Professional Practice Evaluation Research Articles

Connaissances et pratiques des étapes préalables à la stérilisation des dispositifs médicaux thermorésistants : étude au centre hospitalo-universitaire Sahloul, Sousse-Tunisie – 2022

The standard process of central sterilization is crucial for the optimal functioning of the operating room. The outcome of this process is closely linked to the steps preceding the steps prior to the sterilization step itself. These steps include pre-disinfection carried out in the operating rooms and other stages, namely washing, drying and packaging, which must be performed in the central sterilization unit. In this context, this study aimed to describe the knowledge of the staff in the operating rooms and the central sterilization unit at Sahloul University Hospital in Sousse (Tunisia) in 2022, regarding the steps prior to the sterilization of reusable thermoresistant medical devices and to describe their practices in terms of compliance with these steps. A descriptive study was conducted from January 2022to June 2022with the aforementioned staff, using a self-administered questionnaire to assess their knowledge of the pre-sterilization steps and a direct observation audit of their practices with regard to these steps. Both measurement instruments were pre-tested. Out of 102self-administered questionnaires (knowledge assessment) distributed to the staff concerned, only 80were returned and correctly filled out, giving a response rate of 78.4%. Participants' responses regarding the order of steps prior to the sterilization were incorrect in 64% of cases. With regard to the evaluation of professional practices, 224observations were made in the study area (practice audit). In 82% of these observations, the pre-disinfection step was confused with the washing step. The use of Betadine brushes and scrubbing pads for device washing was noted in 89.3%, along with the absence of swabbing of the canals and hollow parts in 9.4% of cases and the absence of drying of the canals with compressed air. Mastery of the steps prior to sterilisation of reusable thermoresistant medical devices was insufficient in our institution, suggesting the importance of reinforcing the implementation of the procedure through a continuous training program followed by action plans.

Credential Method as A Measurement Tool for Nurses' Professionalism in A Hospital

Credentials as an effort to maintain nurse competency and become the basis for granting clinical authority to nurses have not been implemented well. Implementation of processes for achieving goals varies across institutions. This research aims to identify the relationship between credentialing methods and the outcomes of the Ongoing Professional Practice Evaluation (OPPE) by investigating differences in OPPE scores based on years of experience. This is a quantitative research study with a descriptive correlational and comparative approach, involving 66 respondents who meet the criteria: Nurse PK I; less than 5 years of experience. Data analysis was conducted using Rank Spearman correlation and Kruskal-Wallis tests. The credentialing test method used a portfolio, interview, written test, and practical examination. The research results indicate that 48.48% of credentialing is done using these four methods. The majority of OPPE scores are rated as Good, accounting for 66.67%. The longer a nurse works, the better their performance rating. The Spearman rank test obtained a correlation coefficient of 0.353 with p= 0.004 (p<0.05), and the Kruskal-Wallis test obtained a Kruskal-Wallis value of 41.289 with p=0.000 (p<0.05). Conclusion: There is a relationship between credentialing methods and OPPE scores. The more credentialing methods used, the better the OPPE scores.

Evaluation of Current Professional Practices of Perfusionists: Survey Study

Introduction: Cardiac surgical procedures performed with extracorporeal circulation or perfusion techniques retain their importance in treating heart disease and often represent an alternative method.
 Objective: This survey aimed to identify and evaluate the current practice of perfusionists in cardiovascular surgery clinics in Turkey.
 Materials and Methods: This study is a prospective and descriptive etiological study. Surveys regarding the current practices of perfusionists were created as part of the study. The created surveys were sent to perfusionists in Turkey voluntarily through the application "Google Forms", and the data were collected. The data obtained from the surveys were statistically analyzed.
 Results: In this study, 80 perfusionists from 28 centres participated in the survey. Thirty-four participants were under 30 years old, 12 were between 31 and 35 years old, 16 were between 36 and 40 years old, and 16 were over 40 years old. Of the participants, 46 were female and 34 were male. The study collected descriptive data, information on cardiac clinics, CPB practices, use of cardioplegia, and other assistive devices.
 Conclusion: There have been significant advances and changes in cardiac surgery surgeries performed with CPB over approximately 70 years from the past to the present. However, we believe that there are ongoing or pending issues.

