Pre-intervention Phase Research Articles

Thromboprophylaxis in Patients Admitted to the Surgical Ward: Clinical Audit.

Hospital-acquired thrombosis (HAT) is associated with significant morbidity, mortality, and financial burden globally. Following trusted guidelines for VTE prevention has shown effective, safe, and satisfactory results. This prompts national collaborative efforts to maintain a consensus approach for the safe risk assessment of inpatients and the prescription of thromboprophylaxis. This study aimed to detect and estimate deviations from international thromboprophylaxis protocols. The study also aimed to raise the quality of practice and adherence to evidence-based protocols in Alshuhada Teaching Hospital. A cross-sectional audit of general surgical inpatients was performed from October 2021 to May 2022. The first cycle was from 1/10/2021 to 21/10/2021, and the second cycle was from 13/5/2022 to 31/5/2022. The target population was adults aged >18 years. Data were collected via an online checklist on two separate occasions. The criteria were based on the NICE guideline for venous thromboembolism in individuals aged over 16 years: "Reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism NG89". Forty-five surgical inpatients were included in this study: 20 in the first cycle and 25 in the second cycle. The first-cycle report showed that only 25% of VTE candidates received this regimen. In the second cycle, practice significantly improved, with 92% of admitted patients having their risk assessment tool completed within 24 h of admission. 79% of VTE prophylaxis candidates were prescribed adequate pharmacological prophylaxis within 14 h of admission. The rate of adequate thromboprophylaxis for inpatients undergoing surgery was very low before clinicians received education on VTE prevention, whereas was evidently high after they had received them. The cause of non-adherence in the pre-intervention phase was a lack of adequate knowledge regarding the magnitude and burden of HAT and the importance of thromboprophylaxis, which has a potential role in preventing the majority of HAT.

Influence of educational intervention on nurse-midwives’ knowledge and management practices of Intimate Partner Violence (IPV) in healthcare Facilities in Ekiti-State, Nigeria

ObjectiveTo assess the influence of an educational intervention on midwives' knowledge, detection and management of intimate partner violence (IPV). MethodsA quasi-experimental study involving 158 midwives from two districts in Ekiti State, Nigeria. The sample was divided into experimental and control groups (79 midwives per group). Data were collected using a questionnaire and an observation checklist. A customized educational training program on IPV detection and management was conducted in the experimental group. Measurement was performed before the intervention, immediately after and 6 weeks later. Data were analyzed using descriptive and inferential statistics (Chi-square and binary logistic regression) with a level of significance set at p < 0.05. ResultsPrior knowledge regarding IPV detection and management among midwives in both groups was poor, with only 16.5 % of the experimental group and 17.7 % of the control group having good knowledge in the pre-intervention phase. The experimental group had a significant improvement in knowledge of IPV screening and management, with 82.1 % having good knowledge immediately after the intervention and 92.0 % at 6 weeks after the intervention (p = 0.001). Observed practice of IPV detection and management improved significantly from 21.9 % satisfactory practice before the intervention to 63.5 % after the intervention (p = 0.001) in the experimental group, with no appreciable improvement in practice detected in the control group (21.9% versus 36.5%; p = 0.682). ConclusionThe use of a customized educational training program improved midwives' knowledge and practice in the detection and management of intimate partner violence.

Efficacy of Interventions Based on WHO Multimodal Hand Hygiene Improvement Strategy in a Tertiary Care Hospital in Eastern India: A Quasi-Experimental Study.

The study aimed to evaluate the efficacy of the World Health Organization (WHO) multimodal hand hygiene improvement (WHO-5) strategy in enhancing hand hygiene compliance among health care workers at a tertiary care hospital. The interrupted time series study included preintervention, intervention, and postintervention phases, with 2 points of observation each during the pre- and postintervention phases. The baseline hand hygiene compliance was 16%, which improved to 43.9% after the intervention. Health care workers were 4 times more likely to adhere to proper hand hygiene postintervention (odds ratio [OR], 4.117). Independent predictors of hand hygiene compliance included the week of observation (week 3: adjusted odds ratio [AOR], 0.872; week 5: AOR, 3.427; and week 7: AOR, 4.713), health care worker type (consultants: AOR, 0.964; residents: AOR, 2.187; and interns: AOR, 6.684), daytime (AOR, 1.232), and "after" type of hand hygiene opportunity (AOR, 1.577). No significant differences were found in knowledge, attitude, and practices pre- and postintervention, and the interventions' effect was sustained and increased over time, supporting implementation in hospitals across India.

