Heart failure (HF) is a clinical syndrome associated with high morbidity and mortality with a large economic burden, and is the leading cause of hospitalizations among Medicare beneficiaries in the United States. Healthcare reform has focused on strategies to reduce HF readmissions, including outpatient HF clinics. Purpose: The purpose of this DNP Project was to answer the following question: In adult patients diagnosed with HF, how does enrollment in the HF clinic, compared to non-enrollment affect hospital admission and readmission rates? Methods: A retrospective analysis of 767 unique patients and their 1,014 respective admissions and readmissions was conducted. Continuous and categorical data was analyzed and presented as a mean (M), standard deviation (SD), absolute number (N) and percentage (%). A Pearson Chi Square test was used for categorical variables and Analysis of Variance was used for age and ejection fraction (EF). Results: Study sample demographics (N=767); age (M=79.72, SD=7.48); gender (57.6 % male) and EF (M=0.43, SD=0.16) were evaluated. The No HF clinic (No HFC) and HF clinic (HFC) enrollment groups (N=573) were compared for age (M=79.49, SD=7.65) (M=80.39, SD=6.94), male gender (54.6%, 66.5%) and EF (M= 0.44, SD=0.17) (M=0.42, SD=0.15), respectively. Each sample patient had at least one admission for HF during 2015; of which 573 (46.2%) were in the No HFC group and 194 (8.4%) were in the HFC group (p<0.001). There was no difference in all-cause readmissions between the No HFC group [n=95(14.5%)] and the HFC group [n=37(16.2%)] (p=0.534) and no difference in HF-related readmissions between the No HFC group [n=72(11.0%)] and the HFC group [n=23(10.0%)] (p=0.700). Conclusions: This DNP project demonstrated a significant difference in HF admission rates in favor of the HFC group. While no differences were found in all-cause or HF-related readmission rates in No HFC and HFC groups, the rates are less than the national average. Unintended findings were that datasets can be very poorly constructed and populated, resulting in large amounts of unusable data. Recommendations are for more rigor in the organization of datasets to assure accurate comparisons between admission and readmission rates based on enrollment in HF clinics.

No description available.

The extent and quality of strategic planning by institutional pharmacy directors was assessed. Also examined was how the extent and quality of strategic planning, institutional characteristics, pharmacy characteristics, and pharmacy director characteristics might be associated with the pharmacy's overall level of performance in selected areas. The majority of institutional pharmacy directors reported utilizing strategic planning for their departments. The global quality of strategic planning reported by pharmacy directors was average. However, directors conducting strategic planning reported a high level of strategic planning. The directors' rated time available, knowledge, and importance of strategic planning were found to be significantly associated with pharmacy directors' rated quality of strategic planning. Additionally, pharmacy directors' rated quality of strategic planning was found to be significantly associated with pharmacy performance for clinical, distributive, and administrative services.

Unidad de Práctica Prolongada para optar al título de Químico Farmacéutico / Los medicamentos son esenciales para algunos tratamientos y también para la prevención de algunas enfermedades, por lo que es importante corroborar, mediante un sistema de Farmacovigilancia (FV), su seguridad, efectividad y calidad. La FV se define como la ciencia y conjunto de actividades relacionadas con la detección, evaluación, comprensión y prevención de efectos adversos o de cualquier otro problema relacionado con medicamentos (PRM). Se creó un programa de FV en la Unidad de Paciente Crítico (UPC) y en la Unidad de Farmacia del Hospital Padre Hurtado por medio de un estudio observacional prospectivo, de una duración de 6 meses en la Unidad de Farmacia (directa) y en UPC (indirecta). La práctica prolongada se dividió en 3 etapas: 1) recolección y familiarización de la información, 2) Diseño del modelo de FV a realizar (pasiva por reporte espontáneo y activa por alertas en el sistema de prescripción y dispensación), 3) envío de reporte al Instituto de Salud Pública (ISP), caracterización de los reportes realizados y retroalimentación a los profesionales de la salud. Se detectó una serie de errores de medicación en el proceso de prescripción, donde predominó la falta de información acerca del paciente y el medicamento (56 % y 27 %, respectivamente). También se detectó errores en la dispensación, donde se evidenció con mayor importancia el factor humano como causa de los distintos tipos de errores de medicación. Además, se realizaron 21 reportes, los cuales fueron enviados al Sistema Nacional de FV del ISP, 15 provenientes de la UPC y 6 de otras Unidades clínicas. Respecto a los provenientes de la UPC, 12 fueron catalogados como sospechas de reacciones adversas a medicamentos (RAM) y 3 como otros PRM. De las sospechas de RAM de la UPC, se observó que los medicamentos mayormente involucrados en sospechas de RAM fueron los antiinfecciosos con un 82 % y el sistema más afectado fue el de la piel con un 59 % del total. Respecto a la causalidad de los medicamentos sospechosos se obtuvo que 8 fueron catalogados como posible y 4 probables, no habiendo certeza en ningún caso (criterio Organización Mundial de la Salud (OMS) – Uppsala Monitoring Centre (UMC)). De la gravedad que implicaron las sospechas de RAM de la UPC se obtuvo que 6 fueron moderadas, 5 fueron graves y sólo 1 leve (criterio OMS-UMC). El tipo de mecanismo de producción de las sospechas de RAM predominante fueron las de tipo B, que fueron 7 y las de tipo A fueron 5 (criterio OMS-UMC). En promedio se prolongó en 19 días la hospitalización para los pacientes con sospechas de RAM e implicó una estadía de 18 días para los otros pacientes con PRM. Finalmente, se creó un sistema de FV en el hospital, pero sin duda es necesario hacer énfasis en los profesionales de la salud que este sistema no busca castigar los errores reportados con acciones punitivas, sino que más bien corregirlos y prevenirlos a futuro para así cooperar positivamente con el tratamiento del paciente y con su pronta mejoría. Esto es sumamente importante debido a que la UPC posee altas tasas de mortalidad y la acción del profesional Químico Farmacéutico es fundamental / Medications are essential for some treatments and also for the prevention of some diseases, so it’s important to corroborate, through a Pharmacovigilance (PhV) system, safety, effectiveness and quality, which are defined as science and the whole of activities related to detection, evaluation, understanding and prevention of adverse effects of any other drug related problem (DRP). A program of PhV was created in the Critical Patient Unit (CPU) and in the Pharmacy Unit of the Hospital Padre Hurtado by a prospective observational study, with a 6-month stay in the Pharmacy Unit (direct) and CPU (indirect). The project was divided into 3 stages: 1) Collection and familiarization of information; 2) Design of the VF model to be carried out; 3) submission of report to the Public Health Institute (PSI); characterization of reports and feedback to healthcare professionals. A series of medication errors were detected in the prescription process, where the lack of information about the patient and the medication predominated. Errors were also detected in the dispensation where the human factor was more important as a cause of the different types of medication errors. In addition, 21 reports were sent to the National PhV System of the Public Health Institute, 15 from the CPU and 6 from other clinical Units. Regarding those coming from the Critical Care Unit, 12 were classified as adverse drug reactions (ADRs) and 3 as other DRPs. It was observed that the drugs most involved in suspected ADR were anti-infectives with 82 %, the most affected system was the skin with 59 % of the total. Regarding the causality of the suspected drugs, it was obtained that 8 were classified as possible and 4 probable, with no certainty in any case (World Health Organization (WHO) - Uppsala Monitoring Center (UMC)). From the severity of UPC suspicions, 6 were moderate, 5 were severe and only 1 mild (WHO-UMC criteria). The type of mechanism of production of suspected ADRs was type B, which were 7 and type A were 5 (WHO-UMC criteria). On average, hospitalization for patients with suspected ADR was prolonged by 19 days and involved an 18-day stay for other MRP patients. Finally, it was possible to implement a system of VF in the hospital, but it is undoubtedly necessary to emphasize the health professionals, that this system does not seek to punish the errors reported with punitive actions but rather to correct them and to prevent them in the future in order to cooperate positively with the treatment of the patient and with their improvement, this becomes extremely important because the CPU has the high mortality rates and the action of the Pharmacist is fundamental

