The six-bed multi-occupancy bedrooms, several of the two-bed bedrooms on Heather and Hawthorn units, and six- and five-bedded rooms on Fuschia unit were unsuitable in design and layout to protect the privacy and dignity of the residents. The design and layout had a significant impact on residents as they were unable to undertake personal activities in private or to meet with visitors in their bedroom in a private area. This is discussed further in outcome 16, resident’s rights dignity and consultation. In many cases there was not enough room beside the beds to place a visitors chair or a chair for the resident to sit out of bed. Many beds in the two-bed bedrooms were placed with one side up against the wall due to space restrictions. The limited space in these bedrooms had a negative impact on the storage of residents’ clothes and personal belongings. Many residents' wardrobes were not located beside their bed but were located at the end of the bedroom. The wardrobe space was inadequate to meet the residents' storage needs with most residents having clothes stored in the locked linen room on each ward. This issue was also addressed under outcome 17, residents' clothing, personal property and possessions. A bedside locker was not always located beside each resident’s bed and lockable storage was not available in the bedside lockers or the wardrobes. Although there was a beautiful well maintained enclosed garden area in Fuschia unit, the residents in Hawthorne and Heather units did not have access to an enclosed garden.
medications. Medications on Fuschia ward were dispensed by the pharmacist, labelled for each individual resident, and stored in resident named trays on the medication trolleys. Medications on Heather and Hawthorn wards were not dispensed and labelled for individual residents but supplied as stock by the pharmacist and administered by nurses from the medication trolley; staff informed the inspectors that the new system would be implemented on these two wards in due course. The nurses on Fuschia ward reported that they found the new system safer and that it would the risk of medication error. On review of the system the inspector found that the new system for the supply of PRN (as required) medications had not yet been finalised. There were insufficient stocks on the trolley to meet the needs of the residents should they require a PRN (as required) medication. The inspector acknowledges that this system is in development, however the impact of this could result in a PRN (as required) medication not being available when needed for a resident.
The six-bed multi-occupancy bedrooms, several of the two-bed bedrooms on Heather and Hawthorn units, and six- and five-bedded rooms on Fuschia unit were unsuitable in design and layout to protect the privacy and dignity of the residents. The design and layout had a significant impact on residents as they were unable to undertake personal activities in private or to meet with visitors in their bedroom in a private area. This is discussed further in outcome 16, resident’s rights dignity and consultation. In many cases there was not enough room beside the beds to place a visitors chair or a chair for the resident to sit out of bed. Many beds in the two-bed bedrooms were placed with one side up against the wall due to space restrictions. The limited space in these bedrooms had a negative impact on the storage of residents’ clothes and personal belongings. Many residents' wardrobes were not located beside their bed but were located at the end of the bedroom. The wardrobe space was inadequate to meet the residents' storage needs with most residents having clothes stored in the locked linen room on each ward. This issue was also addressed under outcome 17, residents' clothing, personal property and possessions. A bedside locker was not always located beside each resident’s bed and lockable storage was not available in the bedside lockers or the wardrobes. In one of the five bedded rooms in Fuschia unit there was not enough space between the beds and the room was not large enough for five beds.
We performed a descriptive analysis of antibiogram reporting practices in communityhospitals enrolled in the Duke Infection Control Outreach Network (DICON). DICON is a collaborative network of communityhospitals in the southeastern United States that share surveillance data on health care-associated infection, educational materials, and consultative services for their infection prevention programs (5). We requested cumu- lative antibiograms that included data from calendar year 2012 from the 37 acute care hospitals participating in DICON starting in January 2013. Of those facilities that voluntarily provided antibiograms, microbiology laboratory directors were sent a voluntary, electronic survey on antibi- ogram preparation knowledge and practices. The directors were asked to delegate the survey response to the individual responsible for preparing the facility cumulative antibiogram. Surveys were completed in April-May 2014. Surveys were designed and distributed using Qualtrics (Provo, UT).