The Effectiveness of a Yoga Program on Psychological and Cardiovascular Outcomes of Undergraduate Nursing Students.

Psychological problems among nursing students are well documented. Unfortunately, only a minority of these populations seek help related to their psychological distress. Yoga exercises improve individuals' psychological distress and cardiovascular outcomes. Therefore, we conducted this study to test the feasibility and preliminary efficacy of our health promotion theme-based yoga program to reduce the participants' stress levels and anxiety symptoms and improve their blood pressure and heart rate. This study has a pre/posttest quasi-experimental design. A convenience sampling method was used to recruit the participants who were 18 years or older and could speak and read English. Individuals with any contraindication to participate in yoga or receiving any medications for their mental health or cardiovascular health were excluded from the study. The Perceived Stress Scale and the Depression Anxiety Stress Scale-21 were used to measure the participants' stress levels and anxiety symptoms, respectively. Their blood pressure and heart rate were measured by using a standard blood pressure measuring machine. Participants received 50 minutes of weekly yoga sessions in groups and also performed individual yoga sessions 3 times a week for 8 weeks. Descriptive statistics were used to answer our research questions. Our recruitment rate of 47% (n = 19) was lower than our anticipated rate of 80%; however, we had a retention rate of 90%. There was a reduction in participants' stress levels and anxiety symptoms from the preintervention phase to the postintervention phase. A larger study and a randomized controlled trial are warranted to draw conclusions.

Effectiveness of peer assisted learning in improving HIV knowledge, attitude, and perception among community health workers

Background: Community health workers (CHWs) act as a bridge between community and clinical care in caring for HIV patients. This study aimed to evaluate the effectiveness of peer education in improving HIV knowledge, attitude, and perception of CHWs in Babol, Iran in 2019. Methods: This was a quasi-experimental study conducted among CHWs in the health centers of Babol, Iran. The city was divided into two areas of the North and the South according to the geographical map. Then, based on the list of the health centers in each of the areas, one health center was randomly selected and assigned to either the experimental or the control group. Results: Following peer education, all study variables including knowledge score, attitude, and perception about HIV-related issues significantly improved in the experimental group compared to the pre-intervention phase (P=0.002, P=0.02, and P=0.00 respectively). The most significant change was in misconception score with a approximately large effect size (0.78), presenting an increase of 95.53% from 15 to 29.33 after the intervention, while attitude and knowledge respectively presented 85.04% and 81.07% increase with a smaller effect size of 0.57 and 0.52. Conclusion: In the study peer education proved to be an effective strategy in improving the knowledge, attitudes, and perception of CHWs concerning HIV/AIDS. Therefore, the peer-to-peer training model can fill a critical gap in the training of CHW based on the idea that not only do the CHWs themselves need to enhance their knowledge of related topics but they also need to train others. In turn, this will result in providing cost-effective health promotion and prevention services in a more culturally appropriate manner.

Critical care nurses’ knowledge and attitudes toward pressure injury prevention: A pre and post intervention study

ObjectiveTo explore nurses’ knowledge and attitudes towards pressure injury prevention before and after implementing an educational intervention. Design/MethodA pre-and post-intervention study. Pre-intervention data collection involved administering an instrument, including demographic information, the Pressure Ulcer Knowledge Assessment Tool version 2, and the Attitudes towards Pressure Ulcer Prevention instruments. Following the analysis of pre-intervention data, an educational intervention was implemented. Post-intervention data were collected using the same instrument. SettingIntensive care units at three Saudi Arabian hospitals. Main outcome measuresNurses’ knowledge and attitudes towards pressure injury prevention. ResultsThe pre-intervention phase included 190 participants, and the post-intervention phase included 195 participants. Participants completed a paper-based survey at two different time points between June 2021 and March 2022. The mean pre-intervention scores for nurses’ knowledge and attitudes towards pressure injury prevention were 43.22% and 74.77%, respectively. Following the educational intervention, the knowledge and attitude scores increased significantly to 51.22% and 79.02%, respectively. Higher knowledge of pressure injury prevention was positively associated with positive attitudes towards prevention practices. Age, clinical nursing experience, and experience in intensive care units were identified as factors correlated with knowledge of pressure injury prevention. A Bachelor’s qualification or higher predicted better knowledge and attitudes towards pressure injury prevention. ConclusionsNurses’ knowledge and attitudes towards pressure injury prevention greatly improved following tailored, evidence-based education. The educational intervention featured multiple on-site bedside discussions, case studies, small-group presentations, and the provision of printed resources. Implications for Clinical PracticeNurses’ knowledge and attitudes towards pressure injury prevention should be examined, and education provided to ensure evidence-based prevention practices are implemented. Tailored small-group education sessions delivered conveniently could be an effective approach. Efforts should focus on attracting and retaining experienced, highly qualified nurses to ensure the adoption of evidence-based prevention practices.

