Ward Areas Research Articles

Improving recovery after bowel cancer surgery: mixed methods feasibility study of a co-produced information intervention (Recover Together).

Recovery after surgery for colorectal cancer is a complex process, involving numerous physiological, emotional, social and economic challenges. Good information is a key factor for enabling patients to recover well, but there is a paucity of evidence to guide how this should be done. A new information intervention (Recover Together) comprising a booklet, an online video and an inpatient goal board has been developed. This study explores its feasibility, as well as the feasibility of key study methods, during its first use in the United Kingdom National Health Service (NHS). This is a mixed methods, multi-centre, feasibility study of a complex intervention. A total of 105 participants undergoing oncological colorectal surgery will be recruited across three to four study sites in the UK. Participants will receive each component of the Recover Together intervention at defined timepoints before and during hospital admission. A series of patient-centred outcome instruments will be administered in hospital and during follow-up at 30 days and 6 months. Outcomes of feasibility will comprise the time taken to establish the intervention at participating sites, assessments of intervention fidelity and acceptability, as well as return rates of key clinical outcome instruments. The mixed methods design will comprise interviews and focus groups with patients and health professionals, non-participant observation in ward areas and clinics, user-specific video analytics and daily photographs of the goal boards. The findings of this study will provide a feasibility assessment of the Recover Together intervention when used for the first time in NHS practice. If shown to be feasible, this will guide the development of a future definitive study to explore the clinical and cost effectiveness of the Recover Together intervention to improve recovery after surgery. ISRCTN62430915.

Fighting HAIs by monitoring hand hygiene compliance in the Umberto I teaching Hospital in Rome

Abstract Background Healthcare-associated infections (HAIs) are one of the most common preventable complications in hospitalised patients related to increased morbidity and mortality for patients. Proper hand hygiene (HH) can decrease the prevalence of HAIs within care settings. The aim of the study was to evaluate the effects of a monitoring and feedback system on HH compliance (HHC). Methods Three monitoring and feedback studies have been carried out in Umberto I teaching hospital of Rome since 2021. Healthcare workers (HCWs), were trained on how to carry out the direct observation on the 5 WHO moments on HH. The data collection lasted two weeks each year. Following data collection, they were analysed and discussed annually with HCWs. A multivariable logistic regression model was constructed to identify predictors of HH compliance. Results A total of 15874 HH were observed, of which 40.1% in 2023. The recorded HHC was 71.0% in 2021, 75.4% in 2022 and 71.6% in 2023. Multivariable analyses showed that HHC was positively associated with female sex of observed (aOR:1.3, 95% CI:1.1-1.4), during weekend days or holidays (aOR:1.3 95% CI:1.1-1.4) and all indications with respect to ‘before touching a patient’. Regarding the professional category of the observer, compared to physicians, midwives were more likely to report compliant observations (aOR=2.4, 95% CI: 1.4-4.1). On the other hand, a negative association was found with external ward staff and other HCWs and no-HCWs compared to physicians. Ward area and year of observation did not influence the probability of the outcome. Conclusions The results of this study revealed sub-optimal adherence to HH, with the lowest rates observed prior to patient interaction. That, coupled with the variability seen among HCWs, underlines the difficulties in achieving a uniform level of compliance. Therefore, ongoing training to raise awareness among HCWs and to repeat the survey over time identifying any major problems is essential. Key messages • Monitoring the reasons for non-adherence to hand hygiene in healthcare institutions in order to formulate strategies to improve HH adherence among hospital staff is essential. • Hand hygiene (HH) monitoring systems can produce measurable improvements in HH adherence by healthcare personnel, resulting in a reduction in the incidence of healthcare-associated infections.

Adherence to Evidence-Based Guidelines and ImplicationsWhen Designing Electronic Documentation for Urinary Catheters.

