Using Quality Improvement to Reduce IV Acetaminophen Use in a PICU.

OBJECTIVES: Improve medication-related variable ICU costs by increasing value related to a locally identified high-frequency/high-cost medication, IV acetaminophen. DESIGN: Structured quality improvement initiative using the Institute for Healthcare Improvement's Model for Improvement. SETTING: Twenty-three-bed tertiary PICU. PATIENTS: All patients admitted to the PICU receiving IV acetaminophen during the study period of 2015-2018. INTERVENTIONS: PICU staff survey, education to close nurse/provider knowledge gap, optimization of order sets and electronic health record order entry, improving oral/enteral medication transition, and optimization of pharmacy dispensing. MEASUREMENTS AND MAIN RESULTS: The primary outcome of interest was IV acetaminophen doses per patient day reported as a 12-month rolling average. Baseline IV acetaminophen prescribing prior to the study period was initially 0.55 doses per patient day, and in 2014, there were 3,042 doses administered. IV acetaminophen is $43 per dose. The rolling 12-month average post intervention was 0.33 doses per patient day. Enteral and rectal doses increased from 0.42 to 0.58 doses per patient day. Opioid utilization varied throughout the study. A 40% reduction in IV acetaminophen equated to a $35,507 cost savings in a single year. CONCLUSIONS: IV acetaminophen is prescribed with high frequency and impacts variable PICU costs. Value can be improved by optimizing IV acetaminophen prescribing.

Esthetic versus Function in EarlyTreatment of Class III Malocclusion.

A comparison of two Class III malocclusion cases corrected with a modified tandem appliance reveals the importance of criticalesthetic concerns in diagnosing and developing a treatment plan. Because the device employs a rapid palatal expander, it creates interproximal spaces in the case of narrow tooth morpholozg or size discrepancy.

A review of the barriers preventing Indigenous Health Workers delivering tobacco interventions to their communities.

OBJECTIVE: To review available literature addressing the issue of whether smoking status of Indigenous Health Workers (IHWs) impedes provision of health information about smoking tobacco to their communities. METHOD: Databases were searched for publications that examined IHWs' smoking status or quit support programs for IHWs. Studies were categorised as reviews and commentaries, intervention studies or descriptive research. RESULTS: Fourteen studies met inclusion criteria. Overall, the literature suggests that IHWs' smoking status is a barrier. However, the poor quality of most studies weakens the evidence for this conclusion. The issue of IHWs smoking status as a barrier is peripheral to all but two of the studies. Literature cited and reviewed was often not exhaustive and relied on only a few preceding empirical studies. Most studies were unclear about whether IHWs' views were reported as distinct from views of health staff in general. CONCLUSIONS AND IMPLICATIONS: The recent COAG investment to Tackling Smoking is an important contribution to Closing the Gap in the health of Indigenous Australians. However, there remain potential barriers faced by IHWs that may undermine efforts to reduce Indigenous smoking. Overcoming these barriers and assisting IHWs to quit smoking may provide an opportunity to address high rates of smoking in Indigenous communities. Further research is required with a balance between descriptive research to assess the issue and intervention research to address it.

The best bang for our buck: recommendations for the provision of training for tobacco action workers and Indigenous health workers.

While smoking rates among Australians in general have declined over the past two decades, rates for Aboriginal Australians have remained high and continue to contribute to the overall poor health of Aboriginal people. Aboriginal health workers are proposed as one way to help reduce smoking rates for Aboriginal people however there is a need for specifically developed courses to train health workers to deliver smoking interventions.

Canadian physiotherapists' views on certification, specialisation, extended role practice, and entry-level training in rheumatology.

BACKGROUND: Since the last decade there has been a gradual change of boundaries of health professions in providing arthritis care. In Canada, some facilities have begun to adopt new arthritis care models, some of which involve physiotherapists (PT) working in extended roles. However, little is known about PTs' interests in these new roles. The primary objective of this survey was to determine the interests among orthopaedic physiotherapists (PTs) in being a certified arthritis therapist, a PT specialized in arthritis, or an extended scope practitioner in rheumatology, and to explore the associated factors, including the coverage of arthritis content in the entry-level physiotherapy training. METHODS: Six hundred PTs practicing in orthopaedics in Canada were randomly selected to receive a postal survey. The questionnaire covered areas related to clinical practice, perceptions of rheumatology training received, and attitudes toward PT roles in arthritis care. Logistic regression models were developed to explore the associations between PTs' interests in pursuing each of the three extended scope practice designations and the personal/professional/attitudinal variables. RESULTS: We received 286 questionnaires (response rate = 47.7%); 258 contained usable data. The average length of time in practice was 15.4 years (SD = 10.4). About 1 in 4 PTs agreed that they were interested in assuming advanced practice roles (being a certified arthritis therapist = 28.9%, being a PT specialized in rheumatology = 23.3%, being a PT practitioner = 20.9%). Having a caseload of > or = 40% in arthritis, having a positive attitude toward advanced practice roles in arthritis care and toward the formal credentialing process, and recognizing the difference between certification and specialisation were associated with an interest in pursing advanced practice roles. CONCLUSION: Orthopaedic PTs in Canada indicated a fair level of interest in pursuing certification, specialisation and extended scope practice roles in arthritis care. Future research should focus on the effectiveness and cost-effectiveness of the emerging health service delivery models involving certified, specialized or extended scope practice PTs in the management of arthritis.