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BMJ Open Quality

Ryan Christopher Chadwick, Kathleen McGregor, Paula Sneath, Joshua Rempel, Betty Li Qun He, Allison Brown, Grant Seifred, John McAuley, Ralph John Kamatovic, Muhanad Al-Husari, Salim Ahmed, Monica Bertolo, Doug Munkley, Maynard Luterman
Canadian urgent care and walk-in medical clinics provide health care for a population that may be poorly covered by traditional health care structures. Despite evidence suggesting that women with urinary complaints experience a high incidence of sexually transmitted infections (STIs), this population may be under-tested in this particular setting. The aim of this quality improvement initiative was to increase STI testing in women presenting with GU complaints. Implementation of an opt-out method of STI testing for women ages 16 and older was introduced at three walk-in clinics...
2018: BMJ Open Quality
Laurie Goodman, Ekta Khemani, Francis Cacao, Jennifer Yoon, Vanessa Burkoski, Scott Jarrett, Barbara Collins, Trevor N T Hall
Hospital-acquired pressure injuries (HAPI) are a significant cause of morbidity and mortality, and represent a major health concern worldwide. Patients suffering from HAPI report a poor quality of life on several dimensions of health. Moreover, HAPI is reported to lengthen in-hospital stay in the acute setting, posing significant healthcare resource utilisations and costs. Given the clinical and economic burden of HAPI, recent best practice guidelines provide recommendations to reduce the prevalence of pressure injuries...
2018: BMJ Open Quality
Ramez Maximous, Franziska Miller, Carolyn Tan, Mercedes Camargo, Katie Ross, Carl Marshall, Priscilla Yung, Dimitra Fleming, Madelyn Law, Jennifer L Y Tsang
Background: Delirium is a common manifestation in the intensive care unit (ICU) that is associated with increased mortality and morbidity. Guidelines suggested appropriate management of pain, agitation and delirium (PAD) is crucial in improving patient outcomes. However, the practice of PAD assessment and management in community hospitals is unclear and the mechanisms contributing to the potential care gap are unknown. Objectives: This quality improvement initiative aimed to review the practice of PAD assessment and management in a community medical-surgical ICU (MSICU) and to explore the community MSICU nurses' perceived comfort and satisfaction with PAD management in order to understand the mechanisms of the observed care gap and to inform subsequent quality improvement interventions...
2018: BMJ open quality
Smita Bakhai, Gaurav Ahluwalia, Naren Nallapeta, Amanpreet Mangat, Jessica L Reynolds
Colorectal cancer (CRC) is the second leading cause of cancer death in USA, and CRC screening remains suboptimal. The aim of this quality improvement was to increase CRC screening in the internal medicine clinic (IMC) patients, between the ages of 50-75 years, from a baseline rate of 50%-70% over 12 months with the introduction of faecal immunochemical test (FIT) testing. We used the Plan-Do-Study-Act (PDSA) method and performed a root cause analysis to identify barriers to acceptance of CRC screening. The quality improvement team created a driver diagram to identify and prioritise change ideas...
2018: BMJ Open Quality
Caroline Ward
No abstract text is available yet for this article.
2018: BMJ Open Quality
Jessica Caroline Roberts, Lizzie Johnston-Walker, Kim Parker, Katherine Townend, James Bickley
The written medical handover document is frequently poor in quality and highly variable which raises concerns about patient safety. Intensive care unit (ICU) patients have complex medical and social issues which increases the risk of errors during ongoing hospital treatment. Our project team of four doctors and two nurses aimed to improve the documentation of patient problems as they leave the ICU. A literature review and process mapping of both medical and nursing transfer documentation helped in understanding the current process...
2018: BMJ Open Quality
William Regan, Daljit Hothi, Kevin Jones
We describe a quality improvement project (QIP) designed to reduce unnecessary biochemistry samples requested on a paediatric cardiology ward in Great Ormond Street Hospital. Prior to the intervention biochemistry tests were requested on a daily basis by nursing and junior doctor staff at an annual cost of around £27 000 for the ward. The lead author observed that for the majority the true indication for these biochemistry tests was for the purpose of monitoring renal function and plasma electrolytes. However, during a diagnostic analysis trying to understand the behaviours around ordering tests it appeared that a broader profile and more expensive combined test set was being requested that included unnecessary liver and bone profile analyses...
