An increase in elderly patients and severity of illness rates means greater use of nasogastric feeding tubes for both high-risk acutely ill and chronically ill patients. When the QA screening process at Booth Memorial...
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An increase in elderly patients and severity of illness rates means greater use of nasogastric feeding tubes for both high-risk acutely ill and chronically ill patients. When the QA screening process at Booth Memorial Medical Center revealed a certain percentage of complications with small bore, weight-tipped feeding tubes inserted through the nares, a multidisciplinary peer review committee (MPRC) was formed to review the enteral nutrition program. After a literature review to determine possible complications, the MPRC identified lung perforations due to tube misplacement, tube feeding aspiration into the lungs leading to possible aspiration pneumonia, and an internal tip separation from the tube product failure. Unconscious incubated patients on ventilators were shown as at high risk for feeding tube misplacement in an initial MPRC patient study. A second study evaluated several different feeding tube products in the medical, respiratory and surgical ICU. The MPRC established a credentialing process for physician assistants, interns and residents in feeding tube placement. The MPRC proceedings were presented to the hospital-wide QA committee for review, endorsement and recommendations on all policy and procedure changes. The conclusions were that a more concerted effort must be made to improve medical management and encourage ongoing education in the administration of enteral feedings to high-risk patients.
The decision to incorporate cone-beam CT (CBCT) into a dental practice is one that requires serious consideration and careful planning. In the early days of the technology, fewer sources of information existed and a c...
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Healthcare literature suggests that most adverse drug events (ADEs) are the results of errors at the prescribing stage. These ADEs affect patients, physicians, pharmacists, nurses, and hospital administrators. Improvi...
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Healthcare literature suggests that most adverse drug events (ADEs) are the results of errors at the prescribing stage. These ADEs affect patients, physicians, pharmacists, nurses, and hospital administrators. Improving systems and providing education, rather than tracking the performance of individual prescribers, seem to be more effective in preventing and reducing ADEs. Pharmacists' participation on patient medical rounds and their presence in a satellite pharmacy increased their accessibility and their ability to share pertinent clinical information and thereby improved the medication order process and, ultimately, patient care. The pharmacy and medicine departments at one hospital took a proactive multidisciplinary approach that resulted in streamlining the medication order process, decreasing delays in initiating drug therapy, preventing ADEs, enhancing the knowledge of healthcare professionals, meeting the needs and expectations of patients and providers, and employing cost-effective drug therapy.
Incident reporting has emerged as a cornerstone of sound quality improvement programs. Sentinel events, "a serious and undesirable occurrence involving the loss of life, limb, or function of an individual served&...
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Incident reporting has emerged as a cornerstone of sound quality improvement programs. Sentinel events, "a serious and undesirable occurrence involving the loss of life, limb, or function of an individual served" (Joint Commission on Accreditation of Healthcare Organizations, 1996), is a mandated indicator for Joint Commission standards of accreditation for audited healthcare facilities. Properly investigated and documented individual incidents can lead to systemic improvements, which may enhance the quality of client care and the integrity of the healthcare facility. This article proposes a systemic approach to the incident review (IR) process in long-term healthcare facilities. This comprehensive approach incorporates identification, investigation, and management of the IR process from the inception of a problem to the continued follow-up to ensure that improvement plans are effectively implemented.
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