202 results match your criteria BMJ open quality[Journal]


Selecting topic areas for developing quality standards in a resource-limited setting.

BMJ Open Qual 2019 31;8(1):e000491. Epub 2019 Jan 31.

Health Intervention and Technology Assessment Program, Nonthaburi, Thailand.

Variation in practices of and access to health promotion and disease prevention (P&P) across geographical areas have been studied in Thailand as well as other healthcare settings. The implementation of quality standards (QS)-a concise set of evidence-informed quality statements designed to drive and measure priority quality improvements-can be an option to solve the problem. This paper aims to provide an overview of the priority setting process of topic areas for developing QS and describes the criteria used. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2018-000491
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http://dx.doi.org/10.1136/bmjoq-2018-000491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361367PMC
January 2019
4 Reads

All change: a stroke inpatient service's experience of a new clinical neuropsychology delivery model.

BMJ Open Qual 2019 30;8(1):e000184. Epub 2019 Jan 30.

Stroke Service, Department of Neurosciences, St George's University Hospitals, London, UK.

Adults presenting to stroke services are frequently faced with the challenge of adjusting to a different life following a stroke. Difficulties often include cognitive impairments, such as memory deficits, attention and language difficulties, and mood disturbances such as anxiety and depression. It has been highlighted that psychological care for this group is just as important as physical rehabilitation. Read More

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http://dx.doi.org/10.1136/bmjoq-2017-000184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361325PMC
January 2019
2 Reads

Correction: .

Authors:

BMJ Open Qual 2019 14;8(1):e000042corr1. Epub 2019 Jan 14.

[This corrects the article DOI: 10.1136/bmjoq-2017-000042.]. Read More

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http://dx.doi.org/10.1136/bmjoq-2017-000042corr1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340564PMC
January 2019

Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance.

BMJ Open Qual 2019 14;8(1):e000449. Epub 2019 Jan 14.

Research Unit of Chronic Conditions, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark.

Background: Studies assessing institutional performance regarding quality of care are frequently performed using single-level statistical analyses investigating differences between provider averages of various quality indicators. However, such analyses are insufficient as they do not consider patients' heterogeneity around those averages. Hence, we apply a multilevel analysis of individual-patient heterogeneity that distinguishes between 'general' ('latent quality' or measures of variance) and 'specific' (measures of association) contextual effects. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340563PMC
January 2019
1 Read

Putting veterans with heart failure FIRST improves follow-up and reduces readmissions.

BMJ Open Qual 2019 14;8(1):e000386. Epub 2019 Jan 14.

Hospital Medicine Section, Department of Medicine, South Texas Veterans Health Care System, University of Texas Health Science Center, San Antonio, Texas, USA.

Background: Despite improvements in length of stay and mortality, congestive heart failure (CHF) remains the most common cause of 30-day readmissions to the hospital. Though multiple studies have found that early follow-up after discharge (eg, within 7 days) is critical to improving 30-day readmissions, implementation strategies are challenging in resource-limited settings. Here we present a quality improvement initiative aimed at improving early follow-up while maximising available resources. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340603PMC
January 2019
1 Read

Validation of a Norwegian version of SURgical PAtient Safety System (SURPASS) in combination with the World Health Organizations' Surgical Safety Checklist (WHO SSC).

BMJ Open Qual 2019 7;8(1):e000488. Epub 2019 Jan 7.

Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.

Introduction: Surgical safety checklists may contribute to reduction of complications and mortality. The WHO's Surgical Safety Checklist (WHO SSC) could prevent incidents in operating theatres, but errors also occur before and after surgery. The SURgical PAtient Safety System (SURPASS) is designed to intercept errors with use of checklists throughout the surgical pathway. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000488DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327875PMC
January 2019
1 Read

Patient vs provider perspectives of 30-day hospital readmissions.

BMJ Open Qual 2019 7;8(1):e000264. Epub 2019 Jan 7.

Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.

Objective: To compare patients' and providers' views on contributors to 30-day hospital readmissions.

Design: Analysis of a qualitative interview survey between 18 May-30 June 2015.

