Post-intervention Audit Research Articles

Quality improvement project to decrease unnecessary investigations in infants with bronchiolitis in Cork University Hospital

BackgroundBronchiolitis is a common reason for infants to present to the emergency department (ED). Clear evidence-based guidelines exist that recommend against routine radiological and laboratory investigations in this cohort. Despite...

Sharps injuries prevention among healthcare providers in surgical, medical and pediatric wards of a public hospital in Jimma Zone: a best practice implementation project.

Sharps injuries are a serious public health problem that healthcare providers face and constitute a major risk for the transmission of blood-borne infections. Prevention of sharps injuries in hospitals requires that healthcare providers comply with universal precautions. The aim of this study was to assess and improve the compliance of healthcare providers with protocols based on best available evidence for prevention of sharps injuries in medical, surgical and pediatric wards of the hospital. A three-phase clinical audit was carried out using the online JBI Practical Application of Clinical Evidence System and Getting Research into Practice Program. Six audit criteria based on available evidence were used. Phase 1 of the project was the baseline audit, phase 2 the implementation of the best practice, and phase 3 the follow-up audit. Data were collected through observation, interview and resource inventory. The postintervention compliance report showed maximum improvement in compliance in criterion 1 (sharps containers are not filled above the mark that indicates the bin is full) and criterion 2 (sharps containers are positioned out of the reach of children at a height that enables safe disposal by staff). Between the baseline and postintervention audits, the compliance rate for these criteria improved by more than half (criterion 1) and by nine-fold (criterion 2) (from 38 to 100% and 0 to 93%, respectively). During baseline, two nurses reported experiencing sharps injuries, noting that they think it is not important to report the injury if the patient is negative for HIV, and when they do not know where to report it, regardless. At the postintervention audit no injuries were reported. The best practice recommendations using a clinical audit process was an effective intervention for improving knowledge and compliance of healthcare workers with protocols for the prevention of sharps injuries in low-resource settings.

Impact of a quality improvement initiative in ovarian cancer in 2 large U.S. hospital systems

<h3>Objectives:</h3> To identify areas for improvement and design system-based strategies to address challenges in the provision of quality ovarian cancer care, we undertook a quality improvement (QI) program at 2 large US-based hospital systems. <h3>Methods:</h3> At baseline, between 9/2019 and 2/2020, we audited 200 EMR records (100 from each system) of adult patients with recurrent ovarian cancer for assessing physicians' performance of quality-based and National Comprehensive Cancer Network (NCCN) guideline-directed biomarker testing, maintenance treatment, monitoring, and patient-centered practices. Multidisciplinary ovarian cancer teams in each center participated in QI interventions including feedback on baseline EMR results and development of action plans. Post-intervention, 200 additional recurrent ovarian cancer patient EMRs were retrospectively reviewed in each center between 2/2020 and 9/2020 to determine the effect of the intervention on ovarian cancer care. <h3>Results:</h3> At baseline, for 200 patients diagnosed with ovarian cancer who's EMR were audited, the mean age was 66 years and the average time since diagnosis was 3 years. In these patients, documentation of <i>BRCA1/2</i> testing, use of maintenance therapy, patient follow-up, and shared decision-making (SDM) were sub-optimal (<i>Table</i>). Action plans, such as development of resources for guidance with regard to therapy sequencing and patient management strategies, development of a new adverse event management plan, and improvements in documentation and care coordination procedures, were implemented. In the post-intervention EMR audits, 200 patient's demographics were similar to baseline: the mean age was 62 years and the average time since diagnosis was 3 years. At follow-up, EMR audits demonstrated a significant 46% improvement in <i>BRCA1/2</i> testing (<i>P</i><0.001). Maintenance therapy use for patients who responded to platinum-based chemotherapy was numerically, though not significantly, improved from 39% to 47% (<i>P</i>=0.170); the use of PARP inhibitors for maintenance therapy was significantly improved from 4% to 13% (<i>P</i>=0.005). Numerical, though not significant improvements, were also seen in documentation of adverse event monitoring. Documentation of patient monitoring for recurrence were significantly improved over baseline: recurrence monitoring improved from 33% at baseline, to 95% at follow-up (<i>P</i><0.001). Finally, significant improvements in documentation of aspects of SDM were seen at follow-up including improvements in patients who were asked or counselled about treatment goals (44% improvement), treatment expectations (22% improvement), and concerns and fears (29% improvement). <h3>Conclusions:</h3> These results demonstrate that aligning care with guidelines can be challenging; however, implementation of system- and team-based interventions can lead to improved documentation of care practices. These methods and findings from this program are relevant for the future design of intervention to improve the quality of recurrent ovarian cancer care.

