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Objective: Healthcare professionals were the workers most affected by Covid-19, espe-cially during the first waves of the pandemic. Thus, the aim of this study is to evaluate the perceived risk of exposure to Covid-19, the information received and the work participation between nurses, physicians and nursing assistants. Method(s): A cross-sectional study was conducted using an epidemiological survey among nurses, physicians and nursing assistants in a university hospital. Aspect and content validation, cognitive pretest, and piloting of the epidemiological survey was carried out with thirty subjects. A descriptive analysis was per-formed using mean and standard deviation (SD) for quantitative variables and absolute (n) and relative (%) frequencies for qualitative variables. The chi-square test and the ANOVA test were applied to assess the association of the responses with the variables: sex, type of worker, area of work and activity in Covid-19 Units. Result(s): Nurses, physicians and nursing assistants worked mainly in assistance areas and high risk of exposure units. Nursing assistants and nurses had a higher perception of risk. Nurses were less involved in the organiza-tion, but felt more supported by their colleagues. However, physicians felt more supported by their superiors and better care when they had a health problem. Conclusion(s): Nursing assistants and nurses presented higher risk perception, nurses were less involved in the organization of health care, while physicians felt more supported by their superiors.Copyright © 2023, Fundacion Index. All rights reserved.
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Introduction: Families of patients admitted to the Intensive Care Unit (ICU) experience significant emotional distress.1 Visiting restrictions mandated during the COVID-19 pandemic presented new barriers to family communication, including a shift from regular bedside nursing updates and in-person family meetings to scheduled, clinician-led telephone calls and video calls.2 This resulted in loss of non-verbal clues and feedback during family discussions, difficulties establishing rapport with families and risked inconsistent messages and moral injury to staff.3 Objectives: We aimed to design a system where all ICU family discussions were documented in one place in a standardised format, thereby clarifying information given to families to date and helping staff give families a consistent message. In addition, we aimed to provide practical advice for the staff making family update telephone calls and strategies for managing difficult telephone conversations. Method(s): We designed and implemented an ICU family communication booklet: this was colour-coded blue;separate to other ICU documentation within the patient notes;and included communication aids and schematics to help staff optimise and structure a telephone update. Using Quality Improvement methodology, we completed four Plan-Do-Study-Act (PDSA) cycles and gathered qualitative and quantitative feedback: this occurred prior to the project and at one,12,18 and 21 months post introduction. We implemented suggested changes at each stage. We designed staff surveys with questions in a 5-point Likert scale format plus opportunity for free comments. Twenty-one months post implementation, we designed and delivered an MDT awareness campaign using the 'tea-trolley training' method,4 departmental induction sessions for new ICU doctors and nurses and a 'Message of the Week' initiative. An updated version of the booklet was introduced in February 2022 (Figure 1). Result(s): Staff survey results are shown in Table 1. Forty-six staff participated in tea trolley training, feedback form return rate 100%. Following feedback, the family communication booklet was updated to include the following: a prompt to set up a password;a new communication checklist at the front, including documentation of next of kin contact details, a prompt to confirm details for video calls, confirm primary contact and whether the next of kin would like updates during the night;consent (if the patient is awake) for video calls while sedated;information regarding patient property;prompt to give families our designated ICU email address to allow relatives to send in photographs to display next to patients' beds;prompts to encourage MDT documentation and patient diary entry. Conclusion(s): During unprecedented visiting restrictions in the COVID-19 pandemic, we implemented an ICU family communication booklet which has been so successful that we plan to use it indefinitely. We plan to further develop this tool by encouraging MDT involvement, seek further staff feedback in six months' time, incorporate this structure into our electronic patient information system when introduced and collect feedback from patients and their next of kin at our ICU follow up clinic. This communication booklet would potentially be reproducible and transferable to other ICUs and could be used as part of a national ICU family communication initiative.
