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PubMedDate not supplied

Concurrent planning: benefits and pitfalls.

Concurrent planning-working with families toward reunification while developing alternative permanency plans--was designed to fit an out-of-home care population much like that projected for the year 2000 and beyond: very young, chronically neglected children from multiproblem families. As large-scale programs begin to develop nationally, those implementing concurrent planning must be aware of the pitfalls that can undercut its effectiveness, while keeping in mind the benefits it can bring by reducing the trauma experienced by children in placement.

Case Management↗
PubMedDate not supplied

The Nurse Reinvestment Act: the impact of governmental and nongovernmental administrative tools.

The Nurse Reinvestment Act has ushered in a new wave of federal involvement intended to address the issue of the critical nursing shortage. To implement this act, administrators will rely on a series of governance tools often called upon to address issues related to the social welfare of the country. Included among these tools are grants and loans through which the intent of the legislation will be formalized. The purpose of this analysis is to provide an overview of the characteristics associated with these tools, specifically as they relate to nursing education. Consideration will be given to the political environment through which funding, and thus the ability to implement the Nurse Reinvestment Act, will be realized, and the potential obstacles when executing federal programs in a market-driven economy.

Community Participation↗
PubMed2005

Pressure ulcer prevention and care: implementing the revised guidance to surveyors for long-term care facilities.

The revised guidelines for long-term care surveyors by the Centers for Medicare and Medicaid Services link the existing pressure ulcer prevention and treatment evidence base with federal guidelines. The guidance document is detailed and attempts to ensure that residents receive optimal care to help prevent and manage these wounds. Implementation of the guidance document recommendations requires a complete review, and possibly revision, of existing policies and procedures. Understanding the background, rationale, and methods to implement these recommendations will help administrators and clinicians develop protocols of care that are effective, cost efficient, and comply with the new guidelines.

Health Plan Implementation↗
PubMed2005

Implementation of a family intervention to increase fruit and vegetable intake: the Hi5+ experience.

Family is an important, yet challenging, target for dietary intervention. This article describes the implementation of Hi5+, a family fruit and vegetable (FV) promotion program. Complementing a fourth-grade school curriculum, the seven weekly Family Fun Nites were at-home family meal sharing and game evenings. A sample of families (N = 575; 69% consented) from schools in a southeastern U.S. urban area received tailored intervention materials based on their FV attitudes and family interaction styles. A pyramidal organizational design, using peer leaders, facilitated 71% of families to complete all seven sessions, whereas 84% completed at least one session. Significant independent predictors of program completion were attending an introductory Kick-Off Nite, interactive family style, additional adults in the household, married parents, being African American, earning more than 60,000 dollars, and additional children in the household. Family-specific issues and initial program experience are important considerations for implementing a family intervention.

Adult↗
PubMedDate not supplied

[Implementation process evaluation of the Integrated Management Childhood Illness strategy in the Family Health Program, Pernambuco State, Brazil].

This evaluative study attempts to define the contextual determinants of the degree of implementation in the Integrated Management of Childhood Illnesses strategy in Pernambuco State, Brazil. A total of 33 Family Health Program teams were selected from 10 municipalities. In order to define the degree of implementation, the study used a specific score system and the process indicators provided by the strategy. Municipalities were classified as critical, unsatisfactory, and acceptable. All municipalities except for one presented an acceptable degree of implementation in relation to the structure. In relation to process evaluation, two municipalities received one follow-up visit and their scores were unsatisfactory. Four municipalities received two visits, and one was classified as unsatisfactory on the second follow-up visit, while another presented a critical score on the first follow-up visit. Among four municipalities that received three follow-up visits, one was classified as unsatisfactory in the three evaluations. Four municipalities achieved mean unsatisfactory scores, when considering the mean scores acquired in the three follow-up visits. There was no association between the organizational context and degrees of implementation.

Brazil↗
PubMed2004

Suicide-preventive activities in psychiatric care: evaluation of an educational programme in suicide prevention.

