ABSTRACT
AIM: To improve the care of patients presenting to the emergency department who are acutely dying or those in whom further disease-modifying treatment is not appropriate. DESIGN: A quality improvement report on the implementation of a modified Liverpool Care Pathway for the Dying Patient (LCP) in an emergency medicine department. SETTING: The emergency medicine department of Ninewells Hospital, Dundee. Ninewells Hospital is the tertiary referral and teaching hospital for the east coast of Scotland and North East Fife. KEY MEASURES FOR IMPROVEMENT: The pathway was introduced after a 2001 study and a 2003 audit showed that the department had an increasing role in the care of the acutely dying, but some inconsistency in approach. Key measures for improvement were to improve communication between staff, improve the consistency of care and improve the perceived quality of care given. Senior decision making remains a crucial element of the pathway. STRATEGIES FOR CHANGE: A modified LCP was developed and launched in November 2005. Change was managed via a series of meetings and a pilot process. Serial review and audit allowed ongoing quality review of the pathway and improvements. RESULTS: The care of the dying patient has become a more consistent and positive endeavour. Nursing staff are very satisfied with its use, and it is hoped that the LCP pathway can be developed further within the organisation. CONCLUSIONS: It has been a rewarding undertaking to improve the care of dying patients, but one which has taken time and has required consistent management of change to promote the positive outcomes.
Subject(s)
Emergency Service, Hospital/standards , Terminal Care/standards , Adult , Aged , Aged, 80 and over , Critical Pathways/standards , Drug Administration Schedule , Emergencies , Female , Humans , Length of Stay , Male , Medical Audit , Middle Aged , Patient Satisfaction , Quality of Health Care , Scotland , Young AdultABSTRACT
OBJECTIVES: Replacement amalgam restorations account for the largest single cost in the General Dental Services in Scotland. There is little practical advice available to practitioners on the maintenance and replacement of amalgam restorations. A distance learning package is being prepared for distribution to general dental practitioners in Scotland and this paper describes the initial stages in the development of the policy statements for the proposed package. METHODS: In the first stage proposals are being developed by a panel of dental academics using a modified Delphi technique. This technique is designed to produce a consensus view. Seventeen statements have been set out by the expert group. RESULTS AND CONCLUSIONS: While agreement was rapidly reached that 'ditching' of amalgam restoration margins did not justify their replacement and that repair was preferable to total replacement, some difficulty was experienced in arriving at a consensus view on the correct management of 'white spot' lesions at restoration margins and dentinal staining adjacent to amalgam restorations. The next stage in the development will be to present these statements to a selected panel of general dental practitioners and to develop their consensus view of the proposals, again using the Delphi technique.
Subject(s)
Dental Amalgam , Dental Restoration, Permanent/standards , Policy Making , Delphi Technique , Dental Caries/etiology , Dental Restoration, Permanent/adverse effects , Humans , Recurrence , Reoperation , Scotland , Surveys and Questionnaires , Tooth Discoloration/etiology , Tooth Fractures/etiology , Toothache/etiologyABSTRACT
A postal/telephone survey of 400 general dental practitioners working in the Greater Glasgow and Lanarkshire Health Board areas was carried out between May and September 1990. The aims were to monitor any changes in the use of sealant restoration techniques in the last year, to investigate the practitioners' perception of the effects of a distance learning programme on their techniques and to provide data on the use of the techniques in the final months of the 'old contract'. A response rate of 66.7% was achieved. Eighty-eight per cent of the group were placing sealant restorations. Dentists' perceptions of the impact of the distance learning programme were encouraging. In key areas of practice, 16-44% of the group reported changes in their clinical techniques as a result of reading the programme.
Subject(s)
Education, Dental, Continuing/methods , General Practice, Dental/education , Pit and Fissure Sealants/therapeutic use , Dental Fissures/prevention & control , Glass Ionomer Cements , Humans , Program Evaluation , Scotland , Surveys and QuestionnairesABSTRACT
A postal/telephone survey of 452 general practitioners working in the Greater Glasgow and Lanarkshire Health Board areas was carried out between March and June, 1989. The aim was to investigate the use of sealant restorations under section 6 of the National Health Service fee scale for general dental practitioners. Section 6 itemizes fees for fissure sealant, glass-ionomer cement plus sealant, composite resin plus sealant and the laminate restoration. A response rate of 83% was obtained. Eighty-one per cent of the respondents were placing sealant restorations, but less than half were using the laminate or sandwich technique. A wide variety of materials and curing lights were employed. Enamel etching times varied considerably and rubber dam was seldom used. Eighty-nine per cent indicated that they would welcome illustrated fact sheets demonstrating the use of sealant restorations.
