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Chung, Ji Yeon, Seung Jae Lee, Hyuck Jin Lee, Jeong Bin Bong, Chan-Hyuk Lee, Byoung-Soo Shin, and Hyun Goo Kang. "Aconitine Neurotoxicity According to Administration Methods." Journal of Clinical Medicine 10, no. 10 (May 16, 2021): 2149. http://dx.doi.org/10.3390/jcm10102149.
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We evaluated the toxic effects of aconitine on the human nervous system and its associated factors, and the general clinical characteristics of patients who visited the emergency room due to aconitine intoxication between 2008 and 2017. We also analyzed the differences related to aconitine processing and administration methods (oral pill, boiled in water, and alcohol-soaked), and the clinical characteristics of consciousness deterioration and neurological symptoms. Of the 41 patients who visited the hospital due to aconitine intoxication, 23 (56.1%) were female, and most were older. Aconitine was mainly used for pain control (28 patients, 68.3%) and taken as oral pills (19 patients, 46%). The patients showed a single symptom or a combination of symptoms; neurological symptoms were the most common (21 patients). All patients who took aconitine after processing with alcohol showed neurological symptoms and a higher prevalence of consciousness deterioration. Neurological symptoms occurred most frequently in patients with aconitine intoxication. Although aconitine intoxication presents with various symptoms, its prognosis may vary with the processing method and prevalence of consciousness deterioration during the early stages. Therefore, the administration method and accompanying symptoms should be comprehensively investigated in patients who have taken aconitine to facilitate prompt and effective treatment and better prognoses.
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Ford, Clyde D., Julie Killebrew, Penelope Fugitt, Janet Jacobsen, and Elizabeth M. Prystas. "Study of Medication Errors on a Community Hospital Oncology Ward." Journal of Oncology Practice 2, no. 4 (July 2006): 149–54. http://dx.doi.org/10.1200/jop.2006.2.4.149.
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Purpose Medication errors (MEs) have been a significant problem resulting in excessive patient morbidity and cost, especially for cancer chemotherapeutic agents. Although some progress has been made, ME measurement methods and prevention strategies remain important areas of research. Methods During a 2-year period (2003-2004), we conducted a prospective study on the oncology ward of a large community hospital, with the goals of (1) complete nurse reporting of observed medication administration errors (MAEs), (2) classifying observed MAEs, and (3) formulating improvement strategies. We also conducted a retrospective review of a randomly chosen sample of 200 chemotherapy orders to assess the appropriateness of ordering, dispensing, and administration. Results Our nurses reported 141 MAEs during the study period, for a reported rate of 0.04% of medication administrations. Twenty-one percent of these were order writing and transcribing errors, 38% were nurse or pharmacy dispensing errors, and 41% were nurse administration errors. Only three MAEs resulted in adverse drug events. Nurses were less likely to report MAEs that they felt were innocuous, especially late-arriving medications from the pharmacy. A retrospective review of 200 chemotherapy administrations found only one clear MAE, a miscalculated dose that should have been intercepted. Conclusions Significant reported MAE rates on our ward (0.04% of drug administrations and 0.03 MAEs/patient admission) appear to be relatively low due to application of current safety guidelines. An emphasis on studying MAEs at individual institutions is likely to result in meaningful process changes, improved efficiency of MAE reporting, and other benefits.
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Goto, Michihiko, Rajeshwari Nair, Bruce Alexander, Brice Beck, Christopher Richards, Eli N. Perencevich, and Daniel J. Livorsi. "2894. Metrics of Antimicrobial Use Within Inpatient Settings: Impacts of Statistical Methods and Case-Mix Adjustments." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S81. http://dx.doi.org/10.1093/ofid/ofz359.172.
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Abstract Background The necessary data elements and optimal statistical methods for benchmarking hospital-level antimicrobial use are still being debated. We aimed to describe the relative influence of case-mix adjustment and different statistical methods when ranking hospitals on antimicrobial use (AU) within inpatient settings. Methods Using administrative data from the Veterans Health Administration (VHA) system in October 2016, we calculated total antimicrobial days of therapy (DOT) and days present according to the National Healthcare Safety Network (NHSN) protocol. Patient-level demographics, comorbidities, and recent procedures were used for case-mix adjustments. We compared hospital rankings across 4 different methods: (A) crude antimicrobial DOT per 1,000 days present, aggregated at the hospital-level; (B) observed/expected (O/E) AU ratio with risk adjustment for ward-level variables (analogous to NHSN’s Standardized Antimicrobial Administration Ratio); (C) O/E AU ratio with risk adjustment for ward-/patient-level variables; (D) predicted/expected (P/E) AU ratio with risk adjustment for ward-/patient-level variables, based on a multilevel model accounting for clustering effects at hospital- and ward-levels. Results The cohort included 165,949 DOTs and 318,321 days present at 122 acute care hospitals within VHA. Crude DOTs per 1,000 days present ranged from 153.6 to 900.8 (Figure A), and ward-level risk adjustment only modestly changed rankings (Figure B). When adjusted for ward- and patient-level variables (including demographics, 14 comorbidities and 22 procedures), rankings changed substantially (Figure C). Risk-adjustment by a multilevel model changed rankings even further, while shrinking variabilities (Figure D). Ten hospitals in the lowest and 11 hospitals in the highest quartiles by O/E risk adjustment for only ward-level variables were classified to different quartiles on P/E risk adjustment. Conclusion We observed that the selection of variables and statistical methods for case-mix adjustment had a substantial impact on hospital rankings for antimicrobial use within inpatient settings. Careful consideration of methodologies is warranted when providing benchmarking metrics for hospitals. Disclosures All Authors: No reported Disclosures.
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Lyons, Imogen, Dominic Furniss, Ann Blandford, Gillian Chumbley, Ioanna Iacovides, Li Wei, Anna Cox, et al. "Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study." BMJ Quality & Safety 27, no. 11 (April 7, 2018): 892–901. http://dx.doi.org/10.1136/bmjqs-2017-007476.
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IntroductionIntravenous medication administration has traditionally been regarded as error prone, with high potential for harm. A recent US multisite study revealed few potentially harmful errors despite a high overall error rate. However, there is limited evidence about infusion practices in England and how they relate to prevalence and types of error.ObjectivesTo determine the prevalence, types and severity of errors and discrepancies in infusion administration in English hospitals, and to explore sources of variation, including the contribution of smart pumps.MethodsWe conducted an observational point prevalence study of intravenous infusions in 16 National Health Service hospital trusts. Observers compared each infusion against the medication order and local policy. Deviations were classified as errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs.ResultsData were collected from 1326 patients and 2008 infusions. Errors were observed in 231 infusions (11.5%, 95% CI 10.2% to 13.0%). Discrepancies were observed in 1065 infusions (53.0%, 95% CI 50.8% to 55.2%). Twenty-three errors (1.1% of all infusions) were considered potentially harmful; none were judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of errors and discrepancies varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or patient need. Smart pumps, as currently implemented, had little effect, with similar error rates observed in infusions delivered with and without a smart pump (10.3% vs 10.8%, p=0.8).ConclusionErrors and discrepancies are relatively common in everyday infusion administrations but most have low potential for patient harm. Better understanding of performance variability to strategically manage risk may be a more helpful tactic than striving to eliminate all deviations.
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Wundavalli, Laxmitej, SG Bulkapuram, NL Bhaskar, and N. Satyanarayana. "Patient safety at a public hospital in southern India: A hospital administration perspective using a mixed methods approach." National Medical Journal of India 31, no. 1 (2018): 39. http://dx.doi.org/10.4103/0970-258x.243415.
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Rozen, Warren M., Elan D. Kaplan, Katharine J. Drummond, and Robert J. Millar. "A tale of two colleges: do specialist trainees receive adequate hospital-based training?" Australian Health Review 31, no. 3 (2007): 362. http://dx.doi.org/10.1071/ah070362.
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Background: Both medical and surgical trainees have a dual reliance on their specialist training college and their respective teaching hospitals to maintain standards in teaching and training. Although guidelines are in place for the administration of this teaching, hospital-based teaching has been minimally regulated. A review of trainee satisfaction with current levels of hospital-based training was performed, both to reflect the thoughts of trainees themselves and to highlight specific areas requiring improvement. Methods: Sixty-four basic specialist trainees (44 surgical [BSTs] and 20 physician [BPTs]) from all of the major Melbourne metropolitan teaching hospitals completed an anonymous survey. Results: Surgical trainees considered all areas of hospital-based training to be deficient, with overall dissatisfaction significantly greater for BSTs compared with BPTs (P = 0.046). A requirement for increased hospital-based training was similarly greater for BSTs (P = 0.0072). Conclusion: The study confirms the need for a change in the regulation and administration of hospital-based teaching for surgical trainees.
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Pedersen, Craig A., Philip J. Schneider, Michael C. Ganio, and Douglas J. Scheckelhoff. "ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration—2020." American Journal of Health-System Pharmacy 78, no. 12 (March 23, 2021): 1074–93. http://dx.doi.org/10.1093/ajhp/zxab120.
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Abstract Purpose Results of the 2020 ASHP national survey of pharmacy practice in hospital settings are presented. Methods Pharmacy directors at 1,437 general and children’s medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. IQVIA supplied data on hospital characteristics; the survey sample was drawn from the IQVIA hospital database. Results The response rate was 18.7%. Almost all hospitals (92.5%) have a method for pharmacists to review medication orders on demand. Most hospitals (74.5%) use automated dispensing cabinets (ADCs) as their primary method for drug distribution. A third of hospitals use barcodes to verify doses during dispensing in the pharmacy and to verify ingredients when intravenous medications are compounded. More than 80% scan barcodes when restocking ADCs. Sterile workflow management technology is used in 21.3% of hospitals. Almost three-quarters of hospitals outsource some sterile preparations. Pharmacists can independently prescribe in 21.1% of hospitals. Pharmacist practice in ambulatory clinics in 46.2% of health systems and provide telepharmacy services in 28.4% of health systems. Conclusion Pharmacists continue their responsibility in their traditional role in preparation and dispensing of medications. They have successfully employed technology to improve safety and efficiency in performance of these duties and have employed emerging technologies to improve the safety, timeliness, and efficiency of the administration of drugs to patients. As pharmacists continue to expand their role to all aspects of medication use, new opportunities highlighted in ASHP’s Practice Advancement Initiative 2030 have been identified.
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Vanwesemael, Toke, Koen Boussery, Patricia van den Bemt, and Tinne Dilles. "The willingness and attitude of patients towards self-administration of medication in hospital." Therapeutic Advances in Drug Safety 9, no. 6 (March 26, 2018): 309–21. http://dx.doi.org/10.1177/2042098618764536.
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Background: Literature suggests a positive impact of self-administration of medication during hospitalization on medication adherence and safety, and on patient satisfaction. However, self-administration is not a common practice in Belgian hospitals. The aim of this study was to describe patients’ willingness towards self-administration of medication while in hospital. Methods: A cross-sectional observational study was conducted in three Belgian hospitals in November and December 2015. All patients of 14 randomly selected wards were asked to participate. The structured questionnaire comprised patient characteristics, their willingness and attitude towards self-administration of medication, perceived ability to self-administer during hospitalization, and prerequisites and perceived consequences. Results: In total, 124 patients participated (36% of all eligible patients). The main reasons not to participate were the patients’ physical and mental condition (30%) and the absence of patients during the time of data collection (23%). The majority of the 124 participating patients had a positive attitude towards the implementation of self-administration; 83.9% were willing to self-administer their medication while in hospital. Most important prerequisites were self-administration at home before and after hospitalization, patients’ motivation, and a regular evaluation of the patients’ competences. Patients acknowledged benefits such as an increase in autonomy, independence and medication knowledge. Patients did not expect self-administration would cause important safety issues. Conclusion: The majority of patients, capable of participating in the study, would want to self-administer medication during hospitalization. They had a positive attitude towards self-administration of medication. Nevertheless, patients stated important conditions which need to be considered in order to implement self-administration.
