Ward Duties Research Articles

Factors Causing Lack of Interest in Clinical Research Among Postgraduate Trainees at Peoples University of Medical & Health Sciences for Women, Shaheed Benazir Abad. A Mixed Method Study

Background: Conduct of clinical research requires time, resources, dedication, enthusiasm, willingness, knowledge, training of research methodology, and practical skills. Postgraduate medical students show lack of interest towards clinical research attributed to a diverse group of causes. Objectives: The objective of current mixed method study was to evaluate factors contributing to lack of interest in clinical research among PG trainees at PUMHSW SBA. Study Design: This is a Mixed Method Study. Place and Duration of Study: This study was conducted at Peoples University of medical & health sciences for women Shaheed Benazir Abad Sind (PUMHSW - a public sector medical university) from September to November 2022. Methodology: After taking approval from the Institutional Ethical review committee and obtaining written informed consent from the 50 participants selected by purposeful sampling. Two focus group discussions (FGD) were arranged, which were recorded and transcribed. Thematic content analysis of these transcripts was carried out. In the subsequent phase the predesigned validated questionnaire was used and analyzed using descriptive statistics. Results: A total of 92% (46/50) responded, of those 21 were females. The knowledge regarding research and its methodology was 89-93%. Eighty-nine percent strongly agreed to include research in the curriculum and believed that it would facilitate better patient outcome and clinical practice (89.1%). All respondents opined that faculty and mentors play a crucial role in the conduct of research. Factor hindering interest in research were lack of previous exposure to research (54.3%), lack of research curriculum (45.7%), deficient statistical support (43.5%), disinterested faculty (30.4%), lack of time due to heavy ward duties (39.1%), and family commitments (37%). Practical Implication: Conduct of clinical research requires time, resources, dedication, enthusiasm, willingness, knowledge, training of research methodology, and practical skills. Current study will provide help to the new researchers to solve their research hazards for new and innovative developments. Conclusion: Majority of the participants had some knowledge about research and its positive impacts on clinical practice. Factors identified to cause lack of interest included lack of research curriculum, statistical support, time, previous knowledge, financial and family issues. Keywords: Clinical research, factors, lack of interest, attitude, post graduate trainees.

Stressors and coping strategies among frontline nurses during COVID-19 pandemic.

Frontline nurses are more likely to be in close contact with COVID-19 patients and COVID ward duties make nurses to undergo serious emotional disturbances. The physical, psychological, and social well-being of the nurses can be affected in this time and proper training programs and counseling sessions should be undertaken. This study attempts to understand the stressors and coping strategies of nurses from a tertiary hospital. Descriptive survey design was adopted and data were collected in 2021 from 92 frontline nurses from a selected tertiary hospital in Raipur. The data collection tools used were sociodemographic proforma, structured questionnaire on stress factors, and structured checklist on coping strategies. The analysis was done using frequency and percentage distribution. Among the nurses, 51% reported stressors related work- and work-related environment, 50% reported stressors related to self-safety, and 52% on stressors related to family concerns. The coping strategies adopted by the nurses included realization of the fact that service to patients comes as first (75%), and availability of personal protective equipment kits, confidence in following strict protective measures (69%), talking to family members over phone daily (71%), and support from family and friends (70%). Learning about COVID-19 (65%), and team work (61%) also created confidence to work as frontline nurses during this pandemic. The present survey reports that nurses face various stressors and tries to impart different coping strategies to overcome the stress. Understanding their stressors and coping strategies will help the administration to implement measures to create a working situation which will strengthen the health man power resources.