Setting: Interviews were conducted during the 30-day readmission hospitalisation at a single tertiary care academic hospital. Read More

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http://dx.doi.org/10.1136/bmjoq-2017-000264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327873PMC
January 2019

Improving antimicrobial stewardship in the outpatient department of a district general hospital in Sierra Leone.

BMJ Open Qual 2018 16;7(4):e000495. Epub 2018 Dec 16.

Humanitarian Studies Department, Liverpool School of Tropical Medicine, Liverpool, UK.

There is global concern over increasing antibiotic resistance rates due to poor antimicrobial stewardship, particularly in low-income and middle-income countries where there are limited diagnostic facilities, fewer doctors per capita and inadequate control over the production and sale of antibiotics. This quality improvement project was designed to improve the antimicrobial prescriptions practices of paramedical staff in the outpatient department of a rural district general hospital in Masanga, Sierra Leone, West Africa. At baseline, 57 of 66 (86%) of patients were prescribed at least one antimicrobial. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307603PMC
December 2018
1 Read

Improving analgesia prescription for trauma inpatients.

BMJ Open Qual 2018 16;7(4):e000397. Epub 2018 Dec 16.

Trauma and Orthopaedics, Great Western Hospital, Swindon, UK.

Patients value effective pain relief. Complications of inadequate pain control include increased risk of infection, decreased patient comfort and progression to chronic pain, all of which have significant socioeconomic consequence. Accessibility to analgesia is vital to effective administration. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2018-000397
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http://dx.doi.org/10.1136/bmjoq-2018-000397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307579PMC
December 2018
10 Reads

Care bundles for acute kidney injury: a balanced accounting of the impact of implementation in an acute medical unit.

BMJ Open Qual 2018 18;7(4):e000392. Epub 2018 Dec 18.

Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom.

In 2009, a National Confidential Enquiry into Patient Outcome and Death report detailed significant shortcomings in recognition and management of patients with acute kidney injury (AKI). As part of a national collaborative to reduce harm from AKI, the Scottish Patient Safety Programme developed two care bundles to improve response ('SHOUT') and review ('BUMP') of AKI. Baseline data from eight patients with AKI on the acute medical unit (AMU) in Ninewells Hospital showed 62% compliance with SHOUT. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2018-000392
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http://dx.doi.org/10.1136/bmjoq-2018-000392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307581PMC
December 2018
2 Reads

Electronic prescribing: introducing a stat optional dose to improve time to antibiotic on the acute medical unit.

BMJ Open Qual 2018 19;7(4):e000292. Epub 2018 Dec 19.

Acute Medical Unit, County Durham and Darlington Foundation Trust, England, UK.

Darlington Memorial Hospital is a district general hospital in the North East of England. The acute medical unit (AMU) takes referrals from the emergency department and also direct from general practitioners (GPs) in the region. Research shows that early recognition and management of sepsis is key to improving outcomes and significantly decreases mortality. Read More

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http://dx.doi.org/10.1136/bmjoq-2017-000292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307570PMC
December 2018
1 Read

Hepatitis Service Provision at HMP Birmingham: Progressing a Previous Service Improvement Plan.

Authors:
Tooba Arif

BMJ Open Qual 2018 18;7(4):e000192. Epub 2018 Dec 18.

West Midlands East Health Protection Unit, Public Health England, Birmingham, West Midlands, UK.

Introduction: Hepatitis B is a vaccine-preventable disease, and hepatitis C is amenable to treatment. Both are highly prevalent in the prison population. This project provides a comprehensive evaluation of current hepatitis services at Her Majesty's Prison Birmingham, assessing progress since previous work and proposing further suggestions for improvement. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2017-000192
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http://dx.doi.org/10.1136/bmjoq-2017-000192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307565PMC
December 2018
12 Reads

Educational intervention to reduce treatment of asymptomatic bacteriuria in long-term care.

BMJ Open Qual 2018 1;7(4):e000483. Epub 2018 Dec 1.

Antimicrobial Stewardship Program, Saskatchewan Health Authority, Regina, Saskatchewan, Canada.

Objective: To determine if an educational intervention can decrease the inappropriate antibiotic treatment of long-term care (LTC) residents with asymptomatic bacteriuria (ASB).