No Effect of Forest Representations on State Anxiety, Actual and Perceived Noise

Abstract Previous research indicates that nature and nature representations might have positive effects and noise negative effects on various facets of life, such as performance, perceived life quality, and physical and mental health. In this intervention, we observed whether posters showing a representation of nature (forests) can be used to reduce actual noise, perceived noise, and state anxiety in university library users. Measurements were taken twice daily for a 5-day period pre-intervention (before posters were installed) and again during the intervention, when posters were installed. No significant differences were found for perceived or actual noise levels or for self-report state anxiety levels between pre-intervention and intervention phase. Correlations between actual and perceived noise, and actual noise and state anxiety, were small in their magnitude and non-significant, with the exception of state anxiety and perceived noise during the intervention phase, suggesting a weak positive relationship. Finally, in hierarchical linear regression models, actual and perceived (overall and talking) noise and intervention phase were non-significant predictors of state anxiety. Small effect sizes of nature representations on state anxiety, as well as actual and perceived noise, suggest posters of forests to not be an effective intervention for anxiety and actual and perceived noise reduction in a university library.

Benefits of the Light Consumption of Red Wine in Pain, Tender Points, and Anxiety in Women with Fibromyalgia: A Pilot Study.

Fibromyalgia (FM) is characterized by chronic widespread pain, as well as anxiety, sadness, and depression. These symptoms are present in most patients and have a negative impact on their daily, family, and social life. The role of neurotransmitters in the pathophysiology of FM has been extensively discussed. The scientific evidence shows that levels of serotonin are decreased in patients with FM. Numerous studies support the beneficial effects that moderate wine consumption has on the body, with cardiovascular, endocrine, bone, and muscle improvements. The objective of this pilot study was to assess whether light consumption of red wine improves the main symptoms of FM. The study consisted of an experimental study with a control group with a total of 60 women diagnosed with FM following the American College of Rheumatology's criteria. The experimental group ingested 15 g of alcohol per day, in the form of red wine, over a period of four weeks. The outcome measures were: the level of pain in tender points, sadness, anxiety, depression, and quality of life. The assessments tools were: tender point graphics, the visual analogue scale (for the assessment of pain and sadness), the Hamilton Anxiety Scale, the Hamilton Depression Rating Scale, and the Fibromyalgia Impact Questionnaire. The measurements were completed before and after the consumption of red wine. In addition, the differences between groups were evaluated in terms of drug consumption in the pre-intervention and follow-up phases. Statistically significant improvements were obtained in the wine ingestion group for the variables of pain (p = 0.038), tender points (p < 0.001), and anxiety (p = 0.028). An improvement in the mean values was observed in favor of the experimental group for the variables of sadness, depression, and quality of life. The differences observed in the changes seen in the groups that were in favor of the wine ingestion group should not be attributed to the consumption of drugs but to the fact that the experimental group had a light intake of red wine. The results of this pilot study suggest a potential relationship between alcohol intake through the light consumption of red wine as part of the patients' diet and the improvement of the main symptoms of fibromyalgia. Future studies are necessary to confirm these preliminary data; a bigger sample and a controlled diet should be considered, and the mechanisms through which improvements are achieved should be analyzed.

