Monitoring lithium therapy: the impact of a quality improvement programme in the UK

2013 ◽  
Vol 15 (8) ◽  
pp. 865-875 ◽  
Author(s):  
Carol Paton ◽  
Roma Adroer ◽  
Thomas RE Barnes
Keyword(s):  
Quality Improvement ◽  
Lithium Therapy ◽  
Quality Improvement Programme ◽  
Improvement Programme ◽  
The Uk ◽  
The Impact

scholarly journals High-dose and combination antipsychotic prescribing in acute adult wards in the UK: The challenges posed by p.r.n. prescribing

2008 ◽  
Vol 192 (6) ◽  
pp. 435-439 ◽  
Author(s):  
Carol Paton ◽  
Thomas R. E. Barnes ◽  
Mary-Rose Cavanagh ◽  
David Taylor ◽  
Paul Lelliott
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Clinical Guidelines ◽  
Standard Dose ◽  
High Dose ◽  
Quality Improvement Programme ◽  
Prescribing Practice ◽  
Improvement Programme ◽  
Antipsychotic Prescribing ◽  
The Uk

BackgroundClinical guidelines recommend the routine use of a single antipsychotic drug in a standard dose, but prescriptions for high-dose and combined antipsychotics are common in clinical practice.AimsTo evaluate the effectiveness of a quality improvement programme in reducing the prevalence of high-dose and combined antipsychotic prescribing in acute adult in-patient wards in the UK.MethodBaseline audit was followed by feedback of benchmarked data and delivery of a range of bespoke change interventions, and then by a further audit 1 year later.ResultsThirty-two services participated, submitting data for 3942 patients at baseline and 3271 patients at the 1-year audit. There was little change in the prevalence of high-dose (baseline 36%; re-audit 34%) or combined antipsychotic prescribing (baseline 43%; re-audit 39%). As required (‘p.r.n.’) prescriptions were the principal cause of both high-dose and combined antipsychotic prescribing on both occasions.ConclusionsThe quality improvement programme did not have a demonstrable impact on prescribing practice in the majority of services. Future efforts to align practice with clinical guidelines need to specifically target the culture and practice of p.r.n. prescribing.

scholarly journals Managing antibiotics wisely: a quality improvement programme in a tertiary neonatal unit in the UK

2018 ◽  
Vol 7 (2) ◽  
pp. e000285 ◽  
Author(s):  
Vasiliki Makri ◽  
Gemma Davies ◽  
Stephanie Cannell ◽  
Katherine Willson ◽  
Lucy Winterson ◽  
...  
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Antibiotic Stewardship ◽  
Adverse Outcomes ◽  
Neonatal Unit ◽  
Antibiotic Overuse ◽  
Quality Improvement Programme ◽  
Sustained Reduction ◽  
Improvement Programme ◽  
The Uk

Microbial resistance to antibiotics is a serious global health problem compounded by antibiotic overuse and limited investment in new antibiotic research. Inappropriate perinatal antibiotic exposure is increasingly linked to lifelong adverse outcomes through its impact on the developing microbiome. Antibiotic stewardship may be the only effective preventative strategy currently available. As the first tertiary neonatal unit in the UK to collaborate in an international quality improvement programme (QIP) with Vermont Oxford Network (VON), we present the results of our antibiotic stewardship initiative.The QIP was officially launched in January 2016 and aimed to reduce antibiotic usage rate (AUR) by 20% of baseline by 31st December 2016 without compromising patient safety. A multidisciplinary team of professionals and parent representatives shared good practices and improvement strategies through international webinars and local meetings, devised uniform data collection methodology and implemented a number of carefully selected ‘Plan–Do–Study–Act’ cycles. Run charts were used to present data and, where appropriate, statistical analysis undertaken to compare outcomes.The QIP resulted in a sustained reduction in AUR from a baseline median of 347 to 198 per 1000 patient-days (a reduction of 43%). The proportion of culture-negative sepsis screens where antibiotics were stopped within 36–48 hours increased consistently from a baseline of 32.5% to 91%. The antibiotic days per patient at discharge reduced from a median of 3 to 2 days, and there was a reduction in practice variation. Our annual mortality and necrotising enterocolitis rates for the VON cohort (<30 weeks or <1500 g) were the best ever recorded, 5.5% and 1.4%, respectively. Audits confirmed a high level of staff and family awareness of the QIP.The QIP achieved a sustained reduction in antibiotic use without compromising patient safety. Our challenge is to sustain this improvement safely.