Design: Prospective chart audit between May and July 2017.

Setting: Seven LTC facilities in Regina, Saskatchewan, Canada. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000483DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280905PMC
December 2018
2 Reads

DC cardioversion of atrial fibrillation and atrial flutter in the emergency department: improving specialist protocols for the generalist.

BMJ Open Qual 2018 1;7(4):e000260. Epub 2018 Dec 1.

Department of Cardiology, Severn Deanery, Bristol, UK.

Background: Direct current cardioversion (DCCV) is a safe and effective treatment for recent-onset atrial fibrillation (AF) or flutter and when performed in the emergency department (ED), it can provide an excellent treatment option for patients as well as reducing unnecessary hospital admissions and healthcare costs. However, appropriate periprocedural anticoagulation is absolutely essential to reduce the risk of adverse outcomes, chiefly thromboembolic stroke. Our intention was for 100% of patients undergoing DCCV in the ED to receive appropriate periprocedural anticoagulation. Read More

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http://dx.doi.org/10.1136/bmjoq-2017-000260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280898PMC
December 2018
1 Read

Content analysis of 50 clinical negligence claims involving test results management systems in general practice.

BMJ Open Qual 2018 22;7(4):e000463. Epub 2018 Nov 22.

Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.

Background And Aims: Laboratory test results management systems are a complex safety issue in primary care settings worldwide. Related failures lead to avoidable patient harm, medicolegal action, patient complaints and additional workload to problem solve identified issues. We aimed to review and learn from 50 clinical negligence cases involving system failures related to the management of test results. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267325PMC
November 2018

Importance of safety climate, teamwork climate and demographics: understanding nurses, allied health professionals and clerical staff perceptions of patient safety.

BMJ Open Qual 2018 28;7(4):e000433. Epub 2018 Nov 28.

Interprofessional Collaboration and Education, Southlake Regional Health Centre, Newmarket, Ontario, Canada.

Background: There is growing evidence regarding the importance of contextual factors for patient/staff outcomes and the likelihood of successfully implementing safety improvement interventions such as checklists; however, certain literature gaps still remain-for example, lack of research examining the interactive effects of safety constructs on outcomes. This study has addressed some of these gaps, together with adding to our understanding of how context influences safety.

Purpose: The impact of staff perceptions of safety climate (ie, senior and supervisory leadership support for safety) and teamwork climate on a self-reported safety outcome (ie, overall perceptions of patient safety (PS)) were examined at a hospital in Southern Ontario. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267314PMC
November 2018
1 Read

Evaluation of a staff training programme to reimplement a comprehensive health assessment.

BMJ Open Qual 2018 20;7(4):e000353. Epub 2018 Nov 20.

School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.

Background: Health information systems with applications in patient care planning and decision support depend on high-quality data. A postacute care hospital in Ontario, Canada, conducted data quality assessment and focus group interviews to guide the development of a cross-disciplinary training programme to reimplement the Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 comprehensive health assessment into the hospital's clinical workflows. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2018-000353
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http://dx.doi.org/10.1136/bmjoq-2018-000353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267310PMC
November 2018
14 Reads

Reducing acute kidney injury incidence and progression in a large teaching hospital.

BMJ Open Qual 2018 26;7(4):e000308. Epub 2018 Nov 26.

Emergency Admissions Unit, Royal Preston Hospital, Preston, UK.

Acute kidney injury (AKI) is a common syndrome that is associated with significant mortality and cost. The Quality Improvement AKI Collaborative at Salford Royal Foundation Trust was established to review and improve both the recognition and management of AKI. This was a whole-system intervention to tackle AKI implemented as an alternative to employing separate AKI nurses. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2017-000308
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http://dx.doi.org/10.1136/bmjoq-2017-000308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267307PMC
November 2018
18 Reads

Training: improving antenatal detection and outcomes of congenital heart disease.

BMJ Open Qual 2018 24;7(4):e000276. Epub 2018 Nov 24.

School of Sport and Exercise Sciences and College of Engineering, Swansea University, Medical Physics and Biomedical Engineering, Swansea, UK.

