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1.
Enferm. clín. (Ed. impr.) ; 30(1): 4-15, ene.-feb. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-186278

RESUMO

Objetivo: Validar el contenido de un instrumento para la documentación de las etapas del proceso enfermero, utilizando los sistemas de lenguaje de NANDA-I, NOC y NIC, considerando los pacientes hospitalizados en una unidad de cuidados intensivos. Método: Investigación metodológica realizada en 3 etapas: diseño del instrumento existente a partir de los sistemas NANDA-I, NOC y NIC; validación de contenido por 13 jueces a partir de una escala tipo Likert de 4 puntos, evaluando los ítems en cuanto a claridad y pertinencia; aplicabilidad: opinión de 40 enfermeros asistenciales sobre el contenido respecto a la claridad, facilidad de lectura y presentación. Se calculó el índice de validez de contenido y el coeficiente de Kappa para medir la proporción de relevancia y claridad, así como para verificar el nivel de concordancia entre especialistas en cada ítem. Resultados: Se consideró el instrumento claro y pertinente, con índice de validez de contenido por encima de 0,8 en la mayoría de los ítems, e índice de concordancia global de 0,90, evidenciando un nivel satisfactorio de concordancia entre los jueces. En cuanto a la aplicabilidad se consideró el instrumento claro, de fácil lectura y con presentación adecuada por la mayoría de los enfermeros asistenciales, siendo validado a través de 11 diagnósticos con sus respectivos resultados e intervenciones de enfermería. Conclusión: El instrumento ha demostrado ser válido y aplicable para el grupo estudiado. Se espera que este estudio contribuya a la mejora del proceso enfermero en cuidados intensivos


Objective: to validate the content of an instrument for documenting the steps of the Nursing Process, using the standardized languages NANDA-I, NOC, and NIC (NNN), aiming at hospitalized patients in an Intensive Care Unit (ICU). Method: A methodological research performed in three steps: design of the existing instrument from the systems NANDA-I, NOC and NIC; content validation by 13 judges, from a four-point Likert-type scale – items were evaluated as to their clarity and pertinence; applicability: judgement of the content regarding clarity, reading ease, and presentation for 40 critical-care nurses. The Content Validity Index (CVI) and the Kappa coefficient (k) was calculated to measure the proportion of relevance and clarity, was well as to verify the level of agreement between the experts in each item. Results: The instrument was considered clear and pertinent, with CVI above 0.8 in most items and overall Concordance Index (CI) of 0.90, showing a satisfactory level of agreement between judges. Regarding applicability, the instrument was deliberated clear, of easy reading, and with proper presentation by most critical-care nurses, being validated through 11 diagnoses with their respective results and nursing interventions. Conclusion; The instrument showed to be valid and applicable for the group studied. It is expected that this study is able to contribute to the improvement of the Nursing Process in intensive care


Assuntos
Humanos , Avaliação de Programas e Instrumentos de Pesquisa , Registros de Enfermagem , Processo de Enfermagem/organização & administração , Documentação/normas , Cuidados Críticos/métodos , Terminologia Padronizada em Enfermagem , Unidades de Terapia Intensiva , Análise Quantitativa
2.
J Forensic Leg Med ; 69: 101886, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32056803

RESUMO

In countries emerging from authoritarian rule, a major challenge is ending often widespread and systematic torture and ill-treatment practices. Between 2011 and 2019, Physicians for Human Rights (PHR), in collaboration with the Open Society Foundation (OSF), the Open Society Justice Initiative (OSJI) and regional and local partners, worked to establish effective torture investigation and documentation practices in the Central Asian countries of Kyrgyzstan, Tajikistan, and Kazakhstan. Our approach consisted of activities in three sequential phases - (1) assessment, (2) capacity building, and (3) policy reform. In this paper, we briefly describe activities during each phase and identify key lessons learned from these experiences and resulting policy and program reforms as a model for future efforts in other settings.


