Areas For Service Improvement Research Articles

Antibiotic prescribing control by pharmacists within UK NHS hospitals

Abstract Objective To identify the role of clinical pharmacists in antibiotic prescribing control. Method A self-completion postal questionnaire was sent to the chief pharmacist at 465 UK National Health Service hospitals in 2001/2002. It contained questions covering hospital demographics and the role of pharmacists in ensuring adherence with the recommendations on antibiotic prescribing contained in hospital prescribing documents. Key findings Fifty-four per cent of questionnaires (n=253) were completed. Of these, 93% (n=235) of the responding hospitals had at least one of the following prescribing control documents: antibiotic formulary, antibiotic policy and antibiotic guidelines. Pharmacists routinely performed clinical review of adherence with prescribing recommendations (antibiotic prescribing control) in 83% of the responding hospitals but only in approximately two-thirds of hospitals (64%) was this review performed on every ward. The antibiotic prescribing control process appeared to be thorough, with five review activities performed by pharmacists in the majority of hospitals (74%), and proactive, with pharmacists undertaking routine daily visits to all wards (or selected units) in 85% of responding hospitals. Nearly three-quarters (71%) of hospitals had performed an audit of antibiotic prescribing; the majority had done so within the past two years. Pharmacists had been involved in these audits in 92% of responding hospitals. Conclusions Where performed, antibiotic prescribing control appeared to be a thorough process. Key areas for service improvement are extension of antibiotic prescribing control to all wards and the standardisation of intervention documentation. Barriers preventing the provision of a comprehensive clinical pharmacy service are discussed and future strategies identified.

Improving the quality of maternity service provision

Government iniatives have emphasized the need for development of patient-led services. There is a commitment within these initiatives for service user involvement in the development of high quality, safe and accessible care which meets the needs of the local population and that the implementation of this initiative should be within existing funding. The achieving sustainable quality in maternity (ASQUAM) model aims to identify areas for service improvement and involve users in non-threatening, multidisciplinary group discussions and decision making, through a process of democratic prioritization. This article discusses the implementation of the ASQUAM model in Bradford, past implimentation success, recently identified areas for improvement and future development. Overall the ASQUAM model is viewed as positive by service users, the general public and health professionals.

‘Quite an awkward situation to be in’: perceptions of patients, carers and health and social care professionals of the supportive cancer care in British military personnel stationed in Germany

This paper reports findings from a study which identified the nature and volume of supportive care received by British military services personnel and their dependents who experience cancer and are based in Germany. The objectives were to (1) identify any gaps in the provision of supportive care, (2) determine the potential for additional supportive care services (local or remote), and (3) identify any educational or development issues for DMWS personnel. Interviews and focus groups were conducted with people with cancer (n = 7), informal carers (n = 6), British health care professionals employed by British Forces in Germany (n = 8), German health care professionals (n = 3), senior military personnel (n = 6) and army support personnel (n = 5). Analysis of the data was thematic and focused on accounts of care related to core issue identified in the UK's National Institute of Health and Clinical Excellence (NICE) guidelines (24). The paper explores the difficulties which British military personnel experience in their cancer care. The shortfalls in best practice are discussed in the framework of NICE guidelines focusing on communication, information, psychosocial care and coordination of care/inter-agency working. Significant gaps in the supportive care service provision are apparent The limited assessment and discussion of patients' supportive care needs suggests key areas for service improvement for providers both within the British Military in Germany, and in the services provided by German organisations. These findings highlight issues that should be considered by those providing supportive care for marginalised patient groups, such as patients and carers from different cultures.

Measuring quality in services for children with an intellectual disability

To evaluate the application of one particular quality measurement tool, the SERVQUAL instrument, as a potential mechanism to measure quality in services for children with disabilities Staff and family of children with an intellectual disability in two organisations providing specialist therapy and day completed an adapted SERVQUAL questionnaire. A total of 81 SERVQUAL questionnaires were distributed and 59 questionnaires were returned (response rate of 73 per cent). The SERVQUAL instrument can be considered as a useful diagnostic tool to identify particular strengths and areas for improvement in services for people with disabilities as the instrument lends itself for the monitoring of the effectiveness of quality improvement initiatives over time. The findings also showed relatively high customer expectations and the organisations involved in this research are currently not meeting all of these high expectations as significant quality gaps were found in the areas of reliability and responsiveness. The sample size was relatively small and the measurement of quality using the SERVQUAL instrument remains a challenge, due to the conceptual and empirical difficulties. The SERVQUAL instrument is probably most be attractive to service managers and funding organisations because of its ability to identify gaps in the quality of the service. The tool had been used to measure quality in services for people with disabilities and the research has shown that this tool might be an important additional quality measurement tool for services.

Using patient information to identify areas for service improvement

Using patient information to identify areas for service improvement

Using patient information to identify areas for service improvement

Using patient information to identify areas for service improvement