Interprofessional Protocol Research Articles

Community pharmacy & primary care integration: qualitative study on stakeholders' opinions and interventions.

Health systems worldwide are under pressure. Integration seems a possible solution to improve healthcare systems efficiency. This research aims to gather stakeholders' opinions on integrating community pharmacy and the primary healthcare system and secondly to explore and prioritise interventions for an initial integration plan. Using a constructivist qualitative research approach, a two-phase qualitative study was conducted in the Basque Country, Spain. Thematic analysis using NVivo® was undertaken on data gathered during focus groups and semi-structured interviews (phase 1). During phase 2, a nominal group prioritised potential integration interventions identified in phase 1. The study amalgamated findings from four focus groups and nine interviews, revealing six themes. Stakeholders had a diverse understanding of integration, associating the term mainly with collaboration, communication or cooperation. Community pharmacies were positively perceived; however, their commercial and privately owned nature was of concern. Remuneration methods for pharmacists were controversial, with a suggested shift to service-based remuneration. Information availability and barriers such as interprofessional communication gaps were highlighted. The nominal group prioritised, according to importance and feasibility, bidirectional communication development, coordination in using interprofessional protocols and community pharmacist participation in primary healthcare centre meetings as interventions for integrating community pharmacies and primary healthcare centres. Based on the opinions of stakeholders, three interventions are proposed to initiate the integration process of community pharmacy and primary care. The implementation of these interventions will need to be negotiated with the relevant authorities and evaluated.

PROtocol-based MObilizaTION on intensive care units: stepped-wedge, cluster-randomized pilot study (Pro-Motion).

Early mobilization of patients in intensive care units (ICUs) improves patient recovery, but implementation remains challenging. Protocols may enhance the rate of out-of-bed mobilizations. To evaluate the effect of implementing a protocol for early mobilization on the rate of out-of-bed mobilizations and other outcomes of ICU patients. Multicentre, stepped-wedge, cluster-randomized pilot study. After a control period, five ICUs were allocated to the implementation of an inter-professional protocol for early mobilization in a randomized, monthly order. Mobilization of ICU patients was evaluated by monthly 1-day point prevalence surveys using the ICU Mobility Scale. The primary outcome was the percentage of patients mobilized out of bed, defined as level 3 on the ICU Mobility Scale (sitting on edge of bed) or higher. Secondary outcomes were mechanical ventilation, delirium and ICU- and hospital-days, as well as unwanted safety events. Out-of-bed mobilizations increased non-significantly from 36·2% (n=55) of 152 patients during the control period to 45·8% (n=55) of 120 patients during the intervention period (difference 9·6%; 95% confidence interval -2·1 to 21·3%). Of 55 mobilized patients per group, more patients were mobilized once per day during the intervention period (intervention: n=41 versus control: n=23 patients). Multiple daily mobilizations decreased (control: n=32 control versus intervention: n=14 patients). Secondary outcomes, such as days with mechanical ventilation, delirium and in ICU and hospital, did not significantly differ. Adherence to the protocol was >90%; unwanted safety events were rare. Implementing a protocol for early mobilization of ICU patients showed a trend towards more patients being mobilized. Without additional staff in participating ICUs, a significant increase in ICU mobilizations was not to be anticipated. More research should address whether more staff would increase the number of frequent mobilizations and if this is relevant to outcomes. Implementing inter-professional protocols for mobilization is feasible and safe and may contribute to an increase of ICU patients mobilized out of bed.

Implementing the Surviving Sepsis Campaign in an Ambulatory Clinic for Patients With Hematologic Malignancies

Infectious complications can occur in patients receiving cancer treatment and are the most common cause of death not directly related to malignancy. Established international best practices for recognition and management of early sepsis with bundled interventions reduce sepsis-related morbidity and mortality in many patient populations. Integration of these practices is common in emergency departments but has not been documented in ambulatory oncology clinics, where many patients with cancer present for evaluation of infectious symptoms. The current quality improvement project embedded sepsis best practices into routine care for ambulatory clinic patients receiving chemotherapy or undergoing hematopoietic stem cell transplantation for hematologic disease or malignancies. An interprofessional protocol was implemented that included guideline-based universal screening, nurse-activated standing orders for recommended interventions, and clinician-supported decision making for the first six hours. Evaluation of implementation of the protocol showed improved timeliness and adherence to sepsis practice guidelines. Postintervention adherence to threshold times for obtaining blood cultures and blood lactate and start of antibiotics showed improvement. All recommended interventions were completed within the target time frame for the majority of patients.

