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Relevant bibliographies by topics / Orders administration

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Academic literature on the topic 'Orders administration'

Author: Grafiati

Published: 28 June 2021

Last updated: 1 February 2022

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Journal articles on the topic "Orders administration"

1

Norris, T. L., and N. Parton. "The Administration of Place of Safety Orders." Journal of Social Welfare Law 9, no. 1 (January 1987): 1–14. http://dx.doi.org/10.1080/09649068708412157.

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Elliott, Rohan A., Cik Yin Lee, and Safeera Y. Hussainy. "Evaluation of a hybrid paper–electronic medication management system at a residential aged care facility." Australian Health Review 40, no. 3 (2016): 244. http://dx.doi.org/10.1071/ah14206.

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Objectives The aims of the study were to investigate discrepancies between general practitioners’ paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper–electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5–12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18 min to 98 h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper–electronic medication management systems, in which prescribers’ orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care facilities. The accuracy and safety of these systems has not been studied. What does this paper add? The present study identified discrepancies between general practitioners’ orders and pharmacy-prepared electronic medication administration charts, back-up paper medication charts and dose-administration aids, as well as delays between ordering, charting and administering medicines. Discrepancies and delays sometimes led to medication administration errors. What are the implications for practitioners? Facilities that use hybrid systems need to implement robust systems for communicating medication changes to their pharmacy and reconciling prescribers’ orders against pharmacy-generated medication charts and dose-administration aids. Fully integrated, paperless medication management systems, in which prescribers’ electronic medication orders directly populate an electronic medication administration chart and are automatically communicated to the facility’s pharmacy, could improve patient safety.

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Le, Aline, Le Kang, Andrew Noda, Emily Godbout, John Daniel Markley, Kimberly Lee, Amy Pakyz, et al. "Effect of Meropenem Restriction on Time Between Order and Administration in a Medical Intensive Care Unit." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s470. http://dx.doi.org/10.1017/ice.2020.1145.

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Background: In this study, we assessed whether meropenem restriction led to delays in administration for patients in a medical intensive care unit (MICU) at a large tertiary-care urban teaching hospital. Methods: The antimicrobial stewardship program (ASP) at Virginia Commonwealth University Health System (VCUHS) requires approval for restricted antimicrobial orders placed between 8 a.m. and 9 p.m. Between 8 a.m. and 5 p.m. (daytime), authorized approvers include ASP and infectious diseases (ID) physicians. From 5 p.m. to 9 p.m. (evening) orders are approved by ID fellows. Orders were entered as Stat, Now, and Routine. Between 9 p.m. and 8 a.m. (night), patients receive doses without approval. Meropenem restriction began in mid-January 2018. Pre- and postmeropenem restriction periods were defined as February–December 2017 and February–December 2018. Meropenem use data were compared for adult patients in the MICU. A multivariable Cox regression model was implemented to compare (1) time from order entry to approval; (2) time from order approval to patient administration; (3) total time from order entry to patient administration, adjusting for order priority, approver (ASP, ID consult, ID fellow, pharmacy); and (4) time of day of order placement (day, eve, night). The analyses were performed using SAS version 9.4 software (SAS Institute, Cary, NC). Result: Time from order approval to patient administration was significantly decreased in the postrestriction period (HR, 1.840; P < .001) (Table 1). Stat orders were faster compared to routine orders for order entry to approval (HR, 1.735; P < .001), approval to administration (HR, 2.610; P < .001), and total time from order entry to administration (HR, 2.812; P < .001). No significant differences were found in time to approval by approving service. Time from order entry to approval was faster for nighttime orders than for daytime orders (HR, 1.399; P = .037). Conclusions: Our data indicate that the time from order entry to administration decreased following meropenem restriction in our MICU. More research is needed to identify the reason for this finding, but we postulate that this is due to an effect on drug administration prioritization within nursing workflow. These data will inform our local meropenem restriction efforts.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.

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Scardina, Tonya, Shan Sun, Lori Kotsonis-Chiampas, Avani Patel, and Sameer Patel. "1047. Impact of Indication for Antibiotic Orders on Pharmacist Interventions." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S369. http://dx.doi.org/10.1093/ofid/ofz360.911.

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Abstract Background Joint Commission mandates that prescribers document indication for antibiotics at the time of prescribing. Antibiotic indications may offer opportunities for pharmacists to optimize dosing and frequency or provide alternative therapeutic options. We examined the impact of antibiotic indications during order entry on frequency and type of pharmacist interventions, time to order verification, and time to administration of antibiotics. Methods Number of pharmacist interventions documented in EPIC from 4/28/17 through 4/28/18 (pre-intervention) were compared with interventions from 4/29/18 through 2/28/19 (post-intervention). All pharmacist interventions involving antibiotic orders were included. For antibiotic orders involving a pharmacist intervention, data collected included antibiotic prescribed, indication for antibiotic (post-intervention only) and reason for intervention. For administered antibiotics, data collected included order time, time of arrival of order in pharmacist queue, pharmacist verification time, patient administration time. Statistical analysis involved chi-squared test (compare the reason for intervention) and t-test (compare difference in time). Results There were 790 orders and 638 orders that involved a pharmacist’s interventions, pre-intervention and post-intervention, respectively (Tables 1 and 2). Pre-intervention, there were 200 antibiotic orders that had a documented pharmacist intervention and were administered. Post-intervention, there were 184 orders that had a documented pharmacist intervention and were administered. Abdominal/pelvic (29 orders, 16%), sepsis (19 orders, 10%), and surgical prophylaxis (18 orders, 9.7%) were the most frequent indications selected during order entry. Average time to order verification was 119 minutes pre-intervention and 123 minutes post-intervention (P =0.97). Average time to administration of antibiotics was 313 minutes and 360 minutes pre-intervention and post-intervention, respectively (P =0.45). Conclusion Inclusion of the selection of antibiotic indications during order entry did not significantly impact the number of pharmacist interventions, time to order verification nor time to administration. Disclosures All authors: No reported disclosures.

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Vázquez, Carlos Manuel. "Breard and the Federal Power to Require Compliance With ICJ Orders of Provisional Measures." American Journal of International Law 92, no. 4 (October 1998): 683–91. http://dx.doi.org/10.2307/2998131.

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Among the puzzling aspects of the Breard episode was the Clinton administration’s claim that the decision whether or not to comply with the Order of the International Court of Justice requiring the postponement of Breard’s execution lay exclusively in the hands of the Governor of Virginia. The ICJ’s Order provided that “[t]he United States should take all measures at its disposal to ensure that Angel Francisco Breard is not executed pending the final decision in these proceedings.” The Clinton administration argued that the Order was not binding, but it also took the position that, even if the order were binding, there would be no authority in the federal Government to require a postponement of the execution. As the administration explained to the Supreme Court:

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Ferguson, Margaret R., and Cynthia J. Bowling. "Executive Orders and Administrative Control." Public Administration Review 68 (October 21, 2008): S20—S28. http://dx.doi.org/10.1111/j.1540-6210.2008.00975.x.

