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Medicines management after hospital discharge : patients' personal and professional networksFylan Gwynn, Elizabeth Margaret Mary January 2015 (has links)
Improving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored.
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ALIMENTAÇÃO E CRESCIMENTO DE LACTENTES NASCIDOS PRÉ-TERMO DE MUITO BAIXO PESO EGRESSOS DE UTI NEONATAL: ANÁLISE DE INFERÊNCIA CAUSAL / FEEDING AND GROWTH OF PRE-TERM BORN INFANT OF VERY LOW WEIGHT EFFECTS OF NEONATAL UTI: ANALYSIS OF CAUSAL INFERENCERODRIGUES, Marianne de Carvalho 10 February 2017 (has links)
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Previous issue date: 2017-02-10 / FAPEMA / Breast milk (LM) is the best food for the child, especially in the first six months of life,
because it contains fats, vitamins, minerals, immunoglobulins and other nutrients necessary
for the maintenance, growth and development of the children. For preterm newborns
(PTNBs), breastfeeding has also been the main food indication, both in the hospital setting
and after discharge. Breastmilk supplementation has been highly recommended for the
nutrition of PTNB and of very low birth weight, since it has been shown to be effective in
providing calories and nutrients that may be below the needs of these children in their
mothers' milk, for proper growth of the neonate. However, there is no consensus as to how
best to feed these children after discharge. Given the conditions to which PTNBs are exposed
and that breastmilk has components that can provide a better growth for the baby, this study
intends to compare the growth among PTNBs and very low birth weight infants from the
Neonatal Intensive Care Unit exclusively breastfed up to 6 Months of age with those not
exclusively breastfed during this same period.
Cohort study, conducted at the University Hospital of the Federal University of Maranhão,
Unidade Materno Infantil, using data from the children followed up at the Follow-up service
of Neonatology. For data collection, a form was constructed with the variables of interest,
socio-demographic variables and growth variables of the children. The sample consisted of
174 individuals compared to the type of feeding and anthropometric measures of growth at six
months of corrected gestational age. / O leite materno (LM) é o melhor alimento para a criança, principalmente nos seis
primeiros meses de vida, por ter, em sua composição, gorduras, vitaminas, minerais,
imunoglobulinas e demais nutrientes necessários à manutenção, crescimento e
desenvolvimento desta. Para os recém-nascidos pré-termo (RNPT), o aleitamento materno
também tem sido a principal indicação alimentar, tanto em ambiente hospitalar quanto após a
alta. A suplementação do leite materno tem sido bastante recomendada para a nutrição dos
RNPT e de muito baixo peso, pois tem se mostrado eficaz em prover calorias e nutrientes que
podem estar aquém das necessidades destas crianças no leite de suas mães, contribuindo,
desta forma, para o crescimento adequado do neonato. Porém, não se tem um consenso de
qual a melhor forma de alimentar essas crianças após a alta hospitalar. Dadas as condições
às quais os RNPT estão expostos e que o leite materno possui componentes que podem
propiciar melhor crescimento ao bebê, este estudo pretende comparar o crescimento entre
RNPT e de muito baixo peso egressos de Unidade de Terapia Intensiva Neonatal,
amamentados exclusivamente até os seis meses de idade com aqueles não amamentados de
forma exclusiva neste mesmo período.
Estudo de coorte, realizado no Hospital Universitário da Universidade Federal do Maranhão,
Unidade Materno Infantil, utilizando dados das crianças acompanhadas no Follow-up do
Serviço de Neonatologia. Para coleta de dados foi construído um formulário com as variáveis
de interesse, sócio demográficas e variáveis de crescimento das crianças. A amostra foi
composta por 174 indivíduos comparados quanto ao tipo de alimentação e medidas
antropométricas de crescimento aos seis meses de idade gestacional corrigida.
