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BMJ Open Quality

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https://www.readbyqxmd.com/read/29756072/managing-antibiotics-wisely-a-quality-improvement-programme-in-a-tertiary-neonatal-unit-in-the-uk
#1
Vasiliki Makri, Gemma Davies, Stephanie Cannell, Katherine Willson, Lucy Winterson, Joanna Webb, Amit Kandhari, Maha Mansour, Joanne Thomas, Geraint Morris, Jean Matthes, Sujoy Banerjee
Microbial resistance to antibiotics is a serious global health problem compounded by antibiotic overuse and limited investment in new antibiotic research. Inappropriate perinatal antibiotic exposure is increasingly linked to lifelong adverse outcomes through its impact on the developing microbiome. Antibiotic stewardship may be the only effective preventative strategy currently available. As the first tertiary neonatal unit in the UK to collaborate in an international quality improvement programme (QIP) with Vermont Oxford Network (VON), we present the results of our antibiotic stewardship initiative...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29756071/improving-the-quality-of-physical-health-monitoring-in-camhs-for-children-and-adolescents-prescribed-medication-for-adhd
#2
Cristal Oxley, Omer S Moghraby, Rani Samuel, Dan W Joyce
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterised by a persistent, pervasive pattern of inattention, impulsivity and hyperactivity. Stimulant medication such as methylphenidate has an established evidence base in the treatment of children and adolescents with ADHD. However, it is also associated with a risk of side effects which may include decreased appetite, increased blood pressure and possible reduced growth. Monitoring physical health in children and adolescents prescribed medication for ADHD is a key clinical responsibility and includes a number of parameters as outlined in the National Institute for Health and Care Excellence Guidelines...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29756070/reducing-severe-hypoglycaemia-in-hospitalised-patients-with-diabetes-early-outcomes-of-standardised-reporting-and-management
#3
Katherine A Araque, Deepak K Kadayakkara, Nino Gigauri, Diane Sheehan, Sachin Majumdar, Gregory Buller, Clare A Flannery
Background: Severe hypoglycaemic events (HGEs) in hospitalised patients are associated with poor outcomes and prolonged hospitalization. Systematic, coordinated care is required for acute management and prevention of HGEs; however, studies evaluating quality control efforts are scarce. Objective: To investigate the effectiveness of system-based interventions to improve management response to HGEs. Methods: System-based interventions were designed and implemented following a root cause analysis of HGE in adult patients with diabetes from two general medical wards with the highest incidence of HGE...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29756069/implementation-of-depression-and-anxiety-screening-in-patients-undergoing-radiotherapy
#4
Adam L Holtzman, Deidre B Pereira, Anamaria R Yeung
Anxiety and depression are disabling, underdiagnosed issues that affect the management of oncology patients. Until recently, there has been no standard protocol for screening and treating these ailments at our cancer centre. The purpose of this institutional review board-approved study was to analyse the implementation of a screening tool in our clinical workflow with the aim of screening over 90% of patients and increasing referrals to mental health services by 50%.
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29719875/using-an-original-triage-and-on-call-management-tool-aids-identification-and-assessment-of-the-acutely-unwell-surgical-patient
#5
Stacie Hodge, Sebastian Helliar, Hamish Ian Macdonald, Paul Mackey
Until now, there have been no published surgical triage tools. We have developed the first such tool with a tiered escalation policy, aiming to improve identification and management of critically unwell patients. The existing sheet which is used to track new referrals and admissions to the surgical assessment unit was reviewed. The sheet was updated and a traffic light triage tool generated using National Early Warning Scores (NEWS), sepsis criteria and user discretion. A tiered escalation policy to guide urgency of assessment was introduced and education sessions for all staff undertaken, to ensure understanding and compliance...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29719874/reducing-the-rate-of-post-surgical-urinary-tract-infections-in-orthopedic-patients
#6
Amit Thakker, Natasha Briggs, Azusa Maeda, Julie Byrne, John Roderick Davey, Timothy D Jackson
Urinary tract infection (UTI) is the fourth leading cause of healthcare-associated infections, with approximately 70%-80% being attributed to the inappropriate use of indwelling catheters. In many cases, indwelling catheters are used inappropriately without any valid indication, creating potentially avoidable and significant patient distress, discomfort, pain and activity restrictions, together with substantial care burden, cost and hospitalisation. In the Division of Orthopedic Surgery at Toronto Western Hospital (TWH), we identified UTI rate reduction as a quality improvement priority...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29719873/ward-round-template-enhancing-patient-safety-on-ward-rounds
#7
Niall Gilliland, Natalie Catherwood, Shaouyn Chen, Peter Browne, Jacob Wilson, Helena Burden
Introduction and aims: Concerns had been raised at clinical governance regarding the safety of our inpatient ward rounds with particular reference to: documentation of clinical observations and National Early Warning Score (NEWS), compliance with Trust guidance for venous thromboembolism (VTE) risk assessment, antibiotic stewardship, palliative care and treatment escalation plans (TEP). This quality improvement project was conceived to ensure these parameters were considered and documented during the ward round, thereby improving patient care and safety...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29713691/improving-inpatient-warfarin-therapy-safety-using-a-pharmacist-managed-protocol
#8
Paul R Daniels, Dennis M Manning, James P Moriarty, Juliane Bingener-Casey, Narith N Ou, John G O'Meara, Daniel L Roellinger, James M Naessens
Introduction: Safe management of warfarin in the inpatient setting can be challenging. At the Mayo Clinic hospitals in Rochester, Minnesota, we set out to improve the safety of warfarin management among surgical and non-surgical inpatients. Methods: A multidisciplinary team designed a pharmacist-managed warfarin protocol (PMWP) which designated warfarin dosing to inpatient pharmacists with guidance from computerised dosing algorithms. Ordering this protocol was ultimately designed as an 'opt out' practice...
