Implementation Of Standard Operating Procedures Research Articles

Perioperatives Wärmemanagement in Abhängigkeit von der Krankenhausgröße in Deutschland

Improvement of quality of care and patient safety while decreasing costs are major challenges in healthcare systems. This challenge includes the avoidance of perioperative hypothermia to reduce the associated adverse effects, length of stay and treatment costs. Due to the medical and economic relevance the national S3 guidelines for the prevention of perioperative hypothermia were recently published. This study presents and analyses the reality of utilization of thermal management in German hospitals depending on the size of the hospital, which is based on the number of beds. Based on the data of an online survey among all members of the German Society of Anesthesiology and Intensive Care Medicine about perioperative thermal management, a subgroup analysis differentiating between the size of hospitals was performed. The survey included questions about the structural and organizational conditions, the practical implementation of temperature measurement and warming therapy and the developmental status of clinical standard operating procedures (SOP) and educational training. Comparing the structural quality, major differences were found with respect to the availability of core body temperature measurement and the provision of warming devices especially at different peripheral anesthesia workplaces as well as the existence of SOPs and educational training. The availability increased with hospital size. With respect to process quality, the frequency of prewarming increased with hospital size as well as the frequency of intraoperative temperature measurements during different anesthesia procedures. Major differences were found in several aspects of perioperative thermal management depending on the hospital size. The main potential for improvement was found in smaller hospitals. Developmental needs primarily exist in the configuration of peripheral anesthesia workplaces, educational training, implementation of SOPs and prewarming of patients.

SIMULATION STUDY OF A VEHICLE PRODUCTION LINE FOR PRODUCTIVITY IMPROVEMENT

This paper presents the study of a motorcycle frame production line in a particular company in Malaysia. Due to the high demand, the company needs to increase its production by at least 12% compared with current output. In order to improve productivity, the production-floor data was collected and simulated using the discrete event simulation approach. Later, a number of suggestions for improvement were simulated to identify the effect of the suggestions on productivity. In addition, cost analysis was also undertaken to identify the profit margin for a particular period of time for each suggestion. Simulation results indicate that there are three suggestions that are able to fulfill the 12% volume increment. In the short term, the suggestion to hire an assistant line leader will give instant effect to the profit. Meanwhile, for the medium term, Poka-yoke will give higher profit compared with the others, while in the long term, SOP (standard operating procedure) implementation will yield a better profit margin. In future, the simulation of a dynamic demand model for this product is suggested to cope with new trends in the market.

Use of checklists facilitates guideline adherence in prehospital emergency care

Background: High quality emergency medical care requires transfer of evidence based knowledge into practice. The implementation of Standard Operating Procedures (SOP) alone is not sufficient to ensure adherence to guidelines.1 Checklists have proven to reduce perioperative mortality significantly.2 Our study investigated the usability of checklists in order to improve quality and safety in prehospital emergency care.

A Tiered Quality Assurance Review Process for Clinical Data Management Standard Operating Procedures in an Academic Health Center

Standard operating procedures (SOPs) were once considered the province of the pharmaceutical industry but are now viewed as a key component of quality assurance programs. To address variability and increase the rigor of clinical data management (CDM) operations, the Cincinnati Children's Hospital Medical Center (CCHMC) decided to create CDM SOPs. In response to this challenge, and as part of a broader institutional initiative, the CCHMC leadership established an executive steering committee to oversee the development and implementation of CDM SOPs. This resulted in the creation of a quality assurance review process with three review panels: an SOP development team (16 clinical data managers and technical staff members), a faculty review panel (8 senior faculty and administrators), and an expert advisory panel (3 national CDM experts). This innovative, tiered review process helped ensure that the new SOPs would be created and implemented in accord with good CDM practices and standards. Twelve fully vetted, institutionally endorsed SOPs and one CDM template resulted from the intensive, iterative 10-month process (December 2011 to early October 2012). Phased implementation, which incoporated the CDM SOPs into the existing audit process for certain types of clinical research studies, was on schedule at the time of this writing. Once CCHMC researchers have had the opportunity to use the SOPs over time and across a broad range of research settings and conditions, the SOPs will be revisited and revalidated.