The aim of this study was to investigate the point prevalence and the rate of adherence to evidence-based guidelines for patients who had indwelling urinary catheters in three Australian acute care hospitals. A cross-sectional observational design was used. A multisite cross-sectional observational design was utilised in three acute hospitals across Australia. Data were collected from each site in a single day directly from observation of the patient, the bedside notes and medical records. The data collected included observations of clinical care and scrutiny of the documentation of the insertion details and catheter care using best practice guidelines. Of the 1730 patients audited, 47% were female. The mean point prevalence of catheters insitu across three sites was 12.9%. Correct documentation compliance was reported to be, on average, 40%. Documentation was significantly better when a template was available to guide information recorded: this was regardless of whether it was hard copy or electronic. Overall, clinical care compliance with best practices was 77%. Of note for improvement was the fixing of the urinary catheter to the thigh in highly dependent patients. It was identified that there is a need for improvement across all three sites: specifically regarding securement of the urinary catheter to the patient's thigh within the ICU. In addition, it was identified that there is a need for documentation of the urine bag change in ward areas. Documentation may be improved by incorporating templates into healthcare documentation systems in the future. Further work is needed to ensure nurses are aware of the adverse effects of urinary catheters and thus, the need to adhere to best practice guidelines. There has been no patient or public contribution. We have adhered to the STROBE guidelines for reporting.

Harnessing next-generation sequencing to monitor unculturable pathogenic bacteria in the indoor hospital building

The hospital indoor air microbiome, a diverse range of microorganisms, gains prominence amid the COVID-19 pandemic. Elevated awareness underscores implications for patient and staff well-being. Concerns about risks to indoor air quality persist due to prolonged indoor exposure, necessitating further research on specific threats within the hospital environment. In this study, an independent culture-based approach was used to analyze the baseline core microbiome present in hospital environments, utilizing amplicon sequencing on the next-generation sequencing technology to target the V3 region of the 16S rRNA gene. Firmicutes, Proteobacteria, and Actinobacteria were the main bacterial phyla that were most isolated from the wards and clinics with different orders of abundance; Firmicutes being associated more in clinics and Actinobacteriota in wards. The bacteria Niallia taxi, Methyloversatilis universalis, unclassified Rummeliibacillus, unclassified Clostridium, and unclassified Sphingomonadaceae dominated the clinic area while ward areas reported Pseudonocardia bannensis, Rubrobacter aplysinae, unclassified Brachybacterium, unclassified Bradyrhizobium, and unclassified Mycobacterium to be the top five features. While the alpha-diversity index showed no significant differences, the beta-diversity analysis showed a significant difference between clinic and ward areas (p<0.05). Certain bacterial species associated with opportunistic pathogens as well as normal skin flora such as Methylobacterium spp., Cutibacterium spp., unclassified Sphingomonadaceae, and Anoxybacillus B spp., were also identified across all samples. The methods described in this research aim to establish a rapid and sensitive screening process that could be valuable for disease surveillance within the healthcare setting, shedding light on the potential impacts of the hospital microbiome on human illness.

A Pain in the Pilot.

Multi-agency guidelines recommend use of a functional pain assessment tool as an objective assessment of pain, rather than relying on a subjective verbal rating scale. This project was created to address issues managing Patients' pain in inpatient settings. The project aimed to answer: 'How can we adopt the use of a Functional Pain Assessment into our clinical practice, optimising its effectiveness for ALL patient groups in our inpatient ward areas?' Output from multi-disciplinary working group: two electronic documents were created - Pain Assessment Tool and Pain Observations Chart: for staff to document routine pain observations. Five wards participated in the pilot study, with training/support provided. Result: Staff and patients preferred the new approach, compared to previous pain documentation method. However, documentation compliance was not as good as expected. Pilot proved the concept, documents are effective in pain management, but more education and support is needed to embed cultural shift.

