Line Staff Research Articles

Effective remote staff training of objective session notes.

Session notes are a required component of documenting behavior analytic sessions. The direct training of writing objective session notes is important to the success of direct line staff completing adequate documentation and meeting requirements set forth by agencies, certification boards, and insurance funders. However, in-person training is not always immediately available due to contextual restrictions. This study evaluated the effectiveness of implementing the teaching interaction procedure when training staff remotely to objectively document client progress within session notes. Three Registered Behavior Technicians™ (RBT®s) were trained via telehealth to complete session notes objectively. Results showed that all 3 participants met the mastery criterion during probes measuring the objective documentation of home-based behavior analytic sessions. These findings suggest that a training package, such as the teaching interaction procedure, can be effectively implemented remotely when conducting staff training.

Monitoring COVID-19 initiatives and safety concerns at a comprehensive cancer center.

247 Background: The COVID-19 pandemic brought national and local concerns, particularly to a comprehensive cancer center. Cancer patients’ clinical immunosuppressed status puts them in a vulnerable position for serious complications from COVID-19, including a higher risk of death. The institution developed five operational priorities (OP) to minimize exposure to the virus and contain and mitigate COVID-19 transmission and saw the need to monitor and evaluate those priorities. The project aim was to develop a monitoring system to promote timely identification of system threats and failures of the multiple safety processes implemented by engaging and empowering the front line workforce and area leaders to report concerns through a reporting tool. Methods: The COVID-19 Safety Control Center was developed, which consisted of a triage controller, SharePoint tool for front-line and area managers to report concerns or questions using handheld devices and a telephone hotline for urgent/emergent issues. Delegates from each were designated to review and respond to the reports within 24 hours. Metrics were developed for each of the initiatives. An interactive dashboard was built to communicate to leadership the status and trends of safety concerns. Project leadership met weekly to evaluate its’ efficiency and efficacy. Results: During the first 60 days, 476 events were reported and, on average, closed within 19 hours. The highest entries were related to policy and procedures of the hospital entry points, COVID-19 testing, and patient care. No high harm events were reported. A decreasing trend in entries was observed coinciding with the institution providing timely information to employees through daily COVID-19 briefings, weekly town hall meetings and increased familiarity with institutional COVID-19 processes. Conclusions: When multiple interventions are instituted and compliance to these measures are required in a rapid time frame, there needs to be a platform to monitor the process changes and address safety concerns quickly. Providing timely resolution to concerns of the front line staff serve to identify the threats, decrease the potential failures and provide opportunities to improve processes. The steps taken by the institution are a part of the journey toward high reliability.

Modified Veterans Health Administration Clostridioides difficile Infection (CDI) Prevention Bundle: Progress Over 8 Years Decreasing CDI Laboratory-Identified (LabID) Events at a Large Veterans Affairs Medical Center

Background: In March 2012, the Veterans’ Health Administration (VHA) published the Guideline for the Prevention of Clostridium difficile infection (CDI) in VHA Inpatient Acute-Care Facilities, with a goal of 30% reduction of cases within 2 years. In March 2011, this facility, along with 31 others, served as a pilot site to develop the guidelines. Methods: The CDI prevention bundle was implemented to prevent new onset CDI cases in the facility with 4 core measures: (1) environmental cleaning (EMS), (2) hand hygiene, (3) contact precautions, and (4) cultural transformation. Education was provided to EMS staff, nursing, and care providers on the CDI case definition, criteria for testing, empiric isolation for patients with diarrhea, hand hygiene, and PPE to control spread. In 2014, antimicrobial stewardship was added, and within 5 years an algorithm for isolation and testing was published. Cases were reviewed weekly using TheraDoc software and were reported monthly to the national VHA Inpatient Evaluation Center (IPEC). Isolation was communicated using a ward roster/isolation list in TheraDoc for all unit champions to consult daily. CDI cases were classified using NHSN definitions for a laboratory-identified (LabID) event, recurrent cases, and community-onset cases. Real-time case review and weekly multidisciplinary case discussions identified opportunities for improved compliance with the core measures. Results: Over an 8-year period, CDI healthcare-onset LabID events decreased by 73%. The cases decreased from 149 to 40 over the 8-year period. The infection rate decreased 70% from 16.19 per 10,000 bed days of care in FY2011 (October 2010) to 4.88 in FY2019. The incidence of community onset infections increased from 75 in FY2011 to a high of 146 in FY2018 for a rate of 8.15 to 18.17. In FY2019, there was a decrease in both LabID events and community-onset cases to lows of 40 and 102, respectively. Inappropriate testing decreased by 84% from 50 in FY2011 to 8 in FY2019. Conclusions: A multidisciplinary team approach that included support from leadership and clinical providers as well as front line staff involvement, daily rounding, and case review by infection preventionists has reduced all CDI cases over an 8-year period using the modified VHA CDI bundle. TheraDoc enabled case review, correct isolation, changes to cleaning practices, and more appropriate lab testing. The antimicrobial stewardship program that includes clinical pharmacists working daily with providers was a strong driver for change.Funding: NoneDisclosures: None

