BMJ Open Quality最新文献

{"title":"Implementation of the bedside paediatric early warning system, its sustainability in clinical practice and patient outcomes: a quality improvement initiative.","authors":"Ruqiah Ali AlZaher, Syed Jamil, Iris Murabi, Eidah Ahmari","doi":"10.1136/bmjoq-2023-002454","DOIUrl":"https://doi.org/10.1136/bmjoq-2023-002454","url":null,"abstract":"<p><strong>Background: </strong>Paediatric patients in acute care unit settings may be deprived of frequent assessments and monitoring. These spaced observations can put patients at risk of missed clinical deterioration that could ultimately result in unfavourable safety events. Several international guidelines encourage the use of the Paediatric Early Warning System (PEWS), which provides healthcare workers with a standardised approach to monitor patients' clinical status and anticipate deterioration at an early stage. This study aimed to summarise the strategies used for implementing the PEWS and evaluate the impact of this tool on patient safety.</p><p><strong>Method: </strong>We conducted a quality improvement project to implement the Bedside PEWS in 2016. Six plan-do-study-act cycles were used throughout the implementation phase. Three elements were monitored to ensure the proper utilisation of the tool: monitoring, escalation and physician review of patients based on the PEWS protocol. Outcome measures of this initiative were monitored to explore the impact of the PEWS on patient safety.</p><p><strong>Result: </strong>The average number of unplanned paediatric intensive care unit (PICU) admissions increased by 25% in 2017, decreased by 25% in 2018 and decreased by 50% in 2019 compared with the baseline year. The average number of unplanned paediatric high-dependency unit admissions increased by 14.3% in 2017, decreased by 28.6% in 2018 and decreased by 42.9% in 2019 compared with the baseline year. The average length of stay after unplanned PICU admission remained stable in 2016 and 2017 and decreased by 50% from 2018 to 2022 relative to the baseline year. The mortality rate after unplanned PICU admission was also reduced. There was no effect on the cardiopulmonary arrest rate outside of PICUs.</p><p><strong>Conclusion: </strong>Continuous staff training results in a high compliance rate with the PEWS protocol, despite persistent hospital expansion and high staff turnover. PEWS positively affects patient outcomes.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality improvement initiative to improve safe injection practices by nurses in labour room of a tertiary care centre, India.","authors":"Jeena Pradeep, Prabha Kumari, Manju Puri, Charuta Pradeep, Anu Gauba","doi":"10.1136/bmjoq-2024-002955","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002955","url":null,"abstract":"<p><p>Safe injection practices (SIP) are a set of measures intended to prevent transmission of infectious disease between one patient and another, and between a patient and healthcare provider during the preparation and administration of injectable medications. Unsafe injection practices put both the patient and healthcare personnel at risk of infection.SIP involves administration of rational injection by a qualified and well-trained person using a sterile device (syringe, needle, etc), adopting sterile technique and discarding the used devices in a puncture-proof, specially designed container for appropriate disposal. Any breach in the process makes the injections unsafe and hazardous to patients and healthcare workers (HCWs).To implement SIP, the quality improvement team in the labour room initiated an improvement process with the aim of increasing the percentage of compliance with SIP from the existing 20%-80% within 6 weeks from 6 February to 21 March 2024. The team followed Point of Care Quality Improvement methodology to improve the compliance with SIP.The team developed a 15-point practice observation checklist aligned with WHO and Center for Disease Control (CDC) guidelines. This checklist outlined the steps involved in SIP and used to directly observe the process of preparing and administering injections for adherence to SIP. Each item was scored '1' if performed correctly and '0' if not in the checklist. The compliance was calculated in percentage for data analysis and plotted on a time series chart.The team tested a total of 12 plan-do-study-act to achieve the desired aim (80%). The median compliance rate rose to 87% in the first half of the sustenance phase, which came down to 67% in the later part highlighting the challenges in demand-supply chain of resources and attitude shift among HCWs in maintaining SIP. The lessons learnt are generalisable and can be replicated in similar settings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical and legal considerations governing use of health data for quality improvement and performance management: a scoping review of the perspectives of health professionals and administrators.","authors":"Kavisha Shah, Kevin Leow, Anna Janssen, Tim Shaw, Cameron Stewart, Ian Kerridge","doi":"10.1136/bmjoq-2025-003309","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003309","url":null,"abstract":"<p><strong>Background: </strong>The rapid digitisation of healthcare has resulted in the capture of a vast amount of health data, which are increasingly being used for secondary purposes, such as quality improvement and performance management.