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.

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.

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.

The PGH developed and adopted its own AHF order set that is locally applicable and can potentially optimize outcomes of care.

Infant, Newborn ; Humans ; Quality Improvement ; Intensive Care Units, Neonatal

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.

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

Conducting and writing quality improvement studies is a skill that every family and community physician should learn and apply in their practice. As family and community physicians it is one of our responsibilities to provide quality health care to our patients.1 Simply put, “quality” is doing the right thing right the first time and doing it better the next. Similar to the doctor-patient interaction in a typical consult, where the physician’s objective is to learn as much as possible about the patient’s signs and symptoms and medical history in order to make the right diagnosis and thus render the right treatment. The physician strives to do all this on the first visit and hopes to keep up-to-date on the condition so that when another patient presents with the same condition, he or she will receive better and more current care.

Objectives: Adherence to clinical practice guidelines (CPG) has been shown to reduce inter-physician practice variation and improve quality of care. This study evaluated guideline adherence of physicians in two tertiary public hospitals to local CPG on COVID-19. Methods: This was a multicenter, retrospective chart review, rapid assessment method study. Guideline adherence and non-adherence (overuse and underuse) to 15 strong recommendations in the prevailing Philippine COVID-19 Living Recommendations were assessed among a sample of patients admitted in two centers from July to October 2021. Differences in adherence across COVID-19 disease severities and managing hospital units were analyzed. Results: A total of 723 patient charts from two centers were reviewed. Guideline adherence to dexamethasone use among patients with hypoxemia is 91.4% (95% CI 88.6 to 93.6) with 9.2% overuse. Tocilizumab was underused in 52.2% of patients with indications to receive the drug. There was overuse of empiric antibiotics in 43.6% of patients without suspicion of bacterial coinfection. Lowest adherence to antibiotic use was seen among patients with critical disease severity and those managed in the intensive care unit. None of the other non-recommended treatment modalities were given. Conclusion Management of COVID-19 in both centers was generally adherent to guideline recommendations. We detected high underuse of tocilizumab probably related to the global supply shortage during the study period and high overuse of antibiotics in patients without suspicion of bacterial coinfection. While the results of this study cannot be generalized in other healthcare settings, we recommend the application of similar rapid assessment studies in guideline adherence evaluation as a quality improvement tool and to identify issues with resource utilization especially during public health emergencies.
Guideline Adherence ; COVID-19 ; Quality Improvement

INTRODUCTION: Proton pump inhibitors (PPIs) are effective treatments for upper gastrointestinal pathologies and short-term courses are well-tolerated. However, indiscriminate use of PPIs is undesirable due to its potential harms. We implemented a series of deprescribing interventions between 2016 and 2017 to curb PPI overutilisation in our institution. The aim of this study was to evaluate the effectiveness and safety of these interventions. METHODS: An institutional PPI deprescribing guide was disseminated by email and educational roadshows were conducted to prescribers. Interrupted time series analysis was used to evaluate the effectiveness of the deprescribing interventions over a 7-year period from 2013 to 2019. To ascertain the safety of PPI deprescribing, we analysed the peptic ulcer disease incidence from 2015 to 2018 and conducted a retrospective chart review of 262 inpatients who were deprescribed PPIs. RESULTS: Following the first intervention, there was a significant decrease in mean oral PPI utilisation by 2,324.46 defined daily doses (DDD) per 1,000 prescriptions (95% confidence interval [CI] -3,542.66, -1,106.26) per month, followed by a month-to-month decrease of 302.61 DDD per 1,000 prescriptions per month thereafter (95% CI -473.95, -131.27). A second targeted educational intervention was only effective in sustaining the decline in the outpatient, but not in the inpatient setting. There were no significant changes in incidence of peptic ulcer disease. In the retrospective chart review, a majority (62.6%) of patients remained deprescribed at 6 months. CONCLUSION We observed a sustained decrease in PPI utilisation in our institution for more than 12 months following our educational interventions. Cautious deprescribing of PPIs in eligible candidates was found to be safe with low recurrence rates of upper gastrointestinal events.
Deprescriptions ; Humans ; Proton Pump Inhibitors ; Quality Improvement ; Retrospective Studies ; Singapore/epidemiology* ; Tertiary Care Centers

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.

In leading the high-quality development of Chinese medicine preparations, it is an important link to formulate the scientific, reasonable, and feasible guidelines for the change of Chinese medicines in accordance with the change characteristics and principles of the Chinese medicines is an important work to promote the Technical guidelines for the study of pharmaceutical changes in traditional Chinese medicines was formed by a broad consensus based on the characteristics and research results of the pharmaceutical changes in Traditional Chinese Medicines(TCM)with the principles of science and risk management. This guideline has clarified the basic principles and requirements for the evaluation of changes in TCM, specified the research and verification work of common change scenarios, defined the boundaries of changes in TCM, and proposed to encourage the use of new technologies, new methods, and new excipients that meet product characteristics. It will definitely promote the quality improvement and the secondary development of TCM. In this article, the revision background and main content of the guideline were introduced, and the main features of the Guideline were analyzed, in order to provide references for the industry.
Consensus ; Drug Compounding ; Drugs, Chinese Herbal ; Medicine, Chinese Traditional ; Pharmaceutical Preparations ; Quality Improvement

Betacoronavirus ; Coronavirus Infections ; epidemiology ; transmission ; Disease Transmission, Infectious ; prevention & control ; Education, Medical, Graduate ; organization & administration ; Humans ; Internship and Residency ; organization & administration ; Pandemics ; Pneumonia, Viral ; epidemiology ; transmission ; Quality Improvement