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1.
Washington, D.C.; OPS; 2023-01-18.
em Espanhol | PAHO-IRIS | ID: phr-57031

RESUMO

El Presupuesto por Programas de la Organización Panamericana de la Salud 2022-2023 es el segundo en elaborarse y ejecutarse en el marco del Plan Estratégico de la Organización Panamericana de la Salud 2020-2025. En él se establecen los resultados institucionales y las metas de la Organización Panamericana de la Salud (OPS) para el próximo bienio, y se presenta el presupuesto que la Oficina Sanitaria Panamericana necesitará para cumplir esos objetivos y brindar apoyo a los Estados Miembros en las iniciativas dirigidas a mejorar los resultados en materia de salud, al tiempo que se favorece el logro de las metas relativas a la salud establecidas en los marcos regionales y mundiales vigentes. Asimismo, su ejecución contribuirá a avanzar hacia la consecución de los Objetivos de Desarrollo Sostenible. Esta versión es la primera que se elabora durante la pandemia de COVID-19, y las consecuencias y enseñanzas de la prolongada situación de emergencia se ven reflejadas en gran parte de los aspectos tratados. Además, el marco de resultados del proyecto de Presupuesto por Programas 2022-2023 responde a los principales mandatos estratégicos correspondientes al período, incluidos el 13.o Programa General de Trabajo de la Organización Mundial de la Salud (OMS), el Presupuesto por Programas de la OMS 2022-2023, la Agenda de Salud Sostenible para las Américas 2018-2030 y el Plan Estratégico de la OPS 2020-2025.


Assuntos
Orçamentos , Análise de Impacto Orçamentário de Avanços Terapêuticos , Organização Pan-Americana da Saúde , Desenvolvimento Sustentável , Prestação de Contas Financeiras em Saúde , Medição de Risco , Sistemas de Saúde , Doenças Transmissíveis , Doenças não Transmissíveis , Saúde Mental , Qualidade da Assistência à Saúde , Cooperação Técnica , Sistemas de Informação em Saúde , COVID-19 , América
2.
BMC Health Serv Res ; 23(1): 7, 2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36597088

RESUMO

BACKGROUND: India, the seventh-largest country in the world and the second-most populated faces enormous challenges when it comes to healthcare. The country's healthcare system was close to collapse due to the detrimental effects of the COVID-19 pandemic. Telehealth, which enables treating patients remotely, played a critical role during these challenging times. This systematic review investigates in detail the role of telehealth during COVID-19 and its application beyond the pandemic. METHODS: Database searches on PubMed, Scopus, Science Direct and Web of Science were carried out for studies published on telehealth, and articles were included if they focused on any audio or video telehealth consultation during the pandemic in India. Findings were synthesised into three main themes: applications, benefits and challenges of telehealth services. Methodological quality was assessed using JBI critical appraisal tools. RESULTS: The initial search on databases yielded 1143 articles. Of those, 19 met the eligibility criteria. Findings highlight the effective utilisation of telehealth across multiple medical specialities. Although insufficient technological infrastructure and other barriers due to the virtual consultation challenge the successful implementation of telehealth in India, it has the potential to bridge the rural-urban healthcare divide with cost-effective and easily accessible services. CONCLUSION: High patient/provider satisfaction underscores the need to integrate telehealth into routine healthcare practices in the country. However, the review urges the government and healthcare practitioners to address the telehealth challenges with prime importance to ensure quality healthcare throughout the nation even after the pandemic.


