Staff Satisfaction Survey Research Articles

Extending the radius of family-centered care in the pediatric cardiac intensive care unit through virtual rounding.

The arrival of COVID-19 brought urgent limitation of visitation in hospitals across the country. Family-centered care and its delivery rapidly changed and left the family behind-unable to actively participate in their loved one's care. A southeastern academic medical center pediatric cardiac intensive care unit (PCICU) needed to augment family-centered medical rounds when parents could not be at the bedside. No alternative to physical presence for daily medical rounds existed in the PCICU. A virtual rounding (VR) program was implemented allowing parents of patients admitted to PCICU to join medical rounds remotely through teleconferencing. Preintervention and postintervention rounding times, staff perceptions of the program, and parental satisfaction scores using the Pediatric Family Satisfaction in the Intensive Care Unit (pFS-ICU) tool were measured. This quality improvement project implemented a VR program offered to all families of patients in the PCICU. VR did not increase rounding times after implementation (p = .673). Staff satisfaction surveys revealed that staff felt the VR program did not prolong rounding times (p ≤ 0.001), workload impact perceptions improved after intervention (p = <0.001), and staff felt VR should be offered to families in PCICU (p ≤ 0.001). Only nine pFS-ICU surveys were completed giving the family a limited voice in the evaluation of this project. This project demonstrates that VR can be successfully implemented for family engagement without increased burden on staff.

Does leadership matter for healthcare service quality? Evidence from NHS England

In this article, we provide first-hand evidence that leadership quality matters for the quality of healthcare provision, based on NHS England hospital trust data between 2010 and 2014. This is the first paper to study this relationship using individual leadership styles, namely, task-, relations-, change- and integrity-oriented as independent variables and four different metrics of quality of healthcare as dependent variables, including staff and patient satisfaction survey measures and clinical performance indicators. We find that task-oriented leadership has the strongest effect on staff-rated hospital quality while change-oriented leadership affects most patient satisfaction and the clinical measure. We also find some evidence that organizational autonomy and competition across hospitals moderates the effect of leadership quality on healthcare quality. Overall, our results have important policy implications for continued support for the development and funding of integrated leadership programs in healthcare.

A Model for a Standardized and Sustainable Pediatric Anesthesia-Intensive Care Unit Hand-Off Process.

Background and Objectives: The hand-off process between pediatric anesthesia and intensive care unit (ICU) teams involves the exchange of patient health information and plays a major role in reducing errors and increasing staff satisfaction. Our objectives were to (1) standardize the hand-off process in children’s ICUs, and (2) evaluate the provider satisfaction, efficiency and sustainability of the improved hand-off process. Methods: Following multidisciplinary discussions, the hand-off process was standardized for transfers of care between anesthesia-ICU teams. A pre-implementation and two post-implementation (6 months, >2 years) staff satisfaction surveys and audits were conducted to evaluate the success, quality and sustainability of the hand-off process. Results: There was no difference in the time spent during the sign out process following standardization—median 5 min for pre-implementation versus 5 and 6 min for post-implementation at six months and >2 years, respectively. There was a significant decrease in the number of missed items (airway/ventilation, venous access, medications, and laboratory values pertinent events) post-implementation compared to pre-implementation (p ≤ 0.001). In the >2 years follow-up survey, 49.2% of providers felt that the hand-off could be improved versus 78.4% in pre-implementation and 54.2% in the six-month survey (p < 0.001). Conclusion: A standardized interactive hand-off improves the efficiency and staff satisfaction, with a decreased rate of missed information at the cost of no additional time.

Universal Preoperative Antiseptic Nasal and Skin Decolonization for Reduction in SSI and Associated Costs

