High Patient Turnover Research Articles

Adapting the WHO hand hygiene ‘reminders in the workplace’ to improve acceptability for healthcare workers in maternity settings worldwide: a mixed methods study

IntroductionHand hygiene is key in preventing healthcare-associated infections, but it is challenging in maternity settings due to high patient turnover, frequent emergencies and volume of aseptic procedures. We sought to...

Design and development of patient care voice actuated bed in hospital

Manually adjusting hospital beds presents significant challenges for healthcare professionals, which affects their workflow and patient care outcomes. Manual bed modifications consume a significant amount of time, resulting in nurses being less available for other crucial duties. Patient needs can be delayed, and the quality of care delivered overall can be lowered. Manually adjusting the bed to ensure safety and comfort is a risky practice that could result in incorrect placement that can worsen pre-existing medical issues or cause discomfort and pressure sores. In addition, the demand for accurate and frequent bed changes during the day increases the strain on nurses, especially in situations with high patient turnover or complex care needs. The objective of this study is to create a hospital bed that responds to voice commands to improve patient care and monitoring. The bed's voice recognition technology allows patients to adjust their positions and improve comfort and accessibility, particularly for individuals with mobility issues. It includes sensors that continuously measure the patient's heart rate and temperature while they are in bed. These sensors provide real-time data, enabling prompt detection of any irregularities and facilitating immediate intervention in the patient's heartbeat and temperature. The combination of voice control and continuous health monitoring ensures a higher standard of patient care, improves patient autonomy, and reduces the workload on medical staff. The aim of this innovative bed is to create a healthcare environment that is more responsive and efficient, which ultimately leads to better patient outcomes and enhanced overall hospital efficiency.

FTP6.1 A little respect! A closed-loop audit increasing awareness of ReSPECT forms in a busy general surgical department

Abstract Aims ReSPECT forms have been introduced by Resuscitation Council UK to provide recommendations for patients’ emergency care. The primary aim of the audit was to assess the completion rate of ReSPECT forms on a busy surgical ward. Secondly, the audit aimed to both increase the awareness and the completion rate of ReSPECT forms. Methods Data was collected in the form of random spot-checks of completed ReSPECT forms for all general surgical inpatients at our general hospital. The first intervention involved the addition of a column to the surgical ‘take’ list to highlight the presence or absence of ReSPECT forms. Team education using a novel poster, prioritising the urgency of completion of ReSPECT forms dependent on patient’s co-morbidities, and a teaching session was the intervention for the second cycle. Results The initial completion rate of accurate ReSPECT forms was 31%. Following the first intervention the ‘ReSPECT column’ on the list had been completed for 15% of inpatients and the overall completion rate of ReSPECT forms was 35%. After the ReSPECT poster and teaching the usage of the ‘ReSPECT column’ increased to 39% and overall completion rate was 33%. Conclusions The addition of a column to the acute, surgical list was a simple and effective way of increasing awareness of completed ReSPECT forms. Increased compliance may be achieved by finding more efficient methods of monitoring completion. Overall completion of ReSPECT forms had improved with the interventions, however, due to the high turnover of surgical patients, there are still further improvements possible.

Increasing numbers and complexity of Staphylococcus aureus bloodstream infection—14 years of prospective evaluation at a German tertiary care centre with multi-centre validation of findings

