547 results match your criteria BMJ quality improvement reports[Journal]


Improving medicines reconciliation rates at Ashford and St. Peter's Hospitals NHS Foundation Trust.

Authors:
Reshmee Doolub

BMJ Qual Improv Rep 2017 8;6(1):e000064. Epub 2017 Jun 8.

United Kingdom.

Medicines reconciliation is integral to patient safety, symptom control and reducing patient anxiety. During a 3-month period on the respiratory ward at St. Peter's Hospital, 54% of drug charts were not reconciled with pre-admission medicines at the point of discharge for admissions up to 17 days. Read More

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http://dx.doi.org/10.1136/bmjquality-2017-000064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5492467PMC
June 2017
24 Reads

Introducing a post-operative proforma for elective lower limb arthroplasty patients - improving patient care and junior doctor confidence.

BMJ Qual Improv Rep 2017 8;6(1):e000043. Epub 2017 Jun 8.

Royal United Hospital Bath.

The assessment of post-operative patients is vital to identify early complications and ensure patient safety. Good clinical record keeping is essential for effective continuity of care and patient safety in the post-operative period. A group of foundation year 2 (FY2) doctors noted a disparity in levels of confidence and ability in performing this assessment. Read More

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http://dx.doi.org/10.1136/bmjquality-2017-000043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5492475PMC
June 2017
1 Read

Improving patient blood management in obstetrics: snapshots of a practice improvement partnership.

BMJ Qual Improv Rep 2017 23;6(1):e000009. Epub 2017 Jun 23.

Australian National University Medical School, Garran ACT, Australia.

Iron deficiency and anaemia are common in pregnancy. Audit data from our tertiary obstetrics unit demonstrated 22% of maternity patients experiencing a postpartum haemorrhage received a transfusion; a third of whom were anaemic on admission intrapartum. Australian Patient Blood Management (PBM) Module 5 Obstetrics guidelines focuses on maximising red cell mass at the time of delivery and reducing the reliance on transfusion as a salvage therapy to treat blood loss. Read More

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http://dx.doi.org/10.1136/bmjquality-2017-000009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5492477PMC
June 2017
1 Read

Improving door to CT scanner times for potential stroke thrombolysis candidates - The Emergency Department's role.

BMJ Qual Improv Rep 2017 27;6(1). Epub 2017 Jun 27.

Ninewells Hospital Emergency Department, NHS Tayside, Scotland.

Stroke thrombolysis is an important treatment in the management of acute strokes. Its' effectiveness is reliant on prompt administration after stroke onset. Disability free survival at 3-6 months increases by 10% when administered within 3 hours. Read More

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http://dx.doi.org/10.1136/bmjquality.u211470.w4623DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522974PMC
June 2017
2 Reads

Reducing patient waiting time and length of stay in an Acute Care Pediatric Emergency Department.

BMJ Qual Improv Rep 2017 26;6(1). Epub 2017 Jun 26.

King Abdullah Specialized Children's Hospital-Pediatric Emergency Medicine, Riyadh, Saudi Arabia.

Prolonged waiting times and length of stay in Pediatric Emergency Department, are the two of the most challenging patient and clinical outcomes of healthcare institution. These emerged due to various reasons, namely: the use of triaging process and patient flow criteria that eventually lead to bottlenecks and overcrowding in the ED. After realizing the root causes of the prolonged waiting times and length of stay, the KASCH ED instigated a team to study the factors and thereby arrive at a considerable conclusion that will result in an improvement. Read More

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http://dx.doi.org/10.1136/bmjquality.u212356.w7916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522973PMC
June 2017
14 Reads
1 Citation

The use of a validated pre-discharge questionnaire to improve the quality of patient experience of orthopaedic care.

BMJ Qual Improv Rep 2017 16;6(1). Epub 2017 Jun 16.

South Tees NHS Trust, Middlesbrough, UK.

Patient experience is central to the delivery of excellent healthcare. As such it is enshrined within the 2015 NHS outcomes framework, a set of indicators against which quality in healthcare is measured. A variety of tools are available to quantify patient experience across clinical settings. Read More

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http://dx.doi.org/10.1136/bmjqir.w7046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522972PMC
June 2017
2 Reads

Acute kidney injury; improving the communication from secondary to primary care.

BMJ Qual Improv Rep 2017 23;6(1). Epub 2017 Jun 23.

Gloucestershire NHS Foundation Trust.