</p><p><strong>Objectives: </strong>This study examined the legal and ethical considerations that affect if and how health professionals and administrators implement and use their performance data from the perspective of these stakeholder groups.</p><p><strong>Eligibility criteria: </strong>The search strategy focused on the use of health data (1) for quality improvement and performance management, (2) by health professionals and (3) discussion of ethicolegal concerns.</p><p><strong>Sources of evidence: </strong>A scoping review was conducted of three medical databases (Medline, Scopus and Embase) in April 2023, updated in June 2024.</p><p><strong>Charting methods: </strong>Included articles were first charted against 12 descriptive variables and then thematically analysed against the 16 substantive and procedural values of the Ethics Framework for Big Data in Health and Research (the Framework).</p><p><strong>Results: </strong>We identified 16 articles that explored 5/7 procedural and 8/9 substantive values of the Framework. Health professionals were mostly concerned with the fairness of data comparisons defined as the use of accurate and risk-adjusted datasets and the contextualisation of performance data against clinical experiences. Health administrators additionally emphasised the importance of good governance and data stewardship to improving professional engagement with performance data, but privacy remains a key barrier.</p><p><strong>Conclusions: </strong>The growing interest in using health data for quality improvement and performance management requires health services to address barriers to utilisation of performance data. Legal and ethical concerns must be balanced and prioritised in collaboration with end users for performance data to be accepted as a valid form of quality and performance assessment. Although privacy remains a key issue, these fears can be effectively managed by restricting public reporting on performance to only what is essential for public assurance.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the role of audit and feedback cycle in primary healthcare quality improvement.","authors":"Wajiha Omair, Mohammad Bilal Jawaid, Asif Ali Imam","doi":"10.1136/bmjoq-2024-003089","DOIUrl":"10.1136/bmjoq-2024-003089","url":null,"abstract":"<p><strong>Background: </strong>The audit and feedback (A&F) cycle involves systematic assessment of clinical performance, followed by structured feedback to physicians in order to facilitate quality improvement in their clinical practice. This study examines the effectiveness of A&F cycles in improving clinical practices among Primary Healthcare Physicians (PHCPs) and the intervention's applicability in Karachi, Pakistan.</p><p><strong>Methods: </strong>This retrospective study evaluated PHCPs employed by SINA from 2019 to 2023, focusing on the impact of A&F cycles on clinical performance. Data were collected from on-site and Electronic Medical Records (EMR) audits, followed by structured feedback sessions aimed at promoting practice improvements. A total of 61 PHCPs were analyzed based on inclusion criteria encompassing those who completed the A&F protocols. Statistical analysis was conducted using IBM SPSS Statistics Version 26 and the McNemar test was applied to see the significant differences in the baseline and the follow-up audit.</p><p><strong>Results: </strong>The study revealed significant improvements in PHCPs' clinical practices post-intervention. Notable enhancements were observed in consultation skills, history taking, provisional diagnosis, and adherence to clinical protocols. The management of common clinical conditions, including fever, respiratory issues, dermatological cases, and gastrointestinal disorders, also showed marked improvements.</p><p><strong>Conclusion: </strong>The A&F cycle is a viable intervention for enhancing clinical practices in PHC settings. The findings highlight the potential of A&F to drive quality improvements in healthcare delivery to resource-limited settings in Karachi. Further longitudinal studies are recommended to assess the sustainability of these practice enhancements and to explore the role of contextual factors in the effectiveness of A&F interventions.