Quality Improvement Project to Improve Patient Satisfaction and Opportunity to Attend Clinical Team Meetings

AimsClinical Team Meetings (CTM) are weekly multidisciplinary (MDT) meetings to review and discuss patients’ clinical care at Reaside Clinic, a medium secure inpatient forensic unit. Last year, there were significant difficulties in releasing nurses from ward duties to attend CTM, with effects on CTM efficiency and patients’ involvement and satisfaction in care. Furthermore, a hospital ‘protected mealtimes’ deadline commencing at 1230 meant additional pressure and further impacted patient attendance when meetings overran. The MDT (comprising doctors, nurses, psychologists, occupational therapists, pharmacists and admin staff) worked together to generate solutions, formulating a QI project to try to make improvements. Three primer drivers were: increasing patient satisfaction, increasing staff participation and increasing CTM efficiency.MethodsThe MDT generated multiple change ideas to test to improve CTM experience and outcomes. Actions implemented included review of timetabling of patients to ensure adequate timekeeping and ensuring availability of attending ward staff, defining patient expectations from CTM through increased communication, and seeking patient feedback on satisfaction or engagement after each CTM through anonymous questionnaires. Data were collected at CTMs from February to April 2022, retrospectively compared to reference data collected before QI actions were implemented. A Microsoft OneDrive document was shared between the MDT to ensure accurate data collection, with information collected on CTM finish time, number of patients offered to attend, number of patients who did attend and anonymous patient satisfaction feedback from questionnaires.ResultsEarly indications show improvement in meeting timelines and increased staff satisfaction with the CTM process, with data collection ongoing. Baseline results from September 2021 show an average of only 2 of between 13–15 patients attending weekly, in addition to finishing beyond the 1230 target on almost all occasions. Anecdotal evidence from the MDT showed poor patient satisfaction and engagement with the process before QI changes were implemented. Full results will be available by the time of presentation; currently, an average of 4 patients have attended CTM each week with all sessions finishing on time since implementation of changes.ConclusionPatient involvement in care and person-centred care are key to improving engagement and satisfaction with inpatient psychiatric management in forensic settings. Targeted multiple change ideas implemented by the MDT through this QI aim to improve patient satisfaction through enabling increased opportunity to attend weekly CTM, with modifications to the CTM process from key staff. Preliminary results show increased opportunity of patients to attend CTM, increased staff and patient satisfaction, and increased CTM efficiency.

1674 Training Opportunities and Safe Staffing Levels – Loop Closure Audit

Abstract Aim It is not uncommon to find rota gaps at junior doctors’ level across many NHS Trusts within United Kingdom – especially in district general hospitals. In the trauma and orthopaedic department at Huddersfield Royal Infirmary, there were significant rota gaps that frequently relied on locum doctors to provide adequate service coverage. The aim of the audit was to determine whether rota gaps had any impact on safe staffing levels, training of core surgical trainees (CSTs) and costs to the department. Method Retrospective audit - assess daily staffing levels as per rota for three weeks before and after implementation of recommended better utilisation of the department’s Advanced Clinical Practitioners (ACPs) to cover trauma wards. The audit took place over October 2018 – December 2018. Results There were safe staffing levels daily in both audits. Audit 1 demonstrated locum doctors were required to cover 36.6% of ward duties and 42.9% of oncall shifts – costing the department £25, 190. Following implementation of recommendation, where ACPs were rostered to cover trauma, audit 2 reduced the requirements of locum doctors for coverage of ward duties and oncalls to 23.7% and 33.3%, respectively. Protected theatre allocation of CSTs remained less than 1 day/week. The cost of locum doctors in audit 2 was reduced to £17, 050. Conclusions Through better utilisation of the department’s ACPs to cover trauma wards, we managed to significantly reduce cost of locum doctors by £8, 140 over a three-week period. We believe CST theatre allocation will also improve from this intervention.

How to ensure junior staff are safe to step up

COVID-19 has made ward manager duties even more challenging – and it is even more likely that junior staff will have to take them on

Qualitative Study on the Psychological Experience of Nursing Officers Caring COVID-19 Patients