The Joint Commission’s Ongoing Professional Practice Evaluation Process: Costly, Ineffective, and Potentially Harmful to Safety Culture

ObjectiveTo evaluate the estimated labor costs and effectiveness of Ongoing Professional Practice Evaluation (OPPE) processes at identifying outlier performers in a large sample of providers across multiple health care systems and to extrapolate costs and effectiveness nationally. MethodsSix hospital systems partnered to evaluate their labor expenses related to conducting OPPE. Estimates for mean labor hours and wages were created for the following: data analysts, medical staff office professionals, department physician leaders, and administrative assistants. The total number of outlier performers who were identified by OPPE metrics alone and that resulted in lack of renewal, limitation, or revoking of hospital privileges during the past annual OPPE cycle (2022) was recorded. National costs of OPPE were extrapolated. Literature review of the effect of OPPE on safety culture in radiology was performed. ResultsThe evaluated systems had 12,854 privileged providers evaluated by OPPE. The total estimated annual recurring labor cost per provider was $50.20. Zero of 12,854 providers evaluated were identified as outlier performers solely through the OPPE process. The total estimated annual recurring cost of administering OPPE nationally was $78.54 million. In radiology over the past 15 years, the use of error rates based on score-based peer review as an OPPE metric has been perceived as punitive and had an adverse effect on safety culture. ConclusionOPPE is expensive to administer, inefficient at identifying outlier performers, diverts human resources away from potentially more effective improvement work, and has been associated with an adverse impact on safety culture in radiology.

DS01 National dermatological surgery sustainability survey: an evaluation of healthcare professional beliefs and practices

Abstract Given the high prevalence of skin cancer in the UK, dermatological surgery contributes significantly to the environmental impact of healthcare services. To date, there are limited data evaluating current sustainability practices, attitudes and behaviours of UK health professionals involved in skin surgery. We evaluated this with a national sustainability questionnaire. An 11-item e-questionnaire was developed and pilot-tested prior to distribution. This included nested conditional branching, free-text, multiple-choice and Likert-type scale questions. The survey was distributed via professional dermatology groups to dermatological surgeons in the UK and Republic of Ireland (RoI) over 12 weeks in 2022. Qualitative data were evaluated via manual thematic analysis. Quantitative data were analysed using RStudio for descriptive statistics and SPSS for nonparametric tests (P < 0.05 was considered to be statistically significant). In total, 115 healthcare professionals from 15 UK and RoI regions responded, including 67 (58.3%) consultant dermatologists/Mohs fellows, 26 (22.6%) dermatology trainees, 12 (10.4%) specialty and associate specialist dermatologists and 10 (8.7%) nurse surgeons. Single-visit provision (e.g. ‘see and treat’) for non-Mohs skin surgery was reported by 32% of overall respondents, whereas regionally, London respondents displayed a significantly higher proportion (67% vs. 25% in other UK regions; P < 0.001). When working with single-use sets, 42% of respondents noted that there is at least one piece of equipment they use less than half of the time for skin surgeries, including nontoothed forceps, artery clips and skin hooks. Forty-eight per cent observed double wrapping of surgical equipment, with an additional 15% being unsure. On a seven-point Likert scale, when compared with single-use equipment, reusable equipment was perceived to outperform on safety (median 4 vs. 7; P = .006), quality (median 4 vs. 7; P < 0.001) and patient outcome (median 4 vs. 7; P = 0.007); no difference was found in usability (median 7 vs. 7; P = 0.689). Perceived sustainability was greater in reusable (median 7) than in single-use (median 1) equipment (P < 0.001). Almost all respondents believe global climate change is happening (97%), are concerned by the impact of dermatological surgery (74%), believe their patients have already been affected (75%), have adapted their personal/professional life accordingly (74%) and believe dermatological surgery should also take measures to reduce its impact (85%). However, only 44% feel comfortable discussing the health effects of climate change with patients. While 75% turn off surgical lighting in between lists, room lighting (31%), equipment (32%) and heating/air conditioning (22%) are often forgotten. Awareness of the impact of dermatological surgery on global climate change is high among UK dermatologists carrying out skin surgery. We encourage clinicians to translate this into local action, advocacy and service improvement to standards dictated by recently published British Society for Dermatological Surgery national sustainability guidance.