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the Empowering Leadership Questionnaire (ELQ) in paediatric nursing.","authors":"Giulia Pigini, Mauro Salvato, Anna Comotti, Gregorio Paolo Milani, Barbara Maria Cantoni, Dario Laquintana","doi":"10.1136/bmjoq-2024-003128","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003128","url":null,"abstract":"<p><strong>Background: </strong>Empowering leadership plays a crucial role in healthcare settings. To evaluate empowering leadership, a questionnaire (Empowering Leadership Questionnaire, ELQ) has been developed and validated in several working settings. However, the tool is not validated in paediatric nursing. Given the peculiar characteristics of the leadership in this context, this study addresses this gap by assessing the ELQ's properties in paediatric nursing and exploring its association with demographic and occupational factors.</p><p><strong>Methods: </strong>The study was conducted in a large Italian hospital, inviting all nursing staff members from five paediatric units to participate. The anonymous self-reported ELQ questionnaire was administered online together with a perceived quality survey. Statistical analyses included non-parametric tests, correlation analysis and multiple linear regression. Giving the multiple construct structure, we used McDonald's omega total coefficient to estimate internal consistency.</p><p><strong>Results: </strong>A total of 103 questionnaires were collected. The ELQ showed high internal consistency in all its five dimensions. Criterion validity compared with perceived quality of work of nurses showed significant correlation (r=0.35, p<0.001). An association between respondent age (p=0.002), job seniority (p=0.01) and ELQ scores was observed.</p><p><strong>Conclusion: </strong>This study analysed for the first time the ELQ in paediatric nursing, underlying its functioning and utility in evaluating empowering leadership in this peculiar setting. Furthermore, the study findings suggest that fostering empowering leadership can benefit overall work quality and satisfaction in paediatric nursing.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving ototoxicity monitoring in patients receiving aminoglycosides using a novel digital approach: a quality improvement project.","authors":"Jamie Cheong, Shereen Boreland, Elaine Shattock, Elaine Bowman, Barbara Belkarty, Andrew Jones, Imogen Felton, Emem-Fong Ukor, Janet Stowell, Ricardo J Jose, Su Madge, Julie Wilkins, Emily Frost, Presanna Premachandra, Michael Loebinger, Nicholas J Simmonds, Francis Drobniewski, Anand Shah","doi":"10.1136/bmjoq-2024-002847","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002847","url":null,"abstract":"<p><p>Aminoglycoside antibiotics cause ototoxicity for which baseline audiometric testing is recommended but often not done. Barriers to successful implementation include limited availability of sound-booths and audiologists. An ototoxicity monitoring programme (OMP) was implemented using tablet-based audiometry (TBA) by non-audiologists.A quality improvement project conducted over 1 year (19 April 2021 to 18 April 2022), using Plan Do Study Act (PDSA) cycles, monitored the adherence to the OMP using Shoebox Standard Edition application on iPads. Barriers to adoption were identified to determine potential solutions for improved adherence. Adult respiratory patients (cystic fibrosis (CF), bronchiectasis, non-tuberculosis mycobacteria (NTM) infection) aged 17-82 years receiving >1 day of intravenous aminoglycosides (IVAGs) at a single tertiary-referral hospital were included. Other reported outcomes were patient characteristics, risk factors associated with abnormal hearing and ototoxic shift.73 patients were tested in the OMP (46 received ≥2 hearing tests) giving an overall adherence rate of 69% after 12 months. Patient identification using referral and reporting systems initially improved adherence from 36% to 88% (p=0.03) during PDSA 1. Barriers to successful adherence were staff availability and COVID-19 infection outbreaks (p=0.057). Older age (p<0.001), higher Body Mass Index (p=0.041), non-CF bronchiectasis (p=0.01), non-CF NTM (p=0.028) and higher Hearing Handicap Inventory for Adults scores (p=0.002) were significantly associated with abnormal baseline hearing. 78% with hearing loss were asymptomatic. Ototoxic shift was associated with gentamicin use compared to amikacin/tobramycin (p=0.027). TBA was associated with high usability in patients ≤50 years old.TBA by non-audiologists was feasible and demonstrated good patient usability, permitting screening of patients within 72 hours of starting IVAG and earlier referrals for formal audiometry. Hearing loss and ototoxicity were detected at earlier stages, enabling more rapid decision-making and treatment modification.