This document summarizes a quality improvement project on IV tubing compliance at Toledo Hospital. Data was collected from three units on the 6th floor through questionnaires and observations. Compliance with labeling of IV catheters, primary tubing, secondary tubing, and fluid bags was found to be low. Follow up questionnaires identified potential solutions like reminder signs and bundled kits. Financial analysis found noncompliance leads to unnecessary costs and infection risks. Recommendations include ensuring adequate supplies, auditing, and staff education to improve compliance and patient safety.
Usefulness of reverse screening algorithm in the diagnosis of syphilisApollo Hospitals
Worldwide two strategies are followed to diagnose syphilis. One is conventional method of testing the serum by non-specific treponemal test VDRL followed by specific Treponemal Pallidum Hemagglutination Assay (TPHA). The other method is vice-versa. We aim to study the percentage of syphilis case detection rate by both the methods.
The document discusses several studies related to antimicrobial resistance and infection prevention and control in nursing homes. A study from Hong Kong found an overall MDRO colonization rate of 35.1% among nursing home residents, with MRSA and CRAB being the most common. Another study identified risk factors for CRAB and MRSA colonization like being bed-bound or incontinent. Additional studies discussed interventions to reduce MRSA, C. difficile, and infections in nursing homes through improved antimicrobial stewardship, isolation protocols, hand hygiene programs, and screening practices. However, it was noted that nursing homes often lack dedicated infection prevention resources and have difficulty implementing comprehensive control programs.
1) The 6S trial was a randomized controlled trial that compared 6% hydroxyethyl starch 130/0.42 in Ringer's acetate versus Ringer's acetate alone for fluid resuscitation in 800 ICU patients with severe sepsis.
2) The trial found no difference in 90-day mortality between the groups but found that hydroxyethyl starch was associated with more renal replacement therapy use and bleeding events.
3) Based on this trial and other evidence, hydroxyethyl starch does not appear to be a safe choice for fluid resuscitation in sepsis given the increased risks of renal failure and bleeding without proven survival benefits over crystalloids.
The document traces the evidence around the use of hydroxyethyl starch (HES) in critical care from early reviews showing potential benefits to large trials published in 2012-2013 that associated HES with increased mortality and renal failure risk in sepsis patients, leading major clinical guidelines to recommend avoiding HES in high-risk patients like those with severe sepsis. While early evidence suggested HES may be useful for volume resuscitation, later trials involving thousands more patients established the risks of HES outweigh any potential benefits in critically ill populations. Questions remain around the safety and efficacy of low-dose HES for low-acuity non-sepsis
This document summarizes a study that tested over 2,000 patients for hepatitis C virus (HCV) at a primary care clinic in Washington D.C. between 2012-2015. The study found a HCV prevalence of 7.5%, higher than national rates. Non-Hispanic black males had the highest prevalence at 12.8%. While linkage to care for HCV-positive patients was strong, overall testing uptake remained low at 24% despite efforts to encourage more screening. Barriers to increased screening need to be addressed to improve identification of undiagnosed cases.
AHP Unscheduled Care Event 2019 (Morning Session)AHPScot
The document discusses the vital role that allied health professionals (AHPs) play in unscheduled care. It notes that AHPs are an essential group that can support six essential actions to improve unscheduled care. The document highlights several ways that AHPs can make a difference at various points along the patient journey from the ambulance service through the acute setting. It also discusses some of the challenges around patient flow and reasons for delays in discharging patients. Overall, the document emphasizes the importance of AHPs and having the right staff with the right skills in the right places to effectively support patients through the unscheduled care pathway.
Introduction to Critical Appraisal 2015Meguid Nahas
This document outlines the critical appraisal process for evaluating clinical evidence from medical literature. It discusses key aspects of validity, including proper randomization, blinding, sample size estimation, and intention-to-treat analysis. It also addresses utility and whether results can be applied to local populations. The document provides examples of appraising studies on new treatments for chronic kidney disease and examines considerations like surrogate endpoints, statistical versus clinical significance, and assessing risks and benefits.
Usefulness of reverse screening algorithm in the diagnosis of syphilisApollo Hospitals
Worldwide two strategies are followed to diagnose syphilis. One is conventional method of testing the serum by non-specific treponemal test VDRL followed by specific Treponemal Pallidum Hemagglutination Assay (TPHA). The other method is vice-versa. We aim to study the percentage of syphilis case detection rate by both the methods.
The document discusses several studies related to antimicrobial resistance and infection prevention and control in nursing homes. A study from Hong Kong found an overall MDRO colonization rate of 35.1% among nursing home residents, with MRSA and CRAB being the most common. Another study identified risk factors for CRAB and MRSA colonization like being bed-bound or incontinent. Additional studies discussed interventions to reduce MRSA, C. difficile, and infections in nursing homes through improved antimicrobial stewardship, isolation protocols, hand hygiene programs, and screening practices. However, it was noted that nursing homes often lack dedicated infection prevention resources and have difficulty implementing comprehensive control programs.
1) The 6S trial was a randomized controlled trial that compared 6% hydroxyethyl starch 130/0.42 in Ringer's acetate versus Ringer's acetate alone for fluid resuscitation in 800 ICU patients with severe sepsis.
2) The trial found no difference in 90-day mortality between the groups but found that hydroxyethyl starch was associated with more renal replacement therapy use and bleeding events.
3) Based on this trial and other evidence, hydroxyethyl starch does not appear to be a safe choice for fluid resuscitation in sepsis given the increased risks of renal failure and bleeding without proven survival benefits over crystalloids.
The document traces the evidence around the use of hydroxyethyl starch (HES) in critical care from early reviews showing potential benefits to large trials published in 2012-2013 that associated HES with increased mortality and renal failure risk in sepsis patients, leading major clinical guidelines to recommend avoiding HES in high-risk patients like those with severe sepsis. While early evidence suggested HES may be useful for volume resuscitation, later trials involving thousands more patients established the risks of HES outweigh any potential benefits in critically ill populations. Questions remain around the safety and efficacy of low-dose HES for low-acuity non-sepsis
This document summarizes a study that tested over 2,000 patients for hepatitis C virus (HCV) at a primary care clinic in Washington D.C. between 2012-2015. The study found a HCV prevalence of 7.5%, higher than national rates. Non-Hispanic black males had the highest prevalence at 12.8%. While linkage to care for HCV-positive patients was strong, overall testing uptake remained low at 24% despite efforts to encourage more screening. Barriers to increased screening need to be addressed to improve identification of undiagnosed cases.
AHP Unscheduled Care Event 2019 (Morning Session)AHPScot
The document discusses the vital role that allied health professionals (AHPs) play in unscheduled care. It notes that AHPs are an essential group that can support six essential actions to improve unscheduled care. The document highlights several ways that AHPs can make a difference at various points along the patient journey from the ambulance service through the acute setting. It also discusses some of the challenges around patient flow and reasons for delays in discharging patients. Overall, the document emphasizes the importance of AHPs and having the right staff with the right skills in the right places to effectively support patients through the unscheduled care pathway.
Introduction to Critical Appraisal 2015Meguid Nahas
This document outlines the critical appraisal process for evaluating clinical evidence from medical literature. It discusses key aspects of validity, including proper randomization, blinding, sample size estimation, and intention-to-treat analysis. It also addresses utility and whether results can be applied to local populations. The document provides examples of appraising studies on new treatments for chronic kidney disease and examines considerations like surrogate endpoints, statistical versus clinical significance, and assessing risks and benefits.
Balanced crystalloids were compared to saline for intravenous fluid administration in critically ill adults. The study involved over 15,000 patients randomized to receive either balanced crystalloids or saline. The primary outcome was a composite of death, new renal replacement therapy, or persistent renal dysfunction within 30 days. Fewer patients who received balanced crystalloids developed hyperchloremia or acidosis. The use of balanced crystalloids resulted in a 1.1 percentage point lower rate of reaching the primary outcome compared to saline.