Audit on nursing notes in a psychiatry in-patient setting

AimsWe aimed to assess the accessibility and informativeness of the content of daily nursing notes through an audit, and improve deficiencies identified.BackgroundNursing notes are an important source of observation findings, of in-ward psychiatry patients.There can be variations in the quality of the notes as well as information contained within.A basic level of clarity and information within all notes will be helpful in using these to inform the management of patients.MethodAn audit was carried-out in a ward treating working-age patients for psychiatric illnesses.Setting standards - standard required of a daily progress note was decided after discussion in multi-disciplinary team meeting (MDT). Clear language and information on; mental-state, medication, meals, physical health, personal care, activities, risks and use of leave, were identified as requirements.Retrospective audit - First audit cycle was carried-out by assessing the notes two weeks retrospectively. The assessment instrument used a qualitative measurement of the readability of the notes as well as quantitative assessment of the contents.Intervention - The standards set during the MDT, as well as a suggested format for recording notes, were communicated to the staff through email. Follow-up meetings with individual staff members and MDT, to evaluate staff satisfaction and new suggestions to improve the format were held. Difficulties staff encountered when implementing the format were discussed and resolved.Second audit cycle - Following implementation of the intervention, the notes were again assessed using the same instrument.ConclusionDifficulty in accessing information from the notes was noted in the first audit cycle. The average score for accessibility of information when scored on Likert scale + 3 to -3, was 1. Use of language scored 2 on average. On the second audit cycle, accessibility had increased to 3 on average while language score remained 2.Quantitative measurement was done for presence of information on; mental state, medication, meals, physical health, personal care, activities, risks and use of time away from ward. All of these parameters showed an increase in the post-intervention second audit cycle. Information on taking meals, medication, and physical health was present 100% of the time in the second cycle. Most improvement was in information on personal care which showed a five-fold increase, from 17% to 89%In conclusion, standard for nursing notes arrived via discussion and consensus in MDT, has been successful in improving the accessibility and information within nursing notes.

A Quality Improvement Approach to Reduce 30-Day Readmissions and Mortality in Patients with Acute Decompensated Heart Failure

ObjectivesHeart failure [HF] hospital readmissions are a continued challenge in the care of HF patients, which contribute substantially to the high costs of the disease and high mortality rate in lower to middle income country. We implemented a quality improvement project to improve patient outcomes and resource utilization.MethodsThis study was a prospective cohort design with a historical comparison group. It was conducted to assess the difference in 30-day readmissions and mortality and to assess compliance rate with HF guideline between the historical pre-intervention audit 1 cohort and prospective post-intervention audit 2 cohorts. Audit 1 cohort were recruited from January to February 2019, whereas, audit 2 cohort which received the bundled intervention program were recruited from July to December 2019. Clinical outcomes were compared between cohorts using 30-day readmissions and mortality.ResultsA total of 50 and 164 patients were included in audit 1 and audit 2 cohort, respectively. Patients in the audit 2 cohort were younger [63.0 ± 14.5 in audit 1 vs 56.5 ± 12.7 in audit 2, p = 0.003] and majority were male [50.0% in audit 1 vs 72.0% in audit2, p = 0.004]. Thirty-day readmissions were significantly different [36.0% audit 1 vs. 22.0% audit 2, p = 0.045], but the mortality rates were similar [4.0%% audit 1 vs. 5.5% audit 2, p = 0.677] between two cohorts.ConclusionA significant decrease in 30-day readmissions was observed in the post-intervention audit 2 cohort in our setting. Further study in larger population and prolong study follow-up is warranted.

