Effecting change using careplans: experience from two fractured neck of femur pathways

2012 ◽  
Vol 36 (3) ◽  
pp. 308 ◽  
Author(s):  
Kylie Baker ◽  
Stephen Brierley ◽  
Geoffrey Mitchell ◽  
John Roe
Keyword(s):  
Urinary Catheter ◽  
Catheter Insertion ◽  
Evidence Based ◽  
Clinical Practices ◽  
Fractured Neck Of Femur ◽  
Indwelling Catheter ◽  
Neck Of Femur ◽  
Local Practices ◽  
Management Plans ◽  
Chart Audits

Objective. To use a qualitative track of the effects of two fractured neck of femur careplans (1 & 2) implemented at the Ipswich Emergency Department in 2002 and 2003 in order to comment on the reasons for comparative successes and failures as instruments for change in clinical practice. Careplan 1 was initiated by local clinicians in 2002, rescinded in 2003 to make way for the system wide careplan 2, then informally restituted in 2004 after careplan 2 was withdrawn. Careplan 2 did not articulate specific ED management plans. Method. Biennial retrospective chart audits of two newly introduced evidence-based clinical practices over time was used to track changes from careplan 1. These were the use of regional anaesthesia by medical staff, and the compliance with indwelling urinary catheter insertion by nursing staff. Results. Elements of careplan 1 continued despite lack of promotion. There has been significant increase in nerve block (2.8% to 27%) and indwelling catheter insertion (26% to 75%) from 2000 to 2009. Formal use of careplan 1 has declined to 13–20% in 2009. Careplan 2 was withdrawn for review in 2004. Conclusions. Careplans are one way to effect lasting changes in clinical behaviours which may persist beyond their implementation and promotion phases. For acceptance, corporate plans should incorporate local practices. For longevity, local plans should comply with the corporate vision of continuity of care, but local investment in the plan will facilitate uptake.

scholarly journals COMPARISON OF POSITIVE BACTERIAL CULTURE RATE FROM URINE SPECIMEN AND CATHETER SWAB IN INDWELLING CATHETER PATIENTS

1970 ◽  
Vol 17 (2) ◽  
Author(s):  
Marzuki Yusuf ◽  
Sabilal Alif ◽  
Doddy M Soebadi ◽  
Kartuti Debora ◽  
Widodo J P
Keyword(s):  
Bacterial Culture ◽  
Urinary Catheter ◽  
Catheter Insertion ◽  
Indwelling Catheter ◽  
Positive Bacterial Culture ◽  
Before And After ◽  
Positive Rate ◽  
Urinary Culture ◽  
The Difference ◽  
Culture Positive

Objective: The study aims to study the difference between urinary culture before and after indwelling catheter insertion and also the difference in positive bacterial culture rate between urine and catheter swab at the 7th and 14th days. Material & method: The subject of this study were patients who used indwelling catheters in urology outpatient department. The sample was allocated into two groups of 10 patients each, 7 and 14 days group. Sterile urinary culture was initially checked before catheter insertion. After 7 and 14 days of catheterisation respectively, urine and intraluminal catheter swab were performed upon removal. All samples were examined in Microbiology Department using McConkey and Nutrient agar (Mayo technique – T/T33). After 24 hours incubation, bacterial colonies were identified. Results: All urinary cultures obtained before the study were sterile, after 7 days catheter insertion two cultures (20%) remained negative and the remainder (80%) became positive. McNemar test result was 0,008 (p<0,05). In 14 days group after catheter insertion only one (10%) remained negative while 9 others were positive for bacteria. Mcnemar test shows 0,004 (p<0,05). The urinary and catheter swab culture is not significantly different in 7 days of indwelling catheterization patients (0,500; p>0,05) and also in 14 days patients (1,000, p>0,005). While the catheter swab culture is significantly positive after administering the urinary catheter in 7 and 14 days of catheterization (0,002; p<0,05). Conclusion: There was significant difference in urinary culture positive rate before and after catheter insertion in 7th and 14th day. Bacteriuria rose sharply after urinary catheter insertion despite aseptic procedure. There was no difference in culture positive rate between urine and catheter swab at 7th day as well as 14th day.

Evidence-Based Practice & Practice-Based Evidence Applied to Adult, Medical Speech-Language Pathology

2013 ◽  
Vol 18 (1) ◽  
pp. 14-26 ◽  
Author(s):  
Rik Lemoncello ◽  
Bryan Ness
Keyword(s):  
Evidence Based Practice ◽  
Single Case ◽  
Quality Data ◽  
Evidence Based ◽  
Speech Language Pathology ◽  
Clinical Practices ◽  
High Quality ◽  
Randomized Controlled Clinical Trials ◽  
Relative Paucity ◽  
Language Pathology

In this paper, we review concepts of evidence-based practice (EBP), and provide a discussion of the current limitations of EBP in terms of a relative paucity of efficacy evidence and the limitations of applying findings from randomized controlled clinical trials to individual clinical decisions. We will offer a complementary model of practice-based evidence (PBE) to encourage clinical scientists to design, implement, and evaluate our own clinical practices with high-quality evidence. We will describe two models for conducting PBE: the multiple baseline single-case experimental design and a clinical case study enhanced with generalization and control data probes. Gathering, analyzing, and sharing high-quality data can offer additional support through PBE to support EBP in speech-language pathology. It is our hope that these EBP and PBE strategies will empower clinical scientists to persevere in the quest for best practices.