Assuntos
COVID-19 , Telemedicina , Humanos , COVID-19/epidemiologia , Pandemias , Qualidade da Assistência à Saúde , Instalações de Saúde
4.
Nurs Open ; 10(2): 469-478, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36631733

RESUMO

AIM: One of the challenges of robotic-assisted surgery is related to positioning of the patient on the operating table. Technological developments place increased demands on operating room nurses' competence to prevent positioning injuries and ensuring care quality. Therefore, the aim of the present study was to describe operating room nurses' experiences when positioning the patients for robotic-assisted surgery. DESIGN: A descriptive qualitative design. METHODS: Seven operating room nurses with experience in robotic-assisted surgery were included at a university hospital. Data were obtained through individual interviews and analysed using qualitative content analysis. The Consolidated Criteria for Reporting Qualitative research COREQ checklist was used. RESULTS: We identified three categories, (a) patient positioning is challenging during robotic-assisted surgery, (b) operating room nurses take responsibility for patient positioning during robotic-assisted surgery, but teamwork is important and (c) operating room nurses aim to achieve safe patient positioning during robotic-assisted surgery.


Assuntos
Enfermeiras e Enfermeiros , Procedimentos Cirúrgicos Robóticos , Humanos , Salas Cirúrgicas , Pesquisa Qualitativa , Qualidade da Assistência à Saúde
5.
PLoS One ; 18(1): e0280726, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36693061

RESUMO

INTRODUCTION: In 2020, the World Health Organization called for the expansion and greater recognition of all nursing roles, including advanced practice nurses (APNs), to better meet patient care needs. As defined by the International Council of Nurses (ICN), the two most common APN roles include nurse practitioners (NPs) and clinical nurse specialists (CNSs). They help ensure care to communities as well as patients and families with acute, chronic or complex conditions. Moreover, APNs support providers to deliver high quality care and improve access to services. Currently, there is much variability in the use of advanced practice nursing roles globally. A clearer understanding of the roles that are in place across the globe, and how they are being used will support greater role harmonization, and inform global priorities for advanced practice nursing education, research, and policy reform. OBJECTIVE: To identify current gaps in advanced practice nursing research globally. MATERIALS AND METHODS: This review of systematic reviews will provide a description of the current state of the research, including gaps, on advanced practice nursing globally. We will include reviews that examine APNs, NPs or CNSs using recognized role definitions. We will search the CINAHL, EMBASE, Global Health, HealthStar, PubMed, Medline, Cochrane Library Database of Systematic Reviews and Controlled Trials Register, Database of Abstracts of Reviews of Effects, Joanna Briggs Institute, and Web of Science electronic databases for reviews published from January 2011 onwards, with no restrictions on jurisdiction or language. We will search the grey literature and hand search the reference lists of all relevant reviews to identify additional studies. We will extract country, patient, provider, health system, educational, and policy/scope of practice data. We will assess the quality of each included review using the CASP criteria, and summarize their findings. This review of systematic reviews protocol was developed following the PRISMA-P recommendations. PROSPERO REGISTRATION NUMBER: CRD42021278532.


Assuntos
Prática Avançada de Enfermagem , Humanos , Revisões Sistemáticas como Assunto , Metanálise como Assunto , Qualidade da Assistência à Saúde , Papel do Profissional de Enfermagem , Literatura de Revisão como Assunto
8.
Inquiry ; 60: 469580231152080, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36705018

RESUMO

In an emergency, making the correct decision is vital. It is a necessary element of professional nursing care, and the ability of nurses to make successful clinical decisions is the most critical element influencing care quality. The purpose of this study was to assess the factors influencing nurses' clinical decision-making in the emergency department of Palestinan hospitals. A cross-sectional study was targeted at all nurses working in emergency departments at the Palestinian hospitals. The study was completed with 227 nurses, and collecting data was performed with the Clinical Decision Making in Nursing Scale. Results of the study revealed that the average score for the total clinical decision-making score was 3.3 (SD = 0.23). The subscales of clinical decision making were "search for alternatives or options," "canvassing of objectives and values," "evaluation and reevaluation of consequences," and "search for information and unbiased assimilation of new information." Furthermore, multiple linear regression analysis revealed that degree and work hours accounted for 11.7% of the variance in clinical decision-making. The study confirmed the average score for clinical decision-making was slightly higher than the average score. Also, it approved that nursing degree and work hours were predictors of clinical decision-making among nurses in emergency departments.


