Improving urinary catheterisation practices in a rural hospital in Ontario.

INTRODUCTION: A urinary catheter constitutes a one-point patient restraint, can induce deconditioning and may lead to patient mortality. An audit performed at Winchester District Memorial Hospital revealed that 20% of patients had a urinary catheter, of whom 31% did not meet the criteria for catheterisation. The main objective of this study was to use the Influencer Change Model and the Choosing Wisely Canada toolkit to create a bundle of interventions that would reduce the unnecessary use of urinary catheters in hospitalised patients. METHODS: In a rural teaching hospital, a time-series quasi-experiment was employed to decrease inappropriate use of urinary catheters. Both the Choosing Wisely Canada toolkit for appropriate use of urinary catheters and the Influencer change management approach were used to create effective interventions. RESULTS: This study revealed that there was no improvement in appropriate urinary catheter use during Plan-Do-Study-Act (PDSA) cycle 1. There was gradual improvement during PDSA cycle 2, with the percentage of inappropriate urinary catheter use dropping from an initial 31% before any interventions to less than 5% by the end of this study. DISCUSSION/CONCLUSION: This study aimed to reduce the inappropriate use of urinary catheters in a rural hospital with limited resources. The findings indicate that by using a change model, such as the Influencer Change Model, it is possible to promote better patient care through empowering healthcare staff to implement accepted protocols more stringently and thereby to decrease the inappropriate use of urinary catheters to 0%.

Improving patient preparedness for the operating room: A quality improvement study in Winchester District Memorial Hospital - A rural hospital in Ontario.

INTRODUCTION: Full completion of the pre-operative checklist is important for proper preparation of patients before they enter the operating room (OR), thus increasing OR efficiency. It is also critical for patient safety and successful outcomes. According to various literature, full completion of pre-operative checklists varies widely between institutions and occurs anywhere between 21% and 92% of cases.[1],[2] Our pre-project audits revealed a suboptimal patient preparedness for the Winchester District Memorial Hospital (WDMH) OR, since only 25% of cases arriving at the OR had their pre-operative checklist completed in its entirety, with no omissions. METHODS: WDMH performed a 12-month long quality improvement (QI) study to improve patient preparedness for the OR. Multiple QI initiatives were used to induce behavioural change by incorporating process mapping, enabling communication, adjusting the pre-operative checklist based on qualitative staff feedback and implementing a staff education plan. Interventions also included two post-implementation audits. RESULTS: Remarkably, completion of the pre-operative checklist increased from 25% to 67% and finally to 94%. Furthermore, the previous chart's presence and completion of pre-operative orders improved from 87% to 100% and from 82% to 99%, respectively. Another significantly important secondary outcome was improvement in interdepartmental relationships and collaboration. With better communication and checklist completion rates, there came increased patient preparedness and improved efficiency. CONCLUSIONS: Multiple significant improvements and many additional minor improvements strongly suggest that the approaches were used were effective at improving patient preparedness.

Introduction au résumé: Il importe de remplir complètement la liste de vérification préopératoire afin de bien préparer les patients avant leur entrée dans la salle d'opération, ce qui favorise l'efficacité dans la salle d'opération. Cela est aussi essentiel à la sécurité des patients et à l'obtention de résultats positifs chez eux. Selon diverses publications, la réalisation complète de la liste de vérification préopératoire varie considérablement d'un établissement à l'autre, soit de 21 à 92 % des cas[1],[2]. Nos vérifications d'avant-projet ont révélé que les patients du bloc opératoire du Winchester District Memorial Hospital (WDMH) étaient préparés de façon sous-optimale, puisque à peine 25 % des listes de vérification préopératoire étaient complètes et sans omissions à l'arrivée des patients à la salle d'opération. Méthodes: L'hôpital WDMH a réalisé une étude d'amélioration de la qualité (AQ) de 12 mois dans le but d'améliorer la préparation des patients pour la salle d'opération. De nombreuses initiatives d'AQ ont été mises de l'avant pour changer les comportements, soit incorporer la schématisation du processus, favoriser la communication, ajuster la liste de vérification préopératoire en fonction des commentaires qualitatifs du personnel et mettre à exécution un plan d'éducation du personnel. Les interventions comptaient aussi deux vérifications après exécution. Résultats: Remarquablement, la réalisation complète de la liste de vérification préopératoire est passée de 25 à 67% et finalement à 94%. En outre, la présence du dossier et l'exécution des ordonnances préopératoires se sont améliorées, pour passer de 87 à 100 % et de 82 à 99 %, respectivement. L'amélioration des relations et de la collaboration entre services était un autre paramètre d'évaluation secondaire significativement important. La meilleure préparation des patients et une meilleure efficacité ont suivi l'amélioration des communications et des taux de réalisation de la liste de vérification. Conclusions: Les nombreuses améliorations significatives et mineures pointent fortement vers l'efficacité de l'approche utilisée pour améliorer la préparation des patients. Mots-clés: Liste de vérification, efficacité, Ontario, préopératoire, amélioration de la qualité, hôpital rural, service de chirurgie.

Matching women with binge eating disorder to group treatment based on attachment anxiety: outcomes and moderating effects.

We hypothesized that compared to therapy groups homogeneously composed of women with binge eating disorder (BED) and low attachment anxiety, groups with high attachment anxiety would have better outcomes and a greater alliance-outcome relationship. We assigned 102 women with BED to therapy groups homogeneously composed of low attachment anxiety (n =52) or high attachment anxiety participants (n=50) who received Group Psychodynamic Interpersonal Psychotherapy (GPIP). GPIP resulted in improved outcomes with large effects. Attachment anxiety condition did not moderate outcomes. However, attachment anxiety condition did moderate the alliance-outcome relationship: i.e., group alliance growth was associated with improved binge eating only in the high attachment anxiety condition. Clinicians should be attentive to and encourage the growth of group therapy alliance especially for anxiously attached individuals.

Personality dimensions among women with an eating disorder: towards reconceptualizing DSM.

OBJECTIVE: To evaluate the incremental validity of a dimensional assessment of personality, after controlling for diagnostic category, in accounting for meaningful variation in eating disorder attitudes and behaviours and in current affective distress among a clinical sample of eating disordered women. METHODS: 244 treatment seeking eating disordered women and 116 non-eating disordered women were assessed with the NEO five factor inventory (NEO-FFI), and with measures of eating disorder attitudes and of affective distress using a cross sectional design. RESULTS: As predicted, differences were found between eating disordered and non-eating disordered women on several NEO-FFI scales, which provided a context for subsequent analyses. NEO-FFI scales accounted for meaningful variation in eating disordered attitudes and behaviours as well as in levels of current affective distress over and above DSM-IV diagnostic category. CONCLUSION: A flexible approach to diagnosis, which includes personality dimensions along with a description of eating disorder symptoms, may result in a more inclusive and useful diagnostic scheme for treating women with eating disorders.