Archive for the ‘Issue 20: Nov 11’ Category

Clinical Audit

October 31, 2011 Leave a comment

By: Dr. Nitin Srinivasan, Consultant, ENT cum CMO

OPD consultations follow an established process

Audit is well recognized as a fundamental and compulsory part of clinical practice for quality assurance to attain international standards. To achieve this there must be a well defined and smooth protocol in place comprising of on-going treatment starting from patient attending the hospital for the first time to discharge and further follow up. A multidisciplinary input and monitoring of outcome for all variables which could potentially affect the patient care should also be included. Important areas of assessment within this framework also include patient outcomes (treatment results), appropriateness of care, institutional performance, resource management and patient/health care provider satisfaction.  The objectives of Audit can be summarized as

  • To serve as a basis for continuous and sustainable improvement in patient outcomes. A systematic review of untoward results will allow s clinicians to monitor the clinical outcomes and to bring about improvement in service.
  • To support research and development of clinical policies.
  • To provide insight and feedback to clinician’s performance.
  • To serve as a tool of accountability on clinical outcomes and use of resources.

History of Audit

Florence Nightingale was the first to initiate systematic audit during Crimean War of 1853-1855 with her team of 38 nurses. The results were excellent with her input resulting in mortality rates dropping down to 2% from an earlier of 40%.Ernest Codman (1869 – 1940) was the pioneer of modern Surgical Audit. His work anticipated contemporary approaches to quality monitoring and assurance, establishing accountability, and allocating and managing resources efficiently.

Staging of Audit Process-

Stage 1: Identification of  problem or issue

This stage involves the selection of a topic or issue to be audited, and is likely to involve measuring adherence to surgical practices that have been shown to produce best outcomes for patients. Selection of an audit topic is important in:

  • Where national standards and guidelines exist; where there is conclusive evidence about effective surgical practice (i.e. evidence based medicine).
  • Areas where problems have been encountered in practice.
  • Patient and public recommendations to be considered.
  • Looking for improvement in service delivery.
  • Improvement is needed in areas of high volume, high risk or high cost.

Stage 2: Defining criteria & standards

  • Audit Criteria– Decisions regarding the overall purpose of the audit, either as what should happen as a result of the audit, or what question you want the audit to answer, should be written as a series of statements or tasks that the audit will focus on. Collectively, these form the audit criteria. These criteria are explicit statements that define what is being measured and represent elements of care that can be measured objectively. A criterion is a measurable outcome of care, aspect of practice or capacity.
  • Audit Standards- The standards define the aspect of care to be measured, and should always be based on the best available evidence. A standard is the threshold of the expected compliance for each criterion (these are usually expressed as a percentage).

Stage 3: Data compilation

To ensure that the data collected are precise, and that only essential information is collected, certain details of what is to be audited must be established from the outset. These include:

  • The user group to be included, with any exceptions noted.
  • The healthcare professionals involved in the users’ care.
  • The period over which the criteria apply.

Stage 4: Comparison of performance

This is the analysis stage, whereby the results of the data collection are compared with criteria and standards. The end stage of analysis is concluding how well the standards were met and, if applicable, identifying reasons why the standards weren’t met in all cases. These reasons might be agreed to be acceptable, i.e. could be added to the exception criteria for the standard in future, or will suggest a focus for improvement measures.

Stage 5: Implementation of change

Once the results of the audit have been published and discussed, an agreement must be reached about the recommendations for change. Using an action plan to record these recommendations is good practice; this should include who has agreed to do what and by when. Each point needs to be well defined, with an individual named as responsible for it, and an agreed timescale for its completion.

Action plan development may involve refinement of the audit tool particularly if measures used are found to be inappropriate or incorrectly assessed. In other instances new process or outcome measures may be needed or involve linkages to other departments or individuals. Too often audit results in criticism of other organisations, departments or individuals without their knowledge or involvement.

Re-audit: Sustaining Improvements

After a set period, the audit should be repeated. The same strategies for identifying the sample, methods and data analysis should be used to ensure comparability with the original audit. The re-audit should demonstrate that the changes have been implemented and that improvements have been made.

Categories: Issue 20: Nov 11

Clinical nurses’ experiencing occupational burnout within the health care setting

October 31, 2011 Leave a comment

By: Niyaza Abdul Rahman, Senior Staff Nurse

This is a systemic review based on selected ten research papers out of 100 papers for which the aim was to find out answer for the question of :

How do clinical nurses perceive their experiences in living with burnout within the clinical area setting?

This review was my dissertation for the course which I would like to share the result of it with you all, since it is very much related to our working field and might benefit our nurses in the long run.

