Interdisciplinary Meetings Research Articles

A konfliktuspotenciálok elemzésének jelentősége a marketing és az értékesítés integrációjában

Our research aims to identify the critical interfaces between sales and marketing that need to be improved in order to ensure productive cooperation. The relationship between the two departments is full of conflicts and interdependencies. The improvement of communication is of strategical importance, as it is key to staying competitive in the market. The effectiveness and quality of the sales-marketing cooperation is a key factor that is negatively affected by personal and organisational factors as well as a lack of information and conflicts. In addition to the key factors of managing the sales-marketing interfaces, we have also identified the actions that can promote their improvement, including strategic and organisational roles and responsibilities. Our empirical research results show that regular information exchange, more common and interdisciplinary meetings, and a clearly communicated and implemented corporate vision have a positive effect on the coordination and integration of the sales and marketing departments. Consequently, management is reponsible for establishing a corporate vision, i.e. a comprehensive management culture that is clearly communicated across the board in order to increase the employees’ sense of belonging. Of all elements of management culture, the most important factors are coordination and the establishment of a common strategic sysyem. All in all, corporate profit, which is of key importance to the employer, is largely dependent on the successful integration of the sales and marketing departments, which can be achieved through the implementation of the above factors.

A longitudinal perspective on the pharmacotherapy of 24 adult patients with Phelan McDermid syndrome

Over the past years, 24 patients with Phelan-McDermid syndrome were carefully investigated with respect to history, somatic and neurologic antecedents, treatment history, behavioural issues, and psychiatric symptoms including possible catatonic features and regression phenomena. Patients were originally referred for specialized diagnosis and treatment advice because of recurrent challenging behaviours along with instable mood. In all, standardized neuropsychiatric examination was performed including assessment of intellectual and adaptive functioning as well as communication and behaviour concerns. Psychiatric diagnoses were actualized in interdisciplinary consultation meetings according to ICD-10 guidelines. The course of disease was periodically monitored with respect to treatment efficacy and psychopathology over a period varying from one to five years. In 18 patients, a deletion encompassing part of or the entire SHANK3 gene was found. All comprised two or more genes in addition to SHANK3. In six patients, a pathogenic variant in this gene was detected. The psychopathological profile of all patients (nine were published before) was characterized by symptoms from the autism and schizoaffective spectrum while in five, periodic catatonic symptoms were also established. In their third decade, four patients with the deletion subtype developed a regression-like gradual decline of functioning. Based on actual psychiatric classification, in 18 patients, a diagnosis of atypical bipolar disorder was established of which symptoms typically started from late adolescence onward. In most patients, treatment with mood stabilizing agents in combination with individually designed contextual measures, and if indicated with the addition of an atypical antipsychotic, resulted in gradual stabilization of mood and behaviour.

Cluster-Controlled Trial of an Intervention to Improve Prescribing in Nursing Homes Study

ObjectivesTo investigate the impact of a complex multifaceted intervention on the appropriateness of prescribing for Belgian nursing home (NH) residents. DesignA multicenter, nonblinded, cluster-randomized controlled trial, with randomization at the NH level, was set up [Cluster-Controlled Trial of an Intervention to Improve Prescribing in Nursing Homes (COME-ON) Study]. The complex intervention consisted of repeated interdisciplinary case conferences (ICCs) involving the general practitioner, pharmacist, and nurse, aimed at performing a medication review for each NH resident included. The ICCs were supported by a blended training program and local interdisciplinary meetings (discussion of the appropriate use of specific medication classes at the NH level). Control NHs delivered usual care. (isrctn.com: ISRCTN66138978). Setting and participantsBelgian NHs with at least 35 NH residents were eligible to participate. Eligible residents were those aged 65 years or over, not receiving palliative care, and being treated by a participating general practitioner. MeasuresThe primary outcome measure related to appropriateness of prescribing at resident level and was considered successful when at least 1 potentially inappropriate medication (PIM) or potential prescribing omission (PPO) present at baseline had been solved at the end of study and when there were no new PIMs or PPOs at the end of study compared with baseline. Secondary outcomes included clinical outcomes, medication use, criterion-specific prevalence of PIMs and PPOs, and ICC outcomes. ResultsIn total, 54 NHs (24 intervention; 30 control) and 1804 NH residents (847 intervention; 957 control) participated. Using a 3-level mixed-effects model accounting for data clustering, a significant effect in favor of the intervention was observed (odds ratio 1.479 [95% confidence interval 1.062-2.059, P = .021]). There was no significant difference between groups for most clinical outcomes. The median number of medications did not change over time in either group. Conclusions and implicationsThe complex multifaceted intervention tested in the COME-ON study successfully improved appropriateness of prescribing in NHs.