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Transition to home study: the influence of interprofessional team shared mental models on patient post-hospitalization outcomesManges, Kirstin 01 May 2018 (has links)
Background: The quality of team-based care impacts patient post-hospitalization outcomes, yet there is a gap in our understanding of how specific team processes impact patient post-hospitalization outcomes. Shared Mental Models (SMMs) is a team process from organizational psychology; it provides an understanding of how providers coordinate complex tasks as a team. SMMs are the team members’ organized knowledge needed for effective team performance. Military research shows that teams with more convergent SMMs have higher performance and better outcomes. In healthcare, patient discharge exemplifies an activity that requires a high level of coordination among interprofessional team members. Two relevant domains of SMMs are Taskwork SMM (team assessment of patient’s readiness for hospital discharge) and Teamwork SMM (quality of day of discharge teamwork). Because of the newness of SMM to healthcare, we lack measures to understand SMMs among interprofessional discharge teams.
Study Purpose & Aims: The purpose was to pilot a novel measurement approach assessing SMMs of discharge teams, and explore their relationships to patient 30-day post-hospitalization outcomes (quality of care transition and utilization of unplanned medical services). Aim 1 determined the content and degree of convergence of discharge teams’ SMMs (taskwork and teamwork). Aim 2 examined the relationship between discharge team SMMs and patient post-hospitalization outcomes.
Methods: A prospective longitudinal pilot study was used to examine the SMMs of 64 unique discharge events in three inpatient units at a single hospital. Discharge team members independently completed a questionnaire measuring the Teamwork SMM (using the Shared Mental Model Scale) and the Taskwork SMM (using the Discharge Provider-Readiness for Hospital Discharge Scale). Data were collected from the patient 30 days post-discharge to determine the quality of transition (using the Care Transition Measure or CTM-15) and use of unplanned utilization of medical services (unplanned readmission or ED visit). Interrater Agreement (r*wg(j)) was used to determine the SMM convergence (or level of agreement) among the discharge team. The relationship between SMMs and the quality of transition outcome (n = 42) was determined using standard regression analysis. Logistic regression was used determine the relationship of SMMs with utilization of unplanned medical services (n = 56).
Results: Overall, discharge teams reported high levels of Taskwork SMMs (M = 8.46, SD =.91) and Taskwork SMM Convergence (M = .90, SD =.10), indicating that the discharge team perceived and agreed that patients had high levels of readiness for hospital discharge. Discharge teams also reported having high-quality Teamwork SMMs (M = 6.11, SD = 0.39) and Teamwork SMM Convergence (M = .85, SD = .10), suggesting that most discharge teams perceived and agreed that high quality teamwork was provided during the discharge process. Discharge events from the three inpatient units significantly differed in their Teamwork and Teamwork SMM content and convergence scores. Discharge teams’ Teamwork SMMs and Taskwork SMMs were positively associated with the CTM-15 score, while controlling for key contextual factors (t = 3.94, p = .001; t = 3.94, p = .001, respectively).
Conclusion : Discharge teams’ Taskwork SMM and Teamwork SMM was positively associated with patient-reported quality of transition from the hospital. There was insufficient evidence to support that utilization of unplanned medical services is related to discharge teams’ SMMs. Measuring the SMMs of the discharge team provides a method for assessing a team process critical to safe patient discharges.