The term “Burnout” which appeared around (1975) in scientific literature, is referred as a low job satisfaction in many cases (Lauderdale,1982,p35). There is no specific definition for burnout in terms of medical condition, but it is well recognised and defined as a psychological condition. As a matter of fact burnout is said to be the final stage of stress when everything else fails (IMCARES), 2008

Nurses assisting in surgery

Comparatively health care professionals are at higher risk of getting burnout than any other profession, because of the nature of their work (Erikson & Grove 2008) and as well as the life and death decisions they take (Potter 2005). The main reason why nurses move out of the industry is because they experience stress, sadness, powerlessness, exhaustion, and frustration as their daily routine (Erikson & Grove 2008). From a health care commission report on Maidstone and Tunbridge wells NHS (National Health Service) revealed that staff shortage, ill health and heavy work load are contributory factors for failure of effective dealing with the patients. In addition staffs are also unaware of their own wellbeing for the safety of the patients (Bence 2008, p28). This shows that there is a link between nurses’ burnout and patient satisfaction.

A Nursing Times survey, conducted on 2000 nurses revealed that seven out of ten suffered from work related stress, where sick leaves were increased  by 30 or more sick days for the previous years as a result of job threats, increased workload and staff shortage (Jones 2007).

Burnout in nursing effects not only the organisation but also to the patients as well as the nurses’ well being. As a result of burnout, nurses’ job turnover has been increasing day by day

All these things  consequently leads to a low morale, high absenteeism, high job turn over and other personnel conflicts and thereby  reducing the job satisfaction causing low performance in work ( Carson & Fagin 1996, Cited in Fothergill & Hannigan 2000).

The emerged themes from all ten papers were, Unsupportive management,  Physiological and psychological aspects of burnout, Inadequate availability of resources,  Experience of work place alienation,  Excessive and heavy work load, Strategies for coping mechanism

For the theme of unsupportive management a vast negative perceptions were given by nurses. This theme was supported by nurses’ perceptions and experiences of negativism towards their work, lack of recognition, encouragement, support, poor supervision, high expectation from nursing management and unsupportive administrations.

All we want from management is some recognition for our hard work. Just a ‘Thank you, you’re doing a good job!’ will go a long way to motivate us. – Smit (2005, p26, col 2, lines 27 -29)

Physiological and psychological aspects of burnout were apparent from 9 out of 10 papers. Most frequently expressed psychological consequences from all of the papers were frustration, hopelessness, powerlessness, helplessness and emotional exhaustion.

But I still think in a way, I’ve complained several times but it’s not taken seriously. It’s swept under the rug. So then it really feels, what you say, it’s not worth much. In the long run I don’t think this is good for people. You need to feel involved and that you can change things. – Olofsson and Bengstsson and Brink (2003, p355 col 2 lines 16-21)

For the theme of inadequate availability of resources, mainly highlighted within the studies were, inadequacy of staff, time, high responsibilities with limited resources, skilled staff and basic resources for preventive measures.

Experience of work alienation was highlighted as unfamiliar work environment and equipments, inexperience and incompetency in work and lack of knowledge.

Difficulty in handling the advance equipments and operating the new machines were time consuming for them as they do not have the proper guidance and exposure to it.

Most leading issue from all ten papers were experiencing excessive and heavy workload.

This was highlighted in papers as multitasks with frequent interruptions within a limited time or performing multiple interventions at a limited time which further causes staff fatigue and exhaustion.

You never get any peace; never get done with anything, always interrupted by ringing telephones. During all this an assistant nurse comes and some patient is ill and you have to run. Then run from that to talk on the phone with a relative who’s calling and worried. Then rounds have to be done. These constant interruptions. While I’m supposed to do these things I want to get out and see the patients, what am I sitting here and documenting? How is the patient? How is he or she really feeling? – Olofsson and Bengstsson and Brink (2003, p354 col 2,  lines 39-52)

As for the final theme, strategies for coping mechanism, they have provided perceptions and experiences of how they relived and coped with the stressors faced within the care setting. Apparent strategies were; attempting to reduce stress by remaining calm and quite during the stressful situations, relieving by individual interests, using support and assistance from peers and family members, communicating with co workers, getting involved in something else ignoring the situation and reflecting back the situation and communicating with a colleague.

Findings suggest that nurses’ working under heavy workload pressure experiencing high level of burnout affecting them mentally and physically, which is a serious issue to consider. Consequently this leads them to move out of the industry or with a low performance in their work. Thus health care managements should be more cautious about staff satisfaction and their wellbeing in order to restrain nurses. Additionally it is vital for the supervisors and nurse managers to conduct supervisory sessions and meetings to consider nurses’ problem and to assess their workload. Within the light of this review nurses’ should be able to identify and recognise their stressors early in order to prevent them from burnout or post traumatic stress. Moreover nurses should focus on their own health and well being, caring for themselves which would consequently decrease the level of burnout and promote a quality care.

Categories: Issue 20: Nov 11

Your journey : our business

October 31, 2011 Leave a comment

Maldives Airport Company

Maldives Airports Company has awarded ADK Hospital exclusivity to conduct Aviation Class III medical certification for all their employees who require the Medical for the next two years.

In the aviation sector, staff working in the air traffic services has to undergo an Aviation Class III medicals with the under 40 year olds having to take it once every two years and the over 40 age group taking it once a year.