<h3>Background</h3> Preventing surgical site infections (SSI) is more important than ever, as the number and complexity of procedures, the co-morbidities of the patients and antimicrobial resistant pathogens are all increasing over time. Additionally, it has been estimated that as many as half of all SSI are preventable when evidence-based strategies are applied. Given this, one of 7 hospitals in a multihospital system in Florida, planned a trial of universal pre-operative nasal and skin decolonization for all surgical procedures. <h3>Methods</h3> During the trial an alcohol based nasal antiseptic was applied to all pre-operative patients in addition to chlorhexidine bathing already in place, for a period of 6 months. This nasal antiseptic was selected over other nasal decolonizing agents in support of staff satisfaction and antibiotic stewardship goals. Electronic medical record (EMR) audits were performed to confirm compliance with this new protocol. In addition, a staff satisfaction survey was distributed. No other practice change was introduced during this period. <h3>Results</h3> During the 6-month study period, the addition of pre-operative nasal antiseptic to existing CHG bathing for all surgical patients, resulted in a 59% reduction in all cause surgical site infections (SSI) for all procedures, from an average monthly baseline rate of 0.61 to an average monthly rate of 0.25. This reduction represents 22 fewer SSI with an associated estimated cost avoidance of $457,270 ($20,785/infection). The staff survey revealed that 86% of respondents were very or extremely satisfied with efficacy and ease of use of the product, and >80% preferred the nasal antiseptic over mupirocin. <h3>Conclusions</h3> Universal preoperative nasal decolonization with alcohol-based nasal antiseptic, paired with CHG bathing, led to a reduction in the SSI rate and associated costs, while supporting antimicrobial stewardship and increasing staff satisfaction.

Introducing Nurse-Led Patient Education Visits: Empowering Patients and Elevating Nursing Practice.

The literature includes multiple descriptions of successful nurse-led interventions, but the effects of nurse-led education on nurse and patient satisfaction in an executive health program are unknown. Nursing staff desire to practice more fully within their scope of licensure. Increased practice demands raised questions about whether nurse-led education would improve staff and patient satisfaction. A structured quality improvement process was used to design a nurse-led patient education program. Pilot measures included 5-point Likert scale patient and staff satisfaction surveys. Nurse burnout was also measured before and after the pilot. Patient satisfaction was high; 96% reported favorable satisfaction during the pilot, with sustained results over the following 3 years. Nurses' sense of achievement improved by 12 percentage points, and perception of making good use of skills and abilities increased by 39 percentage points. A nurse-led patient education intervention contributed to improved staff satisfaction while sustaining a positive patient experience.

A multidisciplinary approach to treating low back pain in the ED: improving patient outcomes

Background: &#x0D; In collaboration with emergency physicians, the physiotherapy and pharmacy teams at RGH implemented a novel multidisciplinary, evidence-based pathway, addressing a significant care gap in the management of low back pain (LBP) in urban emergency departments (EDs).&#x0D; &#x0D; To accomplish this, the physiotherapist conducts a neuromusculoskeletal exam, prior to the physician. They provide treatment including manual therapy, mobilization, education, home-exercises and referral to community resources. The pharmacist then reviews medications, discusses pain management, prescribes analgesia and creates a plan for outpatient analgesia. This occurs while the patient awaits the physician, avoiding increases to length of stay (LOS) and reducing burden on physicians.&#x0D; &#x0D; Implementation: &#x0D; At minimum, a site wishing to implement the pathway requires a team consisting of a physiotherapist (PT) and pharmacist dedicated to the ED, called the Rapid Assessment Back Team (RABT). To operationalize the RABT successfully, the selected PT and pharmacist must be confident practitioners and have a solid understanding of LBP, red-flags, and appropriate treatment. To avoid increasing LOS, patients are seen during the 2-hour average waiting time required to see a physician. The project team consisted of physiotherapists, pharmacists, nurses, physicians, managers, and QI leaders, formed to facilitate a collaborative approach to implementation. The Prosci® ADKAR model and Plan-Do-Study-Act (PDSA) cycles were used to implement the pathway and troubleshoot operational challenges.&#x0D; &#x0D; Evaluation Methods:&#x0D; Front-line staff manually collected data on response time, treatments, adverse events, and resources provided. The investigators reviewed patient charts to record opioid prescriptions, DI referrals, and arrival/discharge times of the patients. We compared outcomes of patients seen by the RABT to historical site data of patients with a discharge diagnosis of LBP from the ED.&#x0D; &#x0D; We actively sought feedback from physicians, nurses, and the leadership group to ensure that we identified unintended consequences or near-misses early on. We reviewed interim data such as LOS and average time-to-assessment, to identify areas for improvement. This data and feedback were addressed via bimonthly PDSA cycles. We also administered patient and staff satisfaction surveys before and after site implementation of the pathway to develop an understanding of patient and staff thoughts and experiences with the service model.&#x0D; &#x0D; Results:&#x0D; We studied these outcomes in 44 patients exposed to our RABT implementation. Patients who saw a physiotherapist prior to the physician had shorter median ED LOS (3.2 vs. 4.0 hours), lower diagnostic imaging rates (36.4% vs. 49.4%) and less opioid prescribing (31.8% vs. 49.2%). No patients returned to the ED within 72 hours post evaluation, compared to the 7.6% historical recidivism. Not all patients were seen by a pharmacist. When performing a subgroup analysis of patients seen by both a pharmacist and physiotherapist prior to physician, opioid prescriptions were found to drop significantly from a baseline of 49.2% to 16.7%.&#x0D; &#x0D; Advice and Lessons Learned:&#x0D; Valuable learnings from the pilot include:&#x0D; &#x0D; As described above, the physiotherapist and pharmacist must be experienced and confident to be successful in the ED setting. Selection of the appropriate clinicians is crucial to achieving results, and given this is a new area of practice for many physiotherapists, a proper orientation to the setting is required. The combination of a physiotherapist and pharmacist had the largest impact on study outcomes, further confirming the need for a multidisciplinary approach to ED patient care.&#x0D; An “ED toolkit” can greatly facilitate service implementation for future sites, and this was developed to facilitate implementation of the RABT at another ED within the city. The toolkit consisted of items such as resources, workflows, patient handouts, sample documentation and promotional materials to increase awareness.&#x0D; Service hours may need some realignment with patient demand and should be geared towards minimizing service disruptions. Ideally, the physiotherapist and pharmacist would work similar hours to maximize the amount of patients able to be seen.&#x0D; Regular PDSA cycles to review interim data and address operational issues increases the likelihood of success by ensuring the pathway evolves to fit the contextual needs of the site. Reviewing early results motivates the team to continue to utilize the pathway. Reviewing practice issues allows clinicians to improve the care provided. One significant unintended consequence was the increase in ED LOS for patients who were referred to PT/pharmacy following physician assessment. In addition, this subgroup did not show significant reductions in opioid prescriptions or DI referrals. RABT referrals were subsequently restricted to before the physician only.&#x0D;