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Background: Work stress among healthcare staff has been identified as an extensive problem already before the pandemic. To be able to treat the surge of COVID-19 patients in need of intensive care COVID-19 ICUs were swiftly set up and staffed. The aim of this study was to investigate what staff perceived as most stressful. Material(s) and Method(s): During spring 2020 up to 270 COVID-19 patients were simultaneously treated in ICU's in the greater Stockholm and Sormland regions, upholding 100 ICU beds pre-pandemic.1 Staff reactions to work in a COVID-19 ICU was collected in a survey. Nine causes for stress were scored on a five graded likert like scale from does not agree to fully agrees. 612 nurses and physicians, both regular ICU staff and newcomers, working in ICU's in 2 larger and 3 smaller hospitals responded, (response rate approx. 35%). Data was analyzed using structural equation modeling to calculate loading of each factor. Result(s): The highest scoring cause of stress was "making a mistake". "Getting infected" got the lowest score among the 9 predefined causes. Conclusion(s): Clinicians working in COVID-19 ICUs were generally confident not to get infected at work. Commitment to maintain patient safety and frustration not to live up to standards of care in this strained situation was reflected in "making a mistake" and "relatives cannot visit" scoring as the number one and three out of the nine causes of stress. Increased knowledge about work-related stressors is crucial, in order to prevent detrimental impacts of such stressors.
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Objective: Although these days the priority is to fight the Covid-19 pandemic, the importance of human papillomavirus (HPV) infection is not to be neglected. Mechanism: Cervical cancer is caused mainly by a chronic infection with one or more of the high-risk subtypes of HPV -most commonly a sexually transmitted disease acquired early in life. Most HPV infections go away on their own, but some can lead to a precancerous state that, if left untreated, can undergo complete neoplastic transformation. Findings in Brief: There is a hope that in the future the combination of screening tests with vaccinations against oncogenic strains of HPV will allow reductions in the percentage of those contracting cervical cancer. Conclusion(s): The importance of educational activities should be emphasized in developmental gynecology in the context of oncological prevention. The roles of both doctors and nurses are important here. During the Covid-19 Pandemic, these kinds of activities are not to be abandoned. In addition, efforts should be made to develop more practical and workable HPV and cervical screening strategies for use during a pandemic.Copyright © 2022 The Author(s). Published by IMR Press.
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Introduction: National Service Evaluations of COVID-19 ARDS care in the US and UK showed significant variability in clinical practice, and adherence to existing guidelines. To better understand the basis for this, we explored factors influencing decision-making around mechanical ventilation in COVID-19. Method(s): We conducted interprofessional focus groups identifying factors that influenced decision-making through thematic analysis. From this, we developed a questionnaire to validate these themes with a larger sample of critical care professionals across the UK. Kruskal- Wallis or Mann-Whitney U tests were used for data analysis. Result(s): There were 179 complete responses from doctors, nurses and physios. In their usual practice, 66% of clinicians reported adherence to national ARDS guidelines. However, 80% thought COVID-19 ARDS presented differently to their previous clinical knowledge/experience of ARDS and 72% thought deviating from usual practice was necessary. Doctors were more likely to think deviation was necessary (p < 0.001) but there was no difference across level of ICU experience (p = 0.845). Clinicians reported their ventilatory decision-making was most influenced by disease factors, followed by team then contextual and least by environmental factors (p < 0.001). Disease factor was seen as most important across profession and experience level. During COVID-19, 68% of clinicians reported not being confident in their ventilatory decision-making;however, clinicians who felt COVID-19 ARDS presentation fitted with their previous clinical knowledge/experience of ARDS reported greater confidence (p < 0.001). Confidence was not affected by experience (p = 0.522) or profession (p = 0.294) (Fig. 1). Conclusion(s): Clinicians were influenced by the uncertain understanding of COVID-19 ARDS, especially when they considered previous experiences to be less relevant. In the event of another novel disease, developing a consistent, understandable clinical models of disease should be prioritised to optimise decision making.
