Dissertations / Theses: 'Acute Setting'

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Zalin, Anjali. "Stress hyperglycaemia in the acute care setting." Thesis, Imperial College London, 2015. http://hdl.handle.net/10044/1/29751.

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Introduction: Stress hyperglycaemia (SH), defined as transient hyperglycaemia during illness, is seen in up to 50% of inpatients and may progress to glucose intolerance in a significant proportion. SH is also associated with increased mortality. Despite this, there is no consensus on definition and management. Existing work focuses on single disease groups, frequently reporting adverse outcomes and variable success with therapies. There is, however, a scarcity of work profiling individuals with SH in detail. It is hoped that this approach may contribute to individualised management and improved outcomes for people with the condition. Methods: The central hypotheses of this work focus on metabolic profiling and were examined through a prospective observational study. Participants were allocated into study groups based on glucose levels. A 30-day follow-up was organised for people with SH. Novel biomarkers, tools and a diabetes risk calculator were employed to provide the most detailed profile currently available of individuals with stress hyperglycaemia. Finally, results from the first multicentre trial to bear on the effect of metformin in SH are presented. Results: The prevalence of SH was 34% and 31% in prospective (n=62) and metformin (n=52) studies respectively. People with SH had lower fasting insulin levels and insulin resistance. Otherwise, few differences were found. Metabolic profile, glycaemic variability, and HbA1c values were similar in both groups. Metabolic abnormalities and marked glycaemic excursions were also seen in both groups. Metformin was well tolerated but did not result in significantly reduced glucose variability or levels during the study period. Conclusions: People with SH do not appear to be phenotypically different from people without the condition. Marked hyper- and hypoglycaemia are common in hospital patients despite apparent normal glucose levels. Increased vigilance as well as timely and appropriate interventions could significantly improve outcomes for these individuals.

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Belcher, Justin Miles. "Acute Kidney injury in the Setting of Cirrhosis." Thesis, Yale University, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3663447.

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Acute kidney injury (AKI) is a common complication in patients with cirrhosis and is associated with significant mortality. Despite the overall poor outcomes, there exists hope for such patients as, unlike in the majority of setting of AKI, specific treatments are available which have been shown to improve renal function and mortality. However, historically intransient difficulties in differential diagnosis and prognosis have limited the extent to which such treatments can be appropriately utilized. In addition, though AKI has long been appreciated as a feared complication, the definitions of AKI employed in studies involving patients with cirrhosis have not been standardized, lack sensitivity, and have often been limited to narrow clinical settings. We conducted a multicenter, prospective observational cohort study of patients with cirrhosis and AKI, drawn from multiple hospital wards, utilizing the modern acute kidney injury network (AKIN) definition and assessed the association between AKI severity and progression with in-hospital mortality. Following this we investigated whether early changes in serum cystatin C levels were more closely associated with subsequent outcomes than similarly early changes in serum creatinine. We subsequently assessed whether novel biomarkers of kidney structural injury, measured on the day of fulfilling AKI criteria, can predict progression of AKI and mortality. Finally, we investigated the ability of biomarkers to assist with differential diagnosis and potentially change the way in which causes of AKI in cirrhosis are conceptualized.

192 patients were enrolled and included in the study. In the first phase, 85 (44%) of these were found to progress to a higher AKIN stage after initially fulfilling AKI criteria. Patients achieved a peak severity of AKIN stage 1, 26%, stage 2, 24%, and stage 3, 49%. Progression was significantly more common and peak AKI stage higher in non-survivors than survivors (p < 0.0001). After adjusting for baseline renal function, demographics and critical hospital and cirrhosis-associated variables, progression of AKI was independently associated with mortality (adjusted odds ratio = 3.8, 95% confidence interval (CI) 1.3-11.1). We conclude that AKI, as defined by AKIN criteria, in patients with cirrhosis is frequently progressive and severe and is independently associated with mortality in a stage-dependent fashion.

Unfortunately, accurately predicting which patients will experience the worst outcomes is challenging as serum creatinine correlates poorly with glomerular filtration in patients with cirrhosis and fluctuations may mask progression early in the course of AKI. Cystatin C, a low-molecular-weight cysteine proteinase inhibitor, is a potentially more accurate marker of glomerular filtration. In the second phase of our study we evaluated whether early changes in serum cystatin C would associate more strongly with a composite endpoint of dialysis or mortality than early changes in creatinine. Of 106 patients studied with at least 2 blood samples, 37 (35%) met the endpoint. Cystatin demonstrated less variability between samples than creatinine. Patients were stratified into four groups reflecting changes in creatinine and cystatin: both unchanged or decreased 38 (36%) (Scr-/CysC-); only cystatin increased 25 (24%) (Scr-/CysC+); only creatinine increased 15 (14%) (Scr+/CysC-); and both increased 28 (26%) (Scr+/CysC+). With Scr-/CysC- as the reference, in both instances where cystatin rose, Scr-/CysC+ and Scr+/CysC+, the primary outcome was significantly more frequent in multivariate analysis, P = 0.02 and 0.03, respectively. However, when only creatinine rose, outcomes were similar to the reference group. We therefore concluded that changes in cystatin levels early in AKI are more closely associated with eventual dialysis or mortality than creatinine and may allow more rapid identification of patients at risk for adverse outcomes.

The next aspect of the study evaluated urinary biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), IL-18, kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP), albuminuria and the fractional excretion of sodium (FENa) as predictors of AKI progression and in-hospital mortality. Of 188 patients with available urine samples, 44 (23%) experienced AKI progression alone and 39 (21%) suffered both progression and death during their hospitalization. NGAL, IL-18, KIM-1, L-FABP and albuminuria were significantly higher in patients with AKI progression and death. These biomarkers were independently associated with this outcome after adjusting for key clinical variables including model of end stage liver disease score, IL-18 (relative risk [RR], 4.09; 95% CI, 1.56 to 10.70), KIM-1 (RR, 3.13; 95% CI, 1.20 to 8.17), L-FABP (RR, 3.43; 95% CI, 1.54 to 7.64), and albuminuria (RR, 2.07; 95% CI, 1.05-4.10) per log change. No biomarkers were independently associated with progression without mortality. FENa demonstrated no association with worsening of AKI. When added to a robust clinical model, only IL-18 independently improved risk stratification on a net reclassification index. This phase of the study demonstrated that multiple structural biomarkers of kidney injury, but not FENa, are independently associated with progression of AKI and mortality in patients with cirrhosis. However, injury marker levels were similar between those without progression and those with progression alone.

Knowledge of which patients are at the highest risk of adverse outcomes may allow for earlier targeting of treatments but only if clinicians can may objective, accurate diagnoses as to the cause of AKI. The most common etiologies of AKI in this cirrhosis are prerenal azotemia (PRA), acute tubular necrosis (ATN) and hepatorenal syndrome (HRS). However, establishing an accurate differential diagnosis is extremely challenging. Urinary biomarkers of kidney injury distinguish structural from functional causes of AKI and we hypothesized that they may facilitate more accurate and rapid diagnoses. In the next phase of our study we therefore assessed multiple biomarkers for differential diagnosis in clinically adjudicated AKI. Patients (n = 36) whose creatinine returned to within 25% of their baseline within 48 hours were diagnosed with PRA. In addition, 76 patients with progressive AKI were diagnosed by way of blinded retrospective adjudication. Of these progressors, 39 (53%) patients were diagnosed with ATN, 19 (26%) with PRA, and 16 (22%) with HRS. Median values for neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (L-FABP), and albumin differed between etiologies and were significantly higher in patients adjudicated with ATN. The fractional excretion of sodium (FENa) was lowest in patients with HRS, 0.10%, but did not differ between those with PRA, 0.27%, or ATN, 0.31%, P = 0.54. The likelihood of being diagnosed with ATN increased step-wise with the number of biomarkers above optimal diagnostic cutoffs. From these results we concluded that urinary biomarkers of kidney injury are in fact elevated in patients with cirrhosis and AKI due to ATN and that incorporating biomarkers into clinical decision making has the potential to more accurately guide treatment by establishing which patients have structural injury underlying their AKI.

Unfortunately, despite these promising results, it is likely that, as long as the focus is on assigning patients one of three distinct diagnoses, there will always be overlap in biomarkers values between groups such that, on the individual rather than population level, their utility will not be fully optimized. In the final phase of our study we evaluated a diagnostic algorithm utilizing optimal cutoffs for FENa and NGAL and the current diagnostic categories of PRA, ATN and HRS. In conclusion, we suggest moving beyond current diagnoses by instead attempting to physiologically phenotype patients using both function (FENa, urinary cystatin C) and structural (NGAL) urinary biomarkers. Figures are presented demonstrating that patients fall into distinct physiologic clusters which may allow more precise targeting of therapies.

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Boye-Doe, Sylvia B. "Improving Fall Prevention Strategies in an Acute-Care Setting." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3337.

