assignment of hospital wards

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• For authors
• Browse by collection
• BMJ Journals More You are viewing from: Google Indexer

You are here

• Volume 9, Issue 3
• What matters to medical ward patients, and do we measure it? A qualitative comparison of patient priorities and current practice in quality measurement, on UK NHS medical wards
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• http://orcid.org/0000-0001-9381-5556 Samuel Pannick 1 , 2 ,
• http://orcid.org/0000-0003-1349-7178 Stephanie Archer 1 ,
• Susannah Jane Long 1 , 3 ,
• Fran Husson 1 ,
• Thanos Athanasiou 4 ,
• Nick Sevdalis 5
• 1 NIHR Imperial Patient Safety Translational Research Centre , Imperial College London , London , UK
• 2 Gastroenterology , Imperial College Healthcare NHS Trust , London , UK
• 3 Medicine for the Elderly , Imperial College Healthcare NHS Trust , London , UK
• 4 Surgery and Cancer , Imperial College London , London , UK
• 5 Centre for Implementation Science , Kings College London , London , UK
• Correspondence to Dr Samuel Pannick; sam.pannick{at}nhs.net

Objectives To compare the quality metrics selected for public display on medical wards to patients’ and carers’ expressed quality priorities.

Methods Multimodal qualitative evaluation of general medical wards and semi-structured interviews.

Setting UK tertiary National Health Service (public) hospital.

Participants Fourteen patients and carers on acute medical wards and geriatric wards.

Results Quality metrics on public display evaluated hand hygiene, hospital-acquired infections, nurse staffing, pressure ulcers, falls and patient feedback. The intended audience for these metrics was unclear, and the displays gave no indication as to whether performance was improving or worsening. Interviews identified three perceived key components of high-quality ward care: communication, staff attitudes and hygiene. These aligned poorly with the priorities on display. Suboptimal performance reporting had the potential to reduce patients’ trust in their medical teams. More philosophically, patients’ and carers’ ongoing experiences of care would override any other evaluation, and they felt little need for measures relating to previous performance. The display of performance reports only served to emphasise patients’ and carers’ lack of control in this inpatient setting.

Conclusions There is a gap between general medical inpatients’ care priorities and the aspects of care that are publicly reported. Patients and carers do not act as ‘informed choosers’ of healthcare in the inpatient setting, and tokenistic quality measurement may have unintended consequences.

• healthcare quality
• medical ward
• patient experience

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/ .

https://doi.org/10.1136/bmjopen-2018-024058

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Strengths and limitations of this study

Participants included older, frail patients and those who did not speak English as a first language—demographics often excluded from safety and quality research.

Our results build on the findings from postdischarge survey studies, free from recall bias.

Current inpatients are in a vulnerable position and this may have affected some of their interview responses.

The findings of this single-site study may not be generalisable, although the ‘static’ performance measures seen at the study site are typical of those reported in other literature.

We focused on ward displays; other repositories for quality metrics, not in public view, may better approximate patient priorities.

Introduction  

Patient involvement is a priority for the patient safety and healthcare quality movement, 1 but how best to involve patients remains unclear. Policymakers favour the transparent publication of quality metrics (ie, performance reporting) as a means of engaging patients in their care, framing this engagement as an informed choice of healthcare provider. In the right context, providing appropriate information can improve patients’ and carers’ participation in their care, perhaps even improving outcomes. 2 In the UK, this ‘informed choice’ argument has led to the mandatory display of performance metrics on NHS inpatient wards. 3

In the acute setting, however, inpatients are unlikely to use performance measures as would typical ‘consumers’. These patients are rarely given a choice of provider. Instead, they are assigned to an available ward, or medical team, as determined by organisational capacity. In addition, the debilitation and stress of an acute illness can impede information processing, and intense anxiety can lead to active information avoidance. This may equally affect patients’ families or carers, who focus on the immediate health concerns of their loved ones. Even when patients are comfortable accessing complex information at home, they should be treated as ‘situationally impaired’ in the hospital environment. 4 Whether inpatients value service-level metrics, and how they relate to them, have not yet been evaluated.

Here, we compare the quality metrics selected for public display in NHS medical wards to patients’ and carers’ expressed quality priorities. We sought to capture patients’ and carers’ perceptions of a ‘good ward’, to better understand their reactions to the quality metrics on display.

The study was conducted on general medical wards, which provide the majority of acute inpatient care but struggle for organisational attention or targeted improvement strategies. 5 We assessed ward information displays in two acute medical wards and two geriatric wards at a tertiary NHS (public) hospital in London, with a proforma. This captured the type of performance metrics on public view (eg, specific hospital-acquired infections or pressure ulcers); whether the metrics themselves were clearly defined; whether there was a reference performance benchmark or goal; and how the information was displayed. Free text notes highlighted any adjacent information on the display boards.

Examples were photographed with a digital camera. These images provided insights into the time and priority that the displays were afforded in practice: images are powerful conduits for the feel and texture of environments. 6 Visual materials ‘ reveal what is hidden in the inner mechanisms of the ordinary ’, providing perspective on everyday practices. 6 This ‘visual sociology’, or visual research method, also allows the researcher to reflect on what they encounter in their fieldwork. In doing so, photographic meaning is constructed: one must be aware that photos are not themselves unmediated or unbiased, but dependent on the viewer. 7 Although these documents of record are not undisputed, their value lies in triangulation with other data, in this case the objective categorisation of their contents, and in their interpretation by patients and carers.