Mitigation of Inpatient Standard Class Risk at Hospital X

Background: The Standard Inpatient Class Policy (KRIS) in Indonesia aims to provide equitable healthcare services, ensuring the same standards in inpatient wards across all hospitals in Indonesia. This policy has been issued since 2021 and is mandatory for all hospitals to implement by December 2024. The implementation of the KRIS policy impacts hospitals, necessitating analysis and mitigation of risks arising from its implementation. This study aims to provide an overview of the analysis and mitigation of risks in the standard inpatient class implemented by Hospital X. Method: Qualitative research using Focus Group Discussions (FGDs) in November 2023 involving 7 key informants, including Hospital Directors and Department Heads, regarding the mitigation of risks in the standard inpatient class using risk analysis matrices. Results: There are two criteria for the standard inpatient class that pose a very high level of risk, namely the building components lacking high porosity and the density of ward spaces and bed spacing. Conclusion: Hospital X implements risk mitigation by taking actions to reduce the impact of risks through room improvement based on related room reports, risk reduction mitigation by planning inpatient building renovations, and risk acceptance mitigation by allowing ward areas to be 9.8 square meters per bed.

Assessing the impact of socio-demographics and farming activity on ward-level mortality patterns using farm and population decennial censuses.

Farmers experience a specific set of unique dangers, which increases their risk of mortality compared with any other occupation. This study hypothesised that Northern Ireland's (NIs) agriculturally saturated Wards have a higher risk of mortality compared against non-agriculturally based Wards. The Population Census and Farm Census information were downloaded from the Northern Ireland Neighbourhood Service (NINIS) online depository to compile three mortality-based data sets (2001, 2011, pooled data sets). Assessing the impact of socio-demographics and farming activity on Ward-level mortality patterns using farm and population decennial censuses. This study analysed all 582 Ward areas of NI, which enclosed the entire populace of the country in 2001 and 2011. Path analysis was utilised to examine direct and indirect paths linked with mortality within two census years (2001; 2011), alongside testing pathways for invariance between census years (pooled data set). Ward-level results provided evidence for exogenous variables to mortality operating through three/four endogenous variables via: (i) direct effects (age), (ii) summed indirect effects (age; males; living alone; farming profit; and deprivation) and (iii) total effects (age; males; living alone; and deprivation). Multi-group results cross-validated these cause-and-effect relationships relating to mortality. This study demonstrated that farming intensity scores, farming profits and socio-demographics' influence on mortality risk in a Ward were dependent on the specific social-environmental characteristics within that area. In line with earlier area level research, results support the aggregated interpretation that higher levels of farming activity within a Ward increase the risk of mortality within those Wards of NI. This was an essential study to enable future tailoring of new strategies and upgrading of current policies to bring about significant mortality risk change at local level.

A Study to Assess Knowledge regarding Scrub Typhus among adults at a selected community area, Kidangoor

A descriptive study was conducted to assess the level of knowledge regarding scrub typhus among adults at a selected community area, Kidangoor. The study was conducted in selected area of 3rd ward of Kidangoor Panchayath. The study sample consist of 30 adults. Samples are selected by using convenient sample technique. Structured knowledge questionnaire used to collect data. The result shows that among 30 samples 10(33.33%) had poor knowledge, 12(40%) had average level of knowledge and 8(26.67%) had good knowledge.

Penehyclidine for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Gynecological Laparoscopic Surgery Under Combined Intravenous and Inhalation Anesthesia: A Randomized, Double-Blind, Placebo-Controlled Trial.