Prevalence and Associated Factors of Posttraumatic Stress Symptoms and Stigma among Health Care Workers in Contact with COVID-19 Patients.

Objective: The global spread of COVID-19 has caused great psychological stress in health care workers (HCWs). This study aims to assess the prevalence and associated factors of posttraumatic stress symptoms (PTSS) and stigma among health care workers (HCWs) who are involved in treating COVID-19 patients. This study was conducted as part of studies related to assessing the mental health status of HCWs in Iran during the COVID-19 pandemic. Method: Overall, in this cross sectional study, 894 HCWs working in 9 general hospitals in Alborz province, Iran, in the field of diagnostic and treatment care of patients with COVID-19 were selected using multistage sampling method. PTSS and its subscales, including intrusion, avoidance, and hyper vigilance were obtained based on the Posttraumatic Stress Disorder-8 Item validated questionnaire. Information on Stigma's perception among HCWs was also obtained based on a questionnaire adopted from the HIV Stigma Scale. Predictors of PTSS and Stigma's perception among HCWs were assessed using multivariate logistic regression analysis. Results: Overall, 71.4% of the participants were women and 46.9% were front line staff. The prevalence of intrusion, avoidance, and hyper vigilance symptoms was 44.2% (95% CI: 40.8-47.6), 31. 8% (95% CI: 28.8-35.0), and 37.7% (95% CI: 34.5-41.0), respectively. A strong and positive significant correlation was found between stigma score with PTSD total score (coefficient: 0.83) and its components. In multivariate logistic regression model, female gender was associated with intrusion (OR: 1.46, 95% CI: 1.03-2.06) and avoidance (OR: 1.66, 95% CI: 1.147-2.417) and working in frontline increased the odds of intrusion (OR: 1.45, 95% CI: 1.06-1.97) and hyper vigilance (OR: 1.41, 95% CI: 1.03-1.91). Conclusion: The prevalence of PTSS is high among HCWs during COVID-19 pandemic and it is associated with some demographic characteristics of HCWs. This situation should be considered by health policymakers so that while trying to control the disease, the mental health status of this group of personnel should be given much attention.

Analysis of a SARS-CoV-2 daily screening programme for healthcare workers at a district hospital in KwaZulu-Natal, a quality improvement initiativ.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused an unprecedented burden on our healthcare systems and workers. Healthcare workers are at risk of contracting and spreading SARS-CoV-2 given their proximity to positive cases, often with a lack of personal protective equipment. The South African Department of Health requires that all employees be screened daily for symptoms and potential persons under investigation identified timeously. This report aims to assesses the efficacy of daily self-screening tools in detecting and managing potential staff cases of SARS-CoV-2. Our hospital, situated in KwaZulu-Natal, South Africa, developed a daily self-screening tool for all healthcare workers to complete, consisting of questions on symptoms and epidemiological risk factors. The screening tools were collected and assessed after four weeks of use. Fifty-four forms were assessed. Twenty-eight (51.9%) forms were not completed, whilst 12 (22.2%) indicated positive symptoms with no documentation that any further medical assessment, testing or isolation was done. We identified that the poor completion of forms was likely because of the lack of education of staff on the importance of the forms, poor oversight by management, staff forgetfulness or lack of awareness of the forms. Screening of staff is vital during this pandemic but requires constant oversight by line managers, staff motivation and adequate education. Ongoing development of efficient screening programmes is required.