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Lens, Vicki. "Executive Orders and the Trump Administration: A Guide for Social Workers." Social Work 63, no. 3 (May 14, 2018): 210–21. http://dx.doi.org/10.1093/sw/swy024.

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Kirkendall, Eric S., Michal Kouril, Judith W. Dexheimer, Joshua D. Courter, Philip Hagedorn, Rhonda Szczesniak, Dan Li, Rahul Damania, Thomas Minich, and S. Andrew Spooner. "Automated identification of antibiotic overdoses and adverse drug events via analysis of prescribing alerts and medication administration records." Journal of the American Medical Informatics Association 24, no. 2 (August 9, 2016): 295–302. http://dx.doi.org/10.1093/jamia/ocw086.

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Objectives: Electronic trigger detection tools hold promise to reduce Adverse drug event (ADEs) through efficiencies of scale and real-time reporting. We hypothesized that such a tool could automatically detect medication dosing errors as well as manage and evaluate dosing rule modifications. Materials and Methods: We created an order and alert analysis system that identified antibiotic medication orders and evaluated user response to dosing alerts. Orders associated with overridden alerts were examined for evidence of administration and the delivered dose was compared to pharmacy-derived dosing rules to confirm true overdoses. True overdose cases were reviewed for association with known ADEs. Results: Of 55 546 orders reviewed, 539 were true overdose orders, which lead to 1965 known overdose administrations. Documentation of loose stools and diarrhea was significantly increased following drug administration in the overdose group. Dosing rule thresholds were altered to reflect clinically accurate dosing. These rule changes decreased overall alert burden and improved the salience of alerts. Discussion: Electronic algorithm-based detection systems can identify antibiotic overdoses that are clinically relevant and are associated with known ADEs. The system also serves as a platform for evaluating the effects of modifying electronic dosing rules. These modifications lead to decreased alert burden and improvements in response to decision support alerts. Conclusion: The success of this test case suggests that gains are possible in reducing medication errors and improving patient safety with automated algorithm-based detection systems. Follow-up studies will determine if the positive effects of the system persist and if these changes lead to improved safety outcomes.

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Barra, Megan E., Sarah E. Culbreth, Katelyn W. Sylvester, and Megan A. Rocchio. "Utilization of an Integrated Electronic Health Record in the Emergency Department to Increase Prospective Medication Order Review by Pharmacists." Journal of Pharmacy Practice 31, no. 6 (October 10, 2017): 636–41. http://dx.doi.org/10.1177/0897190017735390.

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Purpose: The objective of this study is to evaluate the impact of an integrated medical record system on prospective medication order verification by pharmacists in the emergency department (ED) of a level I trauma center. Methods: This was a single-center retrospective analysis comparing medication orders verified by a pharmacist during a 7-day period in 2013 (phase I) versus 2015 (phase II). Outcome measures include the percentage of medication orders reviewed by a pharmacist prior to administration and time from order entry to each of the following: pharmacist review, medication procurement from an automated dispensing cabinet (ADC), and medication administration. Results: In total, 5450 medication orders were included in the study. The percentage of medication orders reviewed by a pharmacist prior to administration increased from 51.8% to 94% in phase I versus phase II, respectively ( P < .001). Median time from order entry to pharmacist verification decreased from 13 to 4 minutes in phase I versus phase II, respectively ( P < .001). Time from order entry to ADC dispense increased from a median of 9 minutes in phase I to 15 minutes in phase II ( P < .001). Time from order entry to nursing administration increased from a median time of 15 minutes in phase I to 23 minutes in phase II ( P < .001). Conclusion: Implementation of prospective pharmacist order verification in the ED increased the percentage of medications reviewed by a pharmacist prior to administration and improved pharmacist efficiency in the medication verification process. This increase in pharmacist review was associated with a marginal increase in time to medication procurement and administration.

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Frighetto, Luciana, Carlo A. Marra, H. Grant Stiver, Elizabeth A. Bryce, and Peter J. Jewesson. "Economic Impact of Standardized Orders for Antimicrobial Prophylaxis Program." Annals of Pharmacotherapy 34, no. 2 (February 2000): 154–60. http://dx.doi.org/10.1345/aph.19142.

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OBJECTIVE: To assess the effect and economic impact of an intervention aimed at standardizing the timing of preoperative antimicrobial prophylaxis from the perspective of a major teaching hospital. DESIGN: A pre/post study design in which a random sample of 60 procedures from a 12-month period in the preintervention phase were reviewed. A comparative sample of 60 procedures during a seven-month postintervention phase was selected. For each prophylactic course, preoperative dose administration details were classified as early (>2 h prior to incision), on time (0–2 h prior), delayed (0–3 h after), or late (>3 after). To determine the economic impact of this intervention, we used a predictive decision analytic model using institutional costs and the published probabilities of inpatient surgical wound infections (SWIs) following administration of antimicrobials timed according to the above criteria. Two conditions were analyzed: (1) an interdisciplinary two-stage therapeutic interchange program involving staff education and modification of preoperative antimicrobial orders to ensure timely administration and (2) no intervention. SETTING: An 1100-bed tertiary care, university-affiliated institution. PATIENTS: 120 randomly selected procedures involving inpatients who received a preoperative antibiotic. OUTCOME MEASURES: Differences in preoperative antimicrobial timing and cost avoidance associated with the intervention. RESULTS: In the preintervention phase, 68% of prophylactic courses were on time, 22% were early, and the balance were delayed or late. The incidence of on-time prophylaxis increased to 97% during the postintervention phase (p = 0.001). Operating room staff involvement in antimicrobial administration increased from 57% to 92% (p = 0.001). Based on a setup and annual intervention cost of $9100 CAN ($1 CAN = $0.68 US), an annual inpatient SWI avoidance of 51 cases, an average infection-associated extended hospital stay of four days, and an average treatment cost of $1957 CAN per inpatient SWI, we estimated that 153 hospital days were avoided and there was an annual cost avoidance of $90707 CAN ($1779 CAN saved per inpatient infection avoided) due to this intervention. Using sensitivity analyses, no plausible changes in the base case estimates altered the results of the economic model. CONCLUSIONS: An interdisciplinary approach to optimizing the timing of preoperative antimicrobial doses can impact positively on practice patterns and result in substantial cost avoidance. Costs incurred to implement such an intervention are small when compared with the annual cost avoidance to the institution.

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Dissertations / Theses on the topic "Orders administration"

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Coventry, Helen, and n/a. "The administration of community service orders for juvenile offenders in the Australian Capital Territory." University of Canberra. Education, 1985. http://erl.canberra.edu.au./public/adt-AUC20060630.100112.