Background: Coronavirus spreads very rapidly and nursing staff is fighting like warrior. They are facing so many psychological issues. During the pandemic, positive and negative emotions of frontline nurses interlace and exist. Objectives: To explore the psychological experience of nursing officers caring coronavirus disease 2019 (COVID-19) patients. Materials and Methods: Phenomenological research approach was adopted. Twelve nursing officers were enrolled with nonprobability purposive sampling technique who provided care for COVID-19 patients. The interviews were conducted face-to-face and were analyzed by the Colaizzi's 7-step method. Results: The data were obtained from 12 nursing officers caring for patients with COVID-19. The mean age of the participants was 28 ± 1.87 years, with a mean work experience of 3.75 ± 1.05. Three themes were extracted from the detailed interview. First theme: the expression of negative emotions in the initial stage consisting of fear and anxiety regarding infection and family member, fatigue and discomfort related to high work intensity, and protective gear and anxiety regarding changing of ward and long duty hours. Second theme: the use of coping strategies and self-care styles consisting of communication with family members and friends and adjustment to the new era of life. Third theme: expressing positive emotions as adjusted with duty comprised of motivation and support from senior authority, feeling happy to be a part of humanity service, and satisfied with my duty and postduty quarantine facilities. Conclusions: The results of this study show that nursing officers caring COVID-19 patients are experiencing mental and emotional distress at initial stage of duty. As days passed participants used coping strategies and understand the new era of situation. Gradually, they expressed positive emotions and they were happy and satisfied with work.

Labour ward negligence.

No amount of symposia and clinical meetings and formal management will make a clinical difference unless obstetric units regularly and ruthlessly self-assess to curb medical negligence. Court case, which represent a small portion of substandard outcomes, not infrequently reveal a serious lack of obstetric judgment as well as paucity of knowledge which are compatible with unsupervised responsibility of labour ward duties. One UK court case ACF 32(2): 09/2019 presents a factual picture of obstetric practice which is difficult to reconcile with modern UK practice. This article limits itself to a number of facts as presented to court by the claimant, and the comments are directed purely at the resulting implications. These facts as stated are seriously worrying in themselves as they reflect practice well below the minimum care to be expected in a modern country and are far from what is recommended by the Royal College of Obstetricians and Gynaecologists and indeed every day standards. The article recommends the shifting of focus from individual to collective or unit responsibility to achieve better care. In any case where gross mismanagement is found, there should be a wider check on practices within the whole obstetric unit.

Distilling the core meaning of medical engagement to three junior doctor staff groups in a Welsh Health Board

BackgroundHealth systems demonstrate that levels of staff engagement correlate with a variety of performance indicators, including mortality, morbidity, staff sickness. The purpose of this paper is to help healthcare managers...

An Affordable Neurosurgical Training System for Neurosurgical Residents; The Indian Perspective.

Neurosurgical training in India. To establish a sustainable, functional, and relatively inexpensive neurosurgical training system. The training system involved using a relatively inexpensive stereoscopic microscope and ophthalmological microinstruments , including two jewellers' forceps and a microscissors. Training modules were designed using commonly available materials such as gauze, latex gloves, and chicken wings. None. The system proved to be easy to construct, easy-to-use, and highly compact. This system allowed for residents to practice microsuturing and vessel anastomosis and allows the resident to be familiarized with operating under the microscope. Thereby , developing the hand-eye coordination and precise motor control required for neurosurgery as well as the art of appropriate tissue handling. The inexpensive nature of this training system and its inherent simplicity allows for a larger portion of neurosurgical residents in India, without access to sophisticated skills labs, to practice their skills in a controlled environment, without compromising on their ward duties.

Benefits of mouth-dissolving turmeric lozenges among health-care workers: An Indian experience during COVID-19 pandemic

In this qualitative prospective survey, usefulness of a mouth-dissolving turmeric lozenge was evaluated among health-care workers (HCWs) directly involved in COVID-19 duty. 303, HCWs serving COVID-19 ward duties received a globally patented mouth-dissolving turmeric lozenge three times daily for 1 month as an additional protective intervention on top of the standard recommended preventive measures. An intervention that can control the portal of entry of the virus and its replication in the oral cavity must be considered for further research to control the pandemic. The preliminary results with this mouth-dissolving turmeric lozenge hold promise for further research in this area.

Inducing life-like distal radius fractures in human cadaveric specimens: a tool for enhanced surgical training.

