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Audit Data (audit + data)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Implementing the severe sepsis care bundles outside the ICU by outreach

NURSING IN CRITICAL CARE, Issue 5 2007
Chris Carter
Abstract Sepsis is not a new challenge facing the health care team, it remains a complex disease, which is difficult to identify and treat. Mortality from sepsis remains high and continues to be a common cause of death among critically ill patients, despite advances in critical care. Sepsis accounts for an estimated 27% of all intensive care admissions in England, Wales and Northern Ireland, and accounted for 46% of all intensive care bed days. Recent research studies and the surviving sepsis campaign have shown that identifying and providing key interventions to patients with severe sepsis and septic shock prior to their admission to the intensive care unit significantly improve outcomes. The aim of this paper was to identify how the Critical Care Outreach Team at one local hospital implemented the severe sepsis resuscitation care bundle for patients in the emergency department (ED) and on the general wards. It will include a presentation on the various ways the team raised the profile of severe sepsis and the care bundle at hospital and at national level. It also includes audit data that have been collected. The results showed that if the resuscitation care bundle was implemented within the first 24 h of hospital admission, mortality was 29%, whereas if the care bundle was instigated after this time mortality was more than at 49%. Audit data showed that the commonest sign of severe sepsis seen in patients in the ED and on wards was tachypnoea. This article discusses the successful implementation of the severe sepsis resuscitation care bundle and the positive impact an Outreach team can have in changing practice in the way patients are managed with severe sepsis. The audit data support the need for regular physiological observations and the use of a Patient At Risk Trigger scoring tool to identify patients at risk of deterioration. This allows referral to the Outreach team, who assess the patient and if appropriate initiate the care bundle. [source]

Refusing analgesics: using continuous improvement to improve pain management on a surgical ward

JOURNAL OF CLINICAL NURSING, Issue 6 2002
Eloise C. J. Carr BSc, PGCEA
Summary , ,Despite advances in pain control many patients experience moderate to severe pain whilst in hospital. Contributory factors include inadequate assessment and documentation of pain, as well as patient and professional misconceptions. , ,A 28-bedded surgical ward in a District General Hospital in the South of England was the setting for the project. A small preliminary audit of pain on this ward indicated that some patients experienced postoperative pain, which was not effectively controlled. A ,continuous improvement' framework was used to increase understanding of the problem and identify an aim for the project, which was to reduce the number of patients refusing analgesics when offered by nurses. , ,An audit to ascertain how many patients refused analgesia revealed that, of 133 patients offered, 93 (70%) refused. Using the ,Model for Improvement' (Langley et al., 1996) a number of changes were introduced, including a patient information sheet, regular documented pain assessment and an innovative staff education programme. To evaluate if the changes in practice had been successful, further audit data were collected from 167 patients. Sixty-three (44%) accepted analgesics, indicating a significant decrease in the number refusing (P = 0.005). , ,This small project demonstrated that continuous improvement methodology can improve the management of pain and quality of care for patients. Such an approach brings practitioner and patient into meaningful understanding and offers solutions which are realistic, achievable and sustainable over time. Despite finite resources and increased pressure on staff it is possible to motivate people when they feel they have ownership and change is meaningful. , ,Continuous improvement methods offer an exciting, feasible, patient-centred approach to improving care. [source]

Implementing the severe sepsis care bundles outside the ICU by outreach

The Pennsylvania certified safety committee program: An evaluation of participation and effects on work injury rates

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 8 2010
Hangsheng Liu PhD
Abstract Background Since 1994, Pennsylvania, like several other states, has provided a 5% discount on workers' compensation insurance premiums for firms with a certified joint labor management safety committee. This study explored the factors affecting program participation and evaluated the effect of this program on work injuries. Methods Using Pennsylvania unemployment insurance data (1996,2006), workers' compensation data (1998,2005), and the safety committee audit data (1999,2007), we conducted propensity score matching and regression analysis on the program's impact on injury rates. Results Larger firms, firms with higher injury rates, firms in high risk industries, and firms without labor unions were more likely to join the safety committee program and less likely to drop out of the program. The injury rates of participants did not decline more than the rates for non-participants; however, rates at participant firms with good compliance dropped more than the rates at participant firms with poor compliance. Conclusions Firm size and prior injury rates are key predictors of program participation. Firms that complied with the requirement to train their safety committee members did experience reductions in injuries, but non-compliance with that and other requirements was so widespread that no overall impact of the program could be detected. Am. J. Ind. Med. 53:780,791, 2010. © 2010 Wiley-Liss, Inc. [source]

