Improving Hospital Infant Safe Sleep Compliance by Using Safety Prevention Bundle Methodology.

BACKGROUND AND OBJECTIVES: Sudden unexpected infant death often results from unsafe sleep environments and is the leading cause of postneonatal mortality in the United States. Standardization of infant sleep environment education has been revealed to impact such deaths. This standardized approach is similar to safety prevention bundles typically used to monitor and improve health outcomes, such as those related to hospital-acquired conditions (HACs). We sought to use the HAC model to measure and improve adherence to safe sleep guidelines in an entire children's hospital. METHODS: A hospital-wide safe sleep bundle was implemented on September 15, 2017. A safe sleep performance improvement team met monthly to review data and discuss ideas for improvement through the use of iterative plan-do-study-act cycles. Audits were performed monthly from March 2017 to October 2019 and monitored safe sleep parameters. Adherence was measured and reviewed through the use of statistical process control charts (p-charts). RESULTS: Overall compliance improved from 9% to 72%. Head of bed flat increased from 62% to 93%, sleep space free of extra items increased from 52% to 81%, and caregiver education completed increased from 10% to 84%. The centerline for infant in supine position remained stable at 81%. CONCLUSIONS: Using an HAC bundle safety prevention model to improve adherence to infant safe sleep guidelines is a feasible and effective method to improve the sleep environment for infants in all areas of a children's hospital.

Contribuições da auditoria para a gestão na atenção hospitalar: revisão integrativa / Audit contributions to management in hospital care: integrative review / Contribuciones de la auditoría a la gestión de la atención hospitalaria: una revisión integradora

Introdução: A auditoria em saúde é considerada um instrumento que permite auxiliar na gestão de serviços de saúde, e, por meio de sua aplicação, é possível obter um diagnóstico situacional para intervir com a finalidade de obter mudanças e melhorias. Objetivo: Analisar o conhecimento científico produzido sobre a auditoria e sua contribuição para a gestão na atenção hospitalar. Método: Revisão Integrativa realizada nas bases de dados LILACS, MEDLINE via PUBMED, SCOPUS, EMBASE e WEB OF SCIENCE no período de 2009 a 2019. Resultados: 18 artigos foram selecionados e agrupados em duas categorias "A auditoria na qualificação de processos gerenciais e assistenciais" que aborda o seu uso no processo educativo, na implantação de protocolos/diretrizes assistenciais, que possibilitam o planejamento e a tomada de decisão por parte do gestor e, a categoria "Auditoria e gestão de custos" que apresenta a contribuição em relação à adequação de custos e otimização dos recursos envolvidos na assistência ao paciente. Conclusão: A auditoria promove suporte na gestão hospitalar, principalmente em intervenções para revisão e melhorias de processos assistenciais favorecendo a ação educativa e reflexiva da prática profissional, bem como, redução de custos.(AU)

Introduction: Introduction: The health audit is considered an instrument that allows to assist in the management of health services, and, through its application, it is possible to obtain a situational diagnosis to intervene in order to obtain changes and improvements. Objective: To analyze the scientific knowledge produced on the audit and its contribution to hospital care management. Method: Integrative Review performed in the databases LILACS, MEDLINE via PUBMED, SCOPUS, EMBASE and WEB OF SCIENCE from 2009 to 2019. Results: 18 articles were selected and grouped into two categories "Audit in the qualification of management and care processes" that addresses its use in the educational process, in the implementation of care protocols/guidelines, that enable planning and decision-making by the manager and, the category "Audit and cost management" that presents the contribution in relation to the adequacy of costs and optimization of the resources involved in patient care. Conclusion: The audit promotes support in hospital management, mainly in interventions to review and imp...(AU)

Introducción: La auditoría de salud se considera un instrumento que ayuda en la gestión de los servicios de salud y, a través de su aplicación, es posible obtener un diagnóstico situacional para intervenir con el fin de obtener cambios y mejoras. Objetivo: Analizar el conocimiento científico producido sobre la auditoría y su contribución a la gestión de la atención hospitalaria. Método: Revisión Integradora realizada en LILACS, MEDLINE a través de las bases de datos PUBMED, SCOPUS, EMBASE y WEB OF SCIENCE de 2009 a 2019. Resultados: Se seleccionaron 18 artículos y se agruparon en dos categorías "Auditoría en la calificación de procesos de gestión y atención" que abordan su uso en el proceso educativo, en la implementación de protocolos / guías de atención, que posibilitan la planificación y toma de decisiones por parte del gerente, y la categoría "Auditoría y gestión de costos" que presenta la contribución en...(AU)

Applications of liquid biopsy in the Pharmacological Audit Trail for anticancer drug development.