P17: IMPROVING PLASTIC SURGERY OPERATION NOTE ACCESSABILITY AT A MAJOR TRAUMA CENTRE: A PROSPECTIVE COMPLETED AUDIT CYCLE

Abstract Introduction Quality operation note documentation is essential for ensuring continuity of care amongst the multi-disciplinary team. The Royal College of Surgeons has published clear and succinct guidelines which outline the necessity for timely, accurate and accessible operation note documentation. Our department uses a bespoke electronic operation note template which is stored within a departmental database. The aim of this study was to evaluate the effect of online operation note guidance on the accessibility of operative documentation. Method A prospective audit of operation note documentation was conducted during two one-month periods in May and November 2018. All reconstructive surgical procedures, both trauma and elective, were included. A bespoke online reminder system was introduced to our electronic platform to encourage operation note upload onto electronic medical records. Result 224 cases (127 elective, 98 consultant-led) were included in the initial audit and 239 cases (173 elective, 131 consultant-led) in the post-intervention audit. 56% of operation notes were accessible to nursing staff pre-intervention. Post-intervention 83% of operation notes were accessible to nursing staff (p&amp;lt; 0.05). No significant correlation was found between operation note accessibility and the type of case (elective vs emergency, r= -0.179), grade of operating surgeon (consultant vs registrar, r=0.259) and the number of operating surgeons (r=0.208). Conclusion This study highlights the importance of operation note accessibility to every member of the multidisciplinary team. A pop-up based intervention significantly improved accessibility of operation notes within electronic medical records although performance remains significantly below the expected standard. Take-home message The use of bespoke, online platforms may limit access to operation notes. A simple, pop-up based intervention significantly improves upload rate to electronic medical records however accessibility remains significantly below the expected standard.

Reducing falls through the implementation of a multicomponent intervention on a rural mixed rehabilitation ward.

There is an absence of literature to guide staff in how falls can be reduced in a diverse patient population on a mixed acute/subacute rehabilitation unit, especially one with daily fluctuations in acuity that occurs due to frequent changes in its acute/rehabilitation patient ratio. Pre-intervention and post-intervention audits. The Rehabilitation Unit at Tamworth Rural Referral Hospital in Tamworth, NSW. Improvement in the number of falls and repeat fallers. A multicomponent intervention involving: (a) in-service education sessions for nursing staff about falls risk-increasing drugs, (b) patient and family education regarding falls risks and prevention strategies, (c) improving documentation of incident reports by using a set template, (d) ensuring that the correct patient mobility status information is handed over between nursing shifts and physiotherapists providing timely and regular updates, (e) the introduction of the 'traffic light mobility system' and (f) enhancing the use of existing falls prevention strategies. The total falls reduced in number from 36 falls to 19 with a decrease in the number of repeat fallers from 8 to 4. There was also increased compliance with existing falls risk tools and improved documentation of each falls incident which provided insight into activities and times with higher falls risk. A multicomponent approach remained effective even when applied to a mixed acute/subacute rehabilitation ward setting.

Evaluating the Implementation of a Multi-Component Intervention to Prevent Surgical Site Infection and Promote Evidence-Based Practice.

Published clinical practice guidelines on surgical site infection prevention are available; however, adherence to these guidelines remains suboptimal. The aim of this study was to evaluate the effectiveness and perceived benefits of intervention and implementation strategies co-created by researchers and clinicians to prevent surgical site infections. This mixed-method evaluation study involved an audit of nurses' wound care practices, followed by focus group and individual interviews to understand the perceived benefits of the intervention and implementation strategies. Descriptive statistical analyses were used to compare post-intervention audit data with baseline results. Deductive and inductive content analyses were undertaken on the qualitative data. The audit showed improvements in using aseptic technique and wound care documentation practices following intervention implementation. Nurses perceived the change champion as effective in role-modelling good practice. Education strategies including a poster and using a scenario-based quiz were viewed as easy to understand and helpful for nurses to apply aseptic technique in practice. The instructions and education conducted to improve documentation were considered important in the success of the Wound Care Template implementation. The integrated knowledge translation approach used in this study ensured the intervention and the implementation strategies employed were appropriate and meaningful for clinicians. Such strategies may be used in other intervention studies. The change champion played an important role in driving change and acted as a vital partner during the co-creation and the implementation processes. Ongoing education, audit and feedback became integrated in the ward nurses' routine practice, which has the potential to continuously improve and sustain evidence-based practice.