Surgical education consists often times of a discrepancy between necessary amount of provided operative teaching and amount of organizational and ward duties. Operative education is often cut to a minimum. As public awareness toward surgical competence raises, so must the educational system. Courses that provide pre-fractured cadaveric specimens can facilitate surgical teaching realistically, prior to operating on living patients. The aim of this study is to introduce a realistic distal radius fracture simulation setup. 12 cadaveric specimens (3 male, 9 female) were fixed onto a custom drop-test-bench in the hyperextension of the wrist. The forearm was cut midway between elbow and carpus. The distal part of the forearm was potted, and the specimen was exposed to a high energetic impulse. CT imaging was performed after fracture simulation to detect the exact fracture patterns. We used the AO/ASIF recommendations and four-corner concept to classify the achieved fractures by two independent trauma surgeons. All cadaveric specimens could be successfully fractured. 11 fractures were classified as type 23C3.2 and one was classified as type 23C3.3, as additional fracture of diaphysis occurred. Subclassification according to the four-corner concept showed all fractures to be type C. A concomitant ulnar styloid fracture was observed in 4 cases. Furthermore, all cases showed at least one fragment involving the sigmoid notch. There was no statistically significant correlation found regarding Hounsfield Units (HU) and age (p value 0.402), as well as HU and required kinetic energy (p value 0.063). A high energetic impulse induced by a custom-made drop-test bench can successfully simulate realistic distal radius fractures in cadaveric specimens with intact soft tissue. Furthermore, these pre-fractured specimens can be utilized in surgical education to provide a teaching experience as realistic as possible without harming living patients.

Annals for Educators - 2 April 2019.

Annals for Educators - 2 April 2019.

Experience of surgeon in training in COVID Era

I was privileged enough to be in a surgical residency program in an advanced tertiary care hospital under best mentor one can wish for. Early morning ward rounds, daily progress notes, case presentations, and weekend academic seminars were the usual daily routines. Assisting in operation theater, watching seniors doing meticulous surgery, and learning the tips and tricks were my favorite parts of daily routine. There is a saying that “surgeon is a physician who can operate,” but we usually ignored this aspect of surgery. My mentor emphasized the importance of medical and physiological basis of surgery almost on a daily basis.[1] It never felt so important until today. The global coronavirus 2019 (COVID-19) pandemic thwacked nearly every aspect of personal and professional life since the first case was reported in New Delhi on March 2, 2020. In a matter of few days, things changed drastically. Cases were rapidly increasing despite the countrywide lockdown. Being a chirurgien, we were neither trained nor prepared for this unprecedented time. However, emphasis on medical aspects of teaching in surgical patients suddenly became necessary lessons in these times as we were always involved in COVID care directly or indirectly. Inpatient volume reduced as hospitals prepared for the surge of COVID-19 cases and potential reallocation of residents into COVID ward and fever clinic duty. As the number of elective cases dropped, surgical resident duty rosters were modified in a manner to mitigate resident exposure and risk, while also allowing for backup options in case any resident falls ill or comes under quarantine. Surgical cases were restricted to a single resident to preserve personal protection equipment (PPE). Ward rounds include only the necessary personnel in person, and communication is largely moving to electronic forms and daily progress notes are being sent to senior consultants for whetting. Surgical training is a combination of didactic conferences and experiences, as well as hands-on surgical education. When in-person didactics are canceled and surgical volume is significantly reduced, how does a surgical trainee is supposed to fill the deficit? Fortunately, The Association of Colorectal Surgeon of India swiftly and appropriately responded in these unprecedented times by conducting more frequent webinars, video-based education, and virtual simulation for surgical residents. Initially, we were not accustomed to it, but soon, we realized it as an opportunity to embrace technological advances in internet learning and simulation. It does not only help to overcome the deficit in surgical training, but it also helps to fill the gap in academic institutional differences. Despite taking all precautions, I along with one of my resident colleagues came COVID-19 positive in the 3rd week of May 2020. From working as a resident to be admitted as a patient, it was a journey to the other side. My symptoms were mild and resolved soon. Down the road, situations such as COVID-19 will evoke us to reanalyze routines and traditions. What are the new practices that are being innovated during the COVID-19 pandemic can be adopted more broadly to enhance academic and clinical experiences. How new technology and other innovations will serve as a tool for medical care and clinical learning in the future? Likewise, promoting noncontact digital payment methods are now helping us to reduce spread of infection.[2] Surgical education is based upon the strong tradition of passing the beacon of knowledge from one generation to the next. Despite experiencing considerable loss of routines and traditions, educational and hands-on opportunities, loss of social structure, and many witnessing the frequent loss of life, we will continue with unyielding belief on core medical principles, professionalism, altruism, and quality with safety. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Mental Health Hospital Admissions: a Teachable Moment and Window of Opportunity To Promote Change in Drug and Alcohol Misuse

