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Article
Publication date: 12 March 2018

Oisín Conaty, Leah Gaughan, Colum Downey, Noreen Carolan, Megan Joanne Brophy, Ruth Kavanagh, Deborah A.A. McNamara, Edmond Smyth, Karen Burns and Fidelma Fitzpatrick

The purpose of this paper is to improve surgical antimicrobial prophylaxis (SAP) prescribing in orthopaedic surgery using the model for improvement framework.

358

Abstract

Purpose

The purpose of this paper is to improve surgical antimicrobial prophylaxis (SAP) prescribing in orthopaedic surgery using the model for improvement framework.

Design/methodology/approach

Orthopaedic patients receiving joint replacements, hip fracture repairs or open-reduction internal-fixation procedures were included. Antimicrobial(s); dose, time of administration and duration of SAP were evaluated for appropriateness based on the local SAP guidelines. After baseline data collection, a driver diagram was constructed with interventions devised for plan-do-study-act cycles. Data were fed back weekly using a point prevalence design (PPD). Interventions included SAP guideline changes, reminders and tools to support key messages.

Findings

SAP in 168 orthopaedic surgeries from 15 June 2016 to 31 January 2017 was studied. Prescribing appropriateness improved from 20 to 78 per cent. Junior doctor changeover necessitated additional education and reminders.

Practical implications

Due to constant staff changeover; continuous data collection, communication, education and reminders are essential to ensure continuous compliance with clinical guidance. Patients with hip fractures are difficult to weigh, requiring weight estimation for weight-based antimicrobial dosing. Unintended consequences of interventions included the necessity to change pre-operative workflow to accommodate reconstitution time of additional antimicrobials and inadvertent continuation of new antimicrobials post-operatively.

Originality/value

Rather than perform the traditional retrospective focused audit, we established a prospective, continuous, interventional quality improvement (QI) project focusing on internal processes within the control of the project team with rapid cyclical changes and interventions. The weekly PPD was pragmatic and enabled the QI project to be sustained with no additional resources.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 2
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 13 June 2016

Deborah A. McNamara, Paul Rafferty and Fidelma Fitzpatrick

Interdisciplinary healthcare education and collaboration facilitates healthcare quality improvement (QI). Education challenges include cost, logistics and defining the optimum…

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Abstract

Purpose

Interdisciplinary healthcare education and collaboration facilitates healthcare quality improvement (QI). Education challenges include cost, logistics and defining the optimum staff-engaging method. The purpose of this paper is to determine the optimum QI educational model and measure its impact using plan-do-study-act (PDSA) cycles.

Design/methodology/approach

The authors established an on-site interdisciplinary QI learning collaborative: weekly 30-minute learning sessions close to the working environment; a learning materials Twitter repository; and junior doctor-led QI work streams aligned with surgical directorate quality goals supported by a mentorship network. Delivery style (lectures, workshops and QI project reporting) and learning session content was planned weekly using PDSA cycles and modified using participant feedback (score 0-10). All surgical directorate QI work streams were measured before and at nine months.

Findings

From May 2014 to February 2015, there were 32 learning sessions with 266 scores (median 12 weekly, range 5-21). Workshop delivery scored the highest (mean score 9.0), followed by live project reports (mean score 8.8). The surgical QI work streams increased threefold from four to 12, including six junior doctor-led projects.

Practical implications

By proactively acting upon feedback, the authors centralised QI measurement and tailored learning sessions to staff needs. Building sustainability involves continually refining learning curriculum and QI work streams, and expanding the mentorship network.

Originality/value

The collaborative was established at no additional cost. Twitter is used to promote meetings, facilitate conversations and act as a learning repository. The mentorship framework builds QI and coaching expertise.

Details

International Journal of Health Care Quality Assurance, vol. 29 no. 5
Type: Research Article
ISSN: 0952-6862

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