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educate African Americans with type 2 diabetes (T2DM) on the importance of daily foot self-care to prevent the development of diabetic foot ulcers (DFU): a quality improvement project.","authors":"Eldon Thompson, Amanda Hundley","doi":"10.1136/bmjoq-2023-002708","DOIUrl":"https://doi.org/10.1136/bmjoq-2023-002708","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic foot ulcers (DFUs) are a preventable healthcare pandemic. DFUs, a preventable diabetic complication, account for 6% of the diabetic population. Therefore, it is very necessary to address this growing health crisis through educational awareness to attenuate this preventable illness. Lack of education on the importance of routine basic foot care is one of the major casualties of the development of DFU, which, if not addressed, expeditiously leads to preventable lower limb amputation (LLA). Researchers have shown that approximately 0.03%-1.5% of diabetic patients need LLA, a costly and preventable complication. Hence, lack of education on the importance of safe routine foot care, such as lack of basic diabetic foot self-care awareness, walking without proper foot protection, delayed foot care and inappropriate care can negatively augment the pathological changes and lead to severe complications such as DFU, LLA and foot deformity. Researchers have indicated that educating diabetic patients on the importance of safe daily foot self-care will help prevent the development or exacerbation of DFUs. Foot care education for diabetic patients is one of the single most important methods of preventing DFUs. Clinical intervention, in this case, educating African Americans (AAs) on the importance of daily foot self-care in clinical practice will help decrease and prevent the development of DFUs among AAs with type 2 diabetes.</p><p><strong>Result: </strong>Pretest-posttest shows significant knowledge gain. Of the total volunteers screened, 20% had previous ulcers that healed successfully; however, they were not being followed up by a foot specialist. None of the screened volunteers had current or active foot ulcers. 60% of volunteers had diabetic neuropathy determined via monofilament test; these abnormalities were not previously detected. Many volunteers had more than one positive item; therefore, they met the requirement for referral to a diabetic foot specialist.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing door-to-triage time with improving triage coverage in a rural primary healthcare centre in India: a quality improvement project.","authors":"Sushmita Chauhan, Tej Prakash Sinha, Sanjeev Bhoi, Dolly Sharma, Ankit Kumar Sahu, Laxmi Nidhi Pandey","doi":"10.1136/bmjoq-2024-002985","DOIUrl":"10.1136/bmjoq-2024-002985","url":null,"abstract":"<p><strong>Background: </strong>Early recognition, timely management and referrals of emergency and time-sensitive conditions are challenging in the fragmented emergency system of India in primary healthcare settings. Early triage helps in reducing time to care and appropriate referral to the facility for further care. The aim of our quality improvement (QI) project was (a) to reduce the door-to-triage time by 50% from the baseline over a period of 1 month and (b) to improve the coverage of triage from the baseline to 90%.</p><p><strong>Methods: </strong>This study was conducted at the primary health centre (PHC) in the rural Northwestern region of India. The study was conducted from February 2023 to May 2023. The study was divided into three phases: pre-intervention phase (42 patients), intervention phase (204 patients) and post-intervention phase (42 patients). The team identified delays in patient registration and door-to-triage time as bottlenecks using process maps and fishbone analysis. Change ideas were tested through plan-do-check-act (PDCA) cycles using point-of-care QI methodology. Four cycles of PDCA were done in 1 month, which has led to improvements. The majority of change ideas focused on interventions like standardisation of triage protocol, re-organisation of resources and designating dedicated space for triage, training the healthcare providers on using various teaching methods and dedicated staff for triage.</p><p><strong>Results: </strong>The changes have demonstrated a reduction in door-to-triage time from the baseline of 10 min to 3 min, with an improvement in triage coverage from the baseline to 100%.</p><p><strong>Conclusion: </strong>A significant reduction in the door-to-triage time was observed with improvement in triage coverage by introducing standardised triage, optimally using the available resources, using case-based scenarios and simulation for training the staff and assigning a staff member dedicated to the triage process.