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2.
Archives of Disease in Childhood ; 106(SUPPL 1):A218, 2021.
Article in English | EMBASE | ID: covidwho-1495068

ABSTRACT

Background This project was undertaken at a large tertiary teaching hospital involving members of the multi-professional team involved in patient care during the COVID-19 pandemic. Early on, we realised that much of our information distribution relied on emails and face-to-face meetings. With rapidly changing guidelines and recommendations, quantity of information to distribute became overwhelming. Staff were receiving multiple, daily trust-wide and department-specific emails. There was huge information overload, resulting in miscommunication. Objectives 1. To provide up-to-date information that has been appraised for accuracy, relevance and importance 2. Increase effectiveness in information distribution - identify relevant recipients, timely distribution, minimising information overload, and creating a repository for reference Methods Our QI methodology is based on the model for improvement framework and PDSA cycles. PDSA cycle 1: Identifying stakeholders, and a preferred method of communication . Stakeholders were identified and engaged. . Baseline data was taken from the trust's internal communication survey data . We agreed on a trial information distribution via an intranet page PDSA cycle 2: Implementation of the Covid-19 intranet page . Paediatric Consultant led the design of the webpage, including content, location and structure. . The webpage was reviewed using Dalhouse university criteria. . Informal feedback was regularly sought from stakeholders to upkeep the webpage. A formal survey was could not be completed at 3 months due to staff redeployment. PDSA cycle 3: Improving awareness of the intranet page - in progress. . The intranet page was advertised in induction for new staff and disseminated in the monthly staff bulletin. . Survey was performed at 6 months to collect quantitative and qualitative data to assess staff use and satisfaction Results PDSA cycle 1: We identified staff bulletins, emails, intranet and team meetings as staff 's preferred methods of communication. 51% of respondents reporting using the intranet daily, and a further 29% using every few days. 90% rated the intranet as a useful resource. PDSA cycle 3: Survey data showed that 75% reported accessed the website, with 61% of these using it on a weekly basis. It was mostly accessed for information for staff, PPE guidance and testing policies. The website was rated highly for accuracy, ease of access, useful and up-to-date information. All topics were rated useful and respondents were highly likely to recommend it to other colleagues. Qualitative responses were assessed with word clouds. The 3 main words were as follows: key successes - easy, organised, relevant;areas for improvement: awareness, reminders, layout. Of the 25% that did not use the webpage, all cited lack of awareness as the reason. Conclusions These were unprecedented times with rapidly changing guidelines. Creation and distribution of easily accessible up-to-date information to colleagues was increasingly important. Creating a central point of reference worked well for a large hospital where the staff base changes regularly and already have saturated email inboxes. Ensuring that information was aimed at all members of the MDT provided streamlined and unified information.

4.
Anesthesia and Analgesia ; 133(3 SUPPL 1):9-10, 2021.
Article in English | EMBASE | ID: covidwho-1378768

ABSTRACT

Background Perioperative anaemia is independently associated with adverse outcomes such as increased length of stay, complications and mortality1. Around 40% of patients presenting for major surgery are anaemic2. The most common cause of preoperative anaemia is iron deficiency, which can be treated with iron therapy. Identifying patients with anaemia during the perioperative pathway allows for optimisation and prevention of blood transfusions. A key focus of the Perioperative Quality Improvement Programme (PQIP) in the UK is the management of perioperative anaemia3 and recommendations have been made for institutions to set up a perioperative anaemia management service. Methods Data was retrospectively collected from electronic patient health records, which are maintained by the anaemia and research nurses at our centre. We analysed the relevant data to assess the delivery of the perioperative anaemia service from 2018-2020. Results We identified 1391 patients who received IV iron infusions from 2018-2020. 65% of the patients were females. Iron (III) Isomaltoside (Monofer) was the choice of IV iron preparation during all three years, however, there was an increasing use of Ferric Carboxymaltose (Ferrinject) in 2020. Overall number if iron infusions increased steadily and doubled from 2018 to 2020 (see Image 1a). Across the 3 years there was an 18% increase in perioperative iron infusions in surgical patients. This was seen most predominantly in patients having major intra-abdominal surgery (54% increase) (see image 1b). Due to the COVID-19 pandemic restrictions, the iron infusion service was modified to deliver iron infusions post-operatively. Subsequently, a significant proportion of surgical patients (71%) received iron infusions in the post-operative period. Discussion In our centre a perioperative anaemia and iron infusion service has been established for almost four years. This service is coordinated by a consultant anaesthetist, an anaemia specialist nurse and perioperative anaesthesia fellows. It is feasible to operate a perioperative anaemia service for several surgical specialities with the intention of improving patient outcomes. Our preliminary data shows an improvement in haemoglobin levels following iron infusion. However, we await further analysis to assess whether this has resulted in a reduction in blood transfusions. A well-coordinated service at our centre will help guide quality improvement projects and future research.