Assuntos
Enfermeiras e Enfermeiros , Qualidade da Assistência à Saúde , Humanos , Estudos Transversais , Tomada de Decisão Clínica/métodos , Serviço Hospitalar de Emergência
9.
BMC Prim Care ; 24(1): 6, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36627568

RESUMO

BACKGROUND: An advanced level medication review service (CMR) is systematically reimbursed and available nationwide in Slovenian primary care since 2016. CMR is performed by clinical pharmacists (CP). Close collaboration with general practitioner (GP) is required as they perform patient selection and make clinical decisions regarding patient's medication. METHODS: A prospective observational study was conducted in 2018 aiming to evaluate the perspective of GPs on the implementation of pharmacist-led medication review service in Community Health Care Centre Ljubljana, Slovenia. GPs of the patients, who provided written informed consent were invited for the interviews. The semi-structured interview consisted of 5 open ended questions addressing reasons for referral of the patients, implementation of CP recommendations and the GPs' perspective of the service in general. Interviews were audio recorded with GPs written consent, transcribed verbatim and inductive content analysis was performed in NVivo11 Pro. RESULTS: In total 38 interviews with 24 GPs were performed. The emerged themes were nested under 3 main domains representing Donabedian model of quality healthcare - structure, process, outcomes. The service structure is built on broad pharmacotherapy knowledge as the main CP competency, good accessibility, and complementarity of healthcare professions. Patients are mainly referred to the CMR due to polypharmacotherapy, however in majority there is a more in-depth reason behind (e.g., adverse events, etc.). Lack of time to recognize eligible patients and additional workload to study and implement the recommendations present the major challenges in the service process and therefore low number of referrals. CPs recommendations are mostly accepted, although the implementation time varies. When recommendation addresses medicines prescribed by a clinical specialist, the CMR report is forwarded to them for decision regarding implementation. The empowerment of the patients in medicines use was emphasized as the major benefit of the CMR, which consequently supports and enhances the quality of GP's patient care. Transferability of recommendations to similar cases and high satisfaction with the service of GPs and patients, were mentioned. CONCLUSION: GPs experiences with CMR are encouraging and supportive and present a base for further growth of the service.


Assuntos
Clínicos Gerais , Humanos , Farmacêuticos , Revisão de Medicamentos , Qualidade da Assistência à Saúde , Atenção Primária à Saúde
10.
JAMA ; 329(4): 325-335, 2023 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-36692555

RESUMO

Importance: Health systems play a central role in the delivery of health care, but relatively little is known about these organizations and their performance. Objective: To (1) identify and describe health systems in the United States; (2) assess differences between physicians and hospitals in and outside of health systems; and (3) compare quality and cost of care delivered by physicians and hospitals in and outside of health systems. Evidence Review: Health systems were defined as groups of commonly owned or managed entities that included at least 1 general acute care hospital, 10 primary care physicians, and 50 total physicians located within a single hospital referral region. They were identified using Centers for Medicare & Medicaid Services administrative data, Internal Revenue Service filings, Medicare and commercial claims, and other data. Health systems were categorized as academic, public, large for-profit, large nonprofit, or other private systems. Quality of preventive care, chronic disease management, patient experience, low-value care, mortality, hospital readmissions, and spending were assessed for Medicare beneficiaries attributed to system and nonsystem physicians. Prices for physician and hospital services and total spending were assessed in 2018 commercial claims data. Outcomes were adjusted for patient characteristics and geographic area. Findings: A total of 580 health systems were identified and varied greatly in size. Systems accounted for 40% of physicians and 84% of general acute care hospital beds and delivered primary care to 41% of traditional Medicare beneficiaries. Academic and large nonprofit systems accounted for a majority of system physicians (80%) and system hospital beds (64%). System hospitals were larger than nonsystem hospitals (67% vs 23% with >100 beds), as were system physician practices (74% vs 12% with >100 physicians). Performance on measures of preventive care, clinical quality, and patient experience was modestly higher for health system physicians and hospitals than for nonsystem physicians and hospitals. Prices paid to health system physicians and hospitals were significantly higher than prices paid to nonsystem physicians and hospitals (12%-26% higher for physician services, 31% for hospital services). Adjusting for practice size attenuated health systems differences on quality measures, but price differences for small and medium practices remained large. Conclusions and Relevance: In 2018, health system physicians and hospitals delivered a large portion of medical services. Performance on clinical quality and patient experience measures was marginally better in systems but spending and prices were substantially higher. This was especially true for small practices. Small quality differentials combined with large price differentials suggests that health systems have not, on average, realized their potential for better care at equal or lower cost.