Assuntos
Medicina Legal/normas , Violações dos Direitos Humanos , Tortura , Ásia , Fortalecimento Institucional/organização & administração , Documentação/normas , Humanos , Política Pública , Participação dos Interessados , Nações Unidas
3.
Am J Forensic Med Pathol ; 41(1): 11-17, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31977347

RESUMO

Errors in death certification can directly affect the decedent's survivors and the public register. We assessed the effectiveness of an educational seminar targeting frequent and important errors identified by local death certificate (DC) evaluation. Retrospective review of 1500 DCs categorized errors and physician specialty. A 60-minute didactic/case-based seminar was subsequently designed for family medicine physician (FAM) participants, with administration of presurvey, immediate post, and 2-month postsurveys. Most DCs were completed by FAM (73%), followed by internists (18%) and surgeons (3%). Error occurrence (EO) rate ranged between 32 and 75% across all specialities. Family medicine physician experienced in palliative care had the lowest EO rate (32%), significantly lower (P < 0.001) than FAM without interest in palliative care (62%), internal medicine (62%), and surgery (75%). Common errors were use of abbreviations (26%), mechanism as underlying cause of death (23%), and no underlying cause of death recorded (22%). Presurvey participants (n = 72) had an overall EO rate of 72% (64% excluding formatting errors). Immediate postsurvey (n = 75) and 2-month postsurvey (n = 24) participants demonstrated significantly lower overall EO (34% and 24%, respectively), compared with the Pre-S (P < 0.05). A 60-minute seminar on death certification reduced EO rate with perceived long-term effects.


Assuntos
Atestado de Óbito , Documentação/normas , Capacitação em Serviço , Médicos de Família/educação , Alberta , Causas de Morte , Avaliação Educacional , Docentes de Medicina/estatística & dados numéricos , Humanos , Internato e Residência , Determinação de Necessidades de Cuidados de Saúde , Estudos Retrospectivos
4.
World Neurosurg ; 133: e819-e827, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606500

RESUMO

BACKGROUND: The mortality index, or the ratio of observed to expected mortality, is a reported quality metric that has been assumed to directly reflect patient care. However, documentation and coding that does not use knowledge of how a reported mortality index is derived could reflect poorly on a hospital or service line. We present our effort at reducing the reported mortality index of neurosurgery and neurology patients within a neurocritical care unit through documentation and coding accuracy with direct incorporation of mortality modeling. METHODS: Using a reported method from Vizient Inc., we generated a spreadsheet tool to enable direct manipulation of the data to identify documentation and coding issues that influenced the reported mortality index in a retrospective set of patients. Subsequently, we implemented the prospective changes to documentation and coding and compared our calculated mortality index to the reported Vizient mortality index. RESULTS: Prospective implementation of the documentation and coding issues identified through our spreadsheet tool resulted in a drastic reduction of both our calculated and the reported Vizient mortality index. CONCLUSIONS: Incorporating knowledge of mortality index modeling into the documentation and coding resulted in impressive reductions in the reported mortality index for our patients, serving as a both an internal benchmark and a method of comparison with other institutions.


Assuntos
Cuidados Críticos/normas , Documentação/normas , Mortalidade Hospitalar , Procedimentos Neurocirúrgicos/mortalidade , Melhoria de Qualidade/normas , Humanos
5.
N Z Med J ; 132(1488): 28-37, 2019 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-31851659

RESUMO

AIM: Incomplete and incorrect documentation of adverse drug reactions (ADRs) can restrict prescribing choices resulting in suboptimal pharmaceutical care. This study aimed to examine the quality of information held within electronic systems in a hospital setting, to determine the preciseness of ADR documentation, and identify discrepancies where multiple electronic systems are utilised. METHOD: Over a four-week period, consecutive patients admitted to the general medical ward at the study hospital had their electronic profiles reviewed. Patient demographic information (de-identified), ADR history and discrepancies between information sources (as recorded in all electronic systems utilised at initial prescribing) were recorded and analysed. RESULTS: Over the four-week period, 332 patient profiles were reviewed, and over 1,200 alerts were identified and analysed (including duplicates of ADR reactions). Of these patients, 151 (45.5%) had at least one documented allergy or intolerance which generated 585 reactions, relating to 526 unique events. A further 151 (45.5%) were classified as having no known (drug) allergies or intolerances; however, 20 (15%) of these patients did have at least one allergy documented in at least one other electronic system. The remaining 30 (9%) patients were classified as having an unknown allergy status and of those nine had allergies documented in at least one other electronic system. Further, most systems contained information duplication, which had not been addressed during the admission process. CONCLUSION: ADR information was both imprecise and inaccurate, as multiple discrepancies between ADR information recorded in different electronic patient management systems were found to exist. Information sharing between systems needs to be prioritised in order to allow full, accurate and complete ADR information to be collected, stored and utilised; both to reduce current inadequacies and to allow optimal pharmaceutical care.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Documentação/normas , Troca de Informação em Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Centros de Atenção Terciária , Adulto Jovem
6.
Pan Afr Med J ; 33: 225, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692825

