This document discusses several common hospital products that are often used without evidence-based decisions due to assumptions about their low costs and inconsequential impact on budgets. It examines the available evidence on disposable gloves, face masks, and stool softener medications. For each product, it summarizes the existing evidence, provides expert guidelines, and discusses opportunities to optimize usage and potentially reduce costs based on a fuller understanding of the evidence.
Planning the implementation of an EMR or EHR, then you need to understand the basics of defining your clinical workflow. This presentation was made at a variety of medical conferences
How to improve patient flow in emergency and ambulatory care, pop up uni, 10a...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Planning the implementation of an EMR or EHR, then you need to understand the basics of defining your clinical workflow. This presentation was made at a variety of medical conferences
How to improve patient flow in emergency and ambulatory care, pop up uni, 10a...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Building A Global Brand Through Content MarketingLiveWorld
This presentation will discuss how the Cleveland Clinic has established itself as one of the premier healthcare brands in the world through innovative and creative content marketing. Paul Matsen will describe how Cleveland Clinic creates distinctive and trusted content to build awareness, reputation and to generate volume. The Cleveland Clinic has been a leader in digital, social and mobile healthcare marketing and employees a unique mix of paid, earned and owned media to build its brand.
3 Strategies for Maximizing Service Line Efficiency, Quality and ProfitabilityWellbe
Maximizing service line efficiency, quality and profitability is a hot topic, particularly with rising patient care demands, changing reimbursement models, and estimated physician shortfalls. This webinar takes a look at three solutions beginning in the operating room and expanding to the entire patient care journey.
1st solution: A unique clinical and operational service model focused on the specialization of qualified, reimbursable clinical labor to optimize surgeon involvement and reduce OR costs.
2nd solution: Taking a holistic view of the service line through the patient care journey to produce a value stream map to understand the current state. Assisting staff with comparing this current state to the ideal future state, comparing national benchmarks and clinical best practices helps your staff innovate and co-create an individualized plan to get your service line to a higher level.
3rd solution: Utilizing dashboard metrics of the critical to success factors, to sustain and improve your service line.
As a participant, you will be able to:
• Identify key operational and clinical indicators of orthopedic service line efficiency
• Describe how Surgical First Assists can add value in the OR
• List the steps in developing and/or evaluating or building an orthopedic service line
• Describe how metrics/dashboards assist in sustaining change and improvement of orthopedic service line
About the Speaker:
Miki Patterson, PHD ONP, Senior Director of Orthopedics in Intelligent CareDesign at Intralign
Dr. Patterson is a certified orthopedic nurse practitioner and brings over 25 years of clinical experience in healthcare, consulting, direct advanced orthopedic patient care, teaching, NIH level, qualitative and quantitative research and publishing. She is a past president of the National Association of Orthopedic Nurses (NAON) and continues to be nationally recognized for leadership and advancing orthopedic care.
Dr Ian Sturgess: Optimising patient journeysNuffield Trust
In this slideshow Dr Ian Sturgess, Director at IMP Healthcare consultancy, explores how we can better understand admitted flow streams and optimise patient journeys.
Dr Sturgess spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September2014.
Check out the very latest on innovations projects from Australia and around the world....and then there are our bespoke soft skills workshops designed to support managers in VUCA workplaces
We are all engaged in a hospital-wide a system of
patient flow or patient care. We are each part of the
whole. The emergency department is connected
to the ICU. The ICU is connected to the OR. The
discharge and discharge processes are connected
to our admission capabilities and capacity. It’s
like the “Dry Bones” song you learned as a child,
“The foot bone’s connected to the leg bone, the
leg bone’s connected to the knee bone, the knee
bone’s connected to the thigh bone” and so forth.
Overall flow, or “the system,” can only be improved
by applying several key strategic concepts to these
disparate but equal parts.
Do our patients consistently receive evidence-based, effective care every time he or she needs it? This presentation discusses the concepts associated with high reliability:
Change Champions & Associates February 2016 Newsletter sharing innovations in health care from around Australia and NZ
12 pages of the latest innovation news
+
Info about Change Champions forthcoming events with more details at http://www.changechampions.com.au.