The photos were used as prompts in semi-structured interviews with general medical inpatients and their carers at the hospital. Interviews are key tools ‘in assessing user views of services and healthcare provision, and in revealing why some care is perceived as poor quality’. 8 The interviews were based on a topic guide, codeveloped with patient and carer representatives, exploring care priorities and the concept of a good ward (see online supplementary file ). The topic guide was used flexibly, harnessing broad prompts and follow-up questions, in view of the different roles of the participants (carers and patients) and their varying lengths of hospitalisation.

Supplemental material

Ward staff (doctors, nurses and allied professionals) were asked to suggest patients or carers who would be physically capable of taking part in an interview. Participants were aged over 18 years, and able to provide informed consent. Patients were excluded if they were physiologically unstable, had major cognitive or communication difficulties or did not speak English. The interviews took place at patients’ bedsides, as described previously in qualitative work with hospitalised medical patients. 9 Unintentional power relationships and a false therapeutic rapport can develop within sensitive interviews, with implications for data quality. 10 11 To mitigate this, no members of the study team were involved in the participants’ clinical care, and this was clearly communicated to the interviewees when they gave their consent to take part in the study. In addition, the interviews were framed as entirely separate from their ongoing clinical care. 11 The interviews were conducted by a specialist registrar in internal medicine and gastroenterology, undertaking a PhD in healthcare quality improvement, with previous experience of qualitative research (SP). Interviews were audiotaped, and then transcribed verbatim. Using NVivo (QSR International, Australia), two researchers trained in qualitative methods (SP—doctor and SA—psychologist) analysed the transcripts using an inductive (theory-generating) thematic analysis. 12 Each researcher coded the transcripts individually, generating an individual coding frame, which was then discussed and refined between the two coders. The transcripts were coded again, before a group of higher order themes was proposed. A third round of analysis—individually, and then with consensus—confirmed these metathemes and the aggregation of coded transcript fragments within them. The two researchers serially reviewed these results as the interviews were ongoing, and data collection ceased when the study reached saturation, that is, when no new themes were becoming apparent.

Patient and public involvement

The interview topic guide was coproduced with local patient and carer representatives, who in turn canvassed their patient and carer networks for opinions and feedback. The patient representative (FH) coauthored the final manuscript reporting the study’s results.

Interview participants

Fourteen people were interviewed (nine patients and five carers). Seven people (four carers) were female. Patients had a median age of 75 (range 57–86), with a median length of stay of 5 days. Seventy-one per cent of participants spoke English as a first language. Fourty-four per cent (4/9) of patients depended on family or community support, and 33% (3/9) of them had undergone other hospital admissions in the preceding 6 months. Nine interviews took place on the acute medical wards and five on medicine for the elderly wards. Interviews lasted a median of 23 min (range 11–48 min).

What performance metrics were on display, and how were they portrayed?

Performance metrics evaluated hand hygiene, hospital-acquired infections (meticillin-resistant  Staphylococcus aureus and Clostridium difficile ), nurse staffing, pressure ulcers, falls and patient feedback (see online  supplementary file and table 1 ). The intended audience for these metrics was often unclear: individual display boards contained combinations of messages for patients and staff. Possessive pronouns (our and your) and pronouns (we and you) were used interchangeably, within the same display, to refer to both patients and staff.

• View inline

Performance indicators available in public ward areas

Performance measures were displayed with little background information or context. Each metric was displayed as a single, static measure of performance, with no evidence of trends over time. There was no indication of an acceptable benchmark. No patient-actionable information was given for any of the performance measures, other than a suggestion to speak to a senior nurse for more information about staffing on the ward. Ward displays about local quality and safety priorities (eg, ‘MRSA compliance’) were not explicitly linked to previous performance.

Patient and carer interviews were wide ranging. For ease of understanding, we have aggregated the results into the following sections.

What makes a good ward in the eyes of the patients and their carers?

The interviews identified three key components of high-quality ward care: communication, staff attitudes and hygiene.

Communication

Participants felt entirely dependent on staff to keep them abreast of forthcoming investigations and treatments. They valued prompt communication and were keenly aware of its absence. At the same time, they recognised that treatment plans would frequently change, often for reasons outside of their teams’ control and simply held those teams accountable for keeping them updated:

I know it is not always possible that definitive information is available. But as long as you are informed to the ability that they can inform you, you cannot have any gripes about that. If someone says to you, ‘Look, you may go home tomorrow’, I am big enough and ugly enough to know that it may be the day afterwards… (Patient 3)

The value of effective, shared communication within the multidisciplinary team was also highlighted. The capacity to speak to one team member, and have that conversation disseminated promptly to the rest of the team, was a key feature of good performance:

I have found you’ll be speaking to one person—and it could be a nurse or a doctor or anybody else—and at the end of the day, everybody knows what I’m talking about… So you can communicate with [just] one person… It’s a vital thing. (Carer 1)

Most comments about information sharing within multidisciplinary teams came from carers, rather than patients. This perhaps reflected the role of carers in the ward environment, where they act both as an information source for professional teams and as advocates for the patients.