Resident-to-resident elder mistreatment (R-REM) intervention for direct care staff in assisted living residences: study protocol for a cluster randomized controlled trial

BackgroundResident-to-resident elder mistreatment (R-REM) is defined as negative and aggressive physical, sexual, or verbal interactions between (long-term care) residents that in a community setting would likely be construed as unwelcome and have high potential to cause physical and/or psychological harm and distress. R-REM has been established as a serious problem that has a negative impact on the safety, physical well-being, and quality-of-life of residents living in nursing homes. Although there are no in-depth studies, there is evidence that it is prevalent in assisted living residences and associated with a variety of person, environmental, and facility characteristics. The authors conducted the first systematic, prospective study of resident-to-resident elder mistreatment in nursing homes and developed an intervention for direct care staff to enhance knowledge of R-REM and increase reporting and resident safety by reducing falls and associated injuries. The study aim was to examine the effects of this intervention in assisted living residences. The primary distal outcome is falls and injuries, and the key process outcomes are staff knowledge and reporting.MethodsTwelve larger licensed assisted living residences with special care dementia units in two New York State regions will be enrolled on a rolling basis and randomized to intervention or usual care. Data derived from five sources, (1) resident interviews, (2) staff informants, (3) observational data, (4) chart, and (5) incident/accident report data, will be collected at baseline and 6 and 12 months with respect to 1050 residents (750 “downstate” and 300 “upstate”). The intervention is three training modules delivered on-site after baseline data collection for front line staff on all shifts in facilities randomized to the intervention. Modules relate to recognition, management, and reporting of resident-to-resident elder mistreatment.DiscussionGiven the movement toward alternative congregate living arrangements for older individuals with significant comorbidities, including cognitive impairment; it is critical to enhance resident safety measured by falls, accidents, and injuries and staff knowledge related to recognition, reporting, and treatment of resident-to-resident aggressive and related negative interactions in such settings. This project is important in developing approaches for ameliorating and preventing R-REM in assisted living residences and enhancing resident safety and quality of life.Trial registrationClinicalTrials.gov NCT03383289. Registered on 26 December 2017

Fact or Foley: Reducing Catheter Related Urinary Tract Infections by Connecting Evidence to Drive a Multidisciplinary Urinary Program

<h3>Background</h3> Catheter Associated Urinary Tract Infections (CAUTI) are the most frequent healthcare acquired infections. Key initiatives to reduce CAUTI have been supported by multiple healthcare organizations. A quality Improvement project was created to establish a robust, sustainable, enhanced multi-disciplinary CAUTI prevention program reducing catheter utilization and CAUTI rates. <h3>Methods</h3> Collaboration to reduce the incidence of CAUTI occurred through education, product evaluation, and practice changes via Centers Disease Control (CDC) evidence-based guidelines. These guidelines are organized into five evidence-based prevention initiatives: avoiding unnecessary catheters/limiting duration, aseptic technique and standardization for insertion, catheter maintenance, catheter necessity, and engaging healthcare workers (HCW) with culture change. Engaging HCW and culture change was incorporated into each of the other four initiatives. CAUTI were defined using National Healthcare Safety Network (NHSN) patient safety chapter, patient days from finance and device days from the electronic medical record; 10 months pre-implementation was compared with 10 months post-implementation. <h3>Results</h3> Implementing evidence based practices and engaging stakeholders, resulted in decreased catheter utilization and CAUTI rates, 24% and 42%, respectively. After the implementation of the evidence based strategies,10 fewer CAUTI were identified. The evidence-based improvements included: external female collection device, daily review of duration/necessity, limiting catheter insertion in the ED and OR, daily discussions with front line staff regarding necessity/removal, and senior leadership emphasis and support driving culture change. <h3>Conclusions</h3> The equal importance of each initiative was the key to program success, including skilled communication, true collaboration, and focused shared goals are key in developing partnerships to achieve cultural change and promote safe patient care. The most powerful strategy positively impacting these results was the executive leadership promoting initiative accountability. Leadership commitment powered decreased utilization, early catheter removal, and sustainment of evidence based initiatives. Continued decrease in the utilization will promote our low rates of CAUTI.