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Background: Clinical Trial Recruitment Support Systems can booster patient inclusion of clinical trials by automatically analyzing eligibility criteria based on electronic health records. However, missing interoperability has hindered introduction of those systems on a broader scale. Purpose(s): Our aim was to develop a recruitment support system based on FHIR R4 and evaluate its usage and features in a cardiology department. Methods/Implementation: Clinical conditions, anamnesis, examinations, allergies, medication, laboratory data and echocardiography results were imported as FHIR resources. Trial study nurses and physicians were enabled to add new and edit trial information and input inclusion and exclusion criteria using a web-browser user interface in the hospital intranet. All information were recorded on the server side as the FHIR resources ResearchStudy and Group . Eligibility criteria linked by the logical operation OR were represented by using multiple FHIR Group resources for enrollment. On the client side, eligibility criteria were transformed to a tree-like structure (see Figure 1). Upon user demand, all hospitalized and ambulatory patients in the cardiology department were instantly screened for trial eligibility using the FHIR eligibility criteria on the existing patients' FHIR resources. Furthermore, study personal was able to manually edit trial status (i.e. ineligible, on-study, ..) of patients, which was implemented using the FHIR resource ResearchSubject . Result(s): This implementation of a CTRSS based on FHIR R4 was evaluated in clinical practice: Beginning from 1st April 2021 the application was used as an additional patient screening tool for the four trials CLOSUREAF, FAIR-HF2, SPRIRIT-HF and TORCH-PLUS of the German Centre for Cardiovascular Research. As the COVID-19 pandemic is prohibiting any proper comparison of patient inclusion rates, efficacy of the recruitment support system was tested by comparing the numbers of patients identified by the recruitment support system and enrolled in a trial to the actual number of enrolled patients irrespective of the screening method from 1st April 2021 to 23rd November 2021. The system was able to identify 52 of 55 patients included in those four clinical trials. Conclusion(s): Use of FHIR for defining eligibility criteria of clinical trials may facilitate interoperability and allow automatic screening for eligible patients at multiple sites of different healthcare providers in the future. Upcoming changes in FHIR should allow easier description of OR -linked eligibility criteria. (Figure Presented).
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Objective: Can a way forward be created to establish baseline criteria to better assist aeromedical transport crews with optimizing care and increasing the probability of survival of acutely distressed women in their third trimester of pregnancy with SARS-COV-2 symptoms? Information has been derived from a mixed methods research approach. Pregnant individuals with SARS-COV-2 are at increased risk of intensive care unit admission, mechanical ventilation, and death compared with both pregnant individuals without SARS-CoV-2 infection and nonpregnant adults with SARS-CoV-2 infection1. Hypertensive disorders of pregnancy affect up to 20% of pregnancies in the United States and are leading causes of serious obstetric morbidity1. The focus of this research included nearly 2,400 pregnant women infected with SARS-CoV-2 and found that those with moderate to severe infection were more likely to have a cesarean delivery, to deliver preterm, to die around the time of birth, or to experience serious illness from hypertensive disorders of pregnancy, postpartum hemorrhage, or from infection other than SARS-CoV-2. They were also more likely to lose the pregnancy or to have an infant die during the newborn period. Mild or asymptomatic infection was not associated with increased pregnancy risks. Method(s): We intend to develop an algorithm based on current guidelines to smooth the transition of care from prehospital to intrahospital. We will use the guidelines set forth by The American College of Obstetrics and Gynecology (ACOG). In addition, we will take an example of the policies and procedures from a prehospital care aeromedical flight service for inclusion in our proposed treatment recommendation(s). Result(s): We will then use the guidelines to make an all-encompassing protocol to guide the whole trip from onset of symptoms to in hospital care. We believe that a protocol that encompasses the whole of both systems, prehospital flight and in hospital, will help to streamline patient care tasks and reduce the probabilities of morbidity and mortality. Conclusion(s): The aeromedical community should seek out partnerships with the appropriate entities to provide invaluable information about a critical time of transitioning the patient from the point of access to the healthcare system to the appropriate definitive care facility. The aeromedical community has specialized paramedics, nurses, and physicians with knowledge and experience that cannot easily be quantified. These efforts could result in treatment modalities addressing acute management intra/inter hospital upon initial publication and equip air medical personnel with additional critical care education and knowledge to take back to their perceptive communities to enhance the probability of survival with pregnant women adversely affected by SARS-COV-2.Copyright © 2022