The factors effecting the grade of academicians’ satisfaction level: The reality of major field of study for classroom training

The aim of the research is to find out the satisfaction levels of the academicians in the main science branch of class education; management and organizing, education, research, infrastructure and stakeholder relations subscales according to some demographic variables. Mixed method, explicative sequential pattern was used in the research. A sample of 21 academics working at the university, identified as easily accessible, constitutes the working group, with five academics identified according to the criteria sample of the purposeful sample. Quantitative data were collected through the Mehmet Akif Ersoy University Academic Staff Satisfaction Survey and qualitative data were collected through semi-structured interview form. Quantitative data were analyzed by SPSS program and qualitative data by descriptive analysis method. When the findings are examined; the level of satisfaction of academicians did not make a meaningful difference according to their titles, and they showed according to their genders. In addition, the most positive opinion of academicians was sub-dimension, while the most negative was infrastructure. The quantitative findings obtained were examined in depth and the direct opinions of academicians were included. The research was discussed within the framework of related literature and similar study findings and various suggestions were made.

P2.16-11 ADVANCE-1: Development and Feasibility Testing of a Benchmarking Approach for Quality Improvement in Lung Cancer Care

Benchmarking is successfully utilized in industry to improve working process and productivity. In its original sense benchmarking is a systematic process for comparing performances, functions or processes of organisations against the best in the world. However, the majority of research within lung cancer is focused on prevention, diagnosis and treatment rather than examining infrastructure or processes of managing lung cancer patients. ADVANCE-1 is a European Respiratory Society (ERS) funded pilot study with the aim of creating a benchmarking tool that can easily document and reflect the structure and process within a lung cancer centre and its associated registry and how these processes impact on the pathway of a patient through the individual centres. The ADVANCE-1 study group was constituted by the two ERS fellowship-holders and senior lung cancer specialists from the two participating lung cancer services in the Beatson West of Scotland Cancer Centre, Glasgow, Scotland, and the Lungenklinik Heckeshorn in the Helios Klinikum Emil von Behring, Berlin, Germany. We created the study design with direct cooperation of the German Benchmarking Centre as well as the University of Glasgow. Final results were externally reviewed by the German Society for Quality Management in Health Care. Two benchmarking tools were created; the first for documentation of the service provided at each centre, the underlying cancer registry and a test of the robustness and comprehensiveness of information and data collecting resources available at each centre. Secondly; a patient pathway tool to reflect the journey of a patient through each of the relevant centres. Patient satisfaction surveys and staff satisfaction surveys were also created. Prospective testing of these benchmarking tools in Glasgow and Berlin will allow a comparison between the two centres in order to ascertain best practice and learning from each centre in a so called ‘collaborative’ benchmarking approach. This unique study has created a benchmarking tool that can easily document the service of a lung cancer centre and the pathway of a patient through that service. With comparison and learning from each other using this tool we aim to improve the patient care and journey through a lung cancer service.