Secondary Emotional Labor: Supervisors Withholding Support and Guidance in Interdisciplinary Group Meetings in a Community Hospice Program

Emotional labor (EL) can be rewarding, but it can also lead to burnout. Research suggests that supervisor support may be essential to positive experiences with EL. Using qualitative data from a com...

Healthcare professionals’ perceptions of P.I.E.C.E.S. education in supporting care delivery for older adults with responsive behaviours of dementia in acute care

ABSTRACTIntroduction: In acute care settings persons with dementia often use responsive behaviours such as yelling and hitting as a meaningful mode of communication. Staff dementia care education programs such as P.I.E.C.E.S. may help to address these gaps in care. P.I.E.C.E.S. is a holistic clinical assessment framework that focuses on Physical, Intellectual, and Emotional health, Capabilities of an individual, and the living Environment of a person and the Social being.Aims: The aim of this interpretive descriptive study was to explore the perceptions of healthcare professionals of P.I.E.C.E.S. and recommendations to enhance its uptake.Methods: A total of 15 healthcare professionals from acute medical settings in a hospital in Ontario participated in face-to-face, semi-structured interviews. Experiential thematic and secondary data analyses were performed.Findings: P.I.E.C.E.S. had many positive perceived impacts such as promoting interdisciplinary collaboration. However, participants reported that it was challenging to sustain P.I.E.C.E.S. in practice which led to a tapering off of it approximately one year post-education. A barrier to applying P.I.E.C.E.S. was limited time.Conclusions: Findings indicate the need for educational reinforcements and sustainability strategies for dementia care programs in acute care settings. Organizations should implement regular interdisciplinary meetings to provide opportunities for staff to apply P.I.E.C.E.S.

Managing the Psychosocial Complexities of Sickle Cell Disease with Multiple Comorbidities during Allogeneic Hematopoietic Stem Cell Transplantation with Supportive Nursing Care

Topic Significance & Study Purpose/Background/Rationale In 1984, the first successful allogeneic hematopoietic stem cell transplantation (HSCT) was performed to manage sickle cell disease (SCD). Allogeneic hematopoietic stem cell transplantation remains the only curative treatment for sickle cell disease. Although allogeneic HSCT offers the potential for cure, it can cause a host of complications. These complications include infection, narcotic dependency, alloimmunization, sudden death, psychosocial complications, and transfusion dependency. Given these comorbidities and other underlying conditions, the transplant process poses unique difficulties and represents a heavy psychosocial burden for this patient population. While HSCT is a risky procedure for any population, the long-term impact of a chronic disease like SCD on both the psychosocial and physiological level renders this a particularly complex patient population for nursing care. There are many psychosocial concerns for patients and their families. Due to the impact of frequent pain and hospitalizations which result in lack of social interactions/intimacy and a “normal” life, patients may feel hopeless and isolated. Patients may encounter judgmental and prejudicial attitudes from healthcare practitioners and societal stigma impacting patients’ daily lives. Often, there is the misperception that patients are drug seeking creating an atmosphere of mistrust with healthcare professionals and society. Studies have found higher levels of depression and anxiety among individuals with SCD. Nursing care throughout the course of the transplant must take into consideration the chronic nature of SCD and its impact on quality of life and psychological wellbeing. Methods, Intervention, & Analysis Research shows that incorporating a psychosocial plan of care in transplanted patients can improve outcomes. Interventions include scheduled interdisciplinary meetings and scheduling of medications to respect patients' sleep preferences. Managing physical and psychological symptoms in this population has led to increased trust between the patient and providers. Findings & Interpretation This presentation will outline standard nursing recommendations to improve or reinforce psychosocial support for the patient with SCD undergoing transplant. Our experience has shown that a multidisciplinary approach supporting mental health has resulted in a positive patient experience as well as increased compliance with post-transplant self-care. Discussion & Implications We have found that management of the transplant patient with sickle cell disease through an interdisciplinary team approach improves post-transplant outcomes. Compliance with medications, self-care, and development of resilience are the results psychological support from nursing provides these patients. In an effort to prepare these patients for a “normal” life after transplants, consideration of the patient's past experiences prior to transplant are key for restoring hope and trust.