2018: BMJ Open Quality
Aklak Choudhury, Gregor Young, Beshoy Reyad, Nirali Shah, Radhea Rahman
The British Thoracic Society recommends oxygen delivery to achieve target oxygen saturation range between 94% and 98% for medically unwell adult patients, and 88% to 92% in patients at risk of hypercapnic respiratory failure. Interviews with our medical and nursing staff suggested that oxygen was sometimes being given to patients without a valid order and there was a failure to titrate oxygen to the stated oxygen saturation range. Our aim was to improve appropriate oxygen delivery to 90% of our patients on a 30-bedded respiratory ward within 3 months...
2018: BMJ Open Quality
Manju Krishnan, Andrew Jones, Tal Anjum, Srikanth Chenna, Peter Michael Edward Slade, Karen Ward, Sarah Yeap
A patient impact project which successfully reduced the transient ischaemic attack (TIA) clinic waiting time from 9 to 3 days in an acute Welsh hospital, revealing the challenges faced and how alternative thinking and team work improved care given to our service users. Evaluating current situation, careful planning with multiple brainstorming meetings, 4 N chart and driver diagram with change ideas laid the foundation for this service improvement. Run charts, statistical process control and Pareto charts helped to identify the issues that are hindering the progress, which when rectified, reduced the clinic waiting times...
2018: BMJ Open Quality
Tamar L Kutz, Jameson M Roszhart, Marshall Hale, Virginia Dolan, Gerald Suchomski, Cassie Jaeger
Patients with diabetes require access to systematic and ongoing care delivered by a team of healthcare providers. Despite national attention and well-accepted best practices, diabetic care, blood pressure and haemoglobin A1c (A1c) levels for patients with diabetes in our primary care setting were highly variable and below the Healthcare Effectiveness Data and Information Set (HEDIS) 75th percentile benchmark. From January 2015 to January 2016, 22% of patients with diabetes in our primary care setting had both blood pressure and A1c levels controlled and 23% had their annual diabetic care bundle completed, which includes A1c and blood pressure measurements, foot examination and nephropathy attention...
2018: BMJ Open Quality
William Sage, Amulya Gottiparthy, Paul Lincoln, Steven S L Tsui, Stephen J Pettit
Patients supported with implantable left ventricular assist devices (LVAD) have a significant risk of bleeding and thromboembolic complications. All patients require anticoagulation with warfarin, aiming for a target international normalised ratio (INR) of 2.5 and most patients also receive antiplatelet therapy. We found marked variation in the frequency of INR measurements and proportion of time outside the therapeutic INR range in our LVAD-supported patients. As part of a quality improvement initiative, home INR monitoring and a networked electronic database for recording INR results and treatment decisions were introduced...
2018: BMJ Open Quality
Meredith Casella Jean-Baptiste, Stephanie Louis, Christophe Millien, Erwine Dina Jeune, Ornella Sainterant, Jean Paul Joseph
To address the gap in the uptake of long-acting contraception (LAC) methods among high-risk postpartum women who fail to return for a family planning method at HôpitalUniversitaire de Mirebalais in the Central Plateau Department of Haiti, contraceptive implant trainings were held for providers on the Labour and Delivery, Post-Partum and Internal Medicine inpatient wards. A very high maternal mortality rate affects large numbers of women in Haiti; however, contraceptive use can reduce maternal mortality significantly...
2018: BMJ Open Quality
Patrick J Campbell, Mira Patel, Jennifer R Martin, Ana L Hincapie, David Rhys Axon, Terri L Warholak, Marion Slack
Importance: While much is known about hospital pharmacy error rates in the USA, comparatively little is known about community pharmacy dispensing error rates. Objective: The aim of this study was to determine the rate of community pharmacy dispensing errors in the USA. Methods: English language, peer-reviewed observational and interventional studies that reported community pharmacy dispensing error rates in the USA from January 1993 to December 2015 were identified in 10 bibliographic databases and topic-relevant grey literature...