The patient handoff is a contemporaneous, interactive process of passing patient-specific information from one caregiver to another to ensure the continuity and safety of patient care. It is well recognized that the handoff is a point of vulnerability where valuable patient information can be distorted and omitted [1, 2]. A plethora of studies in the nursing literature have identified a variety of problems, including incomplete or inaccurate information [3-6], uneven quality [7], repeated interruptions and lack of anticipatory guidance [8]. Many reports have focused on characterizing the weaknesses with non-operative patient handovers, the use of handoff checklists and aviation safety models for specific groups of patients [1,5,9], and the pre- and post-implementation comparisons. [10-12] However, few studies have focused on prospective cohort studies validating and testing patient information management systems such as smart-templates in the setting of handover quality. [10]
Electronic templates containing patient information help to standardize the type of information conveyed during interactions, discourages ambiguous findings,[13] improves provider satisfaction and improves continuity of care.[14] Within the department, we developed the transfer template (T2) to address the issues in provider workflow and efficiency. With the press of a button, the T2 template automatically extracts live information from the anesthetic record, pertinent fields from the PAC note and laboratory values from IView, and provides a concise output of these relevant details.
Building A Global Brand Through Content MarketingLiveWorld
This presentation will discuss how the Cleveland Clinic has established itself as one of the premier healthcare brands in the world through innovative and creative content marketing. Paul Matsen will describe how Cleveland Clinic creates distinctive and trusted content to build awareness, reputation and to generate volume. The Cleveland Clinic has been a leader in digital, social and mobile healthcare marketing and employees a unique mix of paid, earned and owned media to build its brand.
3 Strategies for Maximizing Service Line Efficiency, Quality and ProfitabilityWellbe
Maximizing service line efficiency, quality and profitability is a hot topic, particularly with rising patient care demands, changing reimbursement models, and estimated physician shortfalls. This webinar takes a look at three solutions beginning in the operating room and expanding to the entire patient care journey.
1st solution: A unique clinical and operational service model focused on the specialization of qualified, reimbursable clinical labor to optimize surgeon involvement and reduce OR costs.
2nd solution: Taking a holistic view of the service line through the patient care journey to produce a value stream map to understand the current state. Assisting staff with comparing this current state to the ideal future state, comparing national benchmarks and clinical best practices helps your staff innovate and co-create an individualized plan to get your service line to a higher level.
3rd solution: Utilizing dashboard metrics of the critical to success factors, to sustain and improve your service line.
As a participant, you will be able to:
• Identify key operational and clinical indicators of orthopedic service line efficiency
• Describe how Surgical First Assists can add value in the OR
• List the steps in developing and/or evaluating or building an orthopedic service line
• Describe how metrics/dashboards assist in sustaining change and improvement of orthopedic service line
About the Speaker:
Miki Patterson, PHD ONP, Senior Director of Orthopedics in Intelligent CareDesign at Intralign
Dr. Patterson is a certified orthopedic nurse practitioner and brings over 25 years of clinical experience in healthcare, consulting, direct advanced orthopedic patient care, teaching, NIH level, qualitative and quantitative research and publishing. She is a past president of the National Association of Orthopedic Nurses (NAON) and continues to be nationally recognized for leadership and advancing orthopedic care.
Dr Ian Sturgess: Optimising patient journeysNuffield Trust
In this slideshow Dr Ian Sturgess, Director at IMP Healthcare consultancy, explores how we can better understand admitted flow streams and optimise patient journeys.
Dr Sturgess spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September2014.
Check out the very latest on innovations projects from Australia and around the world....and then there are our bespoke soft skills workshops designed to support managers in VUCA workplaces
We are all engaged in a hospital-wide a system of
patient flow or patient care. We are each part of the
whole. The emergency department is connected
to the ICU. The ICU is connected to the OR. The
discharge and discharge processes are connected
to our admission capabilities and capacity. It’s
like the “Dry Bones” song you learned as a child,
“The foot bone’s connected to the leg bone, the
leg bone’s connected to the knee bone, the knee
bone’s connected to the thigh bone” and so forth.
Overall flow, or “the system,” can only be improved
by applying several key strategic concepts to these
disparate but equal parts.
Do our patients consistently receive evidence-based, effective care every time he or she needs it? This presentation discusses the concepts associated with high reliability:
Change Champions & Associates February 2016 Newsletter sharing innovations in health care from around Australia and NZ
12 pages of the latest innovation news
+
Info about Change Champions forthcoming events with more details at http://www.changechampions.com.au.