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Background: In December 2020, the vaccination campaign against COVID-19 virus started around the world. The Israel Ministry of Health decided to use vaccines for COVID-19 from Pfizer/Biontech. Early studies with Pfizer COVID-19 vaccines reported that there was a risk of allergic reactions in Britan and several in USA. The patients who had allergic reactions to the vaccine reported prior history of various allergies. Due to these reports Israel Ministry of Health issued warnings cautioning patients with allergies regarding receiving the vaccine. The leading hypothesis was that one of the components of the vaccine, PEG or polyethylene glycol, was the cause of allergic reactions. This substance if found in many other medications.Following these developments, there was a flood of inquiries from the allergic patients in Israel Method: We established a call center in Sheba Medical Center that provided preliminary screening for inquiries from the public. The patients were divided into 3 groups: 1. Patients at low/medium risk level -These patients were vaccinated in the local clinics. Example of patients in this category included patients with allergic rhinitis, well controlled asthma, food allergies, insect venom allergy and mild drug allergy;2. Patients at high risk -These were the patients with more serious drug allergies, not related to PEG. These patients received COVID-19 vaccination under supervision at the Sheba Medical Center;3. Patients at very high risk -These patients had anaphylaxis or severe allergic reactions to IV medications, prior vaccines or PEG. They had a full evaluation at our allergy department including a thorough history and physical and specific allergy testing for PEG and Pfizer COVID-19 vaccine. Result(s): There were 810 patients over the age of 16, who were in high-risk group, and received vaccination in the hospital under supervision of a medical team including allergy physicians and nurses. 217 of these patients were categorized as very high risk and had a full allergy evaluation prior to the vaccination. Out of the patients in the very high risk group, only 5/217 (2.3%) were found to be allergic due to positive skin tests to the vaccine or one of its components. Of all the high risk patients 794/810 (98%) were vaccinated with no immediate response to the vaccine. The 16 patients (2%) had immediate allergic reactions and out of this group 6 (0.7% of total) had an anaphylactic reaction. Conclusion(s): This project describes how an effective algorithm can be established to deal with an urgent need to vaccinate majority of the population.Our data show that the risk of allergic reactions to the Pfizer COVID-19 vaccine is small even within allergic population and that most of the patients can receive the vaccine safely.
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During the coronavirus disease 2019 (COVID-19) pandemic, infectious disease control is of utmost importance in acute stroke treatment. This is a new situation for most stroke teams that often leads to uncertainty among physicians, nurses, and technicians who are in immediate contact with patients. The situation is made even more complicated by numerous new regulations and protocols that are released in rapid succession. Herein, we are describing our experience with simulation training for COVID-19 stroke treatment protocols. One week of simulation training allowed us to identify numerous latent safety threats and to adjust our institution-specific protocols to mitigate them. It also helped our physicians and nurses to practice relevant tasks and behavioral patterns (eg, proper donning and doffing PPE, where to dispose potentially contaminated equipment) to minimize their infectious exposure and to adapt to the new situation. We therefore strongly encourage other hospitals to adopt simulation training to prepare their medical teams for code strokes during the COVID-19 pandemic.Copyright © 2020 Lippincott Williams and Wilkins. All rights reserved.
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During the COVID-19 pandemic, the World Health Organization (WHO) introduced guidelines with respect to hygiene practices, quarantine policies, and medical practices for health institutions to follow. Most studies examining compliance with WHO guidelines have been conducted at individual level but not at institutional level. This study investigates the availability of resources of health institutions in Iraq and their compliance with WHO COVID-19 guidelines. A total of 234 health workers, including physicians, nurses and medical technicians, were recruited in Babylon, Iraq. Self-reported number of health workers available in the health centre and the levels of compliance with the WHO's guidelines were assessed. Implementation of preventive measures for infected persons, fogging procedures, and having a crisis management team in the health centre were the top three common practices as recommended by WHO. There was a weak but significant positive relationship between the number of health workers in the healthcare centre and the levels of compliance with the WHO's COVID-19 guidelines (rho = 0.243, p < 0.05), indicating that manpower may determine the implementation of these guidelines. There is a correlation between the quantity of health workers and the levels of compliance with the WHO's COVID-19 guidelines, showing that it is important to ensure sufficient human resources available in the health centre to implement the standard practices. In addition, more financial resources are needed to provide sufficient protective equipment and disposable supplies to health workers in Iraq.Copyright © 2023 The Authors. World Medical & Health Policy published by Wiley Periodicals LLC on behalf of Policy Studies Organization.
