The objective of this study was to evaluate the quality of the clinical pharmacy service in a Swedish hospital according to the Lund Integrated Medicine Management (LIMM) model, in terms of the acceptance and clinical significance of the recommendations made by clinical pharmacists.
The clinical significance of the recommendations made by clinical pharmacists was assessed for a random sample of inpatients receiving the clinical pharmacy service in 2007. Two independent physicians retrospectively ranked the recommendations emerging from errors in the patients' current medication list and actual drug-related problems according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant).
The random sample comprised 132 patients (out of 800 receiving the service). The clinical significance of 197 recommendations was assessed. The physicians accepted and implemented 178 (90%) of the clinical pharmacists' recommendations. Most of these recommendations, 170 (83%), were ranked 3 (somewhat significant) or higher.
This study provides further evidence of the quality of the LIMM model and confirms that the inclusion of clinical pharmacists in a multi-professional team can improve drug therapy for inpatients. The very high level of acceptance by the physicians of the pharmacists' recommendations further demonstrates the effectiveness of the process.
Equal access to end-of-life care is important. However, social inequality has been found in relation to place-of-death. The question is whether social and economic factors play a role in access to specialist palliative care services.
The study analyzed the association between access to outreach specialist palliative care teams (SPCTs) and socioeconomic characteristics of Danish cancer patients who died of their cancer.
The study was a population-based, cross-sectional register study. We identified 599 adults who had died of cancer from March 1 to November 30, 2006, in Aarhus County, Denmark. Data from health registers were retrieved and linked based on the unique personal identifier number.
Multivariate analysis with adjustment for age, gender, and general practitioner (GP) involvement showed a higher probability of contact with an SPCT among immigrants and descendants of immigrants than among people of Danish origin (prevalence ratio [PR]: 1.55; 95% confidence interval (CI): 1.04;2.31) and among married compared to unmarried patients (PR: 1.25; 95% CI: 1.01;1.54). The trends were most marked among women.
We found an association between females, married patients, and female immigrants and their descendants and access to an SPCT in Denmark. However, no association with the examined economic factor was found. Need for specialized health care, which is supposed to be the main reason for access to an SPCT, may be related to economic imbalance; and despite the relative equality found, SPCT access may not be equal for all Danish residents. Further research into social and economic consequences in palliative care services is warranted.
Over the past decade, the need for healthcare delivery systems to identify and address patient safety issues has been propelled to the forefront. A Canadian survey, for example, demonstrated patient safety to be a major concern of frontline nurses (Nicklin & McVeety 2002). Three crucial patient safety elements, current knowledge, resources, and context of care have been identified by the World Health Organization (WHO 2009). To develop strategies to respond to the scope and mandate of the WHO report within the Canadian context, a pan-Canadian academic-policy partnership has been established.
This newly formed Pan-Canadian Partnership, the Queen's Joanna Briggs Collaboration for Patient Safety (referred throughout as "QJBC" or "the Partnership"), includes the Queen's University School of Nursing, Accreditation Canada, the Canadian Patient Safety Institute (CPSI), the Canadian Institutes of Health Research, and is supported by an active and committed advisory council representing over 10 national organizations representing all sectors of the health continuum, including patients/families advocacy groups, professional associations, and other bodies. This unique partnership is designed to provide timely, focused support from academia to the front line of patient safety. QJBC has adopted an "integrated knowledge translation" approach to identify and respond to patient safety priorities and to ensure active engagement with stakeholders in producing and using available knowledge. Synthesis of evidence and guideline adaptation methodologies are employed to access quantitative and qualitative evidence relevant to pertinent patient safety questions and subsequently, to respond to issues of feasibility, meaningfulness, appropriateness/acceptability, and effectiveness.
This paper describes the conceptual grounding of the Partnership, its proposed methods, and its plan for action. It is hoped that our journey may provide some guidance to others as they develop patient safety models within their own arenas.
The provision of safe, high quality healthcare in the Emergency Department (ED) requires frontline healthcare personnel with sufficient competence in clinical leadership. However, healthcare education curriculum infrequently features learning about clinical leadership, and there is an absence of experienced doctors and nurses as role models in EDs for younger and less experienced doctors and nurses. The purpose of this study was to explore the activities performed by clinical leaders and to identify similarities and differences between the activities performed by charge nurses and those performed by doctors on-call in the Emergency Department after completion of a Clinical Leadership course.
A qualitative exploratory design was chosen. Nine clinical leaders in the ED were shadowed. The data were analyzed using a thematic analysis.
The analysis revealed seven themes: receiving an overview of the team and patients and planning the shift; ensuring resources; monitoring and ensuring appropriate patient flow; monitoring and securing information flow; securing patient care and treatment; securing and assuring the quality of diagnosis and treatment of patient; and securing the prioritization of patients. The last two themes were exclusive to doctors on-call, while the theme "securing patient care and treatment" was exclusive to charge nurses.
Charge nurses and doctors on-call perform multitasking and complement each other as clinical leaders in the ED. The findings in this study provide new insights into how clinical leadership is performed by charge nurses and doctors on-call in the ED, but also the similarities and differences that exist in clinical leadership performance between the two professions. Clinical leadership is necessary to the provision of safe, high quality care and treatment for patients with acute health needs, as well as the coordination of healthcare services in the ED. More evaluation studies of this Clinical Leadership course would be valuable.
