Implementation Of Standard Operating Procedures Research Articles

Evaluation of Work Quality Indicators in Medical Biochemical Laboratories.

A laboratory professional concerned with the quality of work in medical-biochemical laboratories ensures the accuracy and precision of laboratory analyses through the implementation of international and European guidelines for working with hazardous substances, through the availability and implementation of Standard Operating Procedures (SOPs). Laboratory hazards that affect the concentration and safety of workers arise from laboratory deficiencies such as: lack of preventive measures, knowledge and skills implemented through SOPs and good laboratory practice. Biophysical hazards in medical laboratories are manifested by needles and sharp objects, infectious materials, noise, vibration, radiation, poor air quality, temperature inversions. Aim of the research was to raise awareness of the quality of work in medical-biochemical laboratories in order to ensure the safety of workers. A cross-sectional questionnaire-based study was conducted among 100 laboratory proffesionals from Bosnia and Herzegovina and Croatia. The research was conducted over a period of three months. A higher percentage of exposure to infectious agents and needles and sharp objects was found among respondents from BiH compared to CRO (p=0.018 and p=0.001, respectively).We found that respondents employed in accredited laboratories are aware of exposure to hazards in a high percentage related to infectious agents, toxins (p=0.0012 and p=0.0046, respectively). A significant statistical difference was found between respondents with BiH and respondents with CRO in terms of knowledge of accreditation standards of medical-biochemical laboratories (p=0.0155). Respondents who have standard operating procedures available are aware of the hazards of infectious agents (p=0.0001), toxins (p=0.0466), needles and sharp objects (p=0.0052), noise (p=0.0030), vibration (p=0.0007) and extreme temperatures (p=0.0014). Efficient implementation and continuous compliance with the ISO 15189:2018 standard requires constant commitment and active participation of laboratory staff. Laboratories must have standard operating procedures in place and actively monitor their use.

Evaluation of Work Quality Indicators in Medical Biochemical Laboratories.

A laboratory professional concerned with the quality of work in medical-biochemical laboratories ensures the accuracy and precision of laboratory analyses through the implementation of international and European guidelines for working with hazardous substances, through the availability and implementation of Standard Operating Procedures (SOPs). Laboratory hazards that affect the concentration and safety of workers arise from laboratory deficiencies such as: lack of preventive measures, knowledge and skills implemented through SOPs and good laboratory practice. Biophysical hazards in medical laboratories are manifested by needles and sharp objects, infectious materials, noise, vibration, radiation, poor air quality, temperature inversions. Aim of the research was to raise awareness of the quality of work in medical-biochemical laboratories in order to ensure the safety of workers. A cross-sectional questionnaire-based study was conducted among 100 laboratory proffesionals from Bosnia and Herzegovina and Croatia. The research was conducted over a period of three months. A higher percentage of exposure to infectious agents and needles and sharp objects was found among respondents from BiH compared to CRO (p=0.018 and p=0.001, respectively).We found that respondents employed in accredited laboratories are aware of exposure to hazards in a high percentage related to infectious agents, toxins (p=0.0012 and p=0.0046, respectively). A significant statistical difference was found between respondents with BiH and respondents with CRO in terms of knowledge of accreditation standards of medical-biochemical laboratories (p=0.0155). Respondents who have standard operating procedures available are aware of the hazards of infectious agents (p=0.0001), toxins (p=0.0466), needles and sharp objects (p=0.0052), noise (p=0.0030), vibration (p=0.0007) and extreme temperatures (p=0.0014). Efficient implementation and continuous compliance with the ISO 15189:2018 standard requires constant commitment and active participation of laboratory staff. Laboratories must have standard operating procedures in place and actively monitor their use.