Impact of the Dementia Care in Hospitals Program on acute hospital staff satisfaction

BackgroundTo evaluate the impact of the Dementia Care in Hospitals Program (DCHP) on clinical and non-clinical staff job satisfaction, level of confidence and comfort in caring for patients with cognitive impairment (CI). Staff perceptions of how organisational support and hospital environment met the needs of patients with CI were also assessed.MethodsThe DCHP was implemented across four acute hospital sites across Australia. Clinical and non-clinical staff received training on CI screening and communication strategies for patients with CI. A staff satisfaction survey was administered pre- and post-implementation of the DCHP.ResultsOne thousand seven hundred forty-eight staff received DCHP education and 1375 staff participated in the survey. Self-reported confidence and level of comfort in caring for patients with CI significantly improved following implementation. Staff also reported increased job satisfaction and organisational support at all hospital sites.ConclusionsThe DCHP implementation within an acute hospital setting was found to show an improvement in staff confidence, comfort, and job satisfaction when caring for patients with CI. This study has significant implications for the improvement of care for patients with CI as well as staff retention and job satisfaction. Further research is required to determine whether these improvements are sustained in the longer term.

Proactive Psychiatry Intervention Using a Nurse-Led Behavioral Response Model for Hospitalized Patients With Behavioral Disturbances.

The health care sector has one of the highest rates of workplace violence, putting staff at risk and impeding care. To deliver quality health care, staff need targeted resources. This article describes a program to improve staff safety and reduce barriers to care for patients with behavioral disturbances. A nurse-led behavioral response team was created to identify high-risk patients and offer prompt targeted interventions. The Behavioral Optimization and Outcomes Support Team (BOOST) was implemented in November 2012, in conjunction with a proactive model of care, enabling psychiatric intervention. Advanced practice nurses in psychiatry respond to requests from staff on medical/surgical units to assist with management of behavioral disturbances. Consultation and intervention data were reviewed, and staff satisfaction surveys were completed to evaluate the program. The program has contributed to staff feeling more supported and safer at work. There has also been a reduction in staff's experience of perceived burden in the care of patients with behavioral disturbances although they are caring for more of these patients. Although violence risk in health care continues to be a significant issue, programs to intervene early can be effective in supporting staff to minimize these risks.

Improving 3-Hour Sepsis Bundled Care Outcomes: Implementation of a Nurse-Driven Sepsis Protocol in the Emergency Department

ProblemSepsis, a life-threatening condition, can rapidly progress to death. The Hospital Inpatient Quality Reporting program has implemented bundled care metrics for sepsis care, but timely completion of these interventions is challenging. Best-practice interventions could improve patient outcomes and reimbursement. The purpose of this project was to improve the timeliness of sepsis recognition and implementation of bundled care interventions in the emergency department. MethodsThis evidence-based practice improvement project implemented a Detect, Act, Reassess, Titrate (DART)-based nursing protocol embedded within a checklist communication tool in the emergency department of a tertiary level-2 trauma center. Data comparisons between preintervention and post-DART protocol/checklist implementation included compliance with the individual Inpatient Quality Reporting 3-hour bundled elements, number of hospital days, and time to screen. Staff also completed a survey designed to assess their satisfaction with the DART algorithm/checklist. The Pearson χ2 test was used to assess bundled-care intervention variables. Wilcoxon rank sum tests were used to explore hospitalization outcomes. Staff satisfaction survey results were summarized. ResultsImprovement was statistically significant for lactate levels, blood cultures, and early antibiotic administration in the intervention period compared with baseline. Time to screen, ED length of stay, and number of hospital days improved between baseline and the intervention period, with an average number of hospital days decreasing by 2.5 days. Compliance with all Inpatient Quality Reporting metrics increased from 30% to 80%. DiscussionWhen the nurse-driven protocol and communication tool were implemented, compliance with time-sensitive sepsis bundled interventions improved significantly. The outcomes suggest nurse-driven protocols can improve sepsis outcomes.