RESUMO

Drawing up the medical certificate is a crucial step in the judicial process. This judicial document should be drafted during a medical legal consultation. This study aims to evaluate the quality of medical certificates in a medico-judicial consultation and to study interpretative criteria of medical certificate validity. We conducted a retrospective study of patient's victims of intentional wounds and blows receiving a medico-judicial consultation at the Grand Yoff General Hospital, from April 2012 to February 2015. The whole of medical certificates were recorded on a survey form analyzed by Epi Info Version 6.04. The whole of the 249 certificates studied was printed in legible and understandable "Arial police 12". All the studied medical certificates included complete identification of the physician and the victim. The date and the time of aggression were written in 248 certificates (99.6%). The type of abuse suffered was specified on the whole of the 249 certificates: 164 brawls (65.9%), 64 unilateral aggressions (25.7%). The precise description and nature of the lesions was written in 246 certificates. The site of the lesions was established based on fixed anatomical landmarks in the various body plans. Medico-judicial consultation, coordinated by the forensic physician, helped to significantly improve the quality of the documents issued. The dissemination of these drafting practices and of the practices concerning the issuing of certificates is essential in particular in the regional hospital as part of an ongoing training or postgraduate training.


Assuntos
Documentação/normas , Medicina Legal/legislação & jurisprudência , Violência/legislação & jurisprudência , Adolescente , Adulto , Idoso , Agressão , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Médicos/organização & administração , Estudos Retrospectivos , Senegal , Adulto Jovem
7.
Aust N Z J Public Health ; 43(6): 570-576, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31667984

RESUMO

OBJECTIVE: To investigate the under-identification of Indigenous∗ infants in death records and examine the impact of a multi-stage algorithm on disparities in sudden unexpected deaths in infancy (SUDI). METHODS: Data on SUDI in Queensland between 2010 and 2014 were linked to birth and death registrations, health data, and child protection and coronial records. An algorithm was applied to cases of SUDI and population data to derive Indigenous status. Numbers, proportions and rates of SUDI were compared. RESULTS: Using multiple sources of Indigenous status resulted in a 64.9% increase in the number of infants identified as Indigenous. The Indigenous SUDI rate increased by 54.3%, from 1.38 to 2.13 per 1,000 live births after applying the algorithm to SUDI and live births data. CONCLUSIONS: Applying an algorithm to both numerator and denominator data reduced numerator-denominator incompatibility, to more accurately report rates of Indigenous SUDI and measure the gap in Indigenous infant mortality. Implications for public health: Estimation of the true magnitude of the disparity is restricted by under-identification of Indigenous status in death records. Data linkage improved the reporting of Indigenous infant mortality. Accuracy in reporting of measures is integral to determining genuine progress towards Closing the Gap.


Assuntos
Mortalidade Infantil/etnologia , Grupo com Ancestrais Oceânicos , Morte Súbita do Lactente/etnologia , Algoritmos , Causas de Morte , Atestado de Óbito , Documentação/normas , Feminino , Humanos , Lactente , Recém-Nascido , Armazenamento e Recuperação da Informação , Masculino , Queensland/epidemiologia , Fatores de Risco , Morte Súbita do Lactente/epidemiologia
9.
S Afr Med J ; 109(10): 792-800, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31635578