Using Technology to Enhance Infectious Disease Screening During an Outbreak

<h3>Background</h3> From September 2018 to August 2019 New York City experienced a measles outbreak in which 649 cases were identified. During the peak of this outbreak in April 2019, the New York Department of Health emphasized that hospitals should perform enhanced screening to quickly identify and isolate patients with measles. In order to effectively screen for measles the Infection Prevention Department within a large health system partnered with several other hospital departments to design and implement a digital measles screening tool. <h3>Methods</h3> An anonymous screening tool was created using a free and publicly available digital survey application. The tool was administered by hospital personnel to patients near facility entrances, and it asked questions about measles symptoms, vaccination history, exposure history, and place of residence. The tool followed an automated question algorithm that led to one of two outcomes: masking the patient and immediately contacting clinical staff for further assessment; or allowing the patient to proceed forward. Security officers and other front line staff were provided with tablets or computers and educated on how to use the tool. Infection Prevention staff routinely electronically monitored use of the tool and provided feedback over the three month enhanced screening time period to ensure compliance. <h3>Results</h3> Approximately 59,435 patients were surveyed using the digital measles screening tool from 4/25/19 through 8/4/2019. Of these patients, 91 (0.15%) flagged as high risk and required further evaluation by clinical staff to rule out measles. None of these 91 patients were later diagnosed with measles. No cases of confirmed measles were reported at the screening sites during the intervention time period. <h3>Conclusions</h3> The results of the intervention indicate that digital survey applications are effective alternatives to paper screening tools during an outbreak due to ease of use by non-clinical staff and remote compliance monitoring capabilities.

Process Improvement to Reduce Healthcare Associated C. difficile Infections: A Bundled Approach

<h3>Background</h3> A community hospital experienced an increase in Healthcare Associated C. difficile infections in Fiscal Year 2017. Over 70% of the cases were identified in a single unit and were associated with common rooms. Utilizing a continuous improvement process, it was determined that we had multiple opportunities within environmental cleaning, antibiotic utilization, appropriate and prompt testing, compliance with hand hygiene and isolation precautions. <h3>Methods</h3> Front line staff assisted in creating standard work for room stripping and cleaning. Another opportunity was to streamlining our cleaning chemicals. At one point, we utilized two different chemicals and application methods. This variation lead to confusion and compliance downstream. March 2018, UV-C was deployed to treat bathrooms after daily cleaning and after terminal cleaning. Refreshing our Hand Hygiene Campaign was another intervention to increase awareness around appropriateness hand hygiene and tackle barriers to compliance. Our data also showed many of our positive patients received a laxative within 24 hours of testing. We refreshed our education and developed a best practice advisory in our electronic medical record. To ensure prompt collection, a magnetic visual cue was created for the patient's door. A protocol to assist in de-escalating Proton Pump Inhibitor was developed in addition to a process for prophylactic antibiotics for patients with a recent history of C diff. <h3>Results</h3> We have celebrated many new milestones since starting our process improvement journey. From FY 17-FY19, we had a 51% decrease in the number of infections and a 47% reduction in our Standardized Infection Ratio. <h3>Conclusions</h3> We began our journey towards reducing C. diff infections in May 2017 and continue working towards our ultimate goal of zero patient harm. In order to develop solutions and achieve results, we needed to have the front line staff voices heard and work together for what was best for our patients.