Anticancer drug development is a costly and protracted activity, and failure at late phases of clinical testing is common. We have previously proposed the Pharmacological Audit Trail (PhAT) intended to improve the efficiency of drug development, with a focus on the use of tumour tissue-based biomarkers. Blood-based 'liquid biopsy' approaches, such as targeted or whole-genome sequencing studies of plasma circulating cell-free tumour DNA (ctDNA) and circulating tumour cells (CTCs), are of increasing relevance to this drug development paradigm. Liquid biopsy assays can provide quantitative and qualitative data on prognostic, predictive, pharmacodynamic and clinical response biomarkers, and can also enable the characterization of disease evolution and resistance mechanisms. In this Perspective, we examine the promise of integrating liquid biopsy analyses into the PhAT, focusing on the current evidence, advances, limitations and challenges. We emphasize the continued importance of analytical validation and clinical qualification of circulating tumour biomarkers through prospective clinical trials.

A importância dos registros de enfermagem no contexto avaliativo da auditoria / The importance of nursing records within the audit assessment context

Objetivo: Analisar a importância dos registros de enfermagem no contexto avaliativo da auditoria. Método: Trata-se de uma revisão integrativa da literatura realizada nas bases de dados LILACS, MEDLINE e BDENF, por meio dos descritores Auditoria de Enfermagem; Auditoria Clínica; Registros de Enfermagem; Anotações de Enfermagem e Enfermagem. A busca foi realizada de 12 de janeiro a 26 de fevereiro de 2018 e selecionados 17 artigos que compõem o estudo. Resultados: a importância dos registros de enfermagem no contexto avaliativo da auditoria se dá pela investigação da qualidade do cuidado prestado por meio das evidências proporcionadas nos registro/anotações de enfermagem no portuário do paciente, evitar prejuízos na continuação do cuidado, intensificar sugestões de implantações de valores educacionais por meio da educação continuada e permanente, resgatar os valores econômicos perdidos por glosas em contas hospitalares e promover a melhoria da qualidade da assistência. Conclusão: foi possível verificar que, mesmo sendo uma prática que deva ser realizada com qualidade, o processo de auditora ainda encontra muita fragilidade nas informações encontradas nos diversos registros do profissional de enfermagem, o que acarreta grandes prejuízos.

Objective: To analyze the importance of nursing records in the evaluative context of the audit. Method: This is an integrative literature review performed in the LILACS, MEDLINE and BDENF databases using the descriptors Nursing Audit; Clinical audit; Nursing records; Nursing and Nursing Notes. The search was performed from January 12 to February 26, 2018, selecting a total of 17 articles. Results: the importance of nursing records in the evaluative context of the audit is due to the investigation of the quality of care provided through the evidence provided in the nursing records/annotations in the patient's chart, avoiding losses in the continuation of care, intensifying suggestions for implantation of nursing care, educational values through continuing and continuing education, recovering the economic values lost by disallowances in hospital bills and promoting the improvement of the quality of care. Conclusion: it was possible to verify that, even though it is a practice that should be performed with quality, the audit process still finds a lot of fragility in the information found in the various records of the nursing professional, which causes great losses.

Orientações: Atividades Complementares EAD do Curso de Especialização em Auditoria do SUS

Prezado(a)s Aluno(a)s, Informamos que as aulas presenciais deste curso de especialização continuarão suspensas por tempo indeterminado, conforme determinação do Governo do Estado do Paraná. Para tanto, com o objetivo de alinhar a proposta de desenvolvimento das Atividades Complementares na plataforma AVASUS, que têm relação com a proposta de dispersão da estrutura curricular do curso, será realizada uma transmissão ao vivo (LIVE) no dia 27 de maio de 2020 a partir das 19h00. Para acessar ..... Contamos com a participação de todo(a)s! Att. Coordenação.

Especilização em Auditoria do SUS: entrevista Vinicius Filipak

Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review.

