No abstract available.
Quality Improvement

In this study, we attempted to improve hospital food delivery service quality and customer satisfaction by using FMEA (Failure Mode and Effect Analysis), which is applied to the quality control of products in manufacturing plants. Subjective food delivery service quality improvement was judged based on a 5-point likert scale. Traditional FMEA uses an RPN (Risk priority number) to evaluate the risk level of a component or process. The RPN index was determined by calculating the product of severity, occurrence, and detection indexes. In our results, total RPN value (P<0.01) significantly decreased after FMEA introduction, whereas customer satisfaction (P<0.001) and food delivery service quality (P<0.001) significantly increased. Specifically, foodservice errors (P<0.01) and loss cost (P<0.01) were significantly improved by FMEA introduction. Taken together, we suggest that FMEA reduces critical activities and errors in foodservice delivery caused by simple priority selection.
Quality Control ; Quality Improvement

BACKGROUND: Photographic imaging is a valuable tool in Dermatology. Analog cameras have been used for many years for documenting such images. However, with the recent introduction of the digital camera, dermatologists have begun to replace analog images for digital images when recording dermatologic and histologic findings. We employed a continuous quality improvement (CQI) activity to achieve this goal to replace the image recording system. METHODS: A CQI team composed of all the department members was formed to begin digitalization, Problems caused during digitalization were discussed during monthly meetings. RESULT: 1. We could achieve improvements of image management efficacy. 2. There was a reduction of management space. 3. There was a reduction of costs seen in the total expenses of preparing photographic documentation. CONCLUSION: After digitalization of clinical and histological dermatologic imaging, we were able to reduce expenses, use storage spaces more efficiently, and reduce production time. When considering the efficiency of hospital management, these results are very encouraging, and it can be stated that these results are a good outcome of CQI activities.
Dermatology ; Quality Improvement*

No abstract available.
Anesthesiology* ; Publications* ; Quality Improvement*

Background and Objectives: Heart Failure (HF) remains a major health concern worldwide. In the Philippine General Hospital (PGH), HF is consistently a top cause of mortality and readmissions among adults. The American College of Cardiology (ACC) and European Society of Cardiology (ESC) published guidelines for interventions that improve quality of life and survival, but they are underused and untested for local acceptability. Hospitals overseas used order sets created from these guidelines, which resulted in a considerable decrease in in-hospital mortality and healthcare costs. We aimed to develop an order set for adult patients with acute heart failure (AHF) admitted to the PGH Emergency Department (ED) to improve care outcomes. Methods: This study utilized a mixed methods approach to create the AHF order set. ESC and ACC HF guidelines were appraised using the AGREE II tool. Class I interventions for AHF were included in the initial order set. Through focused group discussions (FGD), clinicians and other care team members involved in the management of AHF patients at PGH ED modified and validated the order set. Stakeholders were asked to use online Delphi and FGD to get a consensus on how to amend, approve, and carry out the order given. Results: Upon review of HF guidelines, 29 recommendations on patient monitoring, initial diagnostic, and therapeutic interventions were adopted in the order set. Orders on subspecialty referrals and ED disposition were introduced. The AHF patient was operationally defined in the setting of PGH ED. The clinical orders fit the PGH context, ensuring evidence-based, cost-effective, and accessible care responsiveness to patients’ needs and suitable for local practice. Workflow changes due to COVID-19 were considered. Potential barriers to implementation were identified and addressed. The final order set was adopted for implementation through stakeholder consensus. Conclusion The PGH developed and adopted its own AHF order set that is locally applicable and can potentially optimize outcomes of care.
Quality Improvement ; Critical Pathways

BACKGROUND

The capability of nurse educators to teach and practice quality improvement (QI) is crucial in assisting students in their transition to becoming professionals. Understanding the strengths and limitations of nurse educators on QI can be a logical start to determine if they can keep up with the expectations.

This paper aimed to determine the nurse educators' knowledge, preparation, application, and participation in QI, as well as the differences when grouped according to years of teaching and BSN degree completion.

A descriptive correlational design was utilized involving nurse educators from six nursing schools in Baguio City, Philippines. Only full-time nurse educators with official teaching load during the data gathering, regardless of academic background and position, were eligible. Faculty members who were on leave were excluded. A self-made tool (CVI 0.90, Cronbach's alpha 0.90) was used to gather data. Unpaired t-tests and ANOVA were used to determine the significant differences in the scores. Multiple regression was utilized to compute the relationship between knowledge, preparation, and participation in applying QI.

