The clinical effectiveness of Movicol in children with severe constipation: an outcome audit

This audit reviewed the clinical effectiveness of polyethylene glycol 3350 plus electrolytes (PEG+E, Movicol) in the management of severe paediatric constipation. A seven-day disimpaction regimen was initiated followed by a maintenance dose as appropriate. An information and support service was provided by the community children's nursing team (CCNT) at Darent Valley Hospital. Twenty-three parents completed questionnaires on their children's experiences with previous and current laxative treatments, bowel movement status, in-patient admissions or home visits required and the perceived value of the back up service. The mean age of children studied was 6.7 years. Prior to PEG+E treatment, 57 per cent of children were admitted to hospital and 26 per cent required home visits for constipation treatment. After treatment, no child needed either intervention. Thirty-nine percent of parents used the support service, of which 96 per cent rated the information it provided as adequate. When asked about their satisfaction with the control of their children's constipation, 96 per cent of parents were 'more than happy' after treatment with PEG+E. The treatment of severe paediatric constipation with PEG+E in conjunction with a support and advice service was both clinically and economically effective.     

Research based nursing practice--an evaluation of an educational programme

Although research based practice is being increasingly extolled by both the government and the profession, no clear educational strategy exists as to how practitioners should be supported in achieving this goal. Furthermore, the effectiveness of educational interventions in fostering a positive attitude to research, or a change towards a greater prevalence of research based practice, remains unknown. However, research has indicated that practitioners are dissatisfied with their research skills and the opportunities to enhance them.This paper describes a series of nine workshops on research utilization which were undertaken in a range of Trusts throughout England. The primary purpose of the workshops was to help nurses, health visitors and midwives to:The workshops were evaluated by two methods--a written semi-structured questionnaire and a qualitative study focused on three sites which used pre-workshop telephone interviews and post-workshop focus groups.Overall the workshops were effective in reducing fear and lack of understanding of research, alleviating the problem of jargon, and increasing the skills of critical appraisal. Although the participants' attitude to research was not changed by attending the workshops--it was positive before the workshop and remained so-several personal and professional benefits were accrued. The implications of this evaluation for practice, education, and research are discussed.     

An audit of epilepsy in general practice

A simple records audit of patients with epilepsy revealed some deficiencies in care and that regular follow-up was inadequate. Further information was obtained by a questionnaire. A new protocol of care was introduced and further audit is being undertaken.     

An audit of acupuncture in general practice

An audit was conducted to determine the effects of acupuncture treatment used in a dedicated clinic in primary care by a GP, starting shortly after first learning acupuncture. The outcome measure was MYMOP2 which was developed into the MYMOP pictorial during the course of the audit to improve patient compliance. Out of 62 patients enrolled in the audit, 55 completed both the initial and follow-up questionnaires: they had a mean age of 56 years, and included 43 women. The overall mean improvement in symptom 1 was 2.0 (standard deviation 1.6) scale points, and the improvement was significant in 30 patients (55%). Twenty-eight patients reported significant improvement in activity (58% of those reporting this section), and 23 patients (48% of those reporting) obtained a significant improvement in wellbeing. Adverse events were minor, though one patient fainted and fell to the floor. Although the conclusions of this audit are limited by its small size, nevertheless the results were generally encouraging, and the authors recommend that acupuncture should be considered for use in primary care for a wide range of complaints.     

Cost-effective prescribing of proton pump inhibitor therapy: an audit in general practice

General practitioners must prescribe cost effectively to control drug expenditure and provide optimal treatment for patients requiring long-term management. An audit was implemented in general practices to review the management of dyspepsia, improve care, rationalise therapy and reduce costs. Policy included identifying patients receiving proton pump inhibitor (PPI) therapy and changing to low-dose cost-effective therapy. If PPI therapy was not required, patients were changed to antacids, H2 receptor antagonists or no treatment. This was an audit in general practice, not a clinical trial, therefore findings reflect outcomes in normal clinical practice. This paper describes the implementation and findings of the audit between January 1997 and July 1999 in 91 general practices involving 7121 patients. Extrapolation of the results concluded that savings of up to 50,000 Pounds could be made in a practice of 10,000 patients, allowing reinvestment in health improvement plans and optimal care.     