Analisis Pelaksanaan Prosedur Operasional Standar Sarana dan Prasarana Belajar Laboratorium Berdasarkan Manajemen Mutu ISO 9001:2008 & IWA 2:2007 di Jurusan Teknik Sipil Universitas Negeri Jakarta

The objectives of this study to determine the percentage level implementation of Standard Operating Procedures learning facilities Laboratory of Civil Engineering, State University of Jakarta in the implementation of quality management ISO 9001: 2008 & IWA 2: 2007. The study lasted for three months from September to November 2013.Place of research conducted at the State University of Jakarta, precisely at 5 Laboratory of the Laboratory of Wood, Land, Material, Stone, and Plumbing Department of Civil Engineering, State University of Jakarta. The population in this study was 5 5 Laboratory of Laboratory of Civil Engineering Laboratory UNJ include Wood, Land, Material, Stone, and Plumbing. The method used in this research is survey method with data collection using a questionnaire or questionnaires. The trial questionnaire of 115 statements. The test is done to 7 respondents. After the test phase the results obtained valid instruments as much as 112-point declaration.Data analysis technique is done by searching percentage. The results show that: (a) Laboratory of Civil Engineering UNJ have a Standard Operating Procedure (POS) especially Infrastructures based quality management standard ISO 9001: 2008 and IWA 2: 2007 (b) There are four (4) POS on Infrastructures Laboratory Civil engineering UNJ whose accomplishments are not up to 100%. which amounted to 64.7% which can be categorized fulfillment are lacking, (c) Acquired four (4) percentage level of achievement of the implementation of POS Infrastructures Civil Engineering Laboratory UNJ the percentage rate of the unit does not reach 100%. The results are the result of the analysis of data derived from the 5 respondents who are Laboran of 5 laboratories in this study are: Health, Safety and Environment Laboratory (weight percentage of 73.3%) were categorized been fulfilled, Use of Laboratory (weight percentage of 71% ) categorized been met, Laboratory Equipment Loan (weight percentage of 66.8%) categorized as less fulfilled, and the maintenance and care Laboratory (weight percentage of 47.8%) were categorized are lacking, (d) There is inequality between understanding Laboran percentage of POS by 82 , 8% by POS regarding Infrastructures Laboratory of 64.7%.

Methodological Approaches for Dietary Intake Assessment in Formula‐fed Infants

The estimation of dietary intake remains a challenge in human nutritional studies. In infants, the use of food diaries (FDs) is a suitable method already validated; however, this method is not exempt from error. In formula-fed infants, dilution of powdered formulas may produce errors. Our aim was to develop and validate standard operating procedures (SOPs) for the assessment of dietary intake in formula-fed infants, attending potential sources of error. We analysed sources of error in a random subsample of 3-day FDs from 100 infants enrolled in the European Childhood Obesity Project. Calculations to estimate intakes were standardised and included in a software tool (SOPsystem). An evaluation of a simulated FD was performed by 9 trained nutritionists and 23 nutrition students (n=225 and n=575 bottle evaluations, respectively) to compare the results obtained when using or not the SOPsystem. Correct answers (%), coefficients of variation, and the time spent (minutes) to assess the simulated FD were analysed. Overall, 60% of the FDs contained reports of incorrect volumes, and 37% reported incorrect formula dilutions. When the SOPsystem was used, correct answers in the simulated FD were more frequent (P<0.001) and the mean coefficient of variation and the time spent were lower (P<0.005 and P<0.01, respectively). The development and implementation of SOPs with a software tool that identifies specific sources of error in record-keeping achieved a harmonised and improved process for assessing dietary intakes in formula-fed infants, minimising errors in calculations and reducing the work time invested.

