Our experience of nursing/allied health practitioner led geriatric screening and assessment of older patients with cancer - a highly accessible model of care.

OBJECTIVE: Comprehensive Geriatric Assessment (CGA) has been proven to assist development of tailored treatment plans for older patients with cancer by identifying health issues affecting their ability to complete systemic therapy or cope with and recover from cancer treatment. MATERIALS AND METHODS: Metro North Hospital and Health Service (MNHHS) has significant older population with cancer. Geriatric Oncology services were commenced in February 2018 at two facilities of MNHHS [North Lakes Cancer Care Services/Caboolture Hospital (NLCCS/CBH) Cancer services and Redcliffe Hospital (RH) Cancer services]. The Geriatric 8 (G8) screening tool was administered to predict patient vulnerability and need for CGA. A bespoke CGA suite comprising of 16 assessments was used. A clinical nurse or Allied Health (AH) practitioner conducted screening, followed by CGA. Proposed care was discussed at multidisciplinary case conference and AH interventions were provided. RESULTS: From February'2018 to July'2019, the G8 was administered to 1380 patients between the two facilities (918 patients at NLCCS/CBH and 462 patients at RH), comprising oncology and haematology patients. 825 patients (59%) showed impairment on G8 and were recommended for CGA. Another 50 patients were referred for CGA as per clinical assessment despite normal G8. 65% (572) of recommended CGAs were conducted. The most common impairments identified on CGA leading to AH referrals were timed up & go >13 s, malnutrition, polypharmacy and low mood & depression. CONCLUSION: The nursing/AH practitioner led Geriatric Oncology service is feasible, applicable and beneficial to patients. Further study is planned to assess the impact of the service on patients' health related quality of life and chemotherapy completion rates.

Improving venous thromboembolism prophylaxis through critical thinking and health informatics.

Venous thromboembolism (VTE) is a leading cause of preventable morbidity and mortality in hospitalised patients. Mafraq Hospital, a 450-bed tertiary-level hospital in Abu Dhabi, United Arab Emirates, has identified VTE prevention as a critical patient safety measure and VTE prophylaxis as a key performance indicator (KPI). Mafraq Hospital VTE prevention policy states that all admitted adult patients 18 years and above should receive a VTE risk assessment, and all patients identified at risk of VTE with no contraindications should receive appropriate VTE prophylaxis within 24 hours of admission. In a move towards safer practices, our governing body, Abu Dhabi Health Services SEHA, has raised the VTE prophylaxis KPI target from 85% to 95% for all admitted adult patients within 24 hours of admission. Our average VTE prophylaxis rate was 87%, and achieving this new target was a challenge. We conducted this study on Mafraq Hospital Medical and Surgical wards. The study period was 12 months, from July 2018 to June 2019, and a total of 5475 patients were evaluated. Our aim was to improve VTE prophylaxis rates in order to ensure patient safety and reduce preventable harm. We used Caprini Model electronic VTE risk assessment computerised decision support tool to help identify VTE risk. A multidisciplinary task force team was formed and led this quality improvement project. The purpose of this publication was to indicate the quality improvement interventions implemented to enhance compliance with VTE prophylaxis using integrated critical thinking and health informatics and the outcomes of those interventions. Through implementing critical thinking and health informatics interventions, our VTE prophylaxis within 24 hours of admission rates improved from an average 87% in July 2018 to above 98%, and this improvement was sustained over the last 3 months of the study period April through June 2019.

Examining influences on speaking up among critical care healthcare providers in the United Arab Emirates.

OBJECTIVE: Assess perceived barriers to speaking up and to provide recommendations for reducing barriers to reporting adverse events and near misses. DESIGN, SETTING, PARTICIPANTS, INTERVENTION: A six-item survey was administered to critical care providers in 19 Intensive Care Units in Abu Dhabi as part of an organizational safety and quality improvement effort. MAIN OUTCOME MEASURES: Questions elicited perspectives about influences on reporting, perceived barriers and recommendations for conveying patient safety as an organizational priority. Qualitative thematic analyses were conducted for open-ended questions. RESULTS: A total of 1171 participants were invited to complete the survey and 639 responded (response rate = 54.6%). Compared to other stakeholders (e.g. the media, public), a larger proportion of respondents 'agreed/strongly agreed' that corporate health system leadership and the health regulatory authority encouraged and supported error reporting (83%; 75%), and had the most influence on their decisions to report (81%; 74%). 29.5% of respondents cited fear of repercussion as a barrier, and 21.3% of respondents indicated no barriers to reporting. Barriers included perceptions of a culture of blame and issues with reporting procedures. Recommendations to establish patient safety as an organizational priority included creating supportive environments to discuss errors, hiring staff to advocate for patient safety, and implementing policies to standardize clinical practices and streamline reporting procedures. CONCLUSIONS: Influences on reporting perceived by providers in the UAE were similar to those in the US and other countries. These findings highlight the roles of corporate leadership and regulators in developing non-punitive environments where reporting is a valuable and safe activity.

Implementing a multifaceted intervention to decrease central line-associated bloodstream infections in SEHA (Abu Dhabi Health Services Company) intensive care units: the Abu Dhabi experience.

OBJECTIVE To determine whether implementation of a multifaceted intervention would significantly reduce the incidence of central line-associated bloodstream infections. DESIGN Prospective cohort collaborative. SETTING AND PARTICIPANTS Intensive care units of the Abu Dhabi Health Services Company hospitals in the Emirate of Abu Dhabi. INTERVENTIONS A bundled intervention consisting of 3 components was implemented as part of the program. It consisted of a multifaceted approach that targeted clinician use of evidence-based infection prevention recommendations, tools that supported the identification of local barriers to these practices, and implementation ideas to help ensure patients received the practices. Comprehensive unit-based safety teams were created to improve safety culture and teamwork. Finally, the measurement and feedback of monthly infection rate data to safety teams, senior leaders, and staff in participating intensive care units was encouraged. The main outcome measure was the quarterly rate of central line-associated bloodstream infections. RESULTS Eighteen intensive care units from 7 hospitals in Abu Dhabi implemented the program and achieved an overall 38% reduction in their central line-associated bloodstream infection rate, adjusted at the hospital and unit level. The number of units with a quarterly central line-associated bloodstream infection rate of less than 1 infection per 1,000 catheter-days increased by almost 40% between the baseline and postintervention periods. CONCLUSION A significant reduction in the global morbidity and mortality associated with central line-associated bloodstream infections is possible across intensive care units in disparate settings using a multifaceted intervention.