Brain radiotherapy in patients treated for a newly diagnosed primary central nervous system lymphoma: professional practice evaluation in 19 French centers

Introduction The objective of this study was a multicentric evaluation of professional practices, analyzing the irradiation technique itself and its impact on survival and recurrence sites, in primary central nervous system lymphomas (PCNSLs). Methods We retrospectively analyzed the technical and clinical records of 79 PCNSL patients included in the database of the national expert network for oculocerebral lymphoma (‘LOC’) who were treated with brain radiotherapy as first-line treatment for newly diagnosed primary central nervous system lymphoma between 2011 and 2018. Results The number of patients treated with brain radiotherapy gradually decreased over time. The heterogeneity of radiotherapy prescriptions was significant, and 55% of them did not comply with published recommendations in terms of irradiation dose and/or volume. The proportion of complete responders to induction chemotherapy treated with reduced-dose radiotherapy increased over time. Partial brain radiotherapy was associated with significantly lower overall survival in univariate analysis. In partial responders to induction chemotherapy, increasing the total dose to the brain >30 Gy and adding a boost to the WBRT induced a trend toward improved progression-free and overall survival. Five recurrences (13%) occurred exclusively in the eyes, all in patients whose eyes had been excluded from the irradiation target volume and including 2 patients without ocular involvement at diagnosis. Conclusion The visibility of recommendations for prescribing brain radiotherapy for the treatment of newly diagnosed primary central nervous system lymphoma needs to be improved to harmonize practices and improve their quality. We propose an update of the recommendations.

Étude descriptive des enfants porteurs de troubles du spectre de l’autisme soignés au CHU de Saint-Étienne

ObjectivesIn France, the care of children with autism spectrum disorders (ASD) should, in the contemporary logic of the organization of the health system, be carried out in a medico-social establishment. A descriptive and retrospective study focused on children with ASD admitted to the child psychiatry department of the Saint-Étienne University Hospital. MethodsThe aim was to carry out a descriptive study of the children and their families attending the institution in September 2020, using simple indicators collected on admission : medical, psychological and social indicators. The focus was on the notion of “complex cases”. Results103 files were analysed (93 boys, 10 girls). On admission, the children were aged between two and seven years, one fifth of the children had no place to socialize, and in a third of the cases the siblings included another child with ASD. Only six children had access to language and one to symbolic play, 66 had access to functional play and 36 to sensory play. Behavioural, sleeping and eating disorders were present in a large proportion of the patients. All children had the complexity factor of “global developmental delay (lack of cognitive, language, motor) and/or behavioural problems”. Nine out of ten families had an imperative and urgent need for respite, and three quarters had one or more social difficulties. Half of the families had three complexity factors and a third had four or five. ConclusionsThis work, as part of a professional practice evaluation programme, illustrates the number of complex situations taken into care and the importance of such a system in the contemporary care system at the university hospital. It also identifies ways of improving the quality of care.

Development and Implementation of a Professional Practices Evaluation during Radiopharmaceuticals Administration.

Securing both the patient and radiopharmaceuticals (RPs) circuit is an essential concern in nuclear medicine (NM). These circuits converge at the RP administration phase, a key step in patient management in NM. In a continuous quality improvement approach, we developed and implemented an evaluation of professional practices (EPPs) methodology focused on RPs injection to identify and correct deviations from good practices. The nuclear medicine technologists (NMTs) of a single center were evaluated. A specific audit grid was designed for this purpose, covering 4 main themes. Following the audit campaign, an improvement action plan was set up to address the non-conformities observed. Nine NMTs were audited on 4 RPs injections each. The mean total score was 93.36% with, on average, 7.01% and 3.00% of unmet and partially met criteria, respectively. In view of the non-compliance rates of hygiene and radiation protection items, theoretical reviews of these themes were included in the improvement action plan. As a part of the quality assurance system of a healthcare unit, EPPs are useful for identifying and correcting practice deviations at an early stage. They should be regularly repeated and combined with rigorous training and qualification of operators involved in RPs injection.

Mechanisms of Peer Review and Their Potential Impact on Neurosurgeons: A Pilot Survey.