PD12-05 IMPROVING RATES OF INTRAVESICAL CHEMOTHERAPY FOR LOW GRADE BLADDER CANCER

INTRODUCTION AND OBJECTIVE: Despite advances in urologic research, there is often a disconnect with real-world practice. AUA guidelines recommend consideration of an immediate postoperative instillation of intravesical chemotherapy (IVC) for low grade urothelial cancers, which has been shown to reduce tumor recurrence up to ∼40%. However, rates of postoperative IVC use remains low due to high costs, low availability, and side effects. While Mitomycin C is the standard of care, recent data demonstrates that gemcitabine (Gem) has similar efficacy in reducing tumor recurrences, while being more tolerable and less expensive. We created an implementation protocol to improve usage rates of immediate post-operative Gem. Because histology is not available to the surgeon prior to ordering IVC, the accuracy of visual grading during cystoscopy was determined for our group of surgeons. METHODS: Pre-intervention audits were performed at two hospitals to determine for baseline rates of appropriate use of immediate post-operative IVC in patients with low grade (LG) non-muscle invasive (NMI) urothelial carcinoma (UC) undergoing resection of bladder tumors (TURBT) over a 3-month period. Needs assessment was performed to recognize key stakeholders and identify barriers to use. An intervention protocol was designed and implemented, which included new EMR order sets, education of providers and staff, and establishment of communication checkpoints. A 4 month post-intervention audit was performed. RESULTS: Prior to knowing histology, LG histology was accurately predicted with a PPV of 80%. Pre-intervention rates of appropriate intravesical chemotherapy use were 9% at hospital A and 39% at hospital B. Post-intervention rates were 81% at hospital A and 84% at hospital B. CONCLUSIONS: Prior to knowing histology, our urologists can accurately predict LG histology and thus patients who will require IVC after TURBT. There was a significant improvement in the rates of immediate postoperative Gem at both hospitals. Continued refinement of the protocol will be necessary to further improve and sustain these improved rates. This success indicates that our intervention may be used as a model for other institutions.Source of Funding: Urology Care Foundation Resident Research Award; Kahlert Foundation

Reducing unnecessary neonatal testing in infants of mothers with thyroid disease.

To examine the numbers of asymptomatic infants <8 weeks who had appropriate thyroid function tests (TFTs) in addition to the newborn screening test, because of maternal thyroid disease, before and after the implementation of an updated institutional guideline and staff education. A medical record audit of infants <8 weeks born at a metropolitan teaching hospital, who had TFTs between 1 July 2017 and 31 October 2017 was performed as part of a quality improvement project. Records were reviewed to determine the indication for testing and whether this complied with the current 2011 institutional guideline. A multidisciplinary staff education package was developed to coincide with the publication of an updated guideline in August 2018. Staff education and resources were provided throughout July 2018. A post-intervention audit was repeated between 1 August 2018 and 1 December 2018, assessing compliance with the 2018 guideline. In the baseline period, 40 of 457 infants born had TFTs performed, of which 26 of 40 (65%) were for maternal thyroid disease. Of these 10 of 26 (38%) met the 2011 criteria for testing; 1 of 26 (4%) met the updated 2018 criteria. In the post-intervention period, 14 of 412 infants born had TFTs of which 5 of 14 (36%) were tested due to maternal thyroid disease and all were compliant with the new guideline. Baseline audit revealed unnecessary neonatal thyroid function testing of healthy babies. Implementation of an updated guideline and a brief, targeted education package successfully increased awareness of the updated recommendations, reduced unnecessary testing and led to improved practice.

Everyone has Their Role to Play During the World Health Organisation Surgical Safety Checklist in Australia: A Prospective Observational Study.