Hospital admissions provide a “teachable moment”. Many patients admitted to mental health hospitals have co-existing substance misuse. As acute symptoms decline, a window of increased insight into factors that contributed to becoming unwell and admission may present. This study used this “teachable” opportunity to assess the acceptability of delivering a brief integrated motivational intervention (BIMI) to inpatients and the feasibility of delivery by inpatient staff. Qualitative interviews were completed with 21 inpatients experiencing co-occurring schizophrenia-related or bipolar disorder diagnoses and substance misuse who received the BIMI. Twelve staff members completed either individual interviews or a focus group. Four themes were identified from the qualitative interviews with participants; these were openness/readiness to talk about substance use, feeling valued, understanding substance use and helpful skills and processes; each with a number of subthemes. Participants appeared to find the intervention useful; although, felt they did not always have the “headspace”. One theme emerged from the staff data, the acceptability of the approach for inpatient ward staff, which had four subthemes; training in the intervention; delivering the intervention; joint working; and feasibility. Staff considered the targeted style of the BIMI useful. Delivery considerations included “timing” and competing ward duties. Hospital admission presents a natural window of opportunity for staff to start conversations with inpatients about substance misuse.

Usefulness of the ACT model for nurses in psychiatric inpatient care: A qualitative content analysis

Alleviating the suffering of patients treated in psychiatric inpatient wards is a great challenge. Preliminary or multiple diagnoses, inherent complexities of the inpatient milieu and the lack of potentially effective psychological treatment form part of this challenge. The present study explored the usefulness of a transdiagnostic psychological treatment model (Acceptance & Commitment Therapy, ACT) as a means of improving inpatient care from the perspective of psychiatric nurses. Nurses (n =10) participated in three ACT workshops, a total of 21h, and were interviewed about the experienced usefulness and difficulties of the ACT model, as a tool for improving everyday ward work. Results, revealed by qualitative content analysis, suggest usefulness in the areas of alleviating patients symptoms, enriching typical ward duties, and handling one's own thoughts and feelings. Difficulties stemmed from lack of time, the model itself and patients’ severe illness. Possible adjustments of the ward context are suggested.

Can Health-care Assistant Training improve the relational care of older people? (CHAT) A development and feasibility study of a complex intervention