Objectives: This study describes the design, delivery and efficacy of a regional fetal cardiac ultrasound training programme. This programme aimed to improve the antenatal detection of congenital heart disease (CHD) and its effect on fetal and postnatal outcomes.

Design Setting And Participants: This was a prospective study that compared antenatal CHD detection rates by professionals from 13 hospitals in Wales before and after engaging in our 'skills development programme'. Read More

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http://dx.doi.org/10.1136/bmjoq-2017-000276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267317PMC
November 2018
10 Reads

Evaluation of the McMaster Family Health Team: results and practical implications for quality improvement.

BMJ Open Qual 2018 26;7(4):e000259. Epub 2018 Nov 26.

Department of Family Medicine, McMaster University Health Sciences, Hamilton, Ontario, Canada.

Purpose: To evaluate the McMaster Family Health Team (MFHT) as part of a Continuous Quality Improvement initiative using a set of provincial performance metrics to demonstrate which measures of assessment are actually clinically meaningful in context and where system-level changes might be implemented to improve operational practice.

Methods: Measures were selected from the Primary Care Performance Measurement Framework based on data availability for the MFHT and provincial comparators. The measures explored in this paper are those that were deemed to have actionable properties. Read More

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http://dx.doi.org/10.1136/bmjoq-2017-000259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267324PMC
November 2018
1 Read

Reducing inappropriate antibiotic prescribing in upper respiratory tract infection in a primary care setting in Kolkata, India.

Authors:
Amy Dehn Lunn

BMJ Open Qual 2018 20;7(4):e000217. Epub 2018 Nov 20.

Calcutta Rescue, Kolkata, India.

Inappropriate antibiotic use is a key factor in the emergence of antibiotic resistance. The majority of antibiotics are prescribed in primary care, where upper respiratory tract infection (URTI) is a common presentation. Inappropriate antibiotic prescribing in URTI is common globally and has increased markedly in developing and transitional countries. Read More

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http://dx.doi.org/10.1136/bmjoq-2017-000217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267302PMC
November 2018

Testing of the 'Always Events' approach to improve the patient experience in the emergency department.

BMJ Open Qual 2018 19;7(4):e000195. Epub 2018 Nov 19.

Medical Directorate, NHS Education for Scotland, Glasgow, UK.

Maintaining quality of care and meeting patient expectations in the face of rising demand within emergency departments (ED) is a significant challenge for clinicians. This study tested the Always Events (AE) approach as a means to identify AE's relevance to patient care in the ED and act on this to address patient concerns. The project team looked to identify aspects of care patients would like to see improved within the minor injuries stream (MIS). Read More

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http://dx.doi.org/10.1136/bmjoq-2017-000195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267318PMC
November 2018

Interprofessional education model for geriatric falls risk assessment and prevention.

BMJ Open Qual 2018 10;7(4):e000417. Epub 2018 Nov 10.

Summa Health System, Akron, Ohio, USA.

Background: One in three people over the age of 65 fall every year, with 1/3 sustaining at least moderate injury. Falls risk reduction requires an interprofessional health team approach. The literature is lacking in effective models to teach students how to work collaboratively in interprofessional teams for geriatric falls prevention. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231104PMC
November 2018
2 Reads

Assessing the utility of drug screening in the emergency: a short report.

BMJ Open Qual 2018 10;7(4):e000414. Epub 2018 Nov 10.

Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2018-000414
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http://dx.doi.org/10.1136/bmjoq-2018-000414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231090PMC
November 2018
10 Reads

A team approach to the introduction of safe early mobilisation in an adult critical care unit.

BMJ Open Qual 2018 10;7(4):e000339. Epub 2018 Nov 10.

Department of Intensive Care, Monklands Hospital, Airdrie, North Lanarkshire, UK.

Delirium and intensive care unit acquired weakness are common in patients requiring critical care and associated with higher mortality and poor long-term outcomes. Early mobilisation has been shown to reduce the duration of both conditions and is recommended as part of a strategy of rehabilitation of critically ill patients starting during their stay in intensive care. Our aim was to achieve 95% reliability with a standardised mobilisation process. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231105PMC
November 2018
2 Reads

Using the Model for Improvement to implement the Critical-Care Pain Observation Tool in an adult intensive care unit.