Consistency of Application of Standard Operating Procedures (SOP) for Population Administration Services for Making E-KTP in Sidoarjo Regency

This study aims to identify and analyze the application of population administration service SOPs for making E-KTP in Candi District. This research is a qualitative descriptive study using purposive sampling technique. In this study, the informant was the head of the public service section as key informants, sub-district staff and the community as informants. Data collection techniques by observation, interviews and documentation. Analyzing techniques of data collection, data reduction, data presentation, drawing conclusions. The results of research in the field of implementing SOPs for population administration services for making E-KTP in Candi District are consistently carried out by service officers to the community as service recipients that carry out the appropriate SOP. Commitment that the awareness of service personnel is running, continuous improvement of SOPs every year. The application of SOPs is not binding, but is carried out properly and is flexible. All important elements in the implementation of SOPs that are carried out All officers who run SOPs are in accordance with and never violate the SOPs that are made and mutually agreed upon, Good documentation. The existence of supporting and inhibiting factors in the implementation of SOPs.

336: EVALUATION OF A PHARMACY-MANAGED HEPARIN-INDUCED THROMBOCYTOPENIA STANDARD OPERATING PROCEDURE

Introduction: Heparin-induced thrombocytopenia (HIT) is associated with significant morbidity and mortality, necessitating early identification and timely diagnosis. The objective of this study was to evaluate a pharmacy-managed HIT standard operating procedure (SOP). Methods: A retrospective analysis of HIT laboratory testing at Nebraska Medicine before (April 2018 to August 2019) and after (April 2020 to August 2021) SOP implementation was performed on patients admitted to the ICU. Patients were included if an anti-PF4 antibody and/or SRA test was ordered during hospitalization with prior heparin exposure. Exclusion criteria were age < 19, no heparin product exposure prior to HIT laboratory testing, or if lab testing was ordered ≥15 days from receiving heparin. The primary outcome was appropriately documented heparin allergy field in the medical record. Secondary outcomes include false positive anti-PF4 antibody assays, time from heparin initiation to HIT laboratory testing, duration of direct thrombin inhibitor (DTI) use, hospital length of stay, and in-hospital all-cause mortality. Results: 226 patients were evaluated, 110 in the pre- and 116 in the post-cohort. Baseline characteristics demonstrated most patients were male (58.8%), white (81.4%), and were anticoagulated with an indication of VTE prophylaxis (61.1%). Acute trauma/surgical procedure was the most common reason for admission (31%). Appropriate heparin allergy documentation occurred in 95.5% of patients in the pre- and 97.4% of patients in the post- cohort (p=0.528). No difference was found in the incidence of false positive anti-PF4 antibody assays (9.1% vs 8.6%) or time from heparin initiation to HIT laboratory testing (3.2 vs 3.6 days). DTI’s were utilized for a longer duration of time in the pre- cohort compared to the post-cohort (4.9 vs 2.8 days). There was no difference in hospital length of stay (17.9 vs 17.4 days), but in-hospital all-cause mortality was observed more frequently in the post-cohort than the pre-cohort (36.2% vs 23.6%). Conclusions: The implementation of a pharmacist-driven heparin-induced thrombocytopenia standard operating procedure demonstrated a similar incidence of appropriate heparin allergy documentation in the medical record compared to a physician-driven approach.

IMPLEMENTASI STRATEGI DINAS PEMBERDAYAAN PEREMPUAN DAN PERLINDUNGAN ANAK (DP3A) DALAM MENEKAN PENINGKATAN ANGKA KEKERASAN SEKSUAL ANAK DI KABUPATEN TANGERANG, INDONESIA

Child sexual violence there are still many cases of violence, namely as many as 72 victims of sexual violence against children. This study aims to determine the implementation of the Office of Women's Empowerment and Child Protection strategy in suppressing the increase in child sexual violence in Tangerang Regency. The research method used is descriptive qualitative research and analyzed by descriptive analysis. Based on the data analysis, it can be concluded that the implementation of strategies that can be carried out by the Office of Women's Empowerment and Child Protection in suppressing the increase in the number of child sexual violence in Tangerang Regency is by analyzing programs, budgets, and procedures. The first program is several PATBM in the village or village has not been running. Secondly, advocacy socialization through BK/BP teachers has been given socialization by service to BK/BP teachers, but only part of the socialization has not been right on target, namely all students. Third, socialization to the community through community leaders where community leaders have never received directions from the department or village. The budget still has its budget limitations. There are still programs or activities whose implementation has not been to the plan due to budget limitations. In the implementation of Standard Operating Procedures (SOP), some problems are still victims of violence who are less cooperative in handling cases of child sexual violence.