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management APRIL 2014 / Background: The South African Department of Health stipulated that district hospitals must provide comprehensive package of preventive, promotive, curative and rehabilitative reproductive health services for women that requires medical and special resources, not found in the health centres and clinics (Department of Health, 2002). The Evander District (ED) Hospital, a district hospital situated in the Govan Mbeki Subdistrict in the Mpumalanga Province provides both in-patient (36 beds in maternity unit and four nursery beds) and outpatient services. The Hospital Maternity Unit has recently been criticised by the Mpumalanga Department of Health for high rate of CS (30%), and perinatal mortality rate (40 per 1000). But, the Hospital never analysed the data collected routinely to develop an understanding of the challenges faced by the Unit. The Unit staff complained about inadequate resources as one of the reasons. The Hospital has introduced a Cost centre in the Maternity Unit for efficient management of resource allocation for the Unit. This study analysed the routinely collected data from the Hospital Information System and Maternity Unit Cost centre for assessing the maternity services currently rendered by the Evander District Hospital. Aim: To described the deliveries at the Evander Hospital over a period of 6 months from 01st January 2011 to 30th June 2011. Methodology: It was a cross sectional study that reviewed the records from Hospital Information System (all antenatal cards and Obstetric files of the women who delivered at the labour ward during the study period) and Maternity Unit cost center. The variables used for the study included number and type of deliveries, socio-demographic and clinical profiles of patients, maternal and perinatal complications and outcomes. In addition, costing information collected during the same period. Descriptive and inferential statistics were used for analysis. Permissions were obtained from the Mpumalanga Department of Health and University of the Witwatersrand ‘Human Research Ethics Committee (Medical) before commencement of the study. Results: A total of 1,081 deliveries were performed at the Evander Hospital over sixmonth period. The highest number of deliveries was NVD (67.44%), followed by caesarean sections (31.82%). The majority of the women who delivered came from poor socio-economic class and mostly single and black, which is a reflection of the characteristics of the catchment population of the Evander Hospital. Teenage pregnancy rate was quite high (20%). The majority of the subjects were primipara (41%). Although most of them (91.3%) of them were booked, only 14% had stipulated number of antenatal visits (4 or more visits) and 7.4% of booked mothers, did not have booking blood results, which was a missed opportunity. HIV was the most prevalent (33, 31.3%) medical conditions, which is similar to the HIV prevalence reported in antenatal sero-prevalence survey in South Africa. Only 17% had planned and scheduled CS. Very few patients had post-partum complications indicating well managed third stage of labour. There was no maternal death during this period. All patients were discharged home. More than 17% (n=185) subjects had low birth weight babies (less than 2500 g), which is just above national average of 16%. The median Apgar score among children delivered at Evander Hospital was 9. Interestingly, the Apgar scores of babies of subjects who had operative deliveries were significantly lower than those who had nonoperative deliveries. Most of the babies were born alive. Stillbirth rate (7 per 1000 live births) was significantly lower than South African national average 17.8 per 1000 live births. The total medical cost for the maternity ward for the six months studied amounted to R 4,584,466, the average monthly cost being R 76,407.67. The most expensive items were drugs and pharmaceuticals and least expensive being the medical consumables. Conclusion: This study was the first of its kind to be done in this Hospital and the Health District. The study identified gaps where management of pregnant women in the Evander Hospital could be further improved through improved booking, planned deliveries and thereby reducing low birth weight rates and still birth rate. This would assist the Hospital Management to develop appropriate measures to reduce unnecessary CS being done, NVD being delivered in the hospital rather than using CHC, and strengthening referral system and strategies to reduce HIV and AIDS incidence. In addition, further study is necessary at the PHC facilities in the Sub-district to identify determinants for high rate of teenage pregnancy.