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Introduction: Healthcare Professionals (HCPs) involved in managing Coronavirus Disease 2019 (COVID-19) pandemic were instructed to wear Personal Protective Equipment (PPE) to protect themselves from contracting virus. However, PPE use can sometimes lead to adverse events which create greater impact on health status of HCPs. Thus, the prevalence of adverse events and associated risk factors should be estimated for taking necessary preventive measures. Aim(s): To evaluate the prevalence of adverse events in HCPs due to PPE use during second wave of COVID-19 in Tamil Nadu, India. Material(s) and Method(s): A cross-sectional study was conducted in different levels of healthcare centres in Tamil Nadu, India, from April to May 2021. Data were collected using a pre-validated questionnaire from HCPs of any discipline who were directly involved in managing COVID-19 patients. A total of 282 responses were collected through Google forms and proportion of HCPs who experienced adverse events due to PPE and percentage of different adverse events associated with PPE wearing were assessed. Data were analysed using Chi-square test. Result(s): Out of 282 respondents of the survey included 224 doctors, 34 nurses and 24 lab technicians with a mean age of 30 years. There were 164 females and 118 males. A total of 177 (62.76%) participants experienced adverse events which included dehydration, thirst and heat, headaches, inability to go to restroom and other urinary/respiratory problems. With respect to duration of exposure to PPE, 163 (57.8%) HCPs had >6 hours/day and 102 (36.2%) had 4-6 hours/day. It was observed that factors such as age, gender, profession, various wards posted for COVID-19 duty and duration of PPE worn daily were significantly associated with adverse events to PPE (p-value<0.05). Conclusion(s): The results of the study concluded that higher prevalence of adverse events with PPE was seen among doctors and nurses. Most common encountered adverse events were dehydration, headache and skin problems, which have been associated with prolonged use of PPE.Copyright © 2023 Journal of Clinical and Diagnostic Research. All rights reserved.
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Background: Many women and pregnant women are front-line health care workers in the COVID-19 era and are worried about the possible impacts of COVID-19 on their fetuses. Due to the pressure and high working load on the healthcare workers during the COVID-19 crisis, the healthcare workers were potentially at risk of different types of mental health disorders. Objective(s): We aimed to evaluate the correlation between mental health status and the level of COVID19-related anxiety in pregnant healthcare workers in the COVID-19 era in Iran from August 2020 to December 2020. Method(s): This cross-sectional study included 64 pregnant clinical residents, general physicians, nurses and other medical staff who worked in hospitals in Iran, from August 2020 to December 2020 using an anonymous online survey available on the Google Form platform. The online survey consisted of socio-demographic questions, pregnancy-related questions, and questions about medical/drug history. The participants filled the Persian versions of General Health Questionnaire - 28 (GHQ-28) and Corona Disease Anxiety Scale (CDAS). Result(s): The participants' mean age and gestational age were 31.3+/-3.9 years, and 24.5+/-10.1 weeks respectively. Psychological problems were moderate (total score GHQ-28> 40) in 9.4% (n: 6) of pregnant healthcare workers. The frequency of moderate/severe problems in the four subclasses, including somatic symptoms, anxiety/insomnia, social dysfunction, and depression were 9(14.1%), 25(39.0%), 7(10.9%), and 10(15.6%), respectively. According to CDAS, 26.5% of participants had moderate to severe COVID-19-related anxiety. COVID-19-related anxiety and its subclasses, physical and psychological, were significantly correlated with the GHQ-28 total score and its subclasses, including somatic symptoms, anxiety/insomnia, social dysfunction, and depression among pregnant healthcare workers (p<0.01). Conclusion(s): According to the results of the current study, over 25% of pregnant health care workers have moderate to severe COVID-19-related anxiety;so, it is crucial for policymakers to focus on the mental health of pregnant health care workers during the COVID-19 pandemic.Copyright © 2023 Bentham Science Publishers.