The World Health Organisation Surgical Safety Checklist (SSC) is a mandated part of surgical practice. Adherence to the SSC has been shown to result in improved patient outcomes. The aim of this study was to determine the current adherence to the timeout section of the SSC and, in particular, the function of individual team members. A prospective pre- and post-intervention observational audit was conducted on the timeout section. The intervention involved an in-hospital display of interim results and distribution to theatre staff. Data were collected on participants, duration and compliance with checklist items for 400 theatre cases. There were 200 cases before and after the intervention. There were no cases in which the timeout section was completed correctly in its entirety. Post-intervention, there was a significant improvement in participation of theatre staff (excluding surgeons) as well as a significant improvement in items discussed and documented. Discussion of items such as anticipated critical events, pressure areas and the team introduction remained low. Some items on the checklist were discussed significantly more when a particular staff member participated. Observed completion rates of the timeout section of the SSC were poor. Individual team members positively influenced checklist items more aligned to their role, highlighting the importance of timeout being performed by the entire theatre team. Improved performance was seen following audit and feedback.

Essential pain management at a rural district hospital in Burundi

Background: Pain management is a significant challenge in low- and middle-income countries (LMICs). In settings where resources are limited, interventions to improve pain management must be low-cost and context-appropriate. Methods: At a rural district hospital in Burundi, East Africa we undertook the delivery of a simple educational workshop called Essential Pain Management (EPM) and introduction of regular acute pain rounds for post surgical patients. At the same time, we carried out a pre- and post-intervention audit of pain management. We hypothesised that the use of the EPM educational workshop and introduction of regular acute pain rounds for post-surgical patients would lead to a reduction in patient pain scores, time to first ambulation, hospital length of stay, and changes to analgesic medication prescribing practices. Results: We found improvements in modified visual analogue scale (VAS) scores on postoperative days one (mean VAS 42.3 vs 31.4, p &lt; 0.001) and two (mean VAS 33.7 vs 27, p = 0.001), with no difference on day three. We also found a reduction in time to first ambulation after introduction of this service (median time of 38.8 hours vs 28 hours, p &lt; 0.001) with no change in length of stay (median four days in both groups). There was also a marked increase in administration of analgesic medications after the service was introduced. Conclusion: Our audit demonstrates a positive impact following a simple low-cost intervention in a rural hospital where resources are severely limited. We believe that this intervention offers a feasible and context appropriate approach for improving postoperative pain management in a low-resource setting.

Enhancing the verbal handover process for nurses in inpatient orthopedic wards: a best practice implementation project.

This evidence-based quality improvement project aimed to evaluate the effectiveness of a handover guide in improving handovers from registered nurses to enrolled nurses. Nursing handover involves the transfer of the responsibility of care for a patient from one nurse to another. Handover techniques vary in different healthcare organizations. Non-standardized, incomplete handovers can lead to delays or errors in treatment, increased lengths of stay, and poor health outcomes. This project was conducted in two orthopedic wards of a tertiary hospital, and occurred in four phases over 12 months. The project utilized the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) tools. The baseline audit in March 2017 revealed a poor compliance in handover of essential patient information. The post-intervention audit showed a significant increase (P < 0.001) in the compliance of handover of essential patient information. Registered nurses' handovers of patient information to enrolled nurses improved from 11% to 27% (P < 0.000). Verbal face-to-face handovers occurred throughout the implementation. Eighty-two per cent of the nurses felt that the handover guide had reduced the number of monitoring errors and delays in treatment. The project has successfully improved nurses' clinical handovers and contributed to safe patient care. Further audits are required to sustain the evidence-based practice change. Nursing leaders play a significant role in supporting the project and building a positive evidence-based practice environment.

Pharmacist-Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability.

Inaccurate or missing medication information in medical discharge summaries is a widespread and intractable problem. This study evaluated the effectiveness and sustainability of an intervention in which ward-based hospital pharmacists reviewed, contributed and verified medication information in electronic discharge summaries (EDSs) in collaboration with physicians. Retrospective audits of randomly selected EDSs were conducted on seven wards at a major public hospital before and after implementation of the intervention and repeated two years later on four wards where the intervention was incorporated into usual pharmacist care. EDSs for 265 patients (prescribed a median of nine discharge medications) were assessed across the three time points. Pharmacists verified the EDSs for 47% patients in the first post-intervention audit and 68% patients in the second post-intervention audit. Following the intervention, the proportion of patients with one or more clinically significant discharge medication list discrepancy fell from 40/93 (43%) to 14/92 (15%), p < 0.001. The proportion of clinically significant medication changes stated in the EDSs increased from 222/417 (53%) to 296/366 (81%), p < 0.001, and the proportion both stated and explained increased from 206/417 (49%) to 245/366 (67%), p < 0.001. Significant improvements were still evident after two years. Pharmacists spent a median of 5 (range 2–16) minutes per patient contributing to EDSs. Logistics, timing and pharmacist workload were barriers to delivering the intervention. Additional staff resources is needed to enable pharmacists to consistently deliver this effective intervention.

