Allocation Of Staff Resources Research Articles

Semi-automated versus manual compounding of chemotherapy: a pilot study of dosing accuracy and pharmacy technician perceptions at a university teaching hospital

Abstract Introduction The semi-automated compounding of intravenous chemotherapy is an evolving technology with previously identified benefits to patients and operator safety.[1] The introduction of a Gri-fill® 4 semi-automated unit to University Hospital Limerick (UHL) in 2022 marked the first use of semi-automated chemotherapy compounding in Ireland. To date, limited research exists regarding implementation of semi-automated units within Irish hospitals. Aim To compare dosing accuracy and preparation time of manually versus semi-automated compounded chemotherapy. To understand perceptions of pharmacy technicians regarding manual versus semi-automated compounding of chemotherapy. Methods Dose accuracy, defined as absolute percentage dose error versus the prescribed dose, was obtained gravimetrically for a total of 90 chemotherapy preparations. Preparations of carboplatin (22 manual, 22 semi-automated) and paclitaxel (23 manual, 23 semi-automated) were included. Dose accuracy via both procedures for each drug was compared statistically using the Mann-Whitney U-test, whereby p<0.05 denotes statistical significance. A dose accuracy cut-off, signalling need for repreparation, was >5%. Time in seconds for compounding via each procedure was recorded. An anonymous online survey consisting of both Likert-scale and free-text questions was disseminated to all ten pharmacy technicians who work in the UHL aseptic compounding unit (ACU). Likert-scale responses were analysed using descriptive statistics, while qualitative statements were analysed thematically. Results A statistically significant difference in dose accuracy distribution between manual (mean rank = 28.20) versus semi-automated (mean rank = 16.80) groups was found for the carboplatin preparations (p<0.05, U=367.5). Absolute percentage dose error tended to be higher using the manual procedure. No significant difference in dose accuracy distribution was observed between procedures for paclitaxel (p>0.05, U=285.0) (manual mean rank = 22.61, semi-automated mean rank = 24.39). Overall, zero semi-automated and 2 manual preparations exceeded the >5% dose accuracy limit. For both drugs, median preparation times were longer for the semi-automated (200.5, 199 seconds) versus the manual (116.5, 141 seconds) procedure. Nine out of ten pharmacy technicians responded to the survey. Over half (55%) found working with the semi-automated unit demanding. A higher percentage felt preparations compounded manually were safer than preparations from the semi-automated unit (100% versus 66%). Practical issues with the semi-automated unit, including lack of space within the isolator, staff resource allocation and reliance on machine calibration were highlighted. However, its capacity to produce large multiples of one preparation type was recognised. Conclusion This pilot study highlighted comparative (paclitaxel) or significantly improved (carboplatin) dosing accuracy of a semi-automated compounding unit versus a manual procedure. While the number of preparations analysed was limited and necessity for larger confirmatory studies across numerous ACUs is acknowledged, this data highlights capacity for semi-automated units to accurately prepare chemotherapy. The observed decreased repreparation requirements of the semi-automated procedure highlight potential for such units to aid sustainable chemotherapy production. However, to optimise implementation, future research should investigate solutions to concerns identified by pharmacy technicians and verify the accuracy results obtained. Only then can the benefits of such semi-automated units to both patients and staff be achieved. Reference 1. Seger AC, Churchill WW, Keohane CA, Belisle CD, Wong ST, Sylvester KW, Chesnick MA, Burdick E, Wien MF, Cotugno MC, Bates DW. Impact of robotic antineoplastic preparation on safety, workflow, and costs. Journal of Oncology Practice. 2012;8(6):344–9.