Acute kidney injury (AKI) is a common but preventable event in secondary care. It is known to be associated with poorer outcomes for the patient's future health. Patients therefore require specific after-care in the community following an AKI, both in the short and long term. Read More

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http://dx.doi.org/10.1136/bmjquality.u211147.w6661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483532PMC
June 2017
6 Reads

Reducing the number of unnecessary liver function tests requested on the Paediatric Intensive Care Unit.

BMJ Qual Improv Rep 2017 16;6(1). Epub 2017 Jun 16.

Great Ormond Street Hospital for Children, UK.

Between January and October 2014, Great Ormond Street Hospital Paediatric Intensive Care Unit (PICU) was spending an average £23,392 on blood tests per month. Blood tests should be requested based on previous results and the patient's clinical condition, medication and nutritional status. However, more blood tests were being ordered than clinically indicated: an audit in October 2014 showed liver function tests (LFTs) were requested daily on most patients, even with previous normal results. Read More

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http://dx.doi.org/10.1136/bmjquality.u214071.w5561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483531PMC
June 2017
4 Reads

The Handy Approach - Quick Integrated Person Centred Support Preparation.

BMJ Qual Improv Rep 2017 7;6(1). Epub 2017 Jun 7.

East London NHS Foundation Trust.

Cost effective care requires comprehensive person-centred formulation of solutions. The East London NHS Foundation Trust Community Health Services in Newham have piloted models of Integrated Care called 'Virtual Wards' which aim to keep people living with multiple long-term conditions, well at home by minimising system complexity. These Virtual Wards comprise Interdisciplinary Teams (IDTs) with a General Practitioner (GP) seconded to provide leadership. Read More

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http://dx.doi.org/10.1136/bmjquality.u214461.w5681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483530PMC
June 2017
68 Reads

Reducing DNA Rates and Increasing Positive Contacts in an Outpatient Chronic Fatigue Service.

BMJ Qual Improv Rep 2017 16;6(1). Epub 2017 Jun 16.

East London Foundation Trust, UK.

The Chronic Fatigue Service at East London NHS Foundation Trust recognised and coalesced around its major issue of engaging its service users. Using the systematic approach of quality improvement, and the infrastructure provided within East London NHS FT's quality improvement programme, it tested a number of change ideas which saw a significant reduction in non-attendance at appointments, an increase in patient cancellations when they could not attend, and an increase in positive contacts with the service. All these improvements surpassed the initial aims set within the project, and have been sustained over the course of 18 months. Read More

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http://dx.doi.org/10.1136/bmjquality.u212876.w5262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483529PMC
June 2017
16 Reads

Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm.

BMJ Qual Improv Rep 2017 15;6(1). Epub 2017 Jun 15.

Maastricht UMC+, the Netherlands.

In this controlled before-after study the effect of improvements, derived from Lean Six Sigma strategy, on parenteral medication administration errors and the potential risk of harm was determined. During baseline measurement, on control versus intervention ward, at least one administration error occurred in 14 (74%) and 6 (46%) administrations with potential risk of harm in 6 (32%) and 1 (8%) administrations. Most administration errors with high potential risk of harm occurred in bolus injections: 8 (57%) versus 2 (67%) bolus injections were injected too fast with a potential risk of harm in 6 (43%) and 1 (33%) bolus injections on control and intervention ward. Read More

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http://dx.doi.org/10.1136/bmjquality.u215011.w5936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483528PMC
June 2017
1 Read

A Multifaceted Quality Improvement Programme to Improve Acute Kidney Injury Care and Outcomes in a Large Teaching Hospital.

BMJ Qual Improv Rep 2017 25;6(1). Epub 2017 May 25.

Central Manchester University Hospitals NHS Foundation Trust.

Acute kidney injury (AKI) is now widely recognised as a serious health care issue, occurring in up to 25% of hospital in-patients, often with worsening of outcomes. There have been several reports of substandard care in AKI. This quality improvement (QI) programme aimed to improve AKI care and outcomes in a large teaching hospital. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjquality.u219176.w74
Publisher Site
http://dx.doi.org/10.1136/bmjquality.u219176.w7476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457974PMC
May 2017
5 Reads

Improving bowel preparation for colonoscopy in a cost effective manner.

BMJ Qual Improv Rep 2017 17;6(1). Epub 2017 May 17.

Cardiff & Vale university health board, Wales, United Kingdom.