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Davenport, Caillan. "The Senatorial and Equestrian Orders in the Roman Army and Administration, A.D. 235-337." Thesis, University of Oxford, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.519759.

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MacGinnis, John. "Letter orders from Sippar and the administration of the Ebabbara in the Late-Babylonian period." Thesis, University of Cambridge, 1991. https://www.repository.cam.ac.uk/handle/1810/272412.

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Layne, Sonia Ann. "A Quantitative Examination of the Impact of Protective Orders on Teen Dating Violence." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4228.

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Teen dating violence is a national epidemic with prevalence similar to levels of adult dating and domestic violence. Some states order of protection laws currently fails to protect most teen victims experiencing dating violence. The purpose of this experimental, quantitative study was to determine to what extent domestic violence statutes impact the reporting of teen dating violence in states that provide statutory protection of teen dating violence victims. The advocacy coalition framework was used for the study's theoretical foundation. The research questions focused on differences between the strength of state's advocacy coalition programs, and the prevalence of female teens reporting dating violence. One-way ANOVAs and Games-Howell post hoc tests were used to analyze existing data acquired from Center for Disease Control 2011 State Youth Risk Behavioral Survey of 39,184 high school females from 43 states; 2010 Break the Cycle State Law Report Cards, and 2011-2015 Domestic Violence Counts: National Census of Domestic Violence Services. Findings indicate a statistically significant difference between states that do not provide statutory protection for teen victims and states that do provide statutory protection (p < .001) and implied that stronger state advocacy and coalition programs resulted in higher reported incidents of physical dating violence among female teens. Implications for positive social change include recommendations to lawmakers and crime prevention specialists to consider changes in domestic violence statutes to protect teen victims, provide specific statutory remedy for teen victims and reduce the frequency of teen dating violence as result of increased reporting.

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Bradshaw, Lynn Dahlia. "The use of presidential executive orders to control the management and administration of the federal government." FIU Digital Commons, 1996. http://digitalcommons.fiu.edu/etd/1784.

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As long as governmental institutions have existed, efforts have been undertaken to reform them. This research examines a particular strategy, coercive controls, exercised through a particular instrument, executive orders, by a singular reformer, the president of the United States. The presidents studied- Johnson, Nixon, Ford, Carter, Reagan, Bush, and Clinton-are those whose campaigns for office were characterized to varying degrees as against Washington bureaucracy and for executive reform. Executive order issuance is assessed through an examination of key factors for each president including political party affiliation, levels of political capital, and legislative experience. A classification typology is used to identify the topical dimensions and levels of coerciveness. The portrayal of the federal government is analyzed through examination of public, media, and presidential attention. The results show that executive orders are significant management tools for the president. Executive orders also represent an important component of the transition plans for incoming administrations. The findings indicate that overall, while executive orders have not increased in the aggregate, they are more intrusive and significant. When the factors of political party affiliation, political capital, and legislative experience are examined, it reveals a strong relationship between executive orders and previous executive experience, specifically presidents who served as a state governor prior to winning national election as president. Presidents Carter, Reagan, and Clinton (all former governors) have the highest percent of executive orders focusing on the federal bureaucracy. Additionally, the highest percent of forceful orders were issued by former governors (41.0%) as compared to their presidential counterparts who have not served as governors (19.9%). Secondly, political party affiliation is an important, but not significant, predictor for the use of executive orders. Thirdly, management strategies that provide the president with the greatest level of autonomy-executive orders redefine the concept of presidential power and autonomous action. Interviews of elite government officials and political observers support the idea that executive orders can provide the president with a successful management strategy, requiring less expenditure of political resources, less risk to political capital, and a way of achieving objectives without depending on an unresponsive Congress.

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Abdulla, Zurina. "Parents' experiences of monitoring their adolescents' compliance with diversion orders." Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/d1020090.

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The increased incidence of children committing crime and the realisation that the existing legislature dealing with offenders failed to cater for the rights and needs of child offenders gave rise to the introduction of the Child Justice Act 75 of 2008. This Act enables the South African criminal justice system to deal with children in a manner appropriate to their developmental stage. One of the initiatives introduced by the Act is termed ‘diversion’, where children are diverted from the criminal justice system into restorative developmental programmes, offered by organisations such as NICRO (National Institute for Crime Prevention and the Reintegration of Offenders). Their parents or guardians are tasked with the responsibility of monitoring their compliance with the diversion order in terms of Section 24(5) of the aforementioned Act. The monitoring responsibility assigned to the parents of diverted adolescents prompted the research question and aim of this study, namely to explore parents’ experiences in monitoring their adolescents’ compliance with diversion orders and to identify service needs in supporting parents in fulfilling their role as stipulated in the Act. This was a qualitative study that was exploratory-descriptive and contextual in nature. A non-probability purposive sampling technique was employed to identify the parents or guardians of adolescents aged 14 to 17 years that had been diverted to NICRO between June 2011 and June 2012. Individual semi-structured interviews were conducted with the selected parents, and the data collected was analysed using thematic data analysis. The trustworthiness of the research process and the findings was enhanced by employing a variety of data verification strategies. This research contributes to a greater understanding of parents’ monitoring experiences of their adolescents’ compliance with diversion orders. The study revealed that most parents experienced their role as an additional responsibility; they needed access to counseling and information on the child justice process.

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Liebowitz, David. "Ending to What End? The Impact of the Termination of Court Desegregation Orders on Patterns of Residential Choice and High-School Completion." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:23519637.

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The essays in this thesis examine the impact of the termination of court desegregation orders on patterns of residential choice and high-school completion. I do this by first examining decisions individual households make about where to live in the aftermath of a change in student-assignment policy using evidence from a single school district. Then, I generalize and assess trends in patterns of residential segregation and high-school dropout rates in a national study. In the first essay, my co-author and I examine whether the legal decision to end race-conscious student assignment policies in the Charlotte-Mecklenburg school district increased the probability that families with children enrolled in the district would move to neighborhoods with a greater proportion of student residents of the same race as their own children. We make use of a natural policy experiment—a judicial decision to end court-ordered busing—to estimate the causal impacts of this policy shift on household residential decisions. We find that, for those who moved, the legal decision made white families with children in the Charlotte-Mecklenburg Schools substantially more likely than they were during desegregation to move to a neighborhood with a greater proportion of white residents than their own neighborhood. In the second essay, I assess the impacts of the end of court desegregation orders on a comprehensive national sample of districts under court order in 1991. In a series of analyses, I conclude that the release of these districts from court desegregation orders increased the rates of black-white and, even more conclusively, Hispanic-white residential segregation. Furthermore, the declaration of districts as unitary increased rates of 16-19 year-old school dropouts in these districts by three to seven percentage points for Hispanics, one to two percentage points for blacks, and almost four percentage points for blacks living in school districts outside the South. Taken together, these findings suggest that barring the use of race in the assignment of students to schools has deleterious effects on black and Hispanic students and the communities in which they reside.