ObjectivesStaphylococcus aureus bloodstream infection (SAB) is a common and severe infection. This study aims to describe temporal trends in numbers, epidemiological characteristics, clinical manifestations, and outcomes of SAB. MethodsWe performed a post-hoc analysis of three prospective SAB cohorts at the University Medical Centre Freiburg between 2006 and 2019. We validated our findings in a large German multi-centre cohort of five tertiary care centres (R-Net consortium, 2017–2019). Time-dependent trends were estimated using Poisson or beta regression models. ResultsWe included 1797 patients in the mono-centric and 2336 patients in the multi-centric analysis. Overall, we observed an increasing number of SAB cases over 14 years (6.4%/year and 1000 patient days, 95% CI: 5.1% to 7.7%), paralleled by an increase in the proportion of community-acquired SAB (4.9%/year [95% CI: 2.1% to 7.8%]) and a decrease in the rate of methicillin-resistant-SAB (−8.5%/year [95% CI: −11.2% to −5.6%]). All of these findings were confirmed in the multi-centre validation cohort (6.2% cases per 1000 patient cases/year [95% CI: −0.6% to 12.6%], community-acquired-SAB 8.7% [95% CI: −1.2% to 19.6%], methicillin-resistant S. aureus-SAB −18.6% [95% CI: −30.6 to −5.8%]). Moreover, we found an increasing proportion of patients with multiple risk factors for complicated/difficult-to-treat SAB (8.5%/year, 95% CI: 3.6% to 13.5%, p < 0.001), alongside an overall higher level of comorbidities (Charlson comorbidity score 0.23 points/year, 95% CI: 0.09 to 0.37, p 0.005). At the same time, the rate of deep-seated foci such as osteomyelitis or deep-seated abscesses significantly increased (6.7%, 95% CI: 3.9% to 9.6%, p < 0.001). A reduction of in-hospital mortality by 0.6% per year (95% CI: 0.08% to 1%) was observed in the subgroup of patients with infectious diseases consultations. DiscussionWe found an increasing number of SAB combined with a significant increase in comorbidities and complicating factors in tertiary care centres. The resulting challenges in securing adequate SAB management in the face of high patient turnover will become an important task for physicians.

Medical Jousting: Going for the kill!

Medical Jousting: Going for the kill!

Association of Hospital Bed Turnover With Patient Outcomes in Digestive Surgery.

Performance improvement in surgery aims at increasing productivity while preventing complications. It is unknown whether this relationship can be influenced by the complexity of surgery. A nationwide retrospective cohort study was conducted, based on generalized estimating equation modeling to determine the effect of hospital BTR on surgical outcomes, adjusting for patient mix and clustering within 631 public and private French hospitals. All patients who underwent minor or major digestive surgery between January 1, 2013 and December 31, 2018 were included. Hospital BTR was defined as the annual number of stays per bed for digestive surgery and categorized into tertiles. The primary endpoint was a composite measurement of events occurring within 30 days after surgery: inpatient death, extended intensive care unit (ICU) admission, and reoperation. Rate of adverse events was 2.51% in low BTR hospitals versus 2.25% in high BTR hospitals for minor surgery, and 16.79% versus 16.83% for major surgery. Patients who underwent minor surgery in high BTR hospitals experienced lower complications (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.81-0.97; P = 0.009), mortality (OR, 0.87; 95% CI, 0.78-0.98, P = 0.02), ICU admission (OR, 0.83; 95% CI, 0.70-0.99; P = 0.03), and reoperation (OR, 0.91; 95% CI, 0.85-0.97; P = 0.002) compared to those in low BTR hospitals. Such differences were not consistently observed among patients admitted for major surgery. High turnover of patients in beds is beneficial for minor procedures, but questionable for major surgeries.

Nurses as adverse drug reaction reporting advocates.

Adverse drug reactions (ADRs) is a challenge in modern healthcare, particularly given the increasing complexity of drug therapy, an ageing population, rising multimorbidity, and a high patient turnover. The core activity of detecting potential ADRs over the last half century has been spontaneous reporting systems. A recent Norwegian regulation commits healthcare professionals other than physicians and dentists to report serious ADRs. In this discussion paper, we share our preliminary experience with a training programme using nurses as ADR advocates to stimulate ADR reporting among the clinical staff in a hospital department.

Using a route planner to optimize door-to-door visits for a pediatric home-hospitalization program: Feasibility study.

