Establishing an Electronic Referral System from Speech and Language Therapy to Pharmacy to Improve Medication Administration in Patients with Dysphagia in an Acute Hospital Setting.

Dysphagia affects swallowing not only of food and drink, but also of orally administered medications. Altering solid or liquid dose formulations renders administration unlicensed and may have adverse effects. Medication administration in patients with dysphagia necessitates a multidisciplinary approach with no one profession holding all necessary expertise. This project aimed to improve the process of medication administration for patients with dysphagia in an acute hospital. Following a baseline audit of practice, an electronic referral system from Speech & Language Therapy (SLT) to Pharmacy was established. Repeat post-implementation audits documenting medication administration to patients with dysphagia and SLT compliance in completing electronic referral were conducted. Of the 43 patients included in the post-implementation audits, 14 (32.6%) were referred from SLT to Pharmacy using the electronic referral system. Those patients referred electronically were reviewed by Pharmacy quicker than those patients who were not referred and had a higher percentage of optimally administered medications. All SLTs eligible (n = 10) were surveyed to explore use of the system and barriers to its use; reasons given for not completing an electronic referral included not prioritizing the referral if under time pressure and lack of IT access to make the referral. Overall compliance with use of the electronic referral system was lower than expected; further work is needed to establish consistency of practice in using the electronic referral system in the interest of optimizing medication administration to patients.

Supportive supervision and constructive relationships with healthcare workers support CHW performance: Use of a qualitative framework to evaluate CHW programming in Uganda.

BACKGROUND: While evidence supports community health worker (CHW) capacity to improve maternal and newborn health in less-resourced countries, key implementation gaps remain. Tools for assessing CHW performance and evidence on what programmatic components affect performance are lacking. This study developed and tested a qualitative evaluative framework and tool to assess CHW team performance in a district program in rural Uganda. METHODS: A new assessment framework was developed to collect and analyze qualitative evidence based on CHW perspectives on seven program components associated with effectiveness (selection; training; community embeddedness; peer support; supportive supervision; relationship with other healthcare workers; retention and incentive structures). Focus groups were conducted with four high/medium-performing CHW teams and four low-performing CHW teams selected through random, stratified sampling. Content analysis involved organizing focus group transcripts according to the seven program effectiveness components, and assigning scores to each component per focus group. RESULTS: Four components, 'supportive supervision', 'good relationships with other healthcare workers', 'peer support', and 'retention and incentive structures' received the lowest overall scores. Variances in scores between 'high'/'medium'- and 'low'-performing CHW teams were largest for 'supportive supervision' and 'good relationships with other healthcare workers.' Our analysis suggests that in the Bushenyi intervention context, CHW team performance is highly correlated with the quality of supervision and relationships with other healthcare workers. CHWs identified key performance-related issues of absentee supervisors, referral system challenges, and lack of engagement/respect by health workers. Other less-correlated program components warrant further study and may have been impacted by relatively consistent program implementation within our limited study area. CONCLUSIONS: Applying process-oriented measurement tools are needed to better understand CHW performance-related factors and build a supportive environment for CHW program effectiveness and sustainability. Findings from a qualitative, multi-component tool developed and applied in this study suggest that factors related to (1) supportive supervision and (2) relationships with other healthcare workers may be strongly associated with variances in performance outcomes within a program. Careful consideration of supervisory structure and health worker orientation during program implementation are among strategies proposed to increase CHW performance.

A liquid crystal-based passive badge for personal monitoring of exposure to hydrogen sulfide.

A new liquid crystal (LC)-based passive dosimeter badge for personal monitoring of exposure to hydrogen sulfide (H2S) gas is reported. When a thin film of LC supported on a surface functionalized with lead perchlorate Pb(ClO4)2 (the LC sensor) is exposed to H2S, the orientation of LC molecules in the film changes from perpendicular to parallel. This reorientation induces a change in the appearance of the LC film when viewed between crossed polarizers. A H2S dosimeter was fabricated by pairing a LC sensor with a glass substrate forming a headspace between the two surfaces, to control diffusion of H2S across the LC film. When the dosimeter is exposed to H2S, a bright front appears as a function of exposure time. An algorithm has been developed to correlate this response length and exposure dose. The dosimeters are functionally stable when subjected to extreme temperature and humidity fluctuations, and are immune to a number of potentially interfering chemicals, except mercaptans. These dosimeters detect H2S at 0.2 ppm TWA (8 hr) with ±20% overall accuracy. The dosimeters were used to monitor the personal exposure of personnel working in an oil refinery. The TWA concentrations measured by the LC-based dosimeters correlate strongly with the NIOSH 1063 method that uses a sorbent tube and a pump followed by laboratory analysis. Thus, the LC-based dosimeters can provide a sensitive tool for on-site assessment of personal exposure to H2S in different environments.

Development of a social justice gauge and its use to review the Canadian Nurses Association's Code of Ethics for Registered Nurses.

Betty Bekemeier and Patricia Butterfield undertook a critical review of 3 American nursing documents in relation to the concept of social justice. Their article inspired a review of the Canadian Code of Ethics for Registered Nurses, using a Social Justice Gauge developed by the Canadian Nurses Association. The article outlines the development of the gauge and its use in this review. Although some evidence of generic and outdated language is evident in the Canadian code, the text appears well aligned with social justice ideals overall. That being said however, there still remains significant possibility for enlarging the application of social justice, especially in relation to the place of nurses in healthcare institutions and in nontraditional nursing settings, in future revisions of the code. Work to further examine, adapt, and test the Canadian Nurses Association's Social Justice Gauge is encouraged.

Prevention strategies for chronic kidney disease in Latin America: a strategy for the next decade--a report on the Villarica Conference.

Representatives from 19 Latin American countries gathered to report and deliberate on both the present and future implications of the growing epidemic of chronic kidney disease-as well as cardiovascular disease, diabetes, and hypertension-and to define the role that national health systems need to adopt in order to cope with them. Country-by-country reports provided an excellent overview of the current state of health care in general and chronic diseases in particular. The meeting concluded with a consensus statement on the most urgent needs for the next decade.