Biostatistics in development of Medical Devices By T. Mudde - Clinquest (Qser...qserveconference2013
The document discusses guidelines and considerations for clinical investigations of medical devices, focusing on the role of biostatistics in evaluating safety and effectiveness. It outlines statistical aspects that should be addressed in a clinical investigation plan and protocol, including study objectives, design, analyses, and handling of issues like missing data and sample size calculations. Interactive aspects between biostatisticians and sponsors are also covered, such as balancing precision and bias in study design and choice of endpoints.
This document discusses predicting patient risk of acquiring Klebsiella pneumoniae carbapenemase producing organisms (KCPO) and linking environmental exposure to patient acquisition. It describes developing a patient risk model using a case-control approach and clinical and demographic data. A naïve Bayesian model was built and validated, showing an AUC of 0.746. It then analyzes the impact of positive room environments on patient infection using a treatment effects model, controlling for patient risk and length of stay. The results show room positivity is significantly associated with acquisition of infection, with an odds ratio of 22.25. Ultimately, interventions like hopper covers and heater traps reduced environmental transmission.
Ht ai 2015 poster 238 - Efficiency of the Artificial Urinary SphincterREBRATSoficial
The document summarizes research on the artificial urinary sphincter (AS) for treating urinary incontinence following prostatectomy. It finds that while AS has success rates of around 79% and patient satisfaction, the evidence is limited as only one randomized controlled trial exists. Systematic reviews call for more studies directly comparing AS to other surgical therapies. Health technology assessments in Brazil did not recommend AS for public insurance due to low evidence, but private insurance does cover it. More high-quality research is needed to determine the effectiveness and costs of AS versus other options.
1) The speaker discusses the evidence and guidelines for treating sepsis put forth by the Surviving Sepsis Campaign (SSC), noting that while some elements like antibiotics are strongly evidenced, other physiological targets like CVP are weakly evidenced and may not be suitable for all patients.
2) Compliance with SSC bundles is low even in committed institutions, suggesting the guidelines are difficult to follow or clinicians disagree with some aspects.
3) Attempts to protocolize care need to allow clinical judgment based on the individual patient's full clinical picture rather than strict adherence to bundles.
A forensic analysis of the FEAST trial - Kathryn Maitland - SSAI2017scanFOAM
A talk by Kathryn Maitland at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
Challenging clinical trials: Why doesn't early goal-directed therapy work? De...scanFOAM
A talk by Derek Angus at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
This randomized controlled trial tested the effectiveness of topical kanuka honey for treating rosacea. 138 adults with rosacea were randomly assigned to apply either a cream containing 90% kanuka honey and 10% glycerin or a control cream twice daily for 8 weeks. The primary outcome was the proportion of participants who had at least a 2-point improvement on a 7-point scale assessing rosacea severity at week 8. Secondary outcomes included changes in the severity scale and participant-rated improvement scores at weeks 2 and 8. Results showed a greater proportion of the honey group achieved the primary outcome compared to the control group. The honey group also had greater improvements than the control group on the secondary outcome measures at both time points
Patients prescribed novel oral anticoagulants (NOACs) in University Hospital Limerick were generally elderly with moderate risk of stroke and bleeding. Adherence to NOAC dosing guidelines was 68.2% and adherence to prescribing restrictions was 58.3%. Risk assessment scores were rarely documented and clinical decision making was not well documented. The study found significant non-compliance with NOAC dosing guidelines and prescribing restrictions, highlighting the need for improved risk assessment, documentation and guideline adherence when prescribing NOACs.
Recommendations on ISR in multi‐analyte assays, QA/bioanalytical consultants ...Wei Garofolo
The 5th Global CRO Council for Bioanalysis (GCC) meeting, held in Barcelona, Spain, in November 2011, provided a unique opportunity for CRO leaders to openly share opinions, perspectives and to agree on bioanalytical recommendations on incurred sample reproducibility in multi-analyte assays, regulation of quality assurance/bioanalytical consultants and regulatory requirements for GCP.
Recommendations on biomarker bioanalytical method validation by GCC (Global C...Wei Garofolo
The 5th GCC in Barcelona (Spain) and 6th GCC in San Antonio (TX, USA) closed forums provided a unique opportunity for CRO leaders to openly share opinions and perspectives, and to agree upon recommendations on biomarker bioanalytical method validation.
This document summarizes the results of a journal club presentation on using stellate ganglion block (SGB) to treat electrical storm. The following key points were discussed:
1. SGB significantly reduced the number of ventricular arrhythmia episodes and defibrillator shocks per day compared to before SGB.
2. The efficacy of SGB in reducing arrhythmias was independent of left ventricular function, presence or type of cardiomyopathy, and subtype of ventricular arrhythmia.
3. While SGB shows promise as an effective treatment for electrical storm, larger prospective randomized studies are still needed due to limitations of current retrospective studies.
A empresa de tecnologia anunciou um novo produto, um smartphone com câmera de alta resolução e bateria de longa duração. O aparelho também possui armazenamento expansível e processador rápido. O lançamento está programado para o final do ano com preço inicial sugerido de US$799.
The document discusses UX design at DealerSocket. It defines UX design and explains why it matters through three key points: user experience equals customer experience, good UX leads to more revenue, and mobile devices have raised user expectations. It then outlines the UX design process, including analyzing user needs, conceptualizing, prototyping, validating designs through user testing, and iterating based on feedback. The document also discusses UX deliverables like wireframes, style guides, and a component library. Finally, it emphasizes that everyone at the company can influence and is responsible for the user experience, and should advocate for customers.
Kelly Daza presenta su información personal. Ella proviene de Leiva, Nariño y actualmente estudia Licenciatura en Atención a la Primera Infancia en la Universidad Autónoma del Cauca. Completó parte de sus estudios primarios en Leiva y el resto en Puerto Asís, Putumayo, mientras que su bachillerato lo realizó en Popayán, Cauca. Vive con sus padres y su hermano.
El documento describe varias reglas de seguridad e higiene para equipos de computo. Explica que la limpieza física interna es importante para prevenir la acumulación de polvo y huevos de insectos, los cuales pueden ocasionar fallas eléctricas. También menciona que es importante realizar mantenimiento preventivo periódicamente para corregir fallas de manera oportuna y extender la vida útil del equipo.
HIPAA: How to avoid becoming a worst case scenario ContentBacon
Tom Murphy is an experienced risk management consultant who provides guidance to medical professionals and entities on risk and claims management. He has over 30 years of experience in these areas. Katherine Becker is an associate consultant at Acevedo Consulting who has legal and healthcare compliance experience. She advises clients on HIPAA, Medicare, Medicaid and other regulatory issues. The presentation discusses common HIPAA compliance issues like having updated policies, justifying fees for patient records, securing protected health information, and using business associate agreements. It emphasizes reviewing practices from an audit perspective and training staff on policies to avoid penalties from regulatory agencies for violations.
Universal Design for Learning (UDL) aims to remove barriers for all students and allow them to reach their full learning potential by designing curriculums and lessons that provide multiple means of representation, expression, and engagement. Essential components of UDL include setting clear learning goals, understanding student barriers, activating prior knowledge through various formats, allowing choice in how students demonstrate knowledge, and providing timely feedback. Examples of applying UDL principles in an online lesson include giving students options for presentation format, presenting information in various media, permitting revisions based on feedback, and grouping for discussion.