The patient handoff is a contemporaneous, interactive process of passing patient-specific information from one caregiver to another to ensure the continuity and safety of patient care. It is well recognized that the handoff is a point of vulnerability where valuable patient information can be distorted and omitted [1, 2]. A plethora of studies in the nursing literature have identified a variety of problems, including incomplete or inaccurate information [3-6], uneven quality [7], repeated interruptions and lack of anticipatory guidance [8]. Many reports have focused on characterizing the weaknesses with non-operative patient handovers, the use of handoff checklists and aviation safety models for specific groups of patients [1,5,9], and the pre- and post-implementation comparisons. [10-12] However, few studies have focused on prospective cohort studies validating and testing patient information management systems such as smart-templates in the setting of handover quality. [10]
Electronic templates containing patient information help to standardize the type of information conveyed during interactions, discourages ambiguous findings,[13] improves provider satisfaction and improves continuity of care.[14] Within the department, we developed the transfer template (T2) to address the issues in provider workflow and efficiency. With the press of a button, the T2 template automatically extracts live information from the anesthetic record, pertinent fields from the PAC note and laboratory values from IView, and provides a concise output of these relevant details.
Building a translational team for impacting public policyPre-Congress Worksh...OARSI
David Hunter MBBS, PhD, FRACP
Florance and Cope Chair of Rheumatology, Professor of Medicine
University of Sydney and Royal North Shore Hospital
Chair, Institute of Bone and Joint Research
Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine
Real-World Evidence: Harnessing Data for Clinical Decision-MakingClinosolIndia
Real-world evidence (RWE) refers to data collected from real-world settings, such as routine clinical practice, electronic health records, claims databases, wearable devices, and patient registries. Harnessing RWE has gained increasing importance in clinical decision-making as it provides valuable insights into the effectiveness, safety, and utilization of medical interventions in real-world patient populations. Here are some key aspects of utilizing RWE in clinical decision-making:
Supplementing Randomized Controlled Trials (RCTs): RWE can complement findings from traditional RCTs by providing a broader understanding of how interventions perform in diverse patient populations, real-world healthcare settings, and long-term follow-up. RWE can provide insights into treatment outcomes, patient adherence, comparative effectiveness, and safety profiles.
Expanded Patient Populations: RCTs often have strict eligibility criteria, leading to a limited representation of the real-world patient population. RWE can include a more diverse range of patients, including those with comorbidities, different demographics, and varying treatment histories. This allows for a better understanding of how interventions work in broader patient populations.
Longitudinal Data and Real-World Outcomes: RWE can capture long-term outcomes and provide insights into the effectiveness and safety of interventions over extended periods. By observing patients in their natural healthcare settings, RWE can assess real-world clinical outcomes, healthcare resource utilization, and patient-reported outcomes.
Comparative Effectiveness Research: RWE enables comparative effectiveness research by comparing multiple interventions, treatment strategies, or healthcare delivery approaches in real-world settings. This helps inform clinical decision-making by evaluating the benefits and risks of different treatment options and understanding their impact on patient outcomes.
Safety Surveillance and Adverse Event Monitoring: RWE can play a vital role in post-marketing surveillance by identifying and monitoring adverse events or safety signals associated with medical interventions in real-world populations. This allows for early detection and investigation of potential safety concerns, leading to timely interventions and improved patient safety.
Health Economics and Outcomes Research (HEOR): RWE can be used to assess the economic impact of interventions, including cost-effectiveness, healthcare resource utilization, and budget impact. This information aids in healthcare decision-making by evaluating the value and sustainability of interventions within the healthcare system.
Data Quality and Methodological Considerations: Ensuring the quality and reliability of RWE is crucial. Rigorous data collection methods, standardized data elements, and appropriate statistical methodologies should be employed. Efforts should be made to address biases, confounding factors, and data limitations inherent in rea
Rising Importance of Health Economics & Outcomes ResearchCitiusTech
Health Economics & Outcomes Research (HE&OR) guides stakeholders to make informed decisions regarding patient access to drugs and services. This document highlights specific use cases for healthcare information technology that add value to HE&OR.