BackgroundHospital Sant Joan de Déu (Barcelona) initiated a pediatric acute home-hospitalization program. Due to high patient turnover and the health staff's lack of planning training, daily scheduling was a time-consuming task. Home-hospitalization planning is a vehicle routing problem that can be solved with a technological solution. It was therefore decided to evaluate the efficacy and necessity of the SmartMonkey.io planner.ObjectivesTo compare traditional manual route planning with a route optimizer, and to evaluate the technical feasibility of the implementation of a route planner into a homecare program.MethodsEight participants (experienced homecare staff and inexperienced hospital staff) were included. Personal interviews were performed to assess their eagerness to try a technological solution to the planning problem. Objective benefits including reduced travel time (time planning, distance traveled, and time traveled) were evaluated. Paired t-test, t-test, and Pearson's correlation were used to compare manual and route planner scheduling. Participants then answered a questionnaire to assess planning difficulty and the acceptance of the route planner.ResultsHomecare staff were initially reluctant to use the technology. Significant differences (P < 0.0001) in three variables were found between manual planning and the route planner. A moderate correlation between time planning and plan difficulty (r = 0.59, P < 0.0001) was found with manual planning but not with the route planner. All route planner schedules saved time and distance. No significant differences were found between expertise and planning method. It was noted that it was easy to create plans with the route planner, while difficulty with manual planning increased as more locations were added. All participants evaluated the route planning tool favorably.ConclusionsRoute-planning technology saved planning time and generated better plans than manual planning. The route planner's learning curve was fast and results were obtained in the same amount of time regardless of difficulty and expertise. SmartMonkey.io also has the potential to reduce internal and environmental costs and increase staff productivity.

Preparedness of house officers for independent clinical practice: are we there yet?

&lt;p&gt;&lt;strong&gt;Background and Objective:&lt;/strong&gt; The essential goal of any medical school is to train medical graduates to work as independent clinicians. Inadequately prepared doctors put the well-being of patients at a great risk. The objective of the study was to evaluate the preparedness for independent clinical practice of house officers who graduated from medical schools with the traditional discipline-based curriculum, from both public and private sectors, and with high and low merit.&lt;br /&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A quantitative correlational study was conducted by using an already validated questionnaire. A total of 241 house officers who graduated from public and private sector medical schools from Lahore, Pakistan, with high and relatively low merit, were selected. The data from the filled responses were analyzed by using Statistical Package for the Social Sciences version 25.&lt;br /&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of the 241 respondents, 152 (55.3%) were female and 89 (32.4%) were male. The mean age of the respondents was 24.19 &amp;plusmn; 0.91 years. The difference in mean score between the public and private sectors was significant in the subscales of clinical skills, procedural skills, and patient management.&lt;br /&gt;Analysis of free-text responses showed a deficiency in procedural skills, communication skills, time management, and management of acutely ill patients in the emergency department in both classes of medical schools. Many graduates suggested early clinical exposure with hands-on training and the addition of modules of ethics and medical laws in the curriculum.&lt;br /&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The medical graduates lack pertinent training in professionalism, ethics, medical laws, and communication skills which may hamper their appropriate preparedness before dealing directly with the high turnover of patients during house jobs.&lt;/p&gt;

Comparison of a formatted versus traditional sign out process for physicians in the emergency department

IntroductionFrequent interruptions, critically ill patients, and high patient turnover can make Emergency Department (ED) physician transitions of care (TOCs) challenging. Currently, there is no strict format for TOC in the ED. We structured a formatted ED TOC and evaluated the comparative effects from traditional TOC practice on the perceived quality of sign-out among physicians working in the ED. MethodsWe performed a prospective pre/post-interventional study utilizing convenience sampling in an urban community teaching hospital. The primary outcome was perceived quality of sign-out, as evaluated by the incoming physician one-hour after TOC, using the handoff-Clinical Evaluation Exercise (h-CEX) score with a 9-point scale for each category: Organized/Efficient, Communications Skills, Included Pertinent Information, Clinical Judgment, Patient Focused, Setting, and Overall Sign-Out Quality. Additional evaluation of unexpected tasks and errors from TOC w performed. ResultsWe included 344 patient TOC observed, of which 147 (43%) were formatted interventions while 197 (57%) were standard TOCs. After analysis in a random effects model, statistically significant improvements among resident physicians were seen for the formatted TOC: patient focused (mean difference 0.40), setting (mean difference 1.05), and overall (mean difference 0.68). The rate of unexpected tasks and errors were higher in the standard TOC, though not statistically significant. ConclusionResident physicians saw improvement in several h-CEX categories with a formatted TOC. Consistent with prior studies, a formatted TOC for emergency medicine should be strongly considered, especially among learners.