Este guiso de atún a la mexicana es rápido, sabroso y nutritivo. Se prepara friendo cebolla y jitomate en aceite, agregando atún desmenuzado y sazonando con sal, pimienta y chile. Se cocina a fuego medio hasta que el atún esté caliente y los sabores se hayan integrado.
Este documento presenta una introducción a tres áreas de la psicología: la psicología infantil, la psicología social y la psicología jurídica. La psicología infantil estudia el desarrollo de los niños. La psicología social examina la interacción entre individuos y su entorno social. La psicología jurídica implica el estudio del comportamiento legal y los factores psicológicos relacionados con el sistema de justicia.
La comunidad primitiva se basaba en la caza, recolección y propiedad comunal. Los hombres dependían directamente de la naturaleza para satisfacer sus necesidades básicas. Con el tiempo, mejoraron sus herramientas de piedra y desarrollaron una división rudimentaria del trabajo según sexo y edad. Eventualmente surgieron excedentes de producción y el trueque, dando paso a sociedades más complejas.
This document is a curriculum vitae for Muhammad Zubair Noor. It provides his personal details such as name, date of birth, contact information, education history, and work experience. Currently, he works as a Project Engineer for Canadian Engineering Projects in Saudi Arabia, where he is responsible for supervising construction of a commercial building project. Previously he has worked on other construction projects in Pakistan, holding roles such as QA/QC Engineer and QA Inspector. His professional qualifications include a BSC in civil engineering and he has knowledge of software like AutoCAD.
Balanced crystalloids were compared to saline for intravenous fluid administration in critically ill adults. The study involved over 15,000 patients randomized to receive either balanced crystalloids or saline. The primary outcome was a composite of death, new renal replacement therapy, or persistent renal dysfunction within 30 days. Fewer patients who received balanced crystalloids developed hyperchloremia or acidosis. The use of balanced crystalloids resulted in a 1.1 percentage point lower rate of reaching the primary outcome compared to saline.
Biostatistics in development of Medical Devices By T. Mudde - Clinquest (Qser...qserveconference2013
The document discusses guidelines and considerations for clinical investigations of medical devices, focusing on the role of biostatistics in evaluating safety and effectiveness. It outlines statistical aspects that should be addressed in a clinical investigation plan and protocol, including study objectives, design, analyses, and handling of issues like missing data and sample size calculations. Interactive aspects between biostatisticians and sponsors are also covered, such as balancing precision and bias in study design and choice of endpoints.
This document discusses predicting patient risk of acquiring Klebsiella pneumoniae carbapenemase producing organisms (KCPO) and linking environmental exposure to patient acquisition. It describes developing a patient risk model using a case-control approach and clinical and demographic data. A naïve Bayesian model was built and validated, showing an AUC of 0.746. It then analyzes the impact of positive room environments on patient infection using a treatment effects model, controlling for patient risk and length of stay. The results show room positivity is significantly associated with acquisition of infection, with an odds ratio of 22.25. Ultimately, interventions like hopper covers and heater traps reduced environmental transmission.
Ht ai 2015 poster 238 - Efficiency of the Artificial Urinary SphincterREBRATSoficial
The document summarizes research on the artificial urinary sphincter (AS) for treating urinary incontinence following prostatectomy. It finds that while AS has success rates of around 79% and patient satisfaction, the evidence is limited as only one randomized controlled trial exists. Systematic reviews call for more studies directly comparing AS to other surgical therapies. Health technology assessments in Brazil did not recommend AS for public insurance due to low evidence, but private insurance does cover it. More high-quality research is needed to determine the effectiveness and costs of AS versus other options.
1) The speaker discusses the evidence and guidelines for treating sepsis put forth by the Surviving Sepsis Campaign (SSC), noting that while some elements like antibiotics are strongly evidenced, other physiological targets like CVP are weakly evidenced and may not be suitable for all patients.
2) Compliance with SSC bundles is low even in committed institutions, suggesting the guidelines are difficult to follow or clinicians disagree with some aspects.
3) Attempts to protocolize care need to allow clinical judgment based on the individual patient's full clinical picture rather than strict adherence to bundles.
A forensic analysis of the FEAST trial - Kathryn Maitland - SSAI2017scanFOAM
A talk by Kathryn Maitland at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
Challenging clinical trials: Why doesn't early goal-directed therapy work? De...scanFOAM
A talk by Derek Angus at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
This randomized controlled trial tested the effectiveness of topical kanuka honey for treating rosacea. 138 adults with rosacea were randomly assigned to apply either a cream containing 90% kanuka honey and 10% glycerin or a control cream twice daily for 8 weeks. The primary outcome was the proportion of participants who had at least a 2-point improvement on a 7-point scale assessing rosacea severity at week 8. Secondary outcomes included changes in the severity scale and participant-rated improvement scores at weeks 2 and 8. Results showed a greater proportion of the honey group achieved the primary outcome compared to the control group. The honey group also had greater improvements than the control group on the secondary outcome measures at both time points
Patients prescribed novel oral anticoagulants (NOACs) in University Hospital Limerick were generally elderly with moderate risk of stroke and bleeding. Adherence to NOAC dosing guidelines was 68.2% and adherence to prescribing restrictions was 58.3%. Risk assessment scores were rarely documented and clinical decision making was not well documented. The study found significant non-compliance with NOAC dosing guidelines and prescribing restrictions, highlighting the need for improved risk assessment, documentation and guideline adherence when prescribing NOACs.
Recommendations on ISR in multi‐analyte assays, QA/bioanalytical consultants ...Wei Garofolo
The 5th Global CRO Council for Bioanalysis (GCC) meeting, held in Barcelona, Spain, in November 2011, provided a unique opportunity for CRO leaders to openly share opinions, perspectives and to agree on bioanalytical recommendations on incurred sample reproducibility in multi-analyte assays, regulation of quality assurance/bioanalytical consultants and regulatory requirements for GCP.
Recommendations on biomarker bioanalytical method validation by GCC (Global C...Wei Garofolo
The 5th GCC in Barcelona (Spain) and 6th GCC in San Antonio (TX, USA) closed forums provided a unique opportunity for CRO leaders to openly share opinions and perspectives, and to agree upon recommendations on biomarker bioanalytical method validation.
This document summarizes the results of a journal club presentation on using stellate ganglion block (SGB) to treat electrical storm. The following key points were discussed:
1. SGB significantly reduced the number of ventricular arrhythmia episodes and defibrillator shocks per day compared to before SGB.
2. The efficacy of SGB in reducing arrhythmias was independent of left ventricular function, presence or type of cardiomyopathy, and subtype of ventricular arrhythmia.
3. While SGB shows promise as an effective treatment for electrical storm, larger prospective randomized studies are still needed due to limitations of current retrospective studies.
A empresa de tecnologia anunciou um novo produto, um smartphone com câmera de alta resolução e bateria de longa duração. O aparelho também possui armazenamento expansível e processador rápido. O lançamento está programado para o final do ano com preço inicial sugerido de US$799.
The document discusses UX design at DealerSocket. It defines UX design and explains why it matters through three key points: user experience equals customer experience, good UX leads to more revenue, and mobile devices have raised user expectations. It then outlines the UX design process, including analyzing user needs, conceptualizing, prototyping, validating designs through user testing, and iterating based on feedback. The document also discusses UX deliverables like wireframes, style guides, and a component library. Finally, it emphasizes that everyone at the company can influence and is responsible for the user experience, and should advocate for customers.
Kelly Daza presenta su información personal. Ella proviene de Leiva, Nariño y actualmente estudia Licenciatura en Atención a la Primera Infancia en la Universidad Autónoma del Cauca. Completó parte de sus estudios primarios en Leiva y el resto en Puerto Asís, Putumayo, mientras que su bachillerato lo realizó en Popayán, Cauca. Vive con sus padres y su hermano.