We designed this study to investigate the effect of intravenous use of penehyclidine on postoperative nausea and vomiting (PONV) after gynecological laparoscopic surgery. Ninety-two Women Patients (Aged ≥ 18) Scheduled for Elective Gynecologic Laparoscopy Were Enrolled in the Current Study. Patients Were Equally Randomized Assigned Into Penehyclidine group (PHC group: received a bolus of penehyclidine 10 μg/kg during the induction of anesthesia, then followed by a continuous infusion of 10 μg/kg penehyclidine at a fixed rate of 2.0 mL/h in postoperative intravenous analgesia pump over 48h, 0.5 mg upper limit respectively) or Control group (received 0.9% saline in replace of penehyclidine at the same time points). The primary outcome measure was the incidence of postoperative nausea and vomiting in the postanesthesia care unit and ward area. Quality of Recovery-15 (QoR-15) scores and general comfort questionnaire (GCQ) scores were assessed on postoperative day (POD) 1, 2. Patients between two groups had comparable baseline characteristics. Compared with the Control group, the incidence and severity of PONV, postoperative nausea (PON), and postoperative vomiting (POV) were significantly lower in the PHC group at 2h (PONV: P = 0.002, P = 0.004, respectively; PON: P = 0.018, P = 0.038, respectively; POV: P = 0.011, P = 0.072, respectively), 24h (PONV: P = 0.003, P = 0.001, respectively; PON: P = 0.010, P = 0.032, respectively; POV: P = 0.006, P = 0.044, respectively), and 48h (PONV: P = 0.003, P = 0.002, respectively; PON: P = 0.007, P = 0.019, respectively; POV: P = 0.002, P = 0.013, respectively) after surgery. The QoR-15 and GCQ scores of the PHC group were significantly higher than those of the Control group at POD 1, 2 (P < 0.001; P < 0.001, respectively). Our findings suggest that perioperative intravenous application of penehyclidine can effectively prevent postoperative nausea and vomiting in gynecological laparoscopic surgery patients and improve postoperative recovery.

The First Experience and Benefits of the 12-week VIVIFRAIL Exercise and Its Workout Music Selection for Elder Adults in the Community of Ardirejo, Kepanjen

The VIVIFRAIL program is an Multi Component Physical Exercise (MPC) program which includes strength trainings, aerobics, gait trainings, balance and flexibility exercises tailored for each individual, and designed to facilitate evidence-based exercise interventions for elder adults. This program, which is unprecedented in Indonesia, is targeting elder adults in the pre-frail stage who are aiming for robust or fit status. This study utilizes a qualitative method with 15 older adults as the respondents. The data was collected from semi-structured interviews to encourage respondents to openly share their experience on the VIVIFRAIL program. The Consolidate criteria for Reporting Qualitative research (COREQ) method is used for reporting. The objective of this study is to find out the elderly's first experience of participating in VIVIFRAIL exercise and its benefits in returning the elderly's physical performance to robust or fit status as well as the selection of accompanying music during the 12 week exercise in the Ward Area of Ardirejo, Kepanjen District. The results showed that our respondents experienced positive feeling and felt physically fit and fresh. They could also monitor their blood pressure and train their balance to avoid falling. Moreover, after getting the benefit, respondents expected that the program could be continued. As for the workout music selection, respondents chose Javanese traditional music (gending), dangdut/koplo, local music, campursari, oldies songs, and Malangan songs for accompanying their exercise. In conclusion, after participating in the VIVIFRAIL program for 12 weeks, the respondents felt positive and physically fit and fresh.

Evaluating Thermal Comfort in Ward Areas of the Public Hospital in the Tropical Climates

Thermal comfort in hospitals is a crucial element to provide appropriate indoor air quality for health and well-being. However, the airconditioning system usually has deficiencies to meet target criteria for the relevant thermal environmental factors. Therefore, this study aimed to evaluate thermal comfort in ward areas of the newly built public hospital in Thailand during the operation phase to examine how the building maintain comfort. The measurement equipment was installed for 24 hours in ward areas for collecting data and evaluating thermal comfort using the predicted mean vote (PMV) model. The results indicated that achieving thermal comfort could be found among inpatients and medical staff, with differential considerations on personal factors. As a few studies in hospitals in Thailand has been done, the results from this study can act as evidence to develop building performance assessments and operation strategies to optimally enhance health and well-being of the occupants in a public healthcare facility in Thailand and tropical regions.

Policy Interventions to Address Urban Water Problems of highly urbanised area due to Climate Change

In this research firstly, the rainfall pattern of Ahmedabad and Surat, the fast-growing urban areas of Gujarat state of India have been studied and compared. It is detected that what makes Surat city more prone to floods. Then, analysis for rainfall shift in Surat over the last three decades has been carried out. It is interesting to observe that the rainfall pattern of Surat is following the local calendar, i.e. Indian calendar rather Gregorian calendar. This relation of rainfall pattern with Indian calendar shows that the prediction and the climatic condition responsible for rain is following the local calendar based on the planetary position. For the Water Sensitive Urban Design, four different wards in Surat Municipal Corporation (SMC) named Adajan, Piplod, Anjana and Pandesara are studied. These wards are selected based on land use, having the highest area in commercial, residential, industrial and institutional in total SMC area. For each ward, the previous and impervious area is calculated, and the runoff is determined. Planning interventions for water sensitive urban design at a building level, street level and ward level have been given for the study area. The study will be definitely helpful for the decision-makers to prepare a policy to follow the local calendar to operate the monsoon protocol and to manage water resource infrastructure, including the planning of harvesting activities.