Implementing a Physical Health Clinic on an Acute Adult Inpatient Psychiatric Ward

AimsAcute Inpatient Psychiatric Wards present the challenge of a high turnover of patients who have multiple physical health comorbidities that both contribute to patients’ overall morbidity and may exacerbate any mental illness. Furthermore, there are a number of physical health parameters which must be checked and monitored in the initiation of psychiatric treatments. It is therefore important that patients receive physical examination, blood tests and Electrocardiograms (ECGs). The busy environment of inpatient units and the acute presentation of patients, who often decline interventions, lack capacity or cannot communicate their physical health problems, mean these assessments are often missed when offered in an ad hoc fashion. This Quality Improvement Project looked at implementing a Physical Health Clinic to look at whether this structured environment would provide better coverage of these physical health assessments.MethodsThe number of physical examinations, blood tests and ECGs both offered but declined and successfully obtained was measured on an Inpatient Ward with 20 patients and 2 junior doctors over 2 weeks with assessments being offered in an ad hoc fashion. Following this, a structured clinic run by a doctor and nurse with three 20 minute appointments three times a week was implemented and the same data collected over 2 weeks. A paired T-test was used to evaluate the results.ResultsThere was a statistically significant increase in the number of successfully obtained physical examinations, bloods tests and ECGs when the Physical Health Clinic was implemented (Mean difference = 7.33, Two tailed P value = 0.0480,95% confidence interval 0.16–14.50, t = 4.4, df = 2, standard error of difference = 1.667). However, there was no difference between the number of bloods, examinations and ECGs offered but declined (Mean difference = 4.83, Two tailed P value = 0.2495, 95% confidence interval −3.92–8.58, t = 1.6059, df = 2, standard error of difference = 1.453).ConclusionThe clinic led to a statistically significant increase in the number of examinations, blood tests and ECGs successfully obtained. The reasons for this are hypothesized that having a structured clinic prepares the patient to have a physical assessment and ensures their availability, provides motivation for staff and increases the efficiency of assessments with appropriate teamwork between doctors and nurses. Issues with the Clinic are limited availability of junior doctor and nursing staff and emergencies disrupting the functioning of the clinic. Implementing the clinic on a wider scale is required to assess its effectiveness.

Restructuring Patient Review and Allocation in a South London Home Treatment Team

AimsLambeth Home Treatment Team (LHTT) provides short-term intensive community psychiatric care to a diverse South London population. The high turnover of patients requires a streamlined process to review and discuss their progress. We aimed to discuss patients in more frequent, targeted and shorter meetings, and to improve continuity of medical care using a ‘named doctor’ system. We assessed impact on length of stay with LHTT, on staff time as well as on both patient and staff satisfaction.MethodsThe system of once-weekly day-long discussions of entire caseload was replaced by twice-weekly discussions of new and concerning patients only. The system of medical reviews was changed from ad hoc to MDT-agreed allocation to a specific doctor for the duration of LHTT stay.Data on duration of treatment and caseload size were taken from regular LHTT statistical reports. Staff and patient questionnaires assessed impact on satisfaction and time spent in review discussions.ResultsQualitative reports of staff experience revealed that the new system was felt to provide better continuity of care, better time efficiency (less time spent learning about new patients) and improved learning experiences for doctors in training. Downsides included lack of ‘automatic second opinion’ when a patient was reviewed by a different doctor, felt to be mitigated by more frequent discussions in MDT reviews when needed.Patient feedback showed no significant change was noted in overall experience of LHTT, although patients were more likely to feel involved in their care (88% said ‘definitely’ compared to 68% before the change).Time spent discussing patients in clinical review meetings reduced from an average of 38.5 to 28.5 person-hours per week.Average caseload reduced from 57 to 42. However, duration of treatment increased from 18.8 days to 20.4 days.ConclusionThe reduction in staff time in reviews suggests that the system had been appropriately streamlined. While caseload size reduced, duration of stay slightly increased, so the new system was not found to have had a significant impact on objective measures of patient care.Staff feedback was generally favourable, highlighting continuity of care and time efficiency. Patient feedback, while good both before and after our change, suggested a greater feeling of involvement in their care, possibly due to clearer communication and discussion of plan from the start of LHTT care.