The Value of Infection Control Monitors (ICMs) in Communicating Infection Prevention Practices at a Military Treatment Facility (MTF)

<h3>Background</h3> Dissemination of evidence-based infection prevention (IP) practices throughout an entire MTF are challenging due to staff schedules, patient workload, deployment, or leave. Important topics such as syndromic surveillance, new IP technology and practices, emerging infectious diseases, disinfection and sterilization, education, and bioterrorism planning need to be communicated in a timely fashion. <h3>Methods</h3> Our MTF has an ICM program to assist in sharing new infection prevention information to MTF staff. The monitors consist of active duty, civilians, or contractors with a healthcare background. Meetings are held bi-monthly, and on an as needed basis. MTF leaders allot time for the monitors to attend the meetings. Meeting topics include reports from county, state, and various healthcare resources such as the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and the Joint Commission (TJC). Association for Infection Prevention and Control (APIC) chapter and national meeting items are shared with the program members. ICMs share IP practice challenges experienced at their flights for discussion. Hand hygiene and environment of care inspection rates and observations are shared quarterly. ICMs also assist with hand hygiene and EOC audit compliance. The program members request an IP topic for discussion at the next meeting. Each new ICM receives a role orientation from the infection Preventionist and the group receives training annually. Any member can identify the need for an IP project and is given support and necessary resources. <h3>Results</h3> The ICMs are regarded as resource experts for IP issues. This dedicated group assists the IP program provide heightened awareness of IP issues to front line staff. The ICM members are of great value to the MTF as we fulfill our mission to provide high-quality healthcare and ready medics. <h3>Conclusions</h3> The assistance from Infection Prevention Monitors are essential to share communication within the MTF.

CQC: working in a pandemic

British Journal of NursingVol. 29, No. 13 EditorialCQC: working in a pandemicIan PeateIan PeateEditor in Chief, British Journal of NursingSearch for more papers by this authorIan PeatePublished Online:10 Jul 2020https://doi.org/10.12968/bjon.2020.29.13.727AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Care Quality Commission. Regulating during COVID-19—why raising concerns about care is more important than ever. 17 June 2020a. https://tinyurl.com/yaoum3ep (accessed 1 July 2020) Google ScholarCare Quality Commission. How the care for people from different groups is being managed. 17 June 2020b. https://tinyurl.com/ydfctn3y (accessed 1 July 2020) Google ScholarNHS England, NHS Improvement. Clinical guide for front line staff to support the management of patients with a learning disability, autism or both during the coronavirus pandemic—relevant to all clinical specialities. Version 1. 24 March 2020. https://tinyurl.com/qt8wmho (accessed 1 July 2020) Google Scholar FiguresReferencesRelatedDetails 9 July 2020Volume 29Issue 13ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 10 July 2020 Published in print 9 July 2020 Information© MA Healthcare LimitedPDF download

Surviving trafficking, seeking asylum: waiting, status and the state

PurposeThe purpose of this study was to examine the support available from identification through to recovery for survivors of modern slavery and human trafficking in the United Kingdom (UK) following the introduction of the Modern Slavery Act in 2015.Design/methodology/approachTwenty-nine semi-structured individual and group interviews were conducted with non-governmental organisations (NGOs) providing direct support to survivors and law enforcement engaged in initial identification, rescue and support.FindingsThematic analysis identified that survivors' experiences of support and negotiation of state processes is challenging, requiring lengthy periods of waiting. This experience is often compounded by variations in knowledge of processes and systems by front line staff, resulting in negative impacts on outcomes for survivors.Research limitations/implicationsThe small number of research participants could be regarded as a limitation but is common in qualitative, exploratory studies. A larger study should be conducted to test these initial findings. The implications propose a revision of policy especially for asylum-seeking survivors.Originality/valueThe study was conducted two years after the introduction of the Modern Slavery Act, 2015, during a period in which gaps in processes and support for survivors were beginning to emerge. This study offers a timely assessment of these gaps and argues for a review of policy and its implementation.

