Emerald | Clinical Performance and Quality Healthcare | Table of Contents

Is Clinical Pathology Accreditation worth it? A survey of CPA-accredited laboratories

literatinetwork@emeraldinsight.com (Lindsey A. Gough, Tim M. Reynolds) — Fri, 01 Dec 2000 00:00:00 +0000

Abstract

Following two pilot studies, Clinical Pathology Accreditation (CPA) accreditation was introduced to UK pathology laboratories in 1992. Since then, significant numbers of laboratories have undergone accreditation but many have never applied. We carried out a postal survey of 145 accredited laboratories in the UK to independently determine the opinions of laboratory managers/clinicians about CPA and whether accreditation had produced any significant benefits to pathology services. Ninety-three replies were received (64 per cent) a good response to an unsolicited questionnaire. Most laboratories felt accreditation by CPA had resulted in better laboratory performance with more documentation and better health and safety and training procedures. CPA accreditation was believed to provide useful information by approximately 50 per cent of laboratories but was also felt by a significant proportion of laboratories to be over-bureaucratic, inefficient and expensive (46 of 93 respondents). Many complaints were voiced about the excessive paperwork that CPA generated and there was also a significant body of opinion that felt that CPA assessed areas were the domain of other regulatory bodies such as the CPSM, IBMS and HSE.

Comparison of clinical indicators for performance measurement of health care quality: a cautionary note

Fri, 01 Dec 2000 00:00:00 +0000

Abstract

The use of clinical performance data is increasing rapidly. Yet, substantial variation exists across indicators designed to measure the same clinical event. We compared indicators from several indicator measurement systems to determine the consistency of results. Five measurement systems with well-defined indicators were selected. They were applied to 24 hospitals. Indicators for mortality from coronary artery bypass graft surgery and mortality in the perioperative period were chosen from these measurement systems. Analyses results and concludes that it is faulty to assume that clinical indicators derived from different measurement systems will give the same rank order. Widespread demand for external release of outcome data from hospitals must be balanced by an educational effort about the factors that influence and potentially confound reported rates.

An audit of psychiatric case notes in relation to antipsychotic medication and information giving

Fri, 01 Dec 2000 00:00:00 +0000

Abstract

This paper reports upon a Welsh Office funded “clinical effectiveness” project. The project aimed to produce evidence-based practice guidelines for depot neuroleptic medication. An audit was conducted to establish current practice regarding the provision of illness and treatment specific information to out-patients and their informal carers. Sixty-five patients’ case-notes, under the care of a single community mental health team were examined for evidence of the type, nature and frequency of information given to patients receiving typical depot neuroleptic medications. Service guidelines were produced and are presented.

Introducing ropivacaine into a department’s epidural analgesic practice. Improving acute pain service practice

Fri, 01 Dec 2000 00:00:00 +0000

Abstract

The results of introducing a new licensed local anaesthetic drug, ropivacaine, into routine practice were evaluated by measuring the efficacy and adverse effects of patient controlled epidural analgesia (PCEA), using ropivacaine 2mg/ml (R), or the mixtures in current use: fentanyl 5 (µg/ml with bupivacaine 1mg/ml (BF5) and fentanyl 10 (µg/ml) with bupivacaine 1mg/ml (BF10). All patients were nursed on general wards after surgery. For two months, 102 consecutive patients were studied. Pain scores at rest were significantly better in the fentanyl and bupivacaine groups, (mean rank R: 35.5, BF5: 22.7, BF10: 26.9, P<0.05). There was a significant correlation between patient controlled boluses and pain at rest and (p < 0.001), and pain on moving (p < 0.001). Nausea and vomiting was worse in the BF10 (p < 0.05). Older patients demanded less analgesia (p < 0.001). Postoperatively BF5 provided better pain relief with trends demonstrating fewer side-effects and complications than BF10 or R. We now use fentanyl 5 (µg/ml and bupivacaine 1mg/ml as our standard epidural infusion mixture.

Reviewing a service – discovering the unwritten rules

literatinetwork@emeraldinsight.com (R. Cullen, S. Nicholls, A. Halligan) — Fri, 01 Dec 2000 00:00:00 +0000

Abstract

In our previous article we looked at the history of quality development and discussed how the implementation of clinical governance provides the opportunity to begin the cultural shift necessary to underpin quality in the modern NHS. This article begins an explanation of the model of quality improvement followed by delegates to the Clinical Governance Development Programme by looking at the service review process delegate teams undertake.

Clinical risk – minimising harm in practical procedures and use of equipment

literatinetwork@emeraldinsight.com (Jane Cowan) — Fri, 01 Dec 2000 00:00:00 +0000

Abstract

The article discusses some of the clinical negligence problems and risk management issues arising from training of health professionals (predominantly junior hospital doctors) in practical procedures. There continue to be incidents, claims and complaints in the NHS arising from the clinical practice of doctors or other health professionals who are not perceived to be competent in some of the practical skills they are undertaking. This article addresses some aspects of this training, where it should best be started and who should have responsibility for ensuring that doctors, in particular, continue to work under appropriate supervision. Also acknowledges the current problems facing NHS trusts in trying to ensure that risk management standards are met for training health professionals in the use of medical equipment – a task that has not previously needed to be documented or accounted for on a formal basis. There are considerable resource implications attached to the introduction of systems that can assess and monitor the training provided in the use of medical equipment but the introduction of a baseline assessment is an essential part of sound clinical governance and risk management. It is suggested that risk management exercises of this nature are worthwhile in reducing the potential for harm to patients.