Applying Quality Improvement methods to address gaps in medicines reconciliation at transfers of care from an acute UK hospital

© Published by the BMJ Publishing Group Limited.Objectives Reliable reconciliation of medicines at admission and discharge from hospital is key to reducing unintentional prescribing discrepancies at transitions of healthcare. We introduced a team approach to the reconciliation process at an acute hospital with the aim of improving the provision of information and documentation of reliable medication lists to enable clear, timely communications on discharge. Setting An acute 400-bedded teaching hospital in London, UK. Participants The effects of change were measured in a simple random sample of 10 adult patients a week on the acute admissions unit over 18â €...months. Interventions Quality improvement methods were used throughout. Interventions included education and training of staff involved at ward level and in the pharmacy department, introduction of medication documentation templates for electronic prescribing and for communicating information on medicines in discharge summaries co-designed with patient representatives. Results Statistical process control analysis showed reliable documentation (complete, verified and intentional changes clarified) of current medication on 49.2% of patients discharge summaries. This appears to have improved (to 85.2%) according to a poststudy audit the year after the project end. Pharmacist involvement in discharge reconciliation increased significantly, and improvements in the numbers of medicines prescribed in error, or omitted from the discharge prescription, are demonstrated. Variation in weekly measures is seen throughout but particularly at periods of changeover of new doctors and introduction of new systems. Conclusions New processes led to a sustained increase in reconciled medications and, thereby, an improvement in the number of patients discharged from hospital with unintentional discrepancies (errors or omissions) on their discharge prescription. The initiatives were pharmacist-led but involved close working and shared understanding about roles and responsibilities between doctors, nurses, therapists, patients and their carers

A pilot survey of junior doctors’ attitudes and awareness around medication review: time to change our educational approach?

© 2015, BMJ Publishing Group. All rights reserved.Objectives Our aim was to explore junior doctors attitudes and awareness around concepts related to medication review, in order to find ways to change the culture for reviewing, altering and stopping inappropriate or unnecessary medicines. Having already demonstrated the value of team working with senior doctors and pharmacists and the use of a medication review tool, we are now looking to engage first year clinicians and undergraduates in the process. Method An online survey about medication review was distributed among all 42 foundation year one (FY1) doctors at the Chelsea and Westminster Hospital NHS Foundation Trust in November 2014. Descriptive statistics were used for analysis. Results Twenty doctors completed the survey (48%). Of those, 17 believed that it was the pharmacists duty to review medicines; and 15 of 20 stated the general practitioner (GP). Sixteen of 20 stated that they would consult a senior doctor first before stopping medication. Eighteen of 20 considered the GP and consultant to be responsible for alterations, rather than themselves. Sixteen of 20 respondents were not aware of the availability of a medication review tool. Seventeen of 20 felt that more support from senior staff would help them become involved with medication review. Conclusions Junior doctors report feeling uncomfortable altering mediations without consulting a senior first. They appear to be building confidence with prescribing in their first year but not about the medication review process or questioning the drugs already prescribed. Consideration should be given to what we have termed a bottom-up educational approach to provide early experience of and change the culture around medication review, to include the education of undergraduate and foundation doctors and pharmacists

Effects of inlet conditions on diffuser outlet performance

Building air distribution terminal system designers and system installers require accurate quantitative information on the performance of the installed system to achieve optimum efficiency and levels of human comfort. This requires field installation adjustment values from published ideal pressure loss, air distribution and sound generation installation performance. This study documents the air output performance of different installation configurations of six types of ceiling diffusers and compares the results to performance when installed according to ANSI/ASHRAE Standard 70-2006. A diffuser inlet supply plenum was designed for optimum flow and used to acquire a baseline set of data covering the six types of diffusers at different inlet neck sizes and inlet airflow rates. Full scale laboratory testing of typical field installation variations was completed for the same conditions with variations in damper installation, duct approach angle, duct type, duct vertical height above the diffuser and duct branch to main supply duct installation. A set of simple algorithms were developed that can be used to easily predict how an inlet configuration would affect the performance of a wide variety of installation conditions

Is number sense impaired in chronic pain patients?

BACKGROUND: Recent advances in imaging have improved our understanding of the role of the brain in painful conditions. Discoveries of morphological changes have been made in patients with chronic pain, with little known about the functional consequences when they occur in areas associated with ‘number-sense’; thus, it can be hypothesized that chronic pain impairs this sense. METHODS: First, an audit of the use of numbers in gold-standard pain assessment tools in patients with acute and chronic pain was undertaken. Secondly, experiments were conducted with patients with acute and chronic pain and healthy controls. Participants marked positions of numbers on lines (number marking), before naming numbers on pre-marked lines (number naming). Finally, subjects bisected lines flanked with ‘2’ and ‘9’. Deviations from expected responses were determined for each experiment. RESULTS: Four hundred and ninety-four patients were audited; numeric scores in the ‘moderate’ and ‘severe’ pain categories were significantly higher in chronic compared with acute pain patients. In experiments (n=150), more than one-third of chronic pain patients compared with 1/10th of controls showed greater deviations from the expected in number marking and naming indicating impaired number sense. Line bisection experiments suggest prefrontal and parietal cortical dysfunction as cause of this impairment. CONCLUSIONS: Audit data suggest patients with chronic pain interpret numbers differently from acute pain sufferers. Support is gained by experiments indicating impaired number sense in one-third of chronic pain patients. These results cast doubts on the appropriateness of the use of visual analogue and numeric rating scales in chronic pain in clinics and research

