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.

Submitted by Maria Aparecida (cidazen@gmail.com) on 2017-04-24T13:10:02Z No. of bitstreams: 1 Marianne de Carvalho Rodrigues.pdf: 783432 bytes, checksum: 47b0cab16ad64cf53837adef47c49034 (MD5) / Made available in DSpace on 2017-04-24T13:10:02Z (GMT). No. of bitstreams: 1 Marianne de Carvalho Rodrigues.pdf: 783432 bytes, checksum: 47b0cab16ad64cf53837adef47c49034 (MD5) 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.

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.

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

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.

Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2016-11-24T15:41:03Z No. of bitstreams: 2 Dissertação - Letícia de Araújo Morais - 2016.pdf: 2106540 bytes, checksum: 827c06cec06de435f7fbfd79da7235a7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2016-11-28T17:57:38Z (GMT) No. of bitstreams: 2 Dissertação - Letícia de Araújo Morais - 2016.pdf: 2106540 bytes, checksum: 827c06cec06de435f7fbfd79da7235a7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-11-28T17:57:38Z (GMT). No. of bitstreams: 2 Dissertação - Letícia de Araújo Morais - 2016.pdf: 2106540 bytes, checksum: 827c06cec06de435f7fbfd79da7235a7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) 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.

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.

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

No description available.

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. / University of Bradford studentship