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Slomek, Tomáš. "Vývoj aplikace pro správu objednávek." Master's thesis, Vysoké učení technické v Brně. Fakulta podnikatelská, 2021. http://www.nusl.cz/ntk/nusl-444619.

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The master‘s thesis is focused on the design and creation of an application for administration of lunch orders. The thesis includes a theoretical basis, analysis of the current situation and design of the application for orders administration. The application is created with regard to user requirements and its purpose is to increase work efficiency.

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Donoghue, Jane Catriona. "The use of antisocial behaviour orders (ASBOs) in Britain : unpacking the primacy of legal procedure(s) and judicial discretion." Thesis, University of Stirling, 2007. http://hdl.handle.net/1893/364.

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The primary thesis that the chapters which follow are concerned to elaborate and to substantiate is to what extent legal procedure(s) and judicial discretion influence the administration, management and outcomes of Antisocial Behaviour Order (ASBO) use in Britain. A great deal of the existing academic literature on the use of ASBOs in Britain locates the strategic importance of the ‘relevant authorities’ (local authorities, housing associations, registered social landlords (RSLs), the police) involved in ASBO applications. While acknowledging the importance of existing scholarship which highlights the significance of the contribution of these applicant agencies in shaping ASBO outcomes, this thesis contends that the position of both legal procedure(s) and the court system in ASBO applications is also one of fundamental primacy, which necessitates further examination and analysis. Moreover, there are also no comparative studies in existence that analyse the substantive differences and/or similarities between ASBO administrative procedure(s) in Scotland, and in England and Wales. Hence this thesis will also provide a comparative account of relevant aspects of legal and administrative procedure(s) across these jurisdictions. The data production approach applied in this thesis is both quantitative and qualitative in its composition. An online survey questionnaire was used to obtain data on solicitors’ experiences of ASBO application and court procedure(s) (in Scotland, and in England and Wales), and semi-structured interviews were conducted with Sheriffs in the lower courts in Scotland in order to obtain information on judicial discretion and decision-making in ASBO cases. The study found that legal procedure(s) and judicial discretion fundamentally impacted on the operation of antisocial behaviour legislation and the use of ASBOs in both Scotland, and in England and Wales. Specifically, legal procedure(s) and judicial discretion influenced the form of ASBO prohibitions and the type of behaviour made the subject of an order; the extent of the impact of mitigating factors; the evidentiary requirements necessary for an interim/ASBO application; the sentencing tariffs for breach; the frequency with which orders on conviction are issued; the frequency with which orders are granted to children and young people; and the ability of alleged antisocial behaviour perpetrators to defend or to appeal action against them. Building on existing theoretical frameworks on procedural justice (Galligan, 1996a; 1996b; Halliday, 1998; 2004), and, moreover, on conceptual paradigms of ‘fairness’ and consistency in judicial decision-making developed in other empirical studies of procedure and judicial discretion in the lower courts (Anleu and Mack, 2005; 2007; Cowan et al., 2006 Hunter et al., 2005; Lawrence, 1995), the thesis develops an account of the network of (procedural and juridical) factors that influence the use of ASBOs in Britain. The thesis concludes that, in order to ensure greater consistency, stringency and accuracy in approach to ASBO cases – in essence, in order for there to be more ‘fairness’ in ASBO processes - there must be a greater socio-legal focus upon the influence of both substantive practices and formal procedural rules.

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Blount, Ian Y. "Policy Implementation by Executive Order: A Quantitative Analysis of the Effects of Agency Decisions and Organizational Characteristics on Government Expenditures Through a Minority Businesses Enterprise Set-Aside Program in Ohio." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1366041200.

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Books on the topic "Orders administration"

1

Norris, T. L. The administration of Place of Safety Orders. Huddersfield: Huddersfield Polytechnic, Department of Law and Department of Behavioural Sciences, 1985.

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Read Pakistan Customs guidelines: Customs public notices, standing orders, circulars & office orders. Karachi: National Advisory Forum, 2009.

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London, Malcolm. Implications of liquidations, receiverships, administration orders and voluntary arrangements. London: Institute of Chartered Accountants in England and Wales, 1989.

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New York (State). Division of Management Audit and State Financial Services. Department of Agriculture and Markets, administration of marketing orders. [Albany, NY: The Division, 2000.

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Conrad, Liles W., ed. Manual of admitting orders and therapeutics. 3rd ed. Philadelphia: Saunders, 1994.

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S, Eisenberg Mickey, ed. Manual of admitting orders and therapeutics. 2nd ed. philadelphia: Saunders, 1987.

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Pakistan. Customs general orders: Up to 1st August 2002. 2nd ed. Lahore: Tariq Najib Co., 2002.

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Pakistan. Customs general orders: Up to 2nd May 2005. Lahore: Tariq Najib Corp., 2005.

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Homan, Mark. A survey of administrations under the Insolvency Act 1986: The result of administration orders made in 19877. (Milton Keynes): Research Board of the Institute of Chartered Accountants in England and Wales, 1989.

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Pakistan. Central Board of Revenue. Customs general orders, 1971-1990: Customs law of Pakistan. Lahore: T.N. Corp., 1990.

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Book chapters on the topic "Orders administration"

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Freeman, Adam. "SportsStore: Orders and Administration." In Pro AngularJS, 173–204. Berkeley, CA: Apress, 2014. http://dx.doi.org/10.1007/978-1-4302-6449-1_8.

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Walsh-Haines, Grant. "Executive Orders and Public Administration." In Global Encyclopedia of Public Administration, Public Policy, and Governance, 1–4. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-31816-5_1163-1.

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Walsh-Haines, Grant. "Executive Orders and Public Administration." In Global Encyclopedia of Public Administration, Public Policy, and Governance, 2088–91. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-20928-9_1163.

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Schimanke, Dieter. "The Peculiarities of the Social Security Systems (Indirect State Administration)." In Public Administration in Germany, 91–103. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-53697-8_7.

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AbstractThe welfare state comprises—besides other parts of social policy—the social security systems which provide insurance cover for the five risks of illness, long-term care, occupational accidents, old age (pension) and unemployment. The social security budgets equate to 17.7% of GDP or some 45% of public budget expenditure. The social security systems have had a unique status in the German public sector since their foundation in the late nineteenth century. On the one hand, as legally independent institutions, they enjoy a certain degree of autonomy and therefore constitute the ‘indirect state administration’. On the other hand, the steering by federal legislation (direct state administration) is quite intensive. However, in implementing this legislation, the institutions are only subject to limited state supervision, which is restricted to legal supervision (Rechtsaufsicht). Moreover, the social security institutions can appeal to the social courts against the orders of the supervising state administration.