2018: BMJ open quality
https://www.readbyqxmd.com/read/29713690/improving-medication-reconciliation-at-hospital-admission-discharge-and-ambulatory-care-through-a-transition-of-care-team
#9
John Kreckman, Waiz Wasey, Sharron Wise, Tammy Stevens, Lance Millburg, Cassie Jaeger
Medication reconciliation is an important component to the care of hospitalised patients and their safe transition to the ambulatory setting. In our Family Medicine Hospitalist Service, patient care is frequently transferred between the various physicians, residents, nurses and eventually to a separate group of providers who provide ambulatory management. Due to frequent transitions of care, there was no clear ownership of the medication reconciliation process. To improve the medication reconciliation process, a Transition of Care Team composed of registered nurses was created to oversee the entire reconciliation process...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29713689/improving-rates-of-implantable-cardioverter-defibrillator-deactivation-in-end-of-life-care
#10
M R Javaid, Suzanne Squirrell, Fahad Farooqi
Implantable cardioverter defibrillators (ICDs) save lives in selected patients at risk of sudden cardiac death. However, in patents suffering with terminal illness, ICD therapy could pose a risk of unnecessary futile shocks which could lead to undignified discomfort in their final days of life. National guidelines advise that patients approaching the end of their natural life should be offered a compassionate choice of having their defibrillator deactivated. Following an actual clinical incident involving a patient receiving avoidable ICD shocks in his final hours, we identified shortcomings in communication and gaps in knowledge about ICD management in end-of-life care...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29682619/path-of-least-resistance-how-computerised-provider-order-entry-can-lead-to-and-reduce-wasteful-practices
#11
Joseph Choi, Cori Rebecca Atlin
Background: Computerised provider order entry (CPOE) is rapidly becoming the mainstay in clinical care and has the potential to improve provider efficiency and accuracy. However, this hinges on careful planning and implementation. Poorly planned CPOE order sets can lead to undetected errors and waste. In our emergency department (ED), lactate dehydrogenase (LDH) was bundled into various blood work panels but had little clinical value. Objectives: This quality improvement initiative aimed to reduce unnecessary LDH testing in the ED...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29682618/multidisciplinary-approach-to-improve-the-quality-of-below-knee-plaster-casting
#12
John Teudar Williams, Marta Kedrzycki, Yathish Shenava
Problem: In our trauma unit, we noted a high rate of incorrectly applied below-knee casts for ankle fractures, in some cases requiring reapplication. This caused significant discomfort and inconvenience for patients and additional burden on plaster-room services. Our aim was to improve the quality of plaster casts and reduce the proportion that needed to be reapplied. Methods: Our criteria for plaster cast quality were based on the British Orthopaedic Association Casting Standards (2015) and included neutral (plantargrade) ankle position, adequacy of fracture reduction and rate of cast reapplication...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29682617/improving-local-anaesthetic-systemic-toxicity-last-awareness-in-maternity-care-using-tailored-educational-tools
#13
Amy E Edwards, Gemma M Bowsher, Sahil Deepak, Mohamed Ali
Local anaesthetic (LA) agents are widely used in maternity care. Although relatively safe, their use does carry risks, the most serious of which is systemic toxicity (LAST). LAST poses a major threat to maternal and neonatal safety due to the frequency of LA administration in maternity care and the under-recognition of toxicity in such settings, which has been reported globally. Our aim was to prevent LAST occurrence in a District General Hospital (DGH) maternity unit by improving staff awareness through the implementation of a tailored educational programme...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29610774/implementation-of-failure-mode-and-effects-analysis-to-the-specimens-flow-in-a-population-based-colorectal-cancer-screening-programme-using-immunochemical-faecal-occult-blood-tests-a-quality-improvement-project-in-the-milan-colorectal-cancer-screening-programme
#14
Silvia Deandrea, Enrica Tidone, Aldo Bellini, Luigi Bisanti, Nico Gerardo Leonardo, Anna Rita Silvestri, Dario Consonni
Background: A multidisciplinary working group applied the Healthcare Failure Mode and Effects Analysis (HFMEA) approach to the flow of kits and specimens for the first-level test of a colorectal cancer screening programme using immunochemical faecal occult blood tests. Methods: HFMEA comprised four steps: (1) identification and mapping of the process steps (subprocesses); (2) analysis of failure modes and calculation of the risk priority numbers (RPNs); (3) identification of corrective actions; and (4) follow-up and evaluation of corrective actions...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29610773/are-they-high-on-steroids-tailored-interventions-help-improve-screening-for-steroid-induced-hyperglycaemia-in-hospitalised-patients
#15