Registered nurses' knowledge and interpretation of ECG rhythms: A cross-sectional study.

Electrocardiographic (ECG) monitoring and recording are seen as the most commonly used non-invasive diagnostic tool to identify cardiac arrhythmia and myocardial damage in the clinical setting. There is an expectation that critical care nurses are ideally trained to interpret abnormalities and morphology in the ECG more proficiently than nurses from general ward areas. However, the ability to interpret and recognise ECG abnormalities is dependent on which critical care area nurses are currently working in and their level of experience. The aim of this study was to investigate registered nurses' knowledge in being able to identify and interpret select electrocardiographic rhythms. This was a cross-sectional study that evaluated registered nurses' knowledge of electrocardiogram rhythm identification and interpretation. A convenience sample of 105 registered nurses currently enrolled in a 2-year Master's programme leading to critical care specialism and advanced practice nurse award were recruited. A 20-item multiple choice questionnaire that provided examples of electrocardiogram rhythm (n=14) abnormalities and rhythm abnormalities caused by electrolyte disturbances (n=6) RESULTS: The study included registered nurses from critical care and general ward areas. The overall results were poor with only 55% of questions answered correctly. Coronary care nurses scored the highest in identifying ECG rhythms (12/20 ± 1.58; p < .001). When ECG abnormalities associated with electrolyte imbalances were analysed, both groups were unable to identify the effects of hypokalaemia and hypomagnesaemia effectively (p = .748). Length of time as a registered nurse (r = -0.304, p = .002) and length of time in current work environment were weakly correlated (r = -0.328, p = .001). Having a critical care background showed a positive relationship with nursing knowledge of ECG rhythm identification (r = 0.614, p < .001). The results of this study demonstrate that nurses have a poor knowledge of ECG rhythm identification and interpretation, a consistent finding from other work. A possible solution is a revamp of education and training associated with ECG recognition and morphology. Monitoring and assessing ECG morphology provide important details about cardio-electroconductive stability, especially with fluctuations in serum electrolyte levels seen in critical illness or trauma. For this, critical nurses must improve their proficiency through education/training or internal quality improvement activities in detecting abnormalities associated with ECG changes beyond those most easily recognizable rhythms such as atrial fibrillation or ventricular tachycardia.

Antimicrobial Point Prevalence Survey in four Emergency Departments at Manchester University NHS Foundation Trust