To promote implementation of suicide-preventive activities, the Swedish National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) introduced a 200-h academic, postgraduate educational programme (based on the training-of-trainers model) in suicide prevention. This programme was provided at Karolinska Institute, Stockholm, for key persons in psychiatric care. Twenty-nine key persons from 11 psychiatric intervention clinics in Stockholm County attended the first course. Preconditions for implementing suicide-preventive activities were assessed by means of semi-structured interviews with all course participants still working in the intervention clinics (n=10). In all but one of these 10 clinics, a wide range of suicide-preventive activities had been implemented as a result of the NASP course. Activities varied in scope, but the key persons seemed to have succeeded in pinpointing the key elements in suicide prevention - the need for specific knowledge about the suicidal process and for well-defined suicide-preventive routines. However, organizational factors and staff turnover were obstacles to maintaining and making the activities routine. There is a need to strengthen the course participants' formal roles as implementers and encourage the clinical management in their continuous implementation of suicide-preventive activities.

Adult↗
PubMed2001

HIPAA privacy standards raise complex implementation issues.

In November 1999, under the mandate of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, HHS issued proposed standards to protect the privacy of electronically transmitted personal health information. With publication of the final standards due soon, healthcare organizations must prepare to implement new processes and information systems to comply with the HIPAA requirements. The privacy standards are intended to accomplish three broad objectives: define the circumstances in which protected health information may be used and disclosed, establish certain individual rights regarding protected health information, and require that administrative safeguards be adopted to ensure the privacy of protected health information. Among the required administrative safeguards are designation of a privacy officer, implementation of compliance training programs for all applicable staff, establishment of a complaint system, and implementation of appropriate sanctions for violations of privacy requirements.

Computer Security↗
PubMed2005

Physical exercise interventions to improve disability and return to work in low back pain: current insights and opportunities for improvement.

INTRODUCTION: There is a body of literature that indicates that physical exercise interventions, with a primary focus on improvement of functioning instead of pain relief, might be effective to stimulate return to work and improve function in workers who are absent from work due to low back pain (LBP). Successful application and implementation of these interventions however, depends on multiple factors that need to be addressed carefully in clinical practice as well as research. METHODS: Descriptive literature review, to identify an overview of current knowledge with respect to the safety, content- and context-related aspects of physical exercise interventions, issues relating to timing, the influence of treatment confidence and patient expectations, and the process of changing provider and employer behavior. RESULTS: Physical exercises are not associated with an increased risk for recurrences. The effects of interventions may vary depending on content-related factors (i.e., type of exercises, dosage, frequency, skills of the healthcare providers, etc.) and contextual factors (i.e., treatment setting, compensation system, etc.). Treatment confidence and patients' expectations also significantly influence outcomes of physical exercise interventions. Timing is also important; interventions targeting return to work, applied during the acute phase of work absenteeism, compete with a high rate of spontaneous recovery and may therefore be inefficient. CONCLUSIONS: Despite numerous studies, more quantitative and qualitative investigations are needed to further clarify the requirements for a successful application and implementation of physical exercise interventions for disabled workers with low back pain.

Attitude to Health↗
PubMed2003

Spinal cord injury providers' perceptions of barriers to implementing selected clinical practice guideline recommendations.

BACKGROUND/OBJECTIVE: Twelve focus groups were conducted at 6 Department of Veterans Affairs (DVA) Spinal Cord Injury (SCI) Centers. The purpose of these focus groups was to identify provider-perceived barriers to implementing selected recommendations of two clinical practice guidelines (CPGs)--Prevention of Thromboembolism in Spinal Cord Injury and Management of Neurogenic Bowel in Adults With Spinal Cord Injury--at their sites. METHODS: A total of 75 SCI direct-care staff (including physicians, nurses, dieticians, rehabilitation therapists, psychologists, and social workers) participated in the focus groups, which were conducted by trained focus group facilitators. Woolfs framework was used to classify perceived barriers into 1 of 4 categories: (a) lack of knowledge, (b) lack of agreement, (c) lack of ability, or (d) lack of systematic reminders for implementation. The "lack of ability" category was further expanded to reflect which specific aspect of the environment was seen as the obstacle: (a) patient, (b) provider, (c) SCI unit, (d) hospital or medical center, or (e) non-Veterans Affairs (VA) hospital setting. RESULTS: Providers disagreed with the recommendation to reinstitute prophylaxis in patients with nonacute SCI to prevent deep vein thrombosis and identified a number of system-level problems with providing appropriate prophylaxis. Providers identified patient reluctance to changing their bowel programs and difficulties in documenting changes in the patients' bowel program as obstacles to implementing the neurogenic bowel CPG. CONCLUSION: Based on this feedback, interventions were developed to address provider-perceived barriers. These interventions were implemented at 6 Veterans Affairs SCI Centers.