Information systems in the enterprise's management

The article examines the features of the use of modern information systems and technologies in the activities of enterprises in order to increase the efficiency of management decisions. Based on a study of modern corporate practices in the global financial market, it is proved that corporate information systems for the management of medium and large enterprises is a necessary tool to minimize costs and increase profitability. The purpose of the article is to research the features of modern information systems and technologies using in activity of the enterprises for the purpose of increase of efficiency of administrative decisions. Information system as a set of organizational and technical means for storing and processing information in order to meet the information needs of users, which provides the collection, retrieval, processing and transmission of information. To solve the existing problems of corporate information systems development, an algorithm of actions to increase the level of informatization and efficiency of corporations, which will address current issues of corporate information systems, taking into account domestic legislation and features of corporate governance, increase efficiency and transparency of business processes and provide centralized support for management decisions. at all levels and in all areas of business companies. It is emphasized that one of the main properties of information systems is divisibility into subsystems, which has scales in terms of its development and operation. The stages of creation and functioning (life cycle) of information are specified. It is proved that the use of information systems is a prerequisite for a modern enterprise, that will promote the adoption of sound strategic management decisions aimed at increasing competition (capacity and strengthening the economic security of the enterprise. An effective area for improvement management of the enterprise is implemented modern information systems and technologic, which makes it possible to increase the speed,quality and reliability of collection, storage and information processing; significantly reduce management line staff of the enterprise, which there is preparation of information for the form management decisions; print in the right time management and administration line staff of the enterprise of high-quality other formation; timely and efficient analysis and forecasting of economic activity under receptions; make decisions quickly and efficiently at all levels of enterprise management.

Safety of Healthcare Workers in India

Health is one of our fundamental human rights and the role of workers in the healthcare system is inseparable. Health workers being the front line staff have more complicated situations to deal with especially in the wake of a pandemic like COVID- 19. WHO cautions that they are exposed to hazards that put them at risk of infection. Nevertheless, we are witnessing the relentless efforts put forth by health workers to reinstall the health care system in their respective countries. Amidst all this tension, another concern that derails the COVID-19 battle is the attacks happening against COVID-19 warriors around different parts of the country. This paper is a subjective personal introspection of the authors on the safety of health workers in India. The main objective of the study is to find out the different problems of safety faced by healthcare workers in India and measures to control them.

Investigation and analysis of psychological stress and professional identity of nursing students during COVID-19 pandemic

Certain diseases or infections affect large number of people in short span of time. A local endemic disease can outbreak into an epidemic affecting the whole population or region which at times extend to other countries and continents and become pandemic. Pandemics results inloss of life as well as economy. Pooled efforts and resources, effective sharing of data, parallel multiple approaches as well as physical and mental state of front line staff influence management of pandemics. Thecoronavirus disease COVID-19 caused by SARS-CoV-2started in December 2019 from Wuhan in China, is now aworldwide public health emergency affecting millions of people.It affects many frontline healthcare workers too. Here, we studied psychological stress and professional identity of nursing students for possible correlations, if any, and analyze influencing factors. We used purposive sampling technique with 415 nursing studentsinNanjing, Chinathrough a general information questionnaire, perceived stress scale and nursing professional identity questionnaire. Students' origin, monthly living expenses and their knowledge on epidemic prevention and treatment have shown a significant impact on their psychological stress (P<0.01). Similarly, students' gender, origin, clinical practices and knowledge of prevention and treatment, and whether they actively learn such knowledge impact significantly on their professional identity (P<0.01). The overall score of psychological stress was (24.47±7.35) and professional identity had 72.47±8.07. The stress condition exhibited negative correlation with the degree of professional identity (P<0.01，r = -0.457). Increased psychological stress, had lower sense of professional identity. Overall, analysis of data on perceived stress and professional identity pandemic suggests that stress levels are inversely proportional to knowledge in effective ways of handling the pandemic. Students with clinical practice fared better in terms of professional identity. The study suggests nursing students to stay focused on studies, clinical practice and counselling, if required.