Development of a nurse-led follow-up pathway for patients discharged from cardiology unit: the DIMACC project

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Novartis Background The first year after hospitalisation for Acute Coronary Syndrome (ACS) or Acute Heart Failure (AHF) is the most critical period, with the highest incidence of complications and re-hospitalisations. Multiple epidemiological studies have documented that while hospital mortality in the acute phase has gradually decreased, the mortality trend after discharge remains stable or even increased. These trends may be an expression of inadequate follow-up and poor patient involvement, resulting in poor control of risk factors, and suboptimal adherence to treatments. Aim To present a protocol design for a quality improvement intervention regarding a supported discharge pathway for ACS and AHF patients. Methods The construction of the DIMACC protocol is based on the Plan, Do, Check, Act methodology. Pre-intervention phase: A research project has been developed to introduce a supported discharge pathway from Cardiology wards. The objective and motivation for the change from the existing situation were defined and supported by the theoretical model and international guidelines. Development of the study tools: This phase included the Consensus Conference held with the local institutions, the University delegation, the Head Manager of the District, doctors and nurses, where the actors shared intentions, thus proceeding to their formal approval. Data collection instrument was set. Intervention phase: The group identified strategies to ensure the best possible dissemination of the procedure and the professionals' adherence. A data processing company was involved, which created an online platform to collect the study data. Recruitment within the pilot study started in November 2022. Results The DIMACC project is a PROSPECTIVE OBSERVATIONAL STUDY evaluating the feasibility and performance of a quality improvement intervention on patients discharged from Cardiology following admission for ACS and AHF. The study consists of TWO phases. Phase one aims to implement a structured follow-up in the first year after discharge, with examinations and visits planned according to the severity of the single case. As primary endpoint, there is the achievement of clinical objectives defined on discharge, based on ESC guidelines, improve disease control and reduce the number of admissions to the Emergency dept. and re-hospitalisations. In the second phase, the group plans a series of structured educational interventions held by community nurses care to promote patient engagement and further reduce the elements listed in phase one. In the first two months of the pilot phase, 41 patients were included, with a progressive increase compared to total admissions for ACS or AHF (41% in November and 72% in December). Conclusions This study will generate essential knowledge on CVD patients' experiences and self-empowerment. Findings will be of considerable interest and benefit to many health and care organizations beyond the immediate community of interest.

Effect of intensive training and education of health care workers on the maintenance bundle of venous access devices in critically ill patients at a tertiary care academic hospital

The maintenance bundle of care for all venous access devices (peripheral intravenous catheters, PIVC; central venous catheters, CVCs; hemodialysis ports) is important to prevent secondary sepsis in critically ill patients. This quality improvement project analyzed the effect of intensive training and education of health care workers (HCWs) on maintenance bundles for venous access devices. The study period comprising of preintervention phase (3-months) included 25 random visits to the intensive care unit for point observations regarding maintenance of all venous access devices in-situ in all intensive care unit patients on the day of the visit. The observations were categorized as appropriate or inappropriate practices based on American Society of Anesthesiologists (ASA) guidelines for CVC 2020, INICC guidelines for PIVC 2017, and Australian Commission on Safety and Quality in Health Care (ACQHCS) for PIVC and hemodialysis ports, December 2019. While the intervention phase (1-month) comprised intensive training and education of HCWs, postintervention phase 3 (3-months) included similar visits and point observations as during the preintervention phase. The maintenance of PIVC improved significantly in terms of the condition of site (from 82.7% appropriate observations to 97.8%, P<.05); condition of connectors (45.7%-56.8%, P<.05), and any attached unused IV sets (90.5%-98.56%, P<.05). For CVC, there was significant improvement in condition of insertion site (66%-94%, P<.01); condition of connectors (0%-44.37%, P<.01); fixation (91%-99.3%, P<.05); any attached unused IV sets (38.9%-97.3%, P<.01) and knowledge of HCW (96.52%-100%, P=.05). For hemodialysis ports, no significant improvement was observed. Intensive training and education of HCWs led to significant improvement in the maintenance bundle of care for PIVC and CVC.

A pre and post-test assessment of oral health intervention: caregivers’ knowledge and attitudes at long-term care facilities in the eThekwini district, KwaZulu-Natal.

Oral health remains a neglected aspect of health care among vulnerable populations residing at long-term care facilities. Routine oral health education and training for caregivers have the potential to improve oral health provision. Aims and Objectives To determine the effect of an oral health intervention on caregivers’ knowledge and attitudes. Methods This exploratory study utilised a pre/post-test assessment approach. A total of participated. A pre-test questionnaire was distributed among 145 caregivers from seven long-term care facilities in eThekwini district. An online oral health educational intervention was implemented four weeks later. Six months later, a post-test questionnaire was administered. A Mann-Whitney test and paired sample test were used for statistical analysis. p&lt;0.05 was considered statistically significant. Results Participants (n=19; 13.1%) reported that brushing twice a day and flossing were the two most important dental habits in the pre-intervention phase, compared to 71% (n=103) in the post-intervention phase. Caregivers (n=124; 85.5%) in the pre-intervention phase reported to feel that they should be trained in providing oral health care, compared to 93.8% (n=136) in the post-intervention phase. Conclusion The oral health intervention had a positive effect on caregivers’ knowledge and attitudes. This finding necessitates routine oral health education and training for caregivers.

