This report set out the findings of a follow inspection of St Joseph’s Unit, in ListowelCommunityHospital by the Health Information and Quality Authority (HIQA or the Authority). The hospital was a single storey premises, consisting of two units, St Joseph’s and the District. St Joseph's Unit was the designated section of the premises which was due for re registration. It was situated approximately one kilometre from the centre of Listowel town with car parking facilities at the front of the building. Long term residential, respite and palliative care was provided in St Joseph’s unit for 24 residents. Care was provided primarily for older adults. The centre also provided care for two younger residents with disabilities.
Residents spoke with inspectors about various outings with relatives and staff. Since the previous inspection an activities coordinator had been employed and residents had opportunities to participate in meaningful activities informed by their interests. These activities included card playing, art work, singing, reading and chair based activities. In addition, residents had been facilitated to attend Listowel races and to a nearby farm centre where hens were kept. The activities coordinator informed inspectors that these visits formed part of a reminiscence session as residents reflected on their past lives and experiences when they returned to the centre. Local school students and Fetac Level 5 students were present in the centre on the day of inspection. Residents informed inspectors that they benefitted from the company and conversation with the students, who discussed local events with them. Students were seen to facilitate some activities and were supervised by the CNM2 and the activities co-ordinator.
Sepsis is one of the major cause of morbidity and mortality from infants to adults. It is most important to determine the infected bacterial species found in bloodstream and its antibiotic susceptibility pattern for appropriate treatment. Overall fifteen hundred patients’ data were incorporated into our study, collected from Sanjiban Hospital, Howrah, West Bengal, India. Out of 1500 samples, 190 neonates and 250 adults were positive for bacterial sepsis. The strains expressing extended-spectrum β-lactamases are major threat as therapeutic options are limited. Among the isolates, Gram-positive bacteria were predominated (53.36 %) over Gram-negative bacteria (46.64 %) and Staphylococcus aureus was the most frequent isolate (37.6 %) followed by Pseudomonas aeruginosa (16 %), Escherichia coli (13.60 %), Klebsiella sp. (12.8 %), coagulase- negative Staphylococci (12.4 %), Acinetobacter sp. (4 %) and Enterococci sp. (2.8 %). Levofloxacin was revealed to be more active against all the Gram-negative isolates along with carbapenems, aminoglycosides (except Klebsiella sp.) and polymyxin-resistant strains. Levofloxacin gave superior coverage against both Gram-positive and Gram-negativebacteria whereas most of the penicillins and cephalosporins were found to be ineffective against both Gram-positive and Gram-negative isolates.
Model 1: PEM Faculty in a CommunityHospital ED The north quadrant of the metro area consists pri- marily of working-class populations served mostly by family practitioners and several pediatricians. We began a partnership with a local hospital in 1986, when moonlighting TCH physicians were provided to see pediatric ED patients during peak after-hours. This evolved into coverage by full-time, salaried TCH general pediatricians and, for a time (1987– 1990), included inpatient coverage. Inpatient cover- age was abandoned when it became evident that revenues could not meet expenses because of a low census in the inpatient pediatric unit. However, we continued to provide after-hours care in the ED. In 1994 a competing program was established at a nearby hospital, and our volumes began to decline. In 1996, we began staffing the site with PEM faculty from the TCH ED.
A Study on Community Acquired Pneumonia in Adults Requiring Hospital Admission In Penang ORIGINAL ARTICLE A Study on Community Acquired Pneumonia in Adults Requiring Hospital Admission in Penang L N H[.]
FNAC has inherent limitations related to inadequate sampling, reportedly from 10% to 31% [22-24]. Speci- men procurement may be affected by the level of opera- tor experience, accuracy of localization of the lesion and the needle, method of guidance (palpation or US), num- ber of aspirations, needle gauge, sampling technique, capability for immediate on-site cytologic analysis, and many other factors. Unsatisfactory specimen may be due to cystic fluid, bloody smears or poor technique in ob- taining the sample and/or preparing the slides. The Pa- panicolaou Society of Cytopathology task force on Stan- dards of Practice recommends that aspirators who per- sistently produce a high rate of unsatisfactory aspirates (>15%) should be identified and given remedial training. To develop and maintain the necessary level of staff ex- pertise in an institution, the number of staff members who perform aspiration biopsies and the interpreting cy- topathologists should be kept small. Each staff member who performs aspiration biopsies must complete at least 1 - 5 such procedures per month . Criteria of speci- men adequacy are: 1) aminimum of five or six groups of well-preserved cells, with each group containing ap- proximately 10 - 15 cells; 2) six clusters of benign cells on at least two slides prepared from separate FNA biopsy samples; 3) 10 clusters of follicular cells, with each clus- ter containing at least 20 cells. Adherence to rigid criteria leads to higher nondiagnostic rates and lower false-nega- tive rates; and high nondiagnostic rates exacerbate pa- tient anxieties and lead to the performance of unneces- sary repeat aspiration and unnecessary surgical excision, thereby reducing the overall efficiency and cost-effec- tiveness of the FNA biopsy procedure . In our study, Inconclusive specimens were higher in community hos- pital for both free hand FNAC (29% vs. 15%) and US FNAC (10% vs. 6.25%).
confirmed that relatives and residents were content with care in the centre. The centre had employed an activities coordinator who provided a wide variety of social and recreational activities which were designed to suit individual resident's needs. Community involvement was encouraged in the centre. Relatives and friends of residents were seen visiting during the day. Those who were spoken with by inspectors stated that they were always welcomed by staff and were complimentary of how residents were cared for. Overall there was a good standard of person- centred care in the centre. Inspectors reviewed a large number of HIQA questionnaires which had been sent out to residents and relatives prior to the inspection.