RESUMO

BACKGROUND: South Africa has one of the highest rates of interpersonal violence (IPV), in all its forms, in the world. Incidents of assault are largely under-reported and place an immense burden on the healthcare, fiscal and judicial systems. The first contact a victim of IPV has with a medical practitioner may be the only opportunity to identify, record and preserve valuable evidence, as evidence not captured on this occasion may be lost forever. The accuracy and quality of clinical notes taken at the time may be of paramount importance in facilitating the administration of justice. OBJECTIVES: (i) To investigate the adequacy of medicolegal note keeping by doctors in cases where subsequent legal proceedings may ensue; and (ii) to apprise clinicians of their shared responsibility in contributing to the administration of justice through both appropriate patient management and objective and contemporaneous recording of findings from a medicolegal perspective. METHODS: A prospective descriptive study was conducted over a period of 18 months from 2016 to 2018. The investigators reviewed patient files and critically appraised first-contact clinical notes in fatal-outcome cases of IPV admitted to the Pretoria Medico-Legal Laboratory during the study period. The cases were reviewed using rubrics specifically designed by the investigators to critically but consistently assess the adequacy of documentation of the medicolegal aspects applicable to each case. RESULTS: One hundred cases met the defined criteria for inclusion in the study. The victims were predominantly male (98%), and most (79%) were aged <40 years. Blunt-force injuries were the most frequent type of injury (43%), while gunshot wounds accounted for 36% of cases and sharp-force injuries were documented in 11%. Insufficient medicolegal documentation, wound description and evidence collection, by medical practitioners, was identified across all wounding modalities in the study sample. CONCLUSIONS: This study showed that medicolegal documentation in cases of IPV is suboptimal, with many important parameters not being routinely recorded, which is likely to impact negatively on criminal investigations and downstream legal proceedings. Greater emphasis on these issues is required during the undergraduate training of healthcare workers in a society as severely afflicted by IPV as SA. Although this study focused on fatal-outcome cases, these conclusions are equally applicable to many more cases where investigators, prosecutors and presiding judicial officers may be dependent on findings contemporaneously and objectively recorded by medical professionals.


Assuntos
Documentação/normas , Violência/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , África do Sul/epidemiologia , Adulto Jovem
10.
BMC Health Serv Res ; 19(1): 720, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638973

RESUMO

BACKGROUND: Service modularity could be promising for organizing healthcare delivery to heterogeneous patient groups because it enables cost reductions while also being responsive towards individual patients' needs. However, no research on the applicability of modularity in this context exists. To this end, we conducted a qualitative single-case study on chronic healthcare provision for Down syndrome patients, delivered by multidisciplinary pediatric Downteams in the Netherlands, from a modular perspective. METHODS: We conducted six semi-structured interviews with coordinators of multidisciplinary Downteams in six hospitals. In addition, we gathered data by means of observations and analysis of relevant documentation. We transcribed, coded, and analyzed the interviews utilizing the Miles and Huberman approach. The consolidated criteria for reporting qualitative research (COREQ) were applied in this study. RESULTS: In all six Downteams studied, the modular package for Down syndrome patients (i.e. the visit to the Downteams) could clearly be divided into modules (i.e. the separate consultations with the various professionals), and into different components (i.e. sub-elements of these consultations). These modules and components were linked by different types of customer-flow and information-flow interfaces. These interfaces allowed patients to flow smoothly through the system and allowed for information transfer, respectively. CONCLUSION: Our study shows a modular perspective is applicable to analyzing chronic healthcare for a heterogeneous patient group like children with Down syndrome. The decomposition of the various Downteams into modules and components led to mutual insight into each other's professional practices, both within and across the various Downteams studied. It could be used to increase transparency of delivered care for patients and family. Moreover, it could be used to customize care provision by mixing-and-matching components. More detailed research on chronic modular care provision for patients with DS is needed to explore this.


Assuntos
Assistência à Saúde/organização & administração , Documentação/normas , Síndrome de Down/terapia , Pessoal de Saúde/organização & administração , Assistência de Longa Duração/organização & administração , Criança , Humanos , Comunicação Interdisciplinar , Masculino , Pesquisa Qualitativa
11.
Hand Clin ; 35(4): 449-455, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31585606

RESUMO

Global outreach in hand surgery can be exceptionally rewarding for volunteers and their organizations, patients and their communities, and the host medical community. Success can be defined by individual cases that restore function and provide opportunities for a patient and family to contribute to society; however, the broader missions of medical collaboration, education, cultural exchange, and personal growth are critical factors toward building trust and establishing continuity of care for long-term success. Each outreach site and brigade encounters challenges; however, careful planning facilitates optimal conditions and reasonable expectations for enhancing outcomes.


