The first UK national blepharospasm patient and public involvement day; identifying priorities.

PURPOSE: We describe the planning and outcomes of the first 'Blepharospasm Day' in the UK. Blepharospasm is a distressing condition for patients and carers. Our 'patient and public involvement' event aimed to: cultivate a more informed patient group via active dialogue, help clinicians more effectively prioritise research and to facilitate peer-to-peer support for affected patients and public. DESIGN: A national one-day event was organised by the oculoplastics department at Moorfields Eye Hospital. The event was divided into informative lectures delivered by professionals and a patient panel, during which patients shared their experiences and expectations. METHODS: Data were collected from a variety of sources including: an interactive voting "LiveWall" poster, a pre-event questionnaire; "living with Blepharospasm", transcripts from patient panel discussions; and a feedback questionnaire. RESULTS: The event was well-received with 100% of respondents rating it good or excellent. Four research themes were identified: "aetiology", "alternative treatments", "faster, more accurate diagnosis", and "symptom control". Delegates' self-reported knowledge of blepharospasm increased significantly after the event. Limitations of the BdSI severity-assessment tool were noted with 22% of respondents failing to utilise it appropriately. CONCLUSION: Through our innovative "Blepharospasm Day", patient's priorities for research were identified, delegates understanding of blepharospasm increased and an independent blepharospasm patients-representatives' group was established; a first in the UK. Furthermore, short-fallings identified in the BdSI tool highlight the need for better severity-assessment tools. We demonstrate the benefits of the 'patient and public involvement' approach in the management of complex conditions such as blepharospasm. ABBREVIATIONS: PPI: Patient and public involvement; SLV-PSP: sight loss and vision sector - priority setting partnership; BRC: Biomedical Research Centre; NIHR: National Institute for Health Research; BsDI: Blepharospasm Disability Index.

Prophylactic antibiotic use: hardwiring of physician behavior, not education, leads to compliance.

BACKGROUND: Surgical wound infections can be significantly reduced by appropriate administration of prophylactic antibiotics (ProAbx). The purpose of this study was to determine the effect of interventions, specifically, forced functions, designed to improve administration of ProAbx in a university hospital setting. STUDY DESIGN: We retrospectively reviewed charts from 1,622 consecutive patients, seen between March 2005 and June 2007, for evaluation of ProAbx administration to determine correct choice, appropriate timing of administration, and appropriate postoperative cessation of antibiotics. Processes designed to improve compliance were devising orders to limit ProAbx choice; requiring those orders in preadmission testing; administering ProAbx in the preparation and hold area, subsequently, at the time of the universal timeout; and standardizing postoperative orders in the computerized physician order entry. RESULTS: Specialty-specific standardized orders improved compliance from 76% to 91% (p < 0.001) concerning ProAbx choice. Regarding timing of preoperative administration, a baseline compliance of 55% improved to: 78% (p < 0.001) on requiring orders in the preadmission testing area; 90% (p < 0.008) on administering ProAbx in the preparation and hold area; and 95% (p < 0.07) when ProAbx were administered at the universal timeout. Standardization of postoperative orders in the computerized physician order entry improved compliance with cessation from 60% to 86%, p < 0.001. CONCLUSIONS: Despite hospital-wide education, improving compliance with evidence-based recommendations for ProAbx required processes that "forced" physician behavior, specifically: specialty-specific, preprinted physician orders limiting ProAbx choice; linking administration of preoperative ProAbx administration to the universal timeout; and standardization of the postoperative ProAbx order in the computerized physician order entry.