A Quality Improvement Initiative: Using Lean Methodology to Improve Efficiency of the Morning Cycle Monitoring at an Ambulatory Academic Fertility Clinic

Patients receiving fertility treatments require near-daily blood work and ultrasound for cycle monitoring. Patient volumes at an academic hospital-based ambulatory clinic were expected to increase with expanded provincial funding. The aim of this quality improvement project was for 85% of cycle monitoring patients to have a turnaround time (TAT) of 20 minutes or less from arrival until checkout. This is a time series study analyzed with statistical process control methodology. A baseline survey was conducted to understand patient priorities. Multiple site-specific change ideas were developed by front-line staff using lean methodology including standard processes, standard work, supportive tools, visual management, and staffing and scheduling to meet Takt time. Patient and staff satisfaction surveys were conducted after implementation (Canadian Task Force Classification II-2). With the start of funding in December 2015 the clinic accommodated a 17% increase in daily patient volumes and increased the proportion of patients receiving education at each visit from 50% to 100%. Despite increased patient volumes and added education time, the control chart showed special cause variation with decreased TATs from 38.2 to 34.7 minutes. Patient surveys showed that their priorities were being met or exceeded, and all staff reported increased satisfaction with the new process. By using lean methodology in an ambulatory fertility setting, the clinic was able to improve efficiency in the morning monitoring process to decrease patient TATs while accommodating increased patient volumes and improving the quality of patient care.

Nurses Wellbeing and Primary Nursing: The Experience of the Emergency Surgical Ward in the General Hospital in Piacenza

The growing complex of organizations and the new demand for people's health care lead to a planned and personalized care solution. Primary nursing (PN), is a new model of care focused on the people to be treated and, at the same time, restores responsibility, autonomy and role to the nursing staff. The study was based on an analysis of the wellbeing climate following the implementation of the PN in emergency surgical ward in the General Hospital in Piacenza. In the emergency surgery ward of the General Hospital Guglielmo Da Saliceto in Piacenzathe results of organization remodulation and model of care are being analyzed. In this job the observations are been focussed on wellbeing of nursing staff. The Mc Closkey Mueller Satisfaction Scale (MMSS) is used for the study before and after the change, The Team Climate Inventory (TCI), used after thepractices changes and the staff satisfaction survey after the implementation of PN. At the beginning, with the MMSS methods, the results show impatience with some contractual and remunerative aspects; instead, after the introduction of the PN, the results show a satisfaction for teamwork, the interaction between the team personnel and with patients. Similarly, it alsoincreases the perception of the degree of autonomy of contribution in decision making and in the authoritativeness of the role covered. The new assistance model also shows good results from TCI and Focus Group to achieve the goals of assistance and organization. The increased satisfactions of the nursing staff show a better quality care.

Caesarean Section in African Setting: Current Situation, Problematic and Qualitative Approaches at Laquintinie Hospital (Douala, Cameroon)

Background: Quality control of care aims to reduce or eliminate unnecessary care and to improve the quality of those who are useful both in their indication and in their implementation. Objective: We conducted this study to assess the rate of caesarean section, the rate of irrelevant indications, materno-foetal morbidity and mortality, biases in the management in order to suggest corrective approaches. Methods: It was a cross-sectional study conducted in the gynaeco-obstetrics department of the Laquintinie Hospital of Douala over a period of 4 months from January 1 to April 30, 2017. We included all pregnant women who had a caesarean section and who gave consent to our study as well as new-borns from these caesareans. We excluded caesarean deliveries from other health structures and referred to Laquintinie Hospital due to morbid operative follow-up. The variables collected were grouped under 3 main headings: socio-demographic data, clinical data and post-operative follow-up. Results: A total of 281 caesarean sections were performed out of a total of 967 deliveries; a caesarean section rate of 29.06% in 4 months. After data mining, 250 caesarean sections were included in the study because 31 cases of caesarean deliveries were unusable. Referred pregnancies accounted for 46.8% of the total population and the most common reason for referral was stationary labour (23% of cases). All caesareans were performed by the gynaeco-obstetricians. Women who had caesarean deliveries were informed by the operator of the surgical procedure in 28.4% of cases and 27.6% were notified of the indication for surgery. The operative kit was present in 98% of cases. The operating room was available in 93% of cases. Caesareans were performed mostly in an emergency context (91.2%) with a median turnaround time of 214 minutes (3 h 56 mins). Mechanical dystocia was the major indication in our series (21.2%) and 29 indications were irrelevant (11.6%). Intraoperative complications occurred in 3.2% of cases. Overall maternal mortality (per- and post-operative) was 0.8% (2 cases). We recorded 15 neonatal deaths out of which 8 were still births. Regarding the postoperative period, 78% of the operated patients did not have a good immediate postoperative monitoring. The post-operative protocol was not respected in 17% of cases. Postoperative complications occurred in 21.6% of patients with first cause being infections (10.8% with 5.6% being parietal suppurations). Conclusion: The frequency of Caesarean sections at Laquintinie Hospital is above the World Health Organization’s recommendations of 5% - 15%. There is a very big delay in the execution time of emergency caesareans, far above the international standards despite the quasi-availability of operating kits and the operating theatre. The state of the premises reveals a sub-workforce creating work overload and therefore a demotivation of the staff leading to insufficient communication between the operator and operated, a lack of postoperative follow-up and significant neonatal morbidity and mortality. Hence the need to initiate a staff satisfaction survey.