Staff attitudes

The second element of high-quality care was staff attitude. Considerable attention was paid to how staff went about their work: staff attentiveness, or ‘service’, influenced whether patients felt they were on a good ward. Adjectives like ‘jolly’, ‘respectful’ and ‘helpful’, or ‘abrupt’ and ‘wishy-washy’, were not so much seen as individual personality attributes, as they were features of work performance:

[A] good ward is to be helpful to patients, being more human than a machine, you understand? (Patient 2)

I think it’s the attitude of people [that makes a good ward]. It’s the main thing. (Patient 6)

Thus, the manner of care delivery—rather than the resources available for it—largely defined the care experience. The corollary of this was the potential for a major change between one shift and the next, even on the same ward. There was a sense, perhaps, that rather than a good or bad ward there were just good shifts or bad shifts:

Where it changes more than anything else is at night, when you have a complete change of staff. Sometimes the night staff that come on are absolutely fantastic, and are very engaged. But sometimes they are entirely the opposite. It is like, ‘Well we are just here to get you through until the morning, when the people that are looking after you come back.’ (Patient 3)

As well as analysing their own interactions with staff, patients and carers were keen observers of the working relationships between different professionals on the ward. Whether staff seemed appreciative of each other’s efforts, or were openly disrespectful to one another, caused patients to wonder how they too were being treated:

[You might think] the more staff, the better the person feels, and that is not how I feel… Everything depends on the lower level[s] of staff we’ve got working in the ward… and their position [should be] respected by the doctors and the more senior people… They did all [sorts of tasks], and nobody seemed to recognise that they were doing something like that… (Patient 7)

Two nurses were having a fight with each other, and that’s not very good for the rest of us. And of the course the supervisor was asking them to be quiet, because they were shouting and screaming at each other. (Patient 4)

Yet, these observations of staff behaviours were quite nuanced. Patients recognised different types of unproductive working relationships, describing over-familiarity (‘ almost like a bunch of friends working together ’—Patient 3), as well as open antagonism. They also made allowances for the general workload on the ward, even excusing displays of inappropriate behaviour:

There’s a lot of pressure put on the staff, you know it’s understandable. You can see that they’re actually very tired people, they needed a good rest, and that’s why the whole thing gets on top of them, they’re overworked. (Patient 4)

In a similar vein, patients and carers expressed quite subtle views of why they held hygiene standards to be important. First, good hygiene was de facto evidence of a ward that was providing safe care, with little risk of iatrogenic infection. Patients and carers were conscious of the possibility of hospital-acquired infection, understanding it as a major risk associated with inpatient care. Minimising that risk made it possible to focus on the acute medical issues at hand. Second, good hygiene served as a deeper marker of staff pride, diligence and attention to detail, all of which were reassuring:

The cleanliness aspect, I think, is… more important than possibly people realise… It sets out a marker if you like… if the mindset of the ward is, you know, ‘We are proud of the place that we work in.’ So it is a fairly good marker of how that ward will actually be. (Patient 3)

How did patients and carers perceive the quality metrics on display?

Benefits—using infection data for hand hygiene, and understanding staff performance.

Patients and carers described some benefits of the quality metrics on display, particularly when it came to infection data. They acknowledged prompts to focus on their own hand hygiene, while hoping that staff would do the same. In some cases, a vague familiarity with infection control terminology was helpful:

Because that’s in the press [MRSA rates], I suppose people do want to know that, don’t they? All of this you read in the papers of people being in hospital—they went in with one thing and they came out with that… You don’t want to get worse. They’re meant to be making you better. (Patient 5)

Real-time information on staffing levels was also potentially helpful, in that it could help set realistic expectations of the care patients might receive:

When I’m getting poor service on a particular day, at least I can see that there might be a good reason for it… I would be more understanding, if I had to wait twice as long for help, if I knew that there was only half the number of staff there should be. (Patient 8)

When I saw the amount of staff that you’re supposed to have on the ward, there were not half the staff. So the other staff that turned up were constantly busy, running back and forth, and you can see how much stress they were [under]. But they were doing a good job… You can see the nurse who has turned up is doing a really good job. (Carer 1)

Significant drawbacks—problems in information delivery, prioritisation of personal experience and unintended consequences

However, patients and carers were largely disparaging about the quality metrics on display. There were numerous problems with information delivery, such as inadequate font size or colour contrast. Yet even with these issues addressed, the information provided was fundamentally inadequate to make a judgement about quality. Patients struggled to see the relevance of a single figure when no trend or benchmark was provided:

Obviously as a member of the public I want the minimum [information], but I have nothing to compare it with. So if you [say], ‘We’ve not had one [infection] for three years’, I can’t compare that with anything. So it doesn’t mean anything to me… (Carer 5)

That [single figure] doesn’t mean anything. That doesn’t inform. It could be an increase… but it could be [a] decrease. (Patient 2)

More broadly, participants felt little need for measures that related to their wards’ previous performance. Their ongoing experiences of care would override any other evaluation. From each individual’s perspective, their personal care was the priority, whether or not it reflected a typical standard of care on that ward. In that light, other performance metrics became irrelevant:

I use my own judgement. If I’m satisfied: that’s it. (Patient 9)

If we want information, we ask for it and we get it. As long as [my relative] is alright and getting looked after, I’m not really bothered about nothing else. If she’s getting well looked after, the nurses are lovely, their care is great… that’s all we are concerned about. (Carer 3)

As a result, the production of ward quality metrics had some unintended consequences, even going so far as to reduce patients’ trust in the whole enterprise. The absence of baseline data in quality displays in particular raised suspicions that poor performance was being concealed.