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Falls with or without injuries among the elderly have become a public health concern, with falls among adults age 65 years and older increasing every year. Nurses play a role in ensuring patient safety by following fall prevention guidelines. The purpose of this evidence-based study was to implement the RE-AIM evaluation tool to determine the impact of the Safe Five program on staff compliance with the program; patients' awareness of the need for falls prevention; and falls among older adults, ages 65 years and older, admitted to an acute care nursing unit. The literature supports implementing a falls prevention program with multifactorial and interdisciplinary components, and an evaluation plan to help decrease falls in acute care settings. The Safe Five falls prevention program was implemented on the acute care nursing unit in an effort to decrease the inpatient falls rate on the unit. The inpatient falls data were collected retrospectively, 2 years pre implementation of the Safe Five program, and 8 to 10 months post implementation. Data were collected from the Safe Five checklists, recorded inpatient fall rates, and high fall risk chart audits provided by staff and nurse manager; they were then analyzed using the RE-AIM evaluation tool. The long-term effects of the Safe Five program include an 18% increase in patients' awareness of the importance of preventing falls, an 18% increase in staff compliance with the program, and a 14% decrease in inpatient fall rate on the unit. It is projected that the decrease in inpatient falls will result in decreased healthcare costs and improved patient satisfaction with the healthcare system, communication among the interdisciplinary team, and health outcomes for the patients.

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Philyaw, Charlotte Evette. "Preventing Urinary Tract Infections in the Acute Care Setting." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2574.

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More than 13,000 deaths and $340 million in health care costs are the result of catheter-associated urinary tract infections (CAUTIs) annually in the United States. CAUTIs can also result in acute patient discomfort and potentially preventable exposure to antibiotics. The hospital for which this quality improvement project was developed was above the National Healthcare Safety Network CAUTI bench mark. Framed within the Iowa model of evidence-based practice, a multidisciplinary team of 8 hospital stakeholders guided the project (n=8). The purpose of the project was to develop an indwelling urinary catheter maintenance checklist using evidence-based practice guidelines related to preexisting inappropriate risk factors for catheterization and appropriate indications for catheterization, as well as evidence-based maintenance practices for care of the indwelling catheter. Each piece of evidence to be included in the checklist was evaluated by 4 content experts using a 10 item 5 point Likert scale ranging from 'strongly disagree' to 'strongly agree'. Descriptive analysis showed an average of 4.8/5 for all items with 'agree' being voiced in two of the items rather than 'strongly agree'. The checklist was completed and presented to hospital senior leadership who recommended that the checklist be incorporated into the hospital CAUTI prevention plan. All project team members (n=8) completed an 8 item 5 point Likert scale summative evaluation of the purpose, goal, objectives, and my leadership which averaged as 5 or 'strongly agree' supporting the development of the project. Implications for social change include improved patient outcomes, mindful stewardship of healthcare dollars, and increased patient and family satisfaction.

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Pugliese, Michael. "Mobile Tablet-Based Stroke Rehabilitation in the Acute Care Setting." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/37016.

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Introduction: The number of stroke survivors living with post-stroke deficits is increasing worldwide. Although stroke rehabilitation can improve these deficits and promote the recovery of function when initiated early post-stroke, many survivors are not able to access rehabilitation because of a lack of resources. Early mobile tablet-based stroke rehabilitation may be a feasible means of improving access to recovery promoting therapies. Objective: To summarize and advance the knowledge of early mobile tablet-based therapies (MTBTs) for stroke survivors with regards to feasibility and barriers to care. Methods: This thesis is comprised of two major studies. (1) A scoping review summarizing the literature for MTBTs following stroke. (2) A cohort study testing the feasibility of a MTBT for post-stroke communication, cognitive, and fine-motor deficits. Results: (1) Twenty-three studies of MTBTs following stroke were identified. Most of these therapies targeted communication or fine-motor deficits, and involved patients in the chronic stages of stroke. Barriers to care were summarized. (2) A 48% recruitment rate was achieved and therapy was administered a median of four days post-stroke. However, therapy adherence was very low because of frequently encountered barriers to care. Conclusions: Stroke survivors are interested in using tablet technology to assist with their post-stroke recovery. However, early MTBT post-stroke may be challenging for some survivors because of encountered barriers to care. Regular patient-therapist communication using a convenient method of interaction appears necessary to minimize barriers and to help patients overcome barriers when they occur.

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Brown, April Samantha. "Modern matrons in an acute setting : a qualitative case study." Thesis, University of Hertfordshire, 2013. http://hdl.handle.net/2299/12304.

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The arrival of the modern matron into the NHS acute setting in 2001 was in response to increased public and political concern regarding standards of nursing care and the quality of patient care. As a politically motivated initiative, the modern matron role and its relationship with the concept of the traditional matron has been extensively debated. The aims of this study were to explore: 1. How far the modern matron represents continuity between the traditional matrons of the mid 20th century and the present day. 2. What socio-political forces led to the development and establishment of the modern matron? 3. From the perspective of health professionals, what impact has the modern matron had on the quality of patient care? Adopting a case study design underpinned by realistic evaluation, the study involved interviewing patients and a carer, a focus group and interviews with staff and national policy leads. Documentary analysis was undertaken on a set of traditional matron archives. A number of key themes emerged from the research, including: the importance of uniform and visibility, patient expectations, the impact of policy processes and the political rationale for national policy change. Conflict between ensuring nursing quality and operational demands, which acts as a barrier to the modern matron role, was also found. Long-held assumptions about the functions and the positioning of the traditional matron are explored, with continuity and divergence between the traditional and modern matron roles revealed. Using a realistic evaluation approach, the findings were framed whilst considering the structural and generative elements, which resulted in social interplay or visible phenomena and provided an explanation for the predicament of the modern matron. The key conclusions were that national policy decisions appeared to be diluted once locally implemented. Modern matrons in part did positively impact on care quality. The introduction of modern matrons and the quality agenda may have been the start of a national discussion about how to continually improve patient care in an arena where intermittent care quality challenges which give concern. The effect of previous national policies that impacted on senior nurses may have diverted them away from their core purpose – patient care. The modern matron guidance may have been limited before publication by the inference within it about limiting the authority of the new post-holders. There was limited evidence of the modern matrons’ visibility to patients and this was reflected by the traditional matron’s accounts. The expectation of modern matrons’ physical presence may have been drawn from assumptions embedded in nostalgia and media portrayal of the traditional matron. The thesis concludes with implications for strategic nurse leaders and national policy leads to consider how the organisational arrangements for secondary care can best support and secure the ultimate aim of consistent provision of good quality nursing care.

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Lungui, Ilona. "Hand Hygiene and Compliance Rates in an Acute Care Setting." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6454.

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Hospital-acquired infections (HAIs) are a significant problem faced by healthcare organizations globally. The Centers for Disease Control reported that in 2014, 722,000 patients acquired an HAI, and of those, 75,000 died as a result. This project focused on reeducating healthcare staff on hand hygiene practices to prevent HAIs. Preintervention hand hygiene compliance rates were compared to postintervention hand hygiene compliance rates on 2 units in an acute care setting to evaluate if reeducation of healthcare staff on hand hygiene protocols and practices would increase hand hygiene compliance rates. The evidence-based practice model used for this project was Nightingale's environmental theory. The research question for the study examined the effectiveness of hand hygiene reeducation on hand hygiene compliance rates. Participants included 97 nurses and ancillary staff. Hand hygiene compliance rates were compared 1 month before and 1 month after healthcare staff reeducation. Results showed an 18% increase in compliance rates following reeducation. These results might effect positive social change by reinforcing that reeducation has an impact on compliance rates for hand hygiene among nursing and ancillary staff in acute care settings.

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Belcher, Janet Maxine. "Quality Initiative to Reduce Falls in an Acute Care Setting." ScholarWorks, 2020. https://scholarworks.waldenu.edu/dissertations/7599.

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Falls are the most frequently reported incidents among hospitalized patients in the United States with at least 4 falls per 1,000 patient days occurring annually. Falls are related to high rates of mortality and morbidity and high hospital costs. The purpose of this project was to evaluate a fall prevention quality initiative to reduce falls in an acute care facility by educating staff on an evidence-based fall prevention protocol. The project sought to explore whether implementation of an evidence-based fall prevention initiative in educating nurses would affect the nurses’ professional knowledge and the number of patient fall incidences in the cardiac care unit. The theoretical framework supporting this project was Neuman’s systems theory. The Iowa model was used to guide this evidence-based project. An educational session was implemented to increase nurses’ awareness of fall prevention practices. Two sets of data were collected: the pretest and posttest results, and the number of falls on the unit. A total of 21 unit nurses participated in the pretest; 18 (86.0%) completed the posttest. The mean score on the pretest was 81.62%; the mean score was 85.89% for the posttest with a mean difference of 4.27%. A paired sample t-test revealed no statistically significant differences in scores after education. This project has implications for social change by supporting patient safety, decreased hospital stays, and reduced health care expenses to patients and health care organizations.

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Lad, Raina, Nisha Maymana, Trishna Kuber, and Lisa Goldstone. "Second Generation Antipsychotic Prescribing Patterns in an Acute Inpatient Psychiatric Setting." The University of Arizona, 2016. http://hdl.handle.net/10150/613987.