Patient-centric implementation of an electronic medication management system at a tertiary hospital in Western Sydney

BackgroundTraditional implementations of electronic medication management (EMM) systems have involved two common formats – a ‘big bang’ approach on the day of go-live, or a phased ward-by-ward approach over months.ObjectiveTo...

Implementation of an expanded-scope-of-practice physiotherapist role in a regional hospital emergency department.

The aim of the present study was to describe the implementation of an expanded-scope physiotherapy service in a regional hospital emergency department (ED) in Australia and discuss the lessons learnt in terms of long-term sustainability of these roles in regional areas. The existing ED advanced physiotherapist was trained in extended scope of practice skills. For sustainability, a senior physiotherapist was recruited to develop further ED practice skills through a locally developed professional development package and ultimately be eligible to complete extended-scope training. Mixed methods data collection included document review, patient and staff satisfaction surveys and data mining of routine clinical data sets. The extended-hours service operated for 12 months. The advanced physiotherapist completed postgraduate course requirements and was able to work to an expanded scope of practice including increased autonomy in management and discharge of patients treated in the ED and independent ordering and interpreting of plain film X-rays. The professional development package was not completed and the senior physiotherapist role was filled for only part of the study period. It is feasible to implement an expanded scope of physiotherapy service in a regional hospital ED. For sustainability in regional areas, a larger advanced-level physiotherapy workforce and easier access to expanded-scope training are required.

Integration of Ambulatory Clinical Pharmacy Services in a Gastroenterology Clinic for Management of Hepatitis C Infection: A Pilot Study

Purpose: The purpose of this study is to describe implementation of comprehensive medication management (CMM) services in a gastroenterology (GI) clinic for HCV patients on direct acting antivirals (DAAs), and to evaluate services in terms of identification of medication related problems (MRPs), patient satisfaction, and provider satisfaction.&#x0D; Methods: Six months of visit data was retrospectively collected to determine demographic data and to analyze pharmacist’s identification of MRPs. Patient satisfaction surveys were collected using a thirteen question validated pharmacist-satisfaction survey. After pilot completion, a twelve-question survey was sent to all GI clinic staff members to evaluate overall staff satisfaction with services.&#x0D; Results: Ninety-four CMM visits were completed. A total of 246 MRPs were identified with an average of 2.6 MRPs per visit. Seventy-eight MRPs were related to appropriate indication, 27 to efficacy, 30 to safety, and 109 to adherence. Forty MRPs were related to drug-drug interactions. Patient satisfaction surveys revealed that 86% of respondents rated the quality of care and services from the clinical pharmacist as "Excellent". Patients better understood and felt confident with therapy. All staff satisfaction survey respondents strongly agreed or agreed that the pharmacist made valuable contributions to the clinic and patient care. All also strongly agreed that pharmacy’s CMM services were an essential component to the management of HCV.&#x0D; Conclusion: Data supports continued involvement of clinical pharmacists within the clinic to promote safety and efficacy of DAAs. Patient and staff satisfaction survey results further illustrate the importance and value that CMM provided by clinical pharmacists can provide.&#x0D; Conflict of Interest&#x0D; We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.&#x0D; &#x0D; Type: Original Research

P036: A comprehensive quality improvement initiative to prevent falls in the emergency department