Structured smoking cessation training for health professionals on cardiology wards: a prospective study

Smoking is a major cardiovascular risk factor, and smoking cessation is imperative for patients hospitalized with a cardiovascular event. This study aimed to evaluate a systems-based approach to helping hospitalized smokers quit and to identify implementation barriers. Prospective intervention study followed by qualitative analysis of staff interviews. The prospective intervention study assessed the effects of implementing standard operating procedures (SOPs) for the provision of counselling and pharmacotherapy to smokers admitted to cardiology wards on counselling frequency. In addition, a qualitative analysis of staff interviews was undertaken to examine determinants of physician and nurse behaviour; this sought to understand barriers in terms of motivation, capability, and/or opportunity. A total of 150 smoking patients were included in the study (75 before and 75 after SOP implementation). Before the implementation of SOPs, the proportion of patients reporting to have received cessation counselling from physicians and nurses was 6.7% and 1.3%, respectively. Following SOP implementation, these proportions increased to 38.7% (p < 0.001) and 2.7% (p = 0.56), respectively. Qualitative analysis revealed that lack of motivation, e.g. role incongruence, appeared to be a major barrier. Introduction of a set of standard operating procedures for smoking cessation advice was effective with physicians but not nurses. Analysis of barriers to implementation highlighted lack of motivation rather than capability or opportunity as a major factor that would need to be addressed.

Penyusunan SOP (Standard Operational Procedures) Perpustakaan untuk Meningkatkan Mutu Pelayanan Perpustakaan Perguruan Tinggi

The implementation of SOP (Standard Operational Procedures) in university library is needed to improve the service quality. The arrangement of SOP in University library includes four stages. The first is analysis of SOP needs. The beginning step in arranging of SOP is by analyzing SOP that will be created. Furthermore, the SOP that created depends on the ongoing work condition and procedures. The second is the development of SOP. Because of the change of internal and external organization of university library, SOP also has to change. The third is implementation of SOP. In implementing SOP, it is hoped that there is a balance between the availability of SOP, that organizes the operational activity of university library, and the human resources, that have professional behavior in arranging the library. The fourth is observation and evaluation. In order to implement SOP properly, it should be assessed by reviewers. These four steps are done in sequence to produce SOP that is appropriate to field needs for supporting the completeness of integrated quality management in university library. Therefore, the standard service quality of library can be measured by having SOP. Thus, the service quality which is given to visitors can be determined based on SOP. Keywords: library service, service quality, SOP

Better Moisture Control in Coke Manufacturing- a Case Study

The purpose of coke quenching is to quench the incandescent coke in the hot car using intense water sprays covering entire cross-section of the red hot coke bed and preventing it from burning, at the same time to obtain coke of uniform and minimum deviations in coke moisture. This case study presents a simple approach of developing a Standard Operating Procedure (SOP) to reduce the variation in moisture in Coke by analyzing past data and using Cause and Effect diagram and critically analyzing the contribution of different factors in introducing variation in moisture. The pre and post SOP implementation results are analyzed statistically to ensure that the difference in variance of moisture content is statistically significant. After implementing the action plan for one quarter, overwhelming results were noticed. The standard deviation of moisture on day to day basis has reduced from 2.5% to 1.0%.

Better moisture control in coke manufacturing- a case study

The purpose of coke quenching is to quench the incandescent coke in the hot car using intense water sprays covering entire cross-section of the red hot coke bed and preventing it from burning, at the same time to obtain coke of uniform and minimum deviations in coke moisture. This case study presents a simple approach of developing a Standard Operating Procedure (SOP) to reduce the variation in moisture in Coke by analyzing past data and using Cause and Effect diagram and critically analyzing the contribution of different factors in introducing variation in moisture. The pre and post SOP implementation results are analyzed statistically to ensure that the difference in variance of moisture content is statistically significant. After implementing the action plan for one quarter, overwhelming results were noticed. The standard deviation of moisture on day to day basis has reduced from 2.5% to 1.0%. Keywords: Quenching, Metallurgical coke, Blast furnace, non-recovery oven, Drain time.

Workflow Optimization in Vertebrobasilar Occlusion

In vertebrobasilar occlusion, rapid recanalization is the only substantial means to improve the prognosis. We introduced a standard operating procedure (SOP) for interventional therapy to analyze the effects on interdisciplinary time management. Intrahospital time periods between hospital admission and neuroradiological intervention were retrospectively analyzed, together with the patients' outcome, before (n=18) and after (n=20) implementation of the SOP. After implementation of the SOP, we observed statistically significant improvement of postinterventional patient neurological status (p=0.017). In addition, we found a decrease of 5:33 h for the mean time period from hospital admission until neuroradiological intervention. The recanalization rate increased from 72.2% to 80% after implementation of the SOP. Our results underscore the relevance of SOP implementation and analysis of time management for clinical workflow optimization. Both may trigger awareness for the need of efficient interdisciplinary time management. This could be an explanation for the decreased time periods and improved postinterventional patient status after SOP implementation.