Improving Survival in Cardiogenic Shock-A Propensity Score-Matched Analysis of the Impact of an Institutional Allocation Protocol to Short-Term Mechanical Circulatory Support.

Temporary mechanical circulatory support (tMCS) is a life-saving treatment option for patients in cardiogenic shock (CS), but many aspects such as patient selection, initiation threshold and optimal modality selection remain unclear. This study describes a standard operating procedure (SOP) for tMCS allocation for CS patients and presents outcome data before and after implementation. Data from 421 patients treated for CS with tMCS between 2018 and 2021 were analyzed. In 2019, we implemented a new SOP for allocating CS patients to tMCS modalities. The association between the time of SOP implementation and the 30-day and 1-year survival as well as hospital discharge was evaluated. Of the 421 patients included, 189 were treated before (pre-SOP group) and 232 after implementation of the new SOP (SOP group). Causes of CS included acute myocardial infarction (n = 80, 19.0%), acute-on-chronic heart failure in patients with dilated or chronic ischemic heart failure (n = 139, 33.0%), valvular cardiomyopathy (n = 14, 3.3%) and myocarditis (n = 5, 1.2%); 102 patients suffered from postcardiotomy CS (24.2%). The SOP group was further divided into an SOP-adherent (SOP-A) and a non-SOP-adherent group (SOP-NA). The hospital discharge rate was higher in the SOP group (41.7% vs. 29.7%), and treating patients according to the SOP was associated with an improved 30-day survival (56.9% vs. 38.9%, OR 2.21, 95% CI 1.01-4.80, p = 0.044). Patient allocation according to the presented SOP significantly improved 30-day survival.

ANALISIS MENAJEMEN KESELAMATAN PASIEN TERHADAP MUTU PELAYANAN KESEHATAN DI RUANG RAWAT INAP RUMAH SAKIT X

The most significant metric in the health care system is patient safety, which is meant to serve as a guide in providing the best possible care and lowering patient occurrences. The study's objective is to examine the impact of patient safety management on the standard of care provided in the inpatient unit at X Hospital. Qualitative research methodology is used. The patient safety team, the nursing committee, and the head of quality improvement and patient safety made up the five informants for the September 2022 study. Through observations and interviews, data was gathered. Collaizzi is used in data analysis to reduce data, show data, and draw conclusions.The research results show that there are five themes, namely that the role of the organization in determining patient safety management has been supported by mentors and experts. This is shown by the results of interviews, namely that there are mandatory, meetings, in-house training, reviews and also adequate human resources. Ensuring that patient safety management is supported by mentors and experts, this is shown by the results of interviews, namely that there are mandatory requirements, meetings, in-house training, reviews and also adequate human resources. It is recommended that hospital management provide training and socialization about patient safety programs on a regular basis, provide sanctions for violating the implementation of Standard Operating Procedures and propose a report form using an online system.

The Role of Fiqh Ikhtilaf in the Implementation of Congregational Prayers During COVID-19

Fiqh Ikhtilaf is the diversity of views on fiqh as a result of the differences in the methodology of mujtahids in issuing laws that are understood from the Islamic nas. These differences are influenced by the background of thinking, the level of mastery of knowledge and the current needs. In this phase of the COVID-19 pandemic, society is faced with new issues that require a re-evaluation of Islamic law. The main objective of this concept paper is to explain the role of Fiqh Ikhtilaf in the implementation of SOP (Standard Operating Procedure) of Congregational Prayer in the COVID-19 pandemic. The literature review methodology was used to answer the research questions by analysing the debate on Fiqh Ikhtilaf and SOP of Congregational Prayers. The findings of the study showed that Fiqh Ikhtilaf facilitates the affairs of human life, becomes the basic reference for the Ulama in ijithad, opens the minds of the community towards the expanse of fiqh and helps realize Hifz Al-Din and Hifz Al-Nafs in Maqasid Shariah.&#x0D; Keywords: Fiqh Ikhtilaf, Maqasid Sharia, COVID-19

