Quality improvement programme to improve compliance with initial respiratory support guideline at preterm birth

2019 ◽  
Vol 109 (5) ◽  
pp. 943-947 ◽  
Author(s):  
Emily S. Hoyle ◽  
Francesca Patino ◽  
Charles W. Yoxall
Keyword(s):  
Quality Improvement ◽  
Preterm Birth ◽  
Respiratory Support ◽  
Quality Improvement Programme ◽  
Improve Compliance ◽  
Improvement Programme

scholarly journals Can we improve the prescribing and delivery of oxygen on a respiratory ward in accordance with new British Thoracic Society oxygen guidelines?

2018 ◽  
Vol 7 (4) ◽  
pp. e000371 ◽  
Author(s):  
Aklak Choudhury ◽  
Gregor Young ◽  
Beshoy Reyad ◽  
Nirali Shah ◽  
Radhea Rahman
Keyword(s):  
Quality Improvement ◽  
Oxygen Saturation ◽  
Oxygen Delivery ◽  
British Thoracic Society ◽  
Quality Improvement Programme ◽  
Acute Medical Unit ◽  
Improve Compliance ◽  
Patients At Risk ◽  
Improvement Programme ◽  
Key Steps

The British Thoracic Society recommends oxygen delivery to achieve target oxygen saturation range between 94% and 98% for medically unwell adult patients, and 88% to 92% in patients at risk of hypercapnic respiratory failure. Interviews with our medical and nursing staff suggested that oxygen was sometimes being given to patients without a valid order and there was a failure to titrate oxygen to the stated oxygen saturation range. Our aim was to improve appropriate oxygen delivery to 90% of our patients on a 30-bedded respiratory ward within 3 months. We identified several key steps to safe oxygen delivery on our ward. These include the recording of target oxygen saturation range, the prescribing of an oxygen order on drug chart and the correct bedside delivery of oxygen to the patient. To help improve compliance of these key steps, the following plan-do-study-act (PDSA) interventions were undertaken: (1) Educational announcements at board rounds. (2) A communication oxygen poster. (3) Highlighting improvement progress to teams via email. (4) Pharmacist review of inpatient drug chart. (5) Display of target oxygen saturation range at patient bedside. At baseline, only 50% of drug charts had a recorded oxygen order and 60% of drug charts had a set target oxygen saturation range. Following PDSA interventions, both measures improved to 93%. Our main outcome measure of appropriate oxygen delivery to the patient improved from a baseline of 20% to 80% on completion. Our quality improvement programme has shown simple interventions can improve oxygen prescribing and appropriate delivery of oxygen to the patient. The most effective PDSA interventions were sharing our measurements via email and displaying target oxygen saturation ranges by the patient bedside. We aim to provide future oxygen educational sessions at induction to our staff and scale our quality improvement programme to other wards including our acute medical unit.

Quality improvement programme to increase the rate of deferred cord clamping at preterm birth using the Lifestart trolley

2020 ◽  
Vol 105 (6) ◽  
pp. 652-655
Author(s):  
Emily Suzanne Hoyle ◽  
Sunaya Hirani ◽  
Sally Ogden ◽  
Jenna Deeming ◽  
Charles William Yoxall
Keyword(s):  
Quality Improvement ◽  
Preterm Birth ◽  
Preterm Infants ◽  
Premature Infants ◽  
Instructional Video ◽  
Hospital Policy ◽  
Quality Improvement Programme ◽  
Cord Clamping ◽  
Improvement Programme ◽  
To Receive

AimTo increase the documented use of the Lifestart trolley to allow premature infants’ (<32 weeks’ gestation) resuscitation and stabilisation with an intact umbilical cord at delivery.DesignA 13-month quality improvement programme from April 2018 to April 2019 was undertaken using Plan, Do, Study and Act (PDSA) cycles. Data were reviewed from 113 consecutive preterm (<32 weeks) deliveries to identify whether Lifestart was used and whether 2 min deferred cord clamping (DCC) occurred in eligible infants as per hospital policy. Episodes of non-compliance were analysed, causes established and interventions implemented to reduce similar future non-compliance. Data collected were presented graphically and included in alternate monthly newsletters to staff, which also included lessons learnt from the reviews of non-compliance.ResultsDocumented use of the Lifestart rose from 10% at the start of the project to 79% in the final month. Not all babies are eligible for DCC. Within this project, 40 (35%) of preterm infants were not eligible to receive DCC. Of those that were eligible, the rate of DCC increased from 17% in the first 3 months to 92% in the last 3 months of the project (p<0.0001).Implications and relevanceBy undertaking regular PDSA cycles and improving education surrounding importance of DCC, we have noted a significant improvement in the use of Lifestart, which in turn facilitates DCC.The learning from this project has been used to create an instructional video to help maintain the improved compliance rates.

scholarly journals Each baby counts: National quality improvement programme to reduce intrapartum-related deaths and brain injuries in term babies

2017 ◽  
Vol 22 (3) ◽  
pp. 193-198 ◽  
Author(s):  
Louise Robertson ◽  
Hannah Knight ◽  
Edward Prosser Snelling ◽  
Emily Petch ◽  
Marian Knight ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Brain Injuries ◽  
Quality Improvement Programme ◽  
National Quality ◽  
Improvement Programme

scholarly journals Identifying effective pathways in a successful continuous quality improvement programme: the GEDAPS study