Reducing post-operative caregiver after-hours phone calls to pediatric urology providers: A quality improvement study

Caregiver phone calls are an important part of caring for pediatric patients. At our institution, residents respond to after-hours caregiver calls. While it is critical for families to be able to reach us for urgent concerns, the ease of access has led to overutilization with many phone calls not meeting the urgent nature that is intended for these calls. The primary aim of this quality improvement project was to decrease the number of non-urgent caregiver calls after-hours. Our secondary aim was to improve compliance with telephone encounter documentation and to standardize the documentation content. We conducted a single institution, multiphase quality improvement project. This started with a preintervention phase which included evaluation of our current state, identifying that most calls were for post-operative patients and that our discharge instructions inadequately detailed when caregivers should call. Notes were also inconsistently documented with no standard format. In the first PDSA cycle, launched on November 1, 2021, a standardized note template was created for documentation of caregiver telephone encounters. The PDSA cycle began on January 1, 2022 and included updates to our post-operative instructions with explicit guidance detailing when to call after-hours. Call data from September 2021 to February 2022 was reviewed including variables such as caller demographics, reason for call, and operative details. Primary outcomes were proportion of post-operative calls within 30 days and non-urgent calls. Secondary outcome was proportion of calls documented appropriately. Phases were categorized as current state (Sep/Oct 2021), PDSA cycle 1 (Nov/Dec 2021), PDSA cycle 2 (Jan/Feb 2022). In our current state, the majority of the calls (66%) were for post-operative patients and 59% of all calls during this period were non-urgent. The proportion of post-operative phone calls stayed stable at 67% during PDSA cycle 1, but decreased to 38% with PDSA cycle 2 with implementation of updated post-operative instructions (Summary figure) (p<0.001). The proportion of non-urgent calls was similar (current state - 68%, PDSA cycle 1 - 72%, PDSA cycle 2-73%, p=0.39) (Summary figure). Call documentation was also similar with a documentation rate of 79% pre-intervention and 87% post-intervention (p=0.21) (Summary figure). With interventions focused on post-operative caregiver instructions, the number of post-operative phone calls decreased. Standardization of documentation was achieved. However, the overall call volume did not change, nor the proportion of non-urgent calls.

Effectiveness of an Instructional Module on Knowledge and Anxiety of Caregivers of Children Undergoing Cardiac Catheterization – An Experimental Study

Background: Diagnosis of cardiovascular disorders in children is a very stressful time for the entire family. During this period family caregivers are anxious about their child’s condition. At this time, nurses play an important role to educate the parents or caregivers about the child’s health, procedure that has to be performed, and pre- and post-operative care after procedure. This study was conducted to assess the effectiveness of an “instructional module” on knowledge and anxiety of caregivers of children undergoing cardiac catheterization. Materials and Methods: Caregivers of children with congenital heart disease were randomly enrolled in two groups with 30 caregivers in each control and experimental group. Preoperative knowledge and anxiety in both the groups were assessed by a self-structured questionnaire and the State-Trait Anxiety Inventory. An instructional module in the form of a booklet regarding cardiac catheterization was developed and administered to the experimental group while the control group received routine care instuctions. Caregivers’ postintervention knowledge was assessed by a structured knowledge questionnaire. Results: Median knowledge score was 2 (2–2) in the control group and 2 (1–2) in the experimental group among caregivers of the children during preintervention phase. The median anxiety score of the caregivers of children underwent cardiac catheterization during preintervention phase was 57.50 (47–61) in the control group and 53 (47.75–56) in the experimental group. The results revealed that there was a significant improvement in knowledge score regarding cardiac catheterization procedure and also there was reduction in the level of anxiety among caregivers in the postintervention experimental group (P &lt; 0.001). Conclusion: The study suggests that the “instructional module” is effective in reducing the anxiety and improving the knowledge levels of caregivers regarding the preoperative and postoperative care of children who underwent cardiac catheterization.