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Background: Workplace violence (WPV) has consequences both for healthcare workers and healthcare organizations. Nurses are the most exposed healthcare workers to vertical WPV. Aims and Objectives: Describe the Italian WPV and identify its predictive factors. Method(s): This is a secondary analysis conducted in hospital pneumology settings from a larger study between January and April 2021. Data were collected through the Practice Environment Scale of the Nursing Work Index (PES-NWI;Likert scale 1 to 4) and the Violence in Emergency Nursing and Triage (VENT) Questionnaire. Result(s): The analysis was conducted on 484 pulmonary nurses (72.9% female;mean age 38.9 years, SD 9.8). Thirty-four per cent (n=164) of them have had an experience of WPV in last year and/or their last week and 16.7% (n=81) only in their last week. Comparing main results between nurses with WPV vs no WPV the number of patients was higher for nurses with WPV (MD +4.8;p<.001). The PES-NWI results were significantly worse for nurses with WPV: global mean scores (MD +0.2;p<.001);nurse participation in hospital affairs (MD +0.3;p<.001);nurse manager ability leadership, and support of nurses (MD +0.2;p<.001);physician-nurse relationship (MD +0.2;p<.001). Conclusion(s): Public health companies should reduce WPV by investing in resources for the management and prevention of the phenomenon. Integrated and multimodal programs of prevention and management of WPV are useful to combat it. Improving the work environment and job satisfaction should reduce WPV.
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Introduction: COVID-19 pandemic has affected the KMC practices in our SNCU. Lack of clear guidelines and training about continuing KMC in COVID-19 times has further lead to decrease in KMC practices. Method(s): This is a prospective single centered quality improvement study conducted in the inborn unit of a tertiary care hospital. Intervention phase was done in August and September 2020. Preterm mother-infant dyads who were admitted in the inborn Level 2 Neonatal care unit with birth weight less than 2000 grams were enrolled in this study. A QI team comprising of resident doctors, nurses and supporting staff and a lactation counsellor was formed. The potential barriers for prolonged KMC were evaluated using fish bone analysis. A variety of measures were introduced and subsequently tested by seven plan-do-study-act (PDSA) cycles. Data on percentage of initiation of KMC was measured by bedside nurses on daily basis and the data was plotted on run chart every week during implementation phase. Result(s): 116 eligible mother-infant dyads were studied during implementation period (50 days). We achieved our goal by step-wise implementation of changes through multiple PDSA cycles. The percentage of initiation of KMC among eligible preterm infants has increased from baseline of 43.4% to 83.3% and duration of KMC from 1.5 mean hours to 4.5 hours over a period of eight weeks. Conclusion(s): Ongoing quality improvement measures increased the percentage of initiation and duration of KMC among eligible preterm infants without addition of extra man power.Copyright © 2022 by author(s). This is an Open Access article distributed under Creative Commons Attribution License (CC BY NC ).
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The proceedings contain 31 papers. The topics discussed include: occupational health risk assessment (OHRA) tool for estimating occupational health risk;OH IH emerging risk preparedness - shutdown activities;annoyance among staff and noise in a tertiary care hospital in New Delhi, India: a pilot study;epidemiological study on occupational health psychology in doctors, nurses and physiotherapists in Anand, Gujarat;psychological impact and educational challenges of Covid-19 pandemic among teachers in Goa;practices during Covid-19 pandemic - a case study of refinery in oil and gas exploration industry;respiratory and auditory impairment among sponge iron plant workers, Goa, India: a comparison study;suspected trauma at work place causing axillary vein thrombosis: a case report;health status of workers and their families in selected brick kilns in Anekal Taluk, Bangalore Urban District, Karnataka;and occupational health problems and perceived health hazards among dairy farmers residing in Mugalur gram panchayat, Karnataka: a mixed method study.