Implementation of a Clinical Decision Support Tool to Improve Antibiotic IV-to-Oral Conversion Rates at a Community Academic Hospital

Antibiotic IV-to-oral (IV-PO) conversion is a key initiative of antimicrobial stewardship programs. Guidelines and education are commonly described interventions to promote IV-PO conversion; however, technological interventions may be more effective in changing practice. To determine the impact of a clinical decision support (CDS) tool on the adoption and sustainability of an antibiotic IV-PO conversion program at a community academic hospital. A quasi-experimental study consisting of 3 phases was conducted. During phase 1, the pre-intervention antibiotic IV-PO conversion rate was determined. During phase 2, the IV-PO conversion policy was updated, education was provided to pharmacists and physicians, and a post-intervention evaluation was conducted. During phase 3, a CDS tool was developed to generate real-time electronic alerts prompting pharmacists to assess antibiotic therapy, and post-intervention audits were performed 1 month, 3 months, and 15 months after implementation of the tool. Pantoprazole IV-PO conversion was assessed during each phase as a non-equivalent dependent variable. The primary outcome was the proportion of patients eligible for IV-PO conversion who were switched to oral therapy. Of 332 patients receiving targeted IV antibiotic therapy during the overall study period, 122 (37%) met the criteria for IV-PO conversion. The phase 2 IV-PO conversion rate of 35% (9/26) was comparable to the pre-intervention rate of 29% (10/35) (p = 0.61). Implementation of the CDS tool significantly increased the conversion rate to 78% (14/18), an increase that was sustained at 3 months (71% [17/24]) and 15 months (74% [14/19]) after implementation (p < 0.05 for all comparisons with phases 1 and 2). Pantoprazole conversion rates were similar across all phases. Implementation of the CDS tool was effective in improving and sustaining antibiotic IV-PO conversion rates and enhancing policy compliance beyond the effects of policy revision and education. Refinement of both the policy and the tool is warranted to maximize adoption of the IV-PO conversion program.

Successful implementation of evidence-based guidelines in a regional emergency department for children presenting with acute asthma.

To evaluate the adherence to asthma evidence-based guidelines before and after a quality improvement process. A controlled trial was conducted at two regional hospitals (intervention and control hospitals). We performed a retrospective pre-intervention audit, followed by a post-intervention audit 1year after the implementation of evidence-based guidelines. Emergency departments of two neighbouring hospitals serving regional and rural North West Tasmania. All children (<18years) with acute presentation of doctor-diagnosed asthma. Implementation of evidence-based guidelines using the National Asthma Council of Australia and the Global Initiative of Asthma guidelines, at the intervention hospital and care as usual at the control hospital. The main outcome measures were the compliance to evidence-based guidelines, pre- and postintervention at the intervention hospital, compared to the control hospital. The specific outcomes measure included the clinical presentation, management, referral to asthma and allergy clinic, and hospitilisation. Significantly improved adherence to evidence-based guidelines were noted post-intervention at the intervention hospital, that is severity recorded (21.4%-45.7%, P<0.001), triggers identified (13.5%-45.3%, P<0.001), spirometry usage (3.8%-25.8%, P=0.03) and written action plans (29.7%-58.3%, P<0.001). There was however no effect on hospitilisation (23.3%-29.8%, P=0.48). At the control hospital, however, no significant improved adherence to evidence-based guidelines were noted. Evidence-based implementation led to improved adherence to evidence-based guidelines across an expanded list of domains in a regional setting.

Complementary and alternative therapy use in a regional radiation oncology treatment centre: Can staff knowledge, views, confidence and documentation be improved?