The use of Expressive Therapy as a tool for impaired or disabled individuals is an alternate approach to help those with psychological issues. These issues may arise from the catalyst event causing the impairment or disability, or from their preceding everyday life. The affected individual is not always able to address these issues through verbal psychotherapy, due to their new found physical state. This Expressive Therapy Centre will provide a space for individuals to express themselves through their own personal modus operandi, for later discussion through a therapist guided healing process. Expressive Therapy, such as art, dance, music, drama and writing therapy, affords another route for the individual to express their emotions and experiences. This project considers the history of Expressive Therapy, in conjunction with the existing theories and approaches within the field. This research forms a clear understanding of this type of therapy, along with the required provision for specific spatial needs related to this therapeutic process. An investigation into the theories of Steven Holl, Peter Zumthor and Juhani Pallasmaa sets up current theoretical views around the perception and experience of architecture. Theories of the psychology of space are investigated in relation to health care facilities, and the experience of impaired or disabled individuals treated within traditionally or alternatively designed spaces. The link between nature and health is established through theories and research regarding the development of design drivers. This research focuses on the perception and experience of architectural spaces for such affected individuals. Owing to this, this thesis implores for the establishment of an Expressive Therapy Centre within the Chris Hani Baragwanath Hospital Complex. This paper illustrates the manner in which such a Centre will provide treatment to patients of the Chris Hani Baragwanath Hospital, as well as the surrounding community. The aim of this thesis is to develop a therapeutic healing environment, within an already active and functioning complex.

A research report submitted to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Public Health in the field of Hospital Management, Johannesburg, 2011 / Mecklenburg Hospital provides a comprehensive package of promotive, preventive, curative and rehabilitative reproductive health services for women which are not available in primary health care clinics and community health centres. These services require special equipment (such as cardiotochograph machine) and personnel (such as medical doctors) that are not available in these health facilities. The availability of medical equipment is one of the crucial components of effective maternal health services. Specific life saving medical equipment must be available for routine and emergency management of maternal and neonatal complications. This study is undertaken since no formal study has been done to systematically study the availability and related cost of medical equipment in a district Hospital maternity ward.

Introdução: O termo absenteísmo, palavra de origem francesa, absentéisme, significa pessoa que falta ao trabalho, ausência no serviço por diversos motivos, proposital ou por circunstâncias que não dependem da vontade do trabalhador. Objetivos: Identificar as taxas de absenteísmo, levantar as ações e decisões que os enfermeiros coordenadores adotam frente ao absenteísmo, e as ações de impacto positivo, realizadas frente ao absenteísmo. Método: Descritiva e exploratória adotando o Estudo de Caso desenvolvido em dois momentos: na abordagem quantitativa foram identificadas as taxas de absenteísmo do pessoal de enfermagem das unidades estudadas nos anos de 2010 e 2011. Na abordagem qualitativa, os dados foram coletados mediante a adoção das técnicas da Entrevista e do Grupo Focal. A análise dos dados quantitativos tomou como base a taxa de 6,7%, preconizada pela Resolução do Conselho Federal de Enfermagem 293/04 e dos qualitativos foi efetuada segundo a proposta da análise temática de Minayo. Resultados: Em 2010 e 2011, das 6 unidades que apresentaram as mais altas taxas de absenteísmo, três são Unidades de Terapia Intensiva. No entanto, foram evidenciadas, também, taxas elevadas em unidades como centrais de material esterilizado, ambulatório e internação. Dentre as unidades com as mais baixas taxas de absenteísmo, duas são de hemodiálise, uma unidade transfusional, um laboratório, uma de hematologia e um ambulatório clínico. A análise dos dados obtidos nas entrevistas possibilitou a construção das categorias temáticas e respectivas Unidade de Significado (US): Elementos constitutivos do absenteísmo com as US Característica de absenteísmo, Insatisfação no trabalho e Consequências do absenteísmo; Ações realizadas frente ao absenteísmo com as US Ações de caráter institucional e Ações de caráter profissional; Ações de impacto positivo frente ao absenteísmo com as US Ações de impacto positivo de caráter institucional e Ações de impacto positivo de caráter profissional. O Relatório Síntese resultante desta