Trial of Aspirin and RA 233 in Prevention of Post-operative Deep Vein Thrombosis

1973 ◽  
Vol 30 (01) ◽  
pp. 018-024 ◽  
Author(s):  
Edward H. Wood ◽  
Colin R.M. Prentice ◽  
D. Angus McGrouther ◽  
John Sinclair ◽  
George P. McNicol
Keyword(s):  
Deep Vein Thrombosis ◽  
Controlled Trial ◽  
Oral Anticoagulants ◽  
Antithrombotic Agent ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Vein Thrombosis ◽  
Effective Prophylaxis ◽  
Deep Vein ◽  
Calf Vein

SummaryAlthough the oral anticoagulants provide effective prophylaxis against postoperative deep vein thrombosis following fracture of neck of femur there is a need for an antithrombotic agent which needs less laboratory control and does not cause haemorrhagic complications. It has been suggested that drugs causing inhibition of platelet function may fulfil these requirements. A controlled trial was carried out in which aspirin, RA 233, or a combination of these drugs was compared with a placebo in the prevention of post-operative deep vein thrombosis. In thirty patients undergoing surgery for fractured neck of femur the incidence of post-operative calf vein thrombosis, as detected by 125I-fibrinogen scanning, was not significantly different between the untreated and treated groups.

102 Peer Teaching in Hip Fracture: Responding to the Medical Needs of Surgical Patients and Educational Needs of Junior Doctors

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Jones ◽  
J Francis ◽  
R Parikh ◽  
M Shaath
Keyword(s):  
Metastatic Cancer ◽  
Vascular Complications ◽  
Educational Programme ◽  
Junior Doctors ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Teaching Programme ◽  
Medical Needs ◽  
Strongly Agree ◽  
Case Based

Abstract Introduction Fractured Neck of Femur (FNOF) patients are complex. A mortality project identified topics for a peer-led teaching programme. Method Eight bite-sized case-based sessions were devised, to provide a framework to approach the following topics: Anaemia, delirium/dementia, ECG abnormalities, metastatic cancer, osteoporosis, renal disease, respiratory disease, and vascular complications. Attendees were asked to complete pre- and post- teaching programme questionnaires using a Likert Scale to indicate agreement with statements relating to the topic areas chosen (1=strongly disagree and 5=strongly agree). Result Pre-programme questionnaire: respondents were neutral (average 3.04) when asked whether topic areas were currently “well managed”. Attendees lacked confidence, indicating preparedness as neutral (average 3.35). Trainees agreed that they would benefit from teaching (average 4.56). Post-programme questionnaire: increased confidence was reported when considering preparedness (average 4.3). Attendees felt the teaching programme was “accessible” and the “topics well-chosen”. 100% of attendees regarded the teaching as ‘excellent’ or ‘very-good’. Conclusions Matching patient needs to an educational programme is important. The “bite-sized” nature of the programme paired with case-based learning increased confidence. A peer-led teaching programme is a positive response to themes emerging from morbidity and mortality reviews.

scholarly journals Management of Warfarin Anticoagulation in Patients with Fractured Neck of Femur

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Feras Ashouri ◽  
Wissam Al-Jundi ◽  
Akash Patel ◽  
Jitendra Mangwani
Keyword(s):  
Vitamin K ◽  
Hip Fractures ◽  
National Policy ◽  
District General Hospital ◽  
Pharmacological Therapy ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Time To Surgery ◽  
Group A ◽  
Group B

Background. Most orthopaedic units do not have a policy for reversal of anticoagulation in patients with hip fractures. The aim of this study was to examine the current practice in a district general hospital and determine difference in the time to surgery, if any, with cessation of warfarin versus cessation and treatment with vitamin K. Methods. A retrospective review of the case notes between January 2005 and December 2008 identified 1797 patients with fracture neck of femur. Fifty seven (3.2%) patients were on warfarin at the time of admission. Patients were divided into 2 groups (A and B). Group A patients (16/57; 28%) were treated with cessation of warfarin only and group B patients (41; 72%) received pharmacological therapy in addition to stopping warfarin. Time to surgery between the two groups was compared. Results. The mean INR on admission was 2.9 (range 1.7–6.5) and prior to surgery 1.4 (range 1.0–2.1). Thirty eight patients received vitamin K only and 3 patients received fresh frozen plasma and vitamin K. The average time to surgery was 4.4 days in group A and 2.4 days in group B. The difference was statistically significant (P<.01). Conclusion. Reversal of high INR is important to avoid significant delay in surgery. There is a need for a national policy for reversing warfarin anticoagulation in patients with hip fractures requiring surgery. Vitamin K is safe and effective for anticoagulation reversal in hip fracture patients.

Rapid access imaging for occult fractured neck of femur

2014 ◽  
Vol 26 (1) ◽  
pp. 407-410 ◽  
Author(s):  
S. Tiwari ◽  
W. S. De Rover ◽  
S. Dawson ◽  
C. Moran ◽  
O. Sahota
Keyword(s):  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Rapid Access
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