An interdisciplinary approach to improve surgical antimicrobial prophylaxis.

Purpose The purpose of this paper is to improve surgical antimicrobial prophylaxis (SAP) prescribing in orthopaedic surgery using the model for improvement framework. Design/methodology/approach Orthopaedic patients receiving joint replacements, hip fracture repairs or open-reduction internal-fixation procedures were included. Antimicrobial(s); dose, time of administration and duration of SAP were evaluated for appropriateness based on the local SAP guidelines. After baseline data collection, a driver diagram was constructed with interventions devised for plan-do-study-act cycles. Data were fed back weekly using a point prevalence design (PPD). Interventions included SAP guideline changes, reminders and tools to support key messages. Findings SAP in 168 orthopaedic surgeries from 15 June 2016 to 31 January 2017 was studied. Prescribing appropriateness improved from 20 to 78 per cent. Junior doctor changeover necessitated additional education and reminders. Practical implications Due to constant staff changeover; continuous data collection, communication, education and reminders are essential to ensure continuous compliance with clinical guidance. Patients with hip fractures are difficult to weigh, requiring weight estimation for weight-based antimicrobial dosing. Unintended consequences of interventions included the necessity to change pre-operative workflow to accommodate reconstitution time of additional antimicrobials and inadvertent continuation of new antimicrobials post-operatively. Originality/value Rather than perform the traditional retrospective focused audit, we established a prospective, continuous, interventional quality improvement (QI) project focusing on internal processes within the control of the project team with rapid cyclical changes and interventions. The weekly PPD was pragmatic and enabled the QI project to be sustained with no additional resources.

Qualitative Analysis Following the Delivery of a Farmer Lifestyle Program.

BACKGROUND: Irish farmers are adversely affected by noncommunicable diseases. Although there has been an increase in farmer health promotion activities in Ireland, farmers views on lifestyle programs are currently unknown. OBJECTIVES: To qualitatively analyze the impact of the previously mentioned 6-week physical activity and health education intervention on farmer health and to investigate how best to support this cohort moving forward. METHODS: A qualitative study was conducted online (two interviews, three focus groups) with fourteen Irish farmers (53.5 ± 6.5 years) who completed the 6-week program in December 2019. Interviews and focus groups were recorded, transcribed, and analyzed for themes. RESULTS: The main themes that emerged from this study were barriers, facilitators, and recommendations for lifestyle programs aimed to improve farmer health. Additional views on health and lifestyle behaviors were mentioned. Time of year was reported as the main barrier for farmers to engage in lifestyle programs. The key facilitators reported by farmers were the social health benefits obtained from the program and the farmer-specific nature of the program. Farmers suggested that physical activity and health education programs that are farmer-specific, delivered locally and catering for all fitness abilities should be more widely available to them. Although some farmers reported that they maintained the lifestyle behaviors they established during the initial 6-week program, follow-up supports are needed to encourage sustainable behavior change. CONCLUSIONS: Interventions that are farmer-specific, community-based, and feasible within the context of available resources may be effective in improving farmer health. Working in partnership with organizations that support farmers has the potential to improve farmer health.

What is known about near miss events in the operating room? A systematic review of studies of mixed methods design.

BACKGROUND: A near miss event (NME) in healthcare is an event that did not happen but would have caused serious harm if it did. The operating room (OR) is prone to risk and incidents, with estimates that 50% of all hospital adverse events occur in the OR, yet reporting of NME is uncommon in the OR. OBJECTIVE: To carry out a systematic review of studies with mixed methods to establish what is known about NME reporting in the OR. METHOD: Inclusion criteria will be those studies of mixed methods design, which have been conducted in the OR, with teams of surgeons, anaesthetists or nurses alone or in any combination. Using a publication timeframe of 2001-2023, the following databases were searched: Medline (OVID), CINAHL, Pubmed and Google Scholar. Selected papers for the review were assessed using the Quality Assessment Tool for Studies of Diverse Designs. RESULTS: Fourteen papers were included in the review. NMEs are common occurrences that are underreported in the OR. When NMEs occur in multiples for the same patient, the risk of serious harm increases. Feedback and education about NME helps to improve reporting; ORs with high rates of NME reporting have less serious patient harm events. DISCUSSION: The implications of the findings for improving healthcare safety are discussed and in particular the adoption of the science of Human Factors Ergonomics into healthcare.

The impact of a 6-week community-based physical activity and health education intervention-a pilot study among Irish farmers.

BACKGROUND: There is a higher prevalence of lifestyle-related diseases among Irish farmers than the general adult population. Lifestyle interventions that increase physical activity and improve dietary patterns have been associated with reduced chronic disease risk and improved quality of life among high-risk populations. The impact of lifestyle interventions among Irish farmers is unknown. AIM: To assess the effectiveness of a community-based intervention on farmer health, cardiovascular fitness, lower limb strength endurance, and dietary intake. METHODS: A 6-week physical activity and lifestyle education intervention involving two 60-min circuit-based exercise training sessions and one 60-min health education workshop per week was implemented. Pre- and post-measurements included total body weight, body fat percentage, lean muscle mass, resting blood pressure, fasting blood glucose, cholesterol, triglycerides, cardiovascular fitness, lower limb strength, perceived physical and mental health, and dietary intake. RESULTS: Thirty farmers completed the intervention giving an adherence rate of 75%. At baseline, mean BMI (32.7 ± 4.1 kg/m2), body fat percent (31.7 ± 6.7), waist circumference (110.2 ± 10.4 cm), systolic (128.7 ± 7.8 mmHg) and diastolic (86.2 ± 6.8 mmHg) blood pressure were higher than recommended levels. Significant improvements (p < 0.05) were found for total body weight, BMI, waist and hip circumferences, cardiovascular fitness, lower limb strength endurance, systolic blood pressure, total energy, total fat, total unsaturated fat, monounsaturated fat, saturated fat, trans fat, total carbohydrate, sodium, cholesterol and percentage energy intakes of total fat, saturated fat, protein, and physical and mental health scores. CONCLUSIONS: Irish farmers remain at high risk of developing chronic diseases but respond positively to lifestyle intervention.

Consent and confusion--who decides?

Current trends in the NHS promote patient rights including the right to accept or refuse surgery. Valid consent when the patient appears to have fluctuating competence can place theatre nurses in a difficult position. This article explores the legal framework in which the Department of Health consent forms work and looks at the NMC's Code of Professional Conduct for standards of practice.