análise foi o elemento disparador do Grupo Focal que permitiu a elaboração das categorias Elementos constitutivos do absenteísmo com as U.S Características de absenteísmo e Consequências do absenteísmo e Ações de impacto positivo frente ao absenteísmo com as U.S Ações de impacto positivo de caráter institucional e Ações de impacto positivo de caráter profissional. Considerações finais: O presente estudo corrobora resultados de estudos que atribuem as mais altas taxas de absenteísmo às especificidades de algumas unidades, caracterizadas por maior exposição dos profissionais a desgastes físicos e mentais, como as unidades de tratamento intensivo, que atendem pacientes graves com alta dependência de cuidados. Grande parte dos motivos/causas do absenteísmo, não podem ser gerenciados, e principalmente resolvidos, pelos agentes de âmbito decisório das unidades de serviço. São realizados encaminhamentos para atendimento de problemas pessoais, no entanto, existem encaminhamentos de caráter institucional que precisam ser direcionados a agentes organizacionais com maior poder decisório e governabilidade. / Absenteeism is a term of French origin absentéisme which means absence from work for a number of reasons, absenteeism rates were determined among nursing staff at the units studied between 2010 and 2011. Secondly, as a quality indicator of the nursing staff management at an oncology-specialized hospital. A descriptive and exploratory methodology was adopted for , at the qualitative approach level, at the quantitative approach level, data were collected through the employment of two techniques: interview and focus group. The analysis of qualitative data was carried out according to, dissatisfaction at work and consequences of absenteeism); Actions against absenteeism and the units of meaning (actions of institutional character and, either voluntary or due to circumstances beyond a workers own will. The objective of this study is to validate absenteeism, of the data obtained from interviews enabled the development of the following thematic categories and their respective units of meaning: Absenteeism c, under a given concrete situation

Este estudo de natureza qualitativa teve como objetivo compreender os significados atribuídos ao processo de enfermagem por enfermeiras da unidade clínica num hospital do México. A coleta dos dados foi realizada por meio de entrevistas semiestruturadas com 16 enfermeiras, complementada com observação de sua atuação num período de trabalho, nos diferentes turnos, e consulta documental. Os dados foram analisados tendo como referenciais teórico e metodológico o Interacionismo Simbólico e a Teoria Fundamentada nos Dados, que possibilitaram a construção de categorias, subcategorias e suas inter-relações, utilizando o paradigma de codificação de Strauss e Corbin (2002). A comparação constante dos dados resultou na categoria central \"o processo de enfermagem no contexto hospitalar: entre o fazer rotineiro e o pensar idealizado\", que permitiu compreender o significado atribuído pelas enfermeiras ao processo de enfermagem na sua prática cotidiana assistencial, explicitado nas concepções, idealizações e ações de cuidado rotineiro, despercebido, aplicado de forma diferente ao aprendido na escola, e seguindo protocolos de atenção estabelecidos, como base de seu trabalho, uma maneira de fazer os cuidados e ajudar os pacientes a solucionar seus desconfortos, instrumento e metodologia que lhes permite direcionar suas atividades e assumir a prática profissional autônoma. O processo de enfermagem se mostra como dissociação entre o pensar e fazer, indicando haver distanciamento entre a teoria e a prática. As ações de cuidado das enfermeiras estão orientadas, principalmente, à realização de procedimentos, conforme rotinas e protocolos de atenção. Estas ações consistem em: recepção e entrega de turno, administração de medicamentos, mensuração de sinais vitais, registros clínicos de enfermagem e encaminhamento de pacientes, visando a dar conta da investigação de suas necessidades, planejamento e realização das ações, na perspectiva do cuidado individualizado e uso do processo de enfermagem. Nesse espaço de tomada de decisões, o enfermeiro estabelece relacionamento humanizado refletido na sua satisfação pelo cuidado realizado, evidenciando sua capacidade de lidar com as condições contextuais em que há delimitação de funções, sobrecarga de trabalho, bem como, costumes, crenças e valores pessoais e profissionais, expressos como limitantes na utilização do processo de enfermagem. Com este estudo foi possível compreender o processo social em que as enfermeiras atribuem significados ao processo de enfermagem no contexto hospitalar, captando a intersubjetividade de suas experiências e a participação ativa na construção de uma prática de enfermagem diferente, firmando a proximidade humana nas múltiplas interações do cotidiano hospitalar. Esta proximidade pode vir a ser resgatada e potencializada como objeto sensibilizador de uma prática que questione o caráter instrumental da rotina, avançando na perspectiva do cuidado humanizado. / This