Organisation and Management of Eye Care Programme Service Delivery ModelsHarsh Rastogi
Eye care program management: Efficient models ensure accessibility, quality, and sustainability, promoting community engagement and optimal vision health.
Supporting Cancer Survivors in the Workplace and Managing CostsHuman Capital Media
There are more cancer survivors in the workplace than ever before — and that’s great news. But this poses a growing challenge to employers who are struggling to control health care costs and help their workers lead healthier lives.
There are tools to help employers meet that challenge through benefit design, online resources, wellness programs and other initiatives. Join this webinar to learn how your company can offer support to employees facing a frightening diagnosis and better manage the high cost of treating cancer.
Cancer costs employers an estimated $264 billion a year in medical care and lost productivity. Thanks to medical advancements, the vast majority of the 14 million survivors today return to work, and their numbers are growing.
We'll talk about:
The evolution of cancer in the workplace from taboo topic to public acceptance and awareness.
The latest research on cancer diagnoses and treatment costs.
Innovative approaches to benefit design and managing pharmacy costs.
An overview of "An Employer’s Guide to Cancer Treatment and Prevention,” a toolkit by the National Business Group on Health and the National Comprehensive Cancer Network (NCCN).
Five Data-driven Patient Empowerment StrategiesHealth Catalyst
Data plays a big role toward empowering patients to become more involved in their care. With data, digital tools, and education, patient empowerment can act like a blockbuster drug to produce exceptional outcomes.
Data empowers patients five ways:
Promotes patient engagement.
Produces patient-centered outcomes.
Helps patients practice self-care.
Improves communication with clinicians.
Leads to faster healing and independence.
Clinicians using creative, innovative care strategies, and patients with access to the right tools and technology, can produce remarkable results in terms of cost, health outcomes, and experience.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. Disclosures
• I have no financial disclosures to declare.
• I have been an employee of CADTH for 10 years.
• Cost data shared are all-product combined averages from
available provincial information from 3S Health Shared
Services Saskatchewan and the Ministry of Health (March 2015).
3. Acknowledgements
Suzanne Boudreau-Exner
Director – Materials Management
Services
3S Health Shared Services
Susie Hilton,
Clinical Advisor
3S Health Shared Services
Pamela Bryce
Senior Policy Analyst
Drug Plan & Extended Benefits
Branch, Saskatchewan Health
Susan Yee
Manager - Client Services, Drug
Plan & Extended Benefits Branch,
Saskatchewan Health
Dave Morhart
Director - Client Services, Drug Plan
& Extended Benefits Branch,
Saskatchewan Health
5. Key Messages
• Common hospital products are overlooked for evidence-
based decisions; assumed to be cheap and inconsequential
in budgets.
• So many different products…so little time!
• Many unknowns: state-of-the-evidence, comparative data,
unit costs/patient, and reasons for usage, facility-based
economic analyses
• Absence of evidence does not mean evidence of
absence*
*Altman, D. G. & Bland, J. M. (1995). Absence of evidence is not evidence of absence. British Medical Journal; 311(7003);
485.
7. Discussion In Context
Focus is on:
• “Average” or most-common clients in common (non-specialized) health
care settings such as hospital units, long-term care facilities, community
centres and home usage
• Clients with common medical or surgical conditions with
usual/uncomplicated healing trajectory
• Standard usage rates and approved quantities for insurable benefits for
clients; known (documented) health care professionals and personal
care giver usage rates
8. What do we expect from evidence?
Source: http://ebp.lib.uic.edu/dentistry/?q=node/12
HTA
“health technology assessment”
9. Single-use disposable gloves
• No higher-pyramid evidence available showing:
• Safety differences, standardized clinical or cost-effectiveness across
products, allergy-potential comparison, effectiveness to prevent
pathogen transmission, or evidence-informed duration of use for
latex versus non-latex gloves.
• effects of prolonged usage, impact of perspiration or salts
• Moderate-lower pyramid evidence showing*:
• No difference in touch sensitivity or psychomotor performance
between latex and nitrile gloves;
• Comfort rating differences across health care professionals
• Latex gloves may be more resistant to punctures
• Vinyl gloves permeability to cytotoxic agents
*CADTH Rapid Response (2013). Disposable Gloves for Use in Healthcare Settings: A Review of the Clinical
Effectiveness, Safety, Cost-Effectiveness, and Guidelines http://www.bit.ly/1H6aCnW
10. Gloving Recommendations- WHO
• The World Health Organization
(WHO)* indications guide for
standard usage
• WHO loosely estimates usage
as 20-60 pairs of gloves used
daily by each health care
worker worldwide in clinical
care settings.