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Jeong, Heon-Jae, Wui-Chiang Lee, Hsun-Hsiang Liao, Feng-Yuan Chu, Tzeng-Ji Chen, and Pa-Chun Wang. "The Hospital Patient Safety Culture Survey: Reform of Analysis and Visualization Methods." International Journal of Environmental Research and Public Health 16, no. 19 (September 27, 2019): 3624. http://dx.doi.org/10.3390/ijerph16193624.
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Understanding the topography of hospital safety culture is vital for developing, implementing, and monitoring the effectiveness of tailored safety programs. Since 2009, the Chinese version of the Safety Attitudes Questionnaire (SAQ-C) has been introduced and administered to providers in many Taiwanese hospitals. The mean percentage of SAQ survey respondents who demonstrate attitudinal agreement within each of the SAQ domains, the percent agreement (PA) score, is used worldwide as the main parameter of safety culture surveys. However, several limitations within PA scoring have been identified. Our study sought to improve scoring methodology and develop a new graph layout for cultural topography presentation. A total of 37,163 responses to a national SAQ-C administration involving 200 Taiwan hospitals were retrospectively analyzed. To understand the central tendency and spread of safety culture scores across all participating hospitals, the median and interquartile range (IQR) of PA scores to the SAQ’s teamwork domain were calculated, plotted, and named “safety culture grid.” Study results denote limitations in the current PA scoring scheme, suggest SAQ analysis modification, and introduce a visualization graph layout that can provide richer information about safety culture dissemination than that available from currently utilized tools.
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Shealy, Stephanie, Joseph Kohn, Emily Yongue, Casey Troficanto, Brandon Bookstaver, Julie A. Justo, Michelle Crenshaw, Hana Winders, Sangita Dash, and Majdi Al-Hasan. "Motivational Application of Standardized Antimicrobial Administration Ratios Within a Healthcare System." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s321. http://dx.doi.org/10.1017/ice.2020.918.
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Background: Hospitals in the United States have been encouraged to report antimicrobial use (AU) to the CDC NHSN since 2011. Through the NHSN Antimicrobial Use Option module, health systems may compare standardized antimicrobial administration ratios (SAARs) across specific facilities, patient care locations, time periods, and antimicrobial categories. To date, participation in the NHSN Antimicrobial Use Option remains voluntary and the value of reporting antimicrobial use and receiving monthly SAARs to multihospital healthcare systems has not been clearly demonstrated. In this cohort study. we examined potential applications of SAAR within a healthcare system comprising multiple local hospitals. Methods: Three hospitals within Prisma Health-Midlands (hospitals A, B, and C) became participants in the NHSN Antimicrobial Use Option in July 2017. SAAR reports were presented initially in October 2017 and regularly (every 3–4 months) thereafter during interprofessional antimicrobial stewardship system-wide meetings until end of study in June 2019. Through interfacility comparisons and by analyzing SAAR categories in specific patient-care locations, primary healthcare providers and pharmacists were advised to incorporate results into focused antimicrobial stewardship initiatives within their facility. Specific alerts were designed to promote early de-escalation of antipseudomonal β-lactams and vancomycin. The Student t test was used to compare mean SAAR in the preintervention period (July through October 2017) to the postintervention period (November 2017 through June 2019) for all antimicrobials and specific categories and locations within each hospital. Results: During the preintervention period, mean SAAR for all antimicrobials in hospitals A, B, and C were 0.69, 1.09, and 0.60, respectively. Notably, mean SAARs at hospitals A, B, and C in intensive care units (ICU) during the preintervention period were 0.67, 1.36, and 0.83 for broad-spectrum agents used for hospital-onset infections and 0.59, 1.27, and 0.68, respectively, for agents used for resistant gram-positive infections. After antimicrobial stewardship interventions, mean SAARs for all antimicrobials in hospital B decreased from 1.09 to 0.83 in the postintervention period (P < .001). Mean SAARs decreased from 1.36 to 0.81 for broad-spectrum agents used for hospital-onset infections and from 1.27 to 0.72 for agents used for resistant gram-positive infections in ICU at hospital B (P = .03 and P = .01, respectively). No significant changes were noted in hospitals A and C. Conclusions: Reporting AU to the CDC NHSN and the assessment of SAARs across hospitals in a healthcare system had motivational effects on antimicrobial stewardship practices. Enhancement and customization of antimicrobial stewardship interventions was associated with significant and sustained reductions in SAARs for all antimicrobials and specific antimicrobial categories at those locations.Funding: NoneDisclosures: None
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Livorsi, Daniel J., Katie J. Suda, Cassie Cunningham Goedken, Stacey Hockett Sherlock, Erin Balkenende, Emily E. Chasco, Aaron M. Scherer, et al. "The feasibility of implementing antibiotic restrictions for fluoroquinolones and cephalosporins: a mixed-methods study across 15 Veterans Health Administration hospitals." Journal of Antimicrobial Chemotherapy 76, no. 8 (May 20, 2021): 2195–203. http://dx.doi.org/10.1093/jac/dkab138.
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Abstract Introduction The optimal method for implementing hospital-level restrictions for antibiotics that carry a high risk of Clostridioides difficile infection has not been identified. We aimed to explore barriers and facilitators to implementing restrictions for fluoroquinolones and third/fourth-generation cephalosporins. Methods This mixed-methods study across a purposeful sample of 15 acute-care, geographically dispersed Veterans Health Administration hospitals included electronic surveys and semi-structured interviews (September 2018 to May 2019). Surveys on stewardship strategies were administered at each hospital and summarized with descriptive statistics. Interviews were performed with 30 antibiotic stewardship programme (ASP) champions across all 15 sites and 19 additional stakeholders at a subset of 5 sites; transcripts were analysed using thematic content analysis. Results The most restricted agent was moxifloxacin, which was restricted at 12 (80%) sites. None of the 15 hospitals restricted ceftriaxone. Interviews identified differing opinions on the feasibility of restricting third/fourth-generation cephalosporins and fluoroquinolones. Some participants felt that restrictions could be implemented in a way that was not burdensome to clinicians and did not interfere with timely antibiotic administration. Others expressed concerns about restricting these agents, particularly through prior approval, given their frequent use, the difficulty of enforcing restrictions and potential unintended consequences of steering clinicians towards non-restricted antibiotics. A variety of stewardship strategies were perceived to be effective at reducing the use of these agents. Conclusions Across 15 hospitals, there were differing opinions on the feasibility of implementing antibiotic restrictions for third/fourth-generation cephalosporins and fluoroquinolones. While the perceived barrier to implementing restrictions was frequently high, many hospitals were effectively using restrictions and reported few barriers to their use.
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Mottice, Susan, Sego Matsumiya, and Larry Reimer. "Survey on Testing Criteria and Reporting Methods for Human Immunodeficiency Virus Serologic Tests in Veterans Administration Medical Centers." Infection Control 8, no. 10 (October 1987): 407–11. http://dx.doi.org/10.1017/s0195941700066571.
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AbstractGuidelines for the indications for use, requirements for consent, and mechanisms for reporting of serologic tests for human immunodeficiency virus (HIV) infection are not standardized. In trying to establish such guidelines for our hospital, we surveyed all Veterans Administration Medical Centers regarding their current approach to testing both patients and employees. Infection control practitioners from 67 hospitals representing 37 states responded. Patients are likely to be tested for diverse reasons, unlikely to be counseled about the test or be required to consent to it, and test results are given no special precautions. Although 66% of the respondents do not use any extra precautions concerning patient confidentiality, 80% utilize more stringent criteria for testing and result-reporting with employees than patients. Thus, while the majority of hospitals maintain that current modes of confidentiality are acceptable for patients, practice suggests that these modes are considered inadequate for employees.
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Keikes, Lotte, Miriam Koopman, Martijn M. Stuiver, Valery Lemmens, Martijn G. H. van Oijen, and Cornelis J. A. Punt. "Practice variation on hospital level in the systemic treatment of metastatic colorectal cancer in the Netherlands: A population-based study." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 6612. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.6612.
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6612 Background: Population-based data on the implementation of guidelines for cancer patients in daily practice are scarce. Therefore, we evaluated practice variation patterns and associated variables in the systemic treatment of metastatic colorectal cancer (mCRC) between 2008 and 2015 in the Netherlands. Methods: We selected a random sample of adult mCRC patients diagnosed from 2008 to 2015 from the National Cancer Registry in 20 Dutch hospitals. We examined the influence of patient, demographic and tumor characteristics on the odds of being treated with systemic therapy according to the current guideline and assessed its association with survival. Results: Our study population consisted of 2222 mCRC patients of whom 1307 patients received systemic therapy for mCRC. Practice variation was most obvious in the use of bevacizumab and anti-EGFR therapy in patients with (K)RAS wild-type tumors. Administration rates did not differ between hospital types but fluctuated between individual hospitals for bevacizumab (8-92%; p<0·0001) and anti-EGFR therapy (10-75%; p=0·05). Bevacizumab administration was inversely correlated to higher age (OR:0·2; 95% CI: 0·1-0·3) comorbidity (OR:0·6; 95% CI: 0·5-0·8) and the presence of metachronous metastases (OR:0·5; 95% CI: 0·3-0·7), but patient characteristics did not differ between hospitals with low or high bevacizumab administration rates. Exposure to bevacizumab (HR:0·8; 95% CI: 0·7-0·9) and anti-EGFR therapy (HR:0·6; 95% CI: 0·5-0·8) was associated with prolonged survival. Conclusions: We identified significant inter-hospital variation in targeted therapy administration for mCRC patients, which may affect outcome. Age and comorbidity were inversely correlated with non-administration of bevacizumab, but did not explain inter-hospital practice variation. Our data strongly indicate that practice variation is based on individual strategy of hospitals rather than guideline recommendations or patient-driven decisions. Individual hospital strategies are an additional factor that may explain the observed differences between real-life data and results obtained from clinical trials.
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Kjekshus, Lars, and Terje Hagen. "Do hospital mergers increase hospital efficiency? Evidence from a National Health Service country." Journal of Health Services Research & Policy 12, no. 4 (October 1, 2007): 230–35. http://dx.doi.org/10.1258/135581907782101561.
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Objectives: To analyse the effects on technical and cost efficiency of seven hospital mergers over the period 1992–2000 in Norway. The mergers involved 17 hospitals. Methods: First, efficiency scores were generated using Data Envelopment Analysis for 53 merged and non-merged hospitals over the nine years. Second, the effect of mergers was estimated through panel data analysis. Results: In general, the mergers showed no significant effect on technical efficiency and a significant negative effect of 2–2.8% on cost efficiency. However, positive effects on both cost and technical efficiency were found in one merger where more hospitals were involved, and where administration and acute services were centralized. Conclusion: The findings indicate that large mergers involving radical restructuring of the treatment process may improve efficiency as intended, but most mergers do not.