BACKGROUND: Laboratory tests and transfusions are sometimes ordered inappropriately, particularly in the critical care setting, which sees frequent use of both. Audit and Feedback (A&F) is a potentially useful intervention for modifying healthcare provider behaviors, but its application to the complex, team-based environment of critical care is not well understood. We conducted a systematic review of the literature on A&F interventions for improving test or transfusion ordering in the critical care setting. METHODS: Five databases, two registries, and the bibliographies of relevant articles were searched. We included critical care studies that assessed the use of A&F targeting healthcare provider behaviors, alone or in combination with other interventions to improve test and transfusion ordering, as compared to historical practice, no intervention, or another healthcare behaviour change intervention. Studies were included only if they reported laboratory test or transfusion orders, or the appropriateness of orders, as outcomes. There were no restrictions based on study design, date of publication, or follow-up time. Intervention characteristics and absolute differences in outcomes were summarized. The quality of individual studies was assessed using a modified version of the Effective Practice and Organisation of Care Cochrane Review Group's criteria. RESULTS: We identified 16 studies, including 13 uncontrolled before-after studies, one randomized controlled trial, one controlled before-after study, and one controlled clinical trial (quasi-experimental). These studies described 17 interventions, mostly (88%) multifaceted interventions with an A&F component. Feedback was most often provided in a written format only (41%), more than once (53%), and most often only provided data aggregated to the group-level (41%). Most studies saw a change in the hypothesized direction, but not all studies provided statistical analyses to formally test improvement. Overall study quality was low, with studies often lacking a concurrent control group. CONCLUSIONS: Our review summarizes characteristics of A&F interventions implemented in the critical care context, points to some mechanisms by which A&F might be made more effective in this setting, and provides an overview of how the appropriateness of orders was reported. Our findings suggest that A&F can be effective in the context of critical care; however, further research is required to characterize approaches that optimize the effectiveness in this setting alongside more rigorous evaluation methods. TRIAL REGISTRATION: PROSPERO CRD42016051941.

Effect of a prospective audit with intervention and feedback on Clostridioides difficile infection management.

Background Clostridioides difficile infections are associated with morbidity and mortality in several countries. Their increasing incidence and frequent recurrence make them an urgent public health threat. The lack of adherence to international treatment guidelines for Clostridioides difficile infections is a proven mortality risk factor. Objective To evaluate long-term prescribers' adherence to recommendations on the management of Clostridioides difficile infections and its impact on clinical outcomes after an educational and Clostridioides difficile-prospective audit with intervention and feedback period. Setting All patients admitted to a 1500-bed university hospital with positive Clostridioides difficile tests identified were included. Methods Data were collected retrospectively over a baseline period (May-November 2014) and prospectively over a Clostridioides difficile-prospective audit with intervention and feedback period (November 2015-May 2016) and an observation period (November 2017-September 2018). All Clostridioides difficile cases were reviewed by a Clostridioides difficile-prospective audit with intervention and feedback team composed of pharmacists, an infectious diseases specialist and a microbiologist to obtain a complete overview of patient records in each area of expertise. Main outcome measures Percentage of conformity to the protocol, percentage of recovery at 10 days and percentage of relapse, as well as Clostridioides difficile incidence and percentage of Fidaxomicin use. Results A total of 183 patients were included over the three periods. A significant improvement in conformity to the local protocol was observed between the intervention period (23.9%) and the observation period (67.3%) (P < 10-3). Fidaxomicin prescriptions increased significantly (P = 0.006). Clinical outcomes improved significantly with an increase in the percentage of recovery at 10 days (P = 0.001) and a decrease in the percentage of relapse (P = 0.016). The Clostridioides difficile incidence rate improved significantly to 1.3 per 10,000 patient-days during the observation period. Conclusion This study shows the lasting effect of an educational and Clostridioides difficile-prospective audit with intervention and feedback period on prescribers' adherence to recommendations and a significant impact on clinical outcomes.

A compounding compliance team at an academic medical center.

PURPOSE: Highly publicized safety issues arising from poor sterile compounding practices in facilities around the United States have garnered substantial attention in recent years. This attention has led to increased scrutiny of health systems by regulatory bodies, new regulatory requirements, and changes to existing regulations or their interpretation. Health systems are often resource constrained, and the added work resulting from this scrutiny challenges pharmacy departments in meeting regulatory requirements and United States Pharmacopeia chapter 797 standards for sterile compounding. This article describes the creation of a dedicated compounding compliance team (CCT) and the team's responsibilities in support of pharmacy operations in achieving compliance with those standards. SUMMARY: Visits to our organization by several regulatory bodies resulted in findings that required substantial work in order to achieve compliance with sterile compounding standards. Given the number and complexity of findings and the need for timely resolution, it was felt that specialized staff were needed to understand, evaluate, and correct identified deficiencies and help the already overburdened staff and leadership comply with existing standards. A CCT was formed, and work was simultaneously initiated on ensuring proper credentialing and training of all compounding staff, development of standard operating procedures, improvements in facilities, environmental monitoring, equipment certifications, practice auditing, and documentation. Key activities of the team included strategic planning, building relationships, communicating with stakeholders, self-education, and record keeping. Key partners included environmental services, facilities, and infection prevention and control personnel and departmental staff and leaders. CONCLUSION: The formation and collaborative work of a CCT at an academic medical center was successful in changing the culture of the organization and achieving compliance during visits from several regulatory agencies.