El documento describe varias reglas de seguridad e higiene para equipos de computo. Explica que la limpieza física interna es importante para prevenir la acumulación de polvo y huevos de insectos, los cuales pueden ocasionar fallas eléctricas. También menciona que es importante realizar mantenimiento preventivo periódicamente para corregir fallas de manera oportuna y extender la vida útil del equipo.
HIPAA: How to avoid becoming a worst case scenario ContentBacon
Tom Murphy is an experienced risk management consultant who provides guidance to medical professionals and entities on risk and claims management. He has over 30 years of experience in these areas. Katherine Becker is an associate consultant at Acevedo Consulting who has legal and healthcare compliance experience. She advises clients on HIPAA, Medicare, Medicaid and other regulatory issues. The presentation discusses common HIPAA compliance issues like having updated policies, justifying fees for patient records, securing protected health information, and using business associate agreements. It emphasizes reviewing practices from an audit perspective and training staff on policies to avoid penalties from regulatory agencies for violations.
Universal Design for Learning (UDL) aims to remove barriers for all students and allow them to reach their full learning potential by designing curriculums and lessons that provide multiple means of representation, expression, and engagement. Essential components of UDL include setting clear learning goals, understanding student barriers, activating prior knowledge through various formats, allowing choice in how students demonstrate knowledge, and providing timely feedback. Examples of applying UDL principles in an online lesson include giving students options for presentation format, presenting information in various media, permitting revisions based on feedback, and grouping for discussion.
Este guiso de atún a la mexicana es rápido, sabroso y nutritivo. Se prepara friendo cebolla y jitomate en aceite, agregando atún desmenuzado y sazonando con sal, pimienta y chile. Se cocina a fuego medio hasta que el atún esté caliente y los sabores se hayan integrado.
Este documento presenta una introducción a tres áreas de la psicología: la psicología infantil, la psicología social y la psicología jurídica. La psicología infantil estudia el desarrollo de los niños. La psicología social examina la interacción entre individuos y su entorno social. La psicología jurídica implica el estudio del comportamiento legal y los factores psicológicos relacionados con el sistema de justicia.
La comunidad primitiva se basaba en la caza, recolección y propiedad comunal. Los hombres dependían directamente de la naturaleza para satisfacer sus necesidades básicas. Con el tiempo, mejoraron sus herramientas de piedra y desarrollaron una división rudimentaria del trabajo según sexo y edad. Eventualmente surgieron excedentes de producción y el trueque, dando paso a sociedades más complejas.
This document is a curriculum vitae for Muhammad Zubair Noor. It provides his personal details such as name, date of birth, contact information, education history, and work experience. Currently, he works as a Project Engineer for Canadian Engineering Projects in Saudi Arabia, where he is responsible for supervising construction of a commercial building project. Previously he has worked on other construction projects in Pakistan, holding roles such as QA/QC Engineer and QA Inspector. His professional qualifications include a BSC in civil engineering and he has knowledge of software like AutoCAD.
Este documento presenta información sobre el caso del grupo empresarial Nule en Colombia. Describe a los miembros clave de la familia Nule y su ascenso en el mundo de los negocios y la política a través de contratos gubernamentales. Sin embargo, en 2010 se reveló que el grupo no podía cumplir con la entrega de obras y fueron ordenados a liquidación judicial. La fiscalía presentó pruebas de sobornos, obras sin control y movimiento de fondos entre empresas como evidencia de irregularidades.
La psicología jurídica estudia el comportamiento de los actores legales y se encarga de evaluar criminales y asesorar tanto criminales como víctimas. También incluye el estudio de las víctimas para identificar patrones. Los psicólogos jurídicos deben ser licenciados en psicología, haber tomado cursos especializados y tener experiencia en el área legal.
La comunidad primitiva se basaba en la caza, recolección y pesca para la subsistencia. Los medios de producción como las herramientas eran propiedad colectiva y se distribuían los bienes de manera comunitaria. Con el tiempo, se desarrolló una división del trabajo basada en el sexo y la edad, y surgieron mejoras tecnológicas como el uso del fuego y pieles de animales. Finalmente, la producción empezó a exceder las necesidades de subsistencia y dio paso al trueque y la propiedad privada.
Este documento ofrece una receta para preparar atún a la mexicana, un guiso rápido, sabroso y nutritivo que incluye instrucciones básicas y un enlace a un video que muestra cómo hacerlo.
This document is a curriculum vitae for Nsamwa Precious Moyo. It outlines her personal details including name, date of birth, nationality, languages spoken, and contact information. It also provides her educational history from primary school through obtaining a computer skills certificate. Her work experience as a cashier and sales assistant is described. Computer skills and career goals focusing on being goal-oriented and ambitious are listed, along with referees and their contact information.
This document is a thesis submitted by Chad Furey to Dalhousie University in partial fulfillment of the requirements for a Master of Science degree. The thesis presents a parametric analysis of the shock response of a system of two submerged co-axial cylindrical shells coupled by an inter-shell fluid. Chapter 1 introduces the research, Chapter 2 presents the mathematical formulation, and Chapter 3 describes the solution methodology for the fluid and structural dynamics. Results and discussion from the analysis are provided in Chapter 4, while Chapter 5 presents a parametric study. The conclusion in Chapter 6 summarizes the current research and proposes areas for future work.
This document discusses waterlogging and salinity issues in soils. It defines waterlogging as soils saturated with water and describes various causes like seepage from canals, poor drainage, and interrupted surface runoff. Waterlogging reduces oxygen in soils and affects plant growth. Reclamation methods include interceptor drains and pumping groundwater. Salinity refers to salt presence in soils. Causes in Pakistan include poor leaching, irrigation water, and groundwater. Saline soils are classified and effects on plants described. Reclamation involves leaching salts and adding organic matter or chemicals.
La teoría clásica del comercio internacional se basa en las teorías de la ventaja absoluta y comparativa de Adam Smith y David Ricardo. Estas teorías sostienen que los países se especializarán en la producción de bienes donde tienen menores costos relativos y exportarán esos bienes, importando los bienes donde tienen mayores costos. John Stuart Mill propuso la teoría de la demanda recíproca, que argumenta que el comercio de un país depende de las importaciones de otros países.
This document discusses waterlogging and salinity issues in soils. It defines waterlogging as soils saturated with water and describes various causes of waterlogging including seepage from canals, poor drainage, and flooding. It outlines effects on plant growth like reduced oxygen and gas exchange. Reclamation methods include interceptor drains and pumping groundwater. The document also defines soil salinity and describes processes of formation. Causes in Pakistan include poor leaching and irrigation water. Management includes leaching, crop selection, and adding organic matter or chemicals.
Este documento presenta información sobre el caso del grupo empresarial Nule en Colombia. Describe a los miembros clave de la familia Nule y su ascenso en el mundo de los negocios y contratos del gobierno. Sin embargo, a principios de 2010 se reveló que el grupo no podía cumplir con la entrega de una importante obra vial y fueron ordenados a la liquidación judicial. La fiscalía presentó pruebas de sobornos, obras sin control, movimiento de fondos entre empresas y documentos adulterados para ganar contratos gubernamentales.
Purpose of the Call:
Review the results of the National VTE audit
Discuss lessons learned from the audit – strengths and areas for improvement
Gather ideas for future steps for implementation of VTE prophylaxis
Evidence Based Practice: Assassination of Myths CAUTI (Catheter Associated Ur...man0032
Evidence Based Practice: Assassination of Myths CAUTI (Catheter Associated Urinary Tract Infections) reviews some of the myths healthcare teams use to perpetuate the need for indwelling urinary catheters (aka foleys) and replaces these myths with Evidence Based Practices. Citations and hyperlinks are included for all recommendations and are current as of Spring 2013. This presentation was presented to the Emory Healthcare system-wide CAUTI prevention retreat both in 2013 and 2014 and has been the basis for both entity and unit-based education to healthcare professionals.