Assuntos
Atenção à Saúde , Administração Hospitalar , Qualidade da Assistência à Saúde , Idoso , Humanos , Atenção à Saúde/economia , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Atenção à Saúde/estatística & dados numéricos , Programas Governamentais , Hospitais/classificação , Hospitais/normas , Hospitais/estatística & dados numéricos , Medicare/economia , Medicare/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Estados Unidos/epidemiologia , Administração Hospitalar/economia , Administração Hospitalar/normas , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos
11.
JAMA ; 329(4): 287-288, 2023 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-36692553

RESUMO

This Viewpoint examines in-depth 5 features of health care systems that may influence quality of care: pooled resources, centralization, standardization, interprovider coordination, and cross-practice learning.


Assuntos
Atenção à Saúde , Qualidade da Assistência à Saúde , Atenção à Saúde/normas , Qualidade da Assistência à Saúde/normas
12.
BMJ Open Qual ; 12(1)2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36707125

RESUMO

Patient experience is a key pillar of healthcare quality. We describe a framework of three short generic measures covering Patient Experience, Result Satisfaction and Service Integration. The Result Satisfaction measure is described for the first time.These measures capture twelve aspects of patient experience covering the relationship between patients and clinicians (Patient Experience), the immediate results of the consultation or treatment as perceived by patients (Result Satisfaction) and collaboration between different healthcare services and silos (Service Integration). Each measure has four items.These measures are compared with three national measures: the Friends and Family Test and the General Practice Patient Survey used in England, and HCAHPS used in US hospitals. The expected benefits of national measures are not being achieved and we need to think again about how best to tailor health services to meet patients' expectations.The three measures described (Patient Experience, Result Satisfaction and Service Integration) are generic, short and have low reading ages. They share common forms and scoring schemes, which mean that they can be used individually or in combination at all levels of a healthcare provider.


Assuntos
Satisfação do Paciente , Pacientes , Humanos , Hospitais , Qualidade da Assistência à Saúde , Avaliação de Resultados da Assistência ao Paciente
13.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2023 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-36710262

RESUMO

PURPOSE: This study takes a divergent approach to exploring which construct is more predictive of patient satisfaction (SAT) in a service dominant economy within the context of a healthcare setting. DESIGN/METHODOLOGY/APPROACH: Applying a critical analysis of literature, a service value (SV) model for customer SAT is proposed in this study, which is validated and confirmed with survey data from outpatients at Moorfields Eye Hospital - a world class specialist hospital based in the UK. FINDINGS: Quality of service had the strongest impact on SV but SV had the strongest impact and mediation effect on patient SAT. RESEARCH LIMITATIONS/IMPLICATIONS: The study concludes that since SV rather than quality of service is more predictive of patient SAT, health service providers should focus more on SV in addition to quality of service, if they are to meet the dynamic expectations of their patients. PRACTICAL IMPLICATIONS: Health service providers should focus more on SV in addition to quality of service, if they are to meet the dynamic expectations of their patients. SOCIAL IMPLICATIONS: This poses a strong argument in favour of a paradigm shift in focus from quality of service-based model to service value-based model for greater patient satisfaction. ORIGINALITY/VALUE: This is the first study exploring the inter-relationship of four constructs of patient SAT within the context of a leading major UK healthcare hospital service.