BMJ Open Qual 2018 9;7(4):e000304. Epub 2018 Oct 9.

Department of Anaesthesia and Pain, Raigmore Hospital, Inverness, UK.

Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2017-000304
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http://dx.doi.org/10.1136/bmjoq-2017-000304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231094PMC
October 2018
18 Reads

Evaluation of a toolkit resource package to support positive workplace behaviours in relation to quality end-of-life care in Australian hospitals.

BMJ Open Qual 2018 10;7(4):e000286. Epub 2018 Nov 10.

Palliative and Supportive Services, Flinders University Faculty of Medicine, School of Health Sciences, Adelaide, South Australia, Australia.

Background: The study aimed to determine the effectiveness of an action-orientated toolkit in supporting behaviour change in relation to quality end-of-life care in acute hospital settings. The toolkit was developed to complement a programme of online end-of-life care education.

Methods: A toolkit was developed from an international review of peer-reviewed literature on end of life. Read More

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http://dx.doi.org/10.1136/bmjoq-2017-000286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231109PMC
November 2018
2 Reads

Improving resuscitation decisions: a trust-wide initiative.

BMJ Open Qual 2018 1;7(4):e000268. Epub 2018 Nov 1.

Department of Intensive Care Medicine and Anaesthesia, Medway NHS Foundation Trust, Gillingham, UK.

Introduction: Treatment escalation plans (TEPs) are important to ensure that every patient has their ceiling of care discussed and documented formally. At Medway Foundation Trust, we introduced TEP forms in September 2016 which are to be completed by the relevant consultant within 24 hours of admission.

Aims And Methods: To evaluate whether TEP forms had been effective at improving escalation planning and whether they had a subsequent impact in do not attempt cardiopulmonary resuscitation (DNACPR) decision-making. Read More

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http://dx.doi.org/10.1136/bmjoq-2017-000268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231093PMC
November 2018
3 Reads

Preoperative fasting in the department of plastic surgery.

BMJ Open Qual 2018 10;7(4):e000161. Epub 2018 Nov 10.

Department of Plastic Surgery, North Bristol NHS Trust, Bristol, UK.

Preoperative fasting is necessary to reduce the risk of regurgitation of gastric contents and pulmonary aspiration in patients undergoing general anaesthetic and procedural sedation. Excessive fasting is associated with metabolic, cardiovascular and gastrointestinal complications and patient discomfort. We aimed to reduce the fasting time for patients on the plastic surgery trauma list. Read More

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http://dx.doi.org/10.1136/bmjoq-2017-000161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231091PMC
November 2018
1 Read

Better care: reducing length of stay and bed occupancy on an older adult psychiatric ward.

BMJ Open Qual 2018 1;7(4):e000149. Epub 2018 Nov 1.

Mental Healthcare of Older Adults, East London NHS Foundation Trust, London, UK.

Background: Length of stay and bed occupancy are important indicators of quality of care. Admissions are longer on older adult psychiatric wards as a result of physical comorbidity and complex care needs. The recommended bed occupancy is 85%; levels of 95% or higher are associated with violent incidents on inpatient wards. Read More

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http://dx.doi.org/10.1136/bmjoq-2017-000149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231107PMC
November 2018
1 Read

STI initiative: Improving testing for sexually transmitted infections in women.

BMJ Open Qual 2018 15;7(4):e000461. Epub 2018 Oct 15.

Michael G. DeGroote School of Medicine-Niagara Regional Campus, McMaster University, St. Catharines, Ontario, Canada.

Canadian urgent care and walk-in medical clinics provide health care for a population that may be poorly covered by traditional health care structures. Despite evidence suggesting that women with urinary complaints experience a high incidence of sexually transmitted infections (STIs), this population may be under-tested in this particular setting. The aim of this quality improvement initiative was to increase STI testing in women presenting with GU complaints. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203025PMC
October 2018
1 Read

A comparison of hospital-acquired pressure injuries in intensive care and non-intensive care units: a multifaceted quality improvement initiative.

BMJ Open Qual 2018 25;7(4):e000425. Epub 2018 Oct 25.