IMPACT OF STRATEGY-BASED READING INSTRUCTIONS ON READING ANXIETY OF UNIVERSITY-LEVEL ESL STUDENTS OF PAKISTAN

There is a scarcity of research on the effects of strategy-based reading instructions on reading anxiety in Pakistan. This action research study fills this gap in the literature by examining the impact of strategy-based reading instructions on the reading anxiety of ESL students at the university level in Pakistan. Employing quantitative analysis, this research explored the effects of strategy-based reading instructions on reading anxiety. With a total of 60 participants—30 students in each cycle—the study was carried out in two action research cycles. Over the course of four months, the participants in both cycles received strategy-based reading instructions. The data was gathered by means of a survey of reading strategies (SORS) and the Foreign Language Reading Anxiety Scale (FLRAS) which was administered during the pre-intervention and post-intervention phases of both cycles. The results of this study demonstrate that implementing strategy-based reading instructions effectively reduces reading anxiety in students. The findings of this study provide valuable insights for educators and curriculum developers, emphasizing the significance of integrating reading strategies into instructional practices as they can help reduce reading anxiety.

Implementation of diagnostic stewardship in blood culture laboratory: a large-scale interventional study in a tertiary care hospital, South India

Background: Laboratories with well-established diagnostic stewardship program for culture and antimicrobial susceptibility test (C-AST) play a key role in guiding the clinicians to institute specific targeted therapy. Methods: The study period was divided into three phases; pre-intervention phase, intervention phase and post- intervention phase. During the pre-intervention phase, the blood culture was performed by conventional methods. During the intervention phase, immense efforts were made for full-fledged implementation of all the components of intervention-educational intervention for microbiology and clinical team and automations for culture, workflow modifications for performing preliminary tests in parallel with reporting, enhanced reporting frequency and stage-wise communication of reports to the clinicians. Results: There was a significant improvement in the isolation rate in the post-intervention phase (from 10.3% to 15.5%). There has been a steady decrease in mean turnaround time (TAT) of positive culture reports (from 85 to 45 h), which was in turn due to faster blood culture positivity, identification time and AST time. There was also significant improvement in clinical team performance on various parameters such as % of samples sent in pair, % of specimens with appropriate blood volume collected and % culture drawn before the antibiotic start. Conclusions: Our observation shows significant improvement in the pathogen isolation rate as well as performance of both microbiology and the clinical team. Most patients with sepsis are critically ill, therefore, it is the responsibility of every clinical microbiologist to implement the highest standard of diagnostic stewardship in blood culture laboratory.

Implementation of Partnered Pharmacist Medication Charting in haematology and oncology inpatients.

Partnered Pharmacist Medication Charting (PPMC) in patients admitted under general medical units has been shown to reduce medication errors. The aim of this study is to evaluate the impact of the PPMC model on medication errors in patients admitted under cancer units in Victorian hospitals. A prospective cohort study comparing cohorts before and after the introduction of PPMC was conducted. This included a 2-month pre-intervention phase and 3-month intervention phase. PPMC was implemented during the intervention phase as new model of care that enabled credentialed pharmacists to chart all admission medications, including pre-admission or new medications and cancer therapies, in collaboration with the admitting medical officer. The proportion of medication charts with at least one error was the primary outcome measure. Seven health services across Victoria were included in the study. The majority of health services were using paper-based prescribing systems for oncology. Of the 547 patients who received standard medical medication charting, 331 (60.5%) had at least one medication error identified compared to 18 out of 416 patients (4.3%) using the PPMC model (p < 0.001). The median (interquartile range) inpatient length of stay was 5 (2.9-10.6) days in pre-intervention and 4.9 (2.9-11) days in intervention (p = 0.88). In the intervention arm, 42 patients had cancer therapy charted by a pharmacist with no errors. PPMC was successfully scaled into cancer units as a collaborative medication safety strategy. The model was associated with significantly lower rates of medication errors, including cancer therapies. PPMC should be adopted more widely in cancer units in Australia.