• Estimated Cost:
$ 0.07/glove**
*World Health Organization (2014) http://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf.
** 3S Health Shared Services (Saskatchewan) Average procurement pricing for health care facility usage.
11. The Client at Home
A 3 month supply issued to individuals registered in the paraplegia program*
eligible for coverage for disposable gloves used by clients at home:
Oct – Dec 2014 Non-Sterile Glove Usage N = 275
# of Individual Gloves Used 86,110
Average Price Per Glove $0.13
Average # Used Per Individual in 3 month timeframe 313
Average # Gloves Used per Day Per Person 4
Total Cost for Coverage - 3 month $10,983
* Drug Plan & Extended Benefits Branch, Saskatchewan Health
12. Single-use disposable polypropylene
pleated face masks
There is no higher-pyramid evidence showing:
• Effectiveness of surgical face masks to protect from infectious material in
ORs or other controlled settings;
• Cross-brand comparative fluid or droplet permeability rates
• Safe wearability length of time to ensure personal protection***
Lower pyramid evidence suggests*:
• General benefit derived from wearing masks in health settings to reduce
acute bacterial transmission from staff-to-patients and patients-to-staff
• Lifespan recommendations for some products
Expert consensus without supporting evidence**:
• When masks have become damp, visibly soiled, or contaminated they are no
longer deemed effective; recommend to always change between patients
(IOM)
*CADTH Rapid Response (2013). Use of Surgical Masks in the Operating Room: A Review http://bit.ly/196aOVy
**Institute of Medicine IOM (US). Reusability of facemasks during an influenza pandemic. Washington: 2006
***Derrick JL, Gomersall ,CD. Protecting healthcare staff from severe acute respiratory syndrome: filtration capacity
of multiple surgical masks Hosp Infect. 2005 Apr; 59 (4):365-8.
13. Masking Recommendations- CDC
• Single-use disposable pleated polypropylene face masks are one of
many options of personal protective equipment (PPE)*
• Recommendations are for general for common or routine usage
• Recommendations for masks that cover both nose and mouth during
procedures and patient-care activities that are likely to generate
splashes or sprays of blood or body fluids.
• Cost: $0.15 per mask; No average usage estimates
* 2013 Centers for Disease Control and Prevention: http://www.cdc.gov
14. Call for evidence – Face masks
• Re-validation* that concepts of face mask usage more are entrenched
in clinical practice routines and trust that they prevent against airborne
transmission.
• Issues are more complex than initially thought...
• Facemasks plus gloves and/or regular hand hygiene may better
prevent infection in community settings.
• Respirators vs masks? No evidence
• Cloth masks? Not recommended
• Health economic analyses? Scarce
* MacIntyre, C. R. & Chughtai, A. A. (2015) Facemasks for the prevention of infection in healthcare and
community settings. BMJ; 350. http://www.bmj.com/content/350/bmj.h694 Published April 9, 2015
15. Stool softener medications
Docusate salts (sodium and calcium) are widely available, over-the-counter
medications classified as stool softeners. Their surfactant mechanism of action
has been (theoretically) believed to keep stool pliable and prevents straining
during defecation.
There is limited moderate-high pyramid evidence showing:
• Stool softener products do not increase stool frequency or soften stools
compared with placebo.
• They do not improve the symptoms of constipation.
• They do not improve the difficulties or completeness of stool evacuation in
patients taking opioids.
No rational argument for use of docusate in hospitalized patients or long-term care
residents.
* CADTH Rapid Response (2014). Dioctyl Sulfosuccinate or Docusate (Calcium or Sodium) for the
Prevention or Management of Constipation: A Review of the Clinical Effectiveness
http://bit.ly/1MR8IWR
16. Reduced Usage Recommendations
– Alberta Health Services
• In 2013 there were over 2.1 million doses of 100mg given to
patients within Alberta Health Services*.