IMPLEMENTING COVID-19 STANDARD OPERATION PROCEDURE (SOP) IN MALAYSIA CONSTRUCTION INDUSTRY: CHALLENGES AND STRATEGIES

The COVID-19 disease has impacted the performance of all industries, including the construction industry. In order to curb the spread of the disease, the government has conducted Movement Control Order (MCO). Consequently, a construction project is not allowed to be operated unless the implementation of the new SOP aims to curb the spread of COVID-19 disease among workers on the construction site. The operation of the construction site has resulted in new clusters of COVID-19 in the early phase of the outbreak which led to the project shut down. The objective of this study is to identify the challenges of implementation of SOP during the outbreak of COVID-19 from the contractor’s perspective and to suggest a solution for controlling the effects of the COVID-19 outbreak at the construction site. In collecting data and responses from the respondents, interviews were held through the telephone conversation and video conferencing with nine (9) contractors in Cheras, Kuala Lumpur. The selection was made through the purposive sampling technique in which the contractors were selected from the contractor listing on the Malaysian Construction Industry Development Board (CIDB) website. Content analysis is used to identify the main challenges. Results from interviews found four (4) challenges faced by contractors and five (5) solutions for mitigating the effect of an outbreak. The challenges include wearing face masks, maintaining social distancing, securing authority approval letter, and restriction of workers’ numbers. On the other hand, the solutions that are highlighted include proper planning and scheduling, complying with COVID-19 standard operating procedures (SOP), controlling the movement of workers, providing all workers’ vaccination, and conducting regular COVID-19 tests. These findings have shown that having SOP for COVID-19 has posed challenges to the activities on the construction sites. As such, the findings intend to increase the awareness among construction companies on the challenges towards the implementation of the best practices to overcome these challenges.

Level of knowledge and workload are associated with nurse’s adherence in implementing fall prevention procedures at Tabanan District Hospital, Bali

Background and purpose:Fall prevention is an essential part of patient safety system. At Tabanan District Hospital (BRSUD Tabanan), incidence of falling among patients is still happening. This study aims to determine the relationship between level of knowledge and workload of nurses with compliance in implementing standard operational procedures (SOP) to prevent the risk of falling in the inpatient rooms at Tabanan District Hospital. Methods: This study was a cross-sectional survey. The sample size was 75 nurses in the inpatient room at BRSUD Tabanan. Data collection was carried out in the period of December 2, 2019 - January 2, 2020 which included 1). direct interviews to obtain data on characteristics, the level of knowledge and workload of nurses, 2). observations of nurses’ adherence in the implementation of standard operational procedures to prevent the risk of falling patients. Data analysis was performed by univariate, bivariate with chi-square test and multivariate analysis with logistic regression. Results: Most of the respondents were ≤40 years old (86.7%), female (72%), length of working ≤10 years (81.4%), education level of bachelor in nursing (65.4%). Two third of the respondents have a good level of knowledge (66.7%), with medium workload (26.7%) and heavy workload (73.3%). Most of the respondents (70.7%) adhere to the implementation of standard operating procedures to prevent the risk of falling patients. Variables associated with the compliance to SOP are age (AOR=5.35; 95%CI: 1.230-23.259; p=0.025), level of knowledge (AOR=6.409; 95%CI: 1.720-23.873; p=0.006), and workload (AOR=0.076; 95%CI: 0.17-0.339; p=0.001), where the workload variable has a negative relationship with nurse compliance (AOR&lt;1). Conclusion: The conclusion of this study is that there is a relationship between the level of knowledge and workload on nurses’ compliance in implementing standard operational procedures to prevent the risk of falling patients

Error Reduction in Sterile Processing Through Standardization of Operations and Training