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Background and Aims Since 2015, the medical intensive care unit (ICU) with a focus on hepatology of the Department of Internal Medicine 1 at the University Hospital Regensburg, Germany, has a particular emphasis on interprofessional collaboration with staf nurses and hospital pharmacists. Furthermore, there is a joint training and teaching of medical, nursing and pharmacy students within the intensive care training ward Regensburg (I'M A-STAR project). The study aims to investigate to what extent the newly introduced structural changes afect clinical and economic outcomes. Method We examined clinical performance data and consumption fgures for antibiotics and other drugs over a 10-year period from 2011 to 2021. An electronic platform was developed specifically to improve documentation. The years 2020 and 2021 were considered separately due to the COVID-19 pandemic and the care of numerous COVID-19 patients in the ICU. Results It could be shown that the pharmacist's recommendations regarding drug administration were mainly related to indication (43.6 %), dosage (27.6 %), interactions (9.4 %), and side effects (4.1 %). Antibiotic consumption was reduced by 12.2 % from 2015 to 2019. Encouragingly, this included a 23.4 % reduction in carbapenem use. Antibiotic spending was reduced by 24.9 % overall. In another analysis, antibiotic spending per case-mix point was calculated. While spending was EUR 60.22 per case-mix point in 2015, this could be reduced by 42.9 % to EUR 34.37 per case-mix point by 2019. Conclusion Through close interprofessional collaboration between physicians, staf nurses, and pharmacists, the consumption of antibiotics and other drugs was signifcantly reduced, thus improving patient care.
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Introduction Butterfly ward and Caterpillar outpatients within the International and Private Care division at Great Ormond Street Hospital look after children needing a wide range of specialty services including haematology, oncology, bone marrow transplant, immunology, gene therapy, and thymus transplant. It has been a longstanding practice within the division to ensure the delivery of high-quality patient care using collaborative efforts when reviewing incident reports. Methods To strengthen this partnership, we have continued weekly Datix Review Meetings (DRMs) through the coronavirus pandemic. Our aim is to discuss as a multidisciplinary team (MDT) 1 to 2 incidents per week followed by identifying specific learning objectives. Virtual meetings are led by Butterfly ward manager or matron with participation from the ward consultant, pharmacists, ward doctors, nurses in charge, and practice education team who facilitate the distribution of learning. Knowledge disseminated across the MDT takes the form of meeting notes linking to Trust policies, 'Take 3' measures and bite-sized education at safety huddles, 1:1 teaching sessions with ward staff, other written resources, and tailored local inductions. Results Weekly DRMs have contributed to increased patient safety in our clinical areas. It has increased patient satisfaction with positive comments from Friends and Family forms. We have seen better teamwork and communication across the MDT as it has allowed for the sharing of cohesive working strategies, including MDT presence at safety huddles. We have also received positive feedback when onboarding new staff due to the tailored education provided. Discussion & Conclusion Weekly DRMs have promoted discussing incidents without engaging in blame culture. This initiative has put patient safety at the forefront of our practice by strengthening both collective partnerships and individual teams. Ongoing work is being done to drive education in proactive ways with the aim to reduce the number of incidents within our directorate.
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The COVID19 pandemic resulted in lock-downs and reduction of social interactions to reduce the risks of disease transmission. Routine medical services were affected and telemedicine was rapidly adopted for the diagnosis, monitoring, and treatment of many chronic diseases including hypertension. We look at the considerations for the design and set-up of telemedicine for the management of hypertension. Many aspects need attention in order to ensure a safe, reliable, and effective program. Many regulatory agencies developed guidelines, advisories, regulations, and legislation to manage telemedicine. We examine some of these guidelines and their differences in South East Asian countries. Often, the professional clinical service standards in telemedicine are maintained by the state medical boards or councils. Additional training or certification and licensure is needed prior to providing telemedicine services. In-person visits are required when remote consultations cannot meet the professional clinical standards. Because telemedicine can traverse national boundaries, different regulators differ in their approach to the provision of telemedicine services to overseas patients. Nonetheless, the doctor must meet the same standard of care for overseas patients. Also, practice insurance will need to explicitly cover the practice of telemedicine especially for overseas patients. Besides the professional clinical standards, telemedicine differs by technology platforms, communication devices, software, and blood pressure monitoring devices. These varied devices and software require further evaluation of technical standards for safety, reliability, data privacy, storage, transmission, and licensure. Some of the guidelines also cover the need for quality improvements and technology upgrades. Regardless, there have been many studies of telemedicine in hypertension covering many aspects of care. Some can be simpler telemonitoring of blood pressure to highly sophisticated ones with devices linked to personal communicators (usually cellphone) with feedback to healthcare professionals (doctors, nurses, dietitians, pharmacists) and tagged to clinical interventions to improve the control of hypertension. Reviews of these studies show that hypertension telemedicine programs are effective but the evidence may be available in different practice settings and patient types, thus, complicating the design and recommendations. Therefore, it is important to review the type of practice and patients, determine which aspects are lacking to be targeted, and designing a good program. A good program will lead to better clinical outcomes, patient satisfaction, lower cost, reduced manpower for delivery of care, and convenience all round. Clinical practice guidelines and undergraduate and postgraduate medical training need to encompass telemedicine for the future.