Let us face it… you have got your 100% figure there. Would you put up a 20% figure?… What would you be doing? You would be ruining the confidence of the patients… (Patient 3)

Patients and carers felt that staff had to have ownership of the quality agenda in hospital: quality metrics were for staff—not patients—to digest. Many interviewees drew comparisons with other settings in which they were consumers: as restaurant diners, or as car purchasers, where their ability to exercise a choice was crucial. Here, however, they had no power to choose, and the display of performance reports only served to emphasise their lack of control:

It would be great if I’m admitted and I’m given a choice of five wards, and I would say, ‘Well, how do I know which one’s which, which one’s best?’ My next question would be, ‘Can you give me the audits of those wards to show which has the highest rating?’ and I would go to that… If there’s no choice, then it’s all academic. (Patient 8)

Well, other than clean the wards, there’s not a lot we can do is there? What else can you do? (Carer 4)

The ‘Friends and Family Test’ question was found to be particularly challenging, given that these patients had no choice in arriving on the ward in the first place, nor could subsequent patients exercise a preference to get there. Indeed, the service pressures on hospital admissions were so well publicised that the idea of choosing a ward seemed faintly ridiculous:

Would I recommend a ward? How can you recommend a ward?… I mean, that’s a daft question, because… they put you in the place you need to be, don’t they? (Patient 5)

To our knowledge, this is the first study to compare publicly displayed performance metrics with patient and carer perceptions of high-quality care on UK medical wards. We identified discrepancies between patient-identified and carer-identified priorities and the quality metrics relating to their care on general medical wards. Patients and carers expressed three core components of high-quality general medical care: communication, staff attitudes and hygiene. These were only partially aligned with the performance measures on display. Specifically, we found process and outcome measures relating to hand hygiene and iatrogenic infection, but none specifically relating to attitudes or communication. Patients and carers acknowledged limited benefits to the display of performance data, but had significant reservations about how it was contextualised. They relied on their own experience of care to judge its quality, above any objective measure of performance. More philosophically, they questioned the purpose of publicly displayed performance data, given their lack of choice in this setting. In some cases, these reservations actually eroded trust in ward teams’ performance.

This study builds on a body of research exploring patient priorities and patient involvement in the acute hospital setting. Boyd surveyed recently discharged patients, similarly finding that communication, patient–professional interactions, hygiene and the technical delivery of care were their main priorities. 13 Our study suggests that Boyd’s findings (which excluded current inpatients) were not unduly affected by recall bias. Nonetheless, hospitalised patients remain relatively indifferent to service-level performance and change. 14 We suggest an explanation for this: current inpatients are unable to exercise informed choices about their ward, nor are they able to directly use information to improve performance. They are therefore excluded from the two key pathways by which performance measurement may lead to quality improvement. 15

Our findings question the mandatory collection, and display, of performance data that do not align with patient priorities. These data collection exercises have considerable opportunity costs. We note the recent call for the abolition of the mandatory Friends and Family Test, one of the performance indicators we found on display, which has been criticised on similar lines. 16 These data sets are expensive to maintain, ‘at best tolerated, often ignored, and sometimes ridiculed’. 16 The resulting tokenistic display of performance data erodes patients’ trust in the system that organises and governs their care. It can also be corrosive for staff morale, both at the frontline and at board level. 17 18 This tokenism is perpetuated by a dearth of resources for implementing meaningful improvement. 1 19 A credible, coproduced, quality framework for acute medical inpatients is urgently required, with outcomes that are sensitive to the work 20 and structures 21 of inpatient care. Coproduced quality standards should capitalise on the active contributions of patients and carers, rather than depicting them as ‘informed choosers’ of healthcare provision.

Study limitations include a relatively small sample from a single site. We collected demographic data for patients but not their carers. Nonetheless, the group of interviewees included demographics often excluded from safety and quality research: older, frail patients and those who do not speak English as a first language. 22 The study reached data saturation, with no new themes emerging as the final interviews took place. Ward displays at this site were also typical for regional practice. ‘Static’ performance measures, as seen here, are widespread, and even the performance data presented at healthcare board level rarely depicts the role of chance in the formation of data patterns. 23 24 Finally, other repositories for quality metrics, beyond those ward displays analysed here, may better approximate patient priorities. However, they typically use composites of the data we found, 25 or are aggregated to the hospital level, with no ward-level interpretation. 26 27

In conclusion, we found a gap between general medical inpatients’ care priorities and the aspects of care that are publicly reported. Where performance measurement could have been useful to patients and carers, suboptimal displays only served to emphasise their passive receipt of services. Unless patients and carers are invited to define the quality metrics they hold relevant, ward services may struggle to engage them in improvement efforts. Ultimately, tokenistic quality measurement may have unintended consequences, eroding patients’ trust in their healthcare teams.

Acknowledgments

We are grateful to Drs Louise Hull and Tayana Soukup for their help in facilitating the focus groups. We thank Ms Margaret Turley (carer representative) from the NIHR Imperial PSTRC for her help developing the interview guide.

• O’Hara JK ,
• Sheard L , et al
• Shaller D ,
• Kanouse DE ,
• Schlesinger M
• 3. ↵ Department of Health . Hospital ‘friends and family test’ announced . Available : https://www.gov.uk/government/news/hospital-friends-and-family-test-announced ( Accessed 11 Dec 2017 ).
• Pannick S ,
• Wachter RM ,
• Vincent C , et al
• van Royen P ,
• Tobiano G ,
• Bucknall T ,
• Marshall A , et al
• Baillie J , et al
• Hopewell-Kelly N , et al
• Farnan JM ,
• Arora VM , et al
• Berwick DM ,
• Cornwell J ,

• Philosophies, Beliefs and Goals
• Company Information
• Technology Principles
• Associations
• Blood Banks
• Pathological Labs
• Equipment Suppliers
• Pharma Companies
• Recruiters Section

Ward Management

Home » Cyber Lectures » Hospital Administration » Ward Management

Manish Sharma

Objectives:.