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Cuidado integral à saúde da criança e sua família tecnologia de apoio ao planejamento da alta hospitalar /Oliveira, Elaine Garcia de January 2019 (has links)
Orientador: Vera Lucia Pamplona Tonete / Resumo: Introdução: esta pesquisa volta-se à temática da sistematização da assistência de enfermagem, destacando como objeto de estudo,estratégias facilitadoras do planejamento da alta hospitalar pediátrica para a promoção do cuidado integral em saúde. Objetivo: elaborar tecnologia informatizada de apoio ao planejamento de alta pelo enfermeiro visando promover o cuidado integral em saúde. Método: esta pesquisa foi realizada em uma unidade de internação pediátrica hospitalar e foram desenvolvidos três estudos: revisão integrativa da literatura cientifica sobre estratégias voltadas ao planejamento da alta hospitalar pediátrica pelo enfermeiro para promover o cuidado integral em saúde da criança e sua família; estudo de abordagem qualitativa sobre a perspectiva de enfermeiros atuantes em unidade de internação pediátrica, através de dados coletados por meio de entrevistas semiestruturadas e analisados segundo técnicas de Análise de Conteúdo Temática; e estudo transversal dos registros da sistematização da assistência de enfermagem e do processo de enfermagem contidos em prontuários eletrônicos de amostra probabilística de crianças menores de dois anos internadas de janeiro a dezembro de 2017, utilizando questionário estruturado e empregando-se estatística descritiva na sua análise. Resultados: foram identificados dez artigos que preencheram os critérios de inclusão na revisão de literatura, cuja análise integrada revelou que para se realizar o planejamento da alta hospitalar com vistas a... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: the theme of this research is the systematization of nursing assistance, which highlights the enabling strategies of pediatric hospital discharge and also the promotion of integral health care. Objective: elaborate computerized technology which offers support for the hospital discharge, when made by the nursing team, aiming to promote integral health care. Methodology: this research was carried out in an admission’s pediatric hospital unit and three studies were conducted: Integrative scientific literature review of strategies surrounding pediatric hospital discharge by the nursing team to promote integral care for children and their families; Qualitative approach about the perspectives of working nurses of the pediatric admissions unit through data collection in semi structured interviews and its analysis in accordance with the content analysis technique; and cross sectional observational study of the nursing team's systematization records and the nursing process which were in the electronic patient's record with probability samples from children under the age of two who were admitted from January to December of 2017, using structured questionnaire and applying descriptive statistics in its analysis.Results: ten articles that fit the criteria were identified for the literature review and in which the integrated analysis revealed that, in order to make the hospital discharge planning, keeping children’s integral care in mind, it is important to introduce educati... (Complete abstract click electronic access below) / Mestre
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Transitioning with an Ostomy: The Experience of Patients with Cancer Following Hospital DischargePadilla, Liza L. 05 July 2013 (has links)
The study aim was to describe the lived experience of patients with an ostomy due to cancer following hospital discharge, using a Heideggerian phenomenological lens. Colaizzi’s (1978) process guided a thematic analysis of nine unstructured interviews. The overall essence of patients’ transition experience was Adjusting to a New Way of Living. Four major themes emerged, Some Things are Different, Always on my Mind, Moving Towards Independence, and I’m Not Alone. Results suggest that the transition involves: adjusting to the ostomy and cancer; financial implications; changes in self, physical being, lifestyle, and social aspects of life; and psychological acceptance and preparation for the unexpected. Home care nurses and patients’ support network facilitated meeting their comprehensive care needs; while cancer treatments, the role of the significant other in the loss of privacy, funding inconsistencies, and temporary ostomy status were barriers. Patients need a comprehensive care approach to better facilitate the transition process.