Background Surgical instrument processing is critical to safe surgical care. Hospitals have massive instrument inventories that are organized into thousands of instrument sets. Millions of instrument sets are reprocessed annually due to multiple use. Errors in processing may impact operations, post-surgical infection rates, and/or mortality. Upon review of error data within sterile processing, an analysis was performed that identified a need for process standardization and education. Methods A quality monitoring approach was developed to help identify and reduce errors in sterile processing. An education plan was implemented that included weekly in-services, individual training, process standardization, and modification of orientation program. Standard Operating Procedures (SOP) were created to help avoid missteps in daily operations. Visual, auditory, and kinesthetic learning methods were utilized. Competency was evaluated through observation. A solid orientation program helps instill confidence and demonstrates a commitment to success. An orientation packet was developed that included an employee and preceptor learning packet. Competency is evaluated throughout the orientation period at routine intervals. At the end of the 90-day training, competencies are reviewed to ensure fundamentals were retained and to gather overall feedback on the training program. Results Since beginning this initiative in 2018, quality errors have decreased from an average of 17 per month to three, which is an 80% sustained decrease. Immediate use steam sterilization (IUSS) rates decreased from 6% to less than 1%. This decrease contributes to increased patient safety through reduction of events that could potentially lead to mortality or infection, as well as reduces delays in surgical operations. Conclusions Surgical instrument processing errors are a barrier to the highest quality and safety in surgical care. However, these are modifiable through educational initiatives, standardization, and targeted resources. Implementation of SOPs and standardized training programs have shown success in reducing errors, leading to better quality outcomes, and improving patient safety. Surgical instrument processing is critical to safe surgical care. Hospitals have massive instrument inventories that are organized into thousands of instrument sets. Millions of instrument sets are reprocessed annually due to multiple use. Errors in processing may impact operations, post-surgical infection rates, and/or mortality. Upon review of error data within sterile processing, an analysis was performed that identified a need for process standardization and education. A quality monitoring approach was developed to help identify and reduce errors in sterile processing. An education plan was implemented that included weekly in-services, individual training, process standardization, and modification of orientation program. Standard Operating Procedures (SOP) were created to help avoid missteps in daily operations. Visual, auditory, and kinesthetic learning methods were utilized. Competency was evaluated through observation. A solid orientation program helps instill confidence and demonstrates a commitment to success. An orientation packet was developed that included an employee and preceptor learning packet. Competency is evaluated throughout the orientation period at routine intervals. At the end of the 90-day training, competencies are reviewed to ensure fundamentals were retained and to gather overall feedback on the training program. Since beginning this initiative in 2018, quality errors have decreased from an average of 17 per month to three, which is an 80% sustained decrease. Immediate use steam sterilization (IUSS) rates decreased from 6% to less than 1%. This decrease contributes to increased patient safety through reduction of events that could potentially lead to mortality or infection, as well as reduces delays in surgical operations. Surgical instrument processing errors are a barrier to the highest quality and safety in surgical care. However, these are modifiable through educational initiatives, standardization, and targeted resources. Implementation of SOPs and standardized training programs have shown success in reducing errors, leading to better quality outcomes, and improving patient safety.

Environmental Contamination by Echinococcus spp. Eggs as a Risk for Human Health in Educational Farms of Sardinia, Italy.

Cystic Echinococcosis (CE) is a severe zoonosis caused by the larval stage of the tapeworm Echinococcus granulosus. These parasites are naturally transmitted between canid definitive hosts that harbour the adult stage in the intestine, and mainly ungulate intermediate hosts, with larval cysts developing in their internal organs. The close coexistence between dog and sheep with incorrect hygiene management are the most important factors for the persistence of this parasitic pathology. The Educational Farms (EF) are farms and agritourisms suitably equipped to carry out training activities for people interested in farm practices and agricultural processing, in particular student groups. Public attendance of farms represents a new potential risk factor for the zoonoses transmission. Consumption of contaminated food and water in combination with contact or playing with domestic dogs (Canis familiaris) are possible routes of zoonoses human infection. In fact, Echinococcus spp. eggs may persist in the environment up to several months at low temperatures and moist conditions, having the chance of contaminating different matrices and surfaces. The aim of this investigation was to study environmental contamination by parasitic elements as a risk for zoonoses, such as Echinococcus spp. A total of 116 samples (35 of water, 33 of soil, 23 of vegetables, 25 of dog faeces) were collected in 30 EF in Sardinia. Samples were subjected to biomolecular investigation for the research of specific gene sequences of Echinococcus granulosus, Echinococcus multilocularis and Taenia spp. The study allowed to identify eight positive EF due to the presence of Echinococcus granulosus in eight dog faeces samples and one positive EF due to the presence of Taenia spp. in a water sample. The work has allowed to develop and harmonise the diagnostic methods and operating protocols essential for controlling the spread of the CE to create “One Health” intervention plans in high endemic areas through the implementation of SOP (standard operating procedures) for monitoring the pathology in animals, humans and environment.