Assuntos
Missões Médicas/organização & administração , Ortopedia , Comunicação , Continuidade da Assistência ao Paciente , Competência Cultural , Documentação/normas , Pessoal de Saúde/educação , Humanos , Consentimento Livre e Esclarecido , Registros Médicos , Determinação de Necessidades de Cuidados de Saúde , Equipe de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto , Transferência da Responsabilidade pelo Paciente , Melhoria de Qualidade , Papel (figurativo) , Segurança , Visitas com Preceptor , Confiança
12.
Int J Med Inform ; 132: 103981, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31605881

RESUMO

OBJECTIVES: To determine the effect of a domain-specific ontology and machine learning-driven user interfaces on the efficiency and quality of documentation of presenting problems (chief complaints) in the emergency department (ED). METHODS: As part of a quality improvement project, we simultaneously implemented three interventions: a domain-specific ontology, contextual autocomplete, and top five suggestions. Contextual autocomplete is a user interface that ranks concepts by their predicted probability which helps nurses enter data about a patient's presenting problems. Nurses were also given a list of top five suggestions to choose from. These presenting problems were represented using a consensus ontology mapped to SNOMED CT. Predicted probabilities were calculated using a previously derived model based on triage vital signs and a brief free text note. We evaluated the percentage and quality of structured data captured using a mixed methods retrospective before-and-after study design. RESULTS: A total of 279,231 consecutive patient encounters were analyzed. Structured data capture improved from 26.2% to 97.2% (p < 0.0001). During the post-implementation period, presenting problems were more complete (3.35 vs 3.66; p = 0.0004) and higher in overall quality (3.38 vs. 3.72; p = 0.0002), but showed no difference in precision (3.59 vs. 3.74; p = 0.1). Our system reduced the mean number of keystrokes required to document a presenting problem from 11.6 to 0.6 (p < 0.0001), a 95% improvement. DISCUSSION: We demonstrated a technique that captures structured data on nearly all patients. We estimate that our system reduces the number of man-hours required annually to type presenting problems at our institution from 92.5 h to 4.8 h. CONCLUSION: Implementation of a domain-specific ontology and machine learning-driven user interfaces resulted in improved structured data capture, ontology usage compliance, and data quality.


Assuntos
Algoritmos , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/terapia , Documentação/normas , Serviço Hospitalar de Emergência/normas , Controle de Formulários e Registros/métodos , Aprendizado de Máquina , Estudos de Casos e Controles , Sistemas de Apoio a Decisões Clínicas , Documentação/métodos , Feminino , Humanos , Masculino , Melhoria de Qualidade , Estudos Retrospectivos , Interface Usuário-Computador
13.
Lakartidningen ; 1162019 Sep 10.
Artigo em Sueco | MEDLINE | ID: mdl-31503322

RESUMO

According to the Swedish National Board of Health and Welfare, about 3200 people a year die due to accidents. Around 900 of these are classified as "Accidental exposure to other and unspecified factors". A more precise classification with the board has not been recorded in these cases due to incomplete death certificates. This study examined the death certificates for this group in 2016 and compared it to patient records. This study showed that most cases of incomplete classification are in instances of elderly persons who sustained a fall and subsequently died due to complications of the resulting injury. The doctor has in most cases not perceived the death as accidental.This study showed that there is a lack of knowledge among doctors in how to accurately complete a death certificate.


Assuntos
Acidentes por Quedas/mortalidade , Causas de Morte , Coleta de Dados/normas , Atestado de Óbito , Documentação/normas , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Competência Clínica/normas , Feminino , Humanos , Masculino , Registros Médicos/normas , Pessoa de Meia-Idade , Médicos/normas , Distribuição por Sexo , Suécia/epidemiologia , Fatores de Tempo
14.
Tidsskr Nor Laegeforen ; 139(13)2019 Sep 24.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31556532