This document provides guidelines on appropriate use of common laboratory tests, including indications, non-indications, and minimum frequencies for re-testing. It covers topics in haematology, clinical chemistry, microbiology, and immunology. The guidelines aim to promote quality healthcare and ensure the highest clinical practice standards while reducing unnecessary testing.
The document describes efforts by the Bay Pines Veterans Administration Healthcare System to improve fluid balance measurement and documentation. Specifically:
- Ward 4A formed a work group to incorporate a new charting method and computerized calculation process to improve accuracy of intake-output documentation from 29% to 87%.
- The new process integrated a module in the Computerized Patient Record System to automatically calculate fluid balances entered by staff, eliminating common errors.
- Based on the success in Ward 4A, the new process was expanded to additional wards and intensive care units to standardize fluid balance monitoring across the facility.
Benjamin Bearnot - New treatments for the infectious complications of substan...Benjamin Bearnot, MD
New treatments for infectious complications of substance use disorders and barriers to implementation were discussed. The scope of substance use disorder problems was reviewed. New highly effective treatments for Hepatitis C like Harvoni and Viekira Pak were presented along with barriers like cost and side effects. New treatments for skin and soft tissue infections like dalbavancin were also discussed. Two case studies were then presented to demonstrate management of patients with these issues. Barriers to treatment included access to care, adherence, and cost. Future directions around integrating care and new treatments were proposed.
The document discusses barriers and solutions to adopting diagnostic technologies in healthcare. It provides examples of diagnostic technologies that have been successfully adopted in the UK, such as Coaguchek for INR testing and faecal calprotectin testing. Both faced initial barriers but were able to demonstrate benefits like improved patient outcomes and efficiency. The document outlines tips for implementing diagnostics, such as collecting baseline data, gaining stakeholder support, and clearly defining the patient pathway and expected impact. Overall it advocates that diagnostic technologies can help address gaps in healthcare if barriers are overcome and benefits are demonstrated.
The document discusses point-of-care testing (POCT) in outpatient departments. It defines POCT as medical diagnostic testing performed close to patients and outside clinical laboratories. Key benefits of POCT include faster results and feedback to patients, enabling timely treatment. Specific POCT tests mentioned include complete blood count, blood gases, glucose, CRP, lipid profiles, and urine tests. Challenges of POCT include ensuring quality and appropriate use. The document argues POCT can help reduce unnecessary antibiotic prescription by providing rapid white blood cell counts for pediatric patients.
Purpose of the Call:
Review the results of the National VTE audit day
Discuss lessons learned from the audit day – strengths and areas for improvement
Suggest future value of audits and audit tools for your organization
Gather ideas for future steps for implementation of VTE prophylaxis
Click the link below for more information and to watch the recorded webinar.
http://bit.ly/12QiAf5
Objectives:
1.To review the latest updates in the Canadian VAP Guidelines
2.To highlight the changes and why these changes are important
Read more and watch the recorded webinar: http://bit.ly/1sRCowQ
Making Healthcare Waste Reduction and Patient Safety Actionable - HAS Session 6Health Catalyst
Multiple studies have estimated that at least 30% of US healthcare expenditures are wasteful. But how do you identify and reduce that waste? In this session, we will share with you a three-part framework for understanding, measuring and addressing waste reduction. In particular, we will highlight the importance patient safety and injury prevention, framing the importance of shifting from a system of incident reporting (which creates a culture of blame and guilt) to a system in which patient injury is regarded as a process failure rather than a person failure. To make that transition, health systems will need to 1) define process flows and metrics for each major type of patient injury; and 2) create a learning environment in which team members are engaged in process redesign to prevent process failure and injury. A leading health system in patient safety and quality will also share their best practices in how they have created a culture of patient safety and quality.
Introduction of the NZ Health IT Plan enables better gout management - Reflections of an early adopter. Presented by Peter Gow, Counties Manukau DHB, at HINZ 2014, 12 November 2014, 11.37am, Plenary Room
Rapid oral swab hepatitis C screening in a community-based settingCDC NPIN
This study evaluated the use of rapid oral swab hepatitis C (HCV) screening in community settings in New York City. 503 subjects at high risk of HCV underwent rapid oral swab testing and standard blood testing. The rapid test results agreed with blood tests in 97.5% of cases. Staff preferred the rapid test due to ease of use and reduced safety risks. Rapid testing could increase HCV screening and linkage to care in non-clinical settings but ensuring follow up for confirmatory testing remains a challenge.
Current Controversies in Managing HIV-Infected Patients.2014Hivlife Info
This document discusses controversies in managing HIV-infected patients. It begins with a discussion on whether all naive patients should be started on an integrase inhibitor regimen. It reviews key trials demonstrating the efficacy of integrase inhibitors in treatment-naive patients. Expert panel discussion notes some integrase inhibitors have advantages like high barriers to resistance but others have drawbacks like twice-daily dosing. The next section examines the controversy around performing anal Pap smears routinely on all HIV+ MSM, reviewing guidelines and suggested screening paradigms. The final section discusses the controversy around evaluating all HIV+ patients over 50 with DXA scans. It reviews data on bone disease prevalence and recommendations, including evaluating risk factors before obtaining scans.
Current Controversies in Managing HIV-Infected Patients.2014hivlifeinfo
This document discusses controversies around bone density screening in HIV-positive patients. It presents recommendations from guidelines that baseline bone density screening with DXA scans should be performed for all HIV-positive postmenopausal women and men aged 50 years or older. Studies show both osteopenia and osteoporosis are more common in the HIV-positive population compared to HIV-negative controls. The odds of osteoporosis are approximately 3-4 times higher for HIV patients.
The document summarizes an HIV self-testing seminar that took place on November 26, 2013.
[1] A survey by Terrence Higgins Trust found that 35% of people living with HIV and over 40% of late diagnoses believed they would have tested earlier if self-testing kits had been available. Over 60% of those surveyed said they would consider using self-testing kits.
[2] The Trust's HIV home sampling pilot project in 2013 involved sending 10,000 self-testing kits by mail. The return rate was 60% and nearly 100 people received positive diagnoses.
[3] Legalizing and regulating self-testing kits could increase accessibility to testing, provide more discretion and support for
Driving Point of Care Technology Development: Integrated Approach to Consensu...CFTCC
The WALEX process combines facilitated discussion and discrete choice experiments to define the attributes of a realistic point-of-care test for Chlamydia trachomatis. Key findings include:
1) Participants were willing to accept longer test times and slightly higher instrument costs to preserve attributes like lower test cost, vaginal sample type, and processing multiple samples per batch.
2) Analysis of survey data identified where participants were willing to compromise on attributes and where they were unwilling.
3) The methodology provides a way to understand user needs and tradeoffs to help bridge the gap between need and realization of new diagnostic technologies.
This document discusses introducing fluid stewardship programs to improve intravenous (IV) fluid safety and prescribing. It recommends treating fluids as drugs by considering their indications, adverse effects, dose, duration, and de-escalating when possible. The 4 D's of fluid therapy are outlined as dose, duration, de-escalation and considering fluids as drugs with contraindications. Clinical audits found inappropriate fluid prescriptions and a lack of monitoring electrolytes. Introducing fluid stewardship through education, guidance, and audits can help address these issues and improve outcomes.
Point of care testing can provide clinical and economic benefits over centralized laboratory testing by decreasing turnaround time through elimination of transport and processing delays. This allows for more timely medical decisions and reduces unnecessary additional testing and treatment. Currently available microbiology point of care tests include those for group A strep, H. pylori, HIV, and various provider performed microscopic exams. Advantages include rapid results and controls, while disadvantages include potential for false results and need for training on test procedures.