The effect of extra safety measures on incidence of surgical site infection after alloplastic breast reconstruction

This study aimed to evaluate whether the implementation of extra perioperative safety measures and precautions through adopted standard operating procedures (SOPs) to ensure optimal anti-microbial conditions has led to less surgical site infections (SSI) after alloplastic breast reconstruction (BR). This retrospective study compared two Cohorts of patients treated before and after the implementation of new SOPs (2009-2014: Cohort 1 versus 2014-2019: Cohort 2). Multivariate logistic regression analyses, adjusting for patient confounders, were implemented to compare SSI incidence between both Cohorts. Overall, SSI incidence was equal in both groups (10%, p=0.545). The incidence of deep SSI was 9% for Cohort 1 and 5% for Cohort 2 (p=0.074). Incidence of SSI-related explantation was 8% and 5%, respectively (p=0.136). After adjusting for patient confounders, no statistically significant difference was seen between both Cohorts in overall SSI, deep SSI incidence, and explantation due to SSI (ORadjusted: -0.31, p=0.452, ORadjusted: 0.16, p=0.747 and ORadjusted: 0.18, p=0.712). Higher BMI, smoking, one-stage BR, and immediate BR were associated with the risk for SSI (p<0.001, p=0.036, p<0.001, and p=0.022, respectively). Extra safety measures to assure optimal anti-microbial conditions did not contribute to lower SSI incidence or SSI-related explantation after alloplastic BR. Confounders such as BMI, smoking, immediate BR, and one-stage BR were correlated to an increased risk for overall SSI, deep SSI, and SSI-related explantation of TE/implants.

Implementation of Standard Operating Procedure in Ophthalmic Practice during Covid 19 Era across Pakistan

Purpose: To analyze the implementation of standard operating procedures (SOP) in different ophthalmic settings of Pakistan during Covid 19. Study Design: Cross sectional online survey. Place and Duration of Study: Baqai Medical University &amp; Karachi Medical and Dental College, from 11th to 25th January 2021. Methods: This online survey included doctors working as consultants, medical officers and trainees in ophthalmology setups. A self-designed questionnaire on Google forms was sent online to see the implementation of standard operating procedures during COVID 19. Results: A total of 400 participants were selected by snowball sampling technique. A response rate was 105 (26.5%). Females were 66 (62.86%). Among all participants, 36.19% responded that they always screened patients for COVID 19 at reception. Doctors who always wore masks were 96.19%. Out of those who responded, 16.19% and 11.43% always wore protective goggles and disposable gowns respectively. Only 55.24% practiced hand sanitization, 18.10% washed hands with soap and 30.48% cleaned slit lamps after seeing each patient. Doctors who always asked for PCR before ocular surgery under general anesthesia were 65 (61.90%) and for local anesthesia were 36 (34.29%). Direct Ophthalmoscopy, tonometry, and gonioscopy were performed when necessary by 56.19%, 80.00%, 80.00% of doctors respectively. Only 69.5% were satisfied with precautionary measures. Conclusion: Clinic management needs improvement in implementing SOPs among patients in an eye OPD. Fifty percent of the ophthalmologists received PPE by their administration. Only 69.5% doctors were satisfied with precautionary measures. Key Words: COVID 19, standard operating procedures, Pakistan, Ophthalmology

WHAT NEW NORM? THE ROLE OF SOCIAL MEDIA IN COVID-19

This research is developed to study COVID-19 and the use of social media among students. Specifically, on social media applications used by tertiary university students in Malaysia to obtain current information regarding the COVID-19 outbreak. Apart from that, the pilot study was conducted prior to distributing the main questionnaire to ensure that questions designed are suitable. Changes were made upon feedback received from pilot study. Finding suggests students are aware on the implementation of Standard Operating Procedures by the Malaysian government. However, students cannot fully differentiate the differences to the variations of imposed lockdowns. The finding also shows that Malaysian university students are aware of Malaysia's current issues and the many variations of rules and regulations which have become the new norm. This study expands further literature on the use of social media particularly among the young generation. Additionally, this study adds new knowledge to studies pertaining to the use of social media in times of health crisis in the nation.