Department of Quality and Patient Safety, Humber River Hospital, Toronto, Ontario, Canada.

Hospital-acquired pressure injuries (HAPI) are a significant cause of morbidity and mortality, and represent a major health concern worldwide. Patients suffering from HAPI report a poor quality of life on several dimensions of health. Moreover, HAPI is reported to lengthen in-hospital stay in the acute setting, posing significant healthcare resource utilisations and costs. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2018-000425
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http://dx.doi.org/10.1136/bmjoq-2018-000425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202997PMC
October 2018
117 Reads

Pain, agitation and delirium assessment and management in a community medical-surgical ICU: results from a prospective observational study and nurse survey.

BMJ Open Qual 2018 15;7(4):e000413. Epub 2018 Oct 15.

Niagara Health, St Catharines, Ontario, Canada.

Background: Delirium is a common manifestation in the intensive care unit (ICU) that is associated with increased mortality and morbidity. Guidelines suggested appropriate management of pain, agitation and delirium (PAD) is crucial in improving patient outcomes. However, the practice of PAD assessment and management in community hospitals is unclear and the mechanisms contributing to the potential care gap are unknown. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2018-000413
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http://dx.doi.org/10.1136/bmjoq-2018-000413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203047PMC
October 2018
15 Reads

Faecal immunochemical testing implementation to increase colorectal cancer screening in primary care.

BMJ Open Qual 2018 25;7(4):e000400. Epub 2018 Oct 25.

Department of Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA.

Colorectal cancer (CRC) is the second leading cause of cancer death in USA, and CRC screening remains suboptimal. The aim of this quality improvement was to increase CRC screening in the internal medicine clinic (IMC) patients, between the ages of 50-75 years, from a baseline rate of 50%-70% over 12 months with the introduction of faecal immunochemical test (FIT) testing. We used the Plan-Do-Study-Act (PDSA) method and performed a root cause analysis to identify barriers to acceptance of CRC screening. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2018-000400
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http://dx.doi.org/10.1136/bmjoq-2018-000400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203033PMC
October 2018
10 Reads

Point-of-care C-reactive protein testing to optimise antibiotic use in a primary care urgent care centre setting.

Authors:
Caroline Ward

BMJ Open Qual 2018 15;7(4):e000391. Epub 2018 Oct 15.

Swindon Clinical Commissioning Group, The Pierre Simonet Building, North Latham Road, Swindon, UK.

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2018-000391
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http://dx.doi.org/10.1136/bmjoq-2018-000391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203029PMC
October 2018
4 Reads

Improving communication of patient issues on transfer out of intensive care.

BMJ Open Qual 2018 21;7(4):e000385. Epub 2018 Oct 21.

Department of Intensive Care, Canterbury District Health Board, Christchurch, Canterbury, New Zealand.

The written medical handover document is frequently poor in quality and highly variable which raises concerns about patient safety. Intensive care unit (ICU) patients have complex medical and social issues which increases the risk of errors during ongoing hospital treatment. Our project team of four doctors and two nurses aimed to improve the documentation of patient problems as they leave the ICU. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203008PMC
October 2018
24 Reads

Sustainable approach to reducing unnecessary combined biochemistry tests on a paediatric cardiology ward.

BMJ Open Qual 2018 15;7(4):e000372. Epub 2018 Oct 15.

Quality Improvement Team, Great Ormond Street Hospital, London, UK.

We describe a quality improvement project (QIP) designed to reduce unnecessary biochemistry samples requested on a paediatric cardiology ward in Great Ormond Street Hospital. Prior to the intervention biochemistry tests were requested on a daily basis by nursing and junior doctor staff at an annual cost of around £27 000 for the ward. The lead author observed that for the majority the true indication for these biochemistry tests was for the purpose of monitoring renal function and plasma electrolytes. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203018PMC
October 2018
11 Reads

Can we improve the prescribing and delivery of oxygen on a respiratory ward in accordance with new British Thoracic Society oxygen guidelines?

BMJ Open Qual 2018 15;7(4):e000371. Epub 2018 Oct 15.

Department of Respiratory Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, Queen's Hospital, Romford, UK.