Assuntos
Satisfação do Paciente , Qualidade da Assistência à Saúde , Humanos , Hospitais , Assistência ao Paciente , Pacientes
15.
BMC Pregnancy Childbirth ; 23(1): 52, 2023 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-36681786

RESUMO

BACKGROUND: Person-Centered Maternity Care (PCMC) is known as one of the most important components of maternal care. Every woman has the ultimate right of respectful health care. Previous research documents that lack of supportive care and respectful behavior experienced by pregnant women can act as a barrier to the utilization of health care services. Few studies have used PCMC tool to document this phenomenon. The objective of this descriptive study was to assess the women's perception of PCMC in Pakistan. METHODS: Three hundred and seventy-seven (377) postnatal women of ages 18-49 years participated in the research. The study sites were secondary and tertiary care hospitals located in the twin cities of Rawalpindi and Islamabad. The PCMC tool used in this study is a validated scale with three sub-domains of i) communication and autonomy, ii) supportive care, and iii) dignity and respect. Data was analyzed using SPSS version 16, and descriptive and bivariate analysis was undertaken. RESULTS: The PCMC mean score was 54 ± [10.7] out of 90. About half (55%) of women had good perception of PCMC. Sub-domain of supportive care scored the lowest as compared to the other two domains. Overall, 36% women reported physical abuse while 22% reported verbal abuse at the hands of the healthcare providers. Most of the women (88%) said that health providers did not introduce themselves. About 30% women claimed that health care providers never asked for permission before doing any medical procedures and 20% of women claimed that doctors did not describe the purpose of examination while 178 (47%) of women said that health provider explained the purpose of medications all the time, additionally, about 14% were never given the choice to ask questions. CONCLUSION: The study concluded that the majority of postnatal women perceived that they were not getting optimum Person-Centered Maternity Care. Some core aspects in supportive care domain were missing. In order to improve the quality of hospital-based childbirths, efforts are needed to improve the quality of care.


Assuntos
Serviços de Saúde Materna , Feminino , Gravidez , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Masculino , Cidades , Parto , Gestantes , Percepção , Qualidade da Assistência à Saúde , Parto Obstétrico
16.
Inquiry ; 60: 469580221143273, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36624685

RESUMO

While new offerings of virtual urgent care services from peer hospitals faltered after initial provincial pilot funding lapsed, our 3 regional academic health sciences centers decided to partner to enhance patient access, achieve efficiencies, and support long-term sustainability. Utilizing the Development Model for Integrated Care framework, we progressed through the 4 phases to ensure joint success and high-quality care: (1) initiative and design phase-individual parallel projects but with strong collaborations and broad stakeholder engagement; (2) experimental and execution phase-continuous quality improvement approach for governance, policies, and processes; (3) expansion and monitoring phase-weekly leadership touchpoints on key performance indicators; and (4) consolidation and transformation phase-sustainability through ongoing funding.


Assuntos
Melhoria de Qualidade , Qualidade da Assistência à Saúde , Humanos , Hospitais , Liderança
17.
BMJ Open ; 13(1): e067683, 2023 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-36717137