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Avaliação da informação fornecida ao paciente com doença pulmonar obstrutiva crônica sobre sua doença e tratamento no momento da alta / Evaluation of the information provided by the patient with chronic obstructive pulmonary disease about their disease and treatment at the time of hospital dischargeMorais, Letícia de Araújo 19 October 2016 (has links)
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Previous issue date: 2016-10-19 / Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous and
multifactorial disease that causes a huge impact on the patient and the health
system, causing exaggerated high costs. This study has as aim to evaluate
the provided information to patients with COPD about their disease and
treatment at the time of hospital discharge. A cross-sectional descriptive study
with hospitalized patients for COPD in three tertiary hospitals using a
standardized document for evaluation of the discharge checklist proposed by
the Global Initiative for Chronic Obstructive Pulmonary Disease, containing 7
items. Hospitals were divided into (Group A) with residency in pulmonology
(RMP) and (Group B) without RMP. It was evaluated 54 patients with a mean
age of 66,6 ± 11,4, 25 (46,2%) were male, 22 (40,7%) (Group A) and 32
(59,3%) (Group B). Items related to ensure effective pharmacological
maintenance treatment (item 1), blood gas evaluation/measurement of SpO2
(item 2), reassessment of inhalation technique (item 4), and information
relating to maintenance therapy (item 5) were respectively 79,6%, 96,3%,
70,3%, and 88,9% of information. Comorbidity management plan (item 3)
29,6%, information regarding the completion of antibiotic
therapy/corticosteroid (item 6) 44,4% and following assurance specialist (item
7) 55,6%. There was statistical significance between hospitals for items 1, 4
and 7 (p = 0,002, p ˂ 0,001, and p ˂ 0,001, respectively), with better
performance in the patients in Group A. This study revealed the need for
attention to instructions regarding the length of treatment of
corticosteroid/antibiotics and comorbidity management plan. The lack of
specialized care reveals lower yields in check information provided to COPD
patients at hospital discharge. / A doença pulmonar obstrutiva crônica (DPOC) é uma doença heterogênea e
multifatorial que gera grande impacto ao paciente e ao sistema de saúde,
ocasionando exacerbações com custos elevados. Este estudo tem por
objetivo avaliar a informação fornecida ao paciente com DPOC sobre sua
doença e tratamento no momento da alta hospitalar. Estudo observacional
descritivo transversal com pacientes internados por DPOC em três hospitais
terciários utilizando documento padronizado para avaliação do checklist de
alta hospitalar proposta pela Iniciativa Global para Doença Pulmonar
Obstrutiva Crônica, contendo 7 itens. Os hospitais foram divididos em (Grupo
A) com residência médica em pneumologia (RMP) e (Grupo B) sem RMP.
Foram avaliados 54 pacientes, com idade média de 66,6 ± 11,4, 25 (46,2%)
do sexo masculino, 22 (4,7%) (Grupo A) e 32 (59,3%) (Grupo B). Itens
referentes a garantia de efetivo tratamento farmacológico de manutenção
(item 1), avaliação gasométrica/aferição de SpO2 (item 2), reavaliação da
técnica inalatória (item 4) e informação em relação a terapia de manutenção
(item 5) apresentaram respectivamente 79,6%, 96,3%, 70,3% e 88,9% de
informação. Plano de manejo de comorbidades (item 3) 29,6%, informação
referente ao término de terapia antibiótica/corticóide (item 6) 44,4% e garantia
de seguimento com especialista (item 7) 55,6%. Houve significância
estatística entre hospitais para os itens 1, 4 e 7 (p = 0,002 p ˂ 0,001 e p ˂
0,001, respectivamente), com melhor performance aos pacientes atendidos
no Grupo A. Esse estudo sinaliza para necessidade de atenção em instruções
referentes ao tempo de uso de corticosteroide/antibiótico e plano de manejo
de comorbidades. A ausência de atendimento especializado sinaliza para
menor rendimento na verificação de informações fornecidas aos pacientes
com DPOC no momento da alta.
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Transitioning with an Ostomy: The Experience of Patients with Cancer Following Hospital DischargePadilla, Liza L. January 2013 (has links)
The study aim was to describe the lived experience of patients with an ostomy due to cancer following hospital discharge, using a Heideggerian phenomenological lens. Colaizzi’s (1978) process guided a thematic analysis of nine unstructured interviews. The overall essence of patients’ transition experience was Adjusting to a New Way of Living. Four major themes emerged, Some Things are Different, Always on my Mind, Moving Towards Independence, and I’m Not Alone. Results suggest that the transition involves: adjusting to the ostomy and cancer; financial implications; changes in self, physical being, lifestyle, and social aspects of life; and psychological acceptance and preparation for the unexpected. Home care nurses and patients’ support network facilitated meeting their comprehensive care needs; while cancer treatments, the role of the significant other in the loss of privacy, funding inconsistencies, and temporary ostomy status were barriers. Patients need a comprehensive care approach to better facilitate the transition process.