Frequency and Characteristics of Recommendations from Interdisciplinary Outpatient Cancer Rehabilitation Monthly Team Meetings.

Ambulatory cancer rehabilitation programs vary widely in the types of services offered, and there is a lack of consistency with respect to the coordination of rehabilitation with oncologic treatment plans. There are no guidelines for outpatient interdisciplinary rehabilitation team meetings, and the types and characteristics of recommendations that a physiatrist can provide during these meetings have not been reported. To identify the frequency and characteristics of different types of recommendations that were derived through monthly interdisciplinary outpatient rehabilitation team meetings involving physiatrists, physical therapists, and occupational therapists. Case series-descriptive study. Quaternary cancer center. Outpatient rehabilitation cancer patients discussed during consecutive monthly team meetings. Frequency and characteristics of recommendations. Over a 7-month period, there were 57 potential patients to be discussed, and 42 patients were discussed. Among the 42 patients, 30 received recommendations, which yields 71% of patients receiving at least 1 recommendation. Some patients required repeated discussions in different months; thus, a total of 71 discussions occurred and resulted in 51 recommendations. Out of the 71 discussions, 41 (58%) discussions resulted in recommendations such as coordination of care in 19 (37%) cases, physiatry clinic follow-up in 9 cases (18%), oncology clinic follow-up in 7 cases (14%), and orders for referrals to other health professionals were placed in 5 cases (10%). Thirty discussions (42%) did not result in any recommendations, with the most common reason being stable or having improved functional status. In contrast to acute inpatient rehabilitation interdisciplinary weekly team meetings required by Centers for Medicare and Medicaid Services, there are no guidelines for outpatient interdisciplinary rehabilitation team meetings. Thus, the types and characteristics of recommendations that a physiatrist can provide during these meetings have not been previously reported. Regularly scheduled outpatient interdisciplinary cancer rehabilitation team meetings increase communication among rehabilitation specialists to identify outpatients experiencing barriers to therapy progress, provide recommendations to address those barriers, and reassess rehabilitation goals previously established. IV.

Ideal and reality; Community healthcare professionals' experiences of user-involvement in reablement.

Many welfare states offer reablement, also known as restorative care, as an intervention to promote healthy ageing and support older adults in regaining or maintaining their independence in daily life. Reablement is a time-limited, intensive, multidisciplinary, person-centred and goal-directed rehabilitative intervention. Reablement emanates from the user's goals, thus user-involvement is a key factor. The aim of our study was to explore healthcare professionals' experiences of user-involvement in reablement. The context for the study was an urban municipality in south-eastern Norway where reablement had been implemented into home-care services 1.5years prior to the study. Eighteen healthcare professionals recruited from home-care services participated in focus groups. The material was analysed using qualitative content analysis. The findings resulted in one main theme: Transforming user-involvement from ideal to reality-a demanding process, and four sub-themes: (a) An ideal of self-determination and co-operation; (b) Diverse ability to commit to what user-involvement requires; (c) Continuous co-creation processes; and (d) Challenged by old traditions. User-involvement is a valued ideal that professionals strive towards when providing healthcare. Two main strategies that professionals use to enable user-involvement were identified here: spending sufficient time and having patience with users during the initial stage of an intervention, and starting an intervention by introducing small tasks that users can master. It was also seen that if the time and arenas for interdisciplinary meetings were lacking, professionals could demonstrate traditional attitudes and practice when faced with limited user-involvement in the intervention. There is a need for follow-up over time at the structural, personal, and cultural levels to develop reablement as an intervention with a strong person-centred approach. The findings of this study have relevance for practice development in several reablement settings.