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Feinberg, Melissa. "Trump Administration and Supreme Court Issue Immigration Orders : August 12, August 14, September 11, and October 4, 2019." In Historic Documents of 2019, 400–415. 2455 Teller Road, Thousand Oaks California 91320: CQ Press, 2020. http://dx.doi.org/10.4135/9781544384641.n33.

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Howland, Douglas. "The Alternative Order of International Administration." In International Law and Japanese Sovereignty, 73–97. New York: Palgrave Macmillan US, 2016. http://dx.doi.org/10.1007/978-1-137-56777-2_4.

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Hyde, Georgie D. M. "Educational Administration and Law and Order." In South Korea, 53–72. London: Palgrave Macmillan UK, 1988. http://dx.doi.org/10.1007/978-1-349-10039-2_4.

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Affolter, Laura. "Shaping Administrative Practice: The Institutional Habitus." In Asylum Matters, 1–25. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-61512-3_1.

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AbstractIn order to understand how regularities in administrative practice are produced, the shaping of administrative caseworkers’ discretionary practices must be studied. This chapter adopts a holistic way of doing so, arguing that regulatory frameworks, the structural conditions of bureaucratic decision-making, the ideological environments administrations are embedded in as well as professional norms and values shape administrative caseworkers’ practices. Furthermore, the chapter argues that officials develop specific dispositions through organisational socialisation. For this purpose, building on Bourdieu, the concept of the institutional habitus is introduced. The chapter argues that the institutional habitus not only shapes everyday administrative practice but also reaffirms the very regulatory constraints, norms and values that lie at its heart. With regard to the empirical focus of this book—credibility assessments in asylum procedures—the concept of the institutional habitus allows us to analytically grasp the socialised subjectivity which emerges out of caseworkers’ socialisation in the office.

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"Administration Orders." In Business Law & Practice Tranactions Guide, 431–37. Routledge-Cavendish, 1999. http://dx.doi.org/10.4324/9781843142386-49.

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"Administration orders." In Personal Insolvency, 97–100. Routledge-Cavendish, 2018. http://dx.doi.org/10.4324/9781843145769-16.

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Conference papers on the topic "Orders administration"

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Abdullah, Yahya. "Judicial oversight of applications submitted to the administration is a reason for its development." In INTERNATIONAL CONFERENCE OF DEFICIENCIES AND INFLATION ASPECTS IN LEGISLATION. University of Human Development, 2021. http://dx.doi.org/10.21928/uhdicdial.pp191-212.

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"The administration performs a great task in the life of modern societies, through its intervention to satisfy public needs through the establishment and management of public utilities that aim to achieve the public interest and respond to the requirements and necessities of daily life, as well as protecting public order, and regulating the relationship between them and individuals with constitutional and legal texts, as well as The organizational rules that lay down the general framework for public liberties and individual rights, all to prevent them from practicing any activity outside the framework of legality. Originally, the administration is not obligated to issue its decisions in a specific form, as it is free to choose the external form of these decisions, unless the law requires it otherwise. This requires that the decision be embodied in an external form in order for individuals to know the will of the administration and to adjust their behavior according to its requirements. However, the implementation of this rule on its launch, may negatively affect the rights of individuals, because the administration may sometimes deliberately remain silent about deciding the requests submitted to it, or it may neglect at other times to respond to these requests. Existence of apparent decisions in an external legal form, meaning that the matter remains in the hands of the administration, if it wants it will respond to the requests of individuals, and if it wants to be silent, which constitutes a waste of their rights, a violation of the principle of equality, and confiscation of the right to litigation guaranteed by the constitution, it requires protection of individuals from the inconvenience of the administration And the abuse of their rights, and put an end to the neglect of employees and their indifference to the requests or grievances submitted to them, in addition to the fact that the requirements of the public interest require that the administrative staff exercise the powers entrusted to them by law at the present time. ( ) For these justifications, the legislator intervened in many countries, including France, Egypt, Lebanon and Iraq, to suppose that the administration had announced its will, even if it remained silent or silent about deciding on the request presented to it, and this resulted in an implicit administrative decision of rejection or approval. As a result of the large number of state intervention in the economic and social fields in recent times, it has led to the multiplicity and diversity of state agencies and institutions, and the public administration often does not provide its services to individuals except at the request of individuals. Therefore, it may be difficult for individuals to identify a competent administrative authority to submit their request to. to get those services. He makes a mistake and submits it to a non-competent administrative body. When this authority is silent and does not transfer the request to its competent authority, and the legal period granted to the administration to respond to their requests has passed, individuals resort to the judiciary, and submitting the request to the non-competent authority prevents the judiciary from accepting their claim, which wastes their rights and thus harms them. Therefore, the administrative judiciary in many countries has extended its control over this case to consider the application submitted to a non-competent administrative body as if it was submitted to its competent authority, given that the state is a single public legal person. Accordingly, the request submitted to any party starts from the legal period available to the administration to meet the requests of individuals and in its absence the implicit administrative decision of rejection or acceptance arises. Accordingly, we will study the jurisprudence of the French, Lebanese, Egyptian and Iraqi judiciary in this study. The importance of the study lies in the implications of the subject of requests submitted to the administration, the delay in their completion, the silence of the administration, and the consequent effects and exposure to the rights of individuals. And that it will show how to confront this silence, neglect and intransigence of the administration. The idea of implicit administrative decisions, resulting from the administration’s silence on the requests submitted to it, is an effective means, which makes the administration more positive and enables individuals to confront the administration’s silence, and prevents its intransigence, arbitrariness or neglect. The problem of the research is that can silence be an expression of the will? How do individuals protect themselves from the actions of the administration, and who guarantees its non-bias, arbitrariness and deviation? Does submitting the application to a non-competent body protect the rights of individuals? ? And the extent of judicial oversight on the authority of the administration.? And the extent of the compatibility and divergence of the positions of the administrative judiciary in France, Lebanon, Egypt and Iraq regarding this.? From the above in explaining the importance of the study and its problem, we can deduce the scope of the study, which is the study of judicial control over the requests submitted to the administration by taking an overview of the nature of the requests, their types and distinguishing them from others, and the position of each of the legislation, the judiciary and jurisprudence from it. The research consists of two sections, the first deals with the nature of the request and what is related to it, and the second is judicial control over the applications submitted to the administration, as follows"

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Rapajić, Milan. "POSEBNE (UPRAVNE) ORGANIZACIJE U MILjEU VLADAVINE PRAVA." In XVII majsko savetovanje. Pravni fakultet Univerziteta u Kragujevcu, 2021. http://dx.doi.org/10.46793/uvp21.725r.