Reformation and evaluation of an operating procedure for detecting syphilitic anticardiolipin reagin

Objective To estimate the application value of a standard operating procedure (SOP) in the detection of syphilitic anticardiolipin reagin. Methods Clinical laboratories from 9 local hospitals in Shanghai participated the program. Quality control samples with unknown target value were qualitatively and quantitatively examined according to the uniform SOP in these laboratories with the same reagent and facility of horizontal reaction. External quality assessment (EQA) was carried out by using seven serum samples with no, or low (1∶ 128 dilution) to high (1∶1 dilution) concentrations of target before and after the implementation of SOP. The test results were statistically analyzed and the reasons for the detecting error were assessed. Results A total of 388 tests were performed in the 9 clinical laboratories. The total accuracy rate was 93.0%, including 40.2% in the detection of samples with 1 ∶ 8 dilution of target, 49.2% in the detection of samples with 1 ∶ 16 dilution of target, and 3.6% in the detection of samples with 1 ∶ 32 dilution of target. No forward bias was observed in these tests. There was a significant difference in the accuracy rate between the two times of EQA before and after the implementation of SOP (x2 = 4.17, P < 0.05). Conclusions The improved standard procedure for nontreponemal antigen test is beneficial to the decrease of testing error, and may provide a basis for the establishment of SOP and implementation of internal quality assessment. Key words: Syphilis serodiagnosis; Reference standards; Quality assurance

GLP SOPs for equipment calibration and maintenance. Part 6: implementation of SOPs

AbstractNo one will argue that writing good Standard Operating Procedures (SOPs) is a major undertaking, but success at this task does not guarantee their use and compliance with what they say. In this installment we will look at the critical next step in the life of an SOP: its implementation. Copyright © 2008 John Wiley &amp; Sons, Ltd.

Implementing the International Liaison Committee on Resuscitation guidelines on hypothermia after cardiac arrest. The German experience: still a long way to go?

