Large Acute Teaching Hospital Research Articles

Developing An Online Course To Increase Staff Awareness And Responses To Unwanted And Illegal Sexual Behaviour Perpetrated Against Older People

Abstract Background The idea that older people can be victims of unwanted sexual behaviour or sexual assault in health and social care settings is relatively recent. In the Irish context, 165 reports of sexual abuse of older people were made to the HSE National Safeguarding and Protection teams in 2022. The prevalence of sexual abuse against older people in health and social care settings is poorly understood and there is an acknowledgement that hospital staff require additional training to understand and manage incidents. Methods In response to the need for training and support for staff, an online awareness-raising course based on a pre-developed course from Australia ‘Preventing unwanted sexual behaviour against older people in health and social care settings’ will be adapted, trialled and tested in a large acute teaching hospital. This course sets out to support acute care staff to identify and manage incidents of sexualised behaviour, to seek expert help and to ensure that older people are protected from unwanted and at times, what may constitute illegal sexual behaviour. Results The adapted course ‘Understanding and Responding to Unwanted or Illegal Sexual Behaviour Perpetrated against Older People in Health and Social Care Settings’ utilises a trauma-informed lens and key themes covered include defining unwanted sexual behaviours, understanding older people and sexual behaviour, risk factors for sexual abuse, barriers to recognising and reporting abuse and managing incidents. Conclusion The ‘trial and test’ will involve a feedback survey (N=50 respondents) and focus groups with participating healthcare professionals from the hospital site informing further refinement of the course content in preparation for wider rollout and implementation across Ireland's health and social care settings.

Menu availability for patients on the medicine for older people wards at a large acute teaching hospital: a service evaluation

Menu availability for patients on the medicine for older people wards at a large acute teaching hospital: a service evaluation

Exploring Safety Culture in the ICU of a Large Acute Teaching Hospital through Triangulating Different Data Sources

Safety Culture (SC) has become a key priority for safety improvement in healthcare. Studies have identified links between positive SC and improved patient outcomes. Mixed-method measurements of SC are needed to account for diverse social, cultural, and subcultural contexts within different healthcare settings. The aim of the study was to triangulate data on SC from three sources in an Intensive Care Unit (ICU) in a large acute teaching hospital. A mixed-methods approach was used, including analysing the Hospital Survey for Patient Safety Culture results, retrospective chart reviews using the Global Trigger Tool (GTT) for the ICU, and staff reporting of adverse events (AE). There was a 47% (101/216) response rate for the survey. Further, 98% of respondents stated a positive patient safety rating. The GTT identified 16 AEs and 11 AEs that were reported in the same timeframe. The triangulation of the data demonstrates the complexity of understanding components of SC in particular: learning, reporting, and just culture.

446 A qualitative exploration using focus groups, of the perceived barriers and enablers of hospital pharmacists to participating in simulation based training