BackgroundOlder people account for an increasing proportion of those receiving NHS acute care. The quality of health care delivered to older people has come under increased scrutiny. Health-care assistants (HCAs) provide much of the direct care of older people in hospital. Patients’ experience of care tends to be based on the relational aspects of that care including dignity, empathy and emotional support.Objective(s)We aimed to understand the relational care training needs of HCAs caring for older people, design a relational care training intervention for HCAs and assess the feasibility of a cluster randomised controlled trial to test the new intervention against HCA training as usual (TAU).Design(1) A telephone survey of all NHS hospital trusts in England to assess current HCA training provision, (2) focus groups of older people and carers, (3) semistructured interviews with HCAs and other care staff to establish training needs and inform intervention development and (4) a feasibility cluster randomised controlled trial.Setting(1) All acute NHS hospital trusts in England, and (2–4) three acute NHS hospital trusts in England and the populations they serve.Participants(1) Representatives of 113 out of the total of 161 (70.2%) NHS trusts in England took part in the telephone survey, (2) 29 older people or carer participants in three focus groups, (3) 30 HCA and 24 ‘other staff’ interviewees and (4) 12 wards (four per trust), 112 HCAs, 92 patients during the prerandomisation period and 67 patients during the postrandomisation period.InterventionsFor the feasibility trial, a training intervention (Older People’s Shoes™) for HCAs developed as part of the study was compared with HCA TAU.Main outcome measuresPatient-level outcomes were the experience of emotional care and quality of life during patients’ hospital stay, as measured by the Patient Evaluation of Emotional Care during Hospitalisation and the EuroQol-5 Dimensions questionnaires. HCA outcomes were empathy, as measured by the Toronto Empathy Questionnaire, and attitudes towards older people, as measured by the Age Group Evaluation and Description Inventory. Ward-level outcomes were the quality of HCA–patient interaction, as measured by the Quality of Interaction Scale.Results(1) One-third of trust telephone survey participants reported HCA training content that we considered to be ‘relational care’. Training for HCAs is variable across trusts and is focused on new recruits. The biggest challenge for HCA training is getting HCAs released from ward duties. (2) Older people and carers are aware of the pressures that ward staff are under but good relationships with care staff determine whether or not their experience of hospital is positive. (3) HCAs have training needs related to ‘difficult conversations’ with patients and relatives; they have particular preferences for learning styles that are not always reflected in available training. (4) In the feasibility trial, 187 of the 192 planned ward observation sessions were completed; the response to HCA questionnaires at baseline and at 8 and 12 weeks post randomisation was 64.2%, 46.4% and 35.7%, respectively, and 57.2% of eligible patients returned completed questionnaires.LimitationsThis was an intervention development and feasibility study so no conclusions can be drawn about the clinical effectiveness or cost-effectiveness of the intervention.ConclusionsThe intervention had high acceptability among nurse trainers and HCA learners. Viability of a definitive trial is conditional on overcoming specific methodological (patient recruitment processes) and contextual (involvement of wider ward team) challenges.Future workMethods to ease the burden of questionnaire completion without compromising ethics or methodological rigour need to be explored.Trial registrationCurrent Controlled Trials ISRCTN10385799.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 5, No. 10. See the NIHR Journals Library website for further project information.

Sarah Palin Is My Muse-And Other Lessons Learned From a Sabbatical.

We were given a gift—a sabbatical. For us (2 clinician-educator types at a big medical center) that meant 50% off our full-time responsibilities for a year. No ward attending duties and limited clinic time. Keep up your administrative and educational duties. Go. Create. Flourish. Publish that moldy essay. Go to that funky conference. But . . . do . . . something “academically useful.”For middling career types with hopes of promotion, taking a 12-month nap was not an option. But what to do? Those who had gone before us looked dreamily into the distance. “Ah, yes, I had a sabbatical once . . . I almost finished that paper . . . And there was that great conference in Copenhagen.”One of us vaguely remembered that study about smoking cessation. Weren't you more likely to quit if you told someone about it? Had a specific quit date? Could a sabbatical and nicotine addiction have something in common?We looked into this a bit more. Apparently, the idea of goal setting is gaining traction. There are goal-setting websites where people hold each other accountable to their goals. Real money is on the line—at 1 website it was $22 million.1 The idea is loss aversion: people work harder to avoid losing $50 than they do to gain $50. The website looked easy enough, but who wants 1 more password or 1 more annoying e-mail?We started the sabbatical as 2 clinician-educators with paltry publications. This was our chance to advance our scholarship. We were friendly colleagues, but not exactly friends, who had worked together on a few committees. We took a chance on each other and committed to meet the third Monday of each month at 1 pm. We also committed to making explicit, concrete goals—distinct yes/no-type goals, and we discussed them in detail. “Write more” was amended to “Write 2000 words.” “Work on that presentation” became “Submit that research abstract.”But how to enforce these expectations of our collaboration? Enter not the carrot but the stick: Sarah Palin and the National Rifle Association (NRA). Each month, if we did not reach our goals, we would donate $50 to either Sarah Palin or the NRA. Anonymous donations were not allowed. The image of real and virtual mailboxes filled with solicitations and a lifelong onslaught of e-mails quickened our resolve. One of our wives, nodding her head, quipped, “Oh, honey. . . You shouldn't have. . .” She, too, became invested in our success.Some of our monthly goals were ambitious. “Write 4000 words” (September 2015) was a tall order. Some were more humble: “Actually open the file of that old paper languishing in rejection purgatory and stare at it” (August 2014). Surprisingly, our goals evolved to incorporate more than just academic work. “Go to gym 3 times this week” (February 2015). “Fast on Wednesday and Friday for Lent” (March 2015). We also enjoyed an intellectual renaissance. One of us helped start a monthly discussion group on religion and medicine. Another deepened ties to the palliative care community.Our monthly meetings began with shared accountability, and evolved into collegiality. What began as an exercise to get things done became a renaissance of how to live. At the end of the year, Sarah Palin and the NRA had received zero dollars. We collectively had 7 publications, a handful of abstracts at various meetings, and a few off-campus grand rounds. Oh, yes, and 1 of us did go to a great conference in Copenhagen.