Development of an integrated palliative and supportive care service within an academic cancer center.

99 Background: Timely incorporation of palliative services with chemotherapy treatment has become a new standard of care for oncology patients based on evidence-driven national clinical practice guidelines. However, best practices for service integration are not known, particularly for small academic centers. In our 224 bed university hospital, we hypothesized that advertisement, responsiveness to needs and service integration would result in increased utilization of palliative and supportive care. We report the process of developing our Integrated Model of Care. Methods: The program began with a 1.0 FTE APRN boarded as a FNP and certified as an advanced hospice and palliative nurse. The goal was to identify opportunities for her integration within the outpatient cancer center. A needs-assessment survey was sent to medical oncology faculty with the following items: proposed change in service name, care areas of greatest need, limitations to providing palliative care, additional growth opportunities. The Interdisciplinary Supportive Care Team was created utilizing existing staff. One year of billed consults were reviewed. The APRN attended tumor boards, team meetings, biweekly Interdisciplinary Team Meetings, communicated directly with the Inpatient Hem/Onc Team and provided educational sessions. Results: Needs assessment survey and service name change proposal sent to 14 oncology providers: 50% completed survey; seven responded YES to name change; zero providers responded NO. Of the 489 consults billed within the 1st year of service, 249 were inpatient and 240 outpatients. 168 individual patients were referred; > 72 patients were referred to palliative/hospice services; > 82 patients died. One year satisfaction survey; 17 respondents; 88.23% were satisficed and 100% would consult again. Conclusions: Medical oncology faculty at our institution responded favorably to the development of a designated “Oncology Supportive Care Service” evidenced by increased consultation and utilization of services. Optimizing clinical infrastructure, processes, education and research has led to the success of this integrated care model, lending to recruitment of additional allied health professionals and ongoing program growth.

Improving collaborative mental health care across Australia: development and evaluation of the Mental Health Professionals Network (MHPN) initiative

Introduction : The Mental Health Professionals Network (MHPN) was established in 2008 to improve consumer outcomes in the primary care sector by fostering a collaborative clinical approach to the provision of mental health care in Australia. MHPN is a not-for-profit organization funded by the Australian Government Department of Health. This presentation will describe the development of MHPN and present results of evaluations of MHPN’s two key programs. Short description of practice change implemented : The MHPN national platform has two key programs by which it promotes collaborative mental health care: network meetings and webinars. MHPN interdisciplinary networks comprise groups of practitioners who meet face-to-face on a regular and voluntary basis. While networks are self-directed in determining membership and content covered, MHPN provides strategic and planning advice, and manages meeting logistics, communications, and administration tasks. At 30 June 2016 there were 380 networks across Australia with a total of over 10,000 participants. During 2015-16 there were 1,171 network meetings and 14,835 network meeting attendances. MHPN professional development webinars feature case-based discussions by leading experts, modelling interdisciplinary practice and collaborative care. From December 2010 to 30 June 2016, MHPN produced 52 webinars. Overall, there have been more than 160,000 individual views of the live webinars or downloadable podcasts. Aim and theory of change : Collaborative practice is recognised as a necessary element for an integrated health delivery system. MHPN’s activities are based on the premise that if practitioners from different disciplines connect and communicate on a regular basis, clinical pathways will be more effective, referrals better informed and service-delivery improved. Targeted population and stakeholders: MHPN targets psychiatrists, general practitioners, psychologists, mental health nurses, social workers, pediatricians, occupational therapists and other mental health practitioners. Timeline : MHPN was established in 2008 and continues to grow and evolve. Highlights : During 2015-16, evaluations of MHPN’s two key programs were undertaken: Study 1 surveyed network meeting attendees and assessed change across seven areas relating to increased awareness of and interaction with professionals from other disciplines. More than 75% respondents had made each practice change, with those who attended more meetings significantly more likely to have made changes. Study 2 surveyed webinar attendees. Three months post-webinar, 80% respondents had made practice changes, including increased confidence in providing mental health care, increased discussions about other disciplines and improved targeting of referrals. Comments on sustainability : MHPN continues to monitor its structure, policy and practice in order to maintain sustainability of the initiative. Comments on transferability : The MHPN initiative is potentially transferable to other settings and countries. Discussion and Conclusions : The two studies demonstrate that MHPN interdisciplinary network meetings and professional development webinars have impacted positively on health professionals’ attitudes and practices towards a more collaborative approach to mental health care, highlighting the success of the MHPN initiative. Evaluation findings will be published in the Journal of Integrated Care in 2018. Lessons learned : The high attendance at both network meetings and live webinars underscores the strong interest and desire amongst Australia’s mental health workforce for interdisciplinary networking and professional development opportunities.