This document summarizes several medical journal articles from 2013-2014. It finds that restrictive fluid and salt management for heart failure patients in the hospital is not beneficial. A trial on patients with upper GI bleeding showed no benefit to transfusion unless hemoglobin is below 7. Another study found that monitoring gastric residuals when tube feeding ICU patients did not reduce pneumonia rates compared to symptom monitoring alone. The document also discusses overtreatment of diabetes in older patients and risks of using new oral anticoagulants in patients with mechanical heart valves.
1. +
Quality Improvement: IV Tubing
Toledo Hospital – Urology, Nephrology, & Vascular
Erin Bedell, Katelynn Butler, Sarah Dinger,
Jacquelyn Gawle, Thomas Meridieth, Cait
Zimmel
2. +
Research Outline
Population: 39 beds out of 40
Compliance: Low
Problem: Noncompliance & Lack of Supplies
Consequences: Financial Burden & Infection Risk
3. +
Pre-Data Collection Questionnaire
IV Tubing Change Primary
66% - 96 hours
22% - 96 hours and 24 hours intermittent
11% - 24-72 hours
Secondary
55% - 24 hours
33% - 96 continuous/24 intermittent
11% - after infusion complete
Swab Caps to Each Port 100% - Yes
Changing Swab Caps 44% - every time used
22% - as needed
34% - every 24 hours
Primary Solution 100% - change every 24 hours
Primary Solution Label 100% - said blue label
22% - admitted to forgetting to label every time
67% - answered yes that they use them every time
and a blue label
11% - blue label if it is stocked
4. +
Pre-Data Collection Questionnaire
Primary Tubing Label 34% - admitted to forgetting; knew white for 96 hrs.
and pink for 24 hrs.
22% - white for 96 hrs. & pink for 24 hrs.
44% - white
Secondary Tubing Label 22% - admitted to forgetting; answered pink
22% - admitted to forgetting; use pink for 24 hour
intermittent and white for 96 hour continuous
56% - pink and change every 24 hours
Labeling Improvement 44% - “none”
11% - “none, but needs stocked”
11% - “check daily”
33% - “needs to be stocked”
Suggestions 44% - “N/A” or “none”
56% - “stock labels”
5. +
IV Tubing Data: 6 North TTH
11%
89%
IV Catheter Dressing Labeling on 6N
Labeled Correctly
Labeled Incorrectly
6. +
IV Tubing Data: 6 North TTH
37%
63%
Primary Tubing Labeling on 6N
Labeled Correctly
Labeled Incorrectly
7. +
IV Tubing Data: 6 North TTH
17%
83%
Secondary Tubing Labeling on 6N
Labeled Correctly
Labeled Incorrectly
8. +
IV Tubing Data: 6 North TTH
56%
44%
Fluid Bag Labeling on 6N
Labeled Correctly
Labeled Incorrectly
9. +
IV Tubing Data: 6 Northeast TTH
12%
88%
IV Catheter Dressing Labeling on 6NE
Labeled Correctly
Labeled Incorrectly
10. +
IV Tubing Data: 6 Northeast TTH
87%
13%
Primary Tubing Labeling on 6NE
Labeled Correctly
Labeled Incorrectly
11. +
IV Tubing Data: 6 Northeast TTH
100%
Secondary Tubing Labeling on 6NE
Labeled Correctly
Labeled Incorrectly
12. +
IV Tubing Data: 6 Northeast TTH
75%
25%
Fluid Bag Labeling on 6NE
Labeled Correctly
Labeled Incorrectly
13. +
IV Tubing Data: 6 South TTH
44%
56%
IV Catheter Dressing Labeling on 6S
Labeled Correctly
Labeled Incorrectly
14. +
IV Tubing Data: 6 South TTH
36%
64%
Primary Tubing Labeling on 6S
Labeled Correctly
Labeled Incorrectly
15. +
IV Tubing Data: 6 South TTH
71%
29%
Secondary Tubing Labeling on 6S
Labeled Correctly
Labeled Incorrectly
16. +
IV Tubing Data: 6 South TTH
19%
81%
Fluid Bag Labeling on 6S
Labeled Correctly
Labeled Incorrectly
22. +
Follow-Up Questionnaire
Question 2: “What would help you to remember to label your IV tubing?”
Reminder sign
22%
Sign for 96 vs.
24hr sticker
0%
Sticker on
pump
22%
Sticker on
tubing
45%
Other
11%
27. +
Root Cause Analysis
Nursing Noncompliance
Lack of Supplies on the Units
Low Nursing Priority
Lack of Auditing
28. +
Financial Impact from Primary IV
Sets
Cost of Primary Tubing is $8.37 per Tubing Set (based on
MedShop.com)
15 total primary tubing sets in noncompliance on 6th floor
30 total sets of primary tubing at $8.37/set, on the floor costing
$251.10
15 additional sets of primary tubing at $8.37/set, to replace
noncompliant tubing costing $125.55
Total cost of primary tubing per day on the 6th floor is $376.65
With 100% compliance, tubing would cost $91,651.50 in one year
With the Primary Tubing Compliance at 50%, over one year, the
additional cost to replace noncompliant tubing is $45,825.75
29. +
Financial Impact from Secondary IV
Sets
Cost of Secondary Tubing is $2.13 per Tubing Set (based on
LetMedco.com)
7 total secondary tubing sets in noncompliance on 6th floor
15 total sets of secondary tubing at $2.13/set, on the floor costing
$31.95
7 additional sets of secondary tubing at $2.13/set, to replace
noncompliant tubing costing $14.91
Total cost of secondary tubing per day on the 6th floor is $46.86
With 100% compliance, tubing would cost $11,661.75 in one year
With the Secondary Tubing Compliance at 53%, over one year,
the additional cost to replace noncompliant tubing is $5,442.15
30. +
Financial Impact for Potential
CLABSI’s
$16,350/CLABSI based on research (Ramirez, 2012)
For example, the floor has one CLABSI event in a given calendar
year
Cost: $16,350.00 for CLABSI event
Additional cost: $45,825.75 for noncompliant primary tubing
Additional cost: $5,442.15 for noncompliant secondary tubing
Potential additional cost from noncompliant IV tubing sets:
$67,617.90 for one CLABSI event and noncompliant IV tubing in
one calendar year
31. +
National QI Initiatives
Five Evidence Based Steps to Prevent CLABSI
Use appropriate hand hygiene
Use chlorhexidine for skin preparation
Use full-barrier precaution during central venous catheter insertion
Avoid using the femoral vein for catheters in adult patients
Remove unnecessary catheters
IV Tubing Recommendation for use
Replace tubing used to infuse blood or blood products or lipid-
containing solutions at least every 24 hours
Replace tubing used to infuse Propofol every 6-12 hours
Replace tubing used to infuse solutions containing dextrose and amino
acids without lipids every 72 hours
Replace other tubing every 96 hours
Agency for Healthcare Research & Quality, 2013
32. + Central Line-Associated Bloodstream
Infections Among Critically Ill Patients in the
Era of Bundle Care
Level 4 - Systematic Review and Cohort Study
Limitations (Lin K-Y, et. al., 2015)
These findings were different from the NHSN report and other
studies
Considerable overlap between the definition of CLABSI and CRBSI
They assume that diagnosis of CLABSI often overestimates the true
number of infections that are attributable to central lines
Sample size was limited to a single medical center
The definition of CLABSI had changed since 2011
Compliance rate of intervention bundle and checklist was nearly
95%, so the findings may not be comparable to those in intuitions
whose compliance rates are substantially different from theirs
33. +
Disinfection of Needleless Hubs: Clinical
Evidence Systematic Review
Level 1 - Systematic Review of Current Literature
Limitations (Flynn and Moureau, 2015)
Studies spanned from 1977-2014
Lack of high quality research
Absence of high quality RCT
Low level evidence base
Lack of randomization – unintentional bias
34. +
Swab Cap Articles
“Reducing Bloodstream Infection
Risk in Central and Peripheral
Intravenous Lines: Initial Data on
Passive Intravenous Connector
Disinfection” (DeVries et. al.,
2014)
Provides information on
Bloodstream Infection prevention
with the use of swabcaps on all
ports as an intervention. As a result
the BSI’s decreased in both central
and peripheral lines overall by 45%.