2018: BMJ Open Quality
Emma Redfern, Rebecca Hoskins, Jackie Gray, Jason Lugg, Alex Hastie, Caroline Clark, Jonathan Benger
No abstract text is available yet for this article.
2018: BMJ Open Quality
Emma Shephard, Claire Stockdale, Felix May, Alistair Brown, Hannah Lewis, Sara Jabri, Daniel Robertson, Victoria Moss, Rob Bethune
Interspecialty referrals are an essential part of most inpatient stays. With over 130 referrals occurring per week at the Royal Devon and Exeter Hospital, the process must be efficient and safe. The current paper-based 'white card' system was felt to be inefficient, and a Trust incident highlighted patient safety concerns. Questionnaires reinforced the need for improvement, with concerns such as a lack of referral traceability and delays in the referral delivery due to workload. The aims of the project were to improve patient safety and junior doctor efficiency in the referral process...
2018: BMJ Open Quality
Vaibhav Upadhyay, Evan Walker, Alayn Govea, Tessa Rife, Ivette Jimenez, Maya Dulay, Jessica Beaman
No abstract text is available yet for this article.
2018: BMJ Open Quality
Alfonso Francisco Pantoja, Ann Ryan, Michelle Feinberg, Mark DeMarie, John Britton, Ellina Liptsen, Maggie Chen, Jordan Crow
The practice of delayed cord clamping (DCC) in premature infants has proven benefit to the neonate. In a community-based perinatal centre, the practice of DCC for more than 60 s for premature infants with gestational age of <35 weeks was identified to occur infrequently at 20% in 2013. The perinatology group in conjunction with nursery, labour and delivery, and obstetric staff sought to improve adherence to the best practice of DCC for premature infants. In an effort to achieve this goal, we developed an evidence-based clinical practice guideline, included key stakeholders in its development and provided timely feedback to delivery providers about DCC performance...
2018: BMJ open quality
Matthew T Koroscil, Mitchell H Bowman, Michael J Morris, Andrew J Skabelund, Andrew M Hersh
Introduction: The utilisation of chest CT for the evaluation of pulmonary disorders, including low-dose CT for lung cancer screening, is increasing in the USA. As a result, the discovery of both screening-detected and incidental pulmonary nodules has become more frequent. Despite an overall low risk of malignancy, pulmonary nodules are a common cause of emotional distress among adult patients. Methods: We conducted a multi-institutional quality improvement (QI) initiative involving 101 participants to determine the effect of a pulmonary nodule fact sheet on patient knowledge and anxiety...
2018: BMJ Open Quality
Catherine L Clark, Liza M Weavind, Sara E Nelson, Jennifer L Wilkie, Joel T Conway, Robert E Freundlich
Introduction: Nurses' perceptions of the utility of capnography monitoring are inconsistent in previous studies. We sought to outline the limitations of a uniform education effort in bringing about consistent views of capnography among nurses. Methods: A survey was administered to 22 nurses in three subacute care floors participating in a pragmatic clinical trial employing capnography monitoring in a large, urban tertiary care hospital. A 5-point Likert scale was used to assess the value and acceptance nurses ascribed to the practice...
2018: BMJ Open Quality
Emma Burnett, Peter Davey, Nicola Gray, Vicki Tully, Jenna Breckenridge
Background: There is evidence that medical students have the potential to actively initiate, lead and bring about change through quality improvement within healthcare organisations. For effective change to occur, it is important that students are introduced to, and exposed to the value and necessity of quality improvement early in their careers. The aim of this study was to explore the perspectives and experiences of medical students and their mentors after undertaking quality improvement projects within the healthcare setting, and if such practice-based experiences were an effective way of building improvement capacity and changing practice...
2018: BMJ Open Quality
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