Quality assessment of medical record as a tool for clinical risk management: a three year experience of a teaching hospital Policlinico Umberto I, Rome

Introduction: The medical record was defined by the Italian Ministry of Health in 1992 as "the information tool designed to record all relevant demographic and clinical information on a patient during a single hospitalization episode". Retrospective analysis of medical records is a tool for selecting direct and indirect indicators of critical issues (organizational, management and technical). The project’s aim being the promotion of an evaluation and self-evaluation process of medical records as a Clinical Risk Management tool to improve the quality of care within hospitals. Methods: The Authors have retrospectively analysed, using a validated grid, 1,184 medical records of patients admitted to the Teaching Hospital “Umberto I” in Rome during a three-year period (2013-2015). Statistical analysis was performed using SPSS for Windows © 19:00. All duly filled out criteria (92) were examined. “Strengths” and "Weaknesses" were identified through data analysis and Best and Bad Practice were identified based on established criteria. Conclusion: The data analysis showed marked improvements (statistically significant) in the quality of evaluated clinical documentation and indirectly upon behaviour. However, when examining some sub-criteria, critical issues emerge; these could be subject to future further corrective action

Business Process Redesign in the Perioperative Process: A Case Perspective for Digital Transformation

This case study investigates business process redesign within the perioperative process as a method to achieve digital transformation. Specific perioperative sub-processes are targeted for re-design and digitalization, which yield improvement. Based on a 184-month longitudinal study of a large 1,157 registered-bed academic medical center, the observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy to yield a digital transformation framework that supports patient-centric improvement across perioperative sub-processes. This research identifies existing limitations, potential capabilities, and subsequent contextual understanding to minimize perioperative process complexity, target opportunity for improvement, and ultimately yield improved capabilities. Dynamic technological activities of analysis, evaluation, and synthesis applied to specific perioperative patient-centric data collected within integrated hospital information systems yield the organizational resource for process management and control. Conclusions include theoretical and practical implications as well as study limitations

Development of the quality of Australian nursing documentation in aged care (QANDAC) instrument to measure paper-based and electronic resident records

Aim: To develop an Australian nursing documentation in aged care (Quality of Australian Nursing Documentation in Aged Care (QANDAC)) instrument to measure the quality of paper-based and electronic resident records. Methods: The instrument was based on the nursing process model and on three attributes of documentation quality identified in a systematic review. The development process involved five phases following approaches to designing criterion-referenced measures. The face and content validities and the inter-rater reliability of the instrument were estimated using a focus group approach and consensus model. Results: The instrument contains 34 questions in three sections: completion of nursing history and assessment, description of care process and meeting the requirements of data entry. Estimates of the validity and inter-rater reliability of the instrument gave satisfactory results. Conclusion: The QANDAC instrument has a potential as a useful audit tool for the purposes of quality improvement and research in aged care documentation

A systematic review and critical appraisal of quality indicators to assess optimal palliative care for older people with dementia

© The Author(s) 2019Background: A challenge for commissioners and providers of end-of-life care in dementia is to translate recommendations for good or effective care into quality indicators that inform service development and evaluation. Aim: To identify and critically evaluate quality indicators for end-of-life care in dementia. Results: We found 8657 references, after de-duplication. In all, 19 publications describing 10 new and 3 updated sets of indicators were included in this review. Ultimately, 246 individual indicators were identified as being relevant to dementia end-of-life care and mapped against EAPC guidelines. Conclusions: We systematically derived and assessed a set of quality indicators using a robust framework that provides clear definitions of aspects of palliative care, which are dementia specific, and strengthens the theoretical underpinning of new complex interventions in end-of-life care in dementia.Peer reviewedFinal Published versio

Health-related quality of life in school children: validation of instrument, child self assessment, parent-proxy assessment and school nursing documentation of health check-ups