• Provides Quality nursing care.
• Supervises cleanliness and maintenance of ward.

Introduction:

The implementation of overall plan for nursing department provides for establishment of a number of units of wards. So the process of administration must enter into these wards.

Objectives of Ward Management:

• To provide highest quality nursing care for patient.
• To provide a clean, well ventilated environment for patient and protect him from infection, accidents and hazards.
• To help the staff in achieving highest degree of job satisfaction.
• To provide facilities to meet the needs of patient and their attendants.

Components of Ward Managements:

• Patient care.
• Personnel Management.
• Supply and equipment.
• Environment Cleanliness.
• Interpretation of policies and procedures.

A) Patient Care:

This include all activities necessary to provide nursing care

• Concerned with comfort and well being of every patient.
• Assessment of patients need and planning or care.
• Concerned with carrying out of medical treatment.  Helping physician in carrying out procedures, preparing equipment for assisting physician with diagnostic tests and therapeutic measures.  Giving medicine and carrying out treatment, observing patient for any untoward reaction following treatment and making necessary measures to combat them.
• Concerned with education of Staff Nurses (incidental and planned), concerned with patient and relatives about maintaining and improving his health and to carry out his treatment when he goes home.

B) Personnel:

Assignment of personnel for patient care Staff Nurses can be given assignment according to patient i.e. patient assignment or it can be functional assignment.

It is responsibility of ward sister to take ward round.  Ward round is a tool of super vision, evaluation and teaching.  Ward round is of different types.

• Doctor round
• Matron round
• Ward sister round

Doctor Round:

Two essential figures at a ward round are Doctor and nursing sister.  It is no way necessary for ward sister to feel inferior to a doctor when he comes to her ward as her function is that of coordinating team which function for the benefit of patients.

Preparations for Round:

• Ward should be clean and tidy.
• There should not be too many relatives in the ward.
• Patient charts should be upto date and all relevant information regarding patient should be available.
• Have all patients in bed before round.
• Diagnostic tray should be ready for use.
• Do not conduct round during lunch time/visiting hours.

Conducting Round:

• Instruct the staff nurse to stay on patients left side to help in patient’s examination.
• Remember and report observation to doctor.
• record orders/get them written by doctors.

After the ward Round:

• Instruct staff nurses to carry out orders
• Observe patient carefully.

Matron’s Round:

Matron is usually looked upon a confident adviser.  She must visit patients regularly and take this opportunity to provide guidance to nurses.

Ward Sister Round:

Ward sister should also take round with staff nurses. She observes which patient is critically ill and require skilled attention, to supervisor normal routine of ward.  To check poison cupboard.  To have an idea of condition of stock and equipment and to note the standard of work.

C)  Domestic Management:

Sanitation and provision of therapeutic environment includes:.

• Temperature regulation.
• Proper light.
• Elimination of unpleasant odours.
• Safe water supply.
• Safe disposal of excreta.
• Dust control
• Free from insects and pest.
• Protection from mechanical, thermal, chemical and bacteriological injury.
• Protection from radiation.
• Provide adequate privacy.
• Control of visitors.
• Prevention of infection.

Actions for ward management:

• Analyse nursing needs of patient and skill of person.
• Prepare monthly, weekly and daily time table for S/Nurses.
• give teaching and guidance to juniors.
• Develop good human relations.
• Evaluate personnel.
• Maintain inventories, requisting for supplies and services.
• Assign tasks to nurses.
• Coordinate with other departments for effective patient care.
• Gain co-operation from subordinates and supervisors.
• Delegate responsibility for patient care.

Join The Community

Your Username

Your Password

Remember Me

Submit Post

• Add Research Ppaer / Cyberlectures
• Add Directories
• Add Journals
• Add Association
• Add Blood Bank
• Add College
• Add Conference/Exhibition
• Add Equipment Supplier
• Add Hospital
• Add Pathology Lab
• Add Pharmaceutical Company
• Add Product New
• Add STD Clinic

Job Request

• Pregnancy Calculator - Find out Estimated Conception, Estimated Due Date & Estimated fetal age.
• Body Mass Index - Find out your Body Mass Index & know whether you are underweight, normal or overweight.

Also on Indmedica

• Guestbook - Sign our Guestbook
• E-Greetings - Send a greeting online
• Humour - Enjoy some good jokes
• User's News - News posted by our members
• Book Reviews - Books reviewed by our members
• Grievances/Complaints - Read/post any bitter experiences within the industry
• About Indmedica
• Conditions of Usage
• Advertise On Indmedica

Copyright © 2024 Indmedica. All Rights Reserved.

Towards defining the organization of nursing care in hospital wards: an empirical study

Affiliation.

• 1 Department of Health, University of Newcastle upon Tyne, England.
• PMID: 2229711
• DOI: 10.1111/j.1365-2648.1990.tb01993.x

The method of organizing nursing care known as 'primary nursing' is increasingly being introduced into hospital wards on the assumption that it will have beneficial effects for both patients and staff. Operational definitions of primary nursing, essential to provide replicable research into the organization of nursing care, are, however, lacking in available research literature. This study describes the development of a questionnaire intended to identify and discriminate between three methods of organizing nursing staff and nursing work: task allocation or functional nursing, team nursing and primary nursing. The questionnaire was distributed to 36 ward sisters on 27 acute and rehabilitation care of the elderly wards. Questionnaires were returned from 17 wards, a response rate of 63%. Findings indicate that few wards meet five or more criteria for classification as a particular method of nursing organization. The findings illustrate the difficulties in matching and discriminating between wards in order to conduct research in which organizational modality is an independent variable.