RESIDENT EXPERIENCES OF PERSON-CENTRED CARE AT MEALTIMES IN LONG-TERM RESIDENTIAL CARE: A RAPID ETHNOGRAPHY

Abstract Poor nutrition is a common ongoing problem in long-term residential care, often resulting in reduced quality of life. Previous research has concluded that the content of the meal, dining environment, service style and general atmosphere all add to the mealtime experience, suggesting that person-centred mealtimes are optimal. However, knowledge about which elements of person-centred care can be achieved in a mealtime setting in a given context is currently lacking. As part of the TRANS-SENIOR research network, rapid ethnographies were conducted across multiple sites (including interviews, observations and informal conversations), in long-term residential care homes in the UK, Switzerland and the Netherlands between October 2020 and December 2021. During analysis and interpretation of data, different themes were developed where either successfully achieved or missed opportunities for person-centred moments were observed. We observed differences between the long-term care homes in as much as the setting could be considered, resident choice was implemented, residents were enabled, care was individualized in the communal setting and how much the person of the residents was known with their past and present. In the presentation we will discuss the possibility to provide person-centred care during mealtimes in view of differences between staff approaches, the overall environment (size of dining area, seating arrangements etc.), allocation of staff resources and country-specific rules and regulations. We see an interplay of factors in place for mealtimes to be moments of participatory choice, interaction, independence, and dignity.

Exploring resident experiences of person-centred care at mealtimes in long-term residential care: a rapid ethnography

IntroductionPoor nutrition is a common ongoing problem in long-term residential care, often resulting in reduced quality of life. Previous research has concluded that the content of the meal, dining environment, service style and general atmosphere all add to the mealtime experience, suggesting that person-centred mealtimes are optimal. However, knowledge about which elements of person-centred care can be achieved in a mealtime setting in a given context is currently lacking. We aimed to understand the mealtime experience in long-term residential care by exploring (missed) opportunities for person-centred care in different settings.MethodsAs part of the TRANS-SENIOR research network, rapid ethnographies, were conducted across multiple sites (including interviews, observations and informal conversations), in a long-term residential care home in the UK, Switzerland and the Netherlands between October 2020 and December 2021. ResultsFollowing analysis and interpretation of observations, interviews and informal conversations, the following themes were developed where either successfully achieved or missed opportunities for person-centred moments were observed: 1) considering the setting, 2) listening to and implementing resident choice, 3) enabling residents to help/care for themselves and others, 4) providing individualised care in a communal setting, and 5) knowing the person in the past and present. Residents experienced moments of participatory choice, interaction, independence and dignity, but opportunities for these were often missed due to organisational or policy constraints.ConclusionsThere are opportunities for person-centred moments during the mealtime, some of which are taken and some missed. This largely depended on the setting observed, which includes the overall environment (size of dining area, seating arrangements etc.) and allocation of staff resources, and the level of resident involvement in mealtimes, from preparation to the actual activity.

Covid-19 and orthopaedic trauma: Quantification of orthopaedic trauma workload and staff resource allocation during a global pandemic-related lockdown

IntroductionHealthcare systems across the world have struggled as a result of the Covid-19 pandemic. Most specialties have redeployed their staff and resources to deal with the pandemic whilst ceasing their planned elective activity. However acute specialties such as Trauma and Orthopaedics still have a significant emergency caseload that must be safely managed, even in a pandemic. The aim of this study was to investigate the change in Orthopaedic Trauma caseload in a Trauma Unit and a Major Trauma Centre during a pandemic compared to pre-pandemic levels and the associated staffing requirements. MethodsThe data presented was collected from a Trauma Unit and a Major Trauma Centre in the United Kingdom. We compared the number of accident and emergency referrals, fracture clinic appointments, inpatient admissions and operations during the six weeks of the first lockdown from 23rd March to May 3, 2020, to the same time period in 2019. ResultsThe results showed that the orthopaedic trauma caseload was approximately half that of pre-pandemic levels, reducing by an average of 54.2%. ConclusionA significant orthopaedic trauma caseload still remains to be safely managed during a pandemic and appropriate resources must be allocated. Staff allocation must take into account sick cover and staff wellbeing. A proportion of staff may need to be ring fenced from redeployment to facilitate this.