Physician peer review is a universal practice in U.S. hospitals. While there are many commonalities in peer review procedures, many of them established by law, there is also much institutional variation, which should be well understood by practicing neurosurgeons. A 13-question pilot survey was conducted of a sample of 5 hospital systems with whom members of the Council of State Neurosurgical Societies Medico-Legal Committee are affiliated. Survey questions were constructed to qualitatively assess 3 features of hospital peer review: 1) committee composition and process, 2) committee outcomes, and 3) legal protections and ramifications. The most common paradigm for a physician peer review committee was an interdisciplinary group with representatives from most major medical and surgical subspecialties. Referrals for peer review inquiry could be made by any hospital employee and were largely anonymous. Most institutions included a precommittee screening process conducted by the physician peer review committee leadership. The most common outcomes of an inquiry were resolution with no further action or ongoing focused professional practice evaluation. Hospital privileges were only rarely reported to be revoked or terminated. Members of the physician peer review committee were consistently protected from retaliatory litigation related to peer review participation. Most hospitals had a multilayered decision process and availability of appeal to minimize potential for punitive investigations. According to a recent study, only 62% of hospitals consider their peer review process to be highly or significantly standardized. This pilot survey provides commentary of potential areas of commonality and variation among hospital peer review practices.

The Use of Clinical Data Registries to Improve Care and Meet Ongoing Professional Practice Evaluation Requirements.

The Use of Clinical Data Registries to Improve Care and Meet Ongoing Professional Practice Evaluation Requirements.

Teaching exploration of green building innovation practice course for Construction Engineering Management Major under the background of "carbon peaking and carbon neutrality goals"

With Chinese President Xi’s commitment to “carbon peak and carbon neutrality” to the international community at the 75th United Nations General Assembly, the teaching of practical courses of construction engineering management has faced major challenges. In view of the current problems that the setting of practice course content and evaluation indicators in the training program of construction engineering cannot effectively deal with the " carbon peaking and carbon neutrality goals ", this paper puts forward reform strategies of curriculum teaching methods such as the “four stage, full cycle progressive green building practical ability training system”, and the "multi module practical" green building core teaching system, and the "online + offline" integrated teaching mode exploration, and diversified curriculum evaluation mechanism, etc. This paper also makes appropriate adjustments from the aspects of professional practice teaching content setting, teaching methods and evaluation mechanism, so as to meet the new requirements of "carbon peaking and carbon neutrality goals" for construction engineering management majors.

Tracking procedure outcomes using Epic SmartText and SmartData Elements following minor dermatologic procedures in the ambulatory setting

To the Editor: In 2017, the Department of Dermatology, Duke University, employed a template-generating electronic health record tool to collect variables related to surgical site infections (SSIs) following minor dermatologic procedures, including shave biopsies, punch biopsies, excisions, and electrodessication and curettages in the ambulatory setting. This system uses SmartText (a registered trademark of Epic Systems Corporation) with embedded SmartData Elements (SDEs) through Epic-based electronic health records. Our initiative aimed at improving the documentation of adverse outcomes, such as SSIs, wound bleeding, and wound dehiscence, reducing inconsistency in charting, and facilitating tracking in compliance with the Joint Commission on Accreditation of Healthcare Organizations, specifically regarding the Ongoing Professional Practice Evaluation and SSI tracking standards. 1 What are the key elements needed to meet the ongoing professional practice evaluation (OPPE) requirements? The Joint Commission. https://www.jointcommission.org/standards/standard-faqs/critical-access-hospital/medical-staff-ms/000001500/Date accessed: February 1, 2022 Google Scholar ,2 Surgical site infections (SSI): surveillance and resources. The Joint Commission. Posted September 25, 2017. Accessed February 1, 2022. https://www.jointcommission.org/standards/standard-faqs/critical-access-hospital/infection-prevention-and-control-ic/000002155/ Google Scholar Additionally, our SmartText simplifies documentation at postprocedural follow-up appointments and enables rapid, user-friendly data entry and analysis, offering a springboard for research projects while minimizing manual data extraction requirements.