Colonoscopy is a key investigation used to exclude large bowel pathologies including surveillance for CRC (Colorectal cancer) Poor bowel preparation (bowel prep) is one of the most important factors affecting its diagnostic yield. Different formulations of bowel prep are currently in use depending upon patient tolerance, indication & co-morbidities. In University Hospital Llandough we retrospectively reviewed the outcome of colonoscopies performed over period of 3 months, in relation to the type and outcome of bowel preparations used. Read More

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http://dx.doi.org/10.1136/bmjquality.u204560.w5376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457973PMC
May 2017
11 Reads

Improving inpatient care for older adults: Implementing Dementia Commissioning for Quality and Innovation (CQUIN).

BMJ Qual Improv Rep 2017 17;6(1). Epub 2017 May 17.

Royal Surrey County Hospital NHS Foundation Trust.

Dementia is a common condition, and people with dementia occupy around 25% of hospital beds. Commissioning for Quality and Innovation (CQUIN) is an NHS payment framework that links part of English healthcare providers' income to quality improvement. The dementia CQUIN goals are designed to encourage the recognition of dementia in hospital. Read More

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http://dx.doi.org/10.1136/bmjquality.u212202.w4875DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457972PMC
May 2017
3 Reads

Hydration Stickers - Improving oral hydration in vulnerable patients.

BMJ Qual Improv Rep 2017 25;6(1). Epub 2017 May 25.

Imperial College School of Medicine and Chelsea and Westminster NHS Trust, United Kingdom.

Dehydration is a growing problem among elderly patients in hospital wards. Incidents such as those raised in the Francis Report highlight a problem that may not have been sufficiently addressed by current schemes. This improvement project aimed to identify the barriers faced by staff in improving oral hydration and to design and implement an effective solution. Read More

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http://dx.doi.org/10.1136/bmjquality.u211657.w6106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457971PMC
May 2017
3 Reads

Increasing the uptake of electronic prescribing in primary care.

BMJ Qual Improv Rep 2017 25;6(1). Epub 2017 May 25.

Kings College London, UK.

Electronic prescribing is a form of paperless prescribing that is reported to reduce prescription mistakes and increases the cost effectiveness of the process. In England, around 1.5 million prescriptions are generated in general practice daily. Read More

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http://dx.doi.org/10.1136/bmjquality.u212185.w4870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457970PMC
May 2017
2 Reads

Proper Electronic Order Linkage of Electrocardiograms at a Large Children's Hospital Improves Reporting and Revenue.

BMJ Qual Improv Rep 2017 12;6(1). Epub 2017 May 12.

Cincinnati Children's Hospital, United States of America.

Electrocardiograms (ECGs) are performed to determine an individual's cardiac rhythm. Approximately 25,000 ECGs are performed yearly throughout our hospital system. Historically only 68% of all ECGs were performed with the proper order linked to the electronic ECG reading system (MUSE). Read More

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http://dx.doi.org/10.1136/bmjquality.u217231.w6746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457969PMC
May 2017
14 Reads

Choosing Wisely: A Quality Improvement Initiative to Decrease Unnecessary Preoperative Testing.

BMJ Qual Improv Rep 2017 23;6(1). Epub 2017 May 23.

Dartmouth-Hitchcock Medical Center, USA.

Dartmouth-Hitchcock Medical Center is a rural, academic medical center in the northeastern United States; its General Internal Medicine (GIM) division performs about 900 low and intermediate surgical risk preoperative evaluations annually. Routine preoperative testing in these evaluations is widely considered a low-value service. Our baseline data sample showed unnecessary testing rates of approximately 36%. Read More

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http://dx.doi.org/10.1136/bmjquality.u216281.w6691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457968PMC

Design and Implementation of a Trauma Care Bundle at a Community Hospital.

BMJ Qual Improv Rep 2017 17;6(1). Epub 2017 May 17.

McMaster University - Michael G. DeGroote School of Medicine.

The Niagara Health System (NHS) in Ontario, Canada is comprised of three non-designated trauma center (NTC) hospitals which provide primary care to approximately 100 trauma patients annually. NTCs often lack standardized resources such as trauma surgeons, trauma-trained emergency room physicians, Advanced Trauma Life Support certified staff, trauma protocols, and other resources commonly found at designated trauma centers. Studies indicate that these differences contribute to poorer outcomes for trauma patients treated at community hospitals in Ontario, including the NTC hospitals of the NHS. Read More

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http://dx.doi.org/10.1136/bmjquality.u218901.w5195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457967PMC

Evaluating the quality improvement impact of the Global Tracheostomy Collaborative in four diverse NHS hospitals.