This was an observational study.
“Impact of universal
disinfectant cap
implementation on central
line- associated bloodstream
infections” (Merrill, K. C. et. al.,
2014)
Provides information on central line
associated blood stream infections
resulting in length of stay, cost,
patient morbidity and mortality. This
quasi- experimental study
determined the placement of
disinfectant caps decreased
infection rates by >40% and saved
approximately $300,000 per year.
Limitations of this study include
ongoing education to nurses on the
prevention of CLABSI while the
study was in progress.
35. +
Change IV Tubing Less Often
Not backed by evidence
Cost Australia $1 billion each year
Free up nurses time for patient care
Save 2 million nursing hours
3 year study of 6,500 patients
Comparing 4 and 7 day tubing changes
Largest National Health and Medical Research Council funded
nursing project and research grants awarded
Australian Nursing Journal, 2016
36. +
Change Theory
Kurt Lewin’s Force-Field Model (Finkelman, 2016)
Improves the Change Process
Clarifies Balance of Power
Identifies the Key Players
Identifies Opponents and Allies
Identifies How to Influence Each Other
37. +
Recommendations
Reinforce 60 second
assessment
Ensure adequate stock is
ordered
Notify immediately if labels are
not stocked
Prompt when scanning IV fluids
Care alert notification
Verbalize IV bag and label
changes in bedside report (IHI,
2016)
Morning huddle discussion (IHI,
2016)
Nurse leaders audit unit
(O’Grady, 2011)
Mandatory in-service on policy
and procedure (O’Grady, 2011)
Additional research to support
need to change tubing every 24-
96 hours (O’ Grady, 2011)
Internal Evidence
& Clinical Expertise
Evidence Based
38. +
Hypothesis
Using Lewin’s Change Theory and our recommendations, the
unit will maintain their low CLABSI rate and ensure patient
safety, as well as save their unit money by wasting less
equipment through compliant labeling of solutions and tubing
and keeping accurate records through charting.
39. + Resources
(2011). Change IV tubing less often. Australian Nursing Journal, 19(4), 22-221p
(2013). Agency for Healthcare Research & Quality. Retrieved April 16, 2016, from
http://www.ahrq.gov/professionals/education/curriculum-tools/clabsitools/clabsitoolsap3.html
DeVries, M., Mancos, P. S., & Valentine, M. J. (2014). Reducing Bloodstream Infection Risk in Central and Peripheral
Intravenous Lines: Initial Data on Passive Intravenous Connector Disinfection. Journal Of The Association For Vascular
Access, 19(2), 87-93 7p. doi:10.1016/j.java.2014.02.002
Finkelman, A. (2016). Leadership and management for nurses: core competencies for quality care. 3rd Ed. Pearson
Education, Inc: New York.
Flynn, J. & Moureau, N. L. (2015). Disinfection of needless hubs: clinical evidence systematic review. Nursing Research
and Practice 2015,796762.doi:10.1155/2015/796762
Lin K-Y, et. Al. (2015). Central line-associated bloodstream infections among critically-ill patients in the era of bundle care,
Journal of Microbiology, Immunology and Infection. http://dx.doi.ord/10.1016/j.jmii.2015.07.001
Merrill, K. C., Sumner, S., Linford, L., Taylor, C., & Macintosh, C. (2014). Impact of universal disinfectant cap implementation
on central line- associated bloodstream infections. American Journal of Infection Control, 42, 1274-1277.
O'Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., . . . Saint, S. (2011). Guidelines for the
prevention of intravascular catheter related infections. American Journal of Infection Control, 39(4), S1-S26.
Ramirez, C., Lee, A. M., & Welch, K. (2012). Central Venous Catheter Protective Connector Caps Reduce Intraluminal
Catheter-Related Infection. Journal Of The Association For Vascular Access, 17(4), 210-213 4p.
doi:10.1016/j.java.2012.10.00
Relay Safety Reports at Shift Changes. (n.d.). Retrieved April 20, 2016, from Institute for Health Care Improvement website:
http://www.ihi.org/resources/pages/changes/developacultureofsafety.aspx
Began our project by asking the staff to answer a questionnaire about IV tubing protocols and any recommendations they may have.
How often (per protocol) should you change your tubing?
Do you use a swab cap on each port?
How often do you change your swab caps?
How long can a bag of primary solution hang before you have to change it?
Do you label on your primary solution every time? What color do you use?
Do you place a label on your tubing every time? What color label for primary?
What color for secondary?
What part of labeling or hanging IV solution/medications do you think could use improvement?
Do you have any suggestions about how to improve labeling or swab cap usage?
The North Wing on the 6th Floor at Promedica Toledo Hospital had 9 IV Catheter Dressings on the wing. Of the 9 dressings, only 1 was in compliance with the proper date, time, and initial of the RN. That leaves the wing in 11% compliance for their IV Dressings.
The North Wing on the 6th Floor at Promedica Toledo Hospital had 8 IV Primary Administration sets on the wing. Of the 8 Primary sets, only 3 were in compliance with the proper date, time, and initial of the RN. That leaves the wing in 37% compliance for their Primary IV sets. However, the Primary Tubing sets on the wing were in 100% compliance with orange caps on the ports.
The North Wing on the 6th Floor at Promedica Toledo Hospital had 6 IV Secondary Administration sets on the wing. Of the 6 Secondary sets, only 1 was in compliance with the proper date, time, and initial of the RN. That leaves the wing in 17% compliance for their Secondary IV sets.
The North Wing on the 6th Floor at Promedica Toledo Hospital had 9 IV Fluid Bags on the wing. Of the 9 IV Fluid Bags, only 5 were in compliance with the proper date, time, identification of the fluid, and initial of the RN. That leaves the wing in 56% compliance for their IV Fluid Bags. However, one of the bags that was labeled properly, happened to be expired.
The Northeast Wing on the 6th Floor at Promedica Toledo Hospital had 8 IV Catheter Dressings on the wing. Of the 8 dressings, only 1 was in compliance with the proper date, time, and initial of the RN. That leaves the wing in 12% compliance for their IV Dressings.
The Northeast Wing on the 6th Floor at Promedica Toledo Hospital had 8 IV Primary Administration sets on the wing. Of the 8 Primary sets, only 7 were in compliance with the proper date, time, and initial of the RN. That leaves the wing in 87% compliance for their Primary IV sets. However, the Primary Tubing sets on the wing were in 75% compliance with orange caps on the ports.
The Northeast Wing on the 6th Floor at Promedica Toledo Hospital had 2 IV Secondary Administration sets on the wing. Of the 2 Secondary sets, all 2 were in compliance with the proper date, time, and initial of the RN. That leaves the wing in 100% compliance for their Secondary IV sets.
The Northeast Wing on the 6th Floor at Promedica Toledo Hospital had 8 IV Fluid Bags on the wing. Of the 8 IV Fluid Bags, only 6 were in compliance with the proper date, time, identification of the fluid, and initial of the RN. That leaves the wing in 75% compliance for their IV Fluid Bags.