Family quality of life and autism spectrum disorder: Comparative diagnosis of needs and impact on family life

BackgroundFamilies of children with autism spectrum disorders (ASD) face ongoing challenges that can affect their family life. Helping those families cope with the impact of ASD and promote more positive family and child outcomes requires research to better understand the differential aspects of quality of life for those families. AimThis article examined the quality of life of 77 families (n = 45 families with children with ASD aged 0–12 years old, and n = 32 families with other developmental disabilities). Methods and procedureThe Family Quality of Life Scale (FQOL) was applied. Outcomes and resultsThe relationships between importance and satisfaction were analyzed, contrasting differences between families, and studying the influence of age. Results show the presence of common needs, as the higher ratings in importance versus satisfaction evidenced, but also specific and more evident needs in families of children with ASD, motivated by the differential characteristics of the disorder and their environment. Age was relevant to focus support on priority areas. ConclusionThe need to adapt to family individualities to promote their quality of life was concluded. ImplicationsThose findings reinforce the importance of bringing together theoretical knowledge and evaluation of professional practice as a framework for converting the latter into good practices and quality actions.

Analysis of the importance of nursing care and performance confidence perceived by nurses in the neonatal intensive care unit

Purpose: Neonatal nurses are expected to have clinical competency to provide qualified and safe care for high-risk infants. An educational intervention to enhance nurses’ clinical competence is often a priority in the nursing field. This study was conducted to explore nurses’ perceived importance and performance confidence of nursing care activities in neonatal intensive care units.Methods: One hundred forty-one neonatal nurses from seven hospitals across South Korea participated in the online survey study. The scale of neonatal nursing care activity consisted of 8 subdomains including professional practice (assessment, diagnosis, planning, intervention, evaluation, education, research, and leadership). The Importance-Performance Matrix was used to analyze the importance of and confident performance in each of the nursing subdomains.Results: Both importance and performance confidence increased as nurses’ age (p=.042 and p<.001) and clinical experience (p=.004 and p<.001). Participants scored relatively higher in importance and performance confidence in the professional practice subdomains (assessment, intervention, evaluation), but scored lower in the education and research subdomains.Conclusion: To provide evidence-based nursing care for high-risk infants in neonatal intensive care units, educational interventions should be developed to support nurses based on the findings of the research.

Binomial entropy of anesthesiologists’ ratings of nurse anesthetists’ clinical performance explains information loss when adjusting evaluations for rater leniency

BackgroundManagers and clinical directors have the ethical and administrative responsibility, and professional duty, to identify clinicians who are performing significantly better or worse than their peers. At the University of Iowa, faculty anesthesiologists (raters) working with Certified Registered Nurse Anesthetists (ratees) evaluate their clinical performance daily using a valid and reliable work habits scale. Because the evaluations are used for ongoing professional practice evaluation and performance reviews, rater bias should be reduced. However, adjustment for rater bias (leniency) causes many raters’ evaluations to have little influence on ranking of ratees. MethodsThe retrospective cohort study was from a large teaching hospital. Functionally, ratings are binary: the value is 1 when all six items in the scale are scored at the maximum performance, and 0, otherwise (i.e., any item less than maximum). The 40,027 ratings over 5.8 years were sorted by rater in descending sequence of date. The Shannon information content of the ratings was quantified using binomial entropy. The most recent 6359 ratings from 2020 were analyzed using mixed effects logistic regression, with each rater as a fixed effect and ratees as random effects. ResultsUsing all 74 raters, the Spearman correlation coefficient between the precisions of the raters’ coefficients in the logistic regression and the corresponding binomial entropy was 0.997 (99% confidence interval [CI] 0.992 to 0.999). Excluding the 33 raters who provided all ratings being 1’s or 0’s, the remaining 41 raters’ Spearman correlation was 0.985 (99% confidence interval 0.965 to 0.997). Those 41 raters had median binomial entropies that were 76% of the normalized maximum entropy (99% CI 62% to 86%), while the other 33 raters’ entropy was 0%. When the same rater gave the same rating >10 times in a row, there was a median of 23 more identical ratings in the run (99% CI 21 to 26, N=535). ConclusionsMost loss of information originates from raters who provide all ratees with the largest possible score for all items and from raters who never provide ratings with the maximum score. There should be educative feedback to raters who consistently rate all ratees the same, both for departments with quantitative evaluations using a reliable scale and departments using qualitative evaluations.

