Knowledge management enablers affecting patient care: The perspective of registered nurses in South West Nigeria

Background: The productivity of healthcare institutions is impacted by the nursing workforce and plays a vital role in the provision of effective and efficient patient care. Knowledge management plays a vital role in nursing practice. This study seeks to extend the frontier of knowledge by addressing the paucity of literature on knowledge management in nursing care delivery in Nigeria.Objectives: The study empirically identified crucial knowledge management enablers from extant literature and investigated their influence on patient care in clinical nursing.Method: A cross-sectional survey design using a stratified sampling method was employed. A self-administered questionnaire was used to collect quantitative data from 196 registered nurses in a selected teaching hospital in South West Nigeria. A total of 186 valid responses were analysed using structural equation modelling (SEM).Result: The result of this study indicated that there is a direct and significant relationship between information technology (IT) and patient care. Organisational structure and organisational culture did not directly affect patient care. However, together with IT support, the knowledge management enablers were found to significantly affect patient care in clinical nursing.Conclusion: There is a need for nursing management to develop a flexible organisational structure and knowledge friendly culture including the implementation of functional technical infrastructure, to leverage knowledge management effectiveness in patient care in teaching hospitals in order to facilitate and strengthen service delivery by nurses.

Ethical Perspectives on Costly Drugs and Health Care

High drug prices have created substantial challenges for patients, physicians, health systems, and payers. High drug prices can affect patient care in many ways, including limiting access to treatment, increasing the burden of administrative tasks, and contributing to physician burnout. Exorbitant drug pricing poses direct challenges for distributive justice, which is concerned with fairly distributing benefits and burdens across society. In this position statement, we discuss ethical concerns raised by high drug costs, primarily focusing on concerns around distributive justice. We consider forms of rationing, approaches to allocation, potential complexities in real-life application, and structural forces contributing to high drug costs. Finally, we consider potential policy solutions and ramifications for individual clinicians.

572 Closed-Loop Clinical Audit on Blood Results in Urology Department During Ward Rounds

Aim Clinical governance states that blood results should be flagged during ward rounds to enable better assessment of inpatients. As per our institutional Protocol, each patient is assigned a blood sheet which should be updated every day with outstanding bloods flagged with a circle. The aim of the audit was to evaluate the quality of blood result sheets and to discuss results in order to enhance patient care. Method Data was collected from the Urology ward at Glasgow Royal Infirmary continuously during November 2020. We reviewed the flagging of abnormal bloods and whether clear documentation of baseline eGFR was included. Intervention was carried out by series of discussion with the nursing and the medical staff along with display posters throughout the ward and staff rooms. Results Overall, first cycle assessed 65 folders and second assessed 79. We noticed that the flagging of outstanding blood results increased from 70% to 74%. Documentation of baseline eGFR raised from 32% to 44%. Initially, only 73% of results were appropriately placed in the correct patient nursing folder which improved and reached 100% on review. Conclusions The first cycle of the audit demonstrated serious breach of protocols which could delay and affect patient care. The re-audit cycle post intervention illustrated that active efforts on the part of medical and nursing staff can significantly improve the outcomes. However, sustained intervention in the form of audits and induction program is needed to bring a sustainable change in the departmental practice.

Factors Affecting Secondary Traumatic Stress of Nurses Caring for COVID-19 Patients in South Korea

The secondary traumatic stress (STS) of nurses caring for COVID-19 patients is expected to be high, and it can adversely affect patient care. The purpose of this study was to examine the degree of STS of nurses caring for COVID-19 patients, and we identified various factors that influence STS. This study followed a descriptive design. The data of 136 nurses who had provided direct care to COVID-19 patients from 5 September to 26 September 2020 were collected online. Hierarchical regression analysis was conducted to identify the factors influencing STS. Participants experienced moderate levels of STS. The regression model of Model 1 was statistically significant (F = 6.21, p < 0.001), and the significant factors influencing STS were the duration of care for patients with COVID-19 for more than 30 days (β = 0.28, p < 0.001) and working in an undesignated COVID-19 hospital (β = 0.21, p = 0.038). In Model 2, the factor influencing STS was the support of a friend in the category of social support (β = −0.21, p = 0.039). The nurses caring for COVID-19 patients are experiencing a persistent and moderate level of STS. This study can be used as basic data to treat and prevent STS.

Counting mitoses: SI(ze) matters!

Mitoses are often assessed by pathologists to assist the diagnosis of cancer, and to grade malignancy, informing prognosis. Historically, this has been done by expressing the number of mitoses per n high power fields (HPFs), ignoring the fact that microscope fields may differ substantially, even at the same high power (×400) magnification. Despite a requirement to define HPF size in scientific papers, many authors fail to address this issue adequately. The problem is compounded by the switch to digital pathology systems, where ×400 equivalent fields are rectangular and also vary in the area displayed. The potential for error is considerable, and at times this may affect patient care. This is easily solved by the use of standardized international (SI) units. We, therefore, recommend that features such as mitoses are always counted per mm2, with an indication of the area to be counted and the method used (usually “hotspot” or “average”) to obtain the results.

Building resilient medical technology supply chains with a software bill of materials

An exploited vulnerability in a single software component of healthcare technology can affect patient care. The risk of including third-party software components in healthcare technologies can be managed, in part, by leveraging a software bill of materials (SBOM). Analogous to an ingredients list on food packaging, an SBOM is a list of all included software components. SBOMs provide a transparency mechanism for securing software product supply chains by enabling faster identification and remediation of vulnerabilities, towards the goal of reducing the feasibility of attacks. SBOMs have the potential to benefit all supply chain stakeholders of medical technologies without significantly increasing software production costs. Increasing transparency unlocks and enables trustworthy, resilient, and safer healthcare technologies for all.

A Novel Laboratory Assay to Monitor Unfractionated Heparin Dosing in Patients Taking Apixaban Prior to Hospital Admission

Introduction When monitoring heparin, anti-Xa assays are susceptible to interference from apixaban taken before admission and can result in inappropriate dose adjustments that can negatively affect patient care. Methods We derived a novel assay, termed corrected heparin (CH), using quantified values from a chromogenic anti-Xa assay with heparin calibrators before and after heparinase treatment to eliminate any interference from apixaban within the patient sample. We retrospectively assessed 469 specimens from 72 patients at our institution who had their unfractionated heparin infusion monitored using the CH assay because of known apixaban use. These patients were included in the study if they had detectable apixaban levels (&gt;0.1 IU/mL by anti-Xa). Results The analytical performance of the assay was evaluated, and precision was found to be 8.8% within 1 day and 13.3% over multiple days, with acceptable linearity (R2 = 0.997). Evaluation of clinical performance was compared with the partial thromboplastin time (PTT), showing a lack of correlation similar to comparisons between the PTT and anti-Xa assay (Blood Coagul Fibrinolysis 1993;4:635–8). The mean time to a therapeutic result in this cohort was 10 hours and 10 minutes. The CH assay was used to determine how long the apixaban was detected by the anti-Xa assay. The majority of patients (80%) still had measurable anti-Xa assay interference from apixaban at 24 hours after the last apixaban dose. Conclusions We have developed and evaluated an assay capable of quantifying heparin in the presence of apixaban. This assay showed acceptable performance in both analytical and clinical performance.