BMJ quality improvement reports最新文献

{"title":"Improving pneumococcal vaccination rates of medical inpatients in urban Nepal using quality improvement measures","authors":"A. Bock, K. Chintamaneni, L. Rein, T. Frazer, G. Kayastha, T. MacKinney","doi":"10.1136/bmjquality.u212047.w4835","DOIUrl":"https://doi.org/10.1136/bmjquality.u212047.w4835","url":null,"abstract":"Streptococcus pneumoniae infection is associated with high morbidity and mortality in low income countries. In Nepal, there is a high lung disease burden and incidence of pneumonia due to multiple factors including indoor air pollution, dust exposure, recurrent infections, and cigarette smoking. Despite the ready availability of effective pneumococcal vaccines (PNV), vaccine coverage rates remain suboptimal globally. Quality Improvement (QI) principles could be applied to improve compliance, but it is a virtually new technology in Nepal. This QI study for Patan Hospital sought to introduce the concept of QI there, to measure the baseline pneumococcal vaccination rate of qualifying adult patients discharged from the medical wards and to assess reasons for non-vaccination. QI interventions were instituted to improve this rate, measuring the effectiveness of QI methods to produce the desired outcomes using the Model for Improvement, Plan-Do-Study-Change (PDSA) methodology. In the three week baseline assessment, 2 out of 81 (2%) eligible patients recalled ever receiving a prior pneumococcal vaccine; 68 (84%) unvaccinated patients responded that they were not asked or were unaware of the PNV. After the QI interventions, the pneumococcal vaccination rate significantly increased to 42% (23/56, p<0.001). Post-intervention, the leading reason for non-vaccination was cost (20%, 11/56). Only 5 (9%) unvaccinated patients were not asked or were unaware of the PNV, a significant change in that process outcome from baseline (p<0.001). Quality improvement measures were effective in increasing pneumococcal vaccination rates, despite the limited familiarity with QI methods at this major teaching hospital. QI techniques may be useful in this and other efforts to improve quality in resource-limited settings, without great cost.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u212047.w4835","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63911071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ensuring availability of in date and fit for purpose emergency guidelines in all anaesthetic areas throughout the South East Scotland deanery","authors":"Elise Hindle","doi":"10.1136/bmjquality.u208541.w3405","DOIUrl":"https://doi.org/10.1136/bmjquality.u208541.w3405","url":null,"abstract":"Our aim was to institute a system whereby emergency anaesthetic guidelines are available in >90% of appropriate clinical areas throughout each of the acute hospital sites in three health board administrative regions, and whereby >90% of available guidelines are deemed to be in date and fit for purpose. Our objective was to achieve these targets within 6 months. Using quality improvement methodology, we inventoried available emergency anaesthetic guidelines in 132 locations throughout seven acute care hospitals. Five guidelines were then randomly selected per site per month and assessed for three process markers: was the guideline available in all appropriate areas, was it in-date (i.e. within date of review as specified on guideline or on consultation with author) and was it fit for purpose. Fitness for purpose was assessed by asking a junior colleague to simulate the emergency in a table top exercise using the guideline to aid management. This project was also used as a surveillance system to highlight outdated, unfit or missing guidance. Interventions included iterative revision of the master guideline lists, removal of outdated or unfit guidelines and creation or updating of guideline folders. 30 guidelines were assessed pre-intervention and 203 post-intervention. 52% of guidelines were available in appropriate areas pre-intervention rising to 76% post intervention, 67% of guidelines were in date pre-intervention rising to 82% post-intervention and 87% of guidelines were deemed fit for purpose pre-intervention rising to 92% post-intervention. We have demonstrated that regular review of emergency guidelines to maintain their currency is achievable and also demonstrated the feasibility of recruiting over 20 trainees across a training deanery to complete a QI project. We believe that organisations should maximise the resource of highly motivated trainees to achieve their QI goals.