Adult↗
PubMed2003

Health insurance reform: security standards. Final rule.

This final rule adopts standards for the security of electronic protected health information to be implemented by health plans, health care clearinghouses, and certain health care providers. The use of the security standards will improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general by establishing a level of protection for certain electronic health information. This final rule implements some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2005

Developing and implementing emergency medicine programs globally.

International EM development requires a comprehensive assessment of the current system and careful planning to ensure that the most important needs are addressed. Modeling a country's EM system after an existing foreign system underestimates the complex needs for instituting appropriate system interventions. Planning must include all stakeholders. With appropriate planning, international interventions can contribute to health system advancement.

Emergency Medical Services↗
PubMed2005

Guideline recommendations for the management of patients admitted with acute stroke: implications of a local audit.

AIM: To assess the feasibility of implementing the New Zealand guideline for management of stroke by auditing the gap between recommended care and that provided in Hawke's Bay Hospital (HBH). METHODS: Fifty randomly selected records of patients discharged with acute stroke between 1 June and 30 November 2003 were retrospectively reviewed using an audit tool developed from the guideline. RESULTS: Eight patients (16%) with non stroke syndromes were incorrectly diagnosed or coded as stroke on the basis of computed tomography (CT) scan reports. Brain imaging compliance was 100%; 86% within first 48 hours. Aspirin use or documented contraindications occurred in 62% patients within 48 hours, although the delay after imaging averaged 12.55 hours. At discharge, aspirin compliance was 100% in the surviving 42 patients. Twenty-nine (69%) patients were discharged on antihypertensive therapy, but two patients were readmitted with hypotension. Compliance with recommended multidisciplinary assessments within 48 hours included swallowing (88%), mobility (88%), communication (78%), and self care ability (60%). Patients not admitted directly to the stroke unit (19, 38%) were less likely to receive recommended interventions. Compliance with recommended predischarge assessments included suitability of accommodation (100%) and home supports (92%), but only 19% received documented advice about driving. CONCLUSIONS: Management of inpatients with acute stroke in HBH is close to most of the guideline recommendations. The identified deficiencies in patient care are potentially easily rectifiable and full implementation of the guidelines is feasible.

Acute Disease↗
PubMed2004

A tale of two hospitals: a sociotechnical appraisal of the introduction of computerized physician order entry in two Dutch hospitals.

We compared the implementation of computerized physician order entry (CPOE) in two Dutch hospitals, one being an academic medical center and the other a large regional non-academic hospital. Both implemented the TDS7000 system that was running on the same computer, located in the computing department of the academic medical center. The outcomes of the implementation were different. The introduction of CPOE in the university medical center failed, while it was a success in the non-academic hospital. An appraisal of the different outcomes is possible when we consider the implementation of information as a thorough social process in which the technical and the social are closely interrelated. Our findings suggest that organizational change associated with CPOE implementation should not focus on individual physician behavior but on medical work as a collaborative professional effort

Academic Medical Centers↗
PubMed2005

Development of salt fluoridation in the Americas.