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Class of 2016 Abstract
Objectives: To determine if prescribers took into consideration patients’ metabolic risk factors when prescribing a low, medium or high risk second generation antipsychotic and if non-metabolic risk factors influenced prescribing. Methods: Adults 18 years or older who were admitted to an acute inpatient psychiatry unit and ordered at least one SGA were included in the study. Each patient’s metabolic syndrome risk score was determined using retrospective chart review and they were subsequently divided into low or high-risk groups. Clozapine and olanzapine were categorized as high risk for causing weight gain and diabetes, risperidone and quetiapine were moderate risk, and all others were considered low risk. A chi square test compared the two groups in regard to type of SGA selected, gender, and race, while an independent t-test analyzed the differences in age. Results: 300 patients were analyzed and divided into high (n=57) and low (n=253) risk groups. For the low risk group, 10.7%, 55.1%, and 34.2% were prescribed a low, moderate, or high risk SGA, respectively. For the high-risk group 17.5%, 56.1%, and 26.3% were prescribed a low, moderate, or high risk SGA, respectively. The type of SGA selected was not significantly different between the groups (p=0.262). Equivalence was shown between the two groups in terms of gender and race (p=0.68, p=0.65 respectively). Age was significantly different (p< 0.01). Conclusions: Prescribers may not consider metabolic risk factors when prescribing high risk SGAs such as clozapine and olanzapine.

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Baillie, Lesley. "A case study of patient dignity in an acute hospital setting." Thesis, London South Bank University, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.487082.

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UK healthcare policies emphasise that patients' dignity should be respected. However, studies indicate that hospital patients are vulnerable to a loss of dignity. There is a dearth of research relating to patient dignity generally and little research ~as been undertaken in acute hospital settings specifically. A qualitative case study examined the meaning of patient dignity and how patient, staff and environmental factors affect patients' dignity. The study's setting was a surgical ward, specialising in urology, and ethical approval was obtained. Data were collected from post discharge interviews with patients (n=12); four-hour periods of participant observation (n=12) with follow-up interviews with patients (n=12) and staff (n=13); observation of staff handovers (n=12); interviews with senior nurses (n=6); and examination of Trust documents. Data were analysed using Ritchie and Spencer's (1994) framework approach. A model of patient dignity was presented to portray the definition which developed from the findings: 'Patient dignity is feeling valued and comfortable psychologically with one's physical presentation and behaviour, level of control over the situation, and the behaviour of other people in the environment'. Lack of privacy in hospital threatened dignity, heightened by bodily exposure and a mixed sex environment. A conducive physical environment, a dignity-promoting culture and leadership, and other patients' support promoted patient dignity. Staff being curt, authoritarian and breaching privacy threatened dignity. Staff promoted dignity by providing privacy and interactions which made patients feel comfortable, in control and valued. Patients' impaired health threatened dignity due to loss of function, intimate procedures and psychological impact. Patients promoted their own dignity through their attitudes and developing relationships with staff. A second model was constructed to portray how patients' dignity is threatened or promoted by staff behaviour, the hospital environment and patient factors. The results emphasise that staff behaviour and the hospital environment have an important impact on whether patient dignity is threatened or promoted. However, patient factors can also promote dignity.

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Pompeii, Jo Anna. "Nonpharmacological pain management in pediatric patients in the acute care setting." Honors in the Major Thesis, University of Central Florida, 2009. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1308.

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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.
Bachelors
Nursing
Nursing

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Millward, Louise Maria. "Attitudes towards alcoholics : staff patient relationships in the acute hospital setting." Thesis, King's College London (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251664.

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Steere, Caroline J. "Nurses' management of deliberate self-harm in an acute residential setting." Thesis, University of Hull, 2001. http://hydra.hull.ac.uk/resources/hull:11283.

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The study aimed to address the question of what represents the most therapeutic response when a client self-harms on an acute inpatient mental health unit. The null hypothesis was that nurse response type would have no bearing on how long it was before a client went on to self-harm again. Pilot studies and qualitative analysis led to the development of questionnaires which sought to measure nurse-client interactions across four dimensions: 1) The content of what the nurse said to the client; 2) The length of time the nurse spent with the client; 3) The emotional tone of the response; and 4) The strength of emotion expressed by the nurse. The participants were 19 inpatients and 29 nurses who described incidents of self-harm. Nurses and clients completed questionnaires describing the nurse's response type the first time that a client self-harmed during a new admission. Most of the statistical analyses supported the null hypothesis that nurse response type has no bearing on how long it is before a client engages in self-harm again. There was no evidence that the content, duration or emotional tone of a nurse's response had any bearing on how long it was before the client self-harmed again. The only statistically significant finding was that nurses perceiving themselves to be more strongly emotional was correlated with a longer delay before self-harm was repeated. A finding not directly related to the hypotheses was that nurses and clients perceived behaviour differently. There was poor agreement in terms of their perceptions of the number of minutes that an interaction lasted, how strongly emotional the nurse was, and the severity of the clients' self-harm. The implications of these findings are discussed, together with suggestions for future research.

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Dee, Joan Frances Melville. "What factors assist clinicians to determine dying in an acute setting?" Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:e46c888c-4ae7-48ed-90a4-33ac26a5d96a.

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Background: The End of Life Care Strategy stated that there should be a reduction of expected deaths in the acute setting. In order to achieve this goal, when it has been identified that where the patient's preferred place of care is home, clinicians need to be able to recognise when a patient is dying in order to achieve their preferred place of death. The aims of this study were to identify any factors that help or hinder a clinician when they are determining when irreversible dying begins and to seek consensus on which of these topics would be useful to include in an education programme. Method: A 3 stage mixed methods study was developed. Phase 1was a Systematic Review of current primary research in order to provide an evidence base for the study. Phase 2 involved unstructured interviews with clinicians in the acute setting utilising the Grounded Theory approach to the analysis identify potential factors. Phase 3 was a Delphi study used to identify which of these factors would be useful in an education programme. Conclusions: The Systematic Review identified four themes "Patient Observation", "Knowledge of the Patient", "Communication" and "Attitudes of the Clinician". These were confirmed by the interviews and a further theme "Experience" identified. The over-arching theme emerging from the findings of the interviews was that clinicians have a fear of getting the timing of the recognition of irreversible dying wrong because the decision making process is so complex and this is exacerbated by fear of missing the treatable. Many factors identified in the interviews were acknowledged as factors that could be included in an education package. It was also identified that there is the need for a culture shift in society regarding death and dying and a change in the philosophy of care for health care professionals.

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Labiche, Eppie Ann. "Venous Thromboembolism Prevention Education for Practitioners in the Acute Care Setting." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6597.

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During the last several decades, venous thromboembolism (VTE) has been identified as a preventable health condition. The gaps in clinical practice have led to an increased incidence of VTE. The lack of using existing evidence-based VTE prevention guidelines in practice has limited the implementation of VTE risk assessment stratifications and affected the appropriateness and timeliness of addressing pharmacologic and mechanical prophylaxis. The purpose of the scholarly project was to educate practitioners on existing VTE prevention practice guidelines. The practice-focused question explored whether an educational learning activity on evidence-based VTE prevention guidelines improved the awareness, knowledge, and compliance with existing evidence-based VTE guidelines of practitioners that assess and treat patients at risk for VTE. The theoretical framework for the project was Lewin's change process theory. A total of 38 participants comprised registered nurses (82%), physicians (5%), nurse practitioners (2%), and nonclinical personnel (11%). A program evaluation was provided to determine the effectiveness of the project. The findings showed that practitioners participated in the learning activity to improve knowledge (48%), increase VTE awareness (43%), and would change the management and treatment of patients at risk for VTE (39%). Hospitalized patients at risk for VTE can benefit from the results of this project through a change in clinical practice that might decrease the incidence of VTE and potentially bring about social change by reducing the number of preventable deaths.

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Wright, Marshanell. "Decreasing Catheter-Associated Urinary Tract Infections in the Acute Care Setting." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6707.

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The most important risk factor for developing a catheter-associated urinary tract infection (CAUTI) is the prolonged use of the urinary catheter. To address the CAUTI rate at the project site, which was higher than the national benchmark, a team of healthcare practice leaders developed an evidence-based algorithm addressing the appropriate indications for inserting or discontinuing a patient's Foley catheter. Using the plan-do-study-act model, the purpose of this quality improvement evaluation project was to evaluate the effectiveness of the evidence-based Foley algorithm for decreasing the use of Foley catheters and reducing the CAUTI rate and to explore whether using the Foley algorithm shift assessment tool would reduce the incidence of Foley catheter utilization. Data were compared on the rate of CAUTI and Foley catheter use over 4 months before and 4 months after implementation of the algorithm. There was a statistically significant decrease in the Foley utilization rate after implementing the Foley algorithm; the overall CAUTI rate did not decrease. The outcome of this quality improvement evaluation project could produce social change by highlighting the need for consistent application of the algorithm. In addition, reducing the rate of Foley catheter usage could decrease the incidence of CAUTIs, reduce hospital costs, and improve overall patient health during hospitalization.

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Bentley, Mary Charity. "How clinical psychologists experience working in an acute mental health inpatient setting." Thesis, University of Hertfordshire, 2014. http://hdl.handle.net/2299/14328.