qualitative study aimed to understand the meanings attributed to the nursing process by clinical unit nurses from a Mexican hospital. Data were collected through semistructured interviews with 16 nurses, in addition to observation of their activities during work hours, in different shifts, and consultation of documents. The theoretical and methodological frameworks for data analysis were Symbolic Interactionism and Grounded Theory, which permitted the construction of categories, subcategories and their interrelations, using the coding paradigm by Strauss and Corbin (2002). Constant data comparison resulted in the central category \"the nursing process in the hospital context: between routine actions and idealized thinking\", which permitted an understanding of the meaning nurses attributed to the nursing process in their daily care practice, expressed in conceptions, idealizations and routine care actions, unperceived, applied differently from what they had learned in school, and following established care protocols. This serves as the base of their work, as a way of delivering care and helping patients to solve their discomfort, as an instrument and methodology that allows them to direct their activities and assume an autonomous professional practice. The nursing process reveals itself as dissociation between thinking and doing, indicating a distance between theory and practice. The nurses\' care actions are mainly oriented towards the realization of procedures, according to routines and care protocols. These actions consist of: shift reception and transmission, medication administration, measurement of vital signs, clinical nursing records and patient referral, with a view to coping with needs assessment, action planning and performance, within the perspective of individualized care and use of the nursing process. In this decision making space, nurses establish humanized relations, reflected in their satisfaction with the delivered care, evidencing their capacity to deal with the contextual conditions of function delimitation, work overload, as well as personal and professional customs, beliefs and values, expressed as limiting factors in the use of the nursing process. This study allowed us to understanding the social process in which nurses attribute meanings to the nursing process in the hospital context, capturing the intersubjectivity of their experiences and their active participation in the construction of a different nursing practice, inscribing human proximity in the multiple interactions of daily hospital reality. This proximity can be recovered and potentialized as the sensitizing object of a practice that questions the instrumental nature of routine, advancing in the perspective of humanized care.

O presente estudo tem o objetivo de analisar as notificações dos incidentes relacionados à assistência à saúde em um hospital universitário brasileiro entre os anos de 2015 e 2016.Para tanto, foram coletados dados secundários dos Eventos Adversos (EA) ocorridos no hospital e registrados no sistema VIGIHOSP, e foram descritos eventos de 8 perfis distintos: Procedimentos cirúrgicos, Quedas, Identificação do Paciente, Flebite, Medicamentos utilizados, Perda do Cateter, Lesão na Pele, e Sangue e Hemocomponentes. Os resultados alcançados têm suporte na literatura, tanto em relação à porcentagem de ocorrência de cada notificação, como também no que diz respeito às notificações que se tornam EA. Uma lacuna foi identificada: a literatura científica reforça bastante o problema da subnotificação e as mazelas dela decorrentes; mas, além desse fato, o que este estudo chama atenção é para a efetividade das notificações incompletas. Sugere-se ao hospital pesquisado a promoção das notificações como parte de uma cultura de segurança, buscando mais os resultados do que os culpados. Propõe-se também a utilização dos EA como indicadores de resultado para a gestão hospitalar, atrelados aos objetivos de qualidade e de custo / This study aims to analyze the reports of incidents related to health care in a Brazilian university hospital during the years 2015 and 2016. To do so, secondary data from Adverse Events (AD) occurred at the hospital and were recorded in the VIGIHOSP system, and events of 8 different profiles were described: Surgical Procedures, Falls, Patient Identification, Phlebitis, Medications Used, Catheter Loss, Skin Injury, and Blood and Hemocomponents. The results obtained are supported in the literature, both in relation to the percentage of occurrence of each notification, as well as with regard to notifications that become AD. A gap has been identified: the scientific literature strongly reinforces the problem of underreporting and the ensuing problems; but beyond this fact, what this study calls attention to is the effectiveness of incomplete notifications. For the researched hospital is suggested to promote the notifications as part of a safety culture, seeking more results than the culprits. It is also proposed the use of AD as outcome indicators for the hospital management, linked to quality and cost objectives