IntroductionComplementary and alternative therapies (CATs) are widely used by cancer patients but are infrequently disclosed and documented. This study aimed to improve radiation therapy staff knowledge, confidence, views and documentation of radiation oncology patients' use of CATs.MethodParticipants completed a baseline questionnaire regarding their knowledge, confidence, views and documentation relating to patients' CAT use. An intervention was undertaken whereby participants attended an educational session and a CAT screening tool was implemented simultaneously. Participants immediately completed a post‐intervention questionnaire and later a 6‐month follow‐up questionnaire. A patient record audit was conducted to measure the documentation of CAT use pre‐ and post‐intervention.ResultsFrom baseline to post‐intervention, there was a statistically significant shift in staff knowledge and confidence (P = 0.001–0.01). The observed shift was sustained over a 6‐month period, (P = 0.453–1.00). Participants' perceived views of CATs did not change as a result of the intervention (P = 0.261–1.000). The post‐intervention audit compared to the baseline audit yielded a statistically significant increase in documentation. There was an increase in CAT use mentioned in patient records from 14% (15/108) to 40% (35/88) (P < 0.001).ConclusionsThe implementation of a screening tool and staff education increased radiation therapy staff knowledge of CATs and increased staff confidence when discussing CAT use with patients. Documentation of CATs in the patient record increased post‐intervention. These changes positively affected radiation therapy staff understanding the use of CATs by cancer patients.

Preventive Evidence into Practice: what factors matter in a facilitation intervention to prevent vascular disease in family practice?

BackgroundA perennial challenge of primary care quality improvement is to establish why interventions work in some circumstances, but not others. This study aimed to identify factors explaining variations in the impact on clinical practice of a facilitation led vascular health intervention in Australian family practice.MethodsOur mixed methods study was embedded within a cluster randomised controlled trial of a facilitation intervention designed to increase the uptake of evidence-based prevention of vascular disease in family practices. The study was set in four Australian states using eight of the study’s 16 intervention practices. Facilitators worked with intervention practices to develop and implement improvements in preventive care informed by a vascular risk factor audit. We constructed case studies of each practice’s “intervention narrative” from semi-structured interviews with clinicians, facilitators and other staff, practice observation, and document analysis of facilitator diaries. The intervention narratives were combined with pre- and post-intervention audit data to generate typologies of practice responses to the intervention.ResultsWe found substantial variability between practices in the changes made to vascular risk recording. Context (i.e. practice size), adaptive reserve (i.e. interpersonal relationships, manager and nurse involvement), and occasional data idiosyncrasies interacted to influence this variability.ConclusionThe findings emphasise the importance of tailoring facilitation interventions to practice size, clinician engagement and, critically, the organisation of, and relationships between, the members of the practice team.Trial registrationThe trial was registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000578808 (29/5/2012). This trial registration is retrospective as our first patient returned their consent on the 21/5/2012. Patient recruitment was ongoing until 31/10/2012.

Impact of a nurse engagement intervention on pain, agitation and delirium assessment in a community intensive care unit

BackgroundIn 2013, the Society of Critical Care Medicine published a revised version of the ICU Pain, Agitation, and Delirium (PAD) guidelines. Immobility and sleep were subsequently added in 2018. Despite...

Optimizing the role of social workers in advance care planning within an academic hospital: an educational intervention program

ABSTRACTAdvance Care Planning (ACP) promotes communication to help patients express future health-care preferences and goals for their medical care. Social workers (SWs) are trained to facilitate complex conversations and assist in various ACP tasks across clinical settings. This three-part mixed-method interventional study implemented a comprehensive education and training program for SWs of a large academic hospital, which used pre- and post-training evaluations, chart review, and qualitative data from debrief sessions to examine ACP skills and confidence, and assess the number of ACP conversations initiated with patients. Self-reported level of preparation to facilitate ACP conversations improved significantly (n = 26; pre 36% versus post 82%; p < .05). A 4-month post-intervention chart audit showed an 8.69 fold increase in the number of initiated ACP conversations. Qualitative analysis identified key themes regarding barriers and enablers of initiating ACP conversations during standard care from the perspective of SWs.