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u208541.w3405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63907149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large scale implementation of a medicines reconciliation care bundle in NHS GGC GP practices","authors":"R. Bruce","doi":"10.1136/bmjquality.u212988.w6116","DOIUrl":"https://doi.org/10.1136/bmjquality.u212988.w6116","url":null,"abstract":"Medicines reconciliation (MR) is an essential process for patient safety, promoting safer use of medicines with effective communication at the interface, particularly when patients are admitted and discharged from hospital. Much of the work on MR has been focussed in secondary care, however, the principles are equally important in primary care. The aim of the work was to test the Scottish Patient Safety in Primary Care (SPSP-PC) MR care bundle and consider scale up and spread across all NHS Greater Glasgow and Clyde (NHS GGC) GP practices. Care bundles are a quality improvement tool which can drive improvement by standardising processes to deliver optimum care. Pilot work and testing began with 5 GP practices in 2011 and was spread to over 200 practices by 2015/16. A care bundle compliance process measure was measured monthly, with practices sampling 10 patients per month. Practices could view their run charts in real time and identify which measures resulted in “non-compliance” and PDSA cycles were promoted to test and implement improvements. Data was collated at NHS GGC level with an aim of 95% compliance with the care bundle by March 2016. MR care bundle compliance started at 40% (5 practices reporting) in 2011 with final data in March 2016 demonstrating 92% compliance (192 practices reporting). A sustained “reliability” of 92-93% across >200 practices has been observed since January 2015. In conclusion, the bundle was implemented by 97% of NHS GGC GP practices and resulted in process improvements.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u212988.w6116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63911556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of peer support workers in improving patient experience in Tower Hamlets Specialist Addiction Unit","authors":"W. Kulik, Amar J. Shah","doi":"10.1136/bmjquality.u205967.w2458","DOIUrl":"https://doi.org/10.1136/bmjquality.u205967.w2458","url":null,"abstract":"The aim of the project was to improve patient experience for people in Tower Hamlets Specialist Addictions Unit in order to increase satisfaction by 25% in 12 months starting in August 2014. The team used the model for improvement as part of ELFT's quality improvement programme to support iterative cycles of testing and learning. This involved support from the Trust's quality improvement team. The theory of change was visualised through a driver diagram. A number of outcomes were measured and plotted over time - patient satisfaction, staff satisfaction, and attendance to peer support groups. The impact of changes was then observed using the plan, do, study, act (PDSA) cycles. The changes that positively influenced the outcomes were continued and ones without such impact were discontinued. The most successful intervention to improve patient satisfaction so far was the introduction of peer support facilitation for the “Breakfast club” - recovery orientated meeting of patients with less emphasis on the medical aspects of treatment. Staff satisfaction is proven to be one of the best determinants of patient experience, so this is also measured and plotted over time together with patient's satisfaction and attendance. Service user satisfaction improves attendance and outcomes in this difficult-to-engage group of patients (people with both substance misuse and mental health problems). Patient perspectives and priorities might be quite different to that of the clinical team, further supporting the importance of involving and engaging them in any quality improvement work. Involving peer support workers in improving engagement of people with substance misuse related problems appears essential.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u205967.w2458","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63903842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving asthma care in a pediatric resident clinic","authors":"Julia Lee, Albina Gogo, D. Tancredi, Erik Fernández y García, U. Shaikh","doi":"10.1136/bmjquality.u214746.w6381","DOIUrl":"https://doi.org/10.1136/bmjquality.u214746.w6381","url":null,"abstract":"There is variation in pediatric asthma management in the outpatient setting. Adherence to national asthma guidelines provides a systematic standardized approach to asthma management. There is a gap between usual and guideline-consistent asthma care in resident clinics. Practice improvement modules aimed at improving resident physician adherence to asthma care guidelines have not been consistently utilized and have not yet been studied. Our aim was to increase guideline consistent care in our pediatric resident clinic in a twelve-month period via increasing performance on the following measures to 75%: spirometry testing; influenza immunization recommendation; level of control assessed through the use of a standardized questionnaire; appropriate medications per national guideline; and use of written asthma action plans. A summarized pediatric-specific version of the National Heart Lung and Blood Institute National Asthma Education and Prevention Program Expert Panel Report 3 (NHLBI EPR-3) guidelines was made readily available to increase provider education. Electronic health record (EHR) enhancements included adding templates to create standardized asthma action plan, asthma control test and a pediatric asthma controller medication order-set. We also addressed the education of patients by simplifying patient instructions. We monitored our progress through the