Publication types

• Research Support, Non-U.S. Gov't
• Attitude of Health Personnel*
• Job Description
• Nursing Care / organization & administration*
• Nursing Staff, Hospital / psychology*
• Nursing Staff, Hospital / supply & distribution
• Nursing, Team / organization & administration
• Primary Nursing / organization & administration
• Surveys and Questionnaires

At hospital co-op, this Northeastern student is helping bridge the gap between neonatal care and research

• Search Search

Isabella Rando is completing a co-op the Center for Child Development and Lactation at Brigham and Women’s Hospital.

• Copy Link Link Copied!

Witnessing a live birth can give someone a new perspective on life.

That’s certainly the case for Isabella Rando, a third-year behavioral neuroscience major who is completing a co-op at the Center for Child Development and Lactation at Brigham and Women’s Hospital, which treats babies born prematurely and with complex diseases.

Recently, Rando had one of the most transformative weeks of her life — witnessing five C-section procedures in a matter of two days.

“To be in the room when a human life takes its first breath, and to see the new parents be excited for the adventure, and these doctors saying ‘Welcome to the world!’ It was so life-changing,” she says. “I remember telling one of the residents, ‘I can’t imagine this could ever get old.’” 

This is Rando’s second co-op at the Boston hospital. Last year, she was a medical assistant and worked at an outpatient clinic that treated adults. But she wanted to combine her experience working at the hospital with what she learned at the Center for Cognitive Brain Health at Northeastern University, where she focused on understanding how nutrition, exercise and fitness affect the brain development of young children. 

So she went to work developing her second co-op at the hospital with a focus on pediatrics. That’s what led her to the Center for Child Development and Lactation, where she is now getting clinical experience as well as research experience. 

Premature babies can have challenges feeding 

On the research front, Rando is exploring two areas. First, she is analyzing the results of a survey by the hospital’s pediatrics department. The survey was given to the families of preterm infants that focused on understanding how frequently their newborns showed symptoms of problematic feeding.

“Some of these symptoms include seeming uncomfortable after feeding, getting exhausted during eating, holding their breath while eating, or breathing faster while eating. The survey also asks whether the baby is exclusively breastfeeding, exclusively bottle-feeding, or a combination of both,” Rando says.

Featured Stories

Drinking water in low-income communities is more likely to be contaminated by ‘forever chemicals,’ research finds

Northeastern University announces speakers for global campus commencements, and college and school ceremonies

Is AI revolutionizing rehabilitation care? This Northeastern expert is digging deep on the issue   

This student spent co-op on an island helping protect sea turtles and other endangered species

Rando’s job is to sift through the data to see the differences and frequency of issues that occur in the various ways a baby can be fed — breast, bottle or both.

“I am also looking to see what factors, such as gestational age (a measure of how long pregnancy lasts starting from the beginning of the women’s last menstrual period), are predictors or correlates of feeding issues,” she says. 

Premature babies often have difficulty with feeding, Rando says, because they haven’t had time to develop “mature oral feeding skills.” 

“This is because of issues that occur during one or many of the three phases of mature feeding: issues during the oral phase (involved in sucking) would result in issues like biting and chewing during feeding, whereas issues during the pharyngeal or esophageal phases (involved in swallowing) would result in issues like choking or reflux,” she says. 

These issues can have a long-term impact on a child’s development, Rando stresses. 

Rando is also helping conduct research on understanding the impact transition-to-home programs have on infants’ weight gain and hospital admission rates. 

“Transition-to-home programs, like the one offered at Brigham and Women’s Hospital, are designed to help families and their infants after they leave the NICU by providing support, education, and care coordination to ensure a smooth and seamless transition,” Rando says. “The hope is that these Transition to Home programs reduce rehospitalizations and improve the rate of weight gain so that these babies can grow and develop on par with healthy, full-term infants.”

Gap between clinic and research

Rando is in the clinic Mondays through Thursdays from 8:30 a.m. to 5 p.m. 

She spent the first few weeks, shadowing clinicians and medical professionals, getting the hang of the operations of the clinic. 

“I had never really worked in such a multidisciplinary setting where there’s speech and language pathologists. Those are our feeding therapists. There’s occupational therapists and physical therapists. There’s neonatologists. There’s nutritionists.” 

“Any combination of those providers could be seeing one baby at one visit,” she adds. 

Now that she’s a few months in, she is helping set up follow-up appointments and ensuring patients involved in research studies are regularly checked on. 

“One of my roles is to help bridge the gap between what’s happening in the clinic and what’s happening on the research side of things,” she says. “I will go in and identify any of our patients who are enrolled in research studies, so that we can make sure that everything is taken care of when they come in. They’re getting their clinic visit and seeing the neonatologist, but also any research follow-ups that need to occur are happening at the same time.” 

In addition to playing a role in helping bring a new life into the world, Rando says she’s been greatly encouraged by the clinicians who work with her. The experience has only solidified that she is on the right path.  

“Being surrounded by such intelligent and inspiring women every day in this field is so exciting to me because it shows that I’m doing everything in my power to be in their shoes one day,” she says, “I’m going to embrace every step along that journey.”