Quality Improvement Innovation in a Maternal and Child Health Network: Negotiating Course Corrections in Mid-Implementation

This article analyzes mid-implementation course corrections in a quality improvement innovation for a maternal and child health network working in a large Midwestern metropolitan area. Participating organizations received restrictive funding from this network to screen pregnant women and new mothers for depression, make appropriate referrals, and log screening and referral data into a project-wide data system over a one-year pilot program. This paper asked three research questions: (1) What problems emerged by mid-implementation of this program that required course correction? (2) How were advocacy targets developed to influence network and agency responses to these mid-course problems? (3) What specific course corrections were identified and implemented to get implementation back on track? This ethnographic case study employs qualitative methods including participant observation and interviews. Data were analyzed using the analytic method of qualitative description, in which the goal of data analysis is to summarize and report an event using the ordinary, everyday terms for that event and the unique descriptions of those present. Three key findings are noted. First, network participants quickly responded to the emerged problem of under-performing screening and referral completion statistics. Second, they shifted advocacy targets away from executive appeals and toward the line staff actually providing screening. Third, participants endorsed two specific course corrections, using “opt out, not opt in” choice architecture at intake and implementing visual incentives for workers to track progress. Opt-out choice architecture and visual incentives served as useful means of focusing organizational collaboration and correcting mid-implementation problems.

Implementing barcode medication administration and smart infusion pumps is just the beginning of the safety journey to prevent administration errors.

Healthcare-related technology has been widely acceptedas a key patient safety solution to reduce adverse drug events bydecreasing the risk of human error. The introduction of technology canenhance safety and support workflow; however, it does not eliminateall error types and may create new ones. Barcode medication administrationand smart infusion pumps are two technologies utilized duringmedication administration to prevent medication errors before they reachthe patient. This article reviewed different error types with barcode medicationadministration and smart infusion pumps and examined how theseerrors were able to occur while using the technology. Recommendationsfor preventing these types of errors were also discussed. Hospitals must understand the technology, how it is designedto work, which errors it is intended to prevent, as well as understandhow it will change staff workflow. It is essential that metrics are set byhospital leadership and regularly monitored to ensure optimal use of thesetechnologies. It is also important to identify and avoid workarounds whicheliminate or diminish the safety benefits that the technology was designedto achieve. Front line staff feedback should be gathered on a periodic basis to understand any struggles with utilizing the technology. Leaders must also understand that even with full implementation of technology, medication errors may still occur.

Working with individuals who have experienced homelessness: Stresses and successes

Purpose Staff who work with vulnerable people with multiple needs are known to experience high levels of stress and burnout, as well as high levels of job satisfaction. This paper aims to explore the experiences of staff working in a project with individuals experiencing long-term homelessness in Lincolnshire. Design/methodology/approach An evaluation of a project working with individuals experiencing long-term homelessness included a focus group set up to explore the experiences and well-being of front line staff and managers. One-to-one interviews with staff were also held to provide more in-depth data about the experiences of individual staff members. Findings Six key themes were identified from the discussions with participants. Decision latitude and the ability to follow service users on person-centred journeys over long periods were positive aspects of the work which were highly valued and seemed to contribute to high levels of job satisfaction. Things which also made a positive contribution were elements of support provided by the employer and a number of personal coping strategies. Themes identified which had a negative impact on well-being related to high workloads and to the multiple and competing demands from service users and other agencies. Originality/value Few studies of any kind have explored the experiences and well-being of staff working in the frontline of homelessness services. This small-scale qualitative study provides a number of suggestions for further research with this population. Findings cannot be generalised but match those of other recent studies which suggest high levels of stress but little evidence of burnout, and that carefully developed workplace support mechanisms play a key role in maintaining commitment to the role and preventing burnout.

Hidden in plain sight

Hidden in plain sight

Youth Mental Health First‐Aid: Juvenile Justice Staff Training to Assist Youth with Mental Health Concerns

AbstractMany youth in juvenile justice settings meet criteria for a mental health condition. Front line staff need to be able to recognize and respond to their needs, but training is often lacking. Youth Mental Health First Aid (YMHFA) is an 8‐hour training for adults without mental health education to recognize and assist distressed youth. This study surveyed 1,279 [State blinded] DJS front‐line staff trained in YMHFA. Of 338 returned surveys (26% response), 44% reported using YMHFA skills at work, 56% in preventing a crisis, 25% during crises. Respondents rated YMHFA as significantly improving their responsiveness to distressed young people.