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Evaluating a discharge medication delivery service: a return on investment study and a pilot trialHatoun, Jonathan 03 October 2015 (has links)
Background: Many patients discharged from the hospital do not appropriately fill their discharge medications. At Boston Medical Center, an urban safety net facility, a bedside discharge medication delivery service was pilot tested in 2012 to ensure pediatric patients with asthma left in possession of their new medications. The service was expanded to all pediatric discharges in 2013. It is unknown whether beside delivery increases the proportion of written prescriptions captured by the hospital-owned pharmacy or if the service achieves a positive return on investment. Whether such a service improves patients’ satisfaction, medication adherence, or clinical outcomes is also unknown.
Methods: Two primary methodologies were used to evaluate the impact of this novel service. The first evaluated the relative risk of filling a prescription in the hospital- owned pharmacy after the expansion of delivery eligibility criteria using two years of discharge prescription information, corresponding pharmacy fill data, and a hierarchical model with generalized estimating equations (GEE) to account for non-independent events. Initial patient-level impacts of the delivery service were evaluated through a pilot randomized controlled trial to test logistics and obtain empiric estimates of study parameters.
Results: Patients were 1.44 times more likely to fill a medication at the hospital- owned pharmacy providing the delivery service after the intervention (95%CI 1.3-1.59). The increased profit generated by prescriptions captured as a result of offering the delivery service is estimated to be equivalent to 8-15% of a pharmacist full-time- equivalent (FTE), whereas only 3% of an FTE was required to provide the service, indicating a positive return on investment. Pilot study data suggest families did not differ significantly with regards to perceived satisfaction or reported outcomes whether randomized to usual care or delivery.
Conclusion: A service to deliver discharge medications can yield a positive return on investment, allowing an institution to offset uncompensated care. To further study the intervention, a trial with randomization at the level of the ward or institution is needed. / 2017-10-02T00:00:00Z
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Understanding Discharge Communication for Hospitalized Patients and Caregivers with Limited English ProficiencyChoe, Angela Y. 09 July 2019 (has links)
No description available.
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Hospital and care home nurse perspectives on optimising care for people living with dementia who transfer between hospitals and care homesRichardson, Angela January 2020 (has links)
Background: Transitions out of hospital result in poor outcomes for older
people. Research investigating transitions for care home residents living with
dementia is limited, even though such residents often have multi-morbidities
and frequently use hospital services. Nurses are key care providers. Yet their
perspectives on optimising care for people living with dementia transferring
back to their care home remains under explored.
Aims: This qualitative descriptive study explores hospital and care home
nurses’ perspectives on how they optimise care for people living with
dementia who transfer from hospital back to their care home, and the
alignment of this care with best practice.
Methods: Thirty-three nurses participated in either semi structured
interviews or focus groups. Data were analysed using qualitative content
analysis.
Results: Nurses described four roles: 1) exchanging information, 2)
assessing and meeting needs, 3) working with families and 4) checking and
organising medication. They described care home residents with dementia
as having distinct needs and variation in how they provided care. Nurses
described interdependent roles, but care home nurses were often excluded
from involvement in planning resident’s care on return and were not fully
recognised as members of wider healthcare teams. Facilitators for optimising
care include: nurses understanding the principles of dementia care, nurse
leadership and autonomy, having positive relationships between hospital and
care home nurses and opportunities for joint working. The care practices
nurses described broadly aligned with best practice.
Implications: Hospital and care home nurses require joint working
opportunities to understand their roles and build relationships. Care home
nurses’ status needs to be addressed with action to support their integration
into the wider healthcare system. / Alzheimer’s Society (UK)
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