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Di Bella, Alexandra L., Tracy Comans, Elise M. Gane, Adrienne M. Young, Donna F. Hickling, Alisha Lucas, Ingrid J. Hickman, and Merrilyn Banks. "Underreporting of Obesity in Hospital Inpatients: A Comparison of Body Mass Index and Administrative Documentation in Australian Hospitals." Healthcare 8, no. 3 (September 11, 2020): 334. http://dx.doi.org/10.3390/healthcare8030334.
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Despite its high prevalence, there is no systematic approach to documenting and coding obesity in hospitals. This study aimed to determine the prevalence of obesity among inpatients, the proportion of obese patients recognised as obese by hospital administration, and the cost associated with their admission. A cross-sectional study was undertaken in three hospitals in Queensland, Australia. Inpatients present on three audit days were included in this study. Data collected were age, sex, height, and weight. Body mass index (BMI) was calculated in accordance with the World Health Organization’s definition. Administrative data were sourced from hospital records departments to determine the number of patients officially documented as obese. Total actual costing data were sourced from hospital finance departments. From a combined cohort of n = 1327 inpatients (57% male, mean (SD) age: 61 (19) years, BMI: 28 (9) kg/m2), the prevalence of obesity was 32% (n = 421). Only half of obese patients were recognised as obese by hospital administration. A large variation in the cost of admission across BMI categories prohibited any statistical determination of difference. Obesity is highly prevalent among hospital inpatients in Queensland, Australia. Current methods of identifying obesity for administrative/funding purposes are not accurate and would benefit from reforms to measure the true impact of healthcare costs from obesity.
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Schmücker, P., M. Pedevilla, H. Leitner, J. Naumann, H. Fuchs, H. Pitz, W. Köle, and G. Gell. "SAP and Partners: IS-H™ and IS-H*MED™." Methods of Information in Medicine 42, no. 01 (2003): 16–24. http://dx.doi.org/10.1055/s-0038-1634205.
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Summary Objectives: The Styrian Hospital Organization with 21 hospitals including the Graz University Hospital, and the Heidelberg University Hospital implemented a new HIS based on SAP/R3™, ISH™, ISH*MED™ with the objective to have an integrated system to support patient administration and management, patient care, clinical documentation, research etc. Methods: Heidelberg University Hospital chose a step by step method for the introduction of the system, beginning with patient administration (ISH) and proceeding with clinical functions (ISH*MED). In Styria, the full functionality was implemented – as part of the selection process – in one peripheral hospital and in the Ear, Nose and Throat (ENT) Department of the Graz University Hospital, including special documents to support the processes in the highly specialized ENTunits. Results and Conclusions: The standard modules are performant, stable and basically well accepted. Particularly in Graz, it has been shown that the requirements of highly specialized departments for work flow management, documentation and integration of subsystems and data from different sources can be fulfilled by special documents and programs – although at the expense of additional workload particularly in the initial phases of such a project.
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Dubuis, Giovanni, Francesca Marrone, Francesco Russo, Stefania Ziccardi, and Rosa Annibale. "Gene therapy and hospital pharmacy: the experience of the Hospital Pharmacy unit of L. Vanvitelli university hospital." AboutOpen 8, no. 1 (August 5, 2021): 74–80. http://dx.doi.org/10.33393/ao.2021.2260.
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Background: Since hospital use of gene therapy requires close cooperation between doctors and pharmacists to ensure correct drug handling and administration, it is essential to define standard operating procedures (SOPs) for each phase of the process to ensure therapeutic success in compliance with the safety of patient and healthcare professionals. Among the available gene therapy medicines, voretigene neparvovec is used to treat hereditary dystrophy of the retina caused by biallelic mutations in the RPE65 gene. The aim of this article is to describe the experience of the Hospital Pharmacy unit of L. Vanvitelli university hospital in the management of treatment with voretigene neparvovec in the first two pediatric patients treated in Italy. Methods: SOPs were developed for all phases of gene therapy management process (procurement, receipt, storage, handling, transport of the finished product and waste disposal). Particular attention was paid to the training of personnel involved, to ensure maximum compliance with the procedures at all stages of the process. Results: SOPs were developed according to the European Association of Hospital Pharmacist (EAHP) policies and in full agreement with the operating procedures established by the manufacturer, ensuring correct storage and handling of the drug, as well as safe administration to patients. Conclusions: This example confirms the importance of close collaboration in a multidisciplinary team between hospital pharmacists, ophthalmologists experienced in the treatment of patients with hereditary retinal dystrophies and surgeons experienced in subretinal surgery to ensure the correct management of gene therapy with voretigene neparvovec, through compliance with shared operating procedures.
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Andersen, Bjørg Marit, Bente Seljordslia, Kjersti Hochlin, Mette Rasch, and Gaute Syversen. "A predicted outbreak in an overcrowded, administratively neglected and run-down haemodialysis unit as an offer of “New Public Management” in Norwegian hospitals." Journal of Hospital Administration 2, no. 4 (April 24, 2013): 15. http://dx.doi.org/10.5430/jha.v2n4p15.
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Background: Scandinavian countries had a low rate of vancomycin- resistant enterococci (VRE) until 2007. Since 2007, there has been an alarming spread of VRE in Sweden and later on in Norway. From 2002 on, public hospitals in Norway were transferred from the County administration to a few regional state enterprises, drifted and organized according to the “New Public Management” (NPM), to save money. Four hospitals in Oslo, including Ullevål University Hospital, were, of the same reason, further merged into a 1500 beds Oslo University Hospital in 2009. Methods: This study included the hospital management of infection control and attitudes to reports from routine inspections in a haemodialysis unit at Oslo University Hospital (OUS) - before and after an outbreak of VRE in 2011. Results: Before the outbreak of VRE, repeated site inspections by infection control personnel revealed overcrowding, a poor hospital design, a low hygienic standard, and an imminent risk for hospital infection in a haemodialysis unit at OUS. Reports concerning deviation from proper infection control were sent to the hospital administration. Two project groups were set down consecutively within a year to solve the problems. They were both nearly immediately put on hold because of lack of economic resources. The Board of Health in the Counties of Oslo and Akershus (having the overall supervision of the health care in the Counties) was then notified by the infection control doctor. The outbreak of VRE was detected in May 2011 in this haemodialysis unit. It was promptly stopped after one month, by using a combination of several restrictive infection control methods. All VRE cases were negative after repeated negative samplings for a year. The outbreak resulted in a response from the hospital administration to the serious conditions in this unit. One and a half year later, an extended, refurbished new unit was ready for the patients. Conclusion: A low hygienic standard in an overcrowded and run-down haemodialysis unit was neglected by an administrative organization lacking economic resources after following the ideas of NPM through many years. This situation finally led to an outbreak of VRE. An early and restrictive intensive intervention leads to a rapid termination of the outbreak.
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Kumar Tailor, Sunil, Shiv K Mudgal, Digpal Singh Chundawat, and Krishan Kumar Nehra. "NURSE KNOWLEDGE REGARDING INTRAVENOUS THERAPY IN A TERTIARY CARE HOSPITAL: A CROSS-SECTIONAL STUDY." International Journal of Advanced Research 8, no. 11 (November 30, 2020): 69–73. http://dx.doi.org/10.21474/ijar01/11978.
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Context: In hospital settings, most of the time intravenous fluids and drugs administered to patients and nurses are responsible for administration and care of intravenous therapy. However, patients may develop complications related to intravenous therapy due to inadequate competency and knowledge of nurses regarding intravenous therapy. Aims: The present study was conducted to ascertain the knowledge regarding administration and care of intravenous therapy among the staff nurses working at tertiary care hospitals. Methods: A Cross-Sectional research design was adopted to ascertain the nurses knowledge of intravenous therapy. A total of 400 nurses were selected through simple random sampling technique from a tertiary care hospital. A self-structured questionnaire was used to assess the nurses knowledge of IV therapy. The data were analyzed using descriptive and inferential statistic. Result: The finding of the study indicated that the overall mean knowledge score of nurses was 15.71±4.18. The demographic variables which influenced the level of nurses knowledge significantly were their professional education (p=0.003) and attended refresher courses on IV therapy (p=0.000). Conclusion: Nurses had an inadequate level of knowledge on administration and care of IV therapy. The administration of IV therapy could be improved by the provision of the in-service education programme.
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Voeten, Daan M., Leonie R. van der Werf, Janneke A. Wilschut, Linde A. D. Busweiler, Johanna W. van Sandick, Richard van Hillegersberg, and Mark I. van Berge Henegouwen. "Failure to Cure in Patients Undergoing Surgery for Gastric Cancer: A Nationwide Cohort Study." Annals of Surgical Oncology 28, no. 8 (January 23, 2021): 4484–96. http://dx.doi.org/10.1245/s10434-020-09510-6.
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Abstract Background This study aimed to describe the incidence of failure to cure (a composite outcome measure defined as surgery not meeting its initial aim), and the impact of hospital variation in the administration of neoadjuvant therapy on this outcome measure. Methods All patients in the Dutch Upper Gastrointestinal Cancer Audit undergoing curatively intended gastric cancer surgery in 2011–2019 were included. Failure to cure was defined as (1) ‘open-close’ surgery; (2) irradical surgery (R1/R2); or (3) 30-day/in-hospital mortality. Case-mix-corrected funnel plots, based on multivariable logistic regression analyses, investigated hospital variation. The impact of a hospital’s tendency to administer neoadjuvant chemotherapy on the heterogeneity in failure to cure between hospitals was assessed based on median odds ratios and multilevel logistic regression analyses. Results Some 3862 patients from 28 hospitals were included. Failure to cure was noted in 22.3% (hospital variation: 14.5–34.8%). After case-mix correction, two hospitals had significantly higher-than-expected failure to cure rates, and one hospital had a lower-than-expected rate. The failure to cure rate was significantly higher in hospitals with a low tendency to administer neoadjuvant chemotherapy. Approximately 29% of hospital variation in failure to cure could be attributed to different hospital policies regarding neoadjuvant therapy. Conclusions Failure to cure has an incidence of 22% in patients undergoing gastric cancer surgery. Higher failure to cure rates were seen in centers administering less neoadjuvant chemotherapy, which confirms the Dutch guideline recommendation on the administration of neoadjuvant chemotherapy. Failure to cure provides short loop feedback and can be used as a quality indicator in surgical audits.
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Nance, Martha A., Lesa Boettcher, Germaine Edinger, Joan Gardner, Ron Kitzmann, Lauren O. Erickson, Rose Wichmann, and Catherine L. Wielinski. "Quality Improvement in Parkinson’s Disease: A Successful Program to Enhance Timely Administration of Levodopa in the Hospital." Journal of Parkinson's Disease 10, no. 4 (October 27, 2020): 1551–59. http://dx.doi.org/10.3233/jpd-202024.