use of an online practice improvement module. We found statistically significant increases in use of a standardized instrument to determine level of control (20% to 81%); recommendation of influenza immunization (56% to 97%); use of national medication treatment guidelines (28% to 98%); distribution of asthma action plans (29% to 65%); and provision of asthma self-management education (35% to 74%). Standardizing the implementation of national guidelines for pediatric asthma through the use of a practice improvement module and electronic health records improved adherence to guidelines. The module allowed us to identify goals for improvement, collect and analyze our group performance data over time, assess the impact of each change, and redesign our process. Improving adherence to national pediatric asthma care guidelines is especially important in settings such as resident teaching clinics which provide care to underserved populations at higher risk for complications related to asthma.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u214746.w6381","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63912289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and implementation of a standardized pathway in the Pediatric Intensive Care Unit for children with severe traumatic brain injuries","authors":"L. Rakes, Mary A. King, B. Johnston, R. Chesnut, Rosemary M. Grant, M. Vavilala","doi":"10.1136/bmjquality.u213581.w5431","DOIUrl":"https://doi.org/10.1136/bmjquality.u213581.w5431","url":null,"abstract":"Severe traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. In 2003 and 2012, the Brain Trauma Foundation established and refined evidence-based guidelines for management of severe TBI in children. A recent multicenter study demonstrated an association between TBI guideline adherence and improved discharge survival. However, this study also showed large variation in adherence to pediatric TBI management at our level 1 pediatric trauma center, where overall adherence to fourteen pediatric intensive care unit (PICU) TBI clinical indicators was 64%. The aim of this quality improvement project was to increase TBI guideline adherence by implementing a standard care pathway for PICU management of children with severe TBI. A multi-disciplinary approach was utilized to develop the Pediatric Guideline Adherence and Outcomes (PEGASUS) care pathway, and iterative PDCA cycles were performed. Over an 18 month period following pathway implementation, overall PICU clinical guideline adherence rate increased to 80%.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u213581.w5431","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63912187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Absconding: reducing failure to return in adult mental health wards","authors":"J. Bailey, Bethan F Page, Nokuthula Ndimande, J. Connell, C. Vincent","doi":"10.1136/bmjquality.u209837.w5117","DOIUrl":"https://doi.org/10.1136/bmjquality.u209837.w5117","url":null,"abstract":"Failing to return from leave from acute psychiatric wards can have a range of negative consequences for patients, relatives and staff. This study used quality improvement methodology to improve the processes around patient leave and time away from the ward. The aim of this study was to improve rates of on-time return from leave by detained and informal patients by 50%. Following a baseline period, four interventions were implemented and refined using PDSA cycles. The main outcome measure was the proportion of periods of leave where the patient returned on time. Late return was defined as failure to return to the ward within 10 minutes of the agreed time. At baseline, the rate for on-time return was 56.0%; this increased to 87.1% post-intervention, a statistically significant increase of 55.5%. SPC charts show that the interventions were associated with improvements. The improvements have been sustained and the interventions are fully embedded into daily practice. The project was refined to local context and trialled on six additional wards: four of the six wards have successfully implemented the interventions and have on-time return rates of over 90%. This project produced a marked and sustained improvement in patients returning on-time from leave, facilitating a more open discussion between staff and patients about the purpose and value of periods away from the ward. Quality improvement approaches can be effectively applied in mental health settings.