Accreditation program for gastrointestinal endoscopes reprocessing in Italy: An on-site survey

Background and study aims Endoscope reprocessing has been associated with a variable failure rate. Our aim was to present an overview on current practices for reprocessing in Italian facilities and discuss the principle critical points. Methods In 2014 the Italian Society for Digestive Diseases implemented an accreditation program in collaboration with an independent organization for certification and with the Italian Association for Endoscopy Technical Operators. During a 1-day site visit of the endoscopy center, two endoscopists, one nurse, and the representative of the certification body evaluated the endoscope reprocessing. Results As of July 1, 2020, 28 endoscopy centers had been accredited. Ten centers are completing the measures to correct deficiencies found at the visit. Three centers withdrew from the program. The accreditation program has found variations between the various centers, confirming the poor compliance with guidelines. Major deviations from the standards, established by the model before the site visit according to national and international guidelines, concerned instrument cleaning (44.7 % of the centers), instrument storage (23.7 %), and microbiological tests (31.6 %). Conclusions Our overview demonstrated the lack of many reprocessing phases, which are important to prevent endoscopy-associated infections. Accreditation can achieve a transformation in quality and safety of reprocessing with the Italian centrally-led approach.

Canadian Association of Radiologists Mammography Accreditation Program—Clinical Image Assessment

The Canadian Association of Radiologists Mammography Accreditation Program (CAR-MAP) has advocated for quality mammography since its inception in 1991. Evidence based standards have been employed to address image quality, education of personnel, radiologists experience and reading volume. This article reviews the objectives and components of the accreditation program. Education requirements for the technologist, physicist and radiologist are described. A guide to the evaluation criteria for the clinical images is provided. Positioning requirements and technical considerations are detailed to assist facilities and their personnel in improving and maintaining image quality and choosing appropriate images for submission for accreditation.

A focused ethnography in the context of a European cancer research hospital accreditation program

Background A quality accreditation program (AP) is designed to guarantee predefined quality standards of healthcare organizations. Evidence of the impact of quality standards remains scarce and somewhat challenging to document. This study aimed to investigate the accreditation of a cancer research hospital (Italy), promoted by the Organization of European Cancer Institutes (OECI), by focusing on the individual, group, and organizational experiences resulting from the OECI AP. Methods A focused ethnography study was carried out to analyze the relevance of participation in the accreditation process. Twenty-nine key informants were involved in four focus group meetings, and twelve semistructured interviews were conducted with professionals and managers. Inductive qualitative content analysis was applied to examine all transcripts. Results Four main categories emerged: a) OECI AP as an opportunity to foster diversity within professional roles; b) OECI AP as a possibility for change; c) perceived barriers; and d) OECI AP-solicited expectations. Conclusions The accreditation process is an opportunity for improving the quality and variety of care services for cancer patients through promoting an interdisciplinary approach to care provision. Perceiving accreditation as an opportunity is a prerequisite for overcoming the barriers that professionals involved in the process may report. Critical to a positive change is sharing the values and the framework, which are at the basis of accreditation programs. Improving the information-sharing process among managers and professionals may limit the risk of unmet expectations and prevent demotivation by future accreditation programs. Finally, we found that positive changes are more likely to happen when an accreditation process is considered an activity whose results depend on managers’ and professionals’ joint work.

Modification of the Priority Risk Index: Adapting to Emergency Management Accreditation Program standards for institutes of higher learning hazard mitigation plans

The Priority Risk Index is increasingly used as a methodology for quantifying jurisdictional risk for hazard mitigation planning purposes, and it can evolve to meet specific community needs. The index incorporates probability, impact, spatial extent, warning time, and duration when assessing each hazard, but it does not explicitly integrate a vulnerability and consequence analysis into its final scoring. To address this gap, a new index was developed—the Enhanced Priority Risk Index (EPRI). The new index adds a sixth category, vulnerability, calculated from a vulnerability and consequence analysis of the impacts on seven sectors identified in Standard 4.1.2 of the Emergency Management Accreditation Program (EMAP). To obtain a vulnerability score, impacts are ranked by sector from low (1) to very high (4), then a weighting factor is applied to each sector. The vulnerability score is added to the EPRI and provides risk levels based on the number of exploitable weaknesses and countermeasures identified within a specific jurisdiction. The vulnerability score and resulting EPRI are scalable and can be applied across jurisdictions, providing a transferable methodology that improves the hazard identification and risk assessment process and provides an approach for meeting EMAP accreditation standards.

The Impact of a National Accreditation Program on Patient Safety Culture in a Tertiary Hospital: Pre- and Post-Evaluation Study

ABSTRACT Introduction The objective of this study was to assess the effectiveness of the Saudi national accreditation program on patient safety culture in a secondary-tertiary public hospital in Saudi Arabia. Methods Three hundred health professionals were randomly selected to participate in a survey. The survey was used in three phases: baseline, before accreditation, and after accreditation. Primary and secondary outcome measures were teamwork within hospital units, feedback and communication about errors, hospital handoffs and transitions, overall perceptions of safety, frequency of event reporting, and perception of patient safety grade. Results The survey response rate was 100%. A statistically significant impact of accreditation was found for teamwork within hospital units, feedback and communication about errors, and hospital handoffs and transitions (p = 0.002, 0.009, and 0.010, respectively). Ordinal logistic regression confirmed that the accreditation program had a significant effect on overall perceptions of safety (odds ratio [OR] [1.42–13.56], p = 0.010), frequency of event reporting (OR [0.91–7.96], p = 0.073), and staff awareness of grading safety culture (OR [0.02–0.70]) and reporting behavior (OR 0.10 [0.03–0.37]). Conclusion The Saudi national accreditation program had a significant positive impact on some patient safety culture dimensions and outcomes. These findings provide local empirical evidence on the benefits of implementing national accreditation programs. Further research on a larger scale is highly recommended.

MAPPING QUALITY OF PAUD AND PNF ACCREDITATION IN KULONPROGO DISTRICT, YOGYAKARTA

Accreditation is one of the governments to improve the quality of education. Likewise, to ensure the quality of education at the PAUD and PNF levels, the government held an accreditation program. However, it still has issues that need to be resolved. This study aims to identify and describe the problems of accreditation and quality mapping in the Education Office of Kulonprogo Regency. This research uses a qualitative approach and type of case study research. Based on the results of this research, in mapping the quality of accreditation in PAUD and PNF in Kulonprogo Regency, the first activity carried out was to conduct a quality mapping analysis of each institution. And the results show that the average standard kindergarten, KB, Pos PAUD, LPK and PKBM institutions that must be supervised strictly is the standard of financing. After conducting the analysis, a workshop was conducted with the Dikpora and all PAUD and PNF heads. Keywords: Quality mapping, accreditation, PAUD, PNF.