Improving the handover process in a psychiatry liaison setting

Efficient handover of patient care is integral to clinical safety. Barriers in communication can lead to adverse outcomes. The Integrated Liaison Assessment Team (ILAT) has a daily handover meeting which...

GIS to Explore the Geographical Mysteries of Oral Cancer: Geospatial Distribution of Patients Diagnosed with Oral Potentially Malignant Disorders at the University Dental Hospital Peradeniya

Background: Oral cancers which are often preceded by an oral potentially malignant disorder (OPMD) carries the highest mortality rate among all cancers in Sri Lanka. Dental Teaching Hospital, Peradeniya is one of the tertiary centres in Sri Lanka for treating OPMD with a high patient turnover. Objectives: This study aimed to determine the geospatial distribution of OPMD patients who attended Dental Hospital, Peradeniya (DHP) using geocoding methods. Materials and Methods: A retrospective study was done by obtaining data of 869 OPMD patients who visited DHP within the last 4 years to geo-code their addresses using GIS software. Results: The majority of the sample consisted of oral lichen planus (OLP) (52.47%). 29% and 18.64% of the patients were diagnosed with leukoplakia and oral submucous fibrosis (OSF) respectively. Most of the OPMD patients (60.64%) who visited the clinic were from the Kandy district and surprisingly the majority of OPMD patients had been reported from non-estate areas. The second and third highest number of patients were respectively from Nuwaraeliya (11.28%) and Kegalle (7.48%). More than half (57.19%) of the patients were living within 20 km of the hospital. Conclusion: The composition of patients with OPMDs visited the DHP had deviated from the national data. More than half of the sample residing within a reasonable travel distance to a specialist care centre.

Variation in severity-adjusted resource use and outcome in intensive care units

PurposeIntensive care patients have increased risk of death and their care is expensive. We investigated whether risk-adjusted mortality and resources used to achieve survivors change over time and if their variation is associated with variables related to intensive care unit (ICU) organization and structure.MethodsData of 207,131 patients treated in 2008–2017 in 21 ICUs in Finland, Estonia and Switzerland were extracted from a benchmarking database. Resource use was measured using ICU length of stay, daily Therapeutic Intervention Scoring System Scores (TISS) and purchasing power parity-adjusted direct costs (2015–2017; 17 ICUs). The ratio of observed to severity-adjusted expected resource use (standardized resource use ratio; SRUR) was calculated. The number of expected survivors and the ratio of observed to expected mortality (standardized mortality ratio; SMR) was based on a mortality prediction model covering 2015–2017. Fourteen a priori variables reflecting structure and organization were used as explanatory variables for SRURs in multivariable models.ResultsSMR decreased over time, whereas SRUR remained unchanged, except for decreased TISS-based SRUR. Direct costs of one ICU day, TISS score and ICU admission varied between ICUs 2.5–5-fold. Differences between individual ICUs in both SRUR and SMR were up to > 3-fold, and their evolution was highly variable, without clear association between SRUR and SMR. High patient turnover was consistently associated with low SRUR but not with SMR.ConclusionThe wide and independent variation in both SMR and SRUR suggests that they should be used together to compare the performance of different ICUs or an individual ICU over time.