Abstract Introduction The role of hospital pharmacists has changed significantly over the past decade with a need for further educational interventions to support their professional development. Simulation based training (SBT) is widely used by other healthcare professionals to enhance skill acquisition and performance (1). However, the use of SBT does not appear to have evolved to the same level for hospital pharmacists (1), and there is no evidence exploring their experiences of participating in SBT and the barriers and enablers towards engaging with this training modality. Aim To explore the experiences and perceptions of hospital pharmacists of SBT, and to identify perceived barriers and enablers of participating in SBT. Methods This was a descriptive qualitative case study. A purposive sample of trainee and qualified pharmacists from a large acute teaching hospital were invited to participate in a focus group discussion. A topic guide was utilised to guide discussions, with topics such as previous SBT experience, barriers to participation within SBT and how they feel SBT would impact on their clinical practice. The focus groups were conducted within a private room, recorded, and transcribed verbatim, then analysed thematically using COM-B (capability, opportunity, motivation, behaviour) (2) as an analytical framework. Relevant approvals were obtained prior to commencing the research. Results Seventeen participants were recruited into one of four focus groups, with allocation based on Agenda for Change banding (band 5 to 8A). Focus groups lasted 45-60 minutes. Ten themes were identified and mapped across the COM-B domains with contrasting differences reported depending on participant experience and seniority. Psychological capability (knowledge and understanding of SBT, clinical knowledge and skills), physical opportunity (workload and time pressures, infrastructure to support SBT), social opportunity (social expectations of pharmacists, culture of learning within pharmacy), automatic motivation (emotional factors, desires for professional development), and reflective motivation (perceptions of SBT, belief in own role and abilities) were all factors reported as influencing their participation with SBT in hospital settings. All groups expressed that SBT is mainly focused on clinicians with limited pharmacist involvement as an ‘add on’. Pharmacists reported a lack of confidence in SBT, with limited opportunities for involvement within the hospital setting, and concerns on their ability to communicate with other healthcare professionals during any SBT. Conclusion This is the first known study exploring the experiences of SBT amongst hospital pharmacists. There is a desire to participate in SBT, however it is clear, that significant interventions and further training on SBT modalities are required to enable this, including opportunities to participate in contextualised SBT, reflecting the role, expectations, and professional developmental needs of pharmacists. Clear leadership and signposting are needed to operationalise this and reap the benefits of SBT. These results can be utilised as a framework to support the design and implementation of a successful SBT programme for hospital pharmacists as part of intra-professional and multi-professional SBT programmes. This study is limited as a single-site case study and further investigation is required to explore further views of the hospital pharmacist workforce.

A socio-technical systems analysis of the application of RFID-enabled technology to the transport of precious laboratory samples in a large acute teaching hospital

The scale and pace of improvement in patient safety in healthcare has been unacceptably slow. A paucity of research into the application of systems-thinking concepts and a failure to appreciate health systems complexity are cited as barriers to sustainable health systems improvement. This study reports on a socio-technical systems analysis, called the CUBE, of the characteristics of a large acute teaching hospital's system for the transport of precious specimens, a system enabled by radio-frequency identification tracking technology. The CUBE proved itself to be an effective analytic tool. The analysis provided a constructive framework to link diverse data and documentation; explicitly inviting consideration of the roles and understandings of different stakeholders; as well as broader cultural factors that could influence current or future activity. The analysis also supported recommendations to improve and extend operations. This study supports the argument for systems understanding and systems thinking being at the core of new approaches to patient safety.

AB0908-HPR SIGNED, SEALED, DELIVERED: PHARMACISTS ACHIEVING BETTER CARE CLOSER TO HOME IN RHEUMATOLOGY HIGH COST DRUG MANAGEMENT DURING THE COVID-19 PANDEMIC

Background:The Pharmacy High Cost Drug (HCD) and Homecare (HC) team, based at a large acute teaching hospital consists of a range of skilled pharmacists, technicians and administrative staff. The team act as a HCD liaison between the hospital and commissioners, working closely with an expanding variety of specialist clinical teams to manage prescription processing for the following patient groups; HC: 2238; Hospital FP10: 1060; Outsourced Subsidiary Pharmacy Model: 41. HCD management, particularly immunosuppressive biologic therapies for complex rheumatology conditions such as rheumatoid arthritis, has been challenging during the Covid-19 pandemic. The inelasticity in demand for better care closer to home and a functional Integrated Care Records system has intensified, as many patients are now shielding/self-isolating at home.1 Frugal innovations have been key during this time – achieving value and simplicity in service re-design to deliver better patient care.Objectives:This review explores the support provided by the Pharmacy HCD and HC team to the rheumatology service since March 2020 to aid in service improvements during the pandemic.Methods:The Pharmacy HCD and HC team reviewed existing practice to better respond to the service changes required during the pandemic in regard to the following areas; identifying patients for Covid-19 shielding; responding to changes in HC service provision; communication with commissioners; remote staff working; reviewing HCD formulations and administration routes; changes in commissioning arrangements.Results:i) Rapid development of patient datasets following identification of 1,623 immunosuppressive drug entries in line with BSR Covid-19 guidance (first published in March 2020), thus enabling social distancing/shielding guidance to be issued to patients via letters/virtual platforms.2 ii) Swift re-routing of urgent new biologic HC registrants to a new hospital pharmacy home delivery provision when certain HC providers temporarily imposed restrictions on intake of new registrants. This hospital initiative was further enhanced to a hub and spoke model enabling patients to have easy access to their medications from their nominated local community pharmacy branch. iii) Providing assurance to commissioners that clinical follow up reviews could continue virtually, blood samples could be taken at an external hub and blueteq documentation would be completed covering NICE technology appraisal (TA) criteria. iv) A successful pilot utilising the lean PDSA (Plan, Do, Study, Act) quality improvement methodology, to enable remote working pharmacists and technicians to process HC prescriptions remotely in the absence of an electronic prescribing and medicines administration system. v) Reviewing potential plans to switch certain hospital day-case intravenous biosimilar infusions such as infliximab to subcutaneous administration via HC. vi) Business contingency development plans to protect fragile medication supply chains. vii) Clarifying implications for changes in contracting and payment arrangements announced by NHS England and NHS Improvement due to the pandemic.3Conclusion:In summary, the role of the HCD Pharmacists during the pandemic in supporting rheumatology patients and the multidisciplinary team has been fundamental; ensuring signed prescriptions are securely processed to safely deliver medication to those in need.