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The focus of this study was to explore how Clinical Psychologists narrate their experience of working on acute adult inpatient units. Mental health services in the UK are poorly resourced with treatments dominated by medical model perspectives. This model can conflict with the psychological and social models Clinical Psychologists are trained in. The aims of this study were to explore the experience of Clinical Psychologists working in acute adult inpatient units and, through this, develop insight into how the core values for improving inpatient care could be maintained. This study was guided by Social Constructionist principles. It required a critical stance to be applied on the current system with an understanding that knowledge is co-constructed between and within relationships. Eight individual semi-structured interviews with Clinical Psychologists who work on adult acute inpatient units were conducted and explored using Narrative Analysis. Four dominant narratives were found. These were; ‘You can’t beat the system’, ‘I am screaming’, ‘Connecting with humanity’ and ‘Someone is screaming’. These narratives related to the Clinical Psychologists themselves in conjunction with the system they were working in which included staff, patients, myself as the interviewer and society in general with the understanding that the interviews were co-constructed and represented multiple voices. This research confirmed that cuts and lack of resources to NHS services have created a massive strain on the system. The Clinical Psychologists working in this system are attempting to understand and support individuals in acute distress; however, they appear to be doing this in isolation which puts them in danger of burn out. It would seem the system is organised against thinking and feeling, affecting both staff and patients, and leaving their experiences unheard and invalidated. The people who are admitted to wards are likely to have had abusive and invalidating earlier experiences. Wards need to be a safe place where they can have time to express themselves, process this and experience validation. The opposite seems to be happening, thus, potentially perpetuating their experience of abuse and neglect. Compassion is a Government directive, yet it takes time and space and, thus, is not cost-efficient. To achieve a system, where people who are vulnerable can express their distress and feel heard, provision of ongoing support and resources is required. Further research could explore the experience of staff who work on inpatient units, for instance health care assistants, nurses, psychiatrists and managers in order to provide further insight into the system that is currently in place and help to develop ways to improve it. It would also give voice to professions that did not have a voice in this research. Experiences of Clinical Psychologists on inpatient units where the medical model is not dominant could also be explored, for instance, where the Open Dialogue approach is dominant. Comparisons between the different approaches could then be explored.

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HAN, JIN HO. "ACUTE CORONARY SYNDROMES AND THE ELDERLY PATIENT IN THE EMERGENCY DEPARTMENT SETTING." University of Cincinnati / OhioLINK, 2007. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1172692247.

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Reed, Alexander. "Social network meetings in an acute psychiatric setting : a practitioner research enquiry." Thesis, Northumbria University, 2004. http://nrl.northumbria.ac.uk/39/.

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Examination of the literature suggests that relationships between psychiatric staff and the families of service-users are often characterized as unsatisfactory, and that psychiatric hospitals provide an unconducive environment for the implementation of family and network-orientated approaches. This research focused upon the development in an adult psychiatric admissions unit of family- staff network meetings, that occurred when a person entered hospital. These network meetings, or 'reception meetings', were strongly influenced by the Finnish social network approach (Seikkula, Alakare & Aaltonen 2001), which focuses upon the creation of open dialogue between the service-user, family members and professionals. An overall aim of the study was to generate a body of practice-based narrative accounts which might act as a catalyst to practice developments in this field. Drawing upon a postmodern methodological framework, a range of methods were employed to engage with the multiple voices of service-users, family members and staff in the research site. Data sources included semi-structured interviews, participant observation, secondary data, and material from a research diary that was maintained as a reflexive tool in relation to the practitioner research process. A 'voice-centred relational method' (Brown and Gilligan 1992) provided a heuristic device for guiding data interpretation which facilitated multiple readings from different perspectives. A subsequent stage of data-analysis entailed developing more general connecting themes from across the data-set. A number of themes are developed in the research, which principally relate to the tensions associated with the introduction of a relationally orientated, reflective approach to practice within an individually-based medico-psychiatric organizational context. Practice approaches are discussed which appeared to facilitate an ethos of 'safe uncertainty' (Mason 1993) within network meetings, which is a necessary condition for dialogue. Connections are also drawn between themes generated in this study and the broader contexts of government policy, professional and organizational development, and practice-based research.

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Field, Thomas A. "Implementing Dialectical Behavior Therapy for Adolescents in an Acute Inpatient Psychiatric Setting." Thesis, James Madison University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3620455.

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Although evidence-based practices (EBPs) have been identified in the literature, insufficient information exists about how to successfully implement them. As a result, implementation efforts have been met with failures. Little is currently known about what affects the success of implementation efforts for best practices such as Dialectical Behavior Therapy for adolescents (DBT-A) in an acute inpatient psychiatric setting (AIPS). A longitudinal multiphase mixed methods case study examined an implementation effort to provide DBT-A in an AIPS over a 24-month period. The process of implementation was investigated through in-depth interviews, a focus group, and field observations. Six categories were identified that affected the DBT-A implementation in an AIPS: appeal of DBT as a treatment modality, impact on patients, implementer characteristics, the implementation process, organizational dynamics and structure, and staff support. Implications for implementing EBPs within organizational environments are discussed. This study represents the first attempt to use qualitative and mixed methodology to examine the process of DBT implementation in an AIPS.

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Donaghay-Spire, Eloise G. "An exploration of psychological interventions in the acute inpatient mental health setting." Thesis, Canterbury Christ Church University, 2014. http://create.canterbury.ac.uk/12867/.

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Literature suggests that individuals experiencing acute mental health difficulties can benefit from psychological input, with calls to increase psychological provision in inpatient mental health settings in the United Kingdom (UK). Despite this, there is limited research to support this demand, which may in part be due to inherent difficulties in conducting research in this setting. Using an interview design and narrative analysis, this paper explored staff members’ and service-users’ experiences of inpatient psychological interventions in National Health Service (NHS) inpatient mental health settings. Evidence was found to support the use of direct, indirect and strategic interventions for individuals, groups, families and staff teams. Formulation and the therapeutic relationship were conceptualised as common features of such input. Connections between inpatient psychology and change within the stories suggested that interventions can help people make sense of a crisis, improve relationships and contribute to meaningful recovery. Barriers were also presented, suggesting that psychological input in this setting might not be right for everybody. This paper demonstrates that psychological input in the acute inpatient mental health setting is perceived as meaningful and can lead to changes. There is also a sense that this provision can be challenging, highlighting the need for further research.

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Kelly, Lesly Ann. "Nursing Surveillance in the Acute Care Setting: Latent Variable Development and Analysis." Diss., The University of Arizona, 2009. http://hdl.handle.net/10150/193636.

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The nursing profession has utilized a variety of terms to describe the work that nurses do, such as observing, monitoring, and critical thinking. Nursing surveillance is a term emerging in the research and clinical environment to describe the care, both seen and unseen, by professional registered nurses. It has been described as a complex, multi-dimensional concept that influences patient outcomes, yet little research has been done to examine the concept, how it is measured, and its role in outcomes.The surveillance process includes ongoing data collection, interpretation, and synthesis for decision making. This research proposes that nursing surveillance is comprised of five dimensions: actions, expertise, early recognition, intuition, and decision making. The purpose of this study is to examine the dimensions of nursing surveillance in the acute care setting.This study used a descriptive design to survey nurses on the dimensions of nursing surveillance. The survey consisted of four existing instruments measuring expertise, early recognition, intuition, and decision making, and one new instrument measuring activities associated with nursing surveillance. A content review panel was used to develop the new Nursing Surveillance Activities Scale. A sample of 158 medical-surgical nurses participated in completing the full Nursing Surveillance Survey.The goal of the analysis was to determine how well the dimensions represented the surveillance variable; however, based on sample size, revisions to the methods were made. Factor analysis was used to analyze each instrument's items and total representation of the variable. The instruments performed adequately in psychometric testing, and modifications were made so composite development could be achieved. The dimensions were factored as a composite variable and four of the five dimensions loaded onto a single variable, while the activities dimensions loaded separately. These results can be explained through a theoretical difference between the dimensions or limitations with the newly created Nursing Surveillance Activities Scale.This study identified a relationship between the four cognitive dimensions of nursing surveillance and their representation of the variable. Future research in nursing surveillance should analyze the role of the nursing surveillance variable, including the relationship to nursing outcomes.

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Ross, Helen. "Understanding and achieving person-centred care in an acute medical ward setting." Thesis, Sheffield Hallam University, 2015. http://shura.shu.ac.uk/20799/.

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Person-centred care is a concept often referred to in healthcare. However, it is unclear how it applies to everyday clinical practice. This qualitative study aimed to explore how the concept was understood and achieved in an acute medical ward setting in order to identify potential areas for development related to research, education and practice. The research design was influenced by an interpretive approach with the aim of accessing the meanings that participants assigned to the phenomenon of person-centred care and making this evident to others. A purposive sampling strategy identified 21 participants. These consisted of seven registered nurses, four student nurses, three healthcare support workers, three allied health professionals, two professional development co-ordinators and two nursing lecturers, who all took part in either individual or paired semi-structured interviews. Gathering data from this range of practitioners adds new perspectives to the body of knowledge on person-centred care. Data were analysed using Framework Analysis, which resulted in a model of person-centred care being developed iteratively as a result of data analysis, a priori knowledge of the researcher and the findings of the literature review. The study findings emphasise that all elements of the model; organisational culture, the philosophy of the care environment, characteristics of relationships, personal qualities of staff and principles of person-centred care interlink with each other to indicate what needs to be in place for person-centred care to be achieved. The model also provides a possible structure to inform the planning of future development within education and practice. The study outcomes identify potential areas for development within research, education and practice. These include, working towards a shared vision of person-centred care in the study setting by using work based activities in order to identify ongoing development needs; the testing and evaluation of the use of the model of person-centred care in practice and education and the investigation of the feasibility of conducting a health economic study to explore the cost-benefit of providing person-centred care in acute care settings.