BMJ Qual Improv Rep 2017 23;6(1). Epub 2017 May 23.

University Hospital South Manchester, UK.

Tracheostomies are predominantly used in Head & Neck Surgery and the critically ill. The needs of these complex patients frequently cross traditional speciality working boundaries and locations and any resulting airway problems can rapidly lead to significant harm. The Global Tracheostomy Collaborative (GTC) was formed in 2012 with the aim of bringing together international expertise in tracheostomy care in order to bring about rapid adoption of best practices and to improve the quality and safety of care to this vulnerable group. Read More

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http://dx.doi.org/10.1136/bmjquality.u220636.w7996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5457966PMC
May 2017
40 Reads

Increasing Patient Safety Event Reporting in an Emergency Medicine Residency.

BMJ Qual Improv Rep 2017 27;6(1). Epub 2017 Apr 27.

Midwest Healthcare Quality Alliance.

Patient safety event reporting is an important component for fostering a culture of safety. Our tertiary care hospital utilizes a computerized patient safety event reporting system that has been historically underutilized by residents and faculty, despite encouragement of its use. The objective of this quality project was to increase patient safety event reporting within our Emergency Medicine residency program. Read More

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http://dx.doi.org/10.1136/bmjquality.u223876.w5716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411728PMC
April 2017
2 Reads

Improving antimicrobial prescribing practice for sore throat symptoms in a general practice setting.

BMJ Qual Improv Rep 2017 27;6(1). Epub 2017 Apr 27.

Harrow CCG, London, UK.

Acute sore throat is a common presentation in primary care settings. We aimed to improve our compliance with national antibiotic guidelines for sore throat symptoms to 90% in 3 months' time period. The national guidelines are based on Centor criteria. Read More

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http://dx.doi.org/10.1136/bmjquality.u211706.w4738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411727PMC
April 2017
1 Read

Increasing Organ Donor Registration in a Primary Care Clinic.

BMJ Qual Improv Rep 2017 28;6(1). Epub 2017 Apr 28.

University of Toronto, Canada.

Only 30% of Ontarians are registered organ donors in spite of the vast unmet need for organ donations in Ontario, Canada. The purpose of this quality improvement (QI) initiative was to increase the number of registered organ donors in a primary care practice by providing an educational fact sheet and registration form to patients in the clinic's waiting room. Three Plan-Do-Study-Act (PDSA) cycles were conducted. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjquality.u222401.w83
Publisher Site
http://dx.doi.org/10.1136/bmjquality.u222401.w8341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411726PMC
April 2017
2 Reads

Gout in primary care: Can we improve patient outcomes?

BMJ Qual Improv Rep 2017 25;6(1). Epub 2017 Apr 25.

Sloan Medical Practice, Sheffield.

In the United Kingdom, gout represents one of the most common inflammatory arthropathies predominantly managed in the primary care setting. Gout is a red flag indicator for cardiovascular disease and comorbidity. Despite this, there are no incentivised treatment protocols and suboptimal management in the primary care setting is common. Read More

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http://dx.doi.org/10.1136/bmjquality.u210130.w4918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411725PMC
April 2017
3 Reads

Measuring and improving cervical, breast, and colorectal cancer screening rates in a multi-site urban practice in Toronto, Canada.

BMJ Qual Improv Rep 2017 27;6(1). Epub 2017 Apr 27.

St. Michael's Hospital, Canada.

Our Family Health Team is located in Toronto, Canada and provides care to over 35 000 patients. Like many practices in Canada, we took an opportunistic approach to cervical, breast, and colorectal cancer screening. We wanted to shift to a proactive, population-based approach but were unable to systematically identify patients overdue for screening or calculate baseline screening rates. Read More

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http://dx.doi.org/10.1136/bmjquality.u213991.w5531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411724PMC
April 2017
28 Reads

REDucing Unnecessary Coagulation Testing in the Emergency Department (REDUCED).

BMJ Qual Improv Rep 2017 2;6(1). Epub 2017 May 2.

Department of Medicine, Department of Laboratory Medicine and Pathobiology, Department of Emergency Medicine, Division of Hematology/Oncology, Li Ka Shing Knowledge Institute St. Michael's Hospital, Toronto, Ontario, Canada.