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"13 Suppl 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving safety and timeliness around nasogastric tube feeding on an Acute stroke unit.","authors":"Manju Krishnan, Sarah Yeap, Bessy Howell, Mary Voulgaridou, Holly Robinson, Hannah Breeze-Jones, Tal Anjum, Peter Michael Edward Slade","doi":"10.1136/bmjoq-2025-003353","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003353","url":null,"abstract":"<p><strong>Background/aims: </strong>Nasogastric tube (NGT) feeding is required for artificial nutrition and hydration in those with impaired swallow due to a stroke. A baseline analysis of new NGT insertions on our acute stroke unit revealed considerable delays in the process and poor documentation of the risk-benefit discussions. We undertook a quality improvement project aimed at improving safety and reducing the delay in NGT insertion from an average of 5.2 hours (baseline) to under 3 hours in 6 months with a secondary aim of improving the documentation of risk-benefit discussions from 0% (baseline) to 50% during the same period.</p><p><strong>Methods: </strong>Multiple Plan-Do-Study-Act cycles of change ideas were implemented, including regular staff awareness sessions, introduction of new labels for the multidisciplinary team meetings and an NGT decision tool. The change ideas we used were directly linked to the secondary and primary drivers of the improvement journey with the help of a driver diagram. Process mapping helped to tighten our pathways. Consecutive data of timings were collected on an excel sheet and charted on a statistical process control chart. The compliance with documentation on the NGT decision tool was charted on a run chart.</p><p><strong>Results: </strong>The project achieved a consistent improvement in time taken from decision making to NGT insertion from a baseline average of 5.2 hours to 1.7 hours within 6 months and the new process was stable with an upper control limit reduction from 14.1 hours to 6.7 hours. The usage of the NGT decision tool increased from 0% to 80% during the same time period.</p><p><strong>Conclusions: </strong>The project achieved its aims and was able to improve patient care by changing the behaviour and culture within the team. The improvement has been sustained on an 8-month review, and the change has become 'business as usual' for the team.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Domiciliary subcutaneous furosemide in patients with CKD and HF: a quality improvement project.","authors":"Ella Tumelty, Rosa Montero, Ashwin Anenden, Jane Nokes, Vasa Gnanapragasam, Mahrukh Ayesha Ali, Sabba Hussain, Isaac Chung, Matthew Sunter, Laura Bijman, Tristan Williams, Nicholas M P Annear, Irina Chis Ster, Giuseppe Rosano, Lisa Anderson, Debasish Banerjee","doi":"10.1136/bmjoq-2024-002984","DOIUrl":"10.1136/bmjoq-2024-002984","url":null,"abstract":"<p><p>Hospital admissions to treat fluid overload are common in patients with both heart failure and chronic kidney disease (CKD-HF). This is a population with high levels of frailty. Recurrent hospital admissions are costly to both patients and healthcare systems. We designed a proof-of-concept, multidisciplinary quality improvement project to deliver at-home subcutaneous furosemide to treat fluid overload in patients with CKD-HF. This project involved collaboration between a hospital, community remote monitoring hub and hospital-at-home team, including general practitioners, secondary care physicians, nurses and pharmacists. Patients were considered suitable for the intervention if they had CKD-HF, fluid overload and were haemodynamically stable. Following review, suitable patients were treated at-home with 80 mg subcutaneous furosemide over 5 hours, for 5 days. This was administered by the hospital-at-home team in liaison with hospital specialists, with continuous patient monitoring provided by the remote monitoring hub. Renal function and weight were assessed daily. Following treatment, patients were reviewed by the secondary-care team to adjust their maintenance medications. Data collected and analysed included daily weights, renal function and observations, as well as the number of hospitalisations and/or death at 30 days following the intervention. 10 patients successfully completed treatment. All potentially required hospitalisation at baseline and all avoided hospitalisation during the 5-day course of subcutaneous furosemide. One patient was admitted to the hospital following their final hospital review, and two patients were hospitalised for 4 and 14 days respectively, after their final dose of subcutaneous furosemide. Renal function and potassium did not significantly change throughout the treatment. No major safety concerns were identified. Patients welcomed the intervention. This quality improvement project demonstrates that it is logistically feasible, with primary care collaboration, to treat fluid overload in patients with CKD-HF at-home using subcutaneous furosemide.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}