RESUMO

BACKGROUND: Combination of drugs is the main cause of fatal overdose, and polydrug use is associated with greater treatment needs. This study investigates the prevalence and registration of multiple substance dependence. MATERIAL AND METHOD: Substance dependence diagnoses for 147 inpatients at the Department of Addiction Treatment, Oslo University Hospital were registered and reassessed with a focus on the ICD-10 diagnosis F19 (chaotic intake of multiple substances). The resulting diagnoses were also assessed according to ICD-11. RESULTS: Altogether 116 (79 %) out of 147 patients were addicted to two or more drugs. Only 22 (15 %) out of 147 were diagnosed with F19, but this figure increased to 52 (35 %) after reassessment. Using ICD-11 we found a prevalence of the diagnosis 6C4F (multiple substance dependence) of 79 %. INTERPRETATION: We found an underreporting of the ICD-10 diagnosis F19. It is important to use the F19 diagnosis, because polydrug use is underreported, even though it predicts overdose, prognosis and treatment needs.


Assuntos
Documentação/normas , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Humanos , Classificação Internacional de Doenças , Registros Médicos , Noruega/epidemiologia , Prevalência
15.
Bull Hosp Jt Dis (2013) ; 77(3): 194-199, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487485

RESUMO

INTRODUCTION: Systems-based Practice 3 (SBP 3) in the orthopedic residency developmental milestones evaluates residents' knowledge, understanding, and utilization of the electronic medical record (EMR). In order to better assess SBP 3, we conducted a review of residents' clinical notes in order to quantify the current state of orthopedic residents' documentation in the EMR. The purpose of this study was to objectively evaluate orthopedic resident documentation in the EMR. METHODS: Orthopedic resident medical notes from a single orthopedic residency at one academic medical center were scored by faculty members who had directly observed the clinical encounter. These notes were then independently scored by one investigator (N.F.) using clinical contentspecific, objective criteria. Sixty-five medical records were reviewed. All 62 orthopedic residents anonymously completed an 84-question survey on the value of EMR utilization and documentation within the medical record. RESULTS: Many key elements necessary to diagnosing a patient's injury and developing a treatment plan were often omitted (e.g., "Mechanism of Injury" in 32.3% of records), and the majority of notes did not include "Decision Making and Patient Preference" (95.2%) or "Risks/Benefits of Surgery" (93.7%). However, 95.2% of residents agreed that their notes reflect their medical knowledge and 96.8% agreed that their notes reflect their clinical reasoning. DISCUSSION: The results of this objective review revealed significant deficits in orthopedic resident documentation not identified by faculty observers.


Assuntos
Avaliação Educacional/métodos , Registros Eletrônicos de Saúde/normas , Internato e Residência , Ortopedia/educação , Documentação/normas , Humanos , Internato e Residência/métodos , Internato e Residência/normas , Melhoria de Qualidade , Estados Unidos
16.
Nurse Educ Pract ; 39: 37-44, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31377679

RESUMO

Portfolios are used in midwifery education to provide students with a central place to store their accumulative evidence of clinical experience for initial registration in Australia. Portfolio formats can be paper-based or electronic. Anecdotal discussion between midwifery students in Queensland debated the best format to document the requirements for the Australian Nursing and Midwifery Accreditation Council (ANMAC) standard 8.11. Midwifery students using paper-based portfolios envisioned that an ePortfolio would be streamline, simple, safe to use, and able to be used anywhere with WIFI, while some students using an ePortfolio expressed a desire to have a paper-based portfolio as a hard copy. This situation called for evidence of a comparison to resolve the debate. The aim of this study was to investigate midwifery students' experiences of the benefits and challenges between paper-based and ePortfolios when compiling evidence to meet the requirements for initial registration as a midwife in Australia (ANMAC, 2014).


Assuntos
Competência Clínica/normas , Documentação/normas , Avaliação Educacional/normas , Tocologia/educação , Estudantes de Enfermagem/psicologia , Bacharelado em Enfermagem , Humanos , Queensland
17.
Isr J Health Policy Res ; 8(1): 57, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266536