A Statewide Elder Mistreatment Virtual Assessment Program: Preliminary Data.

To describe the Texas Elder Abuse and Mistreatment Institute Forensic Assessment Center Network (TEAM-FACN), a novel statewide elder mistreatment (EM) virtual assessment program using low-cost videophone technology and innovative web-based coordination to connect an Adult Protective Services (APS) agency and its clients, rural and urban, to a centralized geriatric and EM expert medical team for virtual in-home assessments. Descriptive. Community. APS clients aged 18 and older. Virtual and in-home assessments. Program use and type of services provided. In the first 8 months, 300 APS clients from all regions of the state were referred for assessment. Outcomes realized include a quadrupling in number of client assessments. TEAM-FACN physicians provided an average of 2 services, which included 216 mental health assessments, with 123 conducted virtually; 42 medical assessments; 45 guardianship filings; 5 employee misconduct registry reviews; and more than 230 interdisciplinary team meetings to discuss case findings, safety plans, and medical and social interventions. TEAM-FACN provides an innovative and viable way to increase access of urban and rural older and adults who are being mistreated to expert geriatric and EM protective service assessments. J Am Geriatr Soc 67:151-155, 2019.

Frequency and characteristics of interventions from interdisciplinary outpatient cancer rehabilitation monthly team meetings

Ambulatory cancer rehabilitation programs vary widely in the types of services offered, and there is a lack of consistency with respect to the coordination of rehabilitation with oncologic treatment plans. There are no guidelines for outpatient interdisciplinary rehabilitation team meetings, and the types and characteristics of interventions that a physiatrist can provide during these meetings have not been reported. The aims are as follows: –identify the frequency and characteristics of interventions derived through monthly interdisciplinary outpatient cancer rehabilitation team meetings involving physiatrists, physical therapists, and occupational therapists; –compare the clinical characteristics of patients who did and did not receive interventions. This is a retrospective study of consecutive monthly outpatient interdisciplinary rehabilitation team meetings with physiatrists’ participation. Over a 7-month period, there were 57 potential patients to be discussed and 42 patients were discussed. Among the 42 patients, 12 of them did not receive any interventions and 30 did, which yields 71% of patient receiving at least one intervention. Some patients required repeated discussions in different months; thus, a total of 71 discussions occurred and resulted in 51 interventions. Of the 71 discussions, 41 (58%) resulted in interventions and the most common intervention was coordination of care (37%). Thirty discussions (42%) did not result in any interventions, with the most common reason being stable or having improved functional status. Regularly scheduled outpatient interdisciplinary cancer rehabilitation team meetings increase communication among rehabilitation specialists to identify outpatients experiencing barriers to therapy progress, provide interventions to address those barriers, and reassess rehabilitation goals previously established.