Telemedicine for stroke

The term “telestroke” was first introduced by Levine ad Gorman in 1999. Since then many telestroke networks have been developed throughout the world more than 22 in Germany alone, performing more than 38.211 teleconsultations per year. Most telestroke networks are organized in a hub and spokes system: one or several comprehensive stroke centers (hub), advise several regional or community hospitals (spoke) in stroke care. The degree of treatment possibilities in the spokes hospitals is highly variable; while some telestroke networks offer only hyperacute stroke treatment i.e. identifying strokes and performing thrombolysis onsite (TSRH-telemedicine-assisted Stroke Ready Hospitals), others have developed local stroke Units (TSU-Telemedical Stroke Units) and provide stroke care until the patient is discharged home/to a rehabilitation center. The backbone of every functioning telestroke network remains the implementation of standard operational procedures, regular staff trainings and quality management. Nowadays, telestroke is going far beyond thrombolysis and stroke unit treatment - the ultimate goal being to treat stroke patients from the beginning to the end remotely as close to the patients home as possible. Multiple telestroke projects target stroke from the onset to its rehabilitation and follow up care. To mention only a few, mobile stroke Units including CT scanners have brought thrombolysis to the patients front door, interventionalists are been flown by helicopter to regional hospitals to perform thrombectomy onsite, and patients are being discharged home with telerehabilitation programs. In conclusion, telestroke is a growing field, bringing qualitative and innovative stroke care closer to the patient.

Level of knowledge and workload are associated with nurse’s adherence in implementing fall prevention procedures at Tabanan District Hospital, Bal

Background and purpose: Fall prevention is an essential part of patient safety system. At Tabanan District Hospital (BRSUD Tabanan), incidence of falling among patients is still happening. This study aims to determine the relationship between level of knowledge and workload of nurses with compliance in implementing standard operational procedures (SOP) to prevent the risk of falling in the inpatient rooms at Tabanan District Hospital.Methods: This study was a cross-sectional survey. The sample size was 75 nurses in the inpatient room at BRSUD Tabanan. Data collection was carried out in the period of December 2, 2019 - January 2, 2020 which included 1). direct interviews to obtain data on characteristics, the level of knowledge and workload of nurses, 2). observations of nurses' adherence in the implementation of standard operational procedures to prevent the risk of falling patients. Data analysis was performed by univariate, bivariate with chi-square test and multivariate analysis with logistic regression.Results: Most of the respondents were ≤40 years old (86.7%), female (72%), length of working ≤10 years (81.4%), education level of bachelor in nursing (65.4%). Two third of the respondents have a good level of knowledge (66.7%), with medium workload (26.7%) and heavy workload (73.3%). Most of the respondents (70.7%) adhere to the implementation of standard operating procedures to prevent the risk of falling patients. Variables associated with the compliance to SOP are age (AOR=5.35; 95%CI: 1.230-23.259; p=0.025), level of knowledge (AOR=6.409; 95%CI: 1.720-23.873; p=0.006), and workload (AOR=0.076; 95%CI: 0.17-0.339; p=0.001), where the workload variable has a negative relationship with nurse compliance (AOR&lt;1).Conclusion: The conclusion of this study is that there is a relationship between the level of knowledge and workload on nurses' compliance in implementing standard operational procedures to prevent the risk of falling patients.