Shared learning activities aim to enhance the collaborative skills of health students and professionals in relation to both colleagues and patients. The Readiness for Interprofessional Learning Scale is used to assess such skills. The aim of this study was to validate a Danish four-subscale version of the RIPLS in a sample of 370 health-care students and 200 health professionals.
The questionnaire was translated following a two-step process, including forward and backward translations, and a pilot test. A test of internal consistency and a test-retest of reliability were performed using a web-based questionnaire.
The questionnaire was completed by 370 health care students and 200 health professionals (test) whereas the retest was completed by 203 health professionals. A full data set of first-time responses was generated from the 570 students and professionals at baseline (test). Good internal association was found between items in Positive Professional Identity (Q13-Q16), with factor loadings between 0.61 and 0.72. The confirmatory factor analyses revealed 11 items with factor loadings above 0.50, 18 below 0.50, and no items below 0.20. Weighted kappa values were between 0.20 and 0.40, 16 items with values between 0.40 and 0.60, and six items between 0.60 and 0.80; all showing p-values below 0.001.
Strong internal consistency was found for both populations. The Danish RIPLS proved a stable and reliable instrument for the Teamwork and Collaboration, Negative Professional Identity, and Positive Professional Identity subscales, while the Roles and Responsibility subscale showed some limitations. The reason behind these limitations is unclear.
The hospital is an environment which accomodates the elderly persons and in which these last have to make trainings at one time when they are not in full possession with all their physical, psychological and cognitive capacities. They can then live there humiliating situations which generate feelings of discomfort, embarrassment and shame. The presence of interveners not very warm, lacking compassion lack and impressed negative prejudices towards the elderly patients, is another factor which is added to lead them not to feel at ease, involving, inter alia, consequences a fall of their self-esteem. However the affective touch is a strategy which would have the potential to act on the personal value of the elderly patients and to thus improve their self-esteem. It is with a view to popularize the use of the affective touch in practice nurse that a study was carried out in order to check its effects on the self-esteem of the elderly patients. The results confirm that the emotional touch influences positively the self-esteem of the elderly patients. The authors of the study thus recommend the systematization of the affective touch in nursing practice.
The objectives of this study were to review the literature on alternatives to traditional treatment of acute mental disorders and to describe the effects of these interventions. The main emphasis is on crisis resolution teams (CRT) because there are governmental plans to implement these in all Norwegian community mental health centres.
The reviewed literature is based on a search for randomized controlled studies that compare the effect of standard emergency treatment with alternative emergency services. Quasi-experimental studies of crisis resolution teams were also included.
The identified alternative interventions were: emergency residential/domestic care, emergency day centres, and crisis resolution teams (or assertive/out-reach/mobile crisis teams). Studies of acute day hospitals showed that this treatment is associated with reduced hospitalisation, faster recovery and reduced costs compared with treatment in traditional hospital acute wards. Because of insufficient research, it was not possible to draw conclusions on the effects of residential or domestic care. We identified six randomized controlled studies and four quasiexperimental studies of Crisis Resolution Teams. These studies indicate that Crisis Resolution Teams or other forms of assertive homebased mobile/outreach treatment, is an acceptable alternative to hospitalization for many patients. The clinical effect of such treatment seems to be comparable with traditional treatment, and are associated with reduced hospitalizations and rehospitalizations, and with reduced costs. None of the reviewed treatment can replace traditional acute hospital treatment. Although studies of alternatives to acute hospitalization have congruent results, there are few studies and methodological weaknesses make it difficult to draw firm scientific conclusions about the effect of such interventions.
The article submits the results of the study of the organization and quality of care for diabetic patients, the dynamic observation of which at the out-patient establishments is provided by endocrinologists. The total structure of diabetic patients, the follow-up system, the dimensions of screening, the adequacy of treatment are analysed. It is demonstrated that the lack of continuity and interrelation between endocrinologists and district general practitioners in providing care to diabetic patients, the majority of whom have combined pathology, will result in inadequate provision of curative and preventive care to diabetic patients, according to the expert assessment.
This study aimed to examine anaesthetists' perceptions of facilitative weaning from the mechanical ventilator in the intensive care unit (ICU).
Explorative qualitative interviews in a phenomenographic reference frame with a purposive sample of 14 eligible anaesthetists from four different ICUs with at least one year of clinical experience of ICU and of ventilator weaning.
Four categories of anaesthetists' perceptions of facilitative decision-making strategies for ventilator weaning were identified. These were the instrumental, the interacting, the process-oriented and the structural strategies" for ventilator weaning. The findings refer to a supportive multidisciplinary holistic ICU quality of care. Choice of strategy for ventilator weaning was flexible and individually tailored to the patients'.
Choice of strategy was flexible and individually adjustable. Introduction of evidence-based guidelines from ventilator weaning is necessary in the ICU. The guidelines should also cover the responsibilities of various professional groups. Regular evaluations of methods and strategies used in practice need to be implemented. This may facilitate decision-making strategies for ventilator weaning in practice at the ICU. Greater attention needs to focus on family members' experiences. The strategies should be an integral part of continuous staff training.