The PT/INR (prothrombin time/international normalized ratio) and aPTT (activated partial thromboplastin time) were tests developed in the early 20th century for specific and unique indications. Despite this, they are often ordered together routinely. The objective of this study was to determine if a multimodal intervention could reduce PT/INR and aPTT testing in the emergency department (ED). Read More

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http://dx.doi.org/10.1136/bmjquality.u221651.w8161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411723PMC
May 2017
5 Reads

Improving access for Urgent patients in Paediatric Neurology.

BMJ Qual Improv Rep 2017 27;6(1). Epub 2017 Apr 27.

Hamad Medical Corporation, Qatar.

Referral and flow management is an important part of outpatient care; some patients require to be seen earlier than the next available appointment because of the nature of their presentation. We did not have a clear pathway for urgent patients being referred to our pediatric neurology service. When we reviewed this process in our Quality Improvement meeting we identified wide variation in the length of time such patients wait to be seen in clinic ranging from 2 to 11 weeks. Read More

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http://dx.doi.org/10.1136/bmjquality.u209266.w4648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411722PMC
April 2017
6 Reads

SWITCH: Al Wakra Hospital Journey to 90% Hand Hygiene Practice Compliance, 2011 - 2015.

BMJ Qual Improv Rep 2017 27;6(1). Epub 2017 Apr 27.

Al Wakra Hospital, Hamad Medical Corporation, Qatar.

Hand Hygiene is the cheapest and simplest way to prevent the spread of infection, however international compliance is below than 40% (WHO, 2009). In the experience of Al Wakra Hospital, the improvement in hand hygiene compliance highlighted not just interventions towards training and education but also behavioral motivation and physical allocations of hand hygiene appliances and equipment. Through motivating the behavioral, emotional, physical and intellectual dimensions of the different healthcare worker professions, hand hygiene compliance has increased from 60. Read More

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http://dx.doi.org/10.1136/bmjquality.u211699.w4824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411721PMC
April 2017
71 Reads

Introducing a New Junior Doctor Electronic Weekend Handover on an Orthopaedic Ward.

BMJ Qual Improv Rep 2017 28;6(1). Epub 2017 Apr 28.

Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, UK.

Junior Doctors working on the Orthopaedic wards at a district general hospital identified the lack of a formal weekend handover. The Royal Colleges,GMC and Foundation Programme curriculum all emphasise the importance of a safe and effective handover. Doctors found that the current system of using a written, paper-based handover was unreliable, un-legible, and inefficient. Read More

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http://dx.doi.org/10.1136/bmjquality.u212695.w5059DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411720PMC

Transitional care management in the outpatient setting.

BMJ Qual Improv Rep 2017 27;6(1). Epub 2017 Apr 27.

Analiza Baldonado DNP FNP-C MSN/ED CCRN, Ofelia Hawk MSN RN, Thomas Ormiston MD FACP, Danielle Nelson MD MPH.

Patients who are high risk high cost (HRHC), those with severe or multiple medical issues, and the chronically ill elderly are major drivers of rising health care costs.1 The HRHC patients with complex health conditions and functional limitations may likely go to emergency rooms and hospitals, need more supportive services, and use long-term care facilities.2 As a result, these patient populations are vulnerable to fragmented care and "falling through the cracks". Read More

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http://dx.doi.org/10.1136/bmjquality.u212974.w5206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411719PMC
April 2017
35 Reads

Reducing returns to theatre for neck of femur fracture patients.

BMJ Qual Improv Rep 2017 27;6(1). Epub 2017 Apr 27.

Royal United Hospitals Bath, United Kingdom.

The Royal United Hospital, Bath, admits approximately 550 patients with neck of femur fractures per year. The risks from returning to theatre for this patient group are often life-threatening. Post-operative wound ooze was noted to cause a significant rate of return to theatre, with increased lengths of stay and patient morbidity. Read More

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http://dx.doi.org/10.1136/bmjquality.u215756.w6261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411718PMC
April 2017
9 Reads

Use of Electronic Clinical Decision Support and Hard Stops to Decrease Unnecessary Thyroid Function Testing.

BMJ Qual Improv Rep 2017 28;6(1). Epub 2017 Apr 28.

New York Methodist Hospital, USA.

NewYork-Presbyterian Brooklyn Methodist Hospital embarked on a Zero Unnecessary Study (ZEUS) initiative, whereby all aspects of clinical care were evaluated and strategies were implemented to mitigate waste. An opportunity was found in regards to thyroid function testing. It has been shown that certain TFTs are ordered far more often than clinically indicated. Read More

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http://dx.doi.org/10.1136/bmjquality.u223041.w8346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411717PMC
April 2017
9 Reads

A Unified Electronic Tool for CPR and Emergency Treatment Escalation Plans Improves Communication and Early Collaborative Decision Making for Acute Hospital Admissions.