Exploring the impact of an interprofessional care protocol on the patient experience and outcomes for seniors with diabetes

Contemporary healthcare has placed intensified focus on the patient experience. Ultimately the patient experience is influenced by relationships with healthcare providers. In order to make a positive impact on patient outcomes and quality of care, the patient experience must be positive. Interprofessional collaboration is recognized as a key aspect of a culture that fosters patient-ce ntered care and a positive patient experience. This quasi impact of interprofessional collaboration to develop a preventive services care protocol for seniors with diabetes. Patients were studied over six months using pre outcomes and qualitative data from the Diabetes Quality of Life Questionnaire are used to explore the impact of an interprofessional care protocol on the patient experience for seniors with di conclusive, suggest that significant improvements in blood glucose levels and aspects of quality of life perceptions of being able to manage self care and reported feeling ill less often followed the interprofessional protocol. The study offers insights into the importance of interprofessional collaboration as a factor that can enhance the patient experience and presents a continuing education model to facilitate interprofessional collaboration within the healthcare workforce setting.

An interprofessional team approach to tracheostomy care: A mixed-method investigation into the mechanisms explaining tracheostomy team effectiveness

BackgroundIn an effort to reduce tracheostomy-related complications, many acute care facilities have implemented specialist tracheostomy teams. Some studies, however, generate only mixed support for the connection between tracheostomy teams and patient outcomes. This suggests that the effect of collaborative teamwork in tracheostomy care is still not well understood. ObjectiveThe aim of this paper is to investigate the mechanisms through which an interprofessional team approach can improve the management of patients with a tracheostomy. DesignThe achievement of this research objective requires the collection of rich empirical data, which indicates the use of a qualitative methodology. A case study approach provided an opportunity to collect a wealth of data on tracheostomy team activities and dynamics. Setting and participantsData were collected on an interprofessional tracheostomy team in a large tertiary referral hospital in Australia. The team was composed of clinical nurse consultants, a physiotherapist, a speech pathologist, a dietician, a social worker and medical officers. MethodsData were collected through a focus group and one-to-one, semi-structured in-depth interviews, and thematic analysis was used to analyse experiences of tracheostomy team members. ResultsQualitative analysis resulted in two main themes: interprofessional protocol development and implementation; and interprofessional decision-making. ConclusionsOur findings suggest that tracheostomy teams enhance consistency of care through the development and implementation of interprofessional protocol. In addition, such team allow more efficient and effective communication and decision-making consequent to the collocation of diverse professionals. These findings provide new insight into the role of tracheostomy teams in successfully implementing complex protocol and the explanatory mechanisms through which interprofessional teams may generate positive outcomes for tracheostomy patients.

Interprofessional Education

The past decade witnessed momentum toward redesigning the U.S. health care system with the intent to improve quality of care. To achieve and sustain this change, health professions education must likewise reform to prepare future practitioners to optimize their ability to participate in the new paradigm of health care delivery. Recognizing that interprofessional education (IPE) is gaining momentum as a crucial aspect of health care professions training, this article provides an introduction to IPE programs from three different academic health centers, which were developed and implemented to train health care practitioners who provide patient-centered, collaborative care. The three participating programs are briefly described, as well as the processes and some lessons learned that were critical in the process of adopting IPE programs in their respective institutions. Critical aspects of each program are described to allow comparison of the critical building blocks for developing an IPE program. Among those building blocks, the authors present information on the planning processes of the different institutions, the competencies that each program aims to instill in the graduates, the snapshot of the three curricular models, and the assessment strategies used by each institution. The authors conclude by providing details that may provide insight for academic institutions considering implementation of IPE programs.

Interprofessional primary care protocols: A strategy to promote an evidence-based approach to teamwork and the delivery of care

Primary care reform involving interprofessional team-based care is a global phenomenon. In Ontario, Canada, 150 Family Health Teams (FHTs) have been approved in the past few years. The transition to a FHT is complex involving many changes and the processes for collaborative teamwork are not clearly delineated. To support the transition to team-based care in FHTs, a project was undertaken to develop and implement a series of interprofessional protocols in four clinical areas. These interprofessional protocols would contain relevant and evidence-based resources to support both a team and evidence-based approach to care. This paper reports on a qualitative study to examine the process of interprofessional protocol development and pilot implementation. Adopting an exploratory case study approach (Robson, ), 36 interviews were conducted with health professionals and community group members who participated in the creation and piloting of the protocols, and with project managers. In addition, observational and documentary data were gathered on the protocol development and implementation processes. The findings from the protocol development stage demonstrate the value of the focus on evidence and team, the process of assessing and targeting FHT needs, inter-organizational and interprofessional sharing, the importance of facilitation and support, and expectations for implementation. The findings from the pilot implementation stage report on the importance of champions and leaders, the implementation strategies used, FHT and organizational factors affecting implementation, and outcomes achieved. Findings are discussed in relation to the knowledge translation and interprofessional literature. Research is ongoing to examine the effectiveness of dissemination of the protocols to FHTs across the province of Ontario and its impact on health care outcomes.