Two prospective randomised landmark trials were recently published comparing mild hypothermia for 12–24 hours with normothermia in comatose patients who had survived out-of-hospital cardiac arrest [1,2]. In 2003 the International Liaison Committee on Resuscitation ALS Task Force published the following recommendations [3] on the basis of the aforementioned evidence: unconscious adult patients with spontaneous circulation after out-of-hospital cardiac arrest should be cooled to 32–34°C for 12–24 hours when the initial rhythm was ventricular fibrillation; and such cooling may also be beneficial for other rhythms or inhospital cardiac arrest. Recent evidence, however, suggests that the implementation of guidelines and scientific evidence in clinical routine is very difficult. This fact is circumstantiated by a recently published study reporting a wide variation in the management of acute respiratory distress syndrome that appears to be related to limited awareness of relevant research and adherence to local practice patterns [4]. We therefore conducted a telephone survey to address the implementation of the International Liaison Committee on Resuscitation guidelines in anesthesiological intensive care units in Germany in spring 2005. We either called the head of the department or the head of the intensive care unit of all 39 university hospital departments of anesthesiology and intensive care medicine in Germany. Twenty-eight out of these 39 (71.8%) departments provided information on their management of hypothermia after cardiac arrest in this telephone survey. We asked three simple questions: Do you treat patients after cardiac arrest in your intensive care unit? Do you use therapeutic hypothermia in patients after cardiac arrest? Do you have written standard operating procedures for therapeutic hypothermia after cardiac arrest? In the intensive care units of those departments responding to our survey, a median of 1900 patients (interquartile range, 1000–2500) were treated per year. The median proportion of ventilated patients was 73% (interquartile range, 60–83). Twenty-six out of 28 (92.9%) intensive care units treated patients after cardiac arrest. Sixteen of these 26 (61.5%) departments were not using therapeutic hypothermia. Only 10 departments out of 26 treating patients after cardiac arrest (38.5%) were using therapeutic hypothermia. Eight out of 26 (30.8%) departments had written standard operating procedures (SOP) for therapeutic hypothermia, eight out of 26 (61.5%) had no written SOP and two out of 26 (7.7%) did not provide information on this topic. The low proportion of university intensive care units adhering to published recommendations may be due to several reasons. There might be deep-rooted concern that prolonged mild hypothermia has adverse effects on the immune system, on enzyme function and on the coagulation system. Hypothermia may directly or indirectly impair neutrophil function [5]. Leukocytopenia has been described significantly more frequently in patients with induced mild hypothermia [5]. Some studies reported higher rates of pneumonia in patients treated with mild hypothermia [6]. This was, however, not reported in patients treated with therapeutic hypothermia after out-of-hospital cardiac arrest [1,2]. The widespread belief that therapeutic hypothermia with exact temperature control can be only achieved with special equipment might also result in the fact that less intensive care units use this therapy. However, adequate management of therapeutic hypothermia can be achieved with basic equipment (e.g. an ice-cube maker and a refrigerator to store cold intravenous fluids). Another reason might be that the increased work load imposed on doctors in Germany – with increased nonmedical documentation tasks and the drastically increased clinical work caused by cost-cutting reforms such as the introduction of the Diagnosis Related Group – might slow down the implementation of published guidelines due to shortcomings in medical continuing education [7]. The prompt implementation of guidelines in routine patient care might possibly be difficult as generation and implementation of SOP is a time-consuming process. Unless these SOP are generated in individual department routines, care seems to be influenced by adherence to – sometimes outdated – local practice patterns. Given the low rate of complication with short-term therapeutic hypothermia and the published beneficial effects [1,2,5], therapeutic hypothermia should be a standard treatment within the indications recommended by published guidelines and each hospital should generate or adopt written SOP for the indication and clinical use of therapeutic hypothermia [3]. Even if the optimal duration and temperature of therapeutic hypothermia as well as different cooling techniques still remain a subject of investigation, the implementation of current recommendations by international organisations based on the published evidence should be promoted and adhered to in order to guarantee optimal state-of-the-art treatment for our patients.

The use of standard operating procedures in clinical research trials

Research nurses need to be familiar with standard operating procedure (SOP) documents. SOPs are distinct from nursing care plans. An SOP is an official, detailed, written instruction for the management of clinical trials; it ensures that all the functions and activities of a clinical trial are carried out consistently and efficiently. This article describes the background to, development and implementation of SOPs for a human gene therapy trial.

Quality assessment of sputum for Acid Fast Bacilli(AFB) test in microbiology laboratories before and after implementation of Standard Operating Procedure (SOP): a comparative study

Aims: To evaluate the present status of microbiology laboratory by comparing the test results of investigator with that of laboratory staff for sputum for Acid Fast Bacilli (AFB) withZiehl-NeelsenStaining (Z-N Staining) at primary and secondary level andto assess the present status of a microbiology laboratory for sputum for Acid Fast Bacilli (AFB) withZiehl-NeelsenStaining (Z-N Staining) at tertiary level. Material and Methods: Type of study : Cross sectional, descriptive type of study. Place of study: Department of Microbiology of Dhaka Medical College,Narsingdi Sadar Hospital,Narsingdi,PolashUpzilla Health Complex ,Polash, Narsingdi andDOTS centers. Duration of study: From July, 2007 to June,2008 Method of sampling: Non probability, purposive and convenient sampling Sample Size: Sputum for AFB: 300 sputum samples were collected for detection of AFB by direct Z-N staining, Z-N staining after bleach centrifugation and Auramine phenol staining before implementing SOP. After following SOP 150 sputum samples were collected and tested in direct Z-N method. Results: In the present study, before SOP out of 100 sputum smear at each level, discrepancy was found in 3% cases at primary level, 2% cases at secondary level and 1% case at tertiary level.After following SOP out of 50 sputum smear at each level, discrepancy was reduced to 2% cases at primary level and no discrepancy was found at secondary and tertiary level. Conclusion: Each laboratory must have SOP for laboratory testing to set the minimum acceptable standard for every test in order to improve and maintain the quality of laboratory services. DOI: http://dx.doi.org/10.3329/bjms.v11i1.9824 BJMS 2012; 11(1): 51-56