It is a sign of trust from a major Maldivian Company towards the services of ADK Hospital that they decided to undertake these medicals in partnership with us. ADK Hospital will try to further enhance these services for the benefit of general public at large.

These packages are design to provide a convenient service to the staff who require the medicals. The Hospital is committed to meet the requirements of the Airports Company and looks forward to a fruitful working relationship with Airports Company.

ADK Hospital also provides Aviation Medical Services to Island Aviation Ltd as well. We hope that more companies will take up partnerships with us in future.

Categories: Issue 20: Nov 11

Customer Service Week

October 31, 2011 Leave a comment

By: Hawwa Ali, Customer Relations Officer

Customer serviceprofessionals play a vital role in an organization. They are often the face of a company and the impressions they make have a lasting and long reaching effect.

Red Stars: Azleena, Ulya, Adam, Safa & Rafia

It is no wonder there is a full week set aside to acknowledge these outstanding professionals and their work. In 1992, the U.S. Congress declared the first full week in October “National Customer Service Week”, making it an event celebrated countrywide. The goal of this week is to recognize and thank customer service representatives for their excellent work. Many companies use the week to encourage, express gratitude and show their appreciation for their customer service employees.

In Celebration of this year’s customer service week, we had a survey to recognize and award the best Customer Relation Assistant throughout the week. In additional we rewarded the staffs who give best customer service daily.

The Best Customer Relation Assistant Award is given based on their overall performance which includes greeting the customers, answering phone calls, attending to inquires, directing patients to concerned departments. To check on these criteria, managers had a check list to assess and also evaluated customer feedback slips for customers to tick in order to help us to recognize who gives best service and also for their satisfaction.

Congratulations to all those who performed consistently well and we encourage you to continue doing so. There are many other staff who has the potential to get these awards but remain glued on their chairs and just hope that they will try some day. Those who did not any award this time, set your objectives now and show your capability in giving quality services.

The top performers of the week were, Adam, Azleena, Rafia, Ulya and Safa with Adam and Ulya tying at the top with two stars.

Categories: Issue 20: Nov 11

Prayer Room

October 31, 2011 Leave a comment

Prayer room located near main Laboratory stairs

A prayer room is something that has been missing in the Hospital for quite sometime. Patients, bystanders and even staff ask about the possibility of a prayer room within the Hospital.

Management has always considered this matter and in the past have allocated temporary prayer areas depending on availability of space. However, a small prayer room is now developed to cater for those who are waiting at hospital to utilize. The room can accommodate a decent number of people and is reasonably comfortable for a two to three people at a time.

The prayer room is located near the staircase to the main laboratory. Already many people are seen using the prayer room thus serving the purpose. By providing a convenient way Although this is a small provision, there is a view of the Management to develop a better prayer room in future.

Categories: Issue 20: Nov 11

V-Care activities …

October 31, 2011 Leave a comment

By: V-Care Team

V-Care Nurses Club takes pleasure in writing about our activities on TeamTalk. As we are working hard to achieve our goals and ambitions, we wish to share some of the activities we have scheduled for the month ahead.

In October, we have conducted awareness programs in conjunction with the world breast cancer month. A brochure, vita vital information on breast cancer screening and self testing was developed and distributed to patients. Also a pink ribbon campaign was conducted to create further awareness on breast cancer prevention. We hope that with this campaign, doctors will interact and provide more information on breast cancer prevention to the patients in future.

Our further plans include, celebrating global hand washing day, for which we will be launching a campaign “have you washed your hands?” Thus, we would like all of you to be a part of this campaign in this November with us. In addition to this, First Aid sessions will be organized and conducted to the staff. We would thus, like to see you all in these classes.

Be a part of V CARE and lets us improve the quality and standard of the care we provide.

Categories: Issue 20: Nov 11

In Dr. Nuha’s words …

October 31, 2011 Leave a comment

Employee of the Year 2010

I am immensely proud  to have been rewarded as the ADK Hospital’s  Employee of the Year 2010. ADK as a company is reputed and respected  in Maldives. Health of a Nation is the top most priority for the people. One of the most important and sensitive sectors. ADK Hospital has been rendering  health service to the people of Maldives. ADK, though having some limitations, has been known for its caring service for patients.

I work in the Dental Department as a dentist. To me this is not just a job. I came to work with passion and wanted to serve the people in my profession. There could be no better platform than at ADK Hospital. . The whole team at Dental Department gave me support to deliver day to day performance.

I slowly built a  professional relationship with my patients. They are the people who make us who we are. The dental department is full daily, one of the most pressured departments. To do good work , we need to be on time, have good team work and perform our duties with ethics and dedication .

The management gives us daily support to carryout the work. Assist us in attending issues that come up. A financial raise in our salaries encouraged us to work harder and to deliver good service.

Thank you management and collegues for making me a part of the team. My intention is to work harder and further seek more knowledge and still educate myself in this area of dentistry.

I thank Allah for giving me wisdom and knowledge. I wish ADK hospital every success . This award ADK Hospital gave me is an encouragement to further develop my skills professionally and personally.

Categories: Issue 20: Nov 11