Abstract Introduction Antimicrobial Point Prevalence Surveys (PPS) are a recognised tool to facilitate monitoring of compliance to an organisation’s antimicrobial stewardship (AMS) programme.1 Most PPS tools used within secondary care focus on prescribing of antimicrobials for in-patients. At Manchester University NHS Foundation Trust (MFT) PPS are carried out by clinical pharmacists across all inpatient ward areas. Antimicrobials are one of the most prescribed medicines in the emergency department2 (ED) yet, the current MFT PPS tool does not facilitate undertaking PPS in EDs. A new validated outpatient PPS tool3 from the Global Point Prevalence Survey (GPPS) was released earlier this year. Aim To pilot the GPPS outpatient tool in the EDs at MFT to determine the level of compliance with the MFT antimicrobial guidelines within the EDs, estimate the total burden of antimicrobial use and describe types of infections and prescribed antimicrobials within the EDs. Methods Following the GPPS outpatient protocol3 the four emergency departments (3 general EDs, and 1 paediatric ED) at MFT were assessed in a ten-day period during May 2023. Each ED was assessed continuously for a 4-hour timeslot on a weekday morning by an AMS pharmacist who retrieved the data from the EPIC electronic patient record system remotely. All patients who were allocated a room/bedspace on ED within the timeslot were audited, including patients who were not prescribed antimicrobials. Guideline compliance was checked with the MFT antimicrobial guidelines. The online GPPS data collection tool was used, generating a data download into an Excel spreadsheet for analysis. This study was a service evaluation and so did not require ethical approval. Results 180 patients were audited from 4 EDs yielding a total of 41 prescriptions for antimicrobials. 28/180 patients were prescribed one or more antimicrobial, with an overall antimicrobial prescribing rate of 15.5%. Prescribing was higher in the paediatric ED with a rate of 25%. 92.7% (38/41) of antimicrobials were prescribed intravenously (IV). Choice of antimicrobial was compliant in 38/41 (92.7%). Dose was compliant in 40/41 (97.6%). Duration of treatment was compliant in 39/41 (95.1%). Sepsis accounted for 48.8% of indications. 2/41 prescriptions were based on the C Reactive Protein (CRP) biomarker. Discussion/Conclusion Whilst the study was only conducted over a short time period, the findings suggested that overall compliance with the MFT antimicrobial guidelines was very good. The prescribing rate of 15.5% was low in comparison to the recent MFT inpatient PPS which showed a prescribing rate of 30%. There is a high rate of diagnosis of sepsis and prescribing of IV antimicrobials in comparison to orals which may be anticipated in the emergency setting. The GPPS outpatient audit tool provided an opportunity to do a baseline assessment within the EDs across MFT, providing data on prevalence of antimicrobial prescribing and compliance to the MFT guidelines. The GPPS audit tool did not have the utility to review the accuracy of clinical diagnosis of severe infection/sepsis within the ED, or the appropriateness of IV antimicrobial prescribing. Further research should be undertaken to provide assurance on the clinical diagnosis of severe infection and the appropriateness of IV antimicrobial prescribing with the EDs.

Potentiality and Threats of Avocado Farming in Eastern Hills of Nepal

Innovative and profitable agriculture has become indispensable for the supply of food and nutrients to people as well income generation. Thus, this study deals with the feasibility of commercial avocado farming including the analysis of problems related to this especially in the case of eastern hilly areas of Nepal. This study applied household questionnaire survey, key informant survey, focus group discussions and field observation to collect relevant primary information. Previous research journals, dissertations, books and official records were used as the major sources of secondary data collection. This study covers the entire area of Ward No. 3 of Dhankuta Municipality. Around, 44 percent (223hhs) farm households were selected as a sample out of the total 506 households of this area based on Yamane's sample determination formula (1967).This study proves that the agriculture system can be made profitable and useful through carefully using of new high valued crops. It reveals that avocado is a new commercial crop with maximum potential in the hilly areas of eastern including both challenges and opportunities. Moreover, this study also confirms that the avocado farming is not only a profitable business but also a risky and challenging. The farmers are facing various socio-economic challenges while doing this cultivation. Thus, the conclusion of the study is that the new agricultural activities are not free from challenges so that farmers must be faced patently to achieve success. This conclusion conveys the message that the success achieved only by facing barriers is sustainable.

Rapid Response System Components and In-Hospital Cardiac Arrests Rates 21 Years After Introduction Into an Australian Teaching Hospital.