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Background: Patients hospitalized with Parkinson’s disease (PD) require timely delivery of carbidopa-levodopa (C/L) medication. Ill-timed administration of C/L doses is associated with greater morbidity and longer lengths of stay. Objective: To understand the barriers to timely C/L administration, and implement strategies to improve the administration of the drug to hospitalized PD patients. Methods: Several key strategies were employed in 2015 to improve the timely delivery of C/L doses: 1. three kinds of nursing alert in the electronic medical record (EMR); 2. staff in-service education; 3. stocking immediate-release C/L into automated medication dispensing machines on key hospital units; 4. reports to nurse unit managers on timeliness of C/L administration; and 5. reconciliation of inpatient and outpatient levodopa orders by the hospital pharmacist upon admission. The primary outcome was the percent of C/L doses administered within 60, 30, and 15 minutes of scheduled time. Results: Our urban hospital, affiliated with a Parkinson’s Foundation Center of Excellence, had 5,939 C/L administrations in 2018. There was sustained improvement in timely delivery of doses, from 89.3% in 2012 to 96.5% in 2018 (within 60 minutes of the scheduled time), 65.5% to 86.4% (30 minutes), and 42.3% to 71.1% (15 minutes) (all p < 0.001). Conclusions: With multifaceted but relatively simple measures, we were able to “change the culture” so that hospitalized patients with Parkinson’s disease receive levodopa on time.
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Suzuki, Hiroyuki, Eli N. Perencevich, Bruce Alexander, Brice F. Beck, Michihiko Goto, Brian C. Lund, Rajeshwari Nair, and Daniel J. Livorsi. "Inpatient Fluoroquinolone Stewardship Improves the Quantity and Quality of Fluoroquinolone Prescribing at Hospital Discharge: A Retrospective Analysis Among 122 Veterans Health Administration Hospitals." Clinical Infectious Diseases 71, no. 5 (September 28, 2019): 1232–39. http://dx.doi.org/10.1093/cid/ciz967.
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Abstract Background Despite increasing awareness of harms, fluoroquinolones are still frequently prescribed to inpatients and at hospital discharge. Our goal was to describe fluoroquinolone prescribing at hospital discharge across the Veterans Health Administration (VHA) and to contrast the volume and appropriateness of fluoroquinolone prescribing across 3 antimicrobial stewardship strategy types. Methods We analyzed a retrospective cohort of patients hospitalized at 122 VHA acute-care hospitals during 2014–2016. Data from a mandatory VHA survey were used to identify 9 hospitals that self-reported 1 of 3 strategies for optimizing fluoroquinolone prescribing: prospective audit and feedback (PAF), restrictive policies (RP), and no strategy. Manual chart reviews to assess fluoroquinolone appropriateness at hospital discharge (ie, postdischarge) were performed across the 9 hospitals (3 hospitals and 125 cases per strategy type). Results There were 1.7 million patient admissions. Overall, there were 1 727 478 fluoroquinolone days of therapy (DOTs), with 674 918 (39.1%) DOTs prescribed for inpatients and 1 052 560 (60.9%) DOTs prescribed postdischarge. Among the 9 reviewed hospitals, postdischarge fluoroquinolone exposure was lower at hospitals using RP, compared to no strategy (3.8% vs 9.3%, respectively; P = .012). Postdischarge fluoroquinolones were deemed inappropriate in 154 of 375 (41.1%) patients. Fluoroquinolones were more likely to be inappropriate at hospitals without a strategy (52.8%) versus those using either RP or PAF (35.2%; P = .001). Conclusions In this retrospective cohort, the majority of fluoroquinolone DOTs occurred after hospital discharge. A large proportion of postdischarge fluoroquinolone prescriptions were inappropriate, especially in hospitals without a strategy to manage fluoroquinolone prescribing. Our findings suggest that stewardship efforts to minimize and improve fluoroquinolone prescribing should also focus on antimicrobial prescribing at hospital discharge.
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Murphey, Lisa M., and Debbie C. Byrd. "Phytonadione Education Program in a Community Hospital." Hospital Pharmacy 38, no. 5 (May 2003): 458–62. http://dx.doi.org/10.1177/001857870303800514.
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Purpose Pharmacists and physicians were educated regarding updated guidelines on phytonadione indications, dosing, and routes of administration. Study objectives were to evaluate the use of phytonadione in a community hospital, educate pharmacists and physicians about phytonadione use, and assess the value of education in terms of patient outcomes. Methods Baseline and follow-up data on phytonadione indications, dosages, and routes of administration were collected. Pretests and post-tests were administered before and after an education session. A Pharmacy and Therapeutics newsletter article highlighting the appropriate use of phytonadione was published. Results The baseline and follow-up medication use evaluations (MUEs) revealed that 53% and 62% of patients had an appropriate indication for phytonadione, respectively (P = 0.181). Among patients with an appropriate indication, 44% were administered an appropriate dose in the baseline group and 46% in the follow-up (P = 0.876). The baseline MUE revealed that 20% of phytonadione routes of administration were appropriate; 18% were considered appropriate in the follow-up (P = 0.842). Pharmacists' knowledge showed improvement after education efforts, with the mean score improving from 57% to 93.4% from pretest to post-test (P < 0.05) and the median score changing from 50% to 100%. Conclusion Improving pharmacists' knowledge is beneficial and necessary; however, it was not enough to change practice in this study. Additional steps must be taken to encourage routine application of the knowledge.
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Mohanty, Sailabala. "Awareness of Medication Error, Medication Management and Prevention among Staff Nurses in IMS &Sum Hospital, Odisha." Journal of Health and Allied Sciences NU 06, no. 04 (December 2016): 18–22. http://dx.doi.org/10.1055/s-0040-1708670.
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Abstract Aims: The study aimed to assess the knowledge of staff nurses about medication error, prevention of medication error and its management. Background: Accomplishment of medical order and medication administration are the prominent part of nurse's job. Methods: A descriptive approach was under taken and data was collected in the month of March and April, 2014, from 100 staff nurses of IMS & SUM HOSPITAL. Results: A significant proportion of staff nurses (39%) believed that carefully reading of instruction and labeling of the drug before administrating can prevent medication error followed by heavy workload and high nurse/patient ratio(16%) and insufficient work experience(11%)due to huge turnover were mostly cited by nurses to prevent medication error. Conclusion: Medication administration is the basic function of nurse. So the nurses should be well equipped with skill and knowledge needed for error free medication. Implications for nursing management: Error free medication administration process requires a continuous educational initiative on medication error with regards to prevention of medication error and its reporting and the short-term course on medication error should be added in orientation class by every health care organization.
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Abou Ramdan, Amal H., and Walaa M. Eid. "Toxic Leadership: Conflict Management Style and Organizational Commitment among Intensive Care Nursing Staff." Evidence-Based Nursing Research 2, no. 4 (October 8, 2020): 12. http://dx.doi.org/10.47104/ebnrojs3.v2i4.160.
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Context: Toxic leadership becomes a real problem in nursing administration. Its toxicity harms the nursing staff's progress and creates a challenging work environment full of struggles that, in turn, produce adverse outcomes on the nursing staff's commitment toward the organization.
Aim: This study envisioned to compare toxic leadership among intensive care nursing staff at Tanta University Hospital and El Menshawy hospital and assess its relation to their conflict management style used and organizational commitment at the two hospitals.
Methods: A descriptive, comparative, via cross-sectional research design was applied. All intensive care units at Tanta University Hospitals and El-Menshawy General Hospital were included. All available nurses (n=544) at Tanta University hospitals' ICUs (n=301) and El-Menshawy hospital's ICUs (n=243) was incorporated. Toxic leadership, conflict management styles assessment, and organizational commitment scales were utilized to achieve this study's aim.
Results: The nursing staff perceived that their leaders had high 10.6%, 11.5%, and moderate 12%, 11.9% overall toxic leadership levels at Tanta University Hospitals, and Elmenshawy Hospital, respectively. 43.9% of the nursing staff had a high level of using compromising style to manage conflict with their supervisors at Tanta University hospitals contrasted to 36.6% using competing style at El Menshawy hospital. 78.4% of the nursing staff had a low level of overall organizational commitment at Tanta University hospital's ICUs compared to 63% at El-Menshawy General hospital's ICUs.
Conclusion: Toxic leadership affected the nursing staff's choice of conflict management style used when handling conflict with toxic leaders at two hospitals and had a negative effect on affective and normative dimensions of organizational commitment in both hospitals. Therefore, improving leadership experiences is necessary by conducting a leadership development program to meet the nursing staff's expectations and improve their commitment. Also, adjusting the hospital's policies is vital to permit nursing staffs' involvement in leadership evaluation as a mean for early detection of leaders' toxic behaviors.
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Al-Mulhim, Mohammed A., Mohammed S. Alshahrani, Laila Perlas Asonto, Ahmad Abdulhady, Talal M. Almutairi, Mariam Hajji, Mohammed A. Alrubaish, Khalid N. Almulhim, Mariam H. Al-Sulaiman, and Layla B. Al-Qahtani. "Impact of epinephrine administration frequency in out-of-hospital cardiac arrest patients: a retrospective analysis in a tertiary hospital setting." Journal of International Medical Research 47, no. 9 (July 16, 2019): 4272–83. http://dx.doi.org/10.1177/0300060519860952.
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Introduction Epinephrine is recommended for patients with out-of-hospital cardiac arrest (OHCA). However, whether epinephrine improves or adversely affects OHCA outcomes is controversial. Objectives This study aims to determine whether the frequency of epinephrine administration impacts OHCA patient survival. Methods We conducted a retrospective analysis of OHCA cases registered in the Emergency Department at King Fahd University Hospital, Saudi Arabia between 2005 and 2015. The primary outcomes were mortality and survival rates until discharge. The impact of epinephrine administration timing and frequency on patient survival was analyzed. Results Data from 300 OHCA cases were analyzed. Among them, 66.3% were men, and the overall mean age of 50.4 ± 20.6 years. The overall survival rate until hospital discharge was 12%. There was no statistically significant difference between in gender, age, or time interval to the first epinephrine dose in the survival and non-survival groups. Only the number of epinephrine doses was related to the survival outcome. Conclusion Non-survivors received significantly more epinephrine doses compared with survivors. However, a causal relationship between OHCA patient survival and epinephrine dose and time cannot be confirmed. Further studies are needed to investigate whether the long-term outcomes in OHCA patients are influenced by the timing and frequency of epinephrine administration.
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Pruskowski, Kaitlin A., and Leopoldo C. Cancio. "507 Outcomes After the Administration of Hydroxocobalamin." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S90. http://dx.doi.org/10.1093/jbcr/iraa024.139.
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Abstract Introduction Hydroxocobalamin is administered to patients after injures sustained during structure fires or fires in enclosed spaces. It is unknown how the administration of hydroxocobalamin affects patient outcomes, however, there have been reports of increased risk of acute kidney injury (AKI). The purpose of this study was to determine the population in which hydroxocobalamin is administered and to assess outcomes in patients who receive this medication in the ICU setting. Methods This was a retrospective chart review that included all patients admitted to the burn ICU between July 2016 and April 2019. Patients were included if they received hydroxocobalamin after ICU admission. Patients who received hydroxocobalamin in the pre-ICU or pre-hospital setting were not included in this analysis. Data collected included demographic information, number of hydroxocobalamin doses administered, burn size (% TBSA), presence of inhalation injury (II), lactate levels during the first 72 hours of hospitalization, carboxyhemoglobin levels, need for continuous renal replacement therapy (CRRT), and in-hospital mortality. Results Thirty-five patients received hydroxocobalamin after ICU admission. Patients were, on average, 48 ± 19 years old with a 25.5 ± 24.8% TBSA burn. Twenty-nine patients (82.9%) who received hydroxocobalamin in the ICU were diagnosed with II via bronchoscopy. The median 24-hour fluid resuscitation requirement was 7.4 mL/kg/% TBSA (IQR 4.6, 12.7). Twenty-two patients (63%) who received hydroxocobalamin developed AKI during the first 72 hours of admission. Twenty-one patients (60%) required CRRT during their hospital stay; 42.8% of patients were started on CRRT during the resuscitation period. The mean admission lactate level was 4.4 ± 2.3 mmol/L. On average, lactate clearance occurred in 34.6 hours; 11 (31.4%) patients did not clear lactate within 72 hours. One patient had a carboxyhemoglobin level greater than 10% on admission. Ten (28.9%) patients died during their hospital stay. Conclusions Most patients who receive hydroxocobalamin after ICU admission developed AKI within the first 72 hours. Further studies on the relationship between the administration of hydroxocobalamin and the development of AKI and in-hospital mortality are warranted. Applicability of Research to Practice The use of hydroxocobalamin may carry an increased risk of AKI. Providers should be aware of this risk when prescribing this medication.