The impact of reduced operating room capacity on the time delay of urgent surgical care for neurosurgical patients during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic raised major challenges to the management of patient flows and medical staff resource allocation. To prevent the collapse of medical facilities, elective diagnostic and surgical procedures were drastically reduced, canceled or rescheduled. MethodsWe recorded all in-hospital treated patients and outpatient clinics visits of our neurosurgical department from March 2017 to February 2021. Changes of OR capacity, in-hospital neurosurgical treatments and outpatient clinics visits during the pandemic episode was compared on a monthly bases to the previous years. ResultsA total of 3′214 data points from in-house treated patients and 11′400 outpatient clinics visits were collected. The ratio of elective (73.5% ± 1.5) to emergency surgeries (26.5% ± 1.5) remained unchanged from 2017 to 2021. Significantly less neurosurgical interventions were performed in April 2020 (−42%), significantly more in July 2020 (+36%). Number of outpatient clinics visits remained in the expected monthly range (mean n = 211 ± 67). Total OR capacity was reduced to 30% in April 2020 and 55% in January 2021. No significant delay of urgent surgical treatments was detected during restricted (<85%) OR capacity. On average, the delay of rescheduled consultations was 58 days (range 3 – 183 days), three (6.5%) were referred as emergencies. ConclusionsDynamic monitoring and adjustment of resources is essential to maintain surgical care. The sharp restrictions of surgical activities resulted in significant fluctuations and 5% decrease of treated neurosurgical patients during the COVID-19 pandemic. However, urgent neurosurgical care was assured without significant time delay during periods of reduced OR capacity.

Enhanced Skills Lead to Improved Patient, Nurse Satisfaction

Enhanced Skills Lead to Improved Patient, Nurse Satisfaction

Factors influencing the stewardship activities of Antimicrobial Management Teams: a national cross-sectional survey

The link between inappropriate antibiotic prescribing and the global threat of antimicrobial resistance is well documented. International strategies recommend antimicrobial stewardship (AMS) programmes, with improvement interventions to safeguard antibiotics. This study sought to systematically evaluate the impact of multi-professional Antimicrobial Management Team (AMT) staff resource availability on stewardship activities. We conducted an on-line, cross-sectional survey of AMTs in each regional Health Board and the national specialist hospital in Scotland (N= 15). Responses were analysed descriptively, exploring observed relationships between variables to identify patterns. Results highlighted apparent variation in the levels of AMT resource availability across Scotland, not directly influenced by Health Board size, with some larger Health Boards having proportionately poorer AMT resource allocation. However, the range and frequency of activities to support AMS was not directly linked to either Health Board size or staff resource allocation, indicating a more complex inter-relationship between factors. There is apparent inequity in staff resource available for AMTs across Scotland, with significantly lower resource allocation in comparison with recommendations from other international studies. However, considering these survey findings with our earlier qualitative research indicates that leadership style and team member enthusiasm may be as, if not more, influential than resource availability on the scope of AMT activities. These findings have international relevance for hospital service managers considering the recruitment, training and ongoing support of AMTs, in order to maximize impact from a limited resource.

Institutional Arrangements for Fintech Regulation and Supervision

Fintech developments are shaking up mandates within the existing regulatory architecture. It is not uncommon for financial sector agencies to have multiple policy objectives. Most often the policy objectives for these agencies reflect prudential, conduct and financial stability policy objectives. In some cases, financial sector agencies are also allocated responsibility for enhancing competition and innovation. When it comes to fintech, countries differ to some extent in the manner they balance the objectives of promoting the development of fintech and regulating it. Countries see fintech as a means of achieving multiple policy objectives sometimes with lesser or greater degrees of emphasis, such as accelerating development and spurring financial inclusion, while others may support innovation with the objective of promoting competition and efficiency in the provision of financial services. This difference in emphasis may impact institutional structures, including the allocation of staff resources. Conflicts of interest arising from dual roles are sometimes managed through legally established prioritization of objectives or establishment of separate internal reporting lines for supervision and development.