The aims of the study are: (1) to evaluate the epidemiology of in-hospital cardiac arrests (IHCAs) 21 years after implementing a rapid response teams (RRTs); and (2) to summarize policies, procedures, and guidelines related to a national standard pertaining to recognition of and response to clinical deterioration in hospital. The study used a prospective audit of IHCA (commencement of external cardiac compressions) in ward areas between February 1, 2021, and January 31, 2022. Collation, summary, and presentation of material related to 8 "essential elements" of the Australian Commission for Safety and Quality in Health Care consensus statement on clinical deterioration. There were 3739 RRT calls and 244 respond blue calls. There were 20 IHCAs in clinical areas, with only 10 occurring in general wards (0.36/1000 admissions). The median (interquartile range) age was 69.5 years (60-77 y), 90% were male, and comorbidities were relatively uncommon. Only 5 patients had a shockable rhythm. Survival was 65% overall, and 80% and 50% in patients on the cardiac and general wards, respectively. Only 4 patients had RRT criteria in the 24 hours before IHCA. A detailed summary is provided on policies and guidelines pertaining to measurement and documentation of vital signs, escalation of care, staffing and oversight of RRTs, communication for safety, education and training, as well as evaluation, audit, and feedback, which underpinned such findings. In our mature RRT, IHCAs are very uncommon, and few are preventable. Many of the published barriers encountered in successful RRT use have been addressed by our policies and guidelines.

1072-P: Incidence of Inpatient Hypoglycemia by Specialty Area—A Case for Targeted Inpatient CGM

Inpatient hypoglycemia is traumatic for people with diabetes and increases length of stay, hospital costs and subsequent mortality (at least in the elderly). We report inpatient hypoglycemia by specialty ward in an 800-bed, acute hospital serving a largely deprived population (350,000) with diabetes prevalence 8%. Over 1 year, 21,089 inpatients with diabetes had 176,603 point of care (POC) tests (median 8.4, ward range 1.1-29.2, POC tests/person/stay); and 9.2 (ward range 2.1-24.7)% of subjects experienced hypoglycemia (CBG &amp;lt;72 mg/dl). Patients who experienced hypoglycemia had 2.6 (range 1.2-5.8) episodes of hypoglycemia either from early persistence (failure of protocol-driven hypoglycemia treatment) or late recurrence. There was a strong correlation between POC testing frequency and detection of hypoglycemia (Chi-square, Yates’ correction = 8.4374, p=0.004). Compared with the whole hospital (index 1.0), specialty wards hypo index ranged 10-fold from 0.2 to 5.1. A recent RCT demonstrated CGM superiority over POC testing in preventing recurrent inpatient hypoglycemia. Consistent with this RCT, our data suggest that increased POC testing is associated with increased hypoglycemia detection and our approach might guide initial targeting of CGM to highest risk specialty wards for hospitals unable to deploy CGM simultaneously in every inpatient specialty ward area. Disclosure G.A.Lewis: None. J.Cardwell: None. S.Bujawansa: Stock/Shareholder; Merck &amp; Co., Inc., GlaxoSmithKline plc. K.J.Hardy: Other Relationship; Sanofi, Speaker's Bureau; Napp Pharmaceuticals Limited.

P36 Using the Australian National Antimicrobial Prescribing Survey portal (NAPS) to benchmark antibiotic prescribing within an Integrated Care Board (ICB): a pilot point prevalence survey (PPS) of two NHS Trusts

Abstract Background PPS is useful in evaluating volume and appropriateness of antimicrobial prescribing to guide specific antimicrobial stewardship (AMS) interventions. Integrated care systems enable collaboration within an ICB and benchmarking of antimicrobial prescribing in constituent trusts to identify disparities and learn from sharing best practice. NAPS is a web-based qualitative auditing platform which is used to conduct an annual Australia-wide PPS. To assess the suitability of NAPS in benchmarking antimicrobial prescribing practices, we piloted the NAPS platform in the acute admission ward areas in two NHS Trusts within an ICB. Methods In OUHFT, admissions to 2 acute medicine wards on a single day were extracted using the Cerner electronic prescribing system. Antimicrobial prescriptions were anonymized, reviewed using NAPS protocol and uploaded to the NAPS platform. In BHT, antimicrobial prescriptions on 2 admission wards were collected manually using the NAPS parameters and audit standards and entered directly into Excel®. Ethical approval was not required due to the anonymized nature of this audit. Results A total of 124 patients at OUHFT and 53 patients at BHT were included. The proportion of patients prescribed antimicrobials varied, with a prevalence of 23% (n = 29) at OUHFT and 54% (n = 28) at BHT. The total number of antimicrobial prescriptions was approximately 40 per trust. Compliance with guidelines for OUHFT and BHT (88% versus 83%) and stewardship appropriateness (73% versus 80%) were similar. The main indication for antimicrobials was pneumonia. The most common reasons for inappropriateness were ‘incorrect duration’ and ‘spectrum too broad’. The most prescribed antimicrobials differed, with co-amoxiclav and amoxicillin (43%) at OUHFT and metronidazole and clarithromycin (24%) at BHT. Non-compliance with guidelines was frequently associated with the use of doxycycline and co-amoxiclav (47%) at OUHFT and amoxicillin and piperacillin/tazobactam (72%) at BHT. Conclusions Benchmarking of antimicrobial prescribing was possible as both PPSs were conducted using the NAPS parameters and standards. Focusing efforts on antibiotic prescribing for pneumonia, the use of broad-spectrum antimicrobials and reducing duration of courses will be taken forward as a key focus for AMS efforts. NAPS is a suitable tool for benchmarking, sharing best practice and facilitating discussion of AMS interventions across an ICB. This model should be considered as a template for national benchmarking of antimicrobial prescribing.