RESUMO

INTRODUCTION: Quality variation has been widely witnessed and discussed in China. However, limited evidence reveals quality gaps by the medical institute level, especially between hospitals and primary care institutes. This systematic review will synthesise the available evidence on quality variation between medical institutes at different levels in China. By adopting a quality framework, we will also explore the detailed domains (structure, process and outcomes) and dimensions (safety, effectiveness, timeliness, patient-centredness, efficiency, integration and equity) of quality gaps. METHODS AND ANALYSIS: An extensive literature search will be conducted on eight key electronic databases: MEDLINE, Web of Science, Cochrane Library, Scopus, EMBASE, ProQuest, China National Knowledge Infrastructure and WANFANG database. The Grey Matter Checklist will be used to screen relevant grey literature. The publication time limit should be before 31 December 2022 when we plan to conduct a literature search. All kinds of studies that revealed the quality difference between medical institutes at different levels will be included, no matter if quality improvement intervention is involved. All quality measures and indicators will be recorded and sorted into appropriate domains and dimensions. For those studies that took the completion rate of standard operations to assess the quality, we will also record the name of the clinical pathways, guidelines or checklists used. Two reviewers will independently perform the study selection, data extraction and quality assessment process. A narrative or quantitative synthesis will be performed based on the available data. ETHICS AND DISSEMINATION: Ethics approval is not applicable. The results of this study will be submitted to a widely accepted peer-review journal. The findings will also be used to inform administration about quality gaps by different medical institute levels and, therefore, help them to design policies that will minimise the quality variation. PROSPERO REGISTRATION NUMBER: CRD42022345933.


Assuntos
Qualidade da Assistência à Saúde , Projetos de Pesquisa , Humanos , China , Revisões Sistemáticas como Assunto
18.
Rev Bras Epidemiol ; 26: e230005, 2023.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36629617

RESUMO

OBJECTIVE: To evaluate the quality of care for children under two years of age in the primary health care network with data from the external evaluation of the Program for the Improvement of Access and Quality of Primary Care in 2018. METHODS: Users who had children under two years of age who were in the unit at the time of data collection were eligible for the study. The quality of care was evaluated using a synthetic indicator built with questions from the users' module. The exposure variables were: region, structure of basic health units, and staff process. A univariate analysis was performed and crude and adjusted prevalence ratios were estimated. RESULTS: The sample was composed of 15.745 users who had children under the age of two years. Only 36.8% (95%CI 36,0-37,6) of users were classified as having received good quality care for their children, with a downward trend in prevalence as the child's age increased. Better results were observed in the Northeast region, in units that presented all the inputs and vaccines and for teams that used protocols and materials, kept records, performed active search and healthy eating actions. CONCLUSION: The prevalence of good quality of care for children under two years of age was low. These data can be useful for managers' decision-making and for the implementation of actions aimed at professionals, that encourage a higher quality of care to children, mainly the child leaving a consultation with the next appointment scheduled and a first consultation being carried out until their seventh day of life.


OBJETIVO: Avaliar a qualidade da atenção a menores de dois anos na rede básica, com dados da avaliação externa do Programa de Melhoria de Acesso e Qualidade da Atenção Básica em 2018. MÉTODOS: Foram elegíveis para o estudo usuários com filhos menores de dois anos que estavam na unidade no momento da coleta de dados. A qualidade de atenção foi avaliada por meio de um indicador sintético construído com questões do módulo de usuários. As exposições foram: região, estrutura das unidades básicas de saúde e processo de trabalho das equipes. Realizou-se análise univariada e estimaram-se as razões de prevalências brutas e ajustadas. RESULTADOS: A amostra foi composta de 15.745 usuários que possuíam filhos menores de dois anos. Apenas 36,8% (intervalo de confiança ­ IC95% 36,0­37,6) dos usuários foram classificados como tendo recebido atenção de boa qualidade para as crianças, com redução das prevalências de acordo com o aumento da idade da criança. Observaram-se melhores resultados para a Região Nordeste, em unidades que apresentaram todos os insumos e vacinas e nas equipes que utilizavam protocolos e materiais, realizavam os registros, a busca ativa e ações de alimentação saudável. CONCLUSÃO: A prevalência de qualidade de atenção a menores de dois anos foi baixa. Os dados podem ser úteis para decisões de gestores e para a execução de ações voltadas para os profissionais, que incentivem maior qualidade de cuidado com a criança, principalmente com relação a, após a consulta, a criança já sair com a próxima marcada e à realização de consulta até os sete dias de vida.