104 nurse educators responded. Results show that they are knowledgeable (x̄= 15.82; SD = 0.11), somewhat prepared (x̄= 2.93; SD = 0.08), and participated reasonably well (x̄= 2.77; SD = 0.11) on QI. Higher scores were given to the application of QI in the nursing courses (x̄= 2.44; SD = 0.08) and teaching-learning strategies (x̄= 0.83; SD = 0.07), compared with its application in improving Self as educators (x̄= 2.30; SD = 0.11), and improving student's learning outcomes (x̄= 2.13; SD = 0.11). Scores of nurse educators with more than ten years of teaching experience significantly differed in the extent of knowledge, application in teaching-learning strategies, and application of QI tools to improve Self and participation compared to those with less teaching experience. The scores did not significantly vary when grouped according to BSN degree completion. A positive relationship was observed between preparation and the application of QI tools to improve Self (p = 0.00). Data also showed a positive relationship between participation with application in nursing courses (p = 0.00), application of QI tools to improve Self (p = 0.00), and student learning outcomes. (p = 0.00).

The results of this study are encouraging and show the potential of nurse educators to apply quality improvement in the nursing curriculum. The adept use of technological tools in producing QI projects can augment the strength of nurse educators in meeting patient-centered care. Teaching experience can contribute to a better grasp of the concepts and maximum integration of quality improvement in nursing students' learning. Identifying, mobilizing, and supporting QI champions to spearhead the mentoring of new faculty members on QI may be a viable strategy to sustain a culture that values quality improvement. It further calls for the attention of educational institutions to develop policies to inform nurse educators in applying QI concepts.

No abstract available.
Analgesia, Patient-Controlled* ; Quality Improvement*

No abstract available.
Endoscopy* ; Mass Screening* ; Quality Improvement*

BACKGROUND: There have been few recent reports on the methodological quality of meta-analysis, despite the enormous number of studies using meta-analytic techniques in the field of anesthesia. The purpose of this study was to evaluate the quality of meta-analyses and systematic reviews according to the Assessment of Multiple Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the anesthesia literature. METHODS: A search was conducted to identify all meta-analyses ever been published in the British Journal of Anaesthesia (BJA), Anaesthesia, and Korean Journal of Anesthesiology (KJA) between Jan. 01, 2004 and Nov. 31, 2016. We aimed to apply the AMSTAR and PRISMA checklists to all published meta-analyses. RESULTS: We identified 121 meta-analyses in the anesthesia literature from January 2004 through the end of November 2016 (BJA; 75, Anaesthesia; 43, KJA; 3). The number of studies published and percentage of ‘Yes’ responses for meta-analysis articles published after the year 2010 was significantly increased compared to that of studies published before the year 2009 (P = 0.014 for Anaesthesia). In the anesthesia literature as a whole, participation of statisticians as authors statistically improved average scores of PRISMA items (P = 0.004) especially in the BJA (P = 0.003). CONCLUSIONS: Even though there is little variability in the reporting and methodology of meta-analysis in the anesthesia literature, significant quality improvement in the reporting was observed in the Anaesthesia by applying the PRISMA checklist. Participation of a statistician as an author improved the reporting quality of the meta-analysis.
Anesthesia* ; Anesthesiology ; Checklist* ; Quality Improvement

Objectives. The patient medication counseling (PMC) services at Philippine General Hospital (PGH) started 21 years ago. While several changes have been incorporated into the program, no formal evaluation has been conducted to date. The objective of this evaluation was to assess the relevance, usefulness, responsiveness, acceptability, efficiency, impact, and sustainability of the service using the context, input, process (CIPP) model of Stufflebeam.

Methods. The study utilized a mixed-methods study design. Interviews and surveys were conducted on pharmacist-counselors, a purposive sample of doctors, nurses, and other stakeholders. A review of records from the Department of Pharmacy of UP College of Pharmacy (UPCP) and PGH, such as patient and student satisfaction surveys and monthly reports of counseled patients served from 2015 to 2019, was conducted. The results were analyzed using descriptive statistics for quantitative data and content analysis for qualitative data.

Results. Context evaluation revealed that the establishment of PMC resulted from informal interactions with hospitalized patients due to incorrect use of prescription medicines. Correct information was envisioned to address the irresponsible use of medicines. The input evaluation revealed that only 24% (N=75) of the pharmacists are involved in PMC, which comprise only 10% of their workload. There was also a lack of comprehensive training for counseling and insufficient physical facilities. The process evaluation identified lack of time (94%) as a significant limiting factor for the involvement of pharmacists in PMC. The interns became an additional workforce for the service, but scheduling and the consistent availability of both students and faculty-preceptors were experienced. The product evaluation revealed positive perceptions among the pharmacists, faculty, and student interns. From the patient satisfaction survey records of 5,071 patients counseled, 98 to 100% expressed high service satisfaction, and 100% were likely to recommend PMC to other patients. The pharmacists, interns, and faculty-preceptors suggested that PMC improved their confidence, communication skills, and decision-making.

Conclusion. The PMC service is relevant and valuable to ensure patients' rational and quality use of medicines. As a value-added service to existing hospital pharmacy services, it serves as a venue for enhancing soft skills among pharmacists and students alike. However, physical and human resources and current processes need to be upgraded to improve efficiency, ensure sustainability, and expand service coverage to more patients.