Aggregate National Early Warning Score (NEWS) values are more important than high scores for a single vital signs parameter for discriminating the risk of adverse outcomes

IntroductionThe Royal College of Physicians (RCPL) National Early Warning Score (NEWS) escalates care to a doctor at NEWS values of ≥5 and when the score for any single vital sign is 3. MethodsWe calculated the 24-h risk of serious clinical outcomes for vital signs observation sets with NEWS values of 3, 4 and 5, separately determining risks when the score did/did not include a single score of 3. We compared workloads generated by the RCPL's escalation protocol and for aggregate NEWS value alone. ResultsAggregate NEWS values of 3 or 4 (n=142,282) formed 15.1% of all vital signs sets measured; those containing a single vital sign scoring 3 (n=36,207) constituted 3.8% of all sets. Aggregate NEWS values of either 3 or 4 with a component score of 3 have significantly lower risks (OR: 0.26 and 0.53) than an aggregate value of 5 (OR: 1.0). Escalating care to a doctor when any single component of NEWS scores 3 compared to when aggregate NEWS values ≥5, would have increased doctors’ workload by 40% with only a small increase in detected adverse outcomes from 2.99 to 3.08 per day (a 3% improvement in detection). ConclusionsThe recommended NEWS escalation protocol produces additional work for the bedside nurse and responding doctor, disproportionate to a modest benefit in increased detection of adverse outcomes. It may have significant ramifications for efficient staff resource allocation, distort patient safety focus and risk alarm fatigue. Our findings suggest that the RCPL escalation guidance warrants review.

National survey focusing on the crucial information needs of intensive care charge nurses and intensivists: same goal, different demands

BackgroundAlthough information technology adequately supports clinical care in many intensive care units (ICUs), it provides much poorer support for the managerial information needed to coordinate multi-professional care. To gain a general view of the most crucial multi-professional information needs of ICU shift leaders a national survey was conducted, focusing on the information needs of charge nurses and intensivists.MethodsBased on our previous observation study an online survey was developed, containing 122 information need statements related to the decision-making of ICU shift leaders. Information need statements were divided into six dimensions: patient admission, organisation and management of work, allocation of staff and material resources, special treatments, and patient discharge. This survey involved all ICU shift leaders (n = 738) who worked in any of the 17 highest level ICUs for adults in university hospitals in Finland during the autumn of 2009. Both charge nurses’ and intensivists’ crucial information needs for care coordination were evaluated.ResultsTwo hundred and fifty-seven (50%) charge nurses and 96 (43%) intensivists responded to the survey. The consistency of the survey was found to be good (Cronbach’s α scores between .87–.97, with a total explanatory power of 64.53%). Altogether, 57 crucial information needs for care coordination were found; 22 of which were shared between shift leaders. The most crucial of these information needs were related to organisation and management, patient admission, and allocation of staff resources. The associations between working experience, or shift leader acting frequencies, and crucial information needs were not statistically significant. However, a statistically significant difference was found between the number of ICU beds and the ICU experience of charge nurses with information needs, under the dimension of organisation and management of work. The information needs of charge nurses and intensivists differed. Charge nurses’ information needs related to care coordination, were more varied, and concerned issues at a unit level, whereas intensivists focused on direct patient care.ConclusionsThe reliability and validity of our survey was found to be good. Our study findings show that care coordination at an ICU is a collaborative process among ICU shift leaders with multiprofessional information needs related to organisation and management, patient admission, and allocation of staff resources. Study findings can be used to identify the most crucial information needs of ICU shift leaders when new information technology is developed to support managerial decision-making during care coordination.

Nursing staff numbers and their relationship to conflict and containment rates on psychiatric wards—A cross sectional time series Poisson regression study

Background The link between positive outcomes and qualified nurse staffing levels is well established for general hospitals. Evidence on staffing levels and outcomes for mental health nursing is more sparse, contradictory and complicated by the day to day allocation of staff resources to wards with more seriously ill patients. Objective To assess whether rises in staffing numbers precede or follow levels of adverse incidents on the wards of psychiatric hospitals. Design Time series analysis of the relationship between shift to shift changes over a six month period in total conflict incidents (aggression, self-harm, absconding, drug/alcohol use, medication refusal), total containment incidents (pro re nata medication, special observation, manual restraint, show of force, time out, seclusion, coerced intramuscular medication) and nurse staffing levels. Settings 32 acute psychiatric wards in England. Methods At the end of every shift, nurses on the participating wards completed a checklist reporting the numbers of conflict and containment incidents, and the numbers of nursing staff on duty. Results Regular qualified nurse staffing levels in the preceding shifts were positively associated with raised conflict and containment levels. Conflict and containment levels in preceding shifts were not associated with nurse staffing levels. Conclusions Results support the interpretation that raised qualified nurse staffing levels lead to small increases in risks of adverse incidents, whereas adverse incidents do not lead to consequent increases in staff. These results may be explicable in terms of the power held and exerted by psychiatric nurses in relation to patients.

