Availability and development of guidelines in a tertiary teaching hospital

OBJECTIVE: The purpose of this study was to review existing guidelines in clinical departments and describe their characteristics, development and implementation at a large teaching hospital in Sydney, Australia. METHODS: The study was undertaken in two stages. First, from September to November 2005, we reviewed and classified documents from eight departments as clinical practice guidelines (CPGs), clinical procedural protocols (technology and technique) or administrative guidelines. We also collected information about the scope, format and target user of the guidelines. Second, from March to June 2006, we interviewed department staff in seven of eight participating departments about the guidelines' development and implementation. A revised Appraisal of Guidelines Research and Evaluation questionnaire was used to collect data in both stages. RESULTS: A total of 368 of 509 documents reviewed were classified as CPGs. Almost 90% of the CPGs had five or fewer pages; nearly 80% had no references; and 90% had no application tools. The CPGs had been developed locally by each individual department. The departments used various methods to collect evidence. In six (albeit a different six departments in each case) of seven departments, clinicians' clinical experience was used in the analysis of the evidence; informal expert consensus was used for formulating recommendations; internal peer review was the major method used to review the guidelines (after drafting); hard copy of guidelines was the major medium used; and provision of educational material was the major implementation strategy. CONCLUSIONS: There was great variation in the number, availability and presentation of guidelines in the departments. There was a lack of standardized methods and narrow skills representation during guideline development.     

Implementation of hospital wide dysphagia screening in a large acute tertiary teaching hospital

Abstract

Purpose: There are no examples in the literature of successful long-term hospital-wide implementation of nurse-led dysphagia screening. This article aims to describe strategies used to implement hospital-wide dysphagia screening in a large acute tertiary teaching hospital in Australia. It reports on compliance, accuracy and nursing staff satisfaction using the validated Royal Brisbane and Women’s Hospital Dysphagia Screening Tool (RBWH DST).

Method: A retrospective observational study of audit data was conducted to examine hospital-wide compliance and accuracy of dysphagia screen completion. A nursing staff survey measured staff satisfaction. Implementation included: (1) utilisation of validated tool (RBWH DST); (2) key stakeholder engagement and strong governance; (3) policy development; (4) education; and (5) review and monitoring processes.

Result: Audits conducted over a 9-year period (n?=?3726) showed an average hospital-wide compliance rate of 74% and an accuracy rate of 82%. A nurse satisfaction survey (n?=?109) showed high levels of satisfaction associated with using the RBWH DST.

Conclusion: The RBWH DST was implemented in a large acute tertiary teaching hospital with acceptable compliance and accuracy rates and favourable nursing staff satisfaction. Further study is required to objectively evaluate patient health and cost benefits associated with using the RBWH DST.     

Characteristics of health problems in returned overseas travelers at a tertiary teaching hospital in a suburban area in Japan

Few studies have analyzed the characteristics of patients who develop physical disorders after overseas travel. We retrospectively reviewed the medical records of 183 patients who visited Nara Medical University Hospital from 2008 to 2016 because of physical problems after traveling abroad. The main travel destinations were Southeast Asia (n = 100), Africa (n = 27), and South Asia (n = 23). The main reasons for the travel were leisure (n = 96), business (n = 51), and volunteer work (n = 19). The most common final diagnosis was gastrointestinal disease (n = 72), followed by febrile disease (n = 59) and respiratory disease (n = 19). There were eight malaria cases, including one patient who was infected after <14 days of overseas travel. Additionally, 61 of 71 cases of travelers' diarrhea and 15 of 21 cases of dengue fever occurred after <14 days travel. 26 cases of vaccine preventable diseases, such as hepatitis A, typhoid fever, and influenza, were observed. Consequently, healthcare providers should notify Japanese overseas travelers that there is a non-negligible health risk inherent to short-term travel, while stressing on the importance of pre-travel medical consultation.     

Requests for euthanasia made to a tertiary referral teaching hospital in Sydney, Australia in the year 2000

A request for euthanasia (RFE) in the terminally ill raises concerns that physical and/or mental suffering remain unaddressed and thus mandates a critical appraisal of the physical and psychosocial aspects of the individual concerned. An alert datasheet (AD) is completed at the weekly Palliative Care Service (PCS) meeting as a measure of self-audit and deals with issues considered to be of importance in ensuring high-quality patient care, one of which is a RFE. The ADs for the year 2000 were examined, and where a RFE was made, the contributing factors as documented on the forms together with demographic data, the case synopsis and patient-rated main three problems/issues were appraised. Among 490 patients referred to the service, there were 6 RFE (1.6%) recorded. These were made by 1 female (age 44) and 5 male (age range 58-78 years) patients. Four of these patients had a cancer diagnosis (all had metastatic disease). Median survival from first contact with the PCS was 13 days (range 4-29). The contributing factors identified were: uncontrolled symptoms (2/6 - severe constipation in both), depression (1/6), issues of burden/dependency (6/6), lack of autonomy/control (4/6), sense of hopelessness (3/6) and social isolation (4/6). The patient-rated main three problems were: (i) physical symptoms (5/6), specifically pain (2/6), shortness of breath (2/6), fatigue (1/6) and nausea (1/6), and (ii) psychosocial issues (4/6). A RFE was seen to be a multifactorial entity (issues of burden/dependency being universal) and merits a focused appraisal in order to adequately address potentially unrecognised issues that contribute to suffering. The short median survival from the time of referral to the service suggests that (i) RFEs are made late in the trajectory of the illness and (ii) these patients are being referred late in the course of their illness - thus limiting the window in which these issues can be addressed.     