Fluoridation of water supplies has proven to be an effective preventive measure for dental caries. Many developing countries in the Americas have multiple water systems and economies that do not permit the viable application of this approach. Some of the highest dental caries prevalence in the world was evident in the Americas. Fluoridated salt was considered as a potential solution on account of the urgent need for dental caries prevention to millions of people with limited access to routine dental services. A fluoridated salt trial was initiated in Colombia (1963) and upon successful completion with preventive results comparable to water fluoridation, the approach was introduced to other countries and was supported by resolutions of WHO, PAHO, regional health groups and the FDI. The procedures for addition of fluoride were comparable to those for iodization and the two elements were compatible. In the period 1972-2004, ten countries introduced national or localized programmes and five more initiated programmes. Results, based on addition of F ion at 200-250 mg/kg salt, indicated caries prevalence reductions in 12 year olds ranging from 84% in Jamaica, 73% in Costa Rica to 40% in Uruguay at an average cost of 0.06 U.S. dollars /capita/year. This paper provides a background to the situation in the Americas, illustrates the approaches and feasibility of implementing viable fluoridated salt programmes in countries, and demonstrates the results obtainable at minimum cost.

Adolescent↗
PubMed2006

Using evidence and process improvement strategies to enhance healthcare outcomes for the critically ill: a pilot project.

BACKGROUND: Although the value of evidence-based practice may seem obvious, the process needed to produce more effective delivery of evidence-based healthcare is not obvious. Furthermore, the continuing escalation of healthcare costs fuels the desire of providers and consumers to undertake only those treatments that have benefit. One way to effect necessary changes in healthcare organizations is through focused, interdisciplinary, collaborative projects related to evidence-based practice. OBJECTIVES: To reduce rates of ventilator-associated pneumonia and catheter-related bloodstream infection in patients in the medical intensive care unit of a large, urban tertiary referral hospital in the Southwest. METHODS: The theory of planned behavior served as the basis for providing staff members with research-based, easily controllable strategies that "fit" with the usual methods of care delivery. Implementation of the strategies and data collection were accomplished through routine rounds on patients and regular reporting of objective information. RESULTS: During a 15-month period, use of the selected strategies resulted in a 54% reduction in ventilator-associated pneumonia, a 78% reduction in catheter-related bloodstream infections, and a 18% reduction in mean length of stay in the unit. Use of a multidisciplinary, environmentally tailored approach to concerns about patients' care resulted in estimated cost savings of 1.0 million US dollars to 2.3 million US dollars. CONCLUSIONS: Early, consistent communication about the project's rationale, expected behavior, and outcomes enhanced the manageability and effectiveness of this change in an adult intensive care unit.

Arizona↗
PubMedDate not supplied

Intravenous medication safety system averts high-risk medication errors and provides actionable data.

A major responsibility of nursing leaders is to implement systems and policies to improve patient and staff safety, avoid medication errors, and most importantly safeguard patients against harm. In the medication use process, the nurse at the bedside is the most vulnerable, and intravenous (i.v.) drug administration often results in the most serious medication error outcomes. At a 675-bed, tertiary-care "Magnet Hospital System," nurses played a key role in a multidisciplinary process that led to successful implementation of a computerized i.v. medication safety system. Software customization, staff training and product set-up were completed in approximately 2 months; 685 devices were installed in 3 hospitals within 12 hours. Nursing acceptance is excellent, and implementation of the system is thought to enhance nursing retention and recruitment. Preliminary data indicate an estimated 849 programming changes ("near misses") annually, ie, potential infusion errors averted by the i.v. medication safety system. A chronogram created from safety data demonstrates that most infusion error warnings occurred between 3:00 PM and 9:00 PM, with an unexpected peak at 6:00 PM. Implementation of the i.v. medication safety system has prevented potentially serious infusion errors and has provided previously unavailable, actionable continuous quality improvement data for best practice improvements.

Automation↗
PubMed1996

Implementing therapist-driven protocols.

In January of 1993, as part of a hospital-wide cost-reduction strategy, the University of California San Diego (UCSD) Medical Center Respiratory Care Department implemented a patient-driven protocol program designed to utilize the assessment skills and judgments of respiratory care staff, within physician-approved guidelines. This program produced a 60% reduction in the use of hand-held nebulizer therapy and chest physical therapy in the institution, with a substantial decrease in operational expenses. This article describes key elements of the implementation of protocol-driven programs, provides examples from the UCSD experience, and offers insights gained from others who have been successful agents of change. It describes patient-driven protocols, how they can be implemented, the barriers to and promoters of such protocols, and what the results can be for a respiratory care department.

Clinical Protocols↗