“Enhanced Recovery” Protocol Compliance Influences Length of Stay: Resolving Barriers to Implementation

Initial implementation and maintenance of an enhanced recovery protocol (ERP) is complex and has not been adequately described. The aim of this study was to investigate the efficacy of an ERP at a tertiary care academic institution. A secondary aim was to identify barriers to implementation and continued protocol compliance (PC) to further decrease length of stay (LOS). Patients undergoing colon resection from February 2, 2011 to December 19, 2014 were compared with patients that followed implementation of an ERP from August 10, 2015 to July 14, 2016. The primary endpoint was LOS. Secondary endpoints were PC, analgesia requirements, time to return of bowel function, and ileus. One hundred and seventy-seven historical controls were compared with 68 ERP patients. LOS was shorter in study patients (4.9 vs 7.1 days for open surgery; 3.3 vs 6.1 for laparoscopic surgery). Intraoperative IVF balance, morphine equivalents, and length of time to return of bowel function were significantly less in the ERP group (1445.89 ± 845.25 mL vs 3006.08 ± 1197.97 mL), (64.48 ± 114.49 vs 232.90 ± 541.47), (2.41 ± 1.32 days vs 3.82 ± 2.00 days). Rate of ileus was less in study patients (4.8 vs 14.7%). The readmission rate and 30-day National Surgical Quality Improvement Program complication rates were not significantly different. PC was negatively associated with LOS (r = -0.35, P = 0.0026). Similar to prior studies, this study demonstrates the efficacy of an ERP. Increased PC is associated with decreased LOS, thus providing further evidence that ERPs should be the standard of care. Scheduled interdisciplinary meetings to discuss patient outcomes and methods to increase PC can help further improve efficacy of ERPs.

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

This manuscript describes a streamlined protocol for the management of patients with acute ischemic stroke, which aims at the minimization of time from hospital admission to reperfusion. Rapid restoration of cerebral blood flow is essential for the outcomes of patients with acute ischemic stroke. Endovascular treatment (EVT) has become the standard of care to accomplish this in patients with acute stroke due to large vessel occlusion (LVO). To achieve reperfusion of ischemic brain regions as fast as possible, all in-hospital time delays have to be carefully avoided. Therefore, management of patients with acute ischemic stroke was optimized with an interdisciplinary standard operating procedure (SOP). Stroke neurologists, diagnostic as well as interventional neuroradiologists, and anesthesiologists streamlined all necessary processes from patient admission and diagnosis to EVT of eligible patients. Target times for every step were established. Actually achieved times were prospectively recorded along with clinical data and imaging scores for all endovascularly treated stroke patients. These data were regularly analyzed and discussed in interdisciplinary team meetings. Potential issues were evaluated and all staff involved was trained to adhere to the SOP. This streamlined patient management approach and enhanced interdisciplinary collaboration reduced time from patient admission to reperfusion significantly and was accompanied by a beneficial effect on clinical outcomes.

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke.

This manuscript describes a streamlined protocol for the management of patients with acute ischemic stroke, which aims at the minimization of time from hospital admission to reperfusion. Rapid restoration of cerebral blood flow is essential for the outcomes of patients with acute ischemic stroke. Endovascular treatment (EVT) has become the standard of care to accomplish this in patients with acute stroke due to large vessel occlusion (LVO). To achieve reperfusion of ischemic brain regions as fast as possible, all in-hospital time delays have to be carefully avoided. Therefore, management of patients with acute ischemic stroke was optimized with an interdisciplinary standard operating procedure (SOP). Stroke neurologists, diagnostic as well as interventional neuroradiologists, and anesthesiologists streamlined all necessary processes from patient admission and diagnosis to EVT of eligible patients. Target times for every step were established. Actually achieved times were prospectively recorded along with clinical data and imaging scores for all endovascularly treated stroke patients. These data were regularly analyzed and discussed in interdisciplinary team meetings. Potential issues were evaluated and all staff involved was trained to adhere to the SOP. This streamlined patient management approach and enhanced interdisciplinary collaboration reduced time from patient admission to reperfusion significantly and was accompanied by a beneficial effect on clinical outcomes.

