Heparin, Enoxaparin, and Mechanical Prophylaxis Utilization Evaluation in DVT Prophylaxis in a Major Teaching Hospital in West of Iran

Background: Considering the high prevalence and risk of Deep Vein Thrombosis (DVT) and pulmonary thromboembolism (PTE) in hospitalized patients and the existence of different prophylaxis methods in these patients, the necessity of evaluating the rational administration of heparin or enoxaparin and mechanical prophylaxis is one of the important priorities. The present study aimed to evaluate the consistency of the Heparin/Enoxaparin administration in comparison to guidelines in patients admitted to Imam Reza Hospital. Methods: In this prospective study drug use evaluation (DUE), 300 hospitalized patients receiving venous thrombosis prophylaxis were enrolled, of which 150 patients were selected from surgical wards and 150 patients from internal wards. The demographic and clinical data of patients were collected using clinical records of them. We used the checklists based on the Geneva System for patients admitted to internal wards and the Caprini Questionnaire for patients in surgical wards to evaluate whether patients had received heparin/enoxaparin prophylaxis and mechanical DVT prevention according to guidelines. Results: In the surgical ward, prophylactic treatment for venous thrombosis was administered in 85 (56.6%) patients admitted to surgical wards in accordance with the clinical guideline and in the internal ward, in 42 (28%) patients, with a significant difference between two sections (P: 0.0001). Mechanical prophylaxis, including compressive socks, was performed in 99 (66%) patients in the surgical ward and in the internal ward only in 56 (37.4%) patients, according to the guideline. Drug prophylaxis was administered in surgical wards in 116 (77.3%) patients and in internal wards, in 79 (52.6%) patients according to the guideline. Conclusion: Intravenous thrombosis prophylaxis, according to the guidelines, is more common in patients admitted to surgical wards than in internal wards. But in both sectors, statistics are far from international standards.

The Effects of Gamification on Nurse Work Motivation

A current concern in the medical field is that nurses leave their careers due to low work motivation. Intrinsic motivation is a key factor that influences satisfaction in the workplace. This study aimed to develop a gamification intervention for implementation in a hospital setting and evaluate its effects on nurses' work motivation. It was hypothesized that nurses' work motivation would improve by the end of the intervention. The study was conducted in a surgical ward at a hospital in Finland. The design was descriptive and quasi-experimental. The study found that continuous feedback from gamification interventions influenced nurses' work motivation. The gamified group offered more positive feedback than the non-gamified group. These findings add to our understanding of the effects of gamification interventions on nurses' work motivation in hospital settings. However, more research is needed to demonstrate the potential of gamification to increase the retention of much-needed human resources.

Resistance pattern of infected chronic wound isolates and factors associated with bacterial resistance to third generation cephalosporins at Mbarara Regional Referral Hospital, Uganda

Background The objectives of this study were; (I) to determine the proportion of pathogens isolated from patients with infected chronic wounds in the surgical ward of MRRH that are resistant to the third-generation cephalosporins and (II) to determine the factors associated with resistance to third-generation cephalosporins in the surgical ward of MRRH. Method(s) This study was a descriptive analytical survey of bacterial isolates from infected chronic wounds among patients admitted in the surgical ward of MRRH, Uganda. Seventy five (75) study participants were recruited in the study using convenient sampling technique. Bacterial culture and identification was performed using standard microbiology laboratory procedures whereas broth microdilution method was used to establish the susceptibility of the identified pathogens. Data for objective one (1) was summarized as proportions while the categorized variables were analyzed using logistic regression to determine whether they were associated with the resistance patterns. The level of significance was preset at 5% and p-values less than 0.05 were considered statistically significant. Results Generally, all isolates had complete susceptibility (100%) to Cefoperazone+Sulbactam 2g except 7.1% of proteus spp that were resistant. Of all the bacterial isolates studied, Staphylococcus aureus, Enterobacter agglomerans, providencia spp and pseudomonas earuginosa had complete resistance (100%) to Cefopodoxime 200mg while providencia spp and pseudomomas earuginosa had complete resistance (100%) to Cefixime 400mg and cefotaxime 1g. Finally, higher odds of bacterial resistance to more 2 brands of the third generation cephalosporins were observed among participants who had prior exposure to the third generation cephalosporins (OR, 2.22, 95% CI, 0.80–6.14), comorbidities (OR, 1.76, 95% CI, 0.62–4.96) and those who had more than two hospitalizations in a year (OR, 1.39, 95% CI 0.46–4.25). However, multivariate logistic regression was not performed since no factor was significantly associated with resistance to more than two brands of third generation cephalosporins (p >0.05). Conclusion This study found that cefixime and cefpodoixme had high rates of resistance and should not be used in routine management of infected chronic wounds. In addition, the factors investigated in this study were not significantly associated with bacterial resistance to more than two brands of third generation cephalosporins.

P-O11 Surgical Ambulatory Care: Reducing surgical admissions whilst maintaining patient satisfaction. Experiences over a four year period