RESUMO

BACKGROUND: In recent years, it has become increasingly prevalent internationally to record and archive digital recordings of endoscopic procedures. This emerging documentation tool raises weighty educational, ethical and legal issues - which are viewed as both deterrents and incentives to its adoption. We conducted a survey study aimed at evaluating the use of DRD in endoscopic procedures, to examine physicians' support of this practice and to map the considerations weighed by physicians when deciding whether or not to support a more extensive use of DRD. METHODS: Israeli physicians from specialties that employ endoscopic technics were surveyed anonymously for demographic background, existence and use of recording equipment, existence of institutional guidelines regarding DRD, and self-ranking (on a scale from 1 to 7) of personal attitudes regarding DRD. RESULTS: 322 physicians were surveyed. 84% reported performing routine endoscopic procedures, 78% had the required equipment for digital recording, and 64% of them stated that they never or only rarely actually recorded the procedure. General surgeons had the second highest rate of DRD equipment (96.5%) but the lowest rates of DRD practice (17.5%). The average ranking of support of DRD by all participants was 5.07 ± 1.9, indicating a moderately high level of support. Significant positive correlation exists between actual DRD rates and average support of DRD (p < 0.001). Based on mediation models, for all specialties and with no exceptions, having routine recording guidelines and positive support of DRD were found to increase the probability of actual recording. Being a surgeon or an urologist negatively correlated with support of DRD, and decreased actual recording rates. The argument "Recording might cause more lawsuits" was ranked significantly higher than all other arguments against DRD (p < 0.001), and "Recording could aid teaching of interns" was ranked higher than all other arguments in favor of DRD (p < 0.001). CONCLUSIONS: While DRD facilities and equipment are fairly widespread in Israel, the actual recording rate is generally low and varies among specialties. Having institutional guidelines requiring routine recording and a positive personal support of DRD correlated with actual DRD rates, with general surgeons being markedly less supportive of DRD and having the lowest actual recording rates. Physicians in all specialties were very much concerned about DRD's potential to enhance lawsuits, and this greatly influenced their use of DRD. These findings should be addressed by educational efforts, centering on professionals from reluctant specialties, as well as by the issuing of both professional and institutional guidelines endorsing DRD as well as requiring it where applicable.


Assuntos
Documentação/métodos , Endoscopia Gastrointestinal/métodos , Padrões de Prática Médica/tendências , Gravação em Vídeo/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Documentação/normas , Documentação/estatística & dados numéricos , Endoscopia Gastrointestinal/estatística & dados numéricos , Endoscopia Gastrointestinal/tendências , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Gravação em Vídeo/tendências
20.
Australas Emerg Care ; 22(2): 92-96, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31042528

RESUMO

OBJECTIVE: To determine the nature and extent of misappropriation of medications and equipment from the ED. METHODS: We undertook a retrospective audit of medications procured and administered, and equipment replaced, in 2016, within a tertiary referral ED. Medication procurement and administration data were obtained from our MERLIN® pharmacy system and CERNER® electronic prescribing system, respectively. A medication 'discrepancy rate' was defined as the percentage of a medication procured that could not be accounted for by electronic administrations. The study also comprised a nested intervention sub-study where, from July 1, 2016, all Panadeine Forte tablets were stored in a locked facility. Victorian Hospital Healthcare Equipment invoices were audited to determine which major non-disposable equipment items most commonly needed resupply. RESULTS: Discrepancy rates for paracetamol 500mg and 665mg tablets were 23.3% and 54.9%, respectively. Following the Panadeine Forte intervention, the discrepancy rate for this medication fell from 70.5% to 8.8%. Orally administered medications with the potential for misappropriation had high discrepancy rates: caffeine (90.6%), cephalexin (62.9%), ondansetron (50.1%), pantoprazole (42.9%), amoxicillin (41.1%), metoclopramide (41.0%) and the 'morning after pill' (levonorgestrel) (36.4%). Parenterally administered medications had lower discrepancy rates: ceftriaxone (7.9%) and ampicillin (3.4%). The largest equipment replacement rates were for tourniquets and crutches. CONCLUSION: Discrepancy rates for many medications, especially those administered orally, are high. Further research is required to determine how these medications 'go missing'. Placing a medication with a high discrepancy rate in a locked facility with a 'logbook' substantially reduces this rate. Misappropriation of non-disposable equipment items is uncommon.


Assuntos
Equipamentos e Provisões/provisão & distribução , Roubo/estatística & dados numéricos , Documentação/normas , Documentação/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Equipamentos e Provisões/estatística & dados numéricos , Humanos , Auditoria Administrativa/métodos , Preparações Farmacêuticas/provisão & distribução , Estudos Retrospectivos , Texas
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