Improving the care of patients with lung cancer hospitalized with immune checkpoint inhibitor-related pneumonitis: Implementation of a clinical pathway algorithm.

e18730 Background: Immune checkpoint inhibitor related pneumonitis (ICI-P) is one of the most frequent reasons for discontinuing immunotherapy. High mortality rates have been reported among those with grades ≥3 ICI-P. Early recognition and timely management are key to better patient outcomes. We conducted a quality improvement project that involved developing and implementing a clinical pathway algorithm to standardize the care of patients admitted to our Onco-Hospital Medicine (OHM) service. Methods: We included patients with lung cancer admitted to the OHM service with suspicion of ICI-P from January 1, 2020 to December 31, 2022. We developed a multi-modal educational intervention targeted to providers of the OHM service to promote the use of the developed pathway. Interventions were rolled out in 2 phases and included educational sessions (phase 1), distribution of flashcards, informational notepads, monthly emailers, and presentation of an animation of the clinical pathway (phase 2). Our primary outcome was the time to first ICI-P-directed treatment, i.e. time to treatment (TTT). We used the Kruskal-Wallis test to compare TTT between the pre-intervention and post-intervention phases. Results: Out of 82 patients admitted with a suspicion of ICI-P, 60 were confirmed to have ICI-P based on multi-disciplinary consensus. 19 patients were included in the pre-intervention group, 30 in post-intervention phase 1, and 11 in post-intervention phase 2. 92% of patients in our cohort had NSCLC, and 95% had stage 4 disease. Pembrolizumab was the most common ICI used (55%), followed by combination Ipilimumab+Nivolumab (15%). Pulmonology was consulted in 98% of patients. 98% of patients were treated with steroids. Median TTT(range) was 1 (0-12) day in the pre-intervention group, and 2 (0-17) days and 1 (0-6) day after post-intervention phases 1 and 2, respectively (p = 0.3). Utilization of immunotoxicity order set increased from 0% during pre-intervention to 20% and 27% after phase 1 and phase 2, respectively (p = 0.03). Prescription of Pneumocystis jirovecii pneumonia (PJP) prophylaxis among patients discharged on high-dose steroids increased from baseline but was not statistically significant (pre-intervention = 71%, phase 1 = 95%, phase 2 = 100%, p = 0.09). There was no significant change in ICU admissions or inpatient mortality from pre-intervention to post-intervention phases 1 and 2 (p = 0.5 and 0.6, respectively). Conclusions: We showed a decrease in time to intervention from baseline to post-intervention phase 2 after our educational interventions. While this change was not statistically significant, our multi-level approach was able to help increase the utilization of immunotoxicity tools on the OHM service. Continued education on the OHM service is needed to promote adherence to the developed pathway and help improve patient outcomes.

Implementation of Lung Cancer Screening in Primary Care and Pulmonary Clinics: Pragmatic Clinical Trial of Electronic Health Record-Integrated Everyday Shared Decision-Making Tool and Clinician-Facing Prompts

Although low-dose CT (LDCT) scan imaging lung cancer screening (LCS) can reduce lung cancer mortality, it remains underused. Shared decision-making (SDM) is recommended to assess the balance of benefits and harms for each patient. Do clinician-facing electronic health record (EHR) prompts and an EHR-integrated everyday SDM tool designed to support routine incorporation of SDM into primary care improve LDCT scan imaging ordering and completion? A preintervention and postintervention analysis was conducted in 30 primary care and four pulmonary clinics for visits with patients who met United States Preventive Services Task Force criteria for LCS. Propensity scores were used to adjust for covariates. Subgroup analyses were conducted based on the expected benefit from screening (high benefit vsintermediate benefit), pulmonologist involvement (ie, whether the patient was seen in a pulmonary clinic in addition to a primary care clinic), sex, and race and ethnicity. In the 12-month preintervention phase among 1,090 eligible patients, 77 patients (7.1%) had LDCT scan imaging orders and 48 patients (4.4%) completed screenings. In the 9-month intervention phase among 1,026 eligible patients, 280 patients (27.3%) had LDCT scan imaging orders and 182 patients (17.7%) completed screenings. Adjusted ORs were 4.9 (95%CI, 3.4-6.9; P< .001) and 4.7 (95%CI, 3.1-7.1; P< .001) for LDCT imaging ordering and completion, respectively. Subgroup analyses showed increases in ordering and completion for all patient subgroups. In the intervention phase, the SDM tool was used by 23 of 102 ordering providers (22.5%) and for 69 of 274 patients (25.2%) for whom LDCT scan imaging was ordered and who needed SDM at the time of ordering. Clinician-facing EHR prompts and an EHR-integrated everyday SDM tool are promising approaches to improving LCS in the primary care setting. However, room for improvement remains. As such, further research is warranted. ClinicalTrials.gov; No.: NCT04498052; URL: www. gov.