P21 Promoting antimicrobial stewardship and sustainability utilizing a ‘Go Green’ IV to oral switch (IVOST) policy and electronic prescribing prompts in antimicrobials with high oral bioavailability

Abstract Background Antimicrobial stewardship (AS) is crucial in reducing antimicrobial resistance (AMR) and the sustainability impact of inappropriate antimicrobial use.1 Promotion of the oral route and IV to oral switch (IVOST) are key AS initiatives providing benefits for patients, staff and the environment including reduced risk of line infections and AMR, reduced workload and costs, reduced plastic waste and improved sustainability.2 A recent quality improvement (QI) initiative to promote oral metronidazole (bioavailability &amp;gt; 90%) in eligible surgical patients at the Royal Alexandra Hospital (RAH) resulted in a change in prescribing behaviour and a 45% median reduction in IV metronidazole use.3 Objectives To scale and spread promotion of the oral route in antimicrobials with high oral bioavailability with the aim of reducing collective IV use by 20% by February 2023 at RAH. Methods A QI approach was used to promote the oral route where appropriate in the following agents: metronidazole, levofloxacin, fluconazole, ciprofloxacin, co-trimoxazole, clindamycin, linezolid and rifampicin. Techniques included the following: ‘Go Green IVOST’ posters in key ward areas highlighting benefits of the oral route; targeted pharmacist and pharmacy technician prospective audit and feedback using the electronic prescribing system; presentations to ward and pharmacy teams; staff champions and electronic IVOST prompts displayed when prescribing and administering the targeted agents IV. To measure improvement, oral and IV usage data were measured at baseline and for 24 months post change. Data were displayed on run charts to determine if the QI target was achieved. Results There was a 44% median reduction in IV defined daily doses (DDDs) in the targeted antimicrobials, surpassing the 20% target (Figure 1). There was a median 10% shift in the proportion of these agents given IV as a percentage of total (IV plus oral) use (Figure 2) The greatest reduction (60%) was in IV metronidazole where usage declined from a monthly baseline of 667 to 267 DDDs. This equates to a median reduction of 1200 IV metronidazole administrations and nearly 600 hours nursing time saved per month. IV fluconazole and IV levofloxacin usage declined from baseline by a median of 35% and 24%, respectively. Conclusions A QI approach to promote appropriate use of the oral route in antimicrobials with high oral bioavailability resulted in a change in prescribing behaviour and a sustained reduction in IV prescribing of these agents. This is important in terms of improved AS, patient care and safety, healthcare cost and efficiency and environmental sustainability.

CONCERNS OF PROSPECTIVE HOMEBUYERS IN TOKYO

The purpose of this study is to clarify the concerns for the living environment among residents and people who are considering to purchase the new housings. The paper discussed the nature and exclusivity of people’s unique behavior in relation to the living environment of Tokyo, based on the following three points of analysis; 1) Concern for the living environment in Tokyo wards area, 2) Geographical characters of the concerns, 3) Background of the formation of concerns and discussions.