University News

Recent Stories

• Large Steam Sterilizers
• Washer Disinfectors
• Low Temperature Sterilizers
• Hot Air Sterilizers
• Laboratory Incubators (Thermostats)
• Stainless Steel Furniture
• Laboratory Ovens
• Depyrogenation and Dry Heat Ovens
• Pharmaceutical Ovens
• Pharmaceutical Incubators (Thermostats)
• User Service Support
• Product Support
• Central Sterilization Department
• Sub-Sterilization Department
• Stomatological Workplace
• Installation
• Maintenance
• Adaptations
• Staff Training
• Other Services
• Heat Technology
• Steam sterilizers
• Washer disinfectors
• Other leaflets
• MMM leaflets
• History and Present
• Quality management system
• Certificates
• Patented Solutions, Inventions and Innovations
• Environment
• Trends and Finances
• News - Archive
• Headquarters
• Subsidiary companies
• Contact Form
• Sales and Service Worldwide
• Service support
• We are a member of the international MMM Group

Central sterilization in Semasko Hospital, Moscow

15. 08. 2008 Currently, our biggest customer in the world is Russian Railway RŽD with its headquarters in Moscow. This colossus has about 5 000 000 employees and owns, apart from other things, more than 230 hospitals! Our total volume of deliveries already constitutes more than 100 million CZK. We started to actively cooperate with this company about two years ago. Four hospitals have already been modernized through our devices and more are planned. The RŽD Semasko Clinic in Moscow was opened on 03 July 2008.  RŽD Vice-President, Oleg Atkov, also attended the grand opening ceremony. An article on the opening of the hospital was also printed in its company bulletin on 04 July 2008. We have selected the following part about central sterilization:   Clean work Another hospital has been opened under the RŽD Investment Programme. The railway hospital Semasko at the Moscow - Ljubino station was awarded the unofficial status of best equipped hospital from amongst all of the RŽD hospitals from the point of view of central sterilization. Two new wards were ceremoniously opened yesterday – the Central Sterile Department (CS) and the Surgical Ward. OAO RŽD Vice-President, Mr. Oleg Atkov, and the directors of other hospitals also attended the grand opening ceremony. The equipping for the new wards was purchased from the funds of the Health Care Department and the OAO RŽD Investment Programme. The Central Sterile Department is equipped with sterilizers made in Germany and the Czech Republic. These devices secure absolutely safe conditions for the sterilization of materials and tools. We very much appreciate the opening of the new facility, said the deputy of the Chief Surgeon of the Hospital, Gennadij Osokin. Based on data provided by the World Health Organization, in-hospital infections are responsible for 6 - 7% of the overall sickness rate. The only effective tool to combat this is good quality sterilization of medical materials. Good quality processing and application of the Central Sterile Department enables, according to Oleg Atkov, the Hospital not only to satisfy its needs but also to provide sterile services to other surrounding health care facilities and, by so doing, to generate further profit for itself.  

Inside Medway Maritime Hospital's new respiratory ward aimed at cutting A&E waiting times in Kent

• Medway Maritime Hospital
• Wednesday 24 April 2024 at 1:08pm

Kit Bradshaw

Reporter, ITV News Meridian

ITV News Meridian is given special access to Medway's new respiratory support unit

A new multi-million pound respiratory ward will help reduce long waiting times in accident and emergency, according to NHS bosses.

The £5 million unit will increase the total number of beds at Medway Maritime Hospital by 33, when it opens to patients in the coming days.

Managers told ITV News Meridian that their A&E department was under "a great deal of pressure" with many patients attending with more "complex needs" in recent years.

Medway NHS Foundation Trust’s chief operating officer, Nick Sinclair, said: "We've done a lot of work recently on reducing long wait times in our emergency department through improving efficiency processes.

"However, we get to a point where we need additional bed capacity to manage that increasing demand."

In March, 77.4% of patients attending Medway Maritime's emergency department waited less than four hours to be seen.

The official figures show that 4,124 patients waited more than four hours to be seen in that month alone.

The new facility, funded by NHS England, has also been designed to prepare for potential future pandemics.

The three-bed bays are all sealed from communal areas by automatic glass doors to try to reduce the risk of infections spreading.

Director of Nursing, Kate Holmes, said: "We've come through [the pandemic] and learned from every aspect in terms of patient care, patient experience, and how we can be ready for a possible another pandemic, which we all hope will never happen.

"But we need to be ready and prepared should it do so, to make sure we can still deliver excellent care for patients."

The new respiratory support unit (RSU) is part of a wider project to treat all patients with serous breathing or heart conditions into the same part of the large Gillingham hospital.

The vision from Medway Trust leaders is for a 'cardio-respiratory village' to develop at the site.

The existing respiratory and cardiology wards are at opposite ends of the site, inhibiting close working between the clinic teams.

Want a quick and expert briefing on the biggest news stories? Listen to our latest podcasts to find out What You Need To Know…

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Can J Infect Dis Med Microbiol
• v.25(5); Sep-Oct 2014

Language: English | French

Hospital ward design and prevention of hospital-acquired infections: A prospective clinical trial

Jennifer ellison.

1 Alberta Health Services, Calgary and Area, Calgary, Alberta

Danielle Southern

2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta

3 Institute for Public Health, University of Calgary, Calgary, Alberta

Donna Holton

4 Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta

Elizabeth Henderson

Jean wallace.

5 Department of Sociology, Faculty of Arts, University of Calgary, Calgary, Alberta

Peter Faris

William a ghali.