Good pharmacy practice assessment among community pharmacies in Lebanon

OBJECTIVE: This study aims to assess good pharmacy practice (GPP) aspects and compare GPP scores among community pharmacies in Lebanon, using a tool developed jointly by the International Pharmaceutical Federation (FIP) and the World Health Organization (WHO) to improve and maintain standards of pharmacy practice. METHODS: Data collection was carried out between July and October 2018 by a team of 10 licensed inspectors who work at the Lebanese Order of Pharmacists (OPL) and visited community pharmacies across Lebanon. The questionnaire was adapted to the Lebanese context and included 109 questions organized under five sections: socio-demographics, Indicator A (data management and data recording), Indicator B (services and health promotion), Indicator C (dispensing, preparation and administration of medicines), and Indicator D (storage and facilities). The value of 75% was considered as the cutoff point for adherence to indicators. RESULTS: Out of 276 pharmacies visited, a total of 250 (90.58%) pharmacists participated in the study with one pharmacist being interviewed in every pharmacy. Results showed that 18.8% of pharmacists were generally adherents to GPP guidelines (scores above the 75% cutoff): 23.3% were adherent to indicator A, 21.6% to indicator B, 14.8% to indicator C and 13.2% to indicator D. Moreover, comparison of GPP scores across geographical regions revealed a higher adherence among community pharmacists working in the Beirut region compared to the North region, the South region, Mount Lebanon, and the Bekaa. CONCLUSIONS: Our study shows that community pharmacists in Lebanon do not fulfill GPP criteria set by FIP/WHO, and that this poor adherence is a trend across the country's geographical regions. Therefore, efforts should be made to raise awareness among pharmacists about the necessity to adhere to GPP guidelines and standards, and train them and support them appropriately to reach that goal. This is the first indicator-based comprehensive pilot assessment to evaluate GPP adherence in community pharmacies across Lebanon. Working on the optimization of this assessment tool is also warranted

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Designing clinical practice feedback reports: three steps illustrated in Veterans Health Affairs long-term care facilities and programs.

BACKGROUND: User-centered design (UCD) methods are well-established techniques for creating useful artifacts, but few studies illustrate their application to clinical feedback reports. When used as an implementation strategy, the content of feedback reports depends on a foundational audit process involving performance measures and data, but these important relationships have not been adequately described. Better guidance on UCD methods for designing feedback reports is needed. Our objective is to describe the feedback report design method for refining the content of prototype reports. METHODS: We propose a three-step feedback report design method (refinement of measures, data, and display). The three steps follow dependencies such that refinement of measures can require changes to data, which in turn may require changes to the display. We believe this method can be used effectively with a broad range of UCD techniques. RESULTS: We illustrate the three-step method as used in implementation of goals of care conversations in long-term care settings in the U.S. Veterans Health Administration. Using iterative usability testing, feedback report content evolved over cycles of the three steps. Following the steps in the proposed method through 12 iterations with 13 participants, we improved the usability of the feedback reports. CONCLUSIONS: UCD methods can improve feedback report content through an iterative process. When designing feedback reports, refining measures, data, and display may enable report designers to improve the user centeredness of feedback reports.

How research ethics boards should monitor clinical research.

The objective of this commentary is to provide a framework and ethical justification for a more proactive model of continual, active monitoring of research. We outline what the increased monitoring should consist of, and the practical constraints associated with executing these monitoring functions. We also defend the idea that adequate post-initial-review monitoring requires greater REB involvement, rather than trust and researcher's assurances.

How to improve the quality of care for women with postpartum haemorrhage at Onandjokwe Hospital, Namibia: quality improvement study.

BACKGROUND: Postpartum haemorrhage (PPH) is the leading direct cause of maternal morbidity and mortality worldwide. The sustainable development goals aim to reduce the maternal mortality ratio to 70 per 100,000 live births. In Namibia, the ratio was reported as 265 per 100,000 live births in 2015 and yet little is published on emergency obstetric care. The majority of deliveries in Namibia are facility-based. The aim of this study was to assess and improve the quality of care for women with PPH at Onandjokwe Hospital, Namibia. METHODS: A criterion-based audit cycle in all 82 women with PPH from 2015 using target standards for structure, process and outcomes of care. The audit team then planned and implemented interventions to improve the quality of care over a 10-month period. The audit team repeated the audit on all 70 women with PPH from the same 10-month period. The researchers compared audit results in terms of the number of target standards achieved and any significant change in the proportion of patients' care meeting the predetermined criteria. RESULTS: In the baseline audit 12/19 structural, 0/9 process and 0/3 outcome target standards were achieved. On follow up 19/19 structural, 6/9 process and 2/3 outcome target standards were met. There was one maternal death in the baseline group and none in the follow up group. Overall 6/9 process and 2/3 outcome criteria significantly improved (p <  0.05) from baseline to follow up. Key interventions included training of nursing and medical staff in obstetric emergencies, ensuring that guidelines and standard operating protocols were easily available, reorganising care to ensure adequate monitoring of women postpartum and ensuring that essential equipment was available and functioning. CONCLUSION: The study demonstrates that the quality of care for emergency obstetrics can be improved by audit cycles that focus on the structure and process of care. Other hospitals in Namibia and the region could adopt the process of continuous quality improvement and similar strategies.