Punith Kempegowda, Alana C Livesey, Laura McFarlane-Majeed, Joht Singh Chandan, Theresa Smyth, Martha Stewart, Karen Blackwood, Michelle McMahon, Anitha Vijayan Melapatte, Sofia Salahuddin, Jonathan Webber, Sandip Ghosh
Steroid-induced hyperglycaemia (SIH) is a common adverse effect in patients both with and without diabetes. This project aimed to improve the screening and diagnosis of SIH by improving the knowledge of healthcare professionals who contribute to the management of SIH in hospitalised patients. Monitoring and diagnosis of SIH were measured in areas of high steroid use in our hospital from May 2016 to January 2017. Several interventions were implemented to improve knowledge and screening for SIH including a staff education programme for nurses, healthcare assistants and doctors...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29610772/improving-routine-outpatient-monitoring-for-patients-with-sickle-cell-disease-on-hydroxyurea
#16
Joel Ward, Natasha Lewis, Dimitris A Tsitsikas
Hydroxyurea is the gold standard treatment for prevention of vaso-occlusive crises in patients with sickle-cell anaemia. It has a narrow therapeutic index and dangerous side effects including cytopenias. There is high variation in dose-response across the population. Therefore, a robust outpatient monitoring programme is crucial to ensure efficacy and safety of treatment. However, there has historically been difficulty engaging the target population in regular laboratory test monitoring programmes. This project aimed to ensure that all patients on hydroxyurea had routine blood tests at least once every 2 months which were reviewed and acted upon within the 3-year project life cycle...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29610771/enhancing-the-performance-of-gastrointestinal-tumour-board-by-improving-documentation
#17
Roaa Saleh Alsuhaibani, Hajer Alzahrani, Ghada Algwaiz, Haneen Alfarhan, Ashwaq Alolayan, Nafisa Abdelhafiz, Yosra Ali, Abdul Rahman Jazieh
Tumour board contributes to providing better patient care by using a multidisciplinary team approach. In the efforts of evaluating the performance of the gastrointestinal tumour board at our institution, it was difficult to assess past performance due to lack of proper use of standardised documentation tool. This project aimed at improving adherence to the documentation tool and its recommendations in order to obtain performance measures for the tumour board. A multidisciplinary team and a plan were developed to improve documentation...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29610770/reducing-the-number-of-invalid-surgical-consents-in-the-day-surgery-unit
#18
Wesley Chong, Allan Chee Yang Fong, Yi Lin Yeo, Angie Puay Hong Ng, Eileen May Lin Neo, Veronica Li Ee Sam, Jessica Kai Jun Ong, Loh Huey Peng
Aim: To reduce the number of invalid surgical consents in the Singapore National Eye Centre Day Surgery Unit over a period of 6 months. Methodology: A multidisciplinary team involving doctors, nurses, day surgery unit, operating theatre, listing and clinical audit staff looked into the listing process and the root causes of the high number of invalid consents. A Pareto chart detailing the top causes of invalid consents was drawn, and with a prioritisation matrix, feasible yet effective changes were identified and effected...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29610769/improving-driving-advice-provided-to-cardiology-patients-on-discharge
#19
Amoolya Vusirikala, Mark Backhouse, Sarah Schimansky
Certain cardiac conditions can limit patients' ability to drive. It remains the doctors' responsibility to advise patients of any driving restrictions and is particularly important after certain diagnoses or procedures. We identified that the quality of documented advice was variable and frequently no written driving advice was recorded on discharge. It was apparent that there was a lack of awareness and knowledge of the current Driving and Vehicle Licensing Agency (DVLA) guidance among junior doctors. We therefore designed a quality improvement project using Plan-Do-Study-Act (PDSA) methodology to improve the provision of driving advice on discharge from a cardiology ward by focusing on staff education...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29527576/multidisciplinary-analysis-of-invasive-meningococcal-disease-as-a-framework-for-continuous-quality-and-safety-improvement-in-regional-australia
#20
Kathryn A Taylor, David N Durrheim, Tony Merritt, Peter Massey, John Ferguson, Nick Ryan, Carolyn Hullick
Background: System factors in a regional Australian health district contributed to avoidable care deviations from invasive meningococcal disease (IMD) management guidelines. Traditional root cause analysis (RCA) is not well-suited to IMD, focusing on individual cases rather than system improvements. As IMD requires complex care across healthcare silos, it presents an opportunity to explore and address system-based patient safety issues. Context: Baseline assessment of IMD cases (2005-2006) identified inadequate triage, lack of senior clinician review, inconsistent vital sign recording and laboratory delays as common issues, resulting in antibiotic administration delays and inappropriate or premature discharge...
2018: BMJ Open Quality
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