Browsing by Subject "Guideline Adherence"
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Item Building and Testing a Device to Monitor and Improve Hand Hygiene Compliance in Hospital Care(2016-01-19) Liu, Mary Ashley; van de Bruinhorst, Katrina; Olson, Dai Wai; Aiyagari, VenkateshHand hygiene (HH) is an essential component of hospital care, however, it is not universally practiced by health care workers (HCWs). High-tech solutions exist for monitoring HH, but are not widely used due to high cost and other limitations. The aims of this study were to build and test a system to monitor and remind HCWs and visitors to perform HH before and after patient contact. We designed a HH monitoring system using widely available electronic circuit parts, and tested it in the neuroscience intensive care unit of Zale Lipshy University Hospital. Our device consisted of three motion sensors, one placed on the hand sanitizer dispenser inside the patient room, one placed on the dispenser outside the room, and one on the door. The three sensors were configured to detect if entrance into or exit from a patient's room was immediately preceded by use of the local dispenser. The device also used an audiovisual reminder when a subject failed to initially hand sanitize. A cloud-based method was used to transmit and record data from the devices over the Internet onto online Excel spreadsheets based on whether the person entering or exiting the patient room was compliant or non-compliant in HH. Compliance was defined as subjects hand sanitizing either immediately before entering or exiting the patient room or within the set time period that the reminder was given. Device functionality was tested via a direct observational period, after which observational data were compared with data recorded by the device. Our device was able to monitor and record HH compliance in a high percentage of HCWs and visitors. Out of 100 observations, 73 were recorded by the device as compliant and 27 as non-compliant. Of the 73 compliant cases, 2 were actually non-compliant; of the 27 non-compliant cases, 5 were actually compliant. Sensitivity was 93% and specificity was 92%. The device was able to differentiate compliant from non-compliant subjects entering or exiting the patient room, initiate a reminder, and automatically record the data. Our study shows that HH compliance in hospital care can be monitored with a low cost, easy-to-build electronic device that overcomes several limitations posed by existing solutions. Future studies will continue to look at the long-term effect of an audiovisual reminder on increasing HH compliance in hospital care.Item Efficacy of Botswana's National Cancer Treatment Strategy: A Preliminary Analysis of Radiation Therapy in Breast Cancer Patients(2021-05-01T05:00:00.000Z) Shah, Sidrah Mariam; Grover, Surbhi; Chang, Mary; Nwachukwu, ChikaBACKGROUND: Breast cancer is a significant threat to public health in low- and middle-income countries (LMIC) globally, with the observation of an alarming increase in incidence in sub-Saharan Africa. Radiation Therapy (RT) is an essential component of breast cancer treatment and many LMIC currently lack access to RT. In Botswana, cancer care for citizens is paid for by the government, which has resulted in a unique investment in RT compared to other countries in the region. However, breast cancer mortality remains high, warranting further investigation into patient access to and receipt of RT. OBJECTIVE: This project seeks to investigate and present preliminary data on the percentage of breast cancer patients in Botswana qualifying for RT who actually went on to initiate RT. Demographic and clinical characteristics of breast cancer patients in Botswana are also presented. METHODS: Demographic, clinical, and treatment information was collected prospectively on all breast cancer patients presenting to the Breast Multidisciplinary Team (MDT) clinic at Princess Marina Hospital (PMH) in Gaborone, Botswana from January 2015 to October 2020. Patients with incomplete treatment information were excluded from the analysis. Patients who should have received RT were identified based on National Comprehensive Cancer Network (NCCN) guidelines. RESULTS: A total of 131 patients were included in the analysis. Of these, 29.8% were HIV-positive and 77.5% presented with advanced-stage disease. The vast majority of patients underwent mastectomy, and only 35% received chemotherapy. Based on NCCN guidelines, 121 patients qualified for receipt of radiation. In this population of breast cancer patients in Botswana, 92.6% of patients who needed RT received it. CONCLUSION: Based on this preliminary analysis, the investment of Botswana's Ministry of Health in RT for its citizens is seeing encouraging success among breast cancer patients. This analysis was limited by incomplete treatment information on the majority of breast cancer patients in this cohort, limiting the sample size in the final analysis. Further study is needed to characterize completion of RT in this population and factors that affect this.Item Standardizing Treatment for Acute Exacerbations of COPD (AECOPD) at a Large Academic Hospital(2024-01-30) Peraka, Veena; Wootton, Taylor; Irving, AnnetteBACKGROUND: Acute exacerbations of COPD (AECOPD) are a common problem faced by patients with chronic obstructive pulmonary disease (COPD). There are discrepancies in AECOPD treatment that impact patient outcomes. Despite evidence of improved or non-inferiority outcomes and reduced cost with short oral regimens, steroid prescribing patterns remain variable. Furthermore, there is confusion regarding antibiotic choice that contributes to the problem. LOCAL PROBLEM: The local problem is the lack of standardization of care for AECOPD at Clements University Hospital (CUH). Data from 6/1/2021-5/31/2023 shows that AECOPD treatment at CUH has been variable despite the availability of evidence-based medications. AIM: The aim of this project is to improve the adherence to evidence-based selection of steroids and antibiotics for AECOPD at CUH by 75% at 1 year after the intervention along with a 10% decrease in length of stay and readmissions. METHODS: The intervention is an order set containing guidelines and treatments for AECOPD that can be implemented into Epic electronic health records. Emergency department physicians, hospitalists, and pulmonologists were consulted for insight about treatment recommendations. This advice along with the GOLD guidelines and additional research were used to create the order set. RESULTS: The order set is now ready for implementation into Epic after being presented to physicians and respiratory therapists for feedback. After implementation, data will be collected on the usage and effectiveness of the order set and analyzed for up to one-year post-intervention. CONCLUSION: AECOPD is a complex disease that is treated with various medications that can lead to the different outcomes. Insight from various physician specialties was helpful to understand methods at CUH at different stages of the AECOPD journey. Due to the complexity, the order set can be a helpful resource for physicians when choosing treatments to improve adherence to evidence-based medications and patient outcomes.