5.
Anesthesia and Analgesia ; 133(3 SUPPL 1):14-15, 2021.
Article in English | EMBASE | ID: covidwho-1378767

ABSTRACT

Background Preoperative anaemia affects a high proportion of patients undergoing major elective surgery and is associated with poor outcomes1. At our centre a pre-operative intravenous iron service was the established practice before the COVID-19 pandemic. However, the effects of the pandemic, social distancing and requirements for patient shielding resulted in a shift of our service to post-operative iron infusions. Methods A trust quality improvement service evaluation form was submitted for a retrospective analysis. We identified patients who had received IV iron infusion in the year 2020 via the patient electronic health records system. We aimed to look at the feasibility of a post-operative IV iron Infusion service. Results We retrieved data for 733 patients. The distribution of Iron infusions across our patient cohort is shown below in image 1. 594 ( 81%) infusions were for patients undergoing surgical procedures, whilst 139 (19%) were delivered for medical reasons in the outpatient setting. Image 2 shows the iron infusion distribution by surgical sub-specialities. The highest number of infusions were given to patients undergoing major intra-abdominal surgery (43.4%). In the surgical patient group, 171 received iron pre-operatively, and 423 received iron post-operatively (Image 3). Increments in Transferrin saturations and ferritin in both the pre and post-operative iron infusion groups were comparable. The increments in Haemoglobin (Hb) in both the groups were not significantly different ( P= 0.79). Discussion There is limited evidence to show the benefits of post-operative IV iron infusion2. Although our data did not reveal any significant difference in Hb increments in the pre or post-operative iron infusion groups, this demonstrates that a post-operative iron infusion service is feasible. Iron infusions can be successfully delivered to patients when it is not possible to do so pre-operatively. The non-significant increments could also be due to post-operative test values taken at discharge and not allowing enough time to have elapsed between blood test and an increment to have occurred. We noted that greater iron transfusions were administered in female patients and this could potentially be attributed to a lower starting Hb in this group. In the current climate, the benefits of post-operative iron infusion are favourable to prevent an additional patient visit, particularly when the demonstrated Hb increments are comparable to the pre-operative setting.

6.
Rheumatology (United Kingdom) ; 60(SUPPL 1):i40-i41, 2021.
Article in English | EMBASE | ID: covidwho-1266165

ABSTRACT

Background/AimsIndividuals on immunosuppressive therapies were among thoseidentified by the UK Department of Health and Chief Medical Officeras clinically extremely vulnerable to COVID-19. Advice on shieldingfrom infection was disseminated by NHS England, primary care andNHS hospital trusts to those identified at highest risk. The BritishSociety for Rheumatology (BSR) developed further risk stratificationguidance specifically focused on autoimmune rheumatic disease. As the UK entered a period of nationwide lockdown on 23rd March 2020, the clinically highly vulnerable group were asked to shield frominfection by staying at home and avoiding any face-to-face contact foran initial period of 12 weeks. The implications of social isolation, disruption to planned medical care and economic consequencesbecame increasingly recognised. This work aimed to understand theexperience and wellbeing of this patient group during week 5 -6 of UKLockdown, as a guide to how we might best adapt services andaddress the needs of this group.MethodsShort semi-structured telephone interviews were conducted with 141patients during week five and six of UK lockdown, between 20th Apriland 1st May 2020. Participants were sampled systematically from thedepartmental biologic therapy database at Wexham Park Hospital, ageneral hospital providing services to a diverse population ofapproximately 450, 000 people in Berkshire and SouthBuckinghamshire.ResultsTelephone interview was conducted with 141 patients prescribedbiologic therapy. Written advice on risk and shielding was received byover 90%. Sixty four percent of respondents were female with amedian age of 56 years. Thirty-nine percent of those interviewed fellwithin highest BSR risk category for whom full shielding was highlyrecommended, yet at the time of interview 51.1% of respondentsreported they had committed to full shielding. Four percent ofrespondents self-identified as key workers and had continued theirusual commitments. Amongst those interviewed, 35% reportedsignificant adverse impact on their emotional and mental wellbeingwithin the first six weeks of UK lockdown. Isolation, uncertainty, limitedphysical exercise and cancellations to planned appointments werecommon themes. Twenty-eight percent of respondents felt theirdisease control had significantly deteriorated during the ongoingpandemic. Due to prevailing anxiety about the impact of immunosuppression on COVID-19 risk, 5% of patients had adjusted theirprescribed therapies without the direct supervision or clinical advice.ConclusionThis study gives initial insights into the behaviours and concerns ofpatients with autoimmune and inflammatory disease on biologictherapy during the first wave of COVID-19 in the UK. Wellbeing anddisease management have considerably suffered for many individuals.Further understanding patient experience may help guide restructuringof rheumatology services in next phase of the UK pandemic.

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