Introduction and aimsConcerns had been raised at clinical governance regarding the safety of our inpatient ward rounds with particular reference to: documentation of clinical observations and National Early Warning Score (NEWS), compliance with Trust guidance for venous thromboembolism (VTE) risk assessment, antibiotic stewardship, palliative care and treatment escalation plans (TEP). This quality improvement project was conceived to ensure these parameters were considered and documented during the ward round, thereby improving patient care and safety. These parameters were based on Trust patient safety guidance and CQUIN targets.MethodThe quality improvement technique of plan–do–study–act (PDSA) was used in this project. We retrospectively reviewed ward round entries to record baseline measurements, based on the above described parameters, prior to making any changes. Following this, the change applied was the introduction of a ward round template to include the highlighted important baseline parameters. Monthly PDSA cycles are performed, and baseline measurements are re-examined, then relevant changes were made to the ward round template.Summary of resultsDocumentation of baseline measurements was poor prior to introduction of the ward round template; this improved significantly following introduction of a standardised ward round template. Following three cycles, documentation of VTE risk assessments increased from 14% to 92%. Antibiotic stewardship documentation went from 0% to 100%. Use of the TEP form went from 29% to 78%.ConclusionsFollowing introduction of the ward round template, compliance improved significantly in all safety parameters. Important safety measures being discussed on ward rounds will lead to enhanced patient safety and will improve compliance to Trust guidance and comissioning for quality and innovation (CQUIN) targets. Ongoing change implementation will focus on improving compliance with usage of the template on all urology ward rounds.
ConclusionWe have really enjoyed these meals and they have really helped us get through a set of nights feeling as healthy as possible. We have had really good feedback from trainees that these meals seem healthier and more homely than previous microwave meals they have had, as well as a positive reaction to the sustainable ethos of the project. We look forward to gathering and sharing more feedback from doctors and Food Works.We believe this initiative can be rolled out to the wider hospital, improving the wellbeing of other staff groups, and eventually improving the wellbeing of the families we look after.
M s. B was middle-aged and lying on a gurney without a sheet in the grossly under-resourced ED of the largest public hospital in Phnom Penh, Cambodia. She clearly had an altered level of consciousness, and she was not attached to the monitor that was behind the bed.Her open shirt exposed her to the entire ED, but her family had other concerns.They were quick to leave as we made our way toward the bed. It became evident that she had not been seen by a doctor, despite her deteriorating condition and her family's persistent anxiety. We saw her chest rise and fall irregularly with fast, shallow breaths.Her glassy eyes failed to meet ours as we attempted to introduce ourselves.We rapidly assessed her condition while auscultating her chest. Her lung sounds were not normal. We heard an extra noise upon closer listen; it was similar to a heartbeat, just at the tail end of her expiration. Uncertain of what it was, we auscultated once more, closing our eyes to block out the surrounding mayhem. Her breathing became more labored until it dramatically slowed. That extra sound was still there, but her respirations were agonal. We held our breath as we waited for her chest to rise again. We listened once more, this time unable to identify a heartbeat.We felt for a pulse, struggling to identify its presence because of the girth of her neck. We watched as her heart came to a stop. It was disturbing to realize that we, the most inexperienced people in the room, had recognized a critical situation and needed to act. Her family watched what must have appeared to be an assault on their mother as we began resuscitation and chest compressions. No local staff had discussed the care plan with the family, who only spoke Khmer. Instead, Ms. B's family stood stunned at the pace at which she appeared to deteriorate. A crowd of medical students and nurses quickly circled the bed, yet most were merely observing. They were apprehensive and unsure of how to help.This was unsurprising, given that Cambodian medical and nursing students' knowledge of chest compressions was based solely on textbook learning; they had never practiced on a manikin, much less a live patient. The ED's main physician was nowhere to be seen, which added to the chaos of the situation. Because there was no functioning monitor, we couldn't get a blood pressure or cardiac rhythm for Ms. B, and not one nurse or staff had bothered to call another department for ECG stickers or a defibrillator or a physician with knowledge of advanced life support.It was baffling to us that none of these items or a physician was readily available in the ED. Chest compressions were performed in a chaotic manner because many were struggling with basic techniques and required simultaneous instruction. Medical staff did not know to move when it was time to switch compressions, which resulted in lots of pushing people out of the way. Two doctors finally arrived: One was feeling for a pulse during compressions, while the other, who was in charge of medications, quickly left without a word. No one was ...
between attitudes towards sexual minorities and gender minorities.Results n = 16 after responses were collected, a ~50% response rate from the department's staff of physicians.Respondents universally were aware of common terminology around sexuality ('gay', 'lesbian' etc.) and used it in conversation. Their attitudes to LGB (lesbian, gay or bisexual) people were universally positive.Attitudes towards gender minorities were also overwhelmingly positive. Further, 94% agreed they knew about using the correct names/pronouns for patients as well as misgendering. 69% said that they were aware of what 'intersex' means.Respodents almost universally agreed that they would be comfortable to take a history or perform a physical examination of an LGB or transgender patient.13% felt that taking a history would be harder for LGB patients when none thought that a physical examination would be more challenging. Contrast this to 19% and 31% respectively for transgender patients.Respondents were less confident with health issues that could specifically affect LGB patients, only 63% agreeing, and transgender/intersex patients, with only 44% agreeing. Only 19% agreed they were aware of the potential interactions of transition therapy.30% agreed that they had undertaken training for treating the needs of LGBTQ patients specifically. No respondents disagreed with the statement that they would like to learn about more resources for LGBTQ patients. Conclusion This demonstrates that clinician attitudes were exemplary.Problems identified were perceived ability and knowledge to properly care for LGBTQ patients, particularly gender minorities, with the potential for training to reinforce physicians' ability.
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