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Study goal: Palliative care is an essential part of a complex approach to patients in the intensive care unit (ICU). This study aimed to describe palliative care practice in ICU in the Czech Republic. Study type: a cross-sectional, questionnaire study Material and methods: The inclusion criteria for study participation were nurses or physicians taking care of patients in the ICU for patients with Coronavirus Disease 2019 (COVID-19). The participants could participate by filling out the electronic survey with 40 questions. The questionnaire was evaluated by descriptive statistical analysis. Results: 313 questionnaires were analyzed. Participants reported up to 15 different terms for end-of-life care, the most often being palliative care (75.1%, n=235). The supportive care, especially sedatives, was most frequently adjusted according to the patient's needs. On the other hand, as a standard approach, the parenteral (35.8%, n=112) and enteral (17.3%, n=54) nutrition were most often withdrawn. Regarding organ support, renal replacement therapy (69.7%, n=218) and vasopressors (60.4%, n=189) were often withdrawn. The most rarely withdrawn organ support was artificial ventilation (24.6%, n=77), endotracheal intubation (11.5%,n=36), and tracheostomy cannula (2.9%, n=9). The majority of respondents would appreciate further education in palliative care. Conclusion: Palliative care is an essential theme not only in the COVID-19 pandemic. The palliative care terminology and practice used in the Czech Republic are heterogeneous. There is a space for further research and education in palliative care.
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Background: Misuse of antimicrobials combined with poor infection prevention and control (IPC) can result in antimicrobial resistance (AMR). Health partnerships are ideally placed to enhance antimicrobial stewardship (AMS) through sharing up-to-date evidence and implementing best practice. Purpose(s): Brighton Lusaka Pharmacy Link (BLPL) was awarded a Commonwealth Partnerships for Antimicrobial Stewardships Scheme (CwPAMS) grant to implement AMS at University Teaching Hospital (UTH) (THET, 2020). Pharmacists-led AMS prescribing and monitoring activities aim to implement a robust data collection system and measure the impact of interventions reducing misuse and overuse of antibiotics while increasing knowledge about on IPC and AMS. Method(s): BLPL conducted a three-day workshop in Zambia for pharmacists, physicians, nurses and allied healthcare professionals at UTH to enhance AMS and point prevalence surveillance (PPS). IPC training was provided by the experienced Ndola IPC team. Train the trainer workshops enables UTH to disseminate AMS, PPS, IPC and data collection standards. Result(s): Proactive MDT committee to manage AMS and IPC activities at UTH was established Specialist AMS pharmacist appointed Two Global-PPS undertaken Modified antibiotic prescribing chart introduced and audited-UTH antimicrobial guidelines updated AMS modular training programme for health care accredited by UNZAforCPD recognition-34 IPC trainers trained Bare-below-the-elbow dress code (BBE) adopted nationally by HOPAZ WHO hand-rub production expanded Conclusion(s): This model of pharmacist-led AMS demonstrates sustainability in locally driven AMS knowledge and seeded national IPC capacity-building whilst instigating behavioural change pertinent during the COVID-19 pandemic.