There was evidence of access to a multidisciplinary service for residents. The nurse manager informed inspectors that referrals to consultants in a nearby hospital were arranged when required. A chiropodist visited regularly. Speech and language services and dietician services were available. Training for staff on nutritional supplements, diet consistency and swallowing difficulties was also facilitated by this service and training records were reviewed by inspectors. Inspectors saw evidence in the residents' care plans that there had been referrals and reports from these services for individual residents. The hairdresser attended the centre weekly or as required by residents. However, in the sample of care plans viewed by the inspectors not all were updated as required by legislation or as required by the changing needs of the residents. One at risk resident, who had a body mass index (BMI) of 16, had a malnutrition universal
There was evidence of access to a multidisciplinary service for residents. There was evidence of referrals to consultants in a nearby hospital. A chiropodist visited regularly. Speech and language services and dietician services were available. Training for staff on nutritional supplements, diet consistency and swallowing difficulties was also facilitated by this service. Inspectors saw evidence in the residents' care plans that there had been referrals and reports from these services for individual residents. The hairdresser visited twice weekly or as required and provided a full hairdressing service.
This centre was established in 2004 to provide residential and respite services to persons with a disability in their own community. The centre is open and staffed on a 24 hour full-time basis. A maximum of six residents can be accommodated; five residents live in the centre on a full-time basis and approximately five additional residents currently access the respite service. The model of care is social and the staff team is comprised of social care staff and care assistants led by the person in charge. Nursing advice and support is available from within the providers own resources and staff support residents to access any other required healthcare service. The provider aims to provide a person-centred service and the support provided is informed by the process of individual assessment and consultation with residents and their families. The provider values and promotes community inclusion and supports residents to avail of the services and facilities of the busy local town (including its own day-service) and the surrounding areas. The premises is located on the outskirts of the busy local town a short commute from any required or desired services; transport is provided.
Residents with dementia were supported to maintain their independence. There was an emphasis on promoting health and wellbeing. Residents were encouraged to participate in the social life of the centre. During the inspection a physiotherapist was providing exercise classes to residents. Residents informed inspectors that this was a weekly occurrence. Residents participated in chair-based exercises and individual walking and strengthening exercises with the physiotherapist and staff. The inspector spoke with the physiotherapist who was employed by the nursing home to attend the centre on a weekly basis. On one day of the inspection he had been asked to see 18 residents. Some residents had a private arrangement with him when physiotherapy was required following a hospital stay or for on-going medical issue. He explained that residents with dementia also participated in games such as ball throwing and skittles. He also supplied an individual exercise sheet where appropriate. These exercise sheets were seen in residents' files. Residents informed the inspector that this regular access to
in Ghana. Except for one region (Greater Accra) where it was convenient to collect data from two major referral hospitals (one regional and one tertiary hospital), data was collected from either tertiary teaching or regional hospital which acted as the primary referral hospital in that particular administrative region. In spite of differ- ences in the clinical capacities of the study hospitals on the basis of their status as a tertiary-teaching or regional hospital, these hospitals were chosen because they act as major referral hospitals for other hospitals and health centres in each of the ten administrative regions. Unlike the seven regional hospitals, the tertiary teaching hospi- tals serve as larger referral centres and are better- resourced with diagnostic and therapeutic facilities. They also serve as tertiary academic centres offering training in a range of highly specialised clinical disciplines. As presented in Table 1, the overall hospital bed capacity for admissions in the study sites ranged from 150 to 653 with annual stroke admissions for 2014 within the range of 49 to 1500 stroke cases per hospital.
The inspector reviewed a sample of records for two residents who had recently received end of life care. The records indicated that residents had been medically reviewed by their general medical practitioner on a frequent basis and the nursing care plans and daily nursing notes indicated the residents had also received appropriate nursing care. Upon referral community palliative care services had been made available when required and a multi-disciplinary care approach was clearly evident. The records indicated good communication between all health professionals and the individual residents as well as involvement with the respective relatives.
In part two, all deaths classified as unnatural were dis- cussed by a reference group of six consultants from sur- gery, anaesthesiology and emergency medicine, intensive care, internal medicine, pathology, and the hospital pa- tient safety unit during a one-day meeting. No formal training for this group were done, but we considered it important that this group represented a broad clinical experience since some of these deaths are often ex- tremely difficult to judge in particular with regard to preventability. Consensus about the causes of unnatural deaths was sought. In addition, signs of any adverse event during the hospital stay were discussed and a con- sensus was reached as to whether or not (≥50% likeli- hood) the death could have been prevented. To answer the latter question, a five-point Likert scale was used: 1 was scored as not preventable, 2 as possibly not prevent- able, 3 as uncertain preventability, 4 as possibly prevent- able, and 5 as preventable.