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PubMedDate not supplied

Critical Path education: necessary components and effective strategies.

Proper use of Critical Paths based on a solid educational foundation aids caregivers in meeting the ultimate challenge of today's healthcare environment: to provide a higher quality of care at a lower cost. The components for a comprehensive educational program for Critical Paths include general principles, Path contents, Path development, guidelines for documentation, variance data collection and evaluation. A strategy to provide large numbers of staff with background information is through the use of self-learning packets; the case study approach is an appropriate strategy for Path specific education. Evaluation data indicate that both strategies are effective in assisting staff to develop and implement Critical Paths.

Critical Pathways↗
PubMed1998

Reducing thrombolytic therapy time delays in the emergency department.

A 1 year (1995) retrospective audit of all patients who were discharged or died, with a primary diagnosis of acute myocardial infarction (AMI) was conducted at Auburn Hospital, a level 4 district hospital in Sydney's western suburbs. After their first echocardiogram (ECG), 21 patients of 129 patients who had a primary diagnosis of AMI in the Emergency Department at this time were given thrombolytic therapy. For eight patients there was a time delay of over 60 min to commencement of thrombolytic therapy. This time delay exceeded the Australian Council of Health-care Standards guidelines and was targeted as a quality improvement activity. The hospital cardiologist convened meetings of medical and nursing staff, to develop an action plan for reducing these delays. The strategies adopted, implemented between April and September 1996, involved (i) keeping the ECG machine in the emergency department at all times, (ii) installing a facsimile machine, (iii) keeping Alteplase (rt-PA) in the emergency department, (iv) staff education, (v) allowing senior medical staff to initiate treatment if the consultant was not readily contactable. Resulting from these initiatives time delays (after first ECG) were reduced from a median time of 55 min in 1995 to a median time delay of 43 min in 1997. This study highlights areas of unnecessary delay in patients receiving thrombolytic therapy and shows that these delays can be reduced by the implementation of relatively simple strategies by medical and nursing staff. Time delays from the development of symptoms (usually chest pain) to arrival at triage were recorded when such a time was specified in the clinical notes. The median delay from the development of chest pain to triage was 73 min.

Aged↗
PubMed2006

Defining the competencies of those conducting pharmacovigilance.

PURPOSE: The absence of agreed competencies in pharmacovigilance and patient risk management is a key factor hindering the development of training and a curriculum in these interrelated disciplines. If competencies were to be developed, they could be tailored to the different roles and responsibilities of the various staff involved. PROPOSAL: We describe a simple theoretical model of functional and behavioural competencies that is based on an organisation with three levels of staff: evidence collectors and gatherers, evidence processors and distillers, and decision makers. CONCLUSIONS: To stimulate discussion about how to enhance the progress already being made in pharmacovigilance and patient risk management, we have proposed functional and behavioural competencies for pharmacovigilance as a way of identifying and measuring scientific and personal skills pertinent to pharmacovigilance. Competencies should, we believe, be agreed and adopted by all those seeking to improve pharmacovigilance. We invite discussion of these proposals.

Communication↗
PubMedDate not supplied

Building research productivity in an academic setting.

This article describes the methods that one academic nursing unit used to move from receiving no National Institutes of Health funding to a top-20 ranking. A 1995 school task force recommended changes to move toward greater research productivity, including increased external funding. The school created a research infrastructure to support both the scientific development of research studies and the production of high-quality external grant applications. Barriers to research productivity were successfully managed. The research culture dramatically changed to emphasize innovation, autonomy, peer support and review, long-term investment in research productivity, penetration of research throughout school activities, and public display of research accomplishments. Academic nursing units can develop research cultures to support meaningful research that secures major external funding.

Diffusion of Innovation↗
PubMed2004

Responding to the global human resources crisis.

The global community is in the midst of a growing response to health crises in developing countries, which is focused on mobilising financial resources and increasing access to essential medicines. However, the response has yet to tackle the most important aspect of health-care systems--the people that make them work. Human resources for health--the personnel that deliver public-health, clinical, and environmental services--are in disarray and decline in much of the developing world, particularly in sub-Saharan Africa. The reasons behind this disorder are complex. For decades, efforts have focused on building training institutions. What is becoming increasingly clear, however, is that issues of supply, demand, and mobility (transnational, regional, and local) are central to the human-resource problem. Without substantial improvements in workforces, newly mobilised funds and commodities will not deliver on their promise. The global community needs to engage in four core strategies: raise the profile of the issue of human resources; improve the conceptual base and statistical evidence available to decision makers; collect, share, and learn from country experiences; and begin to formulate and enact policies at the country level that affect all aspects of the crisis.

Africa South of the Sahara↗
PubMedDate not supplied

Perinatal Patient Safety Project: a multicenter approach to improve performance reliability at Kaiser Permanente.

High-reliability organizations, including high-reliability perinatal units, are built on a solid foundation of timely communication and collegial teamwork to maintain patient safety as a top priority. In these units, concise, real-time, and constant communication is valued. Teamwork and collegiality characterize the professional relationships and hierarchy is minimized. The Perinatal Patient Safety Project utilized human factors techniques and systems improvements to create high-reliability perinatal units within a 1-year pilot project. This article focuses on the approaches used to improve communication in 4 Kaiser Permanente medical centers participating in this project.

California↗
PubMed2006

Enhancing the effectiveness of One-Minute Preceptor faculty development workshops.

BACKGROUND: The One Minute Preceptor (OMP) faculty development workshop is aimed at improving outpatient preceptors' abilities to teach in ambulatory settings. Practice applying the 5 microskills is central to learning the OMP, yet participants frequently avoid the role-playing portion of the standard workshop. Task complexity may result in significant cognitive burden while learning these new teaching skills. DESCRIPTION: The development of highly scripted case scenarios and standardized learners (SLs) to role-play authentic teaching situations are aimed at reducing task complexity. We describe case development, SL training, and application of these enhancements in 5 OMP workshops. EVALUATION: Qualitative assessments and workshop participant evaluations showed improved role-playing participation and satisfaction with the authenticity of the training sessions. CONCLUSION: The introduction of highly scripted cases and SLs appear to effectively help participants overcome dissatisfaction with role-playing and provide increasingly challenging yet authentic clinical teaching scenarios for skills practice. We recommend further research using objective measures.

Ambulatory Care↗
PubMedDate not supplied

Introducing a career development pathway.

To respond to the career needs of nurses and midwives working in the fields of clinical practice, education, research and management in North Bristol NHS Trust, a professional development pathway was established. The pathway, which is similar to that followed by medical staff, allows nurses and midwives to identify their chosen career path and work towards it using a flexible scheme of planned clinical rotations supported by academic input. This article discusses the pathway, shows how it meets the needs of staff and service delivery, and closes the gap between education and practice.

Career Choice↗
PubMedDate not supplied

Diversity development.

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Cultural Characteristics↗