Non-attendance at a diabetes transitional clinic and glycaemic control

PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 3 2010
FRCP, MG Masding MB BS
Abstract Young patients with diabetes are particularly vulnerable to long-term complications, and require a carefully planned transition to adult diabetes care. As clinic non-attendance has been identified as an issue for transitional clinics, we audited our well established clinic to look at non-attendance rates, and to examine the characteristics of those who miss transitional clinic appointments. We conducted a retrospective analysis of audit data from the diabetes transitional clinic in January to December 2004, and September 2007 to September 2008. The results showed that 40/53 patients missed at least one appointment in 2004, compared to 19/61 in 2007,8 (p<0.0001). There was no reduction in HbA1c in this group (2004: median HbA1c 9.4% [range 6.8,13.2%]; 2007,8: median HbA1c 9.7% [range 5.7,14.0%[). In 2007,8, the non-attender group had higher HbA1c (full attenders: median [range] HbA1c 8.9% [5.7,12.7%]; those who missed at least one appointment: HbA1c 10.3% [7.7,14.0%]; p<0.001), and were older (non-attenders mean [SD] 18.0 [1.10] years, full attenders 17.3 [1.17] years). Sex and type of diabetes did not affect ,did not attend' rates. Those who miss diabetes transitional clinic appointments have poorer glycaemic control, although non-attendance is complex and may be due to a variety of reasons. New strategies to help young people deal with their diabetes are needed. Copyright © 2010 John Wiley & Sons. [source]

Teleconferenced educational detailing: Diabetes education for primary care physicians

THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 2 2005
FACPM, Stewart B. Harris MD
Abstract Introduction: Formal didactic continuing medical education (CME) is relatively ineffective for changing physician behaviur. Diabetes mellitus is an increasingly prevalent disease, and interventions to improve adherence to clinical practice guidelines (CPGs) are needed. Methods: A stratified, cluster-randomized, controlled trial design was used to evaluate the effects of a teleconferenced educational detailing (TED) CME on glycemic control (hemoglobin [Hb] A1c) and family physician adherence to national diabetes guidelines. TED employed sequential, small-group, case-based education using CPGs delivered by a diabetes specialist. Medical record audit data from baseline through the end of a 12-month postintervention period were compared for the control and intervention groups. Satisfaction with the intervention was evaluated. Results: Sixty-one physicians provided 660 medical records. The intervention did not affect mean Hb A1c levels but did significantly (p = .04) alter the distribution of patients by category of glycemic control, with fewer in the intervention group in inadequate control (15.8% versus 23.9%). More patients took insulin (alone or with oral agents) in the intervention group (21.2% versus 12.0%, p = .03), and more took oral agents only in the control group (89.0% versus 82.9%, p = .005). More patients in the intervention group had documentation of body mass index (7.8% versus 1.9%, p < .02), eye exam (12.1% versus 5.1%, p = .02), and treatment plan (43.5% versus 23.6%, p = .01) and used a flow sheet (14.6% versus 7.7%, p < .03). Although there was general satisfaction with the teleconferencing format, specialist educators found the format more challenging than the family physicians. Discussion: CME delivered by teleconference was feasible, well attended, well received by participants, and improved some key diabetes management practices and outcomes. [source]

Sedation for oocyte retrieval using target controlled infusion of propofol and incremental alfentanil delivered by non-anaesthetists

ANAESTHESIA, Issue 5 2010
J. A. Edwards
Summary Oocyte retrieval is a procedure where sedation is recommended. This paper presents the process of setting up a new, non-anaesthetist delivered service in our institution, the development of safety systems and the audit data we have used to assure quality, effectiveness and safety. Logbook data were collected for 4342 cases, with detailed audit data collected for 260 cases. Safety is acceptable with a respiratory adverse incident rate of 0.5/1000 (95% CI 0.1,1.6/1000 cases). Unplanned, direct anaesthetic assistance was required in 3.5/1000 cases (95% CI 1.7,5.3/1000 cases). Anaesthetic advice was required in 7.5% cases (95% CI 4.2,10.7%) at the inception of the service, but rarely once established: 0.6% (95% CI 0.2,1.0%). Nearly all patients (99%) would have the same sedation method again, no patients required admission, and patients' co-operation was judged by the operating surgeon as very good or good in 91% of cases. [source]