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Patel, Lopa. "Noise Pollution/Reduction Education for Frontline Staff in the Acute Care Setting." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6942.

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Noise levels in hospital settings have risen beyond the recommended range of 35-40 decibels, resulting in poor patient healing outcomes and other health conditions ranging from sleep deprivation, anxiety, agitation, delirium, depression, and high heart rate and blood pressure. These negative patient health experiences are evidenced by poor scores for the Hospital Consumer Assessment of Healthcare Providers and Systems, which are indicators of patients' perceptions of care. This project explored whether an educational activity for 48 direct care staff, who include registered nurses and nursing assistants, in a cardiac unit on the impact of noise pollution on patient healing would increase staff members' knowledge of interventions to reduce noise pollution. The information processing theory guided this project. Eighty-nine percent of the participants strongly agreed that the educational activity was relevant to their practice as health care providers on the cardiac monitored unit. All participants strongly agreed that they would be able to identify when the unit was noisy and when noise was impacting a patient both physiologically and psychologically. Participants indicated that they could implement the suggested behavioral modifications to promote a healing environment. Participants strongly agreed that the speaker was effective in communicating the importance of noise pollution and its impact on patient healing and ways in which to combat the problem (89%), and they were generally satisfied with the learning activity (91%). Reducing noise pollution might create a healing environment for cardiac patients, thus positively impacting patient satisfaction and well-being.

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Ariri, Alex. "HIV Testing Practices and Provider-Identified Barriers in the Acute Care Setting." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3745.

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Despite the Centers for Disease Control and Prevention recommendations to test patients ages 13 to 64 years for HIV at health care settings, routine HIV testing is lacking. As a result, many people are unaware of their HIV seropositive status. The purpose of this quantitative cross-sectional study was to examine relationships between HIV testing and provider type, knowledge, attitudes, and behaviors regarding HIV testing in the acute care setting. The study was informed by social cognitive theory. Using a convenient sampling method, a questionnaire derived from previous surveys (Society of General Internal Medicine and University of Washington) was sent to 600 eligible acute care providers from a suburban Chicago hospital who treated HIV-negative patients ages 13 to 64 years. Completed surveys were received from 88 participants. Chi-square and multiple logistic regression testing showed no significant relationships between HIV testing and provider type (p = .09), age (p = .91), gender (p = .84), experience (p = 1), and race/ethnicity. However, knowledge of HIV testing regulations and positive attitudes about HIV testing were significantly associated with the likelihood of offering an HIV test (p = .026, p = .004 respectively). Results have some clinical importance, but also indicated a lack of routine opt-out HIV testing. Results may be used to promote HIV testing among acute care providers which could reduce HIV-status unawareness in the population.

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Ortiz, Marie Elois. "Educational Interventions to Improve Aggressive Behavior Recognition for an Acute Psychiatric Setting." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4550.

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Nurses working in an acute psychiatric setting within a veterans' administration hospital must maintain a therapeutic milieu by recognizing and managing aggressive behaviors before violence ensues to reduce injuries to staff nurses and patients. The purpose of this project was to develop an evidence-based and theoretically grounded educational program that will help staff nurses manage escalating aggression, violence, and acting out behaviors to provide a safe environment for patients and staff through high risk identifier recognition and intervention training. During the data and information gathering stage, 23 articles were reviewed, rated, and graded to provide the most significant information used to complete the project. The project is a workshop made up of a 6-module curriculum that will be used to train staff nurses. This workshop will be shared with the partnering organization including the recommendation that it is adopted and implemented at a later date. The educational training program will have the potential to become a practice standard for other acute psychiatric settings within the Veterans Integrated Service Network to provide a tool that will assist the nurses as they care for the patient and maintain safety. Social change will occur through the empowerment of nurses who interact with veterans to bring them better and safer care.

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Hudson, Sonia A. "Systematic Literature Review on Fall Prevention in an Acute Care Hospital Setting." ScholarWorks, 2020. https://scholarworks.waldenu.edu/dissertations/7874.

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Falls, with and without injury, in acute care hospitals are quite common but can be prevented if appropriate interventions are in place to address this issue. It is imperative that nurses assess fall risks of all patients admitted to the hospital and advocate for appropriate interventions to prevent falls in those who are found to be at risk. The purpose of this project was to recommend changes to the current fall prevention protocol in the project facility, an acute care hospital, based on best practices identified in a systematic review of the literature. At the time of the project, the hospital had a high rate of falls. The clinical practice question addressed by this project focused on the evidence-based fall prevention interventions that have resulted in a decreased fall rate among patients on medical-surgical units in an acute inpatient hospital setting. This doctoral project was informed by Kolcaba's theory of caring, and the major source of evidence was a systematic review of the literature focusing on fall prevention. Findings indicated that identification of fall risk factors and implementation of multifactorial fall prevention interventions, such as fall prevention teams, unit fall team champions and use of a fall risk scale, can reduce falls on medical surgical units in acute care hospitals. It was recommended that a multidisciplinary fall prevention team be developed in conjunction with unit fall team champions and that a fall risk scale be used to bridge the practice gap. If implemented, these changes may benefit patients, nurses, and the organization as a whole through decreased falls, lengths of stay, and health care costs.

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Cummings, Cynthia L. "The Effect of Moral Distress on Nursing Retention in the Acute Care Setting." UNF Digital Commons, 2009. http://digitalcommons.unf.edu/etd/371.

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This descriptive study explored the relationship between moral distress, professional stress and intent to stay in the hospital setting. The study involved 234 nursing participants and was conducted via an online survey over a 90 day period. The survey tool consisted of 51 items taken from known moral distress, professional stress and intent to stay tools. The items were divided into frequency and intensity of occurrence. Various statistical measures were utilized to conclude that moral distress and professional stress factors were significant (p

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Berghoff, Laurie Swaney. "Nursing Self-Efficacy in the Acute Care Setting with the Neighborhood Staffing Model." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5677.

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Due to changes in health care, along with increasing technological demands, nurse's experiences increased stress. Nurses who are asked to staff another area other than their own have increased stress that can lead to increased nurse turnover, absences, and nursing dissatisfaction scores. The purpose of this quality improvement project was to assess whether limiting what units a nurse works on can reduce nurse stress, improve self-efficacy, and improve nurse job satisfaction. The design of this pilot placed like nursing units within a neighborhood staffing model for floating. The plan-do-check-act model was used as a framework to implement a change in the nurse floating practices. An electronic survey was sent to the nursing team pre and post implementation of the model. Nursing hours will also be tracked during this period of time. Data related to floating after the implementation of the neighborhood staffing model showed a significant increase in floating hours inside (13.1 vs 20.9; t=3.98, p<.001), and there was a significant decrease in hours floated outside the neighborhood (26.3 vs 18.0; t=5.15, p<.000). Self-efficacy results showed an initial decline in the nurses' self-efficacy 4 weeks after the launch and a statistically significant increase over preimplementation levels at 8 weeks (pre 28.46; post 33.51; U=5003, p<.001); on the 3rd administration of the self-efficacy survey, a statistically significant increase was seen (28.5 vs. 33.5; t=12.1, p<.001). Allowing nurses to float to similar nursing areas will result in improved self-efficacy, a precursor to reduced job stress and increased job satisfaction, which represents a positive contribution to social change for the nurses who work in the hospital system.

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Campbell, Jill L. "Incontinence-associated dermatitis in the acute care setting: An exploration of the phenomenon." Thesis, Queensland University of Technology, 2016. https://eprints.qut.edu.au/101514/1/Jill_Campbell_Thesis.pdf.

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Incontinence-associated dermatitis (IAD) is a common, painful and costly threat to skin integrity and quality of life in older hospital patients. Through an exploration of this multidimensional phenomenon, this thesis has advanced understanding of the prevalence of IAD and associated Candida colonisation and infection in the acute care setting. The novel Skin Safety Model integrates the multi-factorial influences of patient, hospital environment and situational stressors, and proposes a re-conceptualisation away from the historical focus on discrete skin injury; pioneering a new framework to guide a unified understanding of maintaining skin integrity that can be applied across the broad range of skin injuries.

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Chow, Yuen-yi, and 周婉儀. "Pre-operative music intervention to reduce patients' pre-operative anxiety in acute care setting." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44623021.

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Lloyd, M. "Exploring the impact and effectiveness of prescribing error feedback in an acute hospital setting." Thesis, University of Liverpool, 2017. http://livrepository.liverpool.ac.uk/3008360/.