Reduced Activity in an Inpatient Liaison Psychiatry Service During the First Wave of the COVID-19 Pandemic: Comparison With 2019 Data and Characterization of the SARS-CoV-2 Positive Cohort.

Background: The COVID-19 pandemic led to changes in the way that healthcare was accessed and delivered in the United Kingdom (UK), particularly during the peak of the first lockdown period (the “first wave”) beginning in March 2020. In some patients, COVID-19 is associated with acute neuropsychiatric manifestations, and there is suggestion that there may also be longer term neuropsychiatric complications. Despite this, at the time of writing there are only emerging data on the direct effects of the COVID-19 pandemic on psychiatric care.Methods: In this retrospective study we analyzed referrals to an inpatient liaison psychiatry department of a large acute teaching hospital during the first wave of covid-19 in the UK and compared this data to the same period in 2019.Results: We saw a 40% reduction in the number of referrals in 2020, with an increase in the proportion of referrals for both psychosis or mania and delirium. Almost one third (28%) of referred patients tested positive for COVID-19 at some point during their admission, with 40% of these presenting with delirium as a consequence of their COVID-19 illness. Save delirium, we did not find evidence for high prevalence of new-onset acute mental illness in COVID-19 positive patients.Conclusion: Our data indicate decreased clinical activity in our inpatient psychiatry liaison department during the first wave of the COVID-19 pandemic, although a relative increase in relative increase in referrals for psychosis or mania, suggesting less of a relative decrease in more severe cases of mental illness. The reasons for this are likely multifactorial, including structural changes in the NHS and patient reluctance to present to emergency departments (ED) due to infection fears and Government advice. Our data also supports the literature suggesting the high relative prevalence of delirium in COVID-19, and we support integration of psychiatry liaison teams in acute general hospital wards to optimize delirium management. Finally, consideration should be given to adequate staffing of community and crisis mental health teams to safely manage the mental health of people reluctant to visit EDs.

Magnitude of error: a review of wrong dose medication incidents reported to a UK hospital voluntary incident reporting system

ObjectivesOur aim was to review medication-related incidents reported to a hospital voluntary incident reporting system to identify and quantify the magnitude of wrong dose errors.MethodsThe study was a retrospective review...

Do nurse staffing levels affect patient mortality in acute secondary care?

This systematic literature review explores and considers whether registered nurse staffing levels affect patient mortality in acute secondary care settings. A discussion makes particular reference to the philosophical foundations of contrasting research approaches used within the literature. At the time of writing, the author was a modern matron for surgery, managing the ear, nose and throat; head and neck; airway; and reconstructive plastic surgery services in a large acute teaching hospital in central London. Effective management and leadership of acute clinical areas requires appropriate nurse:patient ratios. In practice settings, patient to staff ratios are based on care being provided by highly skilled and competent nurses providing best-quality, evidence-based practice.