Assuntos
Qualidade da Assistência à Saúde , Humanos , Criança , Lactente , Pré-Escolar , Brasil , Coleta de Dados
19.
J Obstet Gynaecol Res ; 49(1): 194-200, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36647324

RESUMO

BACKGROUND: Intrapartum care is of paramount importance in overall respectful maternity care (RMC). Uterine fundal pressure maneuver (UFPM) is the most controversial obstetric maneuver considered obsolete in many countries. UFPM is associated with adverse life threatening maternal and fetal effects. The baseline prevalence of UFPM in our tertiary care teaching hospital with a heavy patient load was 78.4% which was quite high. Our aim was to reduce the prevalence of UFPM by 75% from baseline over a period of 10 months. METHODS: After root cause analysis, we formulated the departmental Standard Operating Procedures on safe vaginal delivery and birth practices and initiated the Labour Room Quality Improvement Initiative. We sensitized and created awareness among the resident doctors and nursing staff regarding the high prevalence of UFPM through dedicated lectures, intercommunication via WhatsApp groups and strict vigilance in the labor wards. The point of care quality improvement (QI) methodology was used. The primary outcome was decrease in the prevalence of UFPM. RESULTS: The prevalence of UFPM reduced from the baseline value of 78.4%-4% over the period of 7 months. Post intervention it gradually increased and sustained at 21.2% over a follow-up period of 3 months. CONCLUSION: QI methods can effectively and rapidly improve the acceptance and adherence to newer initiatives in a busy tertiary care health facility to reduce the prevalence of UFPM and eventually improve the overall RMC.


Assuntos
Serviços de Saúde Materna , Melhoria de Qualidade , Gravidez , Feminino , Humanos , Prevalência , Países em Desenvolvimento , Parto Obstétrico/métodos , Segunda Fase do Trabalho de Parto , Qualidade da Assistência à Saúde
20.
Hu Li Za Zhi ; 70(1): 70-77, 2023 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-36647312

RESUMO

BACKGROUND & PROBLEMS: The extracorporeal membrane oxygenation (ECMO) system can provide cardiopulmonary support to and reduce the mortality rate in severely ill newborns. According to our investigation, completion rate of the care process among staff nurses was only 63.5% in our ward. We assumed that the reasons for the above problems included: lack of care awareness, unfamiliarity with the ECMO operation process, inadequate instruments preparation, improper ECMO pipeline fixation, lack of designated space in the unit for placing ECMO supplies, lack of specialty care guidelines, lack of a regular inspection system, and lack of regular on-the-job education. PURPOSE: Improve awareness related to assisting ECMO placement among nurses in the neonatal intensive care unit and the completeness of care. RESOLUTIONS: 1. Create a care process guidebook describing the procedures for ECMO system placement in newborns to help nurse accomplish proper placement. 2. Establish the ECMO system consumables checklist and install an ECMO system-specialized toolbox to reduce the preparation time and smooth the process. 3. Regularly organize comprehensive nurse training and develop performance indicators to enhance ECMO system placement awareness and skills. RESULTS: The cognitive accuracy rate for the assisted placement of ECMO among nurses in the neonatal intensive care unit increased from 51.9% before improvement to 89.9% afterward. Also, the complete care rate of ECMO placement increased from 63.5% before improvement to 100% afterward. CONCLUSIONS: This project effectively improved the accuracy rate of nurses involved in assisting with ECMO placement, made the ECMO system placement process easier to implement, improved the care process completion rate, and improved newborn care quality.


Assuntos
Oxigenação por Membrana Extracorpórea , Enfermeiras e Enfermeiros , Recém-Nascido , Humanos , Unidades de Terapia Intensiva Neonatal , Oxigenação por Membrana Extracorpórea/educação , Oxigenação por Membrana Extracorpórea/métodos , Cuidados Críticos/métodos , Qualidade da Assistência à Saúde
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