Background The tri-association document; The future of Emergency General Surgery (2015) has a number of key recommendations for the provision of emergency general surgical care. Key recommendations include for senior surgeons to triage referrals and to utilise a “hot clinic” model. Prior to 2016 in the authors’ hospital, all General Practitioner/community referrals were formally admitted to General Surgery. A consultant led ambulatory clinic with dedicated Advanced Nurse Practitioner support was instituted in October 2016. It offers preliminary assessment, phlebotomy and priority access to routine imaging modalities. The clinic is located in a tertiary hospital serving a population of 500,000. Methods A retrospective audit of prospectively collected referral and outcome lists for the Surgical Ambulatory clinic was conducted for the time periods of October 2016 to June 2021. The two primary outcomes were defined as admission to the General Surgical ward and discharge to the community/non-general surgical specialty. Secondary outcomes for patient satisfaction were measured by randomly distributing over a six week period a patient satisfaction survey. The survey was designed in accordance with trust guidance, was anonymous and would cover multiple lead Consultant encounters as a cohort. Results In total, 9069 patients presented to the surgical ambulatory clinic over a period of 44 months. 2347 (26%) were admitted to the General Surgical ward whilst 6717 (74%) were discharged directly from the clinic. 71% of survey responders rated their experiences of the ambulatory clinic as “Excellent”, 19% “Very Good”, 0.5% “Good” and 0.5% “Poor.” Conclusions The introduction of an ambulatory care model has demonstrated a marked reduction in surgical admissions whilst remaining favourable to the patient populace. This has a direct impact on overall bed occupancy rates. In the age of COVID-19, efforts must me made to reduce the the number of potential inpatient interactions to protect those most at risk. A reduced admission and bed occupancy rate will contribute to the reduction of this risk.

The Effect of the Behavioral Systems Model on the Concern of Mothers of Children Admitted to the Surgical Ward

Background: The crisis caused by the child's illness and hospitalization affects all family members. Fear, worry, and anxiety are common issues of hospitalized children’s mothers. Betty Newman's system model plays a vital role in adapting to stress detection and control. Objectives: This study aimed to examine the effect of the behavioral systems model on the concerns of mothers of children admitted to the surgical ward. Methods: This quasi-experimental study was conducted on 60 mothers of children admitted to the surgical ward of the Mousavi Hospital, Gorgan, Iran, in 2020. The participants were selected using convenience sampling and then divided into test and control groups using non-probability sampling. According to Neuman's systems model, participants in the test group received nursing care in 3 - 4 sessions (each lasting 30 - 45 minutes). Participants in the control group received only routine ward care. Data were collected using the Parental Concern Scale and analyzed with IBM SPSS Statistics 21 software using statistical tests (analysis of covariance, unpaired samples t-test, and paired sample test). Results: The mean score of maternal concerns before the intervention was 42.6 ± 3.06 in the control group and 43.21 ± 2.27 in the test group. The results of the independent samples t-test did not show any significant difference between the groups in terms of maternal concerns (P = 0.11). The mean post-intervention maternal concern score was 37.6 ± 2.71 and 41.716 ± 2.55 in the test and control groups, showing a significant difference between the groups as indicated by the t-test results (P < 0.01). However, the paired t-test outcomes showed no difference in the mean maternal concern score in the control group before and after the intervention (P = 0.92). In contrast, there was a significant difference in the mean maternal concern score in the test group before and after the intervention (P < 0.01). Conclusions: Given the effectiveness of Betty Neuman’s systems model, it can be used as a low-cost, effective care method to reduce maternal stress as the model was developed for understanding clients’ and caregivers’ needs and reducing their stress.

Impact of profession and wards on moral distress in a community hospital

Background: Recently, a singular survey titled “Measure of Moral Distress—Healthcare Professionals,” which addresses shortcomings of previous instruments, has been validated. Aim: To determine how moral distress affects nurses and physicians differently across the various wards of a community hospital. Participant and research context: We distributed a self-administered, validated survey titled “Measure of Moral Distress—Healthcare Professionals” to all nurses and physicians in the medical/surgical ward, telemetry ward, intensive care units, and emergency rooms of a community hospital. Findings: A total of 101 surveys were included in the study. The mean Measure of Moral Distress—Healthcare Professionals score for all respondents was 143.0 (standard deviation = 79.8). The mean Measure of Moral Distress—Healthcare Professionals score was 1.75 greater for nurses than for physicians (92.5 vs 161.5, p < .001), and nurses were 2.52 times more likely to consider leaving their position due to moral distress (68% vs 27%). The mean Measure of Moral Distress—Healthcare Professionals score for moral distress was least prevalent in the medical/surgical ward (92.5, SD = 38.2) and highest in the telemetry ward (197.7, SD = 83.6). The intensive care unit ward had a mean Measure of Moral Distress—Healthcare Professionals score mildly greater than the emergency room. Ethical considerations: No participant identifying information or information connecting a survey response to an individual was collected. This study was approved by the Raritan Bay Medical Center’s Institutional Review Board. Discussion: This study provides insight into the level of moral distress in the community hospital setting. Telemetry nurses experience significantly more than nurses in other wards. Telemetry nurses typically manage patients sicker than medical/surgical wards, however do not have the resources of the critical care units. This scenario presents challenges for telemetry nurses and may explain their elevated moral distress. Conclusion: In community hospitals, telemetry nurses experience a considerably greater amount of moral distress compared to their colleagues in other wards. As measured by the Measure of Moral Distress—Healthcare Professionals questionnaire, moral distress continues to be higher among nurses compared to physicians.

P145 DERMOID CYST MASQUERADING AS INCARCERATED INGUINAL HERNIA

Aim “For pre operative optimization and educational purposes, rare possibilities should be included in the differential diagnosis”” Material and Methods “CASE REPORT. Inguinal hernia is one of the common operations done by surgeons, often diagnosed clinically. Here we present a case of 29 year old male patient presented with inguinal swelling for 3 years. He was admitted for the surgical ward as a case of incarcerated inguinal hernia for elective repair under GA. Intra op the mass was not consistent with inguinal hernia, two other possibilities were a concern that can cause the swelling; 1) testes, which was excluded by examining the scrotum, 2) Dermoid/Epidermoid cyst which was checked by the mass content of hair and pasty fluid” Results “DERMOID CYST” Conclusions “Most surgeons depend on clinical picture in diagnosing inguinal hernia, thus even other rare possibilities should be included in the differential diagnosis. Unusual presentations of inguinal hernia should be having radiological evaluated.”