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Phillips, Megan E., Rod A. Gilmore, Melody C. Sheffield, and Stephanie V. Phan. "Pain Assessment Documentation After Opioid Administration at a Community Teaching Hospital." Journal of Pharmacy Practice 32, no. 2 (January 15, 2018): 179–85. http://dx.doi.org/10.1177/0897190017751207.
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Purpose: To compare pain assessment documentation postopioid administration in hospitalized patients before and after implementing nurse education. Methods: Patients 18 years and older were randomly selected for inclusion if they received 1 opioid dose while admitted to the hospital. Through retrospective chart review, opioid data, including date and time, were collected for each opioid administered. Pain score data, including time and date of documentation, were recorded for analysis. The primary objective of this study was to determine whether a nursing education intervention would improve documentation of pain scores within an appropriate time frame postadministration of an opioid medication. The intervention was a training presentation uploaded to the institution’s intranet with an assessment. The primary outcome was measured by comparing the frequency by which nurses documented pain scores following opioid administration before and after education. Results: Three hundred twenty patients (160 patients per time period) were evaluated. The percentage of pain scores recorded within the appropriate assessment time following opioid administration increased from 32.9% to 37.8% ( P = .003). The proportion of appropriate pain score documentation increased 4.9% (95% confidence interval [CI]: 1.6%-8.2%). Conclusion: An increase in the documentation of efficacy assessments after opioid administration was demonstrated after nursing education. Further studies should be done to identify additional strategies to increase monitoring as well as to identify a benchmark for institutions with regard to pain management monitoring.
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McLeod, Monsey, Nicholas Barber, and Bryony Dean Franklin. "Facilitators and Barriers to Safe Medication Administration to Hospital Inpatients: A Mixed Methods Study of Nurses’ Medication Administration Processes and Systems (the MAPS Study)." PLOS ONE 10, no. 6 (June 22, 2015): e0128958. http://dx.doi.org/10.1371/journal.pone.0128958.
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Hunt, Nicholas F., Kevin C. McLaughlin, Mary P. Kovacevic, Kenneth E. Lupi, and Kevin M. Dube. "Safety of Intravenous Olanzapine Administration at a Tertiary Academic Medical Center." Annals of Pharmacotherapy 55, no. 9 (January 16, 2021): 1127–33. http://dx.doi.org/10.1177/1060028020988734.
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Background Although approved by the Food and Drug Administration for intramuscular administration only, analyses have described the administration of intravenous push (IVP) olanzapine, particularly for acute agitation. The safety and efficacy of IVP olanzapine has mostly been limited to emergency department patients. Objective To evaluate the safety of IVP olanzapine administration in the inpatient setting. Methods This single-center, retrospective analysis was conducted between July 1, 2018, and December 31, 2019, at Brigham and Women’s Hospital in Boston, Massachusetts. Adult patients who received at least 1 dose of IVP olanzapine were included in the analysis. Safety endpoints analyzed included the following adverse drug events (ADEs): hypotension, bradycardia, cardiac arrhythmias, extrapyramidal adverse effects, and respiratory depressive events. Data on IV site reactions, including phlebitis and infiltration, were also collected. Results A total of 1,247 IVP administrations of olanzapine were identified across 252 patients. Two or more doses were received by 159 patients (63.1%). Most administrations (66%) took place in intensive care units, with 33% administered on general medicine wards. Overall, 104 administrations (8.3%) were associated with at least 1 ADE. Hypotension and bradycardia occurred in 62 (5.2%) and 16 (1.3%) administrations, respectively. Phlebitis occurred with 8 administrations (1.4%). All other adverse events were rare (<1%). Conclusion and Relevance Hypotension, the most commonly noted ADE, occurred more frequently than in previous studies. IVP olanzapine appears to be a safe route of administration in hospitalized patients, including those receiving multiple doses. Further studies are required to evaluate the effect of IV olanzapine on hemodynamics.
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Gopal, Anitha K., Sajini B. Sajini B., Ganamurali S., and Beena Kumari R. "Effectiveness of evidence based regimen for medical abortion over conventional methods." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 3 (February 19, 2017): 881. http://dx.doi.org/10.18203/2320-1770.ijrcog20170549.
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Background: Medical abortion is a means of medical termination of pregnancy by drugs alone. This can be done upto 63 days using mifepristone and misoprostol tablets. For the conventional method, patient has to come to the hospital 3 times. In our study we reduced the interval between the drugs there by reducing the number of hospital visits. The objectives were to study the reduction of induction abortion interval following administration of evidence based regimen and to compare the proportion of patients developing complications in both the groups.Methods: It was a comparative study conducted at Department of Obstetrics and Gynecology, Govermnent MedicalCollege Kottayam, Kerala, India from May 2015 to November 2015.Results: The mean induction abortion interval in experimental group was 14.3 hours and in control group, it was 60.4 hours which was found to be statistically significant. Only 3 patients (7%) of experimental group had side effects whereas 12 patients. (17.4%) had side effects in the control group. Major side effects encountered were severe abdominal pain and severe bleeding per vaginum. Evidence based regimen consist of administration of mifepristone 200mg and vaginal misoprostol 600µg 6 hours later for termination of pregnancy up to 63 days could reduce the induction abortion interval by 46 hours and had less side effects.Conclusions: As it reduces the induction abortion Interval and complications we feel that the evidence based regimen for Medical Termination of Pregnancy is superior to the FDA approved regimen.
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Tziatzios, Georgios, Dimitrios N. Samonakis, Theocharis Tsionis, Spyridon Goulas, Dimitrios Christodoulou, and Konstantinos Triantafyllou. "Sedation/Analgesia Administration Practice Varies according to Endoscopy Facility (Hospital- or Office-Based) Setting: Results from a Nationwide Survey in Greece." Gastroenterology Research and Practice 2020 (October 5, 2020): 1–9. http://dx.doi.org/10.1155/2020/8701791.
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Objectives. To examine the impact of endoscopy setting (hospital-based vs. office-based) on sedation/analgesia administration and to provide nationwide data on monitoring practices among Greek gastroenterologists in real-world settings. Material and Methods. A web-based survey regarding sedation/analgesia rates and monitoring practices during endoscopy either in a hospital-based or in an office-based setting was disseminated to the members of the Hellenic Society of Gastroenterology and Professional Association of Gastroenterologists. Participants were asked to complete a questionnaire, which consisted of 35 items, stratified into 4 sections: demographics, preprocedure (informed consent, initial patient evaluation), intraprocedure (monitoring practices, sedative agents’ administration rate), and postprocedure practices (recovery). Results. 211 individuals responded (response rate: 40.3%). Propofol use was significantly higher in the private hospital compared to the public hospital and the office-based setting for esophagogastroduodenoscopy (EGD) (85.8% vs. 19.5% vs. 10.5%, p<0.0001) and colonoscopy (88.2% vs. 20.1% vs. 9.4%, p<0.0001). This effect was not detected for midazolam, pethidine, and fentanyl use. Endoscopists themselves administered the medications in most cases. However, a significant contribution of anesthesiology sedation/analgesia provision was detected in private hospitals (14.7% vs. 2.8% vs. 2.4%, p<0.001) compared to the other settings. Only 35.2% of the private offices have a separate recovery room, compared to 80.4% and 58.7% of the private hospital- and public hospital-based facilities, respectively, while the nursing personnel monitored patients’ recovery in most of the cases. Participants were familiar with airway management techniques (83.9% with bag valve mask and 23.2% with endotracheal intubation), while 49.7% and 21.8% had received Basic Life Support (BLS) and Advanced Life Support (ALS) training, respectively. Conclusion. The private hospital-based setting is associated with higher propofol sedation administration both for EGD and for colonoscopy. Greek endoscopists are adequately trained in airway management techniques.
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Rautamo, Maria, Kirsi Kvarnström, Mia Sivén, Marja Airaksinen, Pekka Lahdenne, and Niklas Sandler. "A Focus Group Study about Oral Drug Administration Practices at Hospital Wards—Aspects to Consider in Drug Development of Age-Appropriate Formulations for Children." Pharmaceutics 12, no. 2 (January 30, 2020): 109. http://dx.doi.org/10.3390/pharmaceutics12020109.
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Oral drug administration to pediatric patients is characterized by a lack of age-appropriate drug products and the off-label use of medicines. However, drug administration practices at hospital wards is a scarcely studied subject. The aim of this study was to explore the oral drug administration practices at pediatric hospital wards, with a focus on experiences and challenges faced, methods used to mitigate existing problems, drug manipulation habits, perceptions about oral dosage forms and future needs of oral dosage forms for children. This was a qualitative study consisting of focus group discussions with physicians, nurses and clinical pharmacists in a tertiary university hospital with the objective of bringing forward a holistic view on this research topic. These healthcare professionals recognized different administration challenges that were classified as either dosage form-related or patient-related ones. A lack of depot formulations developed especially for children as well as oral pediatric dosage forms of drug substances currently available as intravenous dosage forms was recognized. The preferred oral dosage forms were oral liquids and orodispersible tablets. Patient-centered drug administration practices including factors facilitating drug administration both at hospital wards and at home after patient discharge were identified. Among all healthcare professionals, the efficient cooperation in drug prescribing and administration as well as in educating the child’s caregivers in correct administration techniques before discharge and improving the overall discharge process of patients was emphasized. This study complements the prevalent understanding that new dosage forms for children of varying ages and stages of development are still needed. It also brings a holistic view on different aspects of oral drug administration to pediatric patients and overall patient-centered drug administration practices.
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Welsby, Ian J., Mark F. Newman, Barbara Phillips-Bute, Robert H. Messier, Emil D. Kakkis, and Mark Stafford-Smith. "Hemodynamic Changes after Protamine Administration." Anesthesiology 102, no. 2 (February 1, 2005): 308–14. http://dx.doi.org/10.1097/00000542-200502000-00011.