Exploring antibiotic prescribing in public and private primary care settings in Singapore: a qualitative analysis informing theory and evidence-based planning for value-driven intervention design

BackgroundSingapore’s healthcare system presents an ideal context to learn from diverse public and private operational models and funding systems.AimTo explore processes underpinning decision-making for antibiotic prescribing, by considering doctors’ experiences in different primary care settings.MethodsThirty semi-structured interviews were conducted with 17 doctors working in publicly funded primary care clinics (polyclinics) and 13 general practitioners (GP) working in private practices (solo, small and large). Data were analysed using applied thematic analysis following realist principles, synthesised into a theoretical model, informing solutions to appropriate antibiotic prescribing.ResultsGiven Singapore’s lack of national guidelines for antibiotic prescribing in primary care, practices are currently non-standardised. Themes contributing to optimal prescribing related first and foremost to personal valuing of reduction in antimicrobial resistance (AMR) which was enabled further by organisational culture creating and sustaining such values, and if patients were convinced of these too. Building trusting patient-doctor relationships, supported by reasonable patient loads among other factors were consistently observed to allow shared decision-making enabling optimal prescribing. Transparency and applying data to inform practice was a minority theme, nevertheless underpinning all levels of optimal care delivery. These themes are synthesised into the VALUE model proposed for guiding interventions to improve antibiotic prescribing practices.These should aim to reinforce intrapersonal Values consistent with prioritising AMR reduction, and Aligning organisational culture to these by leveraging standardised guidelines and interpersonal intervention tools. Such interventions should account for the wider systemic constraints experienced in publicly funded high patient turnover institutions, or private clinics with transactional models of care. Thus, ultimately a focus on Liaison between patient and doctor is crucial. For instance, building in adequate consultation time and props as discussion aids, or quick turnover communication tools in time-constrained settings. Message consistency will ultimately improve trust, helping to enable shared decision-making. Lastly, Use of monitoring data to track and Evaluate antibiotic prescribing using meaningful indicators, that account for the role of shared decision-making can also be leveraged for change.ConclusionsThese VALUE dimensions are recommended as potentially transferable to diverse contexts, and the model as implementation tool to be tested empirically and updated accordingly.

1541 Treating Patients with Respect: Assessing the Completion Rate of The ReSPECT Form for Patients Admitted to Hospital

AimTo assess the current completion rate of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form, and to identify ways to improve the completion rate for all inpatients under our care.MethodAll notes of admitted patients were reviewed for a completed ReSPECT form over a two-week period. Data was collected on whether a form had been completed and its respective fields. This was repeated in three cycles, introducing interventions between each cycle – trainee education and reminders were sent through our WhatsApp messenger group between cycles 1 and 2, and posters implemented between cycles 2 and 3.ResultsFor cycle 1, out of 40 patient notes, 9 (22.5%) had a completed ReSPECT form. This increased to 25 out of 57 patients (43.9%) for cycle 2. Cycle 3 found 1 out of 16 patients (6.7%) had a completed ReSPECT form.ConclusionsOur data demonstrated a significant deterioration in our compliance as a department. This could be due to a number of factors ranging from the coronavirus pandemic and staff redeployment to increased workloads, higher patient turnover, and new staff. In any outcome, the poster has proven to be ineffective. Whilst we identified that reminders via electronic message appear to have had an improvement, this has shown to be temporary, and may not be effective in busier times. As such, this audit has revealed a significant need for departmental change and to develop new strategies to improve compliance.