Understanding readmissions: An in-depth review of 50 patients readmitted back to an acute hospital within 30 days

BackgroundReadmissions back into an acute hospital are attracting greater interest as a marker of disconnect between primary, secondary and social care. ObjectiveTo develop an in-depth understanding of the reasons contributing towards short-term readmissions in older people, and identifying potential interventions. DesignIn-depth analysis of 50 patients readmitted back into an acute hospital within 30days; thematic analysis. SettingA large acute teaching hospital in the East Midlands, UK. SubjectsPeople aged 70years or older readmitted within 30days from any speciality into the Acute Medical Unit. MethodsSimple descriptive statistics were used to describe the nature of the sample examined, and thematic analysis was undertaken to summarise the main causes underpinning the readmission. ResultsFifty patients with a mean age 82.2years, 46% male, 9% from their own home, 50% with cognitive impairment, mean 5.2 co-morbidities, mean 6.5 medications and median Rockwoood frailty score 5. Sixty-four percent of the readmissions were related to the index admission, the majority medical in nature (69%) of which 86% were potentially preventable. ConclusionsMost short-term readmissions to an acute hospital are driven by medical issues, which might be addressed by comprehensive assessment during the index admission and early follow-up.

Clinical and academic perspectives on how to develop and enhance nursing research activities

This paper seeks to outline how clinical and academic colleagues can work together to promote nursing research and development in order to enhance care delivery. The literature shows that problems concerning capacity and capability continue to impede progress in developing further the contribution that nursing research can make to patient care. The settings which are the focus of this collaboration are a large acute teaching hospital NHS Trust and a post-1992 university. In order to develop firm foundations that a collaborative nursing research strategy could rest on, a SWOT analysis was undertaken. The SWOT analysis demonstrates that there is a clear need to increase the number of nurses participating in research and development activities in both settings. This is a fundamental requirement if evidence based nursing practice is to be a reality.

Learning from experience: promoting evidence‐based practice

AbstractThe present article describes a project to establish an evidence‐based council in a large acute teaching hospital as a tool for promoting evidence‐based practice. The council aimed to give clinically active nurses ‘ownership’ of research questions and an opportunity to develop confidence in their evidence‐based practice skills. The development and implementation of the project are outlined and recommendations for encouraging capacity and the involvement of nurses with regard to evidence‐based practice are provided. Copyright © 2003 Whurr Publishers Ltd.

The magic matrix of clinical governance

The implementation of effective frameworks which support the clinical governance agenda is proving to be a significant challenge for management teams across the NHS. Since there is no recognised ideal model or gold standard for such frameworks, it is not surprising that many organisations remain in a state of “trial and error” with their clinical governance arrangements. This article provides an insight into the ongoing developments of the clinical governance “infrastructure” at Southampton University Hospitals NHS Trust. A model of delivery for clinical governance within a large acute teaching hospital is proposed and it is hoped that it may prove useful to colleagues across the country, who may well be facing difficulties in their structural arrangements to deliver the clinical governance agenda.

Centralising supply of a trust's pressure-relieving equipment.

This paper discusses the development of a centralised service by one large acute teaching hospital over a three-year period and the new system's impact on incidence and types of pressure ulcers.

Collecting the evidence: the nursing management of intravenous therapy

Objectives: This study was prompted by the need to identify and measure the impact of change on the existing roles and responsibilities of nurses with reference to the management of intravenous (IV) therapy in terms of activity and workload, standards of care, scope of practice and risk management. Design: a study was designed to include: • an activity analysis to identify changes in nursing workload • a small research-based project to examine clinical practice • a risk management exercise to identify ‘the harm’. Setting: a large acute teaching hospital with regional specialities. Participants: key representatives from research, audit, resource management, education and training and clinical practice worked in partnership to inform an evidence-based approach to support practice. Findings: evidence-based practice can be enhanced by combining traditional researchmethods, findings from service evaluation, audit and risk management exercises. Discussion: the use of local data, specific research findings and the expertise of practitioners, managers, educators and researchers can be combined to underpin safer, more clinically and cost-effective approaches to the nurse management of IV therapy.