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Background: Prescribing errors (PEs) are prevalent and a prominent cause of patient safety incidents. Feedback has the potential to improve prescribing with pharmacists potential facilitators of PE feedback. However, evidence supporting PE feedback in a hospital setting is limited. Aims: The aims of this thesis were to explore the effectiveness and impact of feedback on prescribing, prescribing behaviour, and the feedback participants: prescribers and pharmacists. Methods: A mixed methodology was adopted. Focus groups were used to explore pharmacist experiences of delivering PE feedback prior to the intervention. A pilot study was then undertaken with prescribers on two wards receiving constructive PE feedback, and two wards continuing with existing practice. Prescribing was audited over a five-day period before delivery of PE feedback verbally, and in writing. Prescribing was re-audited after 3-months. A larger controlled study across 16 wards was then repeated. Change in PE rates were compared between groups. Semi-structured interviews were used to explore prescriber’s and pharmacist’s experiences of receiving and delivering feedback and the impact on prescribing behaviour. All interviews and focus groups were analysed thematically using a framework approach. Results: Twenty-four pharmacists were recruited to one of four focus groups. Prior to the intervention, PE feedback was delivered inconsistently. Ward-based pharmacists were considered suitable facilitators of PE feedback, but expressed concern that the process may adversely affect prescriber- pharmacist relationships. Ten and eleven prescribers were included in the pilot intervention and control groups. There was a mean reduction in overall PE rates of 11.5% in the intervention group and an increase of 5.9% in the control group, a significant change in PE rates of 17.4% (p < 0.05) between groups. Thirty-six and forty-one prescribers were included in the intervention, and control groups for the larger cohort study. PE rates reduced by 18.3% in the intervention group and increased by 5.4% in the control group, a significant change in PE rates of 23.7% (p < 0.05) between groups. Eighteen pharmacists and ten prescribers were interviewed to explore their experiences of the intervention. Feedback was valued, considered sustainable, and pharmacist’s credible facilitators. Increased information and feedback-seeking behaviours were noted from prescribers with raised discretionary efforts and prioritisation of prescribing tasks. Feedback is an educational process benefiting both facilitator and recipient. Enhanced rapport was noted with pharmacists also reporting improved self-worth and self-efficacy. Thirty-eight interviews were conducted with twenty-three prescribers to explore the impact of feedback on prescribing behaviour. Feedback is an educational process but benefits extend beyond knowledge-based improvements, with a range of adaptive prescribing behaviours reported. These included more mindful prescribing and engagement with prescribing tasks. Feedback facilitates reflection, increases self-awareness and informs self-regulation of prescribing behaviour. Prescribers reported greater situational and error awareness and improvements in their prescribing. Conclusions: PE feedback is valued, considered sustainable and positively influences prescribing. However, it is a complex intervention with potential benefits extending beyond PE reduction with pharmacists working less in parallel, and more integrated within clinical teams. Feedback supports prescribing practice with changes in prescriber behaviour resonating with non-technical prescribing skills. Feedback can develop the situational-awareness for prescribers to reflect-in-action and adapt their behaviour to the clinical environment. Contextualised inter-professional and non-technical skills training could enhance prescribing education further.

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Haslett, Kirsten, Michael Herman, and David Lee. "Probiotics in the Prevention of Clostridium Difficile Associated Diarrhea in the Acute Care Setting." The University of Arizona, 2014. http://hdl.handle.net/10150/614188.

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Class of 2014 Abstract
Specific Aims: Clostridium difficile associated diarrhea (CDAD) frequently occurs in patients exposed to broad-spectrum antibiotics which can result in a life threatening illness. The role of probiotics in the prevention of CDAD is not well established and many medical centers across the United States are opting to remove probiotics from common CDAD prophylaxis. We aim to evaluate the efficacy of lactobacillus probiotics during the use of broad-spectrum antibiotic therapy in the acute care setting for the prophylaxis of CDAD at Kindred Hospital. Methods: We performed a single center, retrospective data analysis efficacy trial of inpatients receiving beta-lactam, fluoroquinolone or clindamycin antibiotics from the Kindred Hospital database. Two study groups will be compared: patients who received lactobacillus probiotic therapy based on protocol since May 2011 and patients who did not receive probiotic therapy. The presence or absence of CDAD will be used to evaluate probiotic efficacy. Main Results: Of the ### patients screened, ## were assigned to the treatment group and ## were assigned to the non-treatment group, a total of ## patients were analyzed for the primary endpoint. CDAD occurred in ## patients (xx%) receiving probiotic therapy while CDAD occurred in ## patients (xx%) not receiving probiotic therapy (relative risk [RR]: xx.x; p=0.xxx). Conclusion: [Anticipated] We identified no statistically significant evidence that the use of lactobacillus was effective in the prevention of CDAD. Further knowledge of the pathophysiology of CDAD and proper antibiotic use is needed for future studies.

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McCooey, Robyn. "Identifying hospital communication activities for a functional communication measure in the acute hospital setting /." St. Lucia, Qld, 2001. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16508.pdf.

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Bare, LaShonda Leigh. "Factors that most influence job satisfaction among cardiac nurses in an acute care setting." Huntington, WV : [Marshall University Libraries], 2004. http://www.marshall.edu/etd/descript.asp?ref=450.

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Perera, K. Prasadini N. "Impact of Post-Discharge Care Setting Following Inpatient Hospitalization on Hospital Revisits in a Medicare Population." Diss., The University of Arizona, 2013. http://hdl.handle.net/10150/301686.

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Background: In the current policy environment hospital readmissions are receiving considerable attention due to a provision in the Affordable Care Act (2010), that penalize hospitals through reduced payments for excess readmissions (the hospital readmissions reduction program (HRRP)). This program primarily holds hospitals accountable, although a multitude of factors not directly in control of hospitals can be contributory to readmissions. Of these, whether or not patients are discharged to an appropriate post-discharge care setting can be one contributory factor, and, this study evaluated the association between post-discharge care setting and hospital revisits. Methods: A retrospective analysis of the 2008 Medicare Current Beneficiary Survey (MCBS) was conducted. Three post-discharge care settings were evaluated: 1) routine discharge to home; 2) home with home healthcare; and 3) skilled nursing facility. Two outcomes were assessed: 1) 30-day all-cause hospital readmissions; and 2) 30-day all-cause hospital revisits (combination of inpatient admissions and emergency department visits). Analyses were carried out among patients with hospitalizations for any reason, as well as among a subgroup that were hospitalized for one of seven priority conditions identified in the HRRP. Weighted logistic regression analyses that incorporated information on the complex survey design were conducted. Results: Of the MCBS sample representing 46,048,125 Medicare beneficiaries (unweighted N=11,723), 4.9 percent (N= 2,293,629; unweighted N=670) contributed at least one index hospitalization to the analysis. Among hospitalization for any reason, 30-day all-cause hospital readmissions and revisits was 12.3 percent and 17.8 percent, respectively. The subgroup consisted of 31.8 percent of hospitalizations for any reason (N=730,174; unweighted N=216). Readmissions and revisits in the subgroup were 17.8 percent, and 24.5 percent, respectively. Post-discharge care setting was not significantly associated with either readmissions (P=0.966) or revisits (P=0.728) for hospitalizations for any reason. Findings for the subgroup were similar with no significant association between post-discharge care setting with either readmissions (P=0.850) or revisits (P=0.483). Conclusion: Absence of a difference in readmissions and revisits by post-discharge care setting suggests that the choice of discharge status might be appropriate following an inpatient admission. However, further research with larger sample sizes for conditions in the subgroup both together and separately is recommended.

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Wyer, N. "A descriptive phenomenological study exploring patient experiences of parenteral nutrition in an acute healthcare setting." Thesis, Coventry University, 2015. http://curve.coventry.ac.uk/open/items/c08450d3-140e-45ab-a2cf-7539be9e8151/1.

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Introduction: Parenteral nutrition (PN) is the intravenous administration of nutrition, required when the gastrointestinal tract is incapable of adequate nutrient absorption (NICE 2006). PN has higher levels of complications than other routes of feeding (Stewart et al. 2010) and restriction or modification of patients’ oral intake is required to control gastrointestinal symptoms (Culkin, Gabe and Madden 2009). There is a lack of research investigating the experience of patients who require parenteral nutrition (PN) in acute care. Improving patient experiences of healthcare is a national priority following the Mid-Staffordshire Public Inquiry (Francis, 2013). The aim of this study was to explore the patient experiences of receiving PN in the acute healthcare setting. Study Design: Descriptive phenomenology was the chosen methodology. Purposive sampling was used to recruit ten participants who had received PN for >7 days in an acute teaching hospital. In-depth interviews were conducted, which were audio-recorded. The interviews were transcribed verbatim and qualitatively analysed, guided by Colaizzi’s (1978) approach. Results: PN was universally considered positive by participants. It was ‘life saving’ and they felt it unlikely that they would have survived the hospital admission without it. Three core themes and seven subthemes were identified: 1) the altered relationship with food (subthemes: coping with the inability to eat ‘normally’ and loss of control over food-related decision making), 2) relationships with healthcare professionals (subthemes: competency, trust, coping with poor team working), 3) the need for patient centred care (subthemes: being heard, empowering the patient). The participants reported a profoundly altered relationship with food and eating whilst on PN due to the underlying intestinal failure. The organisation of nutritional ii services were described as fragmented due to lack of coordination and poor communication. This resulted in confusion and anxiety for the participants due to the conflicting information provided, and affected their trust and confidence in their care. In addition, healthcare professionals frequently did not operate in a patient centred manner, failing to include patients in decision making regarding their nutritional treatment. This was particularly evident when several clinical teams were involved and when enteral nutrition was introduced. The participants were clear that they wished for their nutritional care to be controlled by the nutrition support team, who they described as experts and because they operated in a more patient centred manner. Conclusion: Patient experiences of PN could be improved by nutrition support teams having greater autonomy regarding the provision of nutritional advice, better coordination and communication of nutritional care and by providing more support to patients on coping with the altered relationship with food.