• Based on an estimated cost of $0.26/tablet (OTC estimated
cost*), Docusate sodium (Colace) may in fact reflect
“money flushed down the toilet” **
* Pasay, D. (2014). Drug & Therapeutics Backgrounder – Stool Softeners: Why are they still being used? Alberta
Health Services.
** Mann, J. & Greenwood-Dufour, B. (2014) Docusate for constipation: money down the toilet?
http://hospitalnews.com/docusate-constipation-money-toilet/
17. So what?
Awareness of the state-of-the-evidence, existence of comparative data,
and actual unit costs can:
• Help to support optimal usage decisions
• Potentially mitigate against “hype” and assumed knowledge when
definitive high pyramid evidence is not available*
• Potentially assist in managing ever-increasing hospital medical
supply budgets
There is value in knowing & talking about the unmentionables!
*Altman, D. G. & Bland, J. M. (1995). Absence of evidence is not evidence of absence. British Medical Journal; 311(7003);
485.
Editor's Notes
Why are we exploring/presenting on this topic?
Our customers are asking
Our customers are increasingly aware
While they are not new and sexy, these unmentionable items make a substantive budgetary impact.
Does not reflect any specific vendor or manufacturing group.
I will not be mentioning any specific vendors or manufacturing companies in this presentation.
I will be quoting or referencing procurement groups, insured benefits programs, and USA-based HMO and guidance groups whereby their information is readily available from their respective websites.
Acknowledgement for their support of this presentation and sharing of provincial costs on the unmentionables.
It is not just about hospital usage of products, but also about the impact on insurable benefits programs
There are so many, and we take them for granted in virtually any/all health care setting. They also make up a good part of our home-based first-aid kits and in our bathroom drawers if we have experienced a health care issue whereby self-management of wounds, surgical incisions, drains, catheters or other devices required our attention either short or long term. For some, they are the compression stockings, the walkers/canes, the gauze and the tensor bandages we need. For others, they are the adult incontinence products, saline flush syringes, common face masks and even medications we take (either by prescription of over the counter) such as antacids and stool softeners.
Common hospital products --- overlooked
No evidence, assumed to be cheap
In 2004, (Manager-CCU), my unit operating budget included cost-centre lines exceeding $200,000.00 annually; most managers take these for granted. I also had in excess of 5 different types of gloves, 4 different types of masks available in my unit, primarily due to physician or staff preference or general availability. I can also advise that our CCU had chosen different gloves and masks to stock on our shelves…different than other adjacent units leading to lack of consistency, and surreptitious access to our supplies by others in the building.
The unmentionables remind that absence of evidence does not mean products are ineffective or shouldn’t be used*…. So shouldn’t we make an effort to be aware of the value and costs of our large volume consumables?
For the sake of time, I have arbitrarily chosen 3 unmentionable products to illustrate.
Common non-sterile vinyl gloves available in every hospital location, home care/public health units, easily purchasable in every large-chain drug store across the country.
Secondly, standard-issue polypropylene face masks
Lastly, a pharmacologic product type (family) ---- stool softeners
I will try and illustrate 3 things:
The evidence available to help inform us
The guidelines and advice (not evidence based) that we rely on
The estimated costs we are incurring from usage
Note: I am not encouraging reduced usage through this presentation…. Just awareness and renewed interest in appropriateness….. The right product for the right reasons
8
THE SO WHAT? While we are not likely to change gloving habits or protocols or use less, we could sure use research to help us determine comparative value for usage and more importantly, APPROPRIATE USAGE of specialty products emerging in health care.
CDC recommendations outlined here are for NON-INFLUENZA and not H1N1! They represent general mask recommendations
Consider the condition!
Disposable pleased polypropylene face masks are readily available everywhere and suggested to be affordable by CDC
THE SO-WHAT? Comparative evidence and an awareness of cost and efficacy can help us choose wisely as to which type of mask to use in what clinical situation as part of PPE
It’s never a bad thing to put on a mask…either for yourself as protection, or for patient protection from you, but the availability of evidence to reassure and validate usage becomes a bit eye-opening….
This begs the discussion of why docusate products are prescribed on practically all standing orders in all hospitals across Canada either PRN or by scheduled order, and patients often receive subsidiary prescriptions for same upon discharge, or from primary care prescribers.
Absence of evidence is not evidence of absence (Altman)