2014 ◽  
Vol 20 (6) ◽  
pp. 1137-1143 ◽  
Author(s):  
Danielle H. Bodicoat ◽  
Xavier Mundet ◽  
Laura J. Gray ◽  
Xavier Cos ◽  
Melanie J. Davies ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Continuous Quality Improvement ◽  
Quality Improvement Programme ◽  
Continuous Quality ◽  
Improvement Programme

A quality improvement programme to reduce pressure ulcers

2015 ◽  
Vol 29 (46) ◽  
pp. 62-70 ◽  
Author(s):  
Nicola Heywood ◽  
Lisa Brown ◽  
Michaela Arrowsmith ◽  
Alexa Poppleston
Keyword(s):  
Quality Improvement ◽  
Pressure Ulcers ◽  
Quality Improvement Programme ◽  
Improvement Programme

Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis

2021 ◽  
pp. bmjqs-2021-013110
Author(s):  
Sanjay Mahant ◽  
Jun Guan ◽  
Jessie Zhang ◽  
Sima Gandhi ◽  
Evan Jon Propst ◽  
...  
Keyword(s):  
Time Series ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Health System ◽  
Interrupted Time Series ◽  
Improve Quality ◽  
Interrupted Time Series Analysis ◽  
Quality Improvement Programme ◽  
Improvement Programme

BackgroundTonsillectomy is among the most common and cumulatively expensive surgical procedures in children, with known variations in quality of care. However, evidence on health system interventions to improve quality of care is limited. The Quality-Based Procedures (QBP) programme in Ontario, Canada, introduced fixed episode hospital payment per tonsillectomy and disseminated a perioperative care pathway. We determined the association of this payment and quality improvement programme with tonsillectomy quality of care.MethodsInterrupted time series analysis of children undergoing elective tonsillectomy at community and children’s hospitals in Ontario in the QBP period (1 April 2014 to 31 December 2018) and the pre-QBP period (1 January 2009 to 31 January 2014) using health administrative data. We compared the age-standardised and sex-standardised rates for all-cause tonsillectomy-related revisits within 30 days, opioid prescription fills within 30 days and index tonsillectomy inpatient admission.Results111 411 children underwent tonsillectomy: 51 967 in the QBP period and 59 444 in the pre-QBP period (annual median number of hospitals, 86 (range 77–93)). Following QBP programme implementation, revisit rates decreased for all-cause tonsillectomy-related revisits (0.48 to −0.18 revisits per 1000 tonsillectomies per month; difference −0.66 revisits per 1000 tonsillectomies per month (95% CI −0.97 to −0.34); p<0.0001). Codeine prescription fill rate continued to decrease but at a slower rate (−4.81 to −0.11 prescriptions per 1000 tonsillectomies per month; difference 4.69 (95% CI 3.60 to 5.79) prescriptions per 1000 tonsillectomies per month; p<0.0001). The index tonsillectomy inpatient admission rate decreased (1.12 to 0.23 admissions per 1000 tonsillectomies per month; difference −0.89 (95% CI −1.33 to −0.44) admissions per 1000 tonsillectomies per month; p<0.0001).ConclusionsThe payment and quality improvement programme was associated with several improvements in quality of care. These findings may inform jurisdictions planning health system interventions to improve quality of care for tonsillectomy and other paediatric procedures.

scholarly journals Exploring clinicians’ perspectives on the ‘Obstetric Anal Sphincter Injury Care Bundle’ national quality improvement programme: a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e035674 ◽  
Author(s):  
Posy Bidwell ◽  
Ranee Thakar ◽  
Ipek Gurol-Urganci ◽  
James M Harris ◽  
Louise Silverton ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Focus Groups ◽  
Anal Sphincter ◽  
Implementation Strategies ◽  
Care Bundle ◽  
Quality Improvement Programme ◽  
Anal Sphincter Injury ◽  
National Quality ◽  
Registration Number ◽  
Improvement Programme

IntroductionObstetric anal sphincter injuries (OASI) can have severe debilitating consequences to women and health systems. The OASI Care Bundle quality improvement programme was introduced in 16 maternity units across England, Scotland and Wales (January 2017 to March 2018) to address increasing OASI rates.ObjectivesTo explore clinicians’ (midwives’ and obstetricians’) perspectives of the OASI Care Bundle with respect to (1) acceptability, (2) feasibility, and (3) sustainability.DesignA qualitative exploratory study using focus groups methodology.SettingA total of 16 focus groups were conducted in 16 maternity units in England, Scotland and Wales where the OASI Care Bundle was implemented. Focus groups took place approximately 3 months following initial implementation of the care bundle in each unit.ParticipantsA total of 101 clinicians participated, with an average of six per focus group. Participants volunteered to take part and compromised of 37 obstetricians and 64 midwives (including eight students). The majority were female and the mean age was 36.5 years.ResultsFour main themes emerged: ‘Implementation strategies’, ‘Opportunities to use the OASI Care Bundle’, ‘Does current practice need to change?’ and ‘Perceptions of what women want’. Midwives were more likely than obstetricians to report themes alluding to ‘what women want’ and variations in intrapartum perineal protection techniques. Both professional groups reported similar views of other themes, in particular regarding the supporting clinical evidence. Gaps were identified in clinicians’ knowledge and experience of intrapartum perineal management.ConclusionsAdoption of the OASI Care Bundle was associated with a number of cognitive and interpersonal factors, such as personal values, interprofessional working and how the intervention was launched; which both facilitated and impeded adoption. The ‘what women want’ theme has implications for maternal autonomy and needs further exploration. Our findings can be used by similar initiatives to reduce perineal trauma both nationally and internationally.Trial registration numberISCTRN 12143325; https://doi.org/10.1186/ISRCTN12143325.

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