ABSTRACT. Background. Tele-echocardiography has the potential to bring real-time diagnoses to neonatal facilities without in-house pediatric cardiologists. Many neonates in rural areas, smaller cities, and communityhospitals do not have immediate access to pediatric sonographers or echocardiogram interpretation by pedi- atric cardiologists. This can result in suboptimal echocar- diogram quality, delay in initiation of medical interven- tion, unnecessary patient transport, and increased medical expenditures. Telemedicine has been used with increased frequency to improve efficiency of pediatric cardiology care in hospitals that are not served by pedi- atric cardiologists. Initial reports suggest that telecardi- ology is accurate, improves patient care, is cost-effective, enhances echocardiogram quality, and prevents unneces- sary transports of neonates in locations that are not served by pediatric cardiologists.
A study from Germany  that evaluated the quality cir- cle programmes to implement clinical guidelines in gen- eral practice found that for doctors who participated in the programme there was an increase in knowledge, improved work relationships and was beneficial beyond actual measured clinical care for patients. In the CAPTION project the hospital coordinators reported that the benefit of participation went beyond improving patient care and also improved their inter-professional relationships and their knowledge and was beneficial both personally and to the hospital. An additional paper looking at decreasing in-hospital mortality, reported on components that had the most influence . This demonstrated that leader- ship by the hospital executive contributed to the success of the strategy for change. Similarly where there was support at a District Manager level in the CAPTION hospitals the participants found that the project had wider acceptance. Hospitals may not undertake such projects individually due to the time commitments, including the preparation of audit materials and preparation of education materials, unless there is a designated project staff member such as a DUE pharmacist. A national multicentre drug use evalua- tion project such as CAPTION allows hospitals that would
The national level, Ghana Health Service (GHS) head- quarters, posts newly graduated health professionals to the ten regions in Ghana, each of which are headed by a regional health administration (RHA). The RHA oversee the districts’ human resource (HR) demands and distrib- ute health workers accordingly. The districts, headed by the district health administrations (DHA) and district hospitals (DH), are responsible for adequately staffing all public health facilities and hospitals within their district. The DHA and DH do not have the authority to hire or fire. Thus, staffing is frequently done by transferring existing staff between facilities, including DHs, health centers, and community-based health planning and ser- vices compounds (CHPS). Transfers can take place be- tween facilities within the same district (intra-district), between facilities in different districts within the same region (inter-district), or between facilities in different regions (inter-regional). Transfers can be initiated by health administrators in charge or by health workers.
Since the last inspection the provider had created a pre-retirement group for five residents operated from one of the houses that comprised this designated centre. Staff reported that the programme was well organised and benefited four of the five residents that attended. However, staff also reported that the programme was not suited to the needs of one resident; staff reported negative impacts including reduced opportunity for community access, reduced social engagement, and a further deterioration in an already compromised dietary pattern. These reported impacts were reflected in records seen including the records maintained by the programme co-ordinator, (there was a
Compared to acute hospitals, many of which traditionally used some sort of computerized systems to manage or de- liver patient care, mental health settings in England at the time of this study typically lacked any ‘joined up’ electronic information system. It has been suggested that there is ‘an intrinsic lack of interest in information systems among many staff in mental health’ . It is therefore perhaps unsurprising that computerized patient administration sys- tem (PAS) consisting of basic patient demographics, with little or no clinical functionality, had hitherto been the dominant form of electronic records in mental health settings. The organization of mental health Trusts (the administrative unit in England, which can include one or more hospital or clinic) involves a close working re- lationship with primary care and social services to manage a range of often complex cases involving sev- eral stakeholders. Episodes of care in mental health hospitals typically last longer than in acute settings, on occasions up to several years. Record keeping is also very different from the approach used in the acute sec- tors as the notes tend in mental health settings to be more narrative in nature. Paper record systems were the standard method of record keeping in mental health settings, these offering the advantages of being self-contained, (manually) transferable between clinical locations and well suited to narrative-based recording of clinical entries . Consultations also tend to last longer (about an hour) and consequently notes tend to be very long:
The relationship of general and subspecialist radiologists in Europe is complex and very diverse regarding the number of radiologists and organisational issues between countries and hospitals. The largest academic departments in many small central European countries have a maximum number of 35 radiologists and most hospitals have departments with only 10–15 practising radiologists. The academic hospitals in large, highly developed European countries have a much higher number of radiologists and can organise subspecialist radiol- ogy services much more easily. The added value of the mod- ern radiologist to the patient is primarily to communicate with clinicians and advise on imaging, to relate images and reporting, and to safeguard quality and patient safety. Clini- cians have become subspecialised, with an increasing amount of knowledge about an often small part of medicine, and the only way for radiologists to assert their role in such an envi- ronment is to be clinical partners, with equal knowledge about a medical subspecialty and to take an active part in clinical decision-making. Thus, a clinical model is advocated where radiologists should communicate on image interpretation, not only by report/PACS but also in multidisciplinary team and direct patient discussions.
