Improving intravenous fluid prescribing in the Eastern Cape in South Africa
- Luce, Cate, Soffair,Rosie, Parrish, Andy
- Authors: Luce, Cate , Soffair,Rosie , Parrish, Andy
- Date: 2019
- Subjects: South Africa Intravenous fluids Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5120 , vital:44351 , https://doi:10.1136/bmjoq-2018-000406
- Description: Intravenous fluids are an essential component of patient care, but a 2013 National Institute for Health and Care Excellence (NICE) guideline noted that inappropriate prescribing or administration may lead to actual or potential patient harm in up to 20% of patients.1 This project aimed to improve prescribing documentation and communication between nurses and doctors regarding intravenous fluid management. This was done through the introduction of a fluid chart, in combination with teaching on appropriate fluid management. It was initiated within the medical department of Cecelia Makiwane Hospital in East London, South Africa. 309 patients were included and data were analysed over a 6-month period. The outcome measures were the standards of intravenous fluid prescribing set by the NICE guidelines. The process measure was the use of the new chart. Baseline data highlighted that there was no standardised location for fluid prescriptions within the bedside notes. Following the intervention, 81% of fluid prescriptions were on a fluid chart. The percentage of fluid scripts with a 24-hour fluid prescription, a recorded indication and recorded input increased after the intervention. Seventy six per cent of patients received more than 50% of the fluids prescribed following the intervention compared with 22% at baseline. These results indicated an increase in the doctor’s awareness of appropriate fluid prescribing and an improvement in the communication between doctors and nurses regarding the patient’s fluid management. The engagement of local stakeholders and staff was fundamental to the success of the project and allowed for this change in practice. Fluid management is a vital part of care in many specialties; therefore, a toolkit has been created to allow similar quality improvement projects to be implemented across other hospitals around the Eastern Cape.
- Full Text:
- Date Issued: 2019
- Authors: Luce, Cate , Soffair,Rosie , Parrish, Andy
- Date: 2019
- Subjects: South Africa Intravenous fluids Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5120 , vital:44351 , https://doi:10.1136/bmjoq-2018-000406
- Description: Intravenous fluids are an essential component of patient care, but a 2013 National Institute for Health and Care Excellence (NICE) guideline noted that inappropriate prescribing or administration may lead to actual or potential patient harm in up to 20% of patients.1 This project aimed to improve prescribing documentation and communication between nurses and doctors regarding intravenous fluid management. This was done through the introduction of a fluid chart, in combination with teaching on appropriate fluid management. It was initiated within the medical department of Cecelia Makiwane Hospital in East London, South Africa. 309 patients were included and data were analysed over a 6-month period. The outcome measures were the standards of intravenous fluid prescribing set by the NICE guidelines. The process measure was the use of the new chart. Baseline data highlighted that there was no standardised location for fluid prescriptions within the bedside notes. Following the intervention, 81% of fluid prescriptions were on a fluid chart. The percentage of fluid scripts with a 24-hour fluid prescription, a recorded indication and recorded input increased after the intervention. Seventy six per cent of patients received more than 50% of the fluids prescribed following the intervention compared with 22% at baseline. These results indicated an increase in the doctor’s awareness of appropriate fluid prescribing and an improvement in the communication between doctors and nurses regarding the patient’s fluid management. The engagement of local stakeholders and staff was fundamental to the success of the project and allowed for this change in practice. Fluid management is a vital part of care in many specialties; therefore, a toolkit has been created to allow similar quality improvement projects to be implemented across other hospitals around the Eastern Cape.