The British Thoracic Society recommends oxygen delivery to achieve target oxygen saturation range between 94% and 98% for medically unwell adult patients, and 88% to 92% in patients at risk of hypercapnic respiratory failure. Interviews with our medical and nursing staff suggested that oxygen was sometimes being given to patients without a valid order and there was a failure to titrate oxygen to the stated oxygen saturation range. Our aim was to improve appropriate oxygen delivery to 90% of our patients on a 30-bedded respiratory ward within 3 months. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2018-000371
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http://dx.doi.org/10.1136/bmjoq-2018-000371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203005PMC
October 2018
13 Reads

Challenges in reducing TIA clinic waiting times from 9 to 3 days in an acute Welsh hospital.

BMJ Open Qual 2018 15;7(4):e000237. Epub 2018 Oct 15.

Stroke Medicine Morriston, Morriston Hospital, Swansea, UK.

A patient impact project which successfully reduced the transient ischaemic attack (TIA) clinic waiting time from 9 to 3 days in an acute Welsh hospital, revealing the challenges faced and how alternative thinking and team work improved care given to our service users. Evaluating current situation, careful planning with multiple brainstorming meetings, 4 N chart and driver diagram with change ideas laid the foundation for this service improvement. Run charts, statistical process control and Pareto charts helped to identify the issues that are hindering the progress, which when rectified, reduced the clinic waiting times. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2017-000237
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http://dx.doi.org/10.1136/bmjoq-2017-000237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203044PMC
October 2018
11 Reads

Improving comprehensive care for patients with diabetes.

BMJ Open Qual 2018 15;7(4):e000101. Epub 2018 Oct 15.

Department of Operations Improvement, Memorial Medical Center, Springfield, Illinois, USA.

Patients with diabetes require access to systematic and ongoing care delivered by a team of healthcare providers. Despite national attention and well-accepted best practices, diabetic care, blood pressure and haemoglobin A1c (A1c) levels for patients with diabetes in our primary care setting were highly variable and below the Healthcare Effectiveness Data and Information Set (HEDIS) 75th percentile benchmark. From January 2015 to January 2016, 22% of patients with diabetes in our primary care setting had both blood pressure and A1c levels controlled and 23% had their annual diabetic care bundle completed, which includes A1c and blood pressure measurements, foot examination and nephropathy attention. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2017-000101
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http://dx.doi.org/10.1136/bmjoq-2017-000101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202994PMC
October 2018
18 Reads

Improving anticoagulation of patients with an implantable left ventricular assist device.

BMJ Open Qual 2018 2;7(4):e000250. Epub 2018 Oct 2.

Transplant Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.

Patients supported with implantable left ventricular assist devices (LVAD) have a significant risk of bleeding and thromboembolic complications. All patients require anticoagulation with warfarin, aiming for a target international normalised ratio (INR) of 2.5 and most patients also receive antiplatelet therapy. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2017-000250
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http://dx.doi.org/10.1136/bmjoq-2017-000250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173227PMC
October 2018
14 Reads

Postpartum quality improvement strategy for increasing long-acting contraception uptake at a University Hospital in Haiti.

BMJ Open Qual 2018 3;7(4):e000204. Epub 2018 Oct 3.

Strategic Information, Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.

To address the gap in the uptake of long-acting contraception (LAC) methods among high-risk postpartum women who fail to return for a family planning method at HôpitalUniversitaire de Mirebalais in the Central Plateau Department of Haiti, contraceptive implant trainings were held for providers on the Labour and Delivery, Post-Partum and Internal Medicine inpatient wards. A very high maternal mortality rate affects large numbers of women in Haiti; however, contraceptive use can reduce maternal mortality significantly. A quality improvement strategy to offer LAC methods to immediate postpartum women at a University Hospital in rural Haiti was initiated in March 2016. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2017-000204
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http://dx.doi.org/10.1136/bmjoq-2017-000204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173247PMC
October 2018
2 Reads

Systematic review and meta-analysis of community pharmacy error rates in the USA: 1993-2015.

BMJ Open Qual 2018 2;7(4):e000193. Epub 2018 Oct 2.

Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA.