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The modern state administration and its bodies and special organizations should act in the field of the rule of law. It is a term that originates from the Anglo-Saxon legal world, but it is also a category and a principle of the Constitution of Serbia from 2006. The paper points out the different understandings of the rule of law and briefly looks at the position of the administration or the phase in its historical course until its subsumption under the principle of legality. In Serbia, state administration bodies consist of ministries, administrative bodies within the ministry and special organizations. Administrative or special organizations are formed by the state in order to perform professional and related administrative tasks. In order to permanently and unhinderedly perform the professional work of these organizations, they can act authoritatively. Special organizations have numerous and diverse administrative powers. The paper points out both the similarities and differences of special organizations in relation to administrative bodies. A review of the activities and organizational structure of all special organizations (secretariats, institutes, directorates and one center) established by the Law on Ministries from 2020 was performed. It was also pointed out that all institutes: the Republic Institute of Statistics, the Republic Hydrometeorological Institute, the Republic Geodetic Institute and the Intellectual Property Institute are special organizations that provide services to interested parties. In one part of the final considerations, the author states that for special organizations (as part of the state administration) it could be concluded that they really operate in the field of rule of law as an order with positive properties as characterized by the Constitution, it is necessary to strictly respect the principles organization of state administration prescribed by the Law on State Administration: independence and legality; expertise, impartiality and political neutrality, effectiveness in exercising the rights of the parties, proportionality and respect for the parties; publicity of work.

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Bruns, Glenn, Michael Huth, and Kumar Avijit. "Program synthesis in administration of higher-order permissions." In the 16th ACM symposium. New York, New York, USA: ACM Press, 2011. http://dx.doi.org/10.1145/1998441.1998449.

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Jones, Scott M. "Steady-State Modeling of Gas Turbine Engines Using the Numerical Propulsion System Simulation Code." In ASME Turbo Expo 2010: Power for Land, Sea, and Air. ASMEDC, 2010. http://dx.doi.org/10.1115/gt2010-22350.

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The Numerical Propulsion System Simulation (NPSS) code was created through a joint United States industry and National Aeronautics and Space Administration (NASA) effort to develop a state-of-the-art aircraft engine cycle analysis simulation tool. Written in the computer language C++, NPSS is an object-oriented framework allowing the gas turbine engine analyst considerable flexibility in cycle conceptual design and performance estimation. Furthermore, the tool was written with the assumption that most users would desire to easily add their own unique objects and calculations without the burden of modifying the source code. The purpose of this paper is twofold: first, to present an introduction to the discipline of thermodynamic cycle analysis to those who may have some basic knowledge in the individual areas of fluid flow, gas dynamics, thermodynamics, and turbomachinery theory but not necessarily how they are collectively used in engine cycle analysis. Second, this paper will show examples of performance modeling of gas turbine engine cycles specifically using Numerical Propulsion System Simulation concepts and model syntax. Current practices in industry and academia will also be discussed. While NPSS allows both steady-state and transient simulations and is written to facilitate higher orders of analysis fidelity, the pedagogical example will focus primarily on steady-state analysis of an aircraft mixed flow turbofan at the 0-D and 1-D level. Ultimately it is hoped that this paper will provide a starting point by which both the novice cycle analyst and the experienced engineer looking to transition to a superior tool can use NPSS to analyze any kind of practical gas turbine engine cycle in detail.

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MAHOOD, Sahar. "ADMINISTRATIVE REFORMS IN BAGHDAD DURING THE RULE OF THE GOVERNOR MATHAT PASHA (1869-1872)." In International Research Congress of Contemporary Studies in Social Sciences (Rimar Congress 2). Rimar Academy, 2021. http://dx.doi.org/10.47832/rimarcongress2-8.

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Pasha was one of the most prominent Ottoman governors who ruled Baghdad during the rule of the Ottoman Empire, and he was also one of the most important administrative reformers in the city, as he was appointed as its governor in (1869 AD), so he assumed the task of the Ottoman state’s control over the Arab Gulf countries such as (Kuwait, Qatar, Bahrain, Al-Ahsa We find). This study acquires its importance through the important administrative reforms that Medhat Pasha undertook in Baghdad, so we dealt with it in this research in some detail, as his reforms in the fields of (education, mail, health, administration, and construction, etc.) were of great importance in administrative and urban development. For the city of Baghdad, as it established the first building blocks for establishing a solid central administrative system and distinguished urban development. Perhaps one of the most prominent objectives of this study is to shed light on the important reforms of Governor Medhat Pasha in the city of Baghdad, especially in the administrative, urban, educational and other fields, and to stand on each one of them in order to demonstrate its importance and impact on Al-Baghdadi society. As for the problem of this study, it lies in the disclosure of many challenges that coincided with the reforms of Medhat Pasha, which caused a qualitative shift in the administrative system in Baghdad, the most prominent of which was the popular revolution by the people of this city following the imposition of compulsory conscription, even though the governor faced it And he was able to control it and where he did not stop his reforms, whose effects and features remain fresh to this day. He regretted that Medhat Pasha did not help him with his reforms at the Sublime Porte, so the intrigues and plots were trampled upon him, and he was subsequently transferred to the state of Izmir and he was arrested on charges of killing Sultan Abdul Aziz. The judgment was not executed, so he ordered his exile to the city of Taif, and he died in prison in 1883AD.

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Juwono, Vishnu. "The Perils and Challenges of Advancing Economic Governance Reform in Indonesia: An Endeavor by the Technocrats in the New Order Era." In 1st International Conference on Administrative Science, Policy and Governance Studies (ICAS-PGS 2017) and the 2nd International Conference on Business Administration and Policy (ICBAP 2017). Paris, France: Atlantis Press, 2017. http://dx.doi.org/10.2991/icaspgs-icbap-17.2017.26.

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Arifin, Imron, Juharyanto Juharyanto, Ibrahim Bafadal, and Harti Kartini. "Learning Innovation in Strengthening Higher Order Thinking Skill in the Laboratory Elementary School." In 3rd International Conference on Educational Management and Administration (CoEMA 2018). Paris, France: Atlantis Press, 2018. http://dx.doi.org/10.2991/coema-18.2018.39.

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Landum, Manuel, M. M. M. Moura, and Leonilde Reis. "EVALUATING GREEN IT IN LOCAL ADMINISTRATION." In Fourth International Scientific Conference ITEMA Recent Advances in Information Technology, Tourism, Economics, Management and Agriculture. Association of Economists and Managers of the Balkans, Belgrade, Serbia, 2020. http://dx.doi.org/10.31410/itema.2020.1.