Evaluation of a falls prevention programme in an acute tertiary care hospital

Aims and objectives. To evaluate a systematic, coordinated approach to limit the severity and minimize the number of falls in an acute care hospital. Background. Patient falls are a significant cause of preventable injury and death, particularly in older patients. Best practice principles mandate that hospitals identify those patients at risk of falling and implement interventions to prevent or minimize them. Methods. A before and after design was used for the study. All patients admitted to three medical wards and a geriatric evaluation management unit were enrolled over a six‐month period. Patients’ risk of falling was assessed using a falls risk assessment tool and appropriate interventions implemented using a falls care plan. Data related to the number and severity of falls were obtained from the Australian Incident Monitoring System database used at the study site. Results. In this study, 1357 patient admissions were included. According to their risk category, 37% of patients (n = 496) were grouped as low risk (score = 1–10), 58% (n = 774) medium risk (score = 11–20) and 5% (n = 63) high risk (score = 21–33) for falls. The incidence of falls (per average occupied bed day) was eight per 1000 bed days for the study period. Compared with the same months in 2002/2003, there was a significant reduction in falls from 0·95 to 0·80 (95% CI for the difference ?0·14 to ?0·16, P < 0·001). Conclusion. We evaluated a systematic, coordinated approach to falls management that included a falls risk assessment tool and falls care plan in the acute care setting. Although a significant reduction in falls was found in this study, it could not be attributed to any specific interventions. Relevance to clinical practice. Preventing falls where possible is essential. Assessment of risk and use of appropriate interventions can reduce the incidence of falls.     

Reported incidence, causes, and reporting of medication errors in teaching hospitals in Jordan: a comparative study

This research assessed the reported incidence, causes and reporting of medication errors in intensive care units (ICUs) and wards of Jordanian teaching hospitals. There are few studies about medication errors in Jordan. This survey was conducted in 2010 using a convenience sample of 212 nurses from four teaching hospitals. The response rate was 70.6% (212/300). The mean of the reported incidence of medication errors for the whole sample was 35%; 36.4% in ICUs and 33.8% in wards. An inaccurate rate of total parenteral nutrition (TPN) was the scenario most commonly classified as a drug error; for this nurses would notify the physician, and complete an incident report. Poor quality or damaged medication labels were the most commonly reported causes of errors. Nurses failed to report medication errors because they were afraid that they might be subjected to disciplinary actions. There were some significant differences between ICUs and wards in assessment of clinical scenarios, causes of medication errors as well as their reporting. Reporting of medication errors should be encouraged. Immediate interventions should be initiated by all healthcare professionals in all clinical settings, especially in wards.     

Knowledge,attitude, and practices related to medication errors among nursing professionals: a questionnaire-based study in a tertiary care hospital

Objective: To evaluate the level of understanding(knowledge), beliefs(attitude), and behavior(practice) of staff nurses toward medication errors(MEs). Methods: Self-administered questionnaires were distributed to nursing professionals who had at least 1 year of work experience. Each questionnaire contained 19 items assessing “knowledge,” “attitude,” and “practice” attributes toward MEs. Results: Responses from 47 nursing respondents were included for the final analysis. The mean knowledge score ...     

Obstetric admissions to the intensive care unit in a tertiary referral hospital

PurposeThe present study was conducted to evaluate the obstetric admissions to the intensive care unit (ICU) in the setting of a tertiary referral hospital in an attempt to identify the risk factors influencing maternal outcome.Materials and MethodsAll of the obstetric patients who seeked care for delivery at the emergency department and who were admitted to the ICU between January 2006 to July 2009 were retrospectively identified. The Simplified Acute Physiology Score (SAPS II) was calculated and the maternal mortality rate was estimated for each patient. The mean SAPS II scores and the mean estimated maternal mortality rates for the surviving patients and the nonsurviving patients were compared.ResultsSeventy-three obstetric patients were admitted to the ICU. There were 9 maternal deaths and 24 fetal deaths. For the surviving group of patients, the mean SAPS II score was 34 and estimated maternal mortality rate was 20%, whereas for the nonsurviving group of patients, the SAPS II score was 64 and estimated maternal mortality rate was 73%. The difference between the surviving group of patients and the nonsurviving group of patients was statistically significant regarding both the mean SAPS II scores and the mean estimated maternal mortality rates.ConclusionsPregnancy-induced hypertensive disorders and hemorrhage appear as the major risk factors influencing maternal outcome in obstetric patients. Considering that the use of the SAPS II scores have enabled the reliable estimation of the mortality rates in the present study, the attempts at defining the focus of care for the obstetric patients who bear the major risk factors and who are admitted to the ICU should be carried out under the guidance of the ICU scoring systems such as the SAPS II.