Special issue on vacuum insulation, fundamentals and applications [Guest Editorial

IN the Special Issue, we are proud to present the expanded versions of selected papers presented at the 27th International Symposium on Discharges and Electrical Insulation in Vacuum (ISDEIV). It was held at Suzhou, China, from September 18 to 23, 2016. The International Symposia on Discharge and Electrical Insulation in Vacuum (ISDEIV) is a non-profit, international organization whose purpose is to encourage the advancement of the science and application of electrical insulation and discharges in vacuum, primarily by conducting symposia for the exchange of scientific information. The symposia are held biannually (even-numbered years). The symposia are interdisciplinary meetings for the exchange of results, presentation of progress, and discussion of ideas and challenges for the future in the field of electrical discharges and insulation in vacuum. Both fundamental and applied aspects are covered. Symposia program consists of invited talks, invited oral contributions, and posters. Mini-courses and informal discussions on relevant topics may also be offered in addition to the regular Symposium schedule.

Acute care medical interventions in the palliative care unit versus inpatient hospice.

88 Background: In a survey of different cancer centers in the United States, only 23% reported having dedicated palliative care beds and hospital executives have reported not having further plans for expansion of their program. Barriers that are often cited include poor reimbursement for services, limited institutional support and resources. Patients admitted to an Acute Palliative care unit (APCU) benefit from the multidisciplinary approach that is evident in daily rounds, interdisciplinary team meetings, and family conferences. There could be occasionally misconceptions about the differences between inpatient hospice and an APCU. Even though the psychosocial component of palliative care is extremely important a significant amount of medical interventions also are necessary to provide patients and family with a sense of and optimal care during this time. Methods: A retrospective chart reviewed was performed in 100 consecutives patients admitted to the APCU and inpatient hospice prior to October 2013. From this data we identified the acute medical interventions ordered by the palliative Care specialist tduring the first 5 days of admission. Results: A total of 100 patients from the APCU and 100 patients from inpatient hospice were reviewed. In the APCU 100% of patients had iv fluids vs 7% in inpatient hospice. Antibiotics were given in 52% of APCU patients vs 2% in the inpatient hospice. Steroids were given in 48% of APCU patients vs 30% in inpatient hospices. (See Table). Conclusions: The APCU in comparison to inpatient hospices had higher rate of acute medical interventions with the most common been iv fluids, antibiotics, laboratory and radiologic diagnostic tests. This represent the importance of Acute Palliative Care Units in advanced cancer patients with complicated situations to achieve comfort when transitioning to EOL. [Table: see text]

Interdisciplinary Teamwork - The SMART Approach

Health care professionals are obligated to review their current practice and seek areas for development and improvement that are in line with current health care reforms and public expectation. In the current climate, the focus is on cost effective care that is safe, efficient and does not compromise patient outcomes. An example of innovative practice that strives to provide comprehensive care within the existing resources available is the Surgical and Medical Assessment & Rehabilitation Team (SMART) based in Beaumont hospital, Dublin. It is an interdisciplinary team, comprising of Occupational therapists and Physiotherapists, who have enhanced their existing work practices in order to improve timeliness and quality of therapeutic interventions. These two services provide assessment and rehabilitation services to the medical and surgical patients who are admitted to a busy city hospital. It is a mixed patient population across all age ranges and a variety of diagnostic groups. Through improved communication, timely interventions, duplication avoidance and utilisation of joint working opportunities, this team has created a template for care that could be transferred to many acute settings optimising service provision. This system provides increased support for team members improving morale and job satisfaction. Pre-implementation planning began three months in advance. The development of an interdisciplinary common assessment tool (CAT) was key to this change in practice. The CAT reduced unnecessary duplication of various profession specific assessments and captured vital information relating to patients social situation, premorbid and current functional status. The team launched on October 1st 2016. Operationally, the team meets twice daily to discuss and divide referrals between both disciplines. Meetings allow for more face to face interaction with team members and improved communication regarding ongoing patient care. One team member, be it the physiotherapist or the Occupational therapist then completes a CAT, identifies the needs of the patient in relation to therapeutic input and communicates this with their OT/PT counterpart. From this, a multidisciplinary plan for intervention is formulated. Therapists from each discipline are co-located to a certain group of wards maximising dual working and communication. Overall, this improves inter-professional working. Patients identified by these teams as requiring longer-term, focussed rehabilitation are discussed within the interdisciplinary meetings and transferred to a SMART Rehabilitation stream if deemed appropriate. When working to its full potential, team members reported greater awareness of the rehab needs and discharge plans of patients. While team members have offered much positive feedback on the new structure we acknowledge it is only in its infancy. An improvement in inter-professional communication has been noted as the most positive aspect with it subjectively leading to a perception of improved patient care. Sustainability of the service was challenged during its infancy during a time with a high level of both scheduled and unscheduled leave, coinciding with increased activity level in the hospital. During this period, improved team communication led to improved patient safety as decisions regarding priorities were made based on knowledge of the patient’s performance and discharge plans. This service is constantly evolving to meet the changing needs of the patient population and as a result there have been a number of changes to our documentation, team and meeting structures during the initial months. Change at interdisciplinary level relies on trust between professions and openness to challenging the norm. Both disciplines need to continue working together, constantly reflecting to ensure the smooth running of the team, while monitoring the effects it has on our level of patient care. Review and enhancement of operational processes and team structures is ongoing.