BMJ Qual Improv Rep 2017 25;6(1). Epub 2017 Apr 25.

Kings College Hospital, United Kingdom.

The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report 'Time to Intervene' (2012) stated that in a substantial number of cases, resuscitation is attempted when it was thought a 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision should have been in place. Early decisions about CPR status and advance planning about limits of care now form part of national recommendations by the UK Resuscitation Council (2016). Treatment escalation plans (TEP) document what level of treatment intervention would be appropriate if a patient were to become acutely unwell and were not previously formally in place at King's College Hospital. Read More

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http://qir.bmj.com/lookup/doi/10.1136/bmjquality.u213254.w66
Publisher Site
http://dx.doi.org/10.1136/bmjquality.u213254.w6626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411716PMC
April 2017
2 Reads

Reducing Central Venous Catheter Use in Peripheral Blood Stem Cell Donation: Quality Improvement Report.

BMJ Qual Improv Rep 2017 28;6(1). Epub 2017 Apr 28.

King Abdul-Aziz Medical City - Riyadh.

Peripheral blood stem cell (PBSC) collection from donors through apheresis has become the main source of stem cells for hematopoietic stem cell transplantation. This procedure requires a high blood flow venous access. A peripheral venous catheter (PVC), compared to a central venous catheter (CVC), is considered to provide safer venous access. Read More

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http://dx.doi.org/10.1136/bmjquality.u211975.w4817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411715PMC
April 2017
16 Reads

The Value of a Surgical Assessment Unit Ultrasound Facility.

BMJ Qual Improv Rep 2017 27;6(1). Epub 2017 Apr 27.

Plymouth Hospitals NHS Trust.

Ultrasound scan (USS) is a common and important mode of investigation for emergency surgical admissions. Delay in investigation often leads to delayed diagnosis and treatment, and possible extended length of stay (LOS), which has clinical, cost and service provision implications. We aim to investigate the clinical impact on patient care and the cost-effectiveness of a pilot Surgical Assessment Unit (SAU) USS facility. Read More

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http://dx.doi.org/10.1136/bmjquality.u209155.w3729DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411714PMC
April 2017
1 Read

Using real-time, anonymous staff feedback to improve staff experience and engagement.

BMJ Qual Improv Rep 2017 28;6(1). Epub 2017 Apr 28.

University Hospital Bristol NHS Foundation Trust, UK.

Improving staff engagement has become a priority for NHS leaders, although efforts in this area vary between organisations. University Hospital Bristol NHS Foundation Trust (UH Bristol) is a tertiary teaching hospital where concerns about staff satisfaction and communication were reflected in the 2014 staff survey. To improve staff engagement, a real-time feedback mechanism to capture staff experience and to facilitate feedback from local leaders, was developed and piloted using the Model for Improvement. Read More

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http://dx.doi.org/10.1136/bmjquality.u220946.w7041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411713PMC
April 2017
30 Reads

Improving Bisphosphonate Infusion Monitoring at Haematology Medical Day Unit.

BMJ Qual Improv Rep 2017 31;6(1). Epub 2017 Mar 31.

Epsom General Hospital, United Kingdom.

This project was started after an incident of bisphosphonate-induced hypocalcaemia in September 2015. As part of management of lytic bone lesions in patients with multiple myeloma were given either Zoledronic Acid or Pamidronate Disodium at our Haematology Day Unit. According to the British National Formulary (BNF), it is necessary to correct disturbances of calcium metabolism (e. Read More

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http://dx.doi.org/10.1136/bmjquality.u206586.w4692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388016PMC
March 2017
3 Reads

Elimination of Emergency Department Medication Errors Due To Estimated Weights.

BMJ Qual Improv Rep 2017 27;6(1). Epub 2017 Mar 27.

Midwest Healthcare Quality Alliance.

From 7/2014 through 6/2015, 10 emergency department (ED) medication dosing errors were reported through the electronic incident reporting system of an urban academic medical center. Analysis of these medication errors identified inaccurate estimated weight on patients as the root cause. The goal of this project was to reduce weight-based dosing medication errors due to inaccurate estimated weights on patients presenting to the ED. Read More

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http://dx.doi.org/10.1136/bmjquality.u214416.w5476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387986PMC
March 2017
6 Reads

Improving the safety of chemotherapy prescribing in oncology through the introduction of an assessment proforma.