Introduction: Patients from all population groups visit the emergency department (ED), with increasing visits by elderly patients. Patient falls in the ED are a significant safety concern, and they can lead to serious injuries and worse outcomes. Toronto Western Hospital’s ED Quality Improvement (QI) team identified as a problem our assessment and management of patients at risk for falls. The aim of this project was to develop a comprehensive and standardized approach to patients at risk of falls in the ED, including implementing timely interventions for fall prevention. Methods: A literature review of existing tools was completed to develop our own reliable and valid fall risk screening tool for ED patients. QI methods were used to devise a comprehensive strategy starting with detection at triage and implementation of action-driven steps at the bedside, through multiple PDSA cycles, randomized audits, surveys, and education. Repeated measurements were undergone throughout the project, as were staff satisfaction surveys. Results: The chart audits showed a five-fold increase in the completion rate of the fall risk screening tool in the ED by the end of the QI initiative (from 10% to 50%). Constructive feedback by an engaged team of nurses was used to iteratively improve the tool, and there was mostly positive feedback on it after various PDSA cycles were completed. The various component of this novel and useful ED-based falls screening tool and bundle will be presented in tables and figures for other leaders to replicate in their EDs. Conclusion: We developed a completely new ED-specific fall risk screening tool through literature review, front-line provider feedback, and iterative PDSA cycles. It was used for the identification, prevention, and management of ED patients with fall risk. We also contributed to a positive change in the culture of a busy ED environment towards the promotion of patient safety. Education and feedback continue to be provided to the ED nurses for reflective practice, and we hope to continue to improve our tool and to share it with other EDs.

Abstract WMP118: In Safe Hands: Implementation on the Stroke Unit. Does it Improve Patient Care and Ward Efficiency?

The ‘In Safe Hands” (ISH) is a structured interdisciplinary bedside round developed to increase patients participation in their care in acute hospital wards. This has shown to improve quality of care by reducing communication errors and complications, enhancing a culture of safety in an acute hospital. The purpose of this study was to assess the effect of ISH on length of stay (LOS), in-hospital complications and assess whether the ISH enhances patient and staff satisfaction in a stroke unit of a tertiary hospital in Sydney, Australia. This was a longitudinal study pre and post implementation. A total of 200 patients participated in the study. Data on the length of stay, incidence rate relating to patient safety and patient and staff satisfaction surveys using Patient Experience Tracker (PET) devices were collected pre and post implementation. ISH increased the number of patients with at least 72hours in stroke unit care by 80 percent (P &lt; 0.001). Fever and hyperglycaemia were treated in all patients following ISH implementation vs only 50% and 64% respectively of patients pre ISH implementation. Swallow screen was completed in all patients prior oral intake compared to 92% of patients of the pre ISH group (P = 0.03). There was no significant difference in the LOS and complications. All stroke patients received stroke education and there were no readmissions post implementation. There was no significant difference in the patient and staff satisfaction. In conclusion, although ISH did not improve the primary endpoints of LOS, complications and satisfaction it did improve protocol adherence.

Impact of pharmacist interventions on cost avoidance in an ambulatory cancer center.

Objective To provide a foundation to justify the presence of a full-time clinical pharmacist in the ambulatory cancer center in addition to an existing centralized pharmacist through cost avoidance calculation and patient and staff satisfaction surveys. Methods The prospective, pilot study took place in an ambulatory cancer center over four weeks in 2014. Cost avoidance values were assigned to interventions performed by a pharmacy resident, who was present in the ambulatory cancer center during clinic hours, along with a centralized oncology pharmacist routinely working with the cancer center. Anonymous patient and staff satisfaction surveys based on a 5-point Likert scale were distributed to assess the perceived benefit of a pharmacist located in the ambulatory cancer center. Results Data collection took place over approximately one month. After evaluation of 962 interventions from both pharmacists, the estimated cost avoidance was US$282,741 per pharmacist per year, yielding a net benefit of US$138,441. The most common interventions made by the resident included chemotherapy regimen review (n = 290, 69%) and patient counseling (n = 102, 24%), while the majority of the centralized pharmacist's interventions was chemotherapy regimen review (n = 525, 97%). Results from the anonymous patient and staff surveys revealed an overall positive perception of the pharmacy resident while in the ambulatory cancer center. Conclusion A full-time clinical pharmacist in an ambulatory cancer center is both financially beneficial and positively perceived by patients and staff.