with community stakeholders. Further, it described challenges faced by survey respondents including (1) a lack of dedicated staffing and resources; (2) a lack of sub-county data on health needs; (3) obstacles to coordination with local public health agencies; (4) competition and turf issues among community stakeholders; and (5) a lack of internal policies and procedures that encourage quality improvement and foster increased accountability. These insights gave rise to a set of recommendations to encourage not-for-profit hospitals to learn from the selected best practice initiatives and to increase coordination between hospitals and local public health agencies. On the broader policy level, this report also called for the need to identify a uniform definition and measures for community benefits or charity care and to increase public health understanding about community benefit planning and implementation. Given the qualitative and documentary nature of the study, it is not appropriate to draw any statistical inferences about the impact of the community benefit law from the study findings. In addition, the cross-sectional design of the study did not allow for the examination of time effect on the status of community benefits in California. In other words, the implementation of community benefit law could only be viewed as one of the many contextual factors that influenced hospitals’ commitment to community benefits at one point in time. There was no assessment of the changes in types or amount of health programs and activities provided by the respondent hospitals before and after the implementation of the law for a systematic evaluation.
schedule and organise outings in the community to the local garden centre for example. The centre provided a good range of activities including those specifically designed to support residents with dementia or cognitive impairment. The weekly activity schedule included morning and afternoon arrangements for activities such as music, arts and crafts, Sonas and exercise time. Staff were seen to engage creatively with cognitively impaired residents sometimes using specialised equipment such as interactive toy animals to good effect. The centre had two pet cats that were clearly popular and provided a positive focus for a number of residents. Residents could access secure outside space including a garden balcony on the first floor laid out with tables, seating and equipped with a barbecue and a seating area downstairs adjacent to the donkey paddock and chicken run. On the days of inspection a range of activities were observed including group sessions of music and dancing and also individualised one-to-one sessions. There was a regular hairdressing service with a well equipped salon available and seen to be used by residents in the course of the inspection.
After the hospital’s community is identified, a decision should be made to clarify the community’s geographic boundaries. The geographic boundaries of a community can be expressed in a variety of levels, including census tracts, zip codes, neighborhoods, municipal areas (eg, cities, villages, townships), counties, multicounty regions, or other similar geographic subdivisions. Each level of geographic subdivision has different advantages and disadvantages for a CHNA. Lower-level geographic subdivisions, such as census tracts or neighborhoods, can more precisely define a hospital’s community, but health data at those levels are usually unavailable. Higher-level geographic subdivisions, such as counties and multicounty regions, usually have more readily available information, but they can mask variations within the geographic subdivision. Unless the hospital has access to representative data across the entire community (not just from their own electronic medical records, which only include their patients), hospitals should consider expressing the community’s geographic boundaries at the county level, since epidemiologic data is most available at that level.
The acute hospital network and greater Dublin community hospital network continued to hold regular meetings during the year. In October we hosted a multidisciplinary workshop for staff working in maternity and neonatal settings around Ireland, co-sponsored by the Coombe Women and Infants University Hospital, the National Maternity Hospital, Holles Street and the Rotunda Hospital. We also launched our ‘Competence and Compassion. End-of-Life Care Map’ in April. The resource was developed in consultation with the HSE’s Palliative Care Clinical Care Programme and provides practical advice and prompts along the end-of-life journey.
Killarney nursing home is two storey premises comprising 56 beds, of which 52 are single bedrooms and two are twin-bedded. The centre had suffered some damage caused by the dislodged roof of an adjacent building during a storm resulting in the temporary evacuation of the residents, however, all repair work had been completed prior to this inspection and all residents had returned to the centre.