BMJ Qual Improv Rep 2017 31;6(1). Epub 2017 Mar 31.

Belfast Health and Social Care Trust, UK.

Chemotherapy remains a high risk treatment with the potential to cause significant patient morbidity and mortality. In the UK the Manual for Cancer Services: Chemotherapy Measures provides national quality measures for essential elements that should be incorporated and documented in chemotherapy assessments. It was recognised that in the outpatient oncology chemotherapy unit in the Cancer Centre, Belfast City Hospital, Northern Ireland, that the written records of chemotherapy assessments were sub-optimal. Read More

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http://dx.doi.org/10.1136/bmjquality.u216501.w7906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387984PMC
March 2017
1 Read

Improving Catheter Associated Urinary Tract Infection Rates in the Medical Units.

BMJ Qual Improv Rep 2017 6;6(1). Epub 2017 Apr 6.

Sheikh Khalifa Medical City, United Arab Emirates.

Sheikh Khalifa Medical City (SKMC) in Abu Dhabi is the main tertiary care referral hospital in the United Arab Emirates (UAE) with 560 bed capacity with a high occupancy rate. SKMC senior management has made a commitment to make quality and patient safety a top priority. Preventing health care associated infections, including Catheter Associated Urinary Tract Infection (CAUTI), is a high priority for our hospital. Read More

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http://dx.doi.org/10.1136/bmjquality.u209593.w7966DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387977PMC
April 2017
79 Reads

Chasing the Golden Hour - Lessons learned from improving initial neutropenic sepsis management.

BMJ Qual Improv Rep 2017 31;6(1). Epub 2017 Mar 31.

Belfast Health and Social Care Trust, Northern Ireland, UK.

Neutropenic sepsis remains a time critical and potentially fatal complication of systemic anti-cancer therapy. A target 'door to needle' time of one hour for first dose empirical intravenous antibiotics continues to be promoted nationally. A baseline audit (June 2011) highlighted shortfalls in care in the Belfast Trust, with only 15% of patients receiving antibiotics within sixty minutes. Read More

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http://dx.doi.org/10.1136/bmjquality.u204420.w6531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387975PMC
March 2017
25 Reads

Improving Outpatient Clinic Experience for Core Medical Trainees.

BMJ Qual Improv Rep 2017 27;6(1). Epub 2017 Mar 27.

Royal Free Hospital.

Outpatient clinic experience is an important component of core medical training. Trainees are expected to attend up to 40 clinics, with a minimum requirement of 24, over the two-year programme. 1 Yet on a local and national level they have reported difficulties with attending even the minimum number of clinics, largely due to ward commitments and service demands. Read More

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http://dx.doi.org/10.1136/bmjquality.u221836.w8226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387956PMC

Hypokalaemia: Addressing human factors and improving education around prescription and administration of Intravenous(IV) Potassium infusion in Trauma and Orthopaedics.

BMJ Qual Improv Rep 2017 31;6(1). Epub 2017 Mar 31.

NHS Tayside, Scotland.

A high incidence of hypokalaemia was noted in Trauma and Orthopaedics of Ninewells Hospital. We sought to establish the reason behind this and implemented three PDSA cycles via questionnaires to 30 ward staff, both doctors and nurses over a 1 week period in December, February and July 2016. Key baseline measures include availability of IV fluids with 40mmol potassium on the wards, confidence prescribing or administering IV fluids with 40mmol potassium, necessity for cardiac monitoring during slow IV potassium replacement and recognition of confusion and learning need in this area. Read More

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http://dx.doi.org/10.1136/bmjquality.u213676.w7336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387944PMC

A Quality Improvement Approach to Standardization and Sustainability of the Hand-off Process.

BMJ Qual Improv Rep 2017 6;6(1). Epub 2017 Apr 6.

Stony Brook University, USA.

There is mounting evidence that communication and hand-off failures are a root cause of two-thirds of sentinel events in hospitals. Several studies have shown that non-standardized hand-offs have yielded poor patient outcomes and adverse events. At Stony Brook University Hospital, there were numerous reported adverse events related to poor hand-off during the transfer of patient responsibility from one resident caregiver to the next. Read More

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http://dx.doi.org/10.1136/bmjquality.u222156.w8291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387931PMC
April 2017
44 Reads

Introduction of a Microsoft Excel-based unified electronic weekend handover document in Acute and General Medicine in a DGH: aims, outcomes and challenges.