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Anderson, Valerie Valdez. "The experience of night shift registered nurses in an acute care setting a phenomenological study /." Thesis, Montana State University, 2010. http://etd.lib.montana.edu/etd/2010/anderson/AndersonV0510.pdf.

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The night shift environment in acute care nursing is a unique and poorly understood entity. Retention of experienced nurses on the night shift is vital to the provision of quality care and the nurturing of new nurses. The goal of this phenomenological study was to elicit a description of the lived experience of experienced night shift nurses with the goal of gleaning information that would improve the work environment on the night shift. Five experienced night shift RNs participated in self-directed interviews, responding to the question, "Can you please share your experiences as an RN working the night shift?" The interview data were analyzed using Giorgi's phenomenological method to arrive at a typical and essential structure of the experience. The results revealed negative and positive aspects of working a night shift schedule. Negative aspects of night shift nursing included a feeling of being misunderstood and undervalued professionally and personally. Inadequate resources, on the night shift, was also identified as a barrier to nurse satisfaction, and negatively influencing the provision of quality nursing care and quality orientation of new nurses. Negative physiologic influences of night shift centered around poor quality and quantity of sleep. While these negative influences were consistently presented by all participants, so were the positive aspects of night shift nursing. The participants of this study were strongly invested in the teamwork they experienced within their night shift work environment. Interdependent team spirit was found to have arisen in response to the lack of resources experienced by these nurses. This teamwork, along with the other positive aspects, such as autonomous practice and positive effects on personal time, were seen as incentives for these experienced nurses to continue nursing on the night shift. Nursing administration may be able to utilize the information gleaned from this study to optimize the night shift work environment, and subsequently, increase retention of the experienced nurse. Further research is needed to clarify: the needs of experienced nurses in varying clinical settings, the needs of inexperienced night shift nurses, and the representativeness of the data found in this study to larger numbers of nurses.

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Alfred, Crystal M. "Bullying: The Impact on Intention to Leave of Generational Members in the Acute Healthcare Setting." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1523948285771456.

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Liu, Haiping. "Nurses’ Knowledge about Assessment, Prevention, and Treatment of Skin Tears in the Acute Care Setting." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1575024092388924.

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Gibson, Nicholas P. "The epidemiology of acute asthma managed by ambulance paramedics in the prehospital setting in Western Australia." University of Western Australia. School of Primary, Aboriginal and Rural Health Care, 2007. http://theses.library.uwa.edu.au/adt-WU2007.0142.

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[Truncated abstract] This thesis describes the epidemiology and outcome of acute asthma managed by ambulance paramedics, in the metropolitan area of Perth, Western Australia, for the period of 1990 to 2001. The primary aim of this thesis was to determine demographic, socio-economic and clinical trends for ambulance transported patients with asthma, their outcomes and how they have changed over time. The Perth metropolitan area, located in the south-western corner of Western Australia (WA), accounts for 72% of the state’s population, which was approximately 1.3 million people at Census 2001. This thesis was structured around the analysis of twelve years of St John Ambulance (WA) data. Ambulance data was linked using probabilistic matching techniques to the Western Australian Data Linkage System, custodian of links to thirty five years of morbidity and mortality data of the state’s population . . . Unique geography, a monopolistic ambulance service and access to extensive linked data provided ideal conditions for this population-based epidemiological study of patients with asthma who were transported by ambulance. Observed trends in age and gender characteristics of patients, ambulance codes and temporal variables appear to be consistent over time. Monitoring trends in the use of ventilation procedures recorded in hospital data provided useful indicators for describing the epidemiology of severe, lifethreatening asthma in the prehospital setting. Findings from this study were found to be consistent with published literature.

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Field, Melanie. "The role and clinical utility of acute kidney injury biomarkers in the setting of renal transplantation." Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/6052/.

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Aim: To evaluate the role and utility of acute kidney injury biomarkers in renal transplantation. Method: Analysis of levels of a panel of biomarkers in deceased organ donors correlated to renal graft outcome; ABO incompatible renal transplant recipients correlated to rejection and HLA incompatible renal transplant correlated to rejection. Results: The panel of biomarkers showed comparable ability to creatinine in predicting the outcome of the renal graft following transplant from deceased donors. Of the panel of biomarkers tested to predict rejection, notably NGAL and IP-10 had good ability to predict those HLAi recipients who subsequently developed rejection. Conclusion: Biomarkers previously identified in the context of AKI may have a role in the assessment of deceased organ donor suitability but more promisingly have an excellent ability to identify those patients at risk of rejection following HLAi transplant and would now benefit from evaluation in a wider population prior to adoption in a clinical trial.

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Gibson, Nicholas P. "The epidemiology of acute asthma managed by ambulance paramedics in the prehospital setting in Western Australia /." Connect to this title, 2006. http://theses.library.uwa.edu.au/adt-WU2007.0142.

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Levac, Jody Joseph. "A correlational study of nurse leadership, attitude towards unions, and retention in an acute care setting." Thesis, University of Phoenix, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3578048.

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Short-sighted cost containment strategies and lack of proactive policies in Canadian health care have brought about a national nursing workforce shortage. A shortage in staff creates challenges in terms of access to, quality of, and cost of care for Canadians in a universal health care system. The focus of this quantitative correlational study was to determine the relationship between retention and both nurses’ views of leadership styles and attitudes towards unions in a Canadian acute care setting. The study supports the findings that contingent reward leadership styles and transformational leadership have a positive relationship to retention in a Canadian acute care setting. The study also supports that laissez-faire leadership has a moderately high negative linear relationship to retention. In addition, the study revealed that nurses’ attitudes towards unions have no relationship to retention. The implications of these findings for nursing leadership were also reviewed.

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Crittenden, Joanna Nancy. "Identifying those at risk of depression following a diagnosis of Acute Coronary Syndrome: developing a screening intervention for use in the acute care hospital setting." Thesis, Curtin University, 2013. http://hdl.handle.net/20.500.11937/841.

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Identifying patients at risk of developing depression following a diagnosis of acute coronary syndrome is a new strategy that creates an important opportunity for the provision of early psychological support at a critical phase in a patient’s recovery. The aim of this research programme was to develop a brief depression risk assessment instrument for use by nurses in the clinical setting and test its psychometric properties using a mixed method approach.

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Jones, Craig L. "Neuropsychological symptomatology associated with right and left hemisphere cerebral vascular accidents within an acute care rehabilitation setting." Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/862284.

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The present study investigated the extent to which right and left hemisphere stroke patients, within an acute care rehabilitation unit, differ in neuropsychological symptomatology as reported on a self-report instrument.The subjects were 90 patients admitted to an acute care rehabilitation unit within a midwestern hospital. Two groups of 30 were obtained on the basis of stroke location, either right or left hemisphere. In addition, a group of 30 orthopedic patients were selected to serve as a comparison group.Data was collected using the Neuropsychological Symptom Inventory (Rattan, Dean & Rattan, 1989). A discriminant analysis revealed two discriminant functions which were used to classify group membership. Slightly more than 86% of both left hemisphere stroke patients and orthopedic patients were correctly classified. However, only 46% of right hemisphere stroke patients were accurately predicted. The results clearly support the ability to differentiate the groups and suggest a homogeneous character of the left hemisphere stroke and orthopedic groups. The right hemisphere group appears heterogeneous in make-up. Further statistical analysis revealed no significant difference (a<.05) between stroke groups when examining a factor related to emotional/depression symptoms. However, when stroke patients were compared to orthopedic patients on this factor, a high degree of significance was revealed (p<.001).These results suggest that right hemisphere patients cannot be treated as if they make up a single disorder group within the rehabilitation setting. The use of a self-report measure may prove beneficial with this group is assessing the level of neuropsychological impairment and to make modifications in treatment planning. Additionally, the existence of depression within the stroke group suggest that rehabilitation should focus more on these reactions within the first few weeks post-stroke.
Department of Educational Psychology

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Aquilina, Vanya. "The leadership experience : a qualitative study exploring the perceptions of middle managers in an acute healthcare setting." Thesis, University of Bath, 2017. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.715256.

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Competing tensions are known to be experienced by middle managers in healthcare settings. The increased complexity and higher dynamic nature in acute healthcare contexts increase the demands expected of middle managers. There is limited research focusing on the leadership experience of nurse and allied health middle managers working within acute healthcare contexts. In view of this gap, the aim of this study is to explore the leadership perceptions of nurse and allied health middle managers. Their perceptions of the impact of leadership training and professional development practices are also explored. The Competing Values Framework provides a useful framework for gaining insight into the leadership experience of middle managers. The principal research question is: What is the leadership experience of nurse and allied health middle managers in an acute public general hospital? A qualitative approach using semi-structured interviews was held with nurse and allied health middle managers working within the main acute public general hospital in Malta. Through purposive sampling, 21 middle managers consented to participate in the study. Thematic analysis was conducted identifying codes and themes within the data, from which findings were derived. Findings suggest that nurse and allied health middle managers fulfil contradictory and competing demands within dynamic healthcare contexts, underlining the intense emotions experienced by them, and their struggle to achieve a balance across conflicting situations. Middle managers suggested that they would benefit from communities of practice development approaches and mentoring programmes, to help them cope with workplace demands and the contradictions within their role. A central recommendation of this study is the inclusion of middle managers in planning future leadership training and development programmes. This may be effected through a partnership approach with senior managers and trainers so that training significantly contributes towards enabling optimal performance of middle managers, and the ultimate improvement of patient safety and quality healthcare. This research has implications as to where and how resources for developing middle managers should be invested in acute healthcare contexts.