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This work is prompted by the massive use of Information and Communication Technologies, the need for alignment with the business, the concern for integrated management and the need to protect natural resources and the environment. This article aims to present a framework, multidimensional and multidisciplinary, from the perspective of sustainability, in the treatment of Green IT, involving environmental issues and social responsibility, Governance of Information Technologies and Financial Management, in the context of Public Administration, more specifically in local administration. The methodology used is based on the literature review, in the field of thematic, and on a case study in development in local government, in order to analyze the feasibility and suitability with the validation of the framework. The main results obtained in the case study focus on the use of technology allied to Green IT, with theoretical reflexes for environmental quality and with possible cost reduction.

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Hachi, Mihai, Veronica Raileanu, and Ana Jeleapov. "Nivelul de trai al populatiei si dezvoltarea umana în regiunea de dezvoltare centru." In Impactul antropic asupra calitatii mediului. Institute of Ecology and Geography, Republic of Moldova, 2019. http://dx.doi.org/10.53380/9789975330800.30.

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Nowadays, it is observed an increase of the need for comparative studies of human development in order to attempt to follow the level reached by states, regions or human communities from certain administrative-territorial units, with the aim to evaluate the efficiency of development policies applied by regional or local governments or administrations, beyond certain statistical indicators or series that attest certain aspects of human development. In this context, the HDI (Human development index) applied by the UNO includes four components providing an annual generalization of human development at the level of the world's states. In the performed study we aimed to develop the given index, including indicators and indexes of living standard as a component of HDI, generalizing it at the level of 329 communes of the Center Development Region according to the Regional Development Strategy of the Republic of Moldova.

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Kuncoro, A. Bagus, I. G. A. K. Rachmi Handayani, Y. Taruono Muryanto, and Lego Karjoko. "Consumer Protection Based on Justice in Order to Advance State Administration Systems in Indonesia." In Proceedings of the 3rd International Conference on Globalization of Law and Local Wisdom (ICGLOW 2019). Paris, France: Atlantis Press, 2019. http://dx.doi.org/10.2991/icglow-19.2019.22.

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Reports on the topic "Orders administration"

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SECRETARY OF THE AIR FORCE WASHINGTON DC. Administrative Orders. Fort Belvoir, VA: Defense Technical Information Center, February 1999. http://dx.doi.org/10.21236/ada405019.

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Todorovic, Sinisa, and Narendra Ahuja. Review of Administrative Task Orders for Iraq Reconstruction Contracts. Fort Belvoir, VA: Defense Technical Information Center, January 2006. http://dx.doi.org/10.21236/ada489160.

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McDermott, Joseph T., Karen Bell, Michael Bianco, Frank Bonsiero, James Carrera, Shawn Kline, Peter Lee, Rizwan Shah, Clifton Spruill, and Steven Sternlieb. Review of Administrative Task Orders for Iraq Reconstruction Contracts. Fort Belvoir, VA: Defense Technical Information Center, October 2006. http://dx.doi.org/10.21236/ada489665.

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Cantens, Thomas, and Gaël Raballand. Taxation and Customs Reforms in Fragile States: Between Bargaining and Enforcement. Institute of Development Studies (IDS), May 2021. http://dx.doi.org/10.19088/ictd.2021.009.

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In the last decade, African authorities and the international community have called for support to increase taxation capacity in order to reduce reliance on aid flows. This commitment to support tax administrations was reflected in the 2015 Addis Tax Initiative (ATI), which advocated ‘to double assistance to developing countries in order to strengthen their tax systems and administrations’ by the year 2020 (IMF 2017: 6). Increasing domestic resource mobilisation is even more salient for state-building in fragile states, in terms of providing costly services to citizens, including security, across national territory. There is a rich literature (Acemoglu and Robinson 2012; Besley and Persson 2009) arguing that robust and inclusive fiscal institutions are essential for state-building and economic growth. This is not the situation in fragile states.

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Birney, Cathleen, and Mark J. Krauss. Recommendations and Justifications To Remove Use Restrictions Established under the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office Federal Facility Agreement and Consent Order, Revision 0. Office of Scientific and Technical Information (OSTI), September 2013. http://dx.doi.org/10.2172/1115573.

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Lynn Kidman. Recommendations and Justifications for Modifications for Use Restrictions Established under the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office Federal Facility Agreement and Consent Order, Revision 0. Office of Scientific and Technical Information (OSTI), February 2008. http://dx.doi.org/10.2172/926217.

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Birney, Cathleen, and Mark J. Krauss. Recommendations and Justifications for Modifications To Downgrade Use Restrictions Established under the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office Federal Facility Agreement and Consent Order, Revision 1. Office of Scientific and Technical Information (OSTI), October 2013. http://dx.doi.org/10.2172/1115572.

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Kidman, Lynn. Recommendations and Justifications for Modifications for Use Restrictions Established under the U.S. Department of Energy, National Nuclear Security Administration Nevada Site Office Federal Facility Agreement and Consent Order with ROTC 1, Revision No. 0. Office of Scientific and Technical Information (OSTI), February 2008. http://dx.doi.org/10.2172/948846.

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Rukundo, Solomon. Tax Amnesties in Africa: An Analysis of the Voluntary Disclosure Programme in Uganda. Institute of Development Studies (IDS), December 2020. http://dx.doi.org/10.19088/ictd.2020.005.

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Tax amnesties have taken centre stage as a compliance tool in recent years. The OECD estimates that since 2009 tax amnesties in 40 jurisdictions have resulted in the collection of an additional €102 billion in tax revenue. A number of African countries have introduced tax amnesties in the last decade, including Nigeria, Namibia, South Africa and Tanzania. Despite their global popularity, the efficacy of tax amnesties as a tax compliance tool remains in doubt. The revenue is often below expectations, and it probably could have been raised through effective use of regular enforcement measures. It is also argued that tax amnesties might incentivise non-compliance – taxpayers may engage in non-compliance in the hope of benefiting from an amnesty. This paper examines the administration of tax amnesties in various jurisdictions around the world, including the United States, Australia, Canada, Kenya and South Africa. The paper makes a cost-benefit analysis of these and other tax amnesties – and from this analysis develops a model tax amnesty, whose features maximise the benefits of a tax amnesty while minimising the potential costs. The model tax amnesty: (1) is permanent, (2) is available only to taxpayers who make a voluntary disclosure, (3) relieves taxpayers of penalties, interest and the risk of prosecution, but treats intentional and unintentional non-compliance differently, (4) has clear reporting requirements for taxpayers, and (5) is communicated clearly to attract non-compliant taxpayers without appearing unfair to the compliant ones. The paper then focuses on the Ugandan tax amnesty introduced in July 2019 – a Voluntary Disclosure Programme (VDP). As at 7 November 2020, this initiative had raised USh16.8 billion (US$6.2 million) against a projection of USh45 billion (US$16.6 million). The paper examines the legal regime and administration of this VDP, scoring it against the model tax amnesty. It notes that, while the Ugandan VDP partially matches up to the model tax amnesty, because it is permanent, restricted to taxpayers who make voluntary disclosure and relieves penalties and interest only, it still falls short due to a number of limitations. These include: (1) communication of the administration of the VDP through a public notice, instead of a practice note that is binding on the tax authority; (2) uncertainty regarding situations where a VDP application is made while the tax authority has been doing a secret investigation into the taxpayer’s affairs; (3) the absence of differentiated treatment between taxpayers involved in intentional non-compliance, and those whose non-compliance may be unintentional; (4) lack of clarity on how the VDP protects the taxpayer when non-compliance involves the breach of other non-tax statutes, such as those governing financial regulation; (5)absence of clear timelines in the administration of the VDP, which creates uncertainty;(6)failure to cater for voluntary disclosures with minor errors; (7) lack of clarity on VDP applications that result in a refund position for the applicant; and (8) lack of clarity on how often a VDP application can be made. The paper offers recommendations on how the Ugandan VDP can be aligned to match the model tax amnesty, in order to gain the most from this compliance tool.