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Background Protamine sulfate is standard therapy to reverse heparin anticoagulation. Hemodynamic responses to protamine are common, ranging from minor perturbations to cardiovascular collapse. Although severe fatal reactions occur, the relation of less extreme responses with postoperative mortality is unknown. Therefore, the authors tested the hypothesis that hemodynamic "protamine reactions" (systemic hypotension and pulmonary hypertension) are associated with mortality after cardiac surgery. Methods In a university hospital setting, the authors studied 6,921 coronary bypass patients using automated anesthesia record-keeping data and quality assurance databases. Degree/duration integrals of systemic hypotension (< 100 mmHg) and pulmonary hypertension (> 30 mmHg) for the 30-min after protamine administration were assessed for linear associations with mortality using multiple logistic regression models adjusting for risk factors. Results Overall mortality was 2%; greater hemodynamic responses were associated with increased mortality by odds ratios of 1.28 (systemic hypotension: 95% confidence interval, 1.14-1.43; P < 0.001) and 1.27 (pulmonary hypertension: 95% confidence interval, 1.06-1.48; P < 0.001) per 150-mmHg . min increment. Proximity of the response to protamine administration strengthened the relation, which persisted after exclusion of major hemodynamic disturbances. Tests for linearity confirmed an association even at the lowest range of values for both pressure effects. Conclusions Hemodynamic perturbations after protamine administration are independently related to in-hospital mortality after primary coronary artery bypass surgery; the relation is present even in the lowest observed range of values for both systemic hypotension and pulmonary hypertension. Although randomized trials are necessary to address causality, this evidence suggests that strategies that avoid or attenuate these reactions may improve patient care.
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Meredith, Sean, Jane Hilliard, and Regis Vaillancourt. "Evaluation of a rapid hydration protocol: Safety and effectiveness." Journal of Oncology Pharmacy Practice 23, no. 4 (February 23, 2016): 249–54. http://dx.doi.org/10.1177/1078155216631406.
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Background The Children’s Hospital of Eastern Ontario (CHEO) has implemented a rapid hydration protocol that may reduce the time required to achieve urine specific gravity and pH targets prior to chemotherapy. Objective The aim of this study was to determine if a rapid hydration protocol resulted in a shorter time to chemotherapy administration and during peak staffing levels without increasing adverse effects. Methods A retrospective chart review was conducted using data from electronic and paper medical charts, the hematology/oncology whiteboard, and video recordings. Patients who received cyclophosphamide, methotrexate, cisplatin and ifosfamide during the study period were included in the chart review. A urine specific gravity of ≤1.01, and in most cases a urine pH ≥7 was required to begin chemotherapy. Differences in time parameters between the standard and rapid hydration protocols were measured. Comparable parameters included the time from the start of pre-chemotherapy hydration to meeting urine targets, time from starting hydration to administration of chemotherapy, length of hospital stay and the number of chemotherapy administrations that were initiated prior to the nursing shift change at 19:30 h. Results Data were collected from 116 pre-chemotherapy intravenous hydration events administered to 25 different patients. There was a shorter time required to reach urine specific gravity and pH targets with the rapid hydration protocol compared to the standard hydration protocol, which translated into initiating chemotherapy sooner. There was also a shorter overall length of hospital stay and administration of chemotherapy occurred before the nursing shift change more often in the rapid hydration cohort compared to those patients who received the standard hydration protocol. There were no significant differences in adverse effects between the groups. Conclusion Patients receiving rapid hydration had a shorter time to chemotherapy administration and had a shorter length of stay in hospital. Rapid hydration resulted in the first dose of chemotherapy being administered earlier when more staff are available, which could reduce errors due to change in hospital personnel. The rapid hydration protocol did not result in an increase in reported adverse effects.
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Ali, S., A. Moodley, A. Bhattacharjee, K. Lobay, E. Chang, A. Kabaroff, and D. Allain. "P005: Pre-hospital dexamethasone administration in children with croup: the Edmonton experience." CJEM 18, S1 (May 2016): S80. http://dx.doi.org/10.1017/cem.2016.182.
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Introduction: Croup is one of the most common childhood respiratory illnesses, affecting more than 80,000 Canadian children per year. Early dexamethasone administration in croup can reduce admission rates and length of stay (LOS), as well as return visits to the emergency department (ED). Pre-hospital emergency medical services (EMS) teams in Edmonton administer dexamethasone to children with croup. The objectives of this study were to (a) assess the clinical impact of pre-hospital administration of dexamethasone to children with croup and (b) compare clinical outcomes of these patients to those who did not receive their first dose of dexamethasone via the EMS providers. Methods: This study was a retrospective medical record review that included children between 6 months and 6 years of age who were brought via EMS to the Stollery Children’s Hospital ED with a final diagnosis of croup, between January 1st 2010 and December 31st 2012. Data were collected regarding pre-hospital presentation and management, ED presentation and management, ED LOS and final disposition, and patient demographics. Results: 188 patients were enrolled, 35.1% (66/188) of whom received a pre-hospital diagnosis of croup. The mean age of the participants was 32.96 months (SD±17.18). Overall, 10.6% patients (20/188) were given dexamethasone in the pre-hospital setting, while 30.3% patients (57/188) were given nebulized epinephrine by EMS. Out of the 66 patients with a pre-hospital diagnosis of croup, 10.6% (n=7) were given dexamethasone by EMS. In the ED, dexamethasone was administered to 88.3% of patients (166/188) while 56/188 participants (29.8%) received nebulized epinephrine. There was no statistically significant difference in ED LOS stay between those who received pre-hospital dexamethasone (2.6 hours, SD±1.6, n=18) and those who did not (3.3 hours, SD±2.7, n=159). The number of in-hospital epinephrine doses per patient was influenced by the administration of pre-hospital dexamethasone (p=0.010). Conclusion: Pre-hospital administration of dexamethasone likely influences the severity and short-term persistence of croup symptoms, as evidenced by less epinephrine use in the ED. Contrary to current EMS guidelines, very few patients with a pre-hospital diagnosis of croup received dexamethasone by EMS personnel. This likely represents a missed opportunity to decrease the severity of the patients’ disease.
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Halkoaho, Arja, Emmi Itkonen, Esko Vanninen, and Jori Reijula. "Can Lean Thinking enhance research administration?" Journal of Hospital Administration 3, no. 2 (November 14, 2013): 61. http://dx.doi.org/10.5430/jha.v3n2p61.
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Background: Hospital research administration is expected to provide improved work efficiency and service delivery in the upcoming years. Meanwhile, resources to support scientific research are dwindling, as is the amount of research support personnel. The aim of the study was to investigate the research admission’s user needs, their opinions on the state of today’s scientific research and also to assess its future development needs and find out whether a customer-oriented management philosophy such as Lean Thinking could be implemented in the research administration setting to enhance work processes and services. Methods: In this study, thematic interviews were used as a method. Kuopio University Hospital researchers (n = 7) and research administration personnel (n = 11) were interviewed. The interviews were carried out by one researcher and lasted on average approximately 60 minutes per interviewee. Results: The interviews revealed that several issues, such as bureaucracy, decreased attitudes towards research, lack of transparency and face-to-face customer service by the research administration, have hindered and complicated research work and service delivery. The study addressed a need for a comprehensive, linear, efficiency- and quality-oriented, user-focused management philosophy. Conclusions: The results of the study support implementation of a customer-oriented management philosophy into the research administration to improve its work processes and service delivery. Although Lean Thinking remains untested in the research administration setting, its fundamentals and strengths seem to answer many needs of the research administration.
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حمود, سعد علي, and حسنين غالب علي. "Causes of conflict among Nursery, Medical and Administration Staff Members and the Influence of upon Hospital Decisions: Applied Research." Journal of Economics and Administrative Sciences 21, no. 81 (February 1, 2015): 1. http://dx.doi.org/10.33095/jeas.v21i81.549.
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The aim of this study is to investigate the causes of the conflict, which included (personal interests, differentiation and professional career, lack of coordination, cooperation and ill-defined duties and job description), and their impact on the decisions of the hospital, which included (the achievement of objectives, patient service and picky, efficient use of available resources, and reward employees and motivate them(.
I've been choosing the Baghdad Teaching Hospital and the Hospital Ghazi al-Hariri subsidiaries of the Department of Medical City, as of the most important hospitals, service impact in the lives of citizens and mental health, for how to enable these hospitals to transform the negative aspects of the conflict to the positive aspects, and make it an incentive to raise the spirit of competition and creativity among individuals, which increases the effectiveness of decision-making in hospitals.
Total sample (160) individuals included staffs nursing, medical and administrative staff of all levels, as it has been ignored (13) the identification of the lack of an answer to all the members of the sample paragraphs, and the number of questionnaires midwife for analysis (147) questionnaires. The questionnaire primary means of gathering information adopted by the researcher, as well as his experience through his work in one of those hospitals for several years, were included subject of research, inter questions intellectual crystallized totality of the research problem, and then was determined objectives and its importance, as well as the formulation of hypotheses basic task.
It was the use of a lot of statistical methods, such as (arithmetic mean, standard deviation, percentages, correlation coefficient (Spearman), coefficient of simple regression, and several tests), and by measuring the research variables and diagnosis, testing effect relationships and the differences between them, as the research found a set of conclusions was the most important, the most influential reasons in the decisions of the hospital, he appeared professional and functional differentiation of the most influential, followed by ill-defined duties and job description, followed by lack of coordination and cooperation. There is no reason to take into account the impact of personal interest in the decisions of the hospital, because the hospital when taking into account a certain class at the expense of another class or frequent disputes on the basis of personal interests do not affect the decisions of the hospital all. There are also significant differences between the causes of conflict, as priority will be given to vocational and functional differentiation followed by poor coordination, cooperation, followed by self-interest into account and finally ill-defined duties and job description.
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Gutierrez, Jeydith, Jane Moeckli,, Andrea Holcombe, Amy MJ O’Shea, George Bailey, Kelby Rewerts, Mariko Hagiwara, Steven Sullivan, Melissa Simon, and Peter Kaboli. "Implementing a Telehospitalist Program Between Veterans Health Administration Hospitals: Outcomes, Acceptance, and Barriers to Implementation." Journal of Hospital Medicine 16, no. 3 (February 17, 2021): 156–63. http://dx.doi.org/10.12788/jhm.3570.
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BACKGROUND: Telehospitalist services are an innovative alternative approach to address staffing issues in rural and small hospitals. OBJECTIVE: To determine clinical outcomes and staff and patient satisfaction with a novel telehospitalist program among Veterans Health Administration (VHA) hospitals. DESIGN, SETTING, AND PARTICIPANTS: We conducted a mixed-methods evaluation of a quality improvement program with pre- and postimplementation measures. The hub site was a tertiary (high-complexity) VHA hospital, and the spoke site was a 10-bed inpatient medical unit at a rural (low-complexity) VHA hospital. All patients admitted during the study period were assigned to the spoke site. INTERVENTION: Real-time videoconferencing was used to connect a remote hospitalist physician with an on-site advanced practice provider and patients. Encounters were documented in the electronic health record. MAIN OUTCOMES: Process measures included workload, patient encounters, and daily census. Outcome measures included length of stay (LOS), readmission rate, mortality, and satisfaction of providers, staff, and patients. Surveys measured satisfaction. Qualitative analysis included unstructured and semi-structured interviews with spoke-site staff. RESULTS: Telehospitalist program implementation led to a significant reduction in LOS (3.0 [SD, 0.7] days vs 2.3 [SD, 0.3] days). The readmission rate was slightly higher in the telehospitalist group, with no change in mortality rate. Satisfaction among teleproviders was very high. Hub staff perceived the service as valuable, though satisfaction with the program was mixed. Technology and communication challenges were identified, but patient satisfaction remained mostly unchanged. CONCLUSION: Telehospitalist programs are a feasible and safe way to provide inpatient coverage and address rural hospital staffing needs. Ensuring adequate technological quality and addressing staff concerns in a timely manner can enhance program performance.