The Vision of Educational Actors: Normalist Practitioners, Tutors and Professional Practice Advisors in Times of Covid-19 in Mexico

In Mexico there is talk of making the world change, of new strategies and innovating in education. The Covid-19 abruptly engaged the teacher to do so in an unusual way. The implementation of virtuality to reach every corner, new ways of teaching, relating to parents, interaction with tutors and directors was complex. The challenge was to learn in virtual professional practice. Objectives of the study: 1) Identify the characteristics of the professional practice of the seventh and eighth semester students in virtuality, 2) Analyze the academic-disciplinary factors, personal reflection and technical-pedagogical factors that intervene in professional practice, 3) Verify the presence of challenges of their teaching performance that they face in the virtual classroom. The qualitative and descriptive approach is the basis of the research. 21 elementary schools in Nuevo León participated; 76 teachers and 112 undergraduate students in Primary Education from the Miguel F. Martínez Normal School (ENMFM). Observations, Professional Practice Evaluation Rubric supported the research. It is concluded that the pedagogical practices fulfilled their mission, with innovative characteristics in the teaching practice; the academic-disciplinary factors were activated when planning, organizing, developing, intervening and evaluating the students; the personal-reflective factors were manifested in emotions of despair, helplessness, discouragement, expectations, new proposals, learning in their teacher training; advantages and disadvantages, areas of opportunity and strengths in the use of technology, face-to-face personalized attention and class times and in technical-pedagogical learning skills for real life.

Online exercise classes for people with Parkinson's: Evaluation of participant opinion and professional practice

Online exercise classes for people with Parkinson's: Evaluation of participant opinion and professional practice

Geriatric Choosing Wisely choice of recommendations in France: a pragmatic approach based on clinical audits

BackgroundThe international Choosing Wisely campaign seeks to improve the appropriateness of care, notably through large campaigns among physicians and users designed to raise awareness of the risks inherent in overmedication.MethodsIn deploying the Choosing Wisely campaign, the French Society of Geriatrics and Gerontology chose early operationalization via a tool for clinical audit over a limited area before progressive dissemination. This enabled validation of four consensual recommendations concerning the management of urinary tract infections, the prolonged use of anxiolytics, the use of neuroleptics in dementia syndromes, and the use of statins in primary prevention. The fifth recommendation concerns the importance of a dialogue on the level of care. It was written by patient representatives directly involved in the campaign.ResultsThe first cross-regional campaign in France involved 5337 chart screenings in 43 health facilities. Analysis of the results showed an important variability in practices between institutions and significant percentage of inappropriate prescriptions, notably of psychotropic medication.DiscussionThe high rate of participation of target institutions shows that geriatrics professionals are interested in the evaluation and optimization of professional practices. Frequent overuse of psychotropic medication highlights the need of campaigns to raise awareness and encourage deprescribing.

Evaluation of professional practice in the context of Covid-19

An evaluation of professional practices was carried out in a cancer centre in the wake of the management of the health crisis linked to the severe acute respiratory syndrome coronavirus 2 pandemic. Hospital teams questioned the relevance of the measures adopted, internally and during home care, to manage suspected or confirmed Covid-19 patients and prevent contagion for all.

Homogenization of the management of acute paronychia with abscess formation within the context of an evaluation of professional practices

IntroductionThere is no consensus in the literature, or even within the same team, on the most appropriate treatment option for acute paronychia with abscess formation. The performance of an evaluation of professional practices (EPP) using a clinical audit measures the quality of our practices with the aim of standardizing them. Therefore, the primary objective of this study was to develop a clinical pathway for the management of acute paronychia with abscess formation. The secondary objectives were to evaluate our professional practices using a clinical audit before and after the dissemination of the clinical pathway and then recommend strategies for improving our management of acute paronychia with abscess formation. Materials and MethodsA working group was established that designed an audit grid comprised of 15 items. Thirty patients (Group 1) who had an acute paronychia with abscess formation were included and their health records were analyzed using this audit grid. The working group then developed a clinical pathway for the management of acute paronychia with abscess formation. Thirty new patients (Group 2) were included after the dissemination of this clinical pathway and their records were analyzed using the same audit grid. ResultsOur clinical pathway for the management of acute paronychia was validated by the local infectious disease committee of our university hospital center. The difference between groups 1 and 2 was significant (p<0.05) for eight items. There was no significant difference in the rate of surgical revision between the two groups. DiscussionThis EPP enabled us to develop a clinical pathway that detailed the processes for managing acute paronychia with abscess formation, and in particular it provided indications for antibiotic therapy and its limitations. Level of EvidenceIV, retrospective study.