Optimalisasi Nursing Handover di Rumah Sakit Swasta Banjarmasin

Penyebaran Covid-19 menjadikan permasalahan serius yang berdampak pada perubahan sistem pelayanan di rumah sakit. Menjadi tantangan bagi perawat jika selalu melaksanakan handover di samping tempat tidur pasien karena berisiko tinggi terpapar Covid-19. Tujuan program adalah optimalisasi nursing handover masa pandemi untuk tetap menjamin efektifitas kesinambungan perawatan tanpa mengesampingkan prinsip patient safety. Program ini dirancang dengan mengadakan workshop untuk perawat dan pendampingan pelaksanaan di rawat inap percontohan di rumah sakit swasata Banjarmasin. Bedside handover di kamar pasien saat pandemi dilakukan kurang dari 2 menit demi menjaga kepuasan pasien namun tetap meminimalkan waktu kontak dengan pasien. Formulir handover tidak hanya diterapkan untuk ruang rawat inap, tetapi juga untuk ruang-ruangan lain yang berkaitan dengan tindakan pasien. Pentingnya pelaksanaan dan dokumentasi nursing handover adalah untuk menjamin aspek legal etik asuhan keperawatan. Saran yang diharapkan adalah peningkatan kegiatan supervisi keperawatan untuk menjamin pelaksanaan nursing handover tetap sesuai dengan standar yang ditetapkan. Rumah sakit disarankan mengembangkan dokumentasi asuhan keperawatan digital guna menyikapi tantangan new normal.

161. The Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use: Antibiotic Stewardship Intervention in 389 United States Ambulatory Practices during the COVID-19 Pandemic

Background The AHRQ Safety Program for Improving Antibiotic Use aimed to improve antibiotic use by engaging clinicians and staff to incorporate antibiotic stewardship (AS) into practice culture, communication, and decision making. We report on changes in visits and antibiotic prescribing in AHRQ Safety Program ambulatory practices during the COVID-19 pandemic. Methods The Safety Program used webinars, audio presentations, educational tools, and office hours to engage clinician champions and staff leaders to: (a) address attitudes and culture that pose challenges to judicious antibiotic prescribing and (b) incorporate best practices for the management of common infections into their workflow using the Four Moments of Antibiotic Decision Making framework. Total visits (in-person and virtual), acute respiratory infection (ARI) visits, and antibiotic prescribing data were collected. Using linear mixed models to account for random effects of participating practices and repeated measurements of outcomes within practices over time, data from the pre-intervention period (September-November 2019) and the Ambulatory Care Safety Program (December 2019-November 2020) were compared. Results Of 467 practices enrolled, 389 (83%) completed the program, including 162 primary care practices (42%; 23 [6%] pediatric), 160 urgent care practices (41%; 40 [10%] pediatric), and 49 federally-supported practices (13%). 292 practices submitted complete data for analysis, including 6,590,485 visits. Visits/practice-month declined March-May 2020 but gradually returned to baseline by program end (Figure 1). Total antibiotic prescribing declined by 9 prescriptions/100 visits (95% CI: -10 to -8). ARI visits/practice-month declined significantly in March-May 2020, then increased but remained below baseline by program end (Figure 2). ARI-related antibiotic prescriptions decreased by 15/100 ARI visits by program end (95% CI: -17 to -12). The greatest reduction was in penicillin class prescriptions with a reduction of 7/100 ARI visits by program end (95% CI: -9 to -6). Conclusion During the COVID-19 pandemic, a national ambulatory AS program was associated with declines in overall and ARI-related antibiotic prescribing. Disclosures Pranita Tamma, MD, MHS, Nothing to disclose Sara E. Cosgrove, MD, MS, Basilea (Individual(s) Involved: Self): Consultant Jeffrey A. Linder, MD, MPH, FACP, Amgen (Shareholder)Biogen (Shareholder)Eli Lilly (Shareholder)

Ensuring the safety of construction facilities: economic, environmental and managerial components

The article considers the directions of ensuring the safety of construction objects in the economic, ecological and managerial context. The authors noted that the lack of safety during construction work is a serious problem in this industry. The implementation of the safety program has always been one of the most successful measures to reduce the number of accidents in construction. However, it should be borne in mind that ensuring safety in construction should be based both on competent management of the construction project implementation and on the corresponding economic component, since labor protection management will be effective only if its system is based on coordinated actions of specialists in this field and is supported by appropriate financial costs aimed at financing measures to reduce the impact of negative factors affecting the process of ensuring labor safety on the construction site.