The impact of pharmacist behavioral intervention on antibiotics prescribing in pediatric wards

Background: Antibiotics may be prescribed irrationally, which can lead to significant consequences including the emergence of antimicrobial resistance. Pharmacists can play a key role in enhancing the rational antibiotic prescribing. This study aimed to evaluate the current clinical practice of prescribing antimicrobial agents in pediatric wards and to assess the clinical and economic impact of pharmacist interventions on antibiotic prescribing. Methodology: This study was conducted at the pediatric wards of a general hospital, Babel, Iraq. The study population included all pediatric inpatients aged ≤ 12 years and receiving antibiotic. The study consisted of three phases. The first was a pre-intervention phase where data about antibiotic prescription was collected retrospectively. The second phase involved pharmacist intervention where the researcher had provided an oral presentation to the healthcare workers. The third phase involved prospective data collection which was compared with the pre-intervention data. Independent T-test was used to compare the differences in the parameters between the pre-and post-intervention phases. Results: The study included 250 children in each of the pre- and post-intervention phases who received antibiotic treatment. The medical records were reviewed retrospectively. Four antibiotics (amoxicillin, cefotaxime, vancomycin and meropenem) were significantly less frequently used in the post-intervention phase. Single antibiotic treatment was significantly higher in the post-intervention phase (p-value&lt;0.05). Length and days of therapy, and the total cost of the antibiotics used were significantly lower in the post-intervention phase. Culture and sensitivity tests were performed only in 28% of patients in the post-intervention phase where the isolated bacteria were found to be highly resistant to penicillin and cephalosporin. Conclusions: This study demonstrated that pharmacist intervention in general pediatric wards has resulted in favorable clinical and economic outcomes. This emphasizes the essential role pharmacists can play in rational antibiotic use, not only in the pediatric population but also in the adults.

Development and Economic Evaluation of a Patient-Centered Care Model for Children With Duchenne Muscular Dystrophy: Protocol for a Quasi-Experimental Study.

Duchenne muscular dystrophy (DMD) is a rare progressive muscular disease that primarily affects boys. A lack of comprehensive care for patients living with DMD is directly associated with a compromised quality of life (QoL) for those affected and their caregivers. This disease also has a huge economic impact on families as its treatment requires substantial direct, indirect, and informal care costs. This study presents a protocol developed to evaluate the feasibility and efficacy of a patient-centered care (PCC) model for children with DMD. The care model was designed with the aim to empower families, improve QoL, and reduce economic burden on their families. This study is planned as a quasi-experimental study that will enroll 70 consecutive families with boys (aged 5-15 years) with DMD visiting a tertiary care center. The study is being conducted in 2 phases (preintervention and postintervention phases, referred to as phase 1 and phase 2, respectively). During phase 1, the patients received routine care. The study is now in phase 2, with the intervention currently being administered. The intervention is based on the PCC model individualized by the intervention team. The model has a comprehensive DMD telecare component that includes teleconsultation as one of its key components to reduce in-person physician visits at the health facility. Teleconsultation is especially beneficial for late-ambulatory and nonambulatory patients. Data on economic burden are being collected for out-of-pocket expenses for both phases during in-person visits via telephone or messaging apps on a monthly basis. QoL data for patients and their primary caregivers are being collected at 3 time points (ie, time of enrollment, end of phase 1, and end of phase 2). Outcome measures are being assessed as changes in economic burden on families and changes in QoL scores. Participant recruitment began in July 2021. The study is ongoing and expected to be completed by March 2023. The findings based on baseline data are expected to be submitted for publication in 2023. This paper outlines a research proposal developed to study the impact of a PCC model for patients with DMD in low- and middle-income countries (LMICs). This study is expected to provide evidence of whether a multicomponent, patient-centric intervention could reduce economic burdens on families and improve their QoL. The results of this study could guide policy makers and health professionals in India and other LMICs to facilitate a comprehensive care program for patients living with DMD. The economic impact of a rare disease is an important consideration to formulate or evaluate any health policy or intervention related to new treatments and financial support schemes. Clinical Trials Registry India (ICMR-NIMS) CTRI/2021/06/034274; https://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=56650. PRR1-10.2196/42491.