Optimization of propofol dose shortens procedural sedation time, prevents resedation and removes the requirement for post‐procedure physiologic monitoring

To examine the effect of propofol dosing (total dose and number of doses) on patient sedation time and likelihood of resedation. This was a prospective, observational patient series in an urban district hospital ED with 42 000 attendances per annum. Patients undergoing an emergent procedure requiring procedural sedation were included. Titrated intravenous propofol was administered according to departmental procedure. Standardized consent and data collection forms were used. Time taken for the patient to become conversational after first administration was recorded and any resedation documented. Four hundred patients, undergoing 404 procedures, were enrolled for the period commencing August 2004 until March 2006. The mean initial propofol bolus was 0.8 mg/kg (SD 0.6), and mean total propofol dose was 1.8 mg/kg (SD 1.0), comprising a mean of 2.3 (SD 2.1) doses of 15.8 mg (SD 11.4). Mean sedation time was 11.8 min (SD 6.9), and increased sedation times were associated with higher total propofol dose and number of boluses (P < 0.0001). Resedation occurred in two patients (0.5%, 95% CI 0-1.6%). Shorter sedation times are seen with lower doses of propofol. Patients do not need prolonged post-procedure monitoring because the occurrence of spontaneous resedation associated with propofol use is a rare event. This has implications for patient flow and staff resource allocation in a busy ED.

A Decision Support System For Audit Staff Scheduling Of Multiple And Large-Scaled Engagements

As raising cost of audit and shrinking audit market, the management of accounting firms have put into more efforts on increasing productivity by improving audit planning, upgrade audit technology and cost control. One avenue to accomplish cost savings while maintaining high audit quality is to refine staff scheduling. This study proposes a different approach to resolving audit staff scheduling for multiple and large engagements. The major advantage of the proposed method is to solve staff resource allocation problems by alleviating the limitations of both linear and integer programming. In addition, the objectives and constraints of models proposed in this study can be modified easily to adjust for firm-specific situations.

Professional Assessment of Optimal Nursing Care Intensity Level

In the article a new method is presented for allocation of staff resources, 'Professional Assessment of Optimal Nursing Care Intensity Level' (PAONCIL). This method is presented as an alternative to classical time study, which has traditionally been considered to belong to systems for patient classification. By means of this method the optimal nursing care intensity level for individual wards can be established. The study comprised 8 wards, and the nurses working in these wards provided a total of 8,458 professional assessments of optimal nursing care intensity levels. The material was analysed by means of simple linear regression analysis. The nursing care intensity scores per nurse in a single ward were used as independent variables and the average PAONCIL score for the same calendar day was used as a dependent variable. The average determination coefficient for different wards were 0.37; the PAONCIL instrument thus explained 37% of the nursing care intensity/nurse variation. This corresponded to a linear correlation of 0.60. In five out of six wards for adults the optimal nursing care intensity/nurse scores were close to each other, ranging from 3.0 to 3.6. The advantage of the PAONCIL method is that it can be easily implemented in a ward, can be used time and again, is advantageous and is based on quality aspects. The PAONCIL method has been developed on the basis of a caring science perspective and can be seen as an administrative method for the nurse manager, with whose help 'good care' can become possible.

Planning and Resource Development for Substance Abuse Services in Northern Alaska

I practice medical anthropology in health planning and resource development in Alaska as a staff member of the Northern Alaska Health Resources Association (NAHRA). As one of five professional staff, my position with NAHRA is Director of Planning and Implementation. My administrative role, accounting for about one-third of my time, includes supervision of the programmatic functions of the organization—development of the organization's work program and allocation of staff resources. The majority of my time is spent in health planning. I have worked in several diverse areas including mental health, substance abuse and hospital planning; development of school health education programs; and coordination of emergency medical services. My specific duties are varied. Organizing effective meetings is critical since the recommendations from board committees result in the most tangible products of the organization, such as plans, reports and position papers.