Clinical audit of theophylline use in general practice

The use of therapeutic drug monitoring for theophylline therapy was evaluated in two urban general practices. Of 55 patients studied, 44 (80%) had a sub-therapeutic serum theophylline concentration, 11 (20%) had a therapeutic concentration (10-20 micrograms/ml), and none had an above therapeutic concentration. Patients were reviewed at weekly intervals and had their theophylline dosages adjusted according to serum levels. A therapeutic concentration was achieved in 37 patients (67%). This task proved to be 'laborious but not difficult'. Side-effects were less common than previous reports suggest. The general practice workload involved in adjusting theophylline dosage was approximately four consultations, one dose change and two serum assays per 'average' patient.     

Improving the effectiveness of the emergency management of renal colic in a district general hospital: a completed audit cycle

Methods: Data were collected about the use of analgesia, waiting time for intravenous urography (IVU), and admission status of patients presenting to the hospital with symptoms of renal colic over the period of three months. A literature search into the use of analgesia, imaging, and treatment was performed. Members of the involved departments were consulted and new guidelines developed and implemented. This was followed by further data collection over three months.

Results: Seven of 14 patients were admitted. Five to wait for their IVU. Their average waiting time was 12.3 (SD 2.2) hours. Mainly intramuscular opioid analgesia was used. Literature recommended the use of diclofenac. Although computed tomography was favoured it was decided to continue to use IVU because of circumstances within the hospital. The literature recommended a cut off between conservative and surgical treatment at a calculus size of >4 mm. Existing policies of the relevant departments were obeyed and a training system for the junior doctors was introduced. Emergency department staff were encouraged to perform 3-film IVUs. After this, of 5 of 19 patients were admitted, only one of those to wait for an IVU. The average waiting time for an IVU was 4.1 (SD 0.96) hours. Rectal diclofenac was noted to be the drug of choice.

Conclusion: Coordination of efforts, interdepartmental communication, and a practical application of available literature has resulted in a significant improvement of effectiveness without affecting medical standards, workload, or resources. Accident and emergency senior house officers felt highly satisfied at being able to complete management from presentation to diagnosis and treatment. Interdisciplinary communication has to be continued to maintain smooth operation of the guidelines.

     

An audit of 500 acupuncture patients in general practice

This is an audit of 500 patients treated in a general practice setting. Acupuncture clinics are provided on two evenings each week and are funded by the practice. Short treatment times are favoured but this varies according to condition and response. A wide variety of conditions have been treated the commonest being neck pain, low back pain, shoulder problems, hayfever, knee osteoarthritis, and migraine. An overall improvement of 73% was obtained with 61% classified as 'significant improvement' or 'cure'. Amongst the adverse effects recorded, retained needles and forgotten patients have been the most concerning and have led to changes in practice following 'critical incident' meetings.     

成组工作制在急诊科的试行与效果

目的探讨成组工作制在急诊科运行的可行性及优越性。方法建立成组工作制模式,在急诊设备、人员不变的前提下,选取2003年4~9月和2002年4~9月病人满意度、医生对护理工作质量的满意度、护士工作日进行比较,同时对22位护士进行成组工作制满意度的调查。结果病人和医生对护理工作满意率提高,节约了护理劳动时间,护士对成组工作制表示赞同。结论成组工作制不仅使管理者有效利用人力资源,而且提高了护理质量。     

The transfusion audit as an educational tool

Audits of transfusion used as educational tools can improve transfusion practices. Effective audits must first identify problem(s) in transfusion practice and must then include as educational target, the attending physician. Educational methods that have been shown to the effective include: (1) meeting briefly one-on-one with physicians, (2) teaching at scheduled conferences, (3) making daily clinical rounds on patients who receive transfusion, (4) concurrent review of orders for transfusion prior to issue of the blood product and (5) installing algorithms and guidelines in the operating room. Transfusion practices improved with these educational audit methods.     