Nebulization of emergency medications in the south German rescue service

HintergrundIn der Notfallmedizin ist die Durchführung der inhalativen Therapie auch durch Rettungsfachpersonal vorgesehen. Standard Operating Procedures (SOP) und Handlungsempfehlungen zum Einsatz sind nicht bundeseinheitlich und liegen im Falle der Vernebelung von Notfallmedikamenten nicht in allen Bundesländern und Rettungsdienstbereichen vor. Es existieren auch keine Empfehlungen, welcher Verneblertyp genutzt werden soll. Die Medikamentendepositionsraten von Jet- und Mesh-Verneblern unterscheiden sich aber erheblich; klinisch ist die Verwendung von Mesh-Systemen mit einem besseren Patienten-Outcome assoziiert.Ziel der ArbeitDie vorliegende Umfrage sollte die Praxis des Vernebelns von Notfallmedikamenten im süddeutschen Rettungsdienst evaluieren. Ein besonderes Augenmerk wurde auf den eingesetzten Verneblertyp sowie den Einfluss von SOP und Handlungsempfehlungen auf die Anwendung gelegt.Material und MethodenInsgesamt 4800 in Baden-Württemberg, Bayern und Rheinland-Pfalz tätige Notfallsanitäter*innen und Rettungsassistent*innen erhielten insgesamt 17 Fragen zur Durchführung der Medikamentenvernebelung in ihrer alltäglichen Praxis.ErgebnisseDer Jet-Vernebler ist mit Abstand der am häufigsten eingesetzte Verneblertyp. Die Depositionsraten sowohl des Jet- als auch des Mesh-Verneblers werden deutlich überschätzt. Nur 67,3 % aller Befragten vernebelten im Rahmen von SOP oder Handlungsempfehlungen. Das Vorhandensein dieser war allerdings maßgeblich für den Einsatz der Vernebelung ohne Beisein eines*er Notarzt*ärztin und die gefühlte Sicherheit beim Vernebeln.DiskussionDer flächendeckende Einsatz von Mesh-Verneblern könnte die Therapie von Notfallpatient*innen homogenisieren und möglicherweise das Outcome verbessern. SOP und Handlungsempfehlungen zur Anwendung von Vernebelung in der Notfallsituation könnten die inhalative Therapie verbessern und homogenisieren.Zusatzmaterial onlineDie Online-Version dieses Beitrags (10.1007/s00101-021-00992-x) enthält den der Studie zugrunde liegenden Fragebogen.Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.

Improving public health service delivery response to address contraceptive needs of socio-economically disadvantaged HIV positive people in Maharashtra, India

BackgroundPeople living with HIV (PLHIV) receive free antiretroviral treatment (ART) in public health facilities of India. With improved life expectancy, unmet sexual and reproductive health needs of PLHIV have to be addressed through a converged programmatic response strategy. Evidence shows that socioeconomically disadvantaged women are most vulnerable to high reproductive morbidities, especially HIV positive women with an unmet need of contraception.MethodsProgrammatic convergence by linking ART and family planning services were strengthened at two public health facilities (district hospitals) generally accessed by disadvantaged socio-economic sections of the society. Barriers to linking services including stigma and discrimination were addressed through analysis of existing linkage situation, sensitization and training of healthcare providers and system-level interventions. This facilitated provider-initiated assessment of contraceptive needs of PLHIV, counseling about dual contraception using a couple approach, linkage to family planning centers and maintaining data about these indicators. Six hundred eligible PLHIV seeking care at ART centers were enrolled and followed up for a duration of 6 months. Acceptance of family planning services as a result of the intervention, use of dual contraception methods and their determinants were assessed.ResultsEighty-seven percent HIV couples reached FP centers and 44.6% accepted dual methods at the end of the study period. Dual methods such as oral contraceptive pills (56.2%), IUCDs (19.4%), female sterilization (11.6%), injectable contraception (9.9%) and vasectomy (2.9%) in addition to condoms were the most commonly accepted methods. Condom use remained regular and consistently high throughout. The study witnessed seven unintended pregnancies, all among exclusive condom users. These women availed medical abortion services and accepted dual methods after counseling. Female index participants, concordant couples, counseling by doctors and women with CD4 count above 741 had higher odds of accepting dual contraception methods. Standard operating procedures (SOP) were developed in consultation with key stakeholders to address operational linkage of HIV and family programs.ConclusionThe study saw significant improvement in acceptance of dual contraception by PLHIV couples as a result of the intervention. Implementation of SOPs with supportive supervision can ensure efficient linkage of programs and provide holistic sexual and reproductive healthcare for PLHIV in India.

Implementation of Standard Operational Procedures (SOP) Information Dissemination of BMKG Tsunami Early Warning at the Geophysical Statium of Ternate

Implementation of Standard Operational Procedures (SOP) Information Dissemination of BMKG Tsunami Early Warning at the Geophysical Statium of Ternate