The South Wing on the 6th Floor at Promedica Toledo Hospital had 16 IV Catheter Dressings on the wing. Of the 16 dressings, only 7 were in compliance with the proper date, time, and initial of the RN. That leaves the wing in 44% compliance for their IV Dressings.
The South Wing on the 6th Floor at Promedica Toledo Hospital had 14 IV Primary Administration sets on the wing. Of the 14 Primary sets, only 5 were in compliance with the proper date, time, and initial of the RN. That leaves the wing in 36% compliance for their Primary IV sets. However, the Primary Tubing sets on the wing were in 71% compliance with orange caps on the ports.
The South Wing on the 6th Floor at Promedica Toledo Hospital had 7 IV Secondary Administration sets on the wing. Of the 7 Secondary sets, only 5 were in compliance with the proper date, time, and initial of the RN. That leaves the wing in 71% compliance for their Secondary IV sets.
The South Wing on the 6th Floor at Promedica Toledo Hospital had 16 IV Fluid Bags on the wing. Of the 16 IV Fluid Bags, only 3 were in compliance with the proper date, time, identification of the fluid, and initial of the RN. That leaves the wing in 19% compliance for their IV Fluid Bags.
The average Dressing Label Compliance for the entire 6th Floor at Promedica Toledo Hospital was 27%. While the North wing (11%) and Northeast wing (12%) fell below the average for the floor, the South wing at 44% had the highest compliance rate on their IV dressing labels.
The average Primary Tubing Label Compliance for the entire 6th Floor at Promedica Toledo Hospital was 50%. The North wing (37%) and South wing (44%) fell below the floor average, while the Northeast wing was above average at 87%.
The average Secondary Tubing Label Compliance for the entire 6th Floor at Promedica Toledo Hospital was 53%. The North wing (17%) was the only wing below the entire floor average. While the Northeast wing (100%) and the South wing (71%) were both above the entire floor average.
The average IV Bag Label Compliance for the entire 6th Floor at Promedica Toledo Hospital was 42%. The South wing (19%) was the only wing below the floor average. While the Northeast wing (75%) and North wing (56%) were both above the average for the floor.
This graph represents how the nursing staff on the 6th floor of Toledo Hospital, on 4/13/2016, answered the question “What would help you to remember to label your IV solution bag”. The majority of staff, 34%, chose the answer “ Having central supply tape a label to the solution bags upon stocking”. The second most frequent response (33%) was “Having labels right next to the bags-on the same shelf”. The remaining total were equally distributed at 11%; a reminder sign, labels at station, and other. Other “was having labels period” .
This graph represents how the nursing staff on the 6th floor of Toledo Hospital, on 4/13/2016, answered the question “What would help you to remember to label your IV tubing?”. The majority of the staff, 45%, chose the answer “A sticker taped to the IV tubing”. The Second most frequent response was a tie between “ Having a sign on the shelf to remind you to grab a sticker near the tubing supply” (22%) and “Having a sign that reminds you what sticker to use for 96hr vs. 24hr” (22%). The remaining 11% hand wrote in “ Having the labels available”.
This graph represents how the nursing staff on the 6th floor of Toledo Hospital, on 4/13/2016, answered the question “What would help you to remember to place swab caps on each port?”. The majority of staff, (67%) chose “Keeping swab caps in a closed top container on each WOW”. The second most frequent repose was “Creating and using an IV bundle kit- including swab caps and tubing” (22%). The third most frequent response was “ Only using the flushes with the swab caps attached” (11%).
This graph represents how the nursing staff on the 6th floor of Toledo Hospital, on 4/13/2016, answered the question “Would an IV tubing/infusion bundle kit be more beneficial to facilitating care in amore timely fashion?” Majority of staff, 67%, answered yes and 33% answered no.
This graph represents how the nursing staff on the 6th floor of Toledo Hospital, on 4/13/2016, answered the question “Are there any other physical barriers besides not having the labels stocked on the floor that prevent you from labeling your solution/tubing?”. The majority, 67%, answered no. 33% answered yes; writing the following as barriers: “Want EBP proof of expiration”, “Need labels” and “ Duplicate labels, secondary and primary and bag”.
This graph represents the mean rankings of the importance of nursing task, according to staff on the 6th Floor at Toledo Hospital, on 4/3/2016. The staffs highest priority according to the questionnaire was safety (7.66), the second highest was a pain assessment (5.88), following blood sugar (5.55), a 60 second assessment (4.88), Intake and Output (4.33), Daily weights (3.55), Hourly rounding (2.77), and the lowest ranked was IV tubing at 1.33.
This is based on the information acquired from the questionnaires and the data collection in every patient room on 3/22/2016
Financial burdens occur due to waste of tubing and solutions.
Evidence is based on NQI, CDC and NIH findings and protocols.
Due to the low priority of IV tubing labeling on this unit based on the survey, there is a lack of compliance.
Also, with the new Transitioning Toledo program, the managers said they used to do chart audits on IV tubing, daily weights, etc. and now they do not have the time.
Flynn and Moureau did a systematic review to assess the current literature related to disinfection of needleless connectors to establish recommendations that promote aseptic access and reduce infection risk for the patient. The authors used Pubmed, Medline, Scopus, Ovid, jStor, CINAHL, Cochrane, Athens and ScienceDirect to gather the articles used for this review.
The authors are aware that their review has limitations. In order to find articles for this review, key terms were used to search for any article pertaining to disinfection, aseptic technique or reducing line infections from studies spanning from 1977-2014. There is a lack of high quality research available in the area of testing the cause and effect relationship between needleless connector disinfection practices and patient infection outcomes. There is also an absence of high quality RCT evidence, which limit the authors to clinical observational, cohort and laboratory studies. The evidence base for disinfection strategies is low level. With the lack of randomization, there is a risk of unintentional bias. These studies need randomized controls in order to rigorously evaluate the efficacy of disinfection practices and antiseptic hub protectors in preventing patient infection.
Lead researcher professor Claire Rickard, of Griffith University’s Research Centre for Clinical and Community Practice Innovation, said the current practice of routine tubing changes every 3-4 days was no backed by evidence and cost Australia about $1 billion each year
Study on the prolonged use of intravenous tubing may save 2 million nursing hours per year with no threat to patient safety
3 year study of 6,500 patients at Queensland’s Gold Coast, Prince Charles, Princess Alexandra, Royal Brisbane, and Women’s and Royal Children’s hospitals will study the infection and cost benefits of less frequent changes of IV tubing
The goal is to get the driving forces, or the Allies of the unit, to dominate the resistant forces, or the Opponents of the unit by listening to their concerns, promoting the change, and hopefully creating a new attitudes, values and behaviors to put the change into practice.
Here is our idea for the unit:
Start with
Unfreezing stage: Nurse management holds a mandatory in-service on labeling tubing, solutions, and sites, as well as how they prevent CLABSI.
Then go on to the:
Moving stage: Spread the word about the problem at hand and formulate an auditing team of nurses that checks the compliance of the tubing first thing every shift and for each wing. Goal is complete compliance with labeling to avoid CLABSI and financial cost to the unit. Goal should be met in 30 days and then reevaluation can occur.
Lastly:
Refreezing stage: After 30 days, find out whether the auditing is being done and that compliance is being reached by refreezing and evaluating the protocol as a whole. Make any necessary changes to the protocol and begin the unfreezing stage again.
As a group, we hypothesized that if changes were not put into place to combat these problems, the unit will suffer financially and most importantly, the unit is putting the patient’s at risk for a CLABSI infection.
With the recommendations of auditing rooms and checking the charting, we are helping the unit to maintain their low CLABSI rate and ensuring patient safety and well being. By auditing the labeling process, the unit should see some financial improvements.