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Krasnova, Natalia M., D. A. Sychev, A. I. Vengerovskii, and T. N. Aleksandrova. "Current methods of optimization of pharmacotherapy in elderly patients in multidisciplinary hospital." Clinical Medicine (Russian Journal) 95, no. 11 (March 12, 2018): 1042–49. http://dx.doi.org/10.18821/0023-2149-2017-95-11-1042-1049.
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This research was aimed to study prevalence and patterns of comorbid conditions in patients aged 65 years and older in multidisciplinary hospital, to estimate prevalence of polypharmacy and potentially inappropriate medication prescriptions. Retrospective analysis with medical information system DOCA+ have been performed on electronic case histories of 80 patients aged 65 years and older who were hospitalized in trauma and orthopedic department. Medication administration records have been investigated to identify potentially inappropriate medication prescription according to «STOPP/START» criteria (2014) and Beers criteria (2015). The study demonstrated that 90% of elderly patients, hospitalized because of diseases of the musculoskeletal system, were comorbid, the average number of diseases in one patient was 5.9 ± 2,6: 2 diseases had 6% of patients, 3-5 - 36%, 6-8 - 36% and more than 8-22%. Most commonly, elderly and senile patients were diagnosed with diseases of the cardiovascular system (85%) in different combinations. Average amount of medications administered to one patient equaled 6.8 ± 2.7, polypharmacy was detected in 50% of cases. Investigation of drug prescriptions using the «STOPP/START» and Beers criteria found that in 53.8% and 70.0% of cases, respectively, elderly patients were administered with potentially inappropriate medications. Our research has shown that comorbidity and polypharmacy, which can impact on disease outcome and quality of life, are characteristics for elderly patients. In order to manage polypharmacy and reduce the frequency of adverse drug reactions tools such as «STOPP/START» and Beers criteria should be used for drug therapy optimization.
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Alam, Nadia, Kirtiedevi BNS Doerga, Tahira Hussain, Sadia Hussain, Frits Holleman, Mark H H Kramer, and Prabath WB Nanayakkara. "Epidemiology, recognition and documentation of sepsis in the pre-hospital setting and associated clinical outcomes: a prospective multicenter study." Acute Medicine Journal 15, no. 4 (October 1, 2016): 168–75. http://dx.doi.org/10.52964/amja.0632.
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Introduction: General practitioners (GPs) and the emergency medical services (EMS) personnel have a pivotal role as points of entry into the acute care chain. This study was conducted to investigate the recognition of sepsis by GPs and EMS personnel and to evaluate the associations between recognition of sepsis in the pre-hospital setting and patient outcomes. Methods Design: prospective, observational study during a 12 week period in the emergency department (ED) of two academic hospitals. Study population: Patients >18 years presenting with sepsis at the ED. The information available in the ED discharge letter and the ED charts was used to make a definite diagnosis of sepsis, severe sepsis and septic shock Outcome measures: primary: recognition/documentation of sepsis. Secondary: ED arrival time to antibiotic administration, in-hospital mortality, hospital length of stay (LOS) and intensive care unit (ICU) admission. Results: A total of 301 patients were included in the study. GPs and EMS personnel correctly identified and documented 31.6% (n=114) and 41.4% of all sepsis patients (n=140) respectively. Recognition and documentation of sepsis improved with increasing severity. The mean time to administration of antibiotics (TTA) was nearly halved for the group of patients where sepsis was documented (GP: 66,4 minutes, EMS: 65,6 minutes) compared to the group in which sepsis was not documented (GP: 123,9 minutes, EMS: 101,5 minutes; p= 0.365 and p= 0.024 respectively). Conclusions: There is room for improvement in the recognition of sepsis, severe sepsis and septic shock by practitioners working in the pre-hospital setting. Documentation of sepsis prior to arrival in hospital led to a reduced time delay in administration of antibiotics.
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Blandford, Ann, Dominic Furniss, Galal H. Galal-Edeen, Gill Chumbley, Li Wei, Astrid Mayer, and Bryony Dean Franklin. "Intravenous infusion practices across England and their impact on patient safety: a mixed-methods observational study." Health Services and Delivery Research 8, no. 7 (February 2020): 1–116. http://dx.doi.org/10.3310/hsdr08070.
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Background Intravenous (IV) medication administration has traditionally been regarded to be error-prone with high potential for harm. A recent US multisite study revealed surprisingly few potentially harmful errors despite a high overall error rate. However, there is limited evidence about infusion practices in England and how they relate to prevalence and types of error. Objectives To determine the prevalence, types and severity of errors and discrepancies in infusion administration in English hospitals, and to explore sources of variation in errors, discrepancies and practices, including the contribution of smart pumps. Design Phase 1 comprised an observational point-prevalence study of IV infusions, with debrief interviews and focus groups. Observers compared each infusion against the medication order and local policy. Deviations were classified as either errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs, and analytically in supplementary analyses. Phase 2 comprised in-depth observational studies at five of the participating sites to better understand causes of error and how safety is maintained. Workshops were held with key stakeholder groups, including health professionals and policy-makers, the public and industry. Setting Sixteen English NHS hospital trusts. Results Point-prevalence data were collected from 1326 patients and 2008 infusions. In total, 240 errors were observed in 231 infusions and 1489 discrepancies were observed in 1065 infusions. Twenty-three errors (1.1% of all infusions) were considered potentially harmful; one might have resulted in short-term patient harm had it not been intercepted, but none was judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of deviations varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or to respond to patient need. Smart pumps, as currently implemented, had little effect. Staff had developed practices to manage efficiency and safety pragmatically by working around systemic challenges. Limitations Local observers may have assessed errors differently across sites, although steps were taken to minimise differences through observer training, debriefs, and review and cleaning of data. Each in-depth study involved a single researcher, and these were limited in scale and scope. Conclusions Errors and discrepancies are common in everyday infusion administration but most have low potential for patient harm. Findings are best understood by viewing IV infusion administration as a complex adaptive system. Better understanding of performance variability to strategically manage risk may be more helpful for improving patient safety than striving to eliminate all deviations. Future work There is potential value in reviewing policy around IV infusion administration to reduce unnecessary variability, manage staff workload and engage patients, while retaining the principle that policy has to be fit for purpose, contextualised to the particular ward situation and treatment protocol, and sensitive to the risks of different medications. Further work on understanding infusion administration as a complex adaptive system might deliver new insights into managing patient safety. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 7. See the NIHR Journals Library website for further project information.
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Yasin, Raheel, and Ghulam Abbas Anjum. "REFLECTION ON QUALITY OF HEALTH SERVICES." Professional Medical Journal 22, no. 05 (May 10, 2015): 527–31. http://dx.doi.org/10.29309/tpmj/2015.22.05.1260.
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Health care is the crucial and fundamental right of every human being. Qualityhealth care is the strong desire of every human being. Quality is considered as one of theprime pillar of differentiation in services. Service quality is lifeline of organizational success.This paper throws a public eye on patient’s expectations and the satisfaction level pertaining toquality of service provided by public hospitals. Objectives: (1) To dig out the quality of servicein public teaching hospitals of Lahore, Pakistan by using SERVQUAL model. Study Design:Quantitative Study. Period: Sep 2014 to Oct 2014. Setting: Five Teaching Hospital, JinnahHospital, Mayo Hospital, Services Hospital, General Hospital, Sir Ganga Ram Hospital, Lahorewhich are the Medical Giants of Pakistan. Material & Methods: The research is carried out onprimary data, recording 250 responses from target audience by using structure questionnaire.Regression and correlation analysis were performed to confirm a relationship between ServiceQuality dimensions and patient satisfaction. Results: Study shows that empathy is the mostimportant factor that brings happiness and satisfaction to the patients. Conclusions: Researchfindings are fruitful for health department and hospital administration to plan strategies in orderto improve service quality and become benchmark for others in industry.
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Cao, Xuefeng, Xixiu Wang, Baolei Zhao, Lingqun Kong, Lei Zhou, Wentao Zhu, Xutao Lin, Qiangpu Chen, and Xingyuan Zhang. "Correlation between Intraoperative Fluid Administration and Outcomes of Pancreatoduodenectomy." Gastroenterology Research and Practice 2020 (July 30, 2020): 1–7. http://dx.doi.org/10.1155/2020/8914367.
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Background. Intraoperative fluid (IOF) administration plays an important role during major abdominal surgery although increased fluid intake can adversely influence postoperative outcomes. However, the effect of the IOF rate on the outcomes of pancreatoduodenectomy (PD) is unclear. Methods. 151 patients, who underwent PD at Binzhou Medical University Hospital between January 2010 and May 2017, were categorized into three groups according to IOF rates (ml/kg/hr): restricted (<10, n=47), standard (10–15, n=76), and liberal (>15, n=28). Results. The overall postoperative morbidity was 56.95%. The incidence of postoperative pancreatic fistula (POPF) was 11.26%. The in-hospital mortality rate was 7.28% with the most common cause being grade C POPF and secondary intra-abdominal infections. The patients in the liberal group had significantly higher incidences of POPF (25%) and respiratory complications (21.43%). The other outcome parameters such as recovery of bowel function, hospital stay, and postoperative daily drainage were similar among the groups. Multivariable analysis confirmed the IOF rate to be most strongly associated with POPF (odds ratio: 5.195, confidence interval: 1.142–23.823, P=0.023) and respiratory complications (odds ratio: 7.302, confidence interval: 0.676–58.231, P=0.025). Conclusions. The IOF rate significantly affects the incidence of POPF and respiratory complications after PD. Careful patient-oriented fluid therapy may help to prevent these complications.
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Miller, Sarah J., William J. Docktor, and Ginnie Lee T. North. "Strategies for Effective Hospital Pharmacy Staff Development." Journal of Pharmacy Practice 7, no. 5 (October 1994): 227–35. http://dx.doi.org/10.1177/089719009400700506.
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An active staff development program (SDP) for pharmacists has been associated with provision of higher levels of pharmaceutical care within health-care institutions. Adequate support from pharmacy management, institutional administration, the medical staff, and the pharmacy staff itself is necessary for a successful, ongoing SDP. A SDP run concurrently with implementation of clinical pharmacy services allows pharmacists to immediately apply new skills and knowledge. Such a SDP should emphasize not only information necessary for performance of the clinical service, but also should develop drug information retrieval, problem solving, and organizational skills. A SDP should use a variety of media and methods, with an emphasis on interactive and active learning formats. The staff pharmacists should occasionally make some of the presentations themselves. Continuing education credit should be provided through the SDP. Feedback regarding the success of the newly implemented clinical services should be supplied to the pharmacists as a motivator for continued learning; feedback to administration is necessary for continued justification of both the SDP and clinical services. The hospital pharmacy literature is replete with accounts of successful staff development programs. At Saint Patrick Hospital, a SDP initiated concomitantly with implementation of new clinical services has enjoyed both success and longevity.
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Salazar, Martín R., Soledad E. González, Lorena Regairaz, Noelia S. Ferrando, Verónica V. González Martínez, Patricia M. Carrera Ramos, Laura Muñoz, et al. "Risk factors for COVID-19 mortality: The effect of convalescent plasma administration." PLOS ONE 16, no. 4 (April 29, 2021): e0250386. http://dx.doi.org/10.1371/journal.pone.0250386.