Improving mental health outcomes: achieving equity through quality improvement

Objective. To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative. Design. Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control. Setting. A psychological therapy service in Westminster, London, UK. Participants. People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012. Intervention(s). Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks. Main Outcome Measure(s). (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator. Results. Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), com-pared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low

An observational study to examine how Cumulative Impact Zones influence alcohol availability from different types of licensed outlets in an inner London Borough

OBJECTIVES: Cumulative Impact Zones (CIZs) are a widely implemented local policy intended to restrict alcohol availability in areas proliferated with licensed outlets. Limited previous research has questioned their effectiveness and suggested they may play a more nuanced role in shaping local alcohol environments. This study evaluates the association between CIZ implementation and the number of licence applications made and the number issued, relative to a control region. DESIGN: A quantitative observational study. SETTING: The inner London Borough of Southwark, which currently enforces three CIZs. POPULATION: Licence applications received by Southwark Council’s Licensing Authority between 1 April 2006 and 31 March 2017 (N = 1254). INTERVENTIONS: CIZ implementation. PRIMARY OUTCOME MEASURES: Five outlet types were categorised and evaluated: Drinking Establishments, Eateries, Takeaways, Off Sales, and Other Outlets. Primary outcome measures were the number of applications received and the number of licences issued. These were analysed using Poisson regression of counts over time. RESULTS: Across all CIZs, implementation was associated with greater increases in the number of eateries in CIZ regions (IRR = 1.58, 95% CI: 1.02 – 2.52, P = 0.04) and number of takeaway venues (IRR = 3.89, 95% CI: 1.32 – 11.49, P = 0.01), relative to the control area. No discernible association was found for the remaining outlet types. Disaggregating by area indicated a 10-fold relative increase in the number of new eateries in Peckham CIZ (IRR = 10.38, 95% CI: 1.39 – 77.66, P = 0.02) and a four-fold relative increase in the number of newly licensed takeaways in Bankside CIZ (IRR = 4.38, 95% CI: 1.20 – 15.91, P = 0.03). CONCLUSIONS: Cumulative Impact Zones may be useful as policy levers to shape local alcohol environments to support the licensing goals of specific geographical areas and diversify the night-time economy

Parents’ Experiences of Communication in neonatal care (PEC): a neonatal survey refined for real-time parent feedback

Objective Assessing parent experiences of neonatal services can help improve quality of care; however, there is no formally evaluated UK instrument available to assess this prospectively. Our objective was to refine an existing retrospective survey for ‘real-time’ feedback. Methods Co-led by a parent representative, we recruited a convenience sample of parents of infants in a London tertiary neonatal unit. Our steering group selected questions from the existing retrospective 61-question Picker survey (2014), added and revised questions assessing communication and parent involvement. We established face validity, ensuring questions adequately captured the topic, conducted parent cognitive interviews to evaluate parental understanding of questions,and adapted the survey in three revision cycles. We evaluated survey performance. Results The revised Parents’ Experiences of Communication in Neonatal Care (PEC) survey contains 28 questions (10 new) focusing on communication and parent involvement. We cognitively interviewed six parents, and 67 parents completed 197 PEC surveys in the survey performance evaluation. Missing entries exceeded 5% for nine questions; we removed one and format-adjusted the rest as they had performed well during cognitive testing. There was strong inter-item correlation between two question pairs; however, all were retained as they individually assessed important concepts. Conclusion Revised from the original 61-question Picker survey, the 28-question PEC survey is the first UK instrument formally evaluated to assess parent experience while infants are still receiving neonatal care. Developed with parents, it focuses on communication and parent involvement, enabling continuous assessment and iterative improvement of family-centred interventions in neonatal care

Mixed ice accretion on aircraft wings

Ice accretion is a problematic natural phenomenon that an effects a wide range of engineering applications including power cables, radio masts and wind turbines. Accretion on aircraft wings occurs when supercooled water droplets freeze instantaneously on impact to form rime ice or runback as water along the wing to form glaze ice. Most models to date have ignored the accretion of mixed ice, which is a combination of rime and glaze. A parameter we term the `freezing fraction', is defined as the fraction of a supercooled droplet that freezes on impact with the top surface of the accretion ice to explore the concept of mixed ice accretion. Additionally we consider different `packing densities' of rime ice, mimicking the different bulk rime densities observed in nature. Ice accretion is considered in four stages: rime, primary mixed, secondary mixed and glaze ice. Predictions match with existing models and experimental data in the limiting rime and glaze cases. The mixed ice formulation consequently however provides additional insight into the composition of the overall ice structure, which ultimately influences adhesion and ice thickness; and shows that for similar atmospheric parameter ranges, this simple mixed ice description leads to very different accretion rates. A simple one-dimensional energy balance was solved to show how this freezing fraction parameter increases with decrease in atmospheric temperature, with lower freezing fraction promoting glaze ice accretion

The Ursinus Weekly, May 8, 1975

From the cluttered desk of the U.S.G.A. President • Band finishes • B.C. to A.D. • Record review: Straight shooter - Bad Company • Letters to the editor • Parents\u27 Day plea: Donations for care • Spring Parents\u27 Day events scheduled • Track team takes fourth • Lantern elects • Placement Office active for students • Award to Noar • Telethon • Night school • How to Succeed • Suds abound in Shampoo • Baseball drops two • Girls winhttps://digitalcommons.ursinus.edu/weekly/1038/thumbnail.jp