- Full Text:
- Date Issued: 2019
Improving TB infection control in a regional hospital in the Eastern Cape, South Africa
- Haeusler, Ilsa Louisa, Knights, Felicity, George, Vishaal, Parrish, Andy
- Authors: Haeusler, Ilsa Louisa , Knights, Felicity , George, Vishaal , Parrish, Andy
- Date: 2019
- Subjects: Quality circles Tuberculosis--Prevention Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6399 , vital:45465 , https://doi.org/10.4102/hts.v77i2.6828
- Description: This quality improvement (QI) work was carried out in Cecilia Makiwane Hospital (CMH), a regional public hospital in the Eastern Cape, South Africa (SA). SA has among the highest incidence of tuberculosis (TB) in the world and this is a leading cause of death in SA. Nosocomial infection is an important source of TB transmission. Adherence to TB infection prevention control (IPC) measures in the medical inpatient department was suboptimal at CMH. The overall aim of this QI project was to make sustainable improvements in TB IPC. A multidisciplinary team was formed to undertake a root cause analysis and develop a strategy for change. The main barriers to adherence to IPC measures were limited knowledge of IPC methods and stigma associated with TB. Specifically, the project aimed to increase the number of: ‘airborne precaution’ signs placed above patients’ beds, patients correctly isolated and patients wearing surgical face masks. Four Plan Do-Study-Act cycles were used. The strategy for change involved education and awareness-raising in different formats, including formal in-service training delivered to nurses and doctors, a hospital-wide TB awareness week with engaging activities and competitions, and a World TB Day provincial solidarity march. Data on adherence to the three IPC measures were collected over an 8-month period. Pre-intervention (October 2016), a mean of 2 percent of patients wore face masks, 22 percent were correctly isolated and 12 percent had an airborne precaution sign. Postintervention (May 2017), the compliance improved to 17 percent, 50 percent and 25 percent, respectively. There was a large variation in compliance to each measure. Improvement was greatest in the number of patients correctly isolated. We learnt it is important to work with, not in parallel to, existing teams or structures during QI work. On-the-ground training of nurses and clinicians should be undertaken alongside engagement of senior staff members and managers. This improves the chance of change being adopted into hospital policy.
- Full Text:
- Date Issued: 2019
- Authors: Haeusler, Ilsa Louisa , Knights, Felicity , George, Vishaal , Parrish, Andy
- Date: 2019
- Subjects: Quality circles Tuberculosis--Prevention Computer File
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6399 , vital:45465 , https://doi.org/10.4102/hts.v77i2.6828
- Description: This quality improvement (QI) work was carried out in Cecilia Makiwane Hospital (CMH), a regional public hospital in the Eastern Cape, South Africa (SA). SA has among the highest incidence of tuberculosis (TB) in the world and this is a leading cause of death in SA. Nosocomial infection is an important source of TB transmission. Adherence to TB infection prevention control (IPC) measures in the medical inpatient department was suboptimal at CMH. The overall aim of this QI project was to make sustainable improvements in TB IPC. A multidisciplinary team was formed to undertake a root cause analysis and develop a strategy for change. The main barriers to adherence to IPC measures were limited knowledge of IPC methods and stigma associated with TB. Specifically, the project aimed to increase the number of: ‘airborne precaution’ signs placed above patients’ beds, patients correctly isolated and patients wearing surgical face masks. Four Plan Do-Study-Act cycles were used. The strategy for change involved education and awareness-raising in different formats, including formal in-service training delivered to nurses and doctors, a hospital-wide TB awareness week with engaging activities and competitions, and a World TB Day provincial solidarity march. Data on adherence to the three IPC measures were collected over an 8-month period. Pre-intervention (October 2016), a mean of 2 percent of patients wore face masks, 22 percent were correctly isolated and 12 percent had an airborne precaution sign. Postintervention (May 2017), the compliance improved to 17 percent, 50 percent and 25 percent, respectively. There was a large variation in compliance to each measure. Improvement was greatest in the number of patients correctly isolated. We learnt it is important to work with, not in parallel to, existing teams or structures during QI work. On-the-ground training of nurses and clinicians should be undertaken alongside engagement of senior staff members and managers. This improves the chance of change being adopted into hospital policy.
- Full Text:
- Date Issued: 2019
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