scholarly journals Impact and feasibility of a tailor-made patient communication quality improvement programme for hospital-based physiotherapists: a mixed-methods study

2021 ◽  
Vol 10 (2) ◽  
pp. e001286
Author(s):  
Rudi A Steenbruggen ◽  
Linda AG van Heusden-Scholtalbers ◽  
Thomas J Hoogeboom ◽  
Marjo Maas ◽  
Paul Brand ◽  
...  
Keyword(s):  
Professional Development ◽  
Quality Improvement ◽  
Mixed Methods ◽  
Patient Communication ◽  
Mixed Methods Study ◽  
Barriers And Facilitators ◽  
Added Value ◽  
Quality Improvement Programme ◽  
Improvement Programme ◽  
The Impact

BackgroundIn tailoring a quality improvement programme for hospital-based physiotherapy, the original use of video recordings was replaced by using the tracer methodology.ObjectiveTo examine the impact of a tailor-made quality improvement programme addressing patient communication on the professional development of hospital-based physiotherapists, and to evaluate barriers and facilitators as determinants of feasibility of the programme.MethodsA mixed-methods study was conducted. Participants were clustered in groups per hospital and linked with an equally sized group in a nearby hospital. Within the groups, fixed couples carried out a 2-hour tracer by directly observing each other’s daily work routine. This procedure was repeated 6 months later. Data from feedback forms were analysed quantitatively, and a thematic analysis of transcripts from group interviews was conducted.ResultsFifty hospital-based physiotherapists from 16 hospitals participated. They rated the impact of the programme on professional development, on a scale from 1 (much improvement needed) to 5 (no improvement needed), as 3.99 (SD 0.64) after the first tracer and 4.32 (SD 0.63) 6 months later; a mean improvement of 0.33 (95% CI 0.16 to 0.50). Participants scored, on a scale ranging from 1 to 5 on barriers and facilitators (feasibility), a mean of 3.45 (SD 0.95) on determinants of innovation, 3.47 (SD 0.86) on probability to use and 2.63 (SD 1.07) on the user feedback list. All participants emphasised the added value of the tracer methodology and mentioned effects on self-reflection and awareness most.ConclusionsThe tailor-made quality improvement programme, based on principles of the tracer methodology, was associated with a significant impact on professional development. Barriers and facilitators as determinants of feasibility of the programme showed the programme being feasible.

Antenatal magnesium sulfate to prevent cerebral palsy

2021 ◽  
pp. fetalneonatal-2021-321817
Author(s):  
Amy K Keir ◽  
Emily Shepherd ◽  
Sarah McIntyre ◽  
Alice Rumbold ◽  
Charlotte Groves ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Quality Improvement ◽  
Magnesium Sulfate ◽  
Perinatal Care ◽  
Quality Improvement Programme ◽  
Baseline Rate ◽  
Local Quality ◽  
Improvement Programme ◽  
The Impact

Magnesium sulfate given to women before birth at <30 weeks’ gestation reduces the risk of cerebral palsy in their children. Our study aimed to assess the impact of a local quality improvement programme, primarily using plan-do-study-act cycles, to increase the use of antenatal magnesium sulfate. After implementing our quality improvement programme, an average of 86% of babies delivered at <30 weeks’ gestation were exposed to antenatal magnesium sulfate compared with a historical baseline rate of 63%. Our study strengthens the case for embedding quality improvement programmes in maternal perinatal care to reduce the impact of cerebral palsy on families and society.

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
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