次世代に向けたハイブリッド型薬剤業務の構築

“Additional pharmacist ward operations” were established by revision of the medical payment system in 2012. This new category of operations for pharmacists was established to create a preintervention system for pharmacists by proposals and planning of prescriptions, rather than the conventional system of intervention after prescriptions have been established, in order to achieve appropriate and safe drug therapy in wards. Since April of 2015, pharmacists have been assigned to positions in all wards including the ICU, NICU and GCU in Hokkaido University Hospital.Pharmacists perform duties as part of the medical team in various fields including palliative care, infection control, nutritional support and transplantation therapy.In order for pharmacists to sufficiently provide their expertise, not only standardization and improved efficiency of central duties and expansion of ward duties but also coordination of central, ward and medical team duties are essential. The development of next-generation team medicine (hybrid system) is important. In our hospital, we are aiming to establish a next-generation model for team medicine with a focus on the following three keywords: 1) education (establishment of an education program for newly graduated pharmacists, 2) cooperation (cooperation between ward pharmacists and the medical team), and 3) information and communication technology (efforts to establish an ICT system).Our goal is not to give priority to ward duties but to establish a system for coordination of ward and central pharmacy duties, leading to a paradigm shift from ward duties to clinical care service.

Expected Duties of Pharmacists and Potential Needs of Physicians and Nurses on a Kaifukuki Rehabilitation Ward

This study investigated the required duties of pharmacists in a kaifukuki rehabilitation ward from the viewpoint of the ward physicians and nurses. A questionnaire survey was distributed to 27 facilities with kaifukuki rehabilitation wards. The questionnaire examined which duties the physicians and nurses expected from pharmacists while on the ward (4 areas, 10 items), as well as the time required for pharmacists to carry out those duties. Multivariate analysis was used to investigate which types of work took the most time for pharmacists on kaifukuki rehabilitation wards. Responses were received from 43 physicians and 184 nurses who worked on the kaifukuki rehabilitation wards of 19 facilities. The results revealed that the essential duties performed by pharmacists were the management of medical supplies, instruction on the use of self-medicating drugs at the time of introduction, and monitoring drug side effects. Furthermore, some duties, such as the distribution of medicines and changing or suggesting new drugs, required pharmacists to spend extended time on the ward. The responses indicated that physicians and nurses recognized the necessity for pharmacists to perform ward duties along with their routine work. This study shows that physicians and nurses working in kaifukuki rehabilitation wards demand proactive participation from pharmacists in appropriate medical therapy, such as instruction in the administration of medications and assessment at the time of prescription changes.

Gaps in continuity of care: patients' perceptions of the quality of care during labor ward handover in Mulago hospital, Uganda.

BackgroundClient satisfaction is a common outcome measure for quality of care and goal for quality improvement in healthcare. We assessed women’s perceptions of the structure, process and outcome of intrapartum care in Mulago hospital, specifically, labor ward duty shift handovers.MethodsData was collected through 40 in-depth interviews conducted on two occasions: during the time of hospitalization and within 4–6 months after childbirth. Participants were women who delivered at the hospital, of whom some had life-threatening obstetric complications. Data was analyzed by thematic analysis.ResultsMaternity duty handovers were associated with patient dissatisfaction, particularly the process of hand-over, the decision-making that follows handovers and failure of communication of information to patients and their caretakers. Consequently, duty handovers were perceived inadequate. They were described as gaps in the continuity of care, and contributed to poor quality of care, birth trauma and mothers’ dissatisfaction with the childbirth experience.ConclusionThe handover process and practices should be standardized using protocols and checklists. Health workers need training on handover practices, team work and communication skills (so as to improve patient-health provider and provider-provider interaction.