56 ‘A Closed-Loop Audit on The Appropriateness of Urine Testing Carried Out on Surgical Patients in The Acute Surgical Unit in University Hospital Limerick as Compared with Hospital Guidelines’

Abstract Aim The acute surgical unit (ASU) in University Hospital Limerick (UHL) has a high turnover of patients of all surgical specialties, many of whom are sent home without the need for admission or follow-up. Urinalysis is very accessible, and is carried out on many patients, prior to them being seen by a doctor. Inappropriate urinalysis sets off a cascade of inappropriate urine culture, antimicrobial treatment and a waste of resources and time of nursing, medical and laboratory staff. We aim to identify and reduce inappropriate testing. Method The notes of all ASU patients during a one-week period were analysed using the ‘Therefore Navigator’ application, where all patient notes are scanned on leaving the ASU. Data relating to presenting complaint, presence or absence of urinary symptoms and abdominal pain, and urine dipstick and culture results (if performed) was collected for each patient. The results were compared with UHL guidelines on testing, an information sheet was designed and placed in ASU, and an education session for nursing staff was carried out. The second cycle was performed one month later. Results In the first cycle, 68% of the 99 ASU patients had urinalysis, and 48% had urine culture performed. Of cultures performed, only 23 of 47 (49%) were deemed indicated according to the guidelines. In the second cycle, 39% had urinalysis. 28% had urine cultured, 79% of these were deemed to have been indicated. Conclusions Inappropriate urine testing in the ASU decreased following teaching for nursing staff, together with an information leaflet being placed in the ASU.

347 Read the First Page: An Audit on Medicine Reconciliation in General Surgery Inpatients at London District General Hospital

Abstract Aim Medication-related incidents occur more frequently when medicine reconciliation happens more than 24 hours after admission. The National Institute for Health and Care Excellence recommends a complete reconciliation within 24 hours of admission. General Surgery is a busy specialty with a high patient turnover rate. Hence, this audit was conducted to assess the extent of a problem and mitigate it. Method Every adult General Surgery inpatient who were admitted for over 24 hours were included. Patients on intensive care or high dependency unit were excluded. Drug charts were reviewed every Thursday for nine weeks between October and December 2020. Data from the first three weeks were used to establish baseline. Three interventions were introduced, each lasting two weeks. Any significant harm to patients due to incomplete reconciliation was recorded. Results At baseline (n = 100), 38.0% of patients had incomplete reconciliation. This significantly reduced to 23.4% (n = 64, p-value=0.037) between Weeks 4 and 5 after baseline data was presented at a team meeting and posters were put up. Allowing pharmacists to flag up missing medications on a daily job’s list did not significantly reduce the incompletion rate (23.0%, n = 74, p-value&amp;gt;0.999). Finally, performing a medicine reconciliation ward round on Weeks 8 and 9 further reduced the incompletion rate to 2.8% (n = 74, p-value=0.001). One significant harm was noted on Week 1. Conclusions Medicine reconciliation is a vital aspect of patient safety. Raising awareness of the issue significantly reduced the incompletion rate. However, the most effective intervention is conducting a medicine reconciliation ward round.

Different Techniques for Rubber Dam Isolation: A Cross-Sectional Study

Objective: To assess knowledge, regarding use of rubber dam during root canal treatment among dentists in Rawalpindi and Islamabad.Study Design: Descriptive cross-sectionPlace and Duration of Study: Operative Department Armed Forces Institute of Dentistry (AFID) Rawalpindi from 1st March 2020 to 31st May 2020. Materials and Methods: A web-based questionnaire, comprising of close-ended questions in the categories of demographics, clinical experience, usage of isolation techniques and knowledge regarding rubber dam (RD) use, procedures, and contraindications was sent through internet to 387 dentists of Rawalpindi and Islamabad. The response rate was 77.5%. Data was analyzed using SPSS version 20, and was displayed as numbers and percentages.Results: 79 out of 300 i.e. 26.33% respondents used rubber dam in restorative and endodontic procedures. 73.3% were using other methods of isolation such as cotton rolls, saliva ejectors and high volume suction. All the respondents were aware about the importance of rubber dam. The most challenging factor for dentists (57.3%) was high influx of patients per day.Conclusion: Rubber dam is not being used commonly by participating dentists of tertiary dental hospitals of Rawalpindi and Islamabad mainly because of high patient turnover per day, combination of cotton rolls and saliva high-volume ejector or gauze is the most common alternative to rubber dam isolation. Rubber dam isolation is highly recommended.&#x0D;