BMJ Qual Improv Rep 2017 16;6(1). Epub 2017 Mar 16.

Princess Royal University Hospital, King's College Hospital, UK.

On-call weekends in medicine can be a busy and stressful time for junior doctors, as they are responsible for a larger pool of patients, most of whom they would have never met. Clinical handover to the weekend team is extremely important and any communication errors may have a profound impact on patient care, potentially even resulting in avoidable harm or death. Several senior clinical bodies have issued guidelines on best practice in written and verbal handover. Read More

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http://dx.doi.org/10.1136/bmjquality.u212152.w5721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5361068PMC
March 2017
3 Reads

Electronic Printed Ward Round Proformas: Freeing Up Doctors' Time.

BMJ Qual Improv Rep 2017 20;6(1). Epub 2017 Mar 20.

Basildon and Thurrock University Hospitals NHS Trust, United Kingdom.

The role of a junior doctor involves preparing for the morning ward round. At a time when there are gaps on rotas and doctors' time is more stretched, this can be a source of significant delay and thus a loss of working time. We therefore looked at ways in which we could make the ward round a more efficient place by introducing specific electronic, printed ward round proformas. Read More

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http://dx.doi.org/10.1136/bmjquality.u212969.w5171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5361067PMC
March 2017
2 Reads

Systems for physical health care for mental health patients in the community: different approaches to improve patient care and safety in an Early Intervention in Psychosis Service.

BMJ Qual Improv Rep 2017 20;6(1). Epub 2017 Mar 20.

Avon and Wiltshire Mental Health Partnership NHS Trust, UK.

Patients with mental illnesses have a high rate of physical comorbidity, and specifically, those with psychosis are at an increased risk of cardiometabolic disease and shortened lifespans, due to medication, lifestyle and illness factors. There are recognised challenges with physical health care in this group. At baseline, no patients on the Bath and North East Somerset Early Intervention in Psychosis caseload had a fully completed physical health assessment. Read More

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http://dx.doi.org/10.1136/bmjquality.u209141.w3798DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5361066PMC
March 2017
3 Reads

A multifaceted approach to improving the quality of ENT Emergency Clinic referrals.

BMJ Qual Improv Rep 2017 20;6(1). Epub 2017 Mar 20.

Addenbrooke's Hospital, UK.

It is imperative that primary care referrals are directed to the appropriate secondary care service. Patients presenting to a primary care physician with ENT conditions may require review in an Emergency Clinic. The latter clinics provide patients with rapid access to secondary care, for urgent, yet non-life-threatening conditions. Read More

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http://dx.doi.org/10.1136/bmjquality.u206639.w6166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5361065PMC
March 2017
44 Reads

Impact of health portal enrolment with email reminders at an academic rheumatology clinic.

BMJ Qual Improv Rep 2017 7;6(1). Epub 2017 Mar 7.

Division of rheumatology, Sunnybrook Health Sciences Center, Canada.

Missed appointments reduce the quality, safety and efficiency of healthcare delivery. 'No-Shows' (NS) have been identified as a problem within the rheumatology clinic at Sunnybrook Health Sciences Center in Toronto, Ontario. NS were studied through a prospective chart review and telephone interviews. Read More

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http://dx.doi.org/10.1136/bmjquality.u214811.w5926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348589PMC
March 2017
23 Reads

Early Aspirin administration post Coronary Artery Bypass Graft Surgery - Changing hospital culture through a two-cycled audit.

BMJ Qual Improv Rep 2017 10;6(1). Epub 2017 Mar 10.

Liverpool Heart and Chest Hospital, United Kingdom.

"Early Aspirin" or a medium dose of aspirin 6 hours after Coronary Artery Bypass Graft (CABG) Surgery is strongly recommend by international guidelines (EACTS 2007/AHA 2011 guidelines, Level1a evidence) to protect venous graft patency. However, compliance with Early Aspirin prescription at our centre is poor due to long standing hospital cultural practices and lack of awareness. We completed a two-cycled retrospective audit of 53 (September 2015 Baseline), 65 (January 2016 First Cycle) and 58 (June 2016 Second Cycle) consecutive CABG patients. Read More

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http://dx.doi.org/10.1136/bmjquality.u211402.w6306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348588PMC
March 2017
2 Reads