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Audit Cycle (audit + cycle)
Selected AbstractsAn audit of intra-oral digital radiographs for endodonticsINTERNATIONAL ENDODONTIC JOURNAL, Issue 4 2010R. Austin Aim, The aim of this study was to improve the quality of digital radiographs taken during endodontic treatment at King's College Hospital Dental Institute, UK. There were three phases. The first phase compared the Schick CDR system with Digora Optime. The second and third phases involved ways of improving the quality of the digital radiographs produced by the Schick CDR system. Methodology, The Faculty of General Dental Practitioners Royal College of Surgeons of England (FGDP) guidelines on Selection Criteria for Dental Radiography and Guidance Notes for Dental Practitioners on the Safe Use of X-Ray Equipment-National Radiological Protection Board enabled the use of a three point quality scale (one excellent, two diagnostically acceptable, three unacceptable), which took into consideration sensor angulation, positioning, contrast and focusing. The recommended FGDP guidelines are not less than 70% images scoring excellent. For the first phase 50 exposures recorded with the Schick CDR system were compared with 50 recorded using Digora Optime. For the second and third phases 50 radiographs for each phase were evaluated with images generated by the Schick system with training provided between the phases. Results, Images produced by the Schick system showed an inferior quality compared with the images generated by the Digora method. Both systems failed to reach the desired quality FGDP standard of 70% excellent (Schick 55% Digora 69%). Comparison of the results in the second and third phases showed that training the operator improved the quality but recommended the purchase of a size 1 or 0 Schick sensors to improve positioning errors. Conclusions, This study was carried out in order to minimise the ionising radiation dose to patients and to maximise the clinical and administrative benefits of using a digital system. It demonstrated an improvement in the quality of radiographs across all criteria measured up to and beyond the desired standard, from 55% of radiographs scoring excellent in the first phase to 80% in the third phase. As a result of the study it was decided to install the Schick CDR system because of the speed it produced images even though the first phase of this study demonstrated inferior image quality. The audit had clear, measurable standards with explicit targets. The audits have been through the entire audit cycle, data collection, change and a further data collection to provide evidence of the benefit of the change. A third data collection, demonstrated an ongoing commitment to quality. [source] Modelling emergency decisions: recognition-primed decision making.JOURNAL OF CLINICAL NURSING, Issue 8 2006The literature in relation to an ophthalmic critical incident Aims., To review and reflect on the literature on recognition-primed decision (RPD) making and influences on emergency decisions with particular reference to an ophthalmic critical incident involving the sub-arachnoid spread of local anaesthesia following the peribulbar injection. Background., This paper critics the literature on recognition-primed decision making, with particular reference to emergency situations. It illustrates the findings by focussing on an ophthalmic critical incident. Design., Systematic literature review with critical incident reflection. Methods., Medline, CINAHL and PsychINFO databases were searched for papers on recognition-primed decision making (1996,2004) followed by the ,snowball method'. Studies were selected in accordance with preset criteria. Results., A total of 12 papers were included identifying the recognition-primed decision making as a good theoretical description of acute emergency decisions. In addition, cognitive resources, situational awareness, stress, team support and task complexity were identified as influences on the decision process. Conclusions., Recognition-primed decision-making theory describes the decision processes of experts in time-bound emergency situations and is the foundation for a model of emergency decision making (Fig. 2). Figure 2. ,Influences and processes of RPD making. Relevance to clinical practice., Decision theory and models, in this case related to emergency situations, inform practice and enhance clinical effectiveness. The critical incident described highlights the need for nurses to have a comprehensive and in-depth understanding of anaesthetic techniques as well as an ability to manage and resuscitate patients autonomously. In addition, it illustrates how the critical incidents should influence the audit cycle with improvements in patient safety. [source] Post-operative epidural analgesia: introducing evidence-based guidelines through an education and assessment processJOURNAL OF CLINICAL NURSING, Issue 2 2001DipDN, Janet Richardson BSc ,,The aim of this project was to re-introduce post-operative epidural analgesia on to two orthopaedic wards using an evidence-based practice approach. This was achieved through the provision of appropriate staff education and information, assessment of staff competence, and provision of relevant and appropriate staff support. ,,An education programme was developed which included study days, ward-based teaching and the assessment of competence. ,,The introduction of guidelines followed an audit cycle in order to measure the success of the education programme. ,,All nursing staff involved in the project were asked to complete a questionnaire which assessed their knowledge of caring for patients with postoperative epidural analgesia. This was completed before and following the education programme. ,,The outcome measures were: (i) successful completion of competence-based assessment; (ii) levels of knowledge as assessed by the knowledge questionnaire; and (iii) participant perceptions of the project. ,,The results of the questionnaire demonstrated significant improvements in knowledge following the education programme. Participants commented on the importance of the ward-based teaching. They also felt that pain was controlled more effectively using this method of analgesia. [source] Low vision service delivery: an audit of newly developed outreach clinics in Northern Ireland,OPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 4 2004J. Lindsay Abstract Recent publications recommend that low vision services are multi-professional; easily accessible; freely available to all those with visual impairment; monitored by professional and patient groups, and responsive to user feedback. These standards were applied when developing low vision outreach services in Northern Ireland in 1999/2000. Results are reported of the complete clinical audit cycle, coupled with a patient satisfaction telephone questionnaire, which was used to evaluate the service. Of the 48 patients randomly selected from the list of clinic attendees, 28 (58%) were female, 27 (56%) over 80 years of age and 38 (78%) had a primary ocular diagnosis of age related macular degeneration (AMD). Of the 46 low vision aids issued at patients' first appointments, 30 (67%) were illuminated stand magnifiers and 29 (63%) had magnification levels of ×5 or less. A total of 46 (96%) patients reported that they had benefited from low vision services. [source] Prevention of medication errors: detection and auditBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 6 2009Germana Montesi 1. Medication errors have important implications for patient safety, and their identification is a main target in improving clinical practice errors, in order to prevent adverse events. 2. Error detection is the first crucial step. Approaches to this are likely to be different in research and routine care, and the most suitable must be chosen according to the setting. 3. The major methods for detecting medication errors and associated adverse drug-related events are chart review, computerized monitoring, administrative databases, and claims data, using direct observation, incident reporting, and patient monitoring. All of these methods have both advantages and limitations. 4. Reporting discloses medication errors, can trigger warnings, and encourages the diffusion of a culture of safe practice. Combining and comparing data from various and encourages the diffusion of a culture of safe practice sources increases the reliability of the system. 5. Error prevention can be planned by means of retroactive and proactive tools, such as audit and Failure Mode, Effect, and Criticality Analysis (FMECA). Audit is also an educational activity, which promotes high-quality care; it should be carried out regularly. In an audit cycle we can compare what is actually done against reference standards and put in place corrective actions to improve the performances of individuals and systems. 6. Patient safety must be the first aim in every setting, in order to build safer systems, learning from errors and reducing the human and fiscal costs. [source] | ||||||||||