Nurse practitioner led prostate biopsy: an audit to determine effectiveness and safety for patients

Prostate cancer has become the most commonly diagnosed cancer amongst men and its detection rate continues to increase. The Department of Health in the UK has made great efforts to reduce the waiting time for the diagnosis and treatment of cancer patients leading to new and innovative ways being sought in order to meet these demands and maintain an efficient, effective and seamless service to the patients. This article presents an audit of a nurse practitioner led rapid-access one-stop prostate biopsy clinic and also discusses the complications involved. The audit has shown the service to be effective and safe and has demonstrated an improvement in waiting times for cancer patients.     

An audit of rectal examination on general/geriatric wards in a district general hospital

A study of 187 in-patients on designated medical/geriatric wards revealed that rectal examination was performed as part of physical examination in only 25% of patients. In the elderly (118 patients) it was performed in 36%. A prospective analysis of 100 elderly patients, in whom digital rectal examination was performed, revealed that 46 patients had significant findings. In only 33 of these were there any gastrointestinal or genitourinary symptoms or signs. As a result of these findings it is recommended that digital rectal examination be considered mandatory in the elderly admitted into hospital.     

From audit to effectiveness: an historical evaluation of the changing role of Medical Audit Advisory Groups

MAAGs were introduced as a result of the 1989 White Paper ' Working for Patients ', with the remit to direct, coordinate and monitor medical audit activities in general practice. They were funded through the new FHSA management budget and each MAAG was responsible to its own FHSA. They were accepted as a completely new institution as a part of the introduction of an innovative management structure in a reformed NHS. When viewed in an historical context, MAAGs can actually be seen as a part of an expanding culture of greater objectivity and critical analysis which has burgeoned in medical practice over the last two decades. Although MAAGs began with an educational role with uniprofessional medical audit, they have embraced multiprofessional clinical audit in primary care in the context of the wider aspects of quality in practice.
The last 20 years have seen the development of clinical guidelines, evidence-based medicine and application of business management theory to clinical quality. All these have reflected the increasing demand for explicit standards of care which has also formed the basis of clinical audit and MAAG activity. MAAGs should be seen as an inevitable concomitant of this historical trend to improve the application of scientific rigour in medical practice. With the adoption of clinical effectiveness, incorporating all these themes, as one of the NHS Executive's six medium-term priority areas, MAAGs are uniquely placed to act as agents of change to enhance the quality of primary health care.     

Primary care in London: an evaluation of general practitioners working in an inner city accident and emergency department.

OBJECTIVE: To determine the characteristics of primary care attenders to St Mary's Hospital accident and emergency (A&E) department, evaluate the effects of the introduction of general practitioners (GPs) on patient care in A&E, and make recommendations for the provision of GPs in appropriate A&E departments. DESIGN: Prospective survey over a six week period. METHODS: Data collected from the attendances of 970 consecutive patients triaged with "minor" primary care problems, whether seen by A&E doctors or by GPs working in A&E, were analysed. RESULTS: During the study period 1078 patients (16.6%) were triaged as suitable for primary care. The A&E GPs saw 58.4% of these patients. The majority of primary care patients were young British residents, 71.1% of whom were registered with a GP. Sixty per cent of patients lived within St Mary's catchment area. Of those registered patients asked why they attended A&E, 27.1% thought their problem inappropriate for their GP. A&E doctors were more likely to investigate patients and arrange hospital follow up than GPs, who arranged community follow up in 80% of patients needing further care. CONCLUSIONS: The demand for primary care at St Mary's necessitates the provision of a primary care service, albeit for the first visit only. This can be provided by GPs in A&E. The features of the patients using the service suggests that discouraging first attendance is unrealistic, but using the visit to educate patients and return them to the care of the community is not.