Talking on the telephone with people who have experienced pain in hospital: clinical audit or research?

The adequacy of postoperative pain management in British hospitals appears insufficient to improve patient care, and much of the research and clinical audit in postoperative pain has failed to seek the patient's perspective. This paper reports on the findings from a semi-structured telephone interview survey which formed part of a hospital-wide audit on postoperative pain at a district general hospital in the south of England. Of a total of 360 completed audit questionnaires, 114 patients left their telephone number and 29 were interviewed. Content analysis revealed five main themes: inadequate information, pain at home, staff attitudes, expectations of pain, and ward atmosphere. Several patients identified insightful strategies that potentially could improve pain management. The telephone interview generated a richness of data that had not been reported before in this important area. Some authors view clinical audit and research as having different characteristics but this work raises important questions for both approaches when using the semi-structured telephone interview. The ethical issues pertaining to collection of audit data using the telephone interview are discussed.     

ACE inhibitors and heart failure in hospital: any difference between cardiologists and general physicians?

Cardiologists and generalists have been reported to diverge in terms of their self-reported use of angiotensin-converting enzyme (ACE) inhibitors, but information on their actual use of ACE inhibitors has been lacking. In order to assess ACE inhibitor use in patients with heart failure in a teaching hospital and any differences between specialties we studied all patients in the Western Infirmary of Glasgow between 1 April and 1 October 1996 with an echocardiogram showing moderate or severe left ventricular systolic dysfunction (n = 236). We found that most patients were on an ACE inhibitor (66%), 12% had been tried but found to be intolerant, 10% had not been tried because of a contraindication, but 12% had not been tried despite no contraindication. Of those on treatment, 58% were on a dose used in a major survival study (38% of all patients). Most patients were treated by a cardiologist (64%). Of these, more were on an ACE inhibitor (77% vs 53%, p < 0.01), fewer had been tried but found intolerant (11% vs 18%), and fewer had never been tried (11% vs 29%, p < 0.01), irrespective of whether they had a contraindication (5% vs 18%, p < 0.01) or not (6% vs 12%). More were on a dose used in a major survival study (48% vs 31%, p < 0.05). We conclude that, despite improvements over time, ACE inhibitors are still under-used, sometimes without good reason. There are also differences in the use of ACE inhibitors between cardiologists and generalists which may affect outcome, and could affect resource utilisation.     

Production and evaluation of guidelines for the management of inflammatory bowel disease: the Leicester experience

Consensus guidelines for the management of patients with inflammatory bowel disease were produced by gastroenterologists, gastrointestinal surgeons and a cross-section of general practitioners (GPs) from Leicestershire in order to develop a seamless pattern of care with a common approach to diagnosis and treatment. It was hoped that the guidelines would encourage a movement towards care in the community for many patients with stable disease and so speed up new consultation rates. The study then assessed the impact of these guidelines on the referral letters of GPs to hospital consultants, the prediction of disease and adherence to them on re-referring patients after discharge. The guidelines were distributed to all 487 GPs in the Leicester Health Authority area and the gastroenterology teams within the hospitals. The value of the guidelines was assessed by an audit of referral letters, the length of time from referral letter to out-patient appointment, both before and after the launch of the guidelines, adherence to the guidelines on re-referral, and monitoring the outcome of the discharged patients. Whilst the guidelines may have helped GPs to manage stable patients in the community, the content of referral letters and the diagnostic abilities of GPs were not seen to improve since the launch of the guidelines. However, only 5% of stable patients who were discharged from one clinic were re-referred for inflammatory bowel disease.


     

Audit and Re-audit of the CSP Core Standards of Physiotherapy Practice

The third edition of the Core Standards of PhysiotherapyPractice has been piloted in eight sites, representing the whole breadth of the physiotherapy profession. Part of the pilot involved auditing patient records and soliciting patient feedback using a questionnaire, both in two stages. The first audit was carried out before physiotherapists had knowledge of the content of the new standards. The re-audit was carried out after a period of awareness-raising and implementation of any changes arising from the first audit. All audit criteria including the patient feedback were specifically generated from the standards.Significant and important improvements were reported from the patient record audits, especially in the standards relating to recording of patients' expectations, patients' goals, and use of outcome measures.The patient feedback questionnaire showed a consistently high level of achievement but less real change between the two audits. Some issues around consent improved, as did privacy. Performance against some criteria deteriorated, although not significantly, for example patients' perceptions of the effectiveness of treatment. Documentation in patient records has shown important improvements as a result of the new standards. Feedback from patients suggests little change in conformance with those standards and criteria more appropriately measured by patients.Audit is a useful tool for disseminating and implementing national standards when carried out in partnership with physiotherapy managers.     

A modification of the POSSUM surgical audit system for the minimally invasive therapy community

Summary

The POSSUM system has the potential to be the universally accepted basic surgical audit system. Some modifications are suggested to enhance POSSUM'S sensitivity.     

信息系统审计--备份与灾难恢复方案

信息系统有着与生俱来的风险,这种风险以不同的方式冲击着信息系统。就医院行业来讲,HIS已成为医院业务处理的核心,如何控制和规避风险,就需要在建设实施HIS的同时,按照信息系统审计要求,对HIS的安全、风险管理与控制制定方案与审计,目的是保障系统的正常运行。本文也是本院HIS实施过程中制定的审计文档。     

某院门急诊处方前置审核系统的运行和效果分析

目的对某院门急诊处方前置审核系统的运行和效果进行探究与分析。方法2019年7—12月对该院门诊医生工作站开具的处方数据使用前置审核系统,记录并分析每月系统的处方合格率、预审处方情况、医生端操作记录情况、药师端干预情况、系统审核的不合理处方情况。结果使用处方前置审核系统后该院处方合格率、医生提交前主动修改处方率逐渐上升,预审不合理率、预审待确认率、医生提交的问题处方率、提交药师审核率逐渐下降,在问题处方中用法用量不合理处方占比最高。结论使用处方前置审核系统能够提高相关医护人员的工作效率,降低问题处方率。     

临床、医技科室ISO9001内审检查表的编制与应用

在ISO9001内部审核过程中,结合临床、医技科室的工作内涵,融合ISO9001标准和卫生行业要求,编制检查表,把检查表作为内部审核的引擎,在全面审核基础上,重点精化审核内容,把握审核重点,突出审核专业性,使内部审核与卫生行业检查相融合、与日常管理工作相结合,成为评价医疗服务质量的一种有效方式。     

Structure and content in Norwegian nursing care documentation.

In 1994, the Norwegian Board of Health (NBH) published recommendations for nursing care documentation. The two-fold purpose of the present study was to see if 5 wards in 2 Norwegian hospitals fulfilled the proposed NBH recommendations and guidelines regarding documentation, and to evaluate them in terms of the proposed structure and key words of the VIPS model. Results showed that all nursing records (n = 55) had an admission assessment. A nursing care plan was present in 62% of the records. Nursing goals were lacking in the remaining 38%, diagnosis and planned interventions were absent in 18%, and 45% of the diagnoses lacked information concerning patient progress or outcome. The nursing care plans were updated in only 40% of the records and discharge notes were present in 35%, confirming that NBH recommendations were not met in this sample. The key words of the VIPS model covered all information present in the records, and high interrater reliability was obtained for the majority of key words categorized by two independent researchers. It is suggested that the VIPS model components and key words can contribute to a reliable and uniform model for nursing care documentation and enhance comprehensive and systematic documentation, which is presently lacking in Norwegian records.