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Background Convalescent plasma, widely utilized in viral infections that induce neutralizing antibodies, has been proposed for COVID-19, and preliminary evidence shows that it might have beneficial effect. Our objective was to determine the risk factors for 28-days mortality in patients who received convalescent plasma for COVID-19 compared to those who did not, who were admitted to hospitals in Buenos Aires Province, Argentina, throughout the pandemic. Methods This is a multicenter, retrospective cohort study of 2-month duration beginning on June 1, 2020, including unselected, consecutive adult patients with diagnosed COVID-19, admitted to 215 hospitals with pneumonia. Epidemiological and clinical variables were registered in the Provincial Hospital Bed Management System. Convalescent plasma was supplied as part of a centralized, expanded access program. Results We analyzed 3,529 patients with pneumonia, predominantly male, aged 62±17, with arterial hypertension and diabetes as main comorbidities; 51.4% were admitted to the ward, 27.1% to the Intensive Care Unit (ICU), and 21.7% to the ICU with mechanical ventilation requirement (ICU-MV). 28-day mortality was 34.9%; and was 26.3%, 30.1% and 61.4% for ward, ICU and ICU-MV patients. Convalescent plasma was administered to 868 patients (24.6%); their 28-day mortality was significantly lower (25.5% vs. 38.0%, p<0.001). No major adverse effects occurred. Logistic regression analysis identified age, ICU admission with and without MV requirement, diabetes, and preexistent cardiovascular disease as independent predictors of 28-day mortality, whereas convalescent plasma administration acted as a protective factor. Conclusions Our study suggests that the administration of convalescent plasma in COVID-19 pneumonia admitted to the hospital might be associated with improved outcomes.
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Loukianov, M. M., S. Yu Martsevich, O. M. Drapkina, S. S. Yakushin, A. N. Vorobyev, K. G. Pereverzeva, A. V. Zagrebelnyy, et al. "The Therapy with Oral Anticoagulants in Patients with Atrial Fibrillation in Outpatient and Hospital Settings (Data from RECVASA Registries)." Rational Pharmacotherapy in Cardiology 15, no. 4 (September 2, 2019): 538–45. http://dx.doi.org/10.20996/1819-6446-2019-15-4-538-545.
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Aim. To evaluate an incidence of oral anticoagulants (OAC) administration during longterm follow-up period in patients with atrial fibrillation (AF) enrolled in outpatient and hospital RECVASA registries.Material and methods. 3169 patients with AF were enrolled in outpatient registries RECVASA (Ryazan), RECVASA AF-Yaroslavl and hospital registries RECVASA AF (Moscow, Kursk, Tula), age 70.9±10.7 years, 43.1% men. The incidence of OAC administration was evaluated in hospital and outpatient settings, including longterm follow-up period (2-6 years).Results. OAC were administrated only in 42.2% of cases (1335 from 3169 patients; age 69.1±10.4 years, 43% men), including warfarin (817 patients; 26%) and non-vitamin K antagonist oral anticoagulants (NOAC) – 518 (16%). Patients with permanent and persistant types of AF had lower incidence of OAC administration (43% and 40%) than in cases of paroxysmal type (47.6%, p<0.05), despite of the higher СНА2DS2-VASc risk score (4.69±1.66 and 4.23±1.57 vs 3.81±1.69; р<0.05). Patients with and without history of stroke received OAC in 42.5% and 40% of cases that means no significant difference (p>0.05) contrary to the pronounced difference of thromboembolic risk in these groups (6.14±1.34 and 3.77±1.39; р<0.001). The incidence of OAC administration in hospitals (54.1%) was 2.3 times higher than before hospitalization (23.8%) and was 4.1 times higher than in outpatient registries (13.5%). During follow-up period after hospital treatment (2.3±0.9 years) this parameter decreased from 54.1% to 41.2%, but was still 1.8 times higher than before admission to the hospital. After 4 years follow-up in RECVASA (Ryazan) registry we revealed 4.4 times higher incidence of OAC administration compared with enrollment data (4.2% and 18.3%, р<0.0001). This data was confirmed by the information from outpatient medical cards of accidentally generated group (75 from 297 patients survived during follow-up period): 5.3% at baseline and 22.7% six years later.Conclusions. RECVASA registries in 5 regions of Russia revealed low incidence of OAC administration. The risk of thromboembolic events was higher in patients with AF and no OAC administration compared with patients who received OAC. Patients with paroxysmal type of AF received OAC more often than those with permanent type. There were no significant differences of incidence of OAC therapy in patients with and without history of stroke. Both questioning of patients with AF and analysis of medical cards in outpatient clinics revealed higher incidence of OAC administration after 4-6 years of follow-up compared with the stage of enrollment in registries.
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Daly, Mary Louise, Andrea Zimmer, Julia Stickling, Thomas Daikeler, and Florian F. Grossmann. "COVID-19 driven care changes in high risk patients from an outpatient to a community setting." Pflege 33, no. 4 (August 2020): 219–27. http://dx.doi.org/10.1024/1012-5302/a000753.
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Abstract. Background: COVID-19 has led to a change in care for patients with chronic conditions, involving a transfer of drug administration from an outpatient to a community setting. Aim: To investigate patient preferences for treatment settings in the light of the current pandemic. Methods: Patients, who prior to the pandemic had attended two different outpatient clinics in a university hospital for their infusions or injections, were interviewed by telephone. The semi-structured interviews were analyzed using qualitative and quantitative methods. Results: Out of 49 patients with either anti-inflammatory or immunoglobulin treatments (response rate: 83 %), 24 (49.0 %) switched from subcutaneous (sc) injections in the hospital to the community setting, 18 (36.7 %) from intravenous infusions (iv) in the hospital to sc administration at home and 7 (14.3 %) moved to iv at home. During the pandemic 38 (80.9 %) wanted to continue their treatment at home, but after the pandemic 22 (46.8 %) would opt to go back to the hospital. Satisfaction was high with both settings, slightly favoring drug administration in hospital. Qualitative data shows that patients while emphasizing the importance of the relationship with the healthcare team, had increased concerns about safety as a result of COVID-19. Conclusions: The experience during the COVID-19 pandemic has increased self-management-skills in some patients, but long-term follow-up is needed. It has repercussions for future shared decision making for patients and their healthcare teams.
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Tolley, C. L., N. W. Watson, A. Heed, J. Einbeck, S. Medows, L. Wood, L. Campbell, and S. P. Slight. "The Impact of a Bedside Medication Scanning Device on Administration Errors in the Hospital Setting: A Prospective Observational Study." International Journal of Pharmacy Practice 29, Supplement_1 (March 26, 2021): i9. http://dx.doi.org/10.1093/ijpp/riab016.011.
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Abstract Introduction The medication administration process is complex and influenced by interruptions, multi-tasking and responding to patient’s needs and is consequently prone to errors.1 Over half (54.4%) of the 237 million medication errors estimated to have occurred in England each year were found to have taken place at the administration stage and 7.6% were associated with moderate or severe harm. The implementation of a Closed Loop Medication Administration solution aims to reduce medication administration errors and prevent patient harm. Aim We conducted the first evaluation to assess the impact of a novel optical medication scanning device, MedEye, on the rate of medication administration errors in solid oral dosage forms. Methods We performed a before and after study on one ward at a tertiary-care teaching hospital that used a commercial electronic prescribing and medication administration system and was implementing MedEye (a bedside tool for stopping and preventing medication administration errors). Pre-MedEye data collection occurred between Aug-Nov 2019 and post-MedEye data collection occurred between Feb-Mar 2020. We conducted direct observations of nursing drug administration rounds before and after the MedEye implementation. Observers recorded what they observed being administered (e.g., drug name, form, strength and quantity) and compared this to what was prescribed. Errors were classified as either a ‘timing’ error, ‘omission’ error or ‘other’ error. We calculated the rate and type of medication administration errors (MAEs) before and after the MedEye implementation. A sample size calculation suggested that approximately 10,000 medication administrations were needed. Data collection was reduced due to the COVID 19 pandemic and implementation delays. Results Trained pharmacists or nurses observed a total of 1,069 administrations of solid oral dosage forms before and 432 after the MedEye intervention was implemented. The percentage of MAEs pre-MedEye (69.1%) and post-MedEye (69.9%) remained almost the same. Non-timing errors (combination of ‘omission’ + ‘other’ errors) reduced from 51 (4.77%) to 11 (2.55%), which had borderline significance (p=0.05) however after adjusting for confounders, significance was lost. We also saw a non-significant reduction in ‘other’ error types (e.g., dose and documentation errors) following the implementation of MedEye from 34 (3.2%) to 7 (1.62%). An observer witnessed a nurse dispense the wrong medication (prednisolone) instead of the intended medication (furosemide) in the post-MedEye period. After receiving a notification from MedEye that an unexpected medication had been dispensed, the nurse corrected the dose thus preventing an error. We also identified one instance where the nurse correctly dispensed a prescribed medication (amlodipine) but this was mistakenly identified by the MedEye scanner as another prescribed medication (metoclopramide). Conclusions This is the first evaluation of a novel optical medication scanning device, MedEye on the rate of MAEs in one of the largest NHS trusts in England. We found a non-statistically significant reduction in non-timing error rates. This was notable because incidents within this category e.g., dose errors, are more likely to be associated with harm compared to timing errors.2 However, further research is needed to investigate the impact of MedEye on a larger sample size and range of medications. References 1. Elliott, R., et al., Prevalence and economic burden of medication errors in the NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK, 2018. 2. Poon, E.G., et al., Effect of bar-code technology on the safety of medication administration. New England Journal of Medicine, 2010. 362(18): p. 1698–1707.
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Thompson, R. Zachary, Brian Gardner, Thomas Carter, Aric Schadler, Joye Allen, and Abby Bailey. "Decreasing the Time to Oral Antibiotics in a University Hospital Pediatric Emergency Department." Journal of Pediatric Pharmacology and Therapeutics 22, no. 4 (July 1, 2017): 272–75. http://dx.doi.org/10.5863/1551-6776-22.4.272.
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OBJECTIVES To compare time to administration of oral antibiotics in the pediatric emergency department (ED) when antibiotics are stored in the pediatric ED versus when they were dispensed by central pharmacy services within an academic medical center. METHODS This was a retrospective review of patients who received a one-time dose of oral antibiotics within the pediatric ED and were subsequently discharged home. Two 3-month time periods were compared to determine the metrics of providing oral antibiotics before and after these medications were stocked in the pediatric ED automated dispensing cabinet (ADC). The primary outcome was to compare the time to administration. Secondary outcomes were to assess wastage of stocked medications and time to ED discharge. RESULTS In the ADC time period (n = 74), the median time to administration was 17.5 minutes versus 57 minutes in the central pharmacy time period (n = 34) (p < 0.001). The ED length of stay during the ADC time period was 188.5 minutes versus 228.5 minutes (p = 0.094). 35.4% of doses from the ADC expired resulting in a wholesale acquisition cost of $53.14 wasted. CONCLUSION Stocking commonly used oral antibiotics in the pediatric ED led to a significant decrease in the time to medication administration. This decreased time to administration has the potential to lead to improved patient and nursing satisfaction. Routine surveillance is needed after implementation to ensure compliance and to minimize wastage.