The aims of this study were to validate an international Health-Related Quality of Life (HRQL) instrument, to describe child self and parent-proxy assessed HRQL at child age 10 to 12 and to compare child self assessments with parent-proxy assessments and school nursing documentation. The study is part of the Schools on the Move –research project. In phase one, a cross-cultural translation and validation process was performed to develop a Finnish version of Pediatric Quality of Life Inventory™ 4.0 (PedsQL™ 4.0). The process included a two-way translation, cognitive interviews (children n=7, parents n=5) and a survey (children n=1097, parents n=999). In phase two, baseline and follow-up surveys (children n=986, parents n=710) were conducted to describe and compare the child self and parent-proxy assessed HRQL in school children between the ages 10 and 12. Phase three included two separate data, school nurse documented patient records (children n=270) and a survey (children n=986). The relation between child self assessed HRQL and school nursing documentation was evaluated. Validity and reliability of the Finnish version of PedsQL™ 4.0 was good (Child Self Report α=0.91, Parent-Proxy Report α=0.88). Children reported lower HRQL scores at the emotional (mean 76/80) than the physical (mean 85/89) health domains and significantly lower scores at the age of 10 than 12 (dMean=4, p=<0.001). Agreement between child self and parent-proxy assessment was fragile (r=0,4, p=<0.001) but increased as the child grew from age 10 to 12 years. At health check-ups, school nurses documented frequently children’s physical health, such as growth (97%) and posture (98/99%) but seldom emotional issues, such as mood (2/7%). The PedsQLTM 4.0 is a valid instrument to assess HRQL in Finnish school children although future research is recommended. Children’s emotional wellbeing needs future attention. HRQL scores increase during ages between childhood and adolescence. Concordance between child self and parent-proxy assessed HRQL is low. School nursing documentation, related to child health check-ups, is not in line with child self assessed HRQL and emotional issues need more attention.Siirretty Doriast

Modified Pro-Self Pain Control to Increase Activity in Patients with Colorectal Cancer

Background: Barriers to performing activities of daily living are common complaints of patients with cancer. One of the factors causing these barriers is pain. A modified pro-self pain control is a method used to enhance the patients' ability to cope with pain to increase their activity.Purpose: This study aimed to evaluate the modified pro-self pain control to increase activity in patients with colorectal cancer undergoing chemotherapy.Methods: The present study employed an experimental design. Patients with colorectal cancer undergoing chemotherapy were randomly assigned to the intervention group (n=24) and the control group (n=24). The patients in the control group were given a standard hospital intervention, while the patients in the intervention group were given the modified pro-self pain control for nine days. The data were collected using the instrument of KATZ index and analyzed using the independent t-test.Results: The result of this study showed that there was a higher increase of activity among the patients in the intervention group than in the control group. Independent t-test showed that there was a significant difference between the intervention group and the control group (p=0.00).Conclusion: The modified pro-self pain control was found more effective to increase the activity in patients with colorectal cancer undergoing chemotherapy than that of the standard hospital intervention

A Review of whether peri-operative nursing records used in the Western Cape Metropolitan health region are in line with international standards and recommendations for standard content and design characteristics for the Western Cape

Bibliography: leaves 180-193.Peri-operative nursing is faced with increasing pressure to improve productivity while coping with diminishing resources. Nurses have to work harder and faster while still maintaining a high standard of patient care. This emphasises the need for comprehensive, yet easy-to-use peri-operative nursing records. A descriptive, non experimental research design was used to survey peri-operative nursing records used in the Western Cape Metropolitan Health Region and content and design characteristics were identified. A comparison was made between these records and the standard set by the Association of Operating Room Nurses (AORN) in the United States of America. The criteria stipulated by the AORN standard were found to be relevant to South African peri-operative nursing practice with a few exceptions. In spite of this, the perioperative nursing records reviewed did not compare well with the AORN standard and were particularly deficient in risk management areas such as potential injury related to positioning the patient, and electrical and physical hazards. Content criteria not mentioned by the standard, but appearing in the local records were identified and certain aspects of design recognised in the literature were also discussed. Recommendations for a South African standard for peri-operative nursing records were made, as well a$ recommendations for further research into the use and design of peri-operative nursing records