evolving patient safety framework at aga khan university hospital [AKUH]

Objective: To evaluate and improve the nursing competences in different fields

Study Design: A prospective analytic study

Place and Duration: An analysis of the concept of Dr. Donabedian's model of structure, process and outcome [SPO] at Aga Khan University Hospital, from 2005 to 2007

Methodology: Using Donabedian's Model of Quality Care of Structure, Process and Outcome [SPO] a Patient Safety Framework [PSF] was developed and implemented at Karachi, Aga Khan University Hospital, Pakistan. This newly-developed framework determined failures in structures and processes which were below benchmarks and improved patient outcomes through nursing practice

Results: After application of Patient Safety Model the Nursing staffing levels were improved to 88% to 90% from 76%, in 2006 and nurse staffing skill mix was 98-100% from 80% in 2006, and nursing competencies 90% from 70% in 2006. Fall rate was 0.103 percent in 2007 against the National Database of Nursing Quality Indicator [NDNQI] benchmark of 3.12, pressure ulcers decreased from 6.33 in 2003 to 4.76 in 2007 medication error rate was 5.5%, VAP reduced to 3.2, BSI rate 2.9 and patient satisfaction improved from 3.68 to 3.78 with nursing practice

Conclusion: Positive outcomes resulting from application of framework has resulted positive image of the nursing profession and more self respect on the part of individual nurses

Validity and reliability testing: Urdu translated modified response to symptoms questionnaire

To determine validity and reliability of the Urdu translated, modified "Response to symptoms questionnaire" [RSQ] among acute coronary syndrome [ACS] patients in Karachi. A qualitative, tool validation study. Two tertiary care hospitals in Karachi, the Aga Khan University Hospital, Karachi and the Karachi Institute of Heart Diseases, from December 2010 to April 2011. After making certain modifications, the original tool in English was translated into Urdu. Next, five cardiology experts evaluated the tool for its content and face validity. Test retest and inter rater reliabilities were computed for the RSQ using 5% of the total sample size of the parent study. Sufficient conceptual and semantic equivalence was found between the Urdu and English versions of the modified RSQ. Content validity index was calculated to be 1 for both relevance and linguistic clarity. Test retest and inter rater reliabilities were calculated to be 95.9% and K = 0.97, respectively. The Urdu translated modified RSQ has sufficiently acceptable content validity, test retest and inter rater reliability; hence, it should be used by the researchers for the evaluation of factors associated with pre-hospital delay among Urdu speaking ACS patient populations

Self-glucose monitoring and glycaemic control at a tertiary care university hospital, Karachi, Pakistan

To explore the association between Self Monitoring of Blood Glucose [SMBG] levels and improved glycemic control [HbAlc level] among type 2 diabetic patients, receiving oral hypoglycaemic agents and insulin, and to ascertain the factors influencing SMBG. Using Comparative cross sectional study design five hundred Type 2 diabetes patients through convenient sampling between 30-70 years were interviewed through a structured questionnaire in year 2006 and 2007 at AKUH Ambulatory setting. These 500 subjects were divided as 250 in case [doing SMBG] and 250 in control [not doing SMBG] groups. We identified that HbAlc value was maintained at good and fair levels in case [56%] as compared to controls [p=0.002]. There was a high association of SMBG with education level, as graduate and above were monitoring SMBG at high level as evident by [p=0.005]. Furthermore, there was a high association of SMBG with duration of diabetes as subjects having diabetics more than 5 years were monitoring their blood glucose level at frequent intervals [p=0.001]. In case, 96.8% subjects had knowledge about the target of fasting and random blood glucose in comparison to 91.6% subjects in controls. The frequency of blood sugar checking varied among all subjects in case group such as 55% checked their blood sugar occasionally, 26% monitored daily, and 13% twice a day and 3% checked their blood sugar before and after each meal. Self-monitoring of blood glucose levels was associated with clinically and statistically better glycaemic control regardless of diabetes type or therapy. Therefore, healthcare personnel must increase awareness on the importance of SMBG and strongly promote this practice among diabetic patients

nursing performance card - how it helps in improvement

Clinical indicators are measures that relate to specific clinical conditions, and are used to outline the trends in the clinical practices and identify gaps in practices. Benefit is gained if the data is analyzed and used to achieve sustained improvements in clinical practice. Nursing performance card indicates clinical indicators that have been evaluated and used to improve patient care, infection rates, and nursing development