Do corporate governance mechanisms and internal control systems matter in reducing mortality rates?

Internal controls are critical to guarding an institution against fraud, error, and devastation. They are effective tools for preventing losses and achieving organizational goals. However, internal control mechanisms need to be relevant, because the organization cannot comprehend the effectiveness of the system if they are out-of-touch with the operation. Health care control practices are not exceptionally different from what pertains in other industries. The health care organizations require effective corporate governance mechanisms to uphold their operations and performances. These practices assist health care organizations to exhume cynical practices that generate unproductive results and also factors militating against the hospital's goals or objectives. This study revealed that practices such as enhanced Board diligence, Health Professionals on board, financial prudence, and effective communication have the tendency of reducing mortality, if well executed.

Outcomes following colorectal cancer surgery: Results from a population-based study in Queensland, Australia, using quality indicators.

RATIONALE, AIMS AND OBJECTIVES: Colorectal cancer (CRC) is one of the most common cancers diagnosed worldwide, and rates are continuing to rise. Surgery is the primary treatment for CRC, and our aim was to examine clinical outcomes following major resection using a series of established quality indicators and to identify factors associated with poor clinical outcomes. METHOD: This population-based retrospective study included 4321 patients with diagnosed with CRC in 2012 and 2014 in Queensland, Australia, who underwent a major resection. Primary outcomes included in-hospital mortality, 30-day unplanned readmission, extended hospital stay (>21 days), and 30- and 90-day mortality. Multivariable logistic regression modelling was conducted to establish factors independently associated with each outcome of interest. RESULTS: Overall, in-hospital mortality was 1.5%, 3.0% had an unplanned readmission, 8% had an extended hospital stay, and 30- and 90-day postoperative mortality was 1.6% and 3.1%, respectively. After adjustment, we found that factors such as older age, presence of comorbidities, emergency admission, and stoma formation were significantly associated with poorer outcomes with these findings being consistent across each of the outcomes of interest. In addition to these factors, the risk of 90-day mortality was significantly elevated for patients with advanced stage disease (OR = 1.95, CI 1.35-2.82). Sex, primary site, hospital volume, residential location, nor socioeconomic status was found to be associated with any of the outcomes of interest. CONCLUSION: Overall, the risk of poorer clinical outcomes for CRC patients in Queensland, Australia, is low. There is however a subgroup of patients at particularly elevated risk of poorer outcomes following CRC. Strategies to reduce the poorer clinical outcomes this group of patients experience should be explored.

Nursing staff perceptions regarding the clinical audit tool used for relicensing inspections within eThekwini private hospitals in South Africa.

Purpose The purpose of this paper is to assess nursing staff perceptions regarding the clinical audit tool used for relicensing inspections within private hospitals in eThekwini district. Design/methodology/approach An exploratory sequential mixed method research design was used with a qualitative first phase involving a total population of 40 nurse managers through purposive sampling. Nurse managers ( n=24) were interviewed. This was followed by a quantitative phase in which a structured questionnaire was administered to nurses ( n=270) who were randomly sampled for the study from ( n=4) hospitals. Documentation review, a third phase was used to corroborate the findings of the first two phases of the study. Findings The results of the study showed that the participants perceptions of the selected private hospitals in eThekwini district is that they have not fully implemented the approach to practice standards and healthcare audits in relation to three clinical domains of the National Core Standards and the Batho Pele principles. These findings were significant and denoted the need for a standardised clinical audit tool for private hospitals in eThekwini district. Research limitations/implications This study was confined to an independent group of hospitals and the findings may not be suitable for generalising across all private hospitals in eThekwini district. Originality/value These findings led to the development of a clinical audit tool with measurements representing elements of care that are critical to the provision of safe, quality health care services.

Antimicrobial Stewardship Metrics: Prospective Audit with Intervention and Feedback.

[Full article available at http://rimed.org/rimedicaljournal-2018-06.asp].