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Stall, Nathan M., Kevin A. Brown, Antonina Maltsev, Aaron Jones, Andrew P. Costa, Vanessa Allen, Adalsteinn D. Brown, et al. COVID-19 and Ontario’s Long-Term Care Homes. Ontario COVID-19 Science Advisory Table, January 2021. http://dx.doi.org/10.47326/ocsat.2021.02.07.1.0.

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Key Message Ontario long-term care (LTC) home residents have experienced disproportionately high morbidity and mortality, both from COVID-19 and from the conditions associated with the COVID-19 pandemic. There are several measures that could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes, if implemented. First, temporary staffing could be minimized by improving staff working conditions. Second, homes could be further decrowded by a continued disallowance of three- and four-resident rooms and additional temporary housing for the most crowded homes. Third, the risk of SARS-CoV-2 infection in staff could be minimized by approaches that reduce the risk of transmission in communities with a high burden of COVID-19. Summary Background The Province of Ontario has 626 licensed LTC homes and 77,257 long-stay beds; 58% of homes are privately owned, 24% are non-profit/charitable, 16% are municipal. LTC homes were strongly affected during Ontario’s first and second waves of the COVID-19 pandemic. Questions What do we know about the first and second waves of COVID-19 in Ontario LTC homes? Which risk factors are associated with COVID-19 outbreaks in Ontario LTC homes and the extent and death rates associated with outbreaks? What has been the impact of the COVID-19 pandemic on the general health and wellbeing of LTC residents? How has the existing Ontario evidence on COVID-19 in LTC settings been used to support public health interventions and policy changes in these settings? What are the further measures that could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes? Findings As of January 14, 2021, a total of 3,211 Ontario LTC home residents have died of COVID-19, totaling 60.7% of all 5,289 COVID-19 deaths in Ontario to date. There have now been more cumulative LTC home outbreaks during the second wave as compared with the first wave. The infection and death rates among LTC residents have been lower during the second wave, as compared with the first wave, and a greater number of LTC outbreaks have involved only staff infections. The growth rate of SARS-CoV-2 infections among LTC residents was slower during the first two months of the second wave in September and October 2020, as compared with the first wave. However, the growth rate after the two-month mark is comparatively faster during the second wave. The majority of second wave infections and deaths in LTC homes have occurred between December 1, 2020, and January 14, 2021 (most recent date of data extraction prior to publication). This highlights the recent intensification of the COVID-19 pandemic in LTC homes that has mirrored the recent increase in community transmission of SARS-CoV-2 across Ontario. Evidence from Ontario demonstrates that the risk factors for SARS-CoV-2 outbreaks and subsequent deaths in LTC are distinct from the risk factors for outbreaks and deaths in the community (Figure 1). The most important risk factors for whether a LTC home will experience an outbreak is the daily incidence of SARS-CoV-2 infections in the communities surrounding the home and the occurrence of staff infections. The most important risk factors for the magnitude of an outbreak and the number of resulting resident deaths are older design, chain ownership, and crowding. Figure 1. Anatomy of Outbreaks and Spread of COVID-19 in LTC Homes and Among Residents Figure from Peter Hamilton, personal communication. Many Ontario LTC home residents have experienced severe and potentially irreversible physical, cognitive, psychological, and functional declines as a result of precautionary public health interventions imposed on homes, such as limiting access to general visitors and essential caregivers, resident absences, and group activities. There has also been an increase in the prescribing of psychoactive drugs to Ontario LTC residents. The accumulating evidence on COVID-19 in Ontario’s LTC homes has been leveraged in several ways to support public health interventions and policy during the pandemic. Ontario evidence showed that SARS-CoV-2 infections among LTC staff was associated with subsequent COVID-19 deaths among LTC residents, which motivated a public order to restrict LTC staff from working in more than one LTC home in the first wave. Emerging Ontario evidence on risk factors for LTC home outbreaks and deaths has been incorporated into provincial pandemic surveillance tools. Public health directives now attempt to limit crowding in LTC homes by restricting occupancy to two residents per room. The LTC visitor policy was also revised to designate a maximum of two essential caregivers who can visit residents without time limits, including when a home is experiencing an outbreak. Several further measures could be effective in preventing COVID-19 outbreaks, hospitalizations, and deaths in Ontario’s LTC homes. First, temporary staffing could be minimized by improving staff working conditions. Second, the risk of SARS-CoV-2 infection in staff could be minimized by measures that reduce the risk of transmission in communities with a high burden of COVID-19. Third, LTC homes could be further decrowded by a continued disallowance of three- and four-resident rooms and additional temporary housing for the most crowded homes. Other important issues include improved prevention and detection of SARS-CoV-2 infection in LTC staff, enhanced infection prevention and control (IPAC) capacity within the LTC homes, a more balanced and nuanced approach to public health measures and IPAC strategies in LTC homes, strategies to promote vaccine acceptance amongst residents and staff, and further improving data collection on LTC homes, residents, staff, visitors and essential caregivers for the duration of the COVID-19 pandemic. Interpretation Comparisons of the first and second waves of the COVID-19 pandemic in the LTC setting reveal improvement in some but not all epidemiological indicators. Despite this, the second wave is now intensifying within LTC homes and without action we will likely experience a substantial additional loss of life before the widespread administration and time-dependent maximal effectiveness of COVID-19 vaccines. The predictors of outbreaks, the spread of infection, and deaths in Ontario’s LTC homes are well documented and have remained unchanged between the first and the second wave. Some of the evidence on COVID-19 in Ontario’s LTC homes has been effectively leveraged to support public health interventions and policies. Several further measures, if implemented, have the potential to prevent additional LTC home COVID-19 outbreaks and deaths.

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