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Kariuki, Symon Muchiri. "The prevalence, risk factors and behavioural and emotional consequences of acute seizures in a rural Kenyan setting." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:8e0d9861-b39b-49a2-975e-83eed25b45d6.

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The incidence of acute seizures (e.g. both febrile seizures and acute symptomatic seizures) is higher in Africa than elsewhere, but most studies are based on hospital admissions. Acute seizures in children are associated with behavioural/emotional problems which may be related to the seizures, underlying aetiology, neurological impairments and/or genetic predisposition. Behavioural/emotional problems occur in up to 26% of older Kenyan children in the community, but there are no large community-based studies in preschool children in Africa to plan interventions. I screened 7,047 children aged 1-6 years living in Kilifi, Kenya for acute seizures with a proportion of these (N=3,273) examined for behavioural/emotional problems using the Child Behaviour Checklist (CBCL). Factorial structure of the CBCL was examined using structural equation modelling, while associations were determined using several regression analysis techniques. Prevalence of behavioural/emotional problems and acute seizures was computed as a probability of occurrence, by exponentiation of the constant term of a logit model. The CBCL had between good and excellent psychometric properties and the seven-syndrome structure fitted well with the Kenyan preschool children. The prevalence of total behavioural/emotional problems was high (13% (95%CI, 12%-14%)) and so was that for acute seizures (6.1% (95%CI, 5.5%-6.8%)). Behavioural/emotional problems were particularly associated with seizure disorders, which explained the greatest variation in a structural equation model. Risk factors for acute seizures included family history of seizures, previous hospitalisation and snoring at night. The overall crude prevalence of behavioural/emotional problems in those with acute seizures was 27% (95%CI, 21%-34%), being significantly greater than for those without seizures (11% (95%CI, 11%-12%); X2 p=0.001). Acute seizures remained associated with behavioural/emotional problems (RR=2.40 (95%CI, 1.61-3.58)), externalising problems (RR=2.09 (95%CI, 1.40-3.13)) and internalising problems (RR=1.99 (95%CI, 1.36-2.91)), after accounting for potential confounders. The prevalence of behavioural/emotional problems and acute seizures is high in preschool children in this rural area, and are associated with preventable risk factors. Behavioural/emotional problems are associated with acute seizures and should be assessed and addressed in preschool children with seizures.

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Irving, Athene. "Factors contributing to falls in a tertiary acute care setting in Cape Town, South Africa: a descriptive study." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32677.

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Introduction. Patient falls occur frequently in the acute hospital setting and are one of the most common adverse events experienced by hospitalised patients. In-hospital falls have negative outcomes for patients, causing injuries in up to half of those who fall. Falls in hospital create additional costs for health services due to increased length of stay (LOS), and greater health resource use. In contrast to much research focused on in-hospital falls worldwide, little is known about the rate, contributing factors and outcomes of inpatient falls in the state sector in South African hospitals. At the research hospital, a Falls Policy has been in place since 2013. The chosen falls risk screening tool, the Morse Falls Scale (MFS), had not been locally validated, and therefore its ability to accurately discriminate between patients who fall and patients who do not fall was unknown. A focused analysis of local falls incident reporting, and a description of contributory factors and consequences of falls, could better inform and target falls and fall injury prevention. Furthermore, this research may assist in service development and refining the Falls Policy. Methodology. The aim of this study was to obtain broad-based data on the magnitude of patient falls, and to identify factors contributing to falls. The aim was achieved in two parts, the first was a retrospective record review design. Predictive risk factors for falls were explored by comparing two patient groups, a Fall-Group and a Non-fall Group. In the FallGroup, further objectives related to describing circumstances surrounding fall events, including activities patients were performing at the time of the fall, the time of day and day of week the fall occurred, locations of fall events, and the clinical consequences sustained as a result of the fall. The use of the existing falls risk screening tool, the MFS, as well as its predictive accuracy to correctly identify patients at increased risk of falling was investigated. Second, a survey of nurses at the research hospital was undertaken to examine nurses' knowledge, attitudes and beliefs around the Falls Policy and current falls prevention practices. Results. There were 171 reported fall events during the ten-month period, representing 11.77% of adverse events and a falls rate of 0.73 per 1000 patient occupied bed days (POBD) during this time. Significant predictive risk factors for falling were a longer LOS and having a greater number of comorbid conditions. While the mean age of the sample was 50.0 years (SD=17.3 years), the Fall Group was significantly older than the Non-fall Group (p = .004). There were significantly more deaths in the Fall Group (p = .001), and this group had a longer average LOS (p < .001) compared to the Non-fall Group. The only sub-scale from the MFS that was significantly associated with falls was walking status. Minor-moderate clinical consequences were experienced as a result of the fall in 97% of cases (n=124). This study demonstrated that the MFS in use in the hospital has a low predictive accuracy of 55% at the current cut-off score of 50. At this score, the MFS has a sensitivity of 35.9% and a specificity of 75.4%. While an initial MFS was found in each of the cases, there was only evidence of a repeat MFS in 13 participants (9.7%) in the Fall Group. The nursing survey showed 70% of respondents had not had training on the Falls Policy (n=93) and only 37% (n=49) reported receiving regular feedback on fall rates. Receptiveness of most (66%, n=91) nurses to more training in falls prevention is encouraging. Discussion. The fall rate of 0.73 falls per POBD was lower than expected when compared to international studies. At the research hospital, when the Falls Policy was introduced in 2013, a fall was not defined in the policy and as highlighted in the nursing survey, there still appears to be lack of clarity on the fall definition. The MFS had a low predictive accuracy at the current cut-off score. The low sensitivity and specificity of the MFS in this setting may be due to the MFS not being updated regularly as per the Falls Policy. A further reason for the MFS poor predictive value may be the younger age group found in this sample when compared to international studies where the scale has performed better. Recommendations. The poor predictive value of the current risk screening tool found in this study is concerning. Therefore, further investigation into whether the MFS performs better if it is updated more frequently, and if completed in full, as per the Falls Policy, is recommended. Alternatively, the hospital should consider all patients with multiple comorbidities and those with longer length of stays at high risk, and provide interventions to minimise risk as per the Falls Policy. Future research into factors contributing to fall events and falls prevention should follow a prospective design and be supported at management as well as ward level. Further investigation into the most appropriate way to reduce harm from falls is recommended at the research site. Conclusion. This descriptive study provides a starting point for the hospital to examine the Falls Policy and falls prevention strategies currently in use. It is hoped that the study will contribute to local awareness-raising and capacity-building and help the hospital evaluate current practice and set a baseline for improvement.

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Chyan, Vivian, Megan Shell, and Lisa Goldstone. "Evidence-Based Use of Prophylactic Anticholinergic Medication in Combination with Antipsychotic Pharmacotherapy in an Acute Inpatient Psychiatric Setting." The University of Arizona, 2015. http://hdl.handle.net/10150/614026.

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Class of 2015 Abstract
Objectives: The study aimed to increase EPS risk factor assessment when prescribers order prophylactic anticholinergics with antipsychotics. An evidence-based pharmacist checklist card was developed to aid in this decision making process. Methods: A retrospective chart review of patients admitted to the acute inpatient psychiatry units at an academic medical center was conducted to determine baseline prophylactic anticholinergic prescribing habits over a two-month period. Charts were included if the patient was at least 18 years old and ordered at least one scheduled antipsychotic during the admission. An educational intervention session introduced the pharmacist checklist card and shared baseline findings. Post-intervention data was collected during a two-month period following the intervention. The percentage of prophylactic anticholinergic orders based upon pharmacist checklist card parameters pre and post-intervention was analyzed using chi-square test. Results: There was a significant decrease in the total percentage of orders for prophylactic anticholinergics from 72.7% in the pre-intervention period to 50.8% in the post-intervention period (p<0.001). Significant changes in the percentage of orders for prophylactic anticholinergics were also found for patients at no-to-low risk for EPS (56.4% versus 31.8%, p=0.014) and at low-to-moderate risk for EPS (79.6% versus 50.8%, p=0.003). There were no significant changes observed in the percentage of orders for prophylactic anticholinergics for patients at moderate-to-high risk for EPS. A lower percentage of patients prescribed a prophylactic anticholinergic experienced adverse effects in the post versus the pre-intervention period (52.31% versus 75.27%, p=0.003). Conclusions: Significant differences were found between pre and post-intervention anticholinergic medication prescribing habits. This suggests that increased patient risk factor assessment in the form of a pharmacist checklist card is effective in decreasing orders for prophylactic anticholinergic medications not clinically indicated and reducing the incidence of adverse effects.

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