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u209837.w5117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63909166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous thromboembolism capture on electronic systems in obstetrics patients at St Thomas' Hospital","authors":"A. Ahmad, Megan L Byrne, Nazia Imambaccus, D. Hubert, A. Gateley, S. Abdullahi Idle, J. Lloyd","doi":"10.1136/bmjquality.u212405.w5122","DOIUrl":"https://doi.org/10.1136/bmjquality.u212405.w5122","url":null,"abstract":"Venous thromboembolism (VTE) is one of the leading causes of maternal mortality in the UK. Therefore, timely VTE risk assessment is essential in all obstetrics patients. The Commissioning for Quality and Innovation (CQUIN) payment framework set a target for trusts to complete a VTE risk assessment within 24 hours of admission for 95% of patients. A combination of factors, including lack of integration between multiple IT systems, means that this CQUIN target is currently not being met for obstetric patients in the Hospital Birth Centre at Guys and St Thomas' NHS Trust. This project aims to increase staff awareness of this issue and educate them regarding the correct procedure for VTE assessment. Trialled methods included reminders at staff handovers, use of magnets on the patient whiteboard, posters and stickers displayed around the unit and a loyalty card scheme as incentive to complete assessments. Initial average completion rate was 20.7%, which increased to 67.5% after the first plan, do, study, act (PDSA) cycle with a slight drop to 65.7% after the second cycle. Completion rates increased to 92.3% on the last day of the third PDSA cycle. Although we did not reach the 95% target, we have raised awareness of the importance of recording VTE assessment on electronic systems, and hope we have created sustainable change.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u212405.w5122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63911430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the accuracy of electronic prescribing in West Bay Health Center in Qatar","authors":"Wafaa Yousuf, Sheren Elkomy, M. Soliman, Noof Al-Mansouri, M. Salem, Amal Al-Ali, Mohamed H Mahmoud, Hisham Elmahdi","doi":"10.1136/bmjquality.u210962.w4393","DOIUrl":"https://doi.org/10.1136/bmjquality.u210962.w4393","url":null,"abstract":"Primary healthcare in Qatar uses electronic prescribing to reduce the risk of medication errors. Electronic prescribing is supported by computerized Physician Order Entry systems through Cerner (electronic medical record system). There are still prescription errors, despite electronic prescribing being in place for one year at West Bay Health Center. West Bay Health Center is a famous primary healthcare center in Qatar. It is a training center for the family medicine residency program, which is accredited by the accreditation council of general medical education international (ACGME-I). It serves a population of about 98,000 in Qatar with 35 physicians and 12 pharmacists. The aim of this project was to decrease medication errors by 30% from baseline measurement (according to type of error) from October 2015 to March 2016. It was found that there was a discrepancy between the pharmacy medication list and the list within Cerner. A master drug index was created to eliminate the discrepancy. Training on the use of this index was provided through lectures and one to one education, with material also sent through email. We found that there was some resistance from the physician side and therefore introduced a second intervention. We sent out a survey to find out more about these difficulties and provided more training and education. Our results showed an decrease in the proportion of wrong dose errors from 11.8% to 10.6%, wrong name from 6.9% to 6.2%, wrong duration from 11.7% to 10.3%, and non-formulary drug errors from 2.6% to 1.6%.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u210962.w4393","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63911264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A project to improve the management of patients on warfarin in a primary care setting through the introduction of a POC analysis","authors":"T. Karlsson","doi":"10.1136/bmjquality.u211003.w4421","DOIUrl":"https://doi.org/10.1136/bmjquality.u211003.w4421","url":null,"abstract":"When noticed that patients commonly misunderstood their warfarin prescriptions when they were given by telephone. We found that the average TIR (time in range) (the relative time period the patients PT-INR value was in the therapeutic range) for patients decreased, and we noticed that the numbers of incidents increased. We made several interventions over a period of close to three years (2010-2012) to improve the quality of care, increase patients' TIRs, and decrease incidents. The interventions included; taking extra care when speaking to patients about their warfarin prescriptions on the phone and using an express mail delivery system to make sure patients got their letters in time. However, these changes made little difference to the measured results. In 2012, we introduced a point of care analysis. Through these simple actions TIR figures increased from 55 % to 75-80 % and fewer non-conformance reports were filed. Medical incidents, leading to costly hospitalizations, after the introduction of POC (point of care analysis) fell from six to two to three instances a year. The number of patients undergoing treatment and included in the study increased from 200 in 2008 to 250 in 2015. We found that these changes improved the quality of the care given without causing extra work for the staff. Patients were satisfied and the method has spread to other primary care centres.","PeriodicalId":91218,"journal":{"name":"BMJ quality improvement reports","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/bmjquality.u211003.w4421","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63910903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}