EXPANSION of diabetes education in a United States–Mexico border community (Expanding Services for Patients to Acquire New Skills, Set Goals, and Improve Overall Knowledge)

ObjectivesTo describe the process used by a pharmacy team at a community health center to coordinate and expand diabetes education services (English and Spanish) for a predominantly Hispanic, Spanish-speaking population. SettingThe project was implemented at 2 clinics in a federally qualified community health center system based in a low-income southwest U.S.–Mexico border community. Practice innovationThis project enhanced accessibility to diabetes education to improve knowledge, skills, and goal setting through existing pharmacy services at the primary clinic and 1 rural satellite clinic. EvaluationThe success of the project was evaluated quantitatively. Metrics used to evaluate enhancement of existing practices included enrollment and completion rates, number of sessions, and diabetes leadership meetings. ResultsOver the 5-month project period assessed, 7 interdisciplinary professionals were certified as Diabetes Empowerment Education Program educators. Four sessions were conducted at both clinics. A total of 31 participants completed the diabetes classes. An educational attainment of 8th grade or less was reported in 91% of the rural participants compared with 50% of the urban participants. Ten interdisciplinary leadership meetings centered on recruitment, progress toward goals, and action items to ensure quality of classes. A nurse practitioner and pharmacist piloted a shared-visit model with 5 patients during a 45-minute time period. ConclusionSuccessful diabetes education services occurred by implementing an evidence-based curriculum, identifying provider champions, increasing patient enrollment through provider referrals, and generating reports. Patient accountability was facilitated by setting patient-centered goals for knowledge and skills. Last, support groups provided ongoing support once patients graduated from a structured diabetes program.

Survey highlights the need for specific interventions to reduce frequent conflicts between healthcare professionals providing paediatric end-of-life care.

This study explored how paediatric healthcare professionals experienced and coped with end-of-life conflicts and identified how to improve coping strategies. A questionnaire was distributed to all 2300 professionals at a paediatric university hospital, covering the frequency of end-of-life conflicts, participants, contributing factors, resolution strategies, outcomes and the usefulness of specific institutional coping strategies. Of the 946 professionals (41%) who responded, 466 had witnessed or participated in paediatric end-of-life discussions: 73% said these had led to conflict, more frequently between professionals (58%) than between professionals and parents (33%). Frequent factors included professionals' rotations, unprepared parents, emotional load, unrealistic parental expectations, differences in values and beliefs, parents' fear of hastening death, precipitated situations and uncertain prognosis. Discussions with patients and parents and between professionals were the most frequently used coping strategies. Conflicts were frequently resolved by the time of death. Professionals mainly supported designating one principal physician and nurse for each patient, two-step interdisciplinary meetings - between professionals then with parents - postdeath ethics meetings, bereavement follow-up protocols and early consultations with paediatric palliative care and clinical ethics services. End-of-life conflicts were frequent and predominantly occurred between healthcare professionals. Specific interventions could target most of the contributing factors.