Importance: While much is known about hospital pharmacy error rates in the USA, comparatively little is known about community pharmacy dispensing error rates.

Objective: The aim of this study was to determine the rate of community pharmacy dispensing errors in the USA.

Methods: English language, peer-reviewed observational and interventional studies that reported community pharmacy dispensing error rates in the USA from January 1993 to December 2015 were identified in 10 bibliographic databases and topic-relevant grey literature. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2017-000193
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http://dx.doi.org/10.1136/bmjoq-2017-000193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173242PMC
October 2018
16 Reads

Emergency department checklist: an innovation to improve safety in emergency care.

BMJ Open Qual 2018 26;7(3):e000325. Epub 2018 Sep 26.

Emergency Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.

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http://dx.doi.org/10.1136/bmjoq-2018-000325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173256PMC
September 2018
1 Read

E-referrals: improving the routine interspecialty inpatient referral system.

BMJ Open Qual 2018 28;7(3):e000249. Epub 2018 Sep 28.

Royal Devon and Exeter Hospital, Exeter, UK.

Interspecialty referrals are an essential part of most inpatient stays. With over 130 referrals occurring per week at the Royal Devon and Exeter Hospital, the process must be efficient and safe. The current paper-based 'white card' system was felt to be inefficient, and a Trust incident highlighted patient safety concerns. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2017-000249
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http://dx.doi.org/10.1136/bmjoq-2017-000249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173238PMC
September 2018
2 Reads

Implementing delayed cord clamping in premature infants.

BMJ Open Qual 2018 21;7(3):e000219. Epub 2018 Sep 21.

Department of Neonatology, Saint Joseph Hospital, Denver, Colorado, USA.

The practice of delayed cord clamping (DCC) in premature infants has proven benefit to the neonate. In a community-based perinatal centre, the practice of DCC for more than 60 s for premature infants with gestational age of <35 weeks was identified to occur infrequently at 20% in 2013. The perinatology group in conjunction with nursery, labour and delivery, and obstetric staff sought to improve adherence to the best practice of DCC for premature infants. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjoq-2017-000219
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http://dx.doi.org/10.1136/bmjoq-2017-000219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157520PMC
September 2018
10 Reads

Effect of a pulmonary nodule fact sheet on patient anxiety and knowledge: a quality improvement initiative.

BMJ Open Qual 2018 14;7(3):e000437. Epub 2018 Sep 14.

San Antonio Military Medical Center, Fort Sam Houston, Texas, USA.

Introduction: The utilisation of chest CT for the evaluation of pulmonary disorders, including low-dose CT for lung cancer screening, is increasing in the USA. As a result, the discovery of both screening-detected and incidental pulmonary nodules has become more frequent. Despite an overall low risk of malignancy, pulmonary nodules are a common cause of emotional distress among adult patients. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6144906PMC
September 2018

Nursing attitudes towards continuous capnographic monitoring of floor patients.

BMJ Open Qual 2018 15;7(3):e000416. Epub 2018 Sep 15.

Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Introduction: Nurses' perceptions of the utility of capnography monitoring are inconsistent in previous studies. We sought to outline the limitations of a uniform education effort in bringing about consistent views of capnography among nurses.

Methods: A survey was administered to 22 nurses in three subacute care floors participating in a pragmatic clinical trial employing capnography monitoring in a large, urban tertiary care hospital. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6144903PMC
September 2018
2 Reads

Medical students as agents of change: a qualitative exploratory study.

BMJ Open Qual 2018 4;7(3):e000420. Epub 2018 Sep 4.

School of Nursing and Health Sciences, University of Dundee, Dundee, UK.

Background: There is evidence that medical students have the potential to actively initiate, lead and bring about change through quality improvement within healthcare organisations. For effective change to occur, it is important that students are introduced to, and exposed to the value and necessity of quality improvement early in their careers. The aim of this study was to explore the perspectives and experiences of medical students and their mentors after undertaking quality improvement projects within the healthcare setting, and if such practice-based experiences were an effective way of building improvement capacity and changing practice. Read More

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http://dx.doi.org/10.1136/bmjoq-2018-000420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135436PMC
September 2018
2 Reads