6 Calvin, Phoebe and Joan Synder Institute for Chronic Diseases, Faculty of Medicine, University of Calgary and Alberta Health Services, Calgary and Area, Calgary, Alberta

Several factors related to the hospital environment may affect the spread of hospital-acquired infections including ward design characteristics such as the number and location of handwashing stations and washrooms, and the number of beds per room. However, opportunities to study the effects of these factors are rare. The authors of this study conducted an analysis of the number of hospital-acquired infections in an older, ‘historic design’ hospital ward compared with a recently built ‘new design’ ward.

BACKGROUND:

Renovation of a general medical ward provided an opportunity to study health care facility design as a factor for preventing hospital-acquired infections.

To determine whether a hospital ward designed with predominantly single rooms was associated with lower event rates of hospital-acquired infection and colonization.

A prospective controlled trial with patient allocation incorporating randomness was designed with outcomes on multiple ‘historic design’ wards (mainly four-bed rooms with shared bathrooms) compared with outcomes on a newly renovated ‘new design’ ward (predominantly single rooms with private bathrooms).

Using Poisson regression analysis and adjusting for time at risk, there were no differences (P=0.18) in the primary outcome (2.96 versus 1.85 events/1000 patient-days, respectively). After adjustment for age, sex, Charlson score, admitted from care facility, previous hospitalization within six months, isolation requirement and the duration on antibiotics, the incidence rate ratio was 1.44 (95% CI 0.71 to 2.94) for the new design versus the historic design wards. A restricted analysis on the numbers of events occurring in single-bed versus multibed wings within the new design ward revealed an event incidence density of 1.89 versus 3.47 events/1000 patient-days, respectively (P=0.18), and an incidence rate ratio of 0.54 (95% CI 0.15 to 1.30).

CONCLUSIONS:

No difference in the incidence density of hospital-acquired infections or colonizations was observed for medical patients admitted to a new design ward versus historic design wards. A restricted analysis of events occurring in single-bed versus multibed wings suggests that ward design warrants further study.

HISTORIQUE :

La rénovation d’une unité d’hospitalisation générale a permis d’étudier la conception des établissements de santé comme facteur pour prévenir les infections nosocomiales.

Déterminer si une unité d’hospitalisation contenant surtout des chambres individuelles s’associe à un taux plus faible d’infections nosocomiales et de colonisations.

MÉTHODOLOGIE :

Un essai prospectif contrôlé avec répartition aléatoire des patients a permis de comparer les résultats dans diverses « anciennes » unités (surtout des chambres à quatre lits dont les toilettes sont partagées) à ceux dans des unités « rénovées » (surtout des chambres individuelles dotées de toilettes individuelles).

RÉSULTATS :

D’après l’analyse de régression de Poisson et après rajustement en fonction du temps à risque, il n’y avait pas de différences (P=0,18) dans les résultats primaires (2,96 par rapport à 1,85 événements sur 1 000 patients-jour, respectivement). Après rajustement compte tenu de l’âge, du sexe, de l’indice de Charlson, de l’admission en provenance d’un établissement de soins, d’une hospitalisation dans les six mois précédents, de la nécessité d’isolement et de la durée de l’antibiothérapie, le ratio d’incidence était de 1,44 (95 % IC 0,71 à 2,94) pour les nouvelles chambres par rapport aux anciennes. Une analyse restreinte du nombre d’événements qui se produisent dans les nouvelles unités de chambres individuelles plutôt que de chambres communes a révélé une densité d’incidence de 1,89 par rapport à 3,47 événements sur 1 000 patients-jour, respectivement (P=0,18), et un ratio d’incidence de 0,54 (95 % IC 0,15 à 1,30).

CONCLUSIONS :

Il n’y avait pas de différence dans la densité d’incidence des infections nosocomiales ou des colonisations chez les patients admis dans une nouvelle unité plutôt qu’une ancienne. D’après une analyse restreinte des événements qui se produisent dans des unités de chambres individuelles plutôt que de chambres communes, la conception des unités devrait faire l’objet d’études plus approfondies.

The importance of health care facility design as a basic component of preventing infectious disease transmission has been discussed for many years ( 1 ). Recent studies have underscored the importance of optimizing design standards to maximize patient and health care worker safety ( 2 – 6 ) including the prevention of health care-acquired infections, with an estimated direct cost in the United States of between $35.7 and $45 billion annually ( 7 ). Ulrich et al ( 8 ) identified >600 studies that examined the hospital environment and its effects on staff effectiveness, patient safety, patient and family stress, quality and costs. They suggested that an important element in improving patient safety was reducing hospital-acquired infections. Several factors unique to the hospital environment may contribute to an increased propensity for hospital-acquired infections and transmission of antimicrobial-resistant pathogens, including physical plant design, engineering controls (sink placement, space design to facilitate hygienic practices, ease of hand-washing, ability to maintain general environmental hygiene), the use of aseptic technique and the host-health care provider interaction ( 8 ). These environmental factors have taken on increasing importance in recent years, especially with the increased acuity in the types of patients admitted to health care facilities. To date, studies examining environmental factors have been of quasiexperimental design using before-after interventions. With the construction of a new medical teaching ward with features designed to reduce hospital-acquired infections, an opportunity existed to rigorously study the impact of hospital ward design on specific hospital-acquired infections and antibiotic-resistant organism (ARO) colonization. In the first four years of operation, the incidence density of hospital-acquired infections and/or colonization with AROs, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and Clostridium difficile, declined by almost 70% ( 9 ). Given that there were no changes in the types of patients, medical, nursing or housekeeping staff, we hypothesized that the design of the new ward was the major factor that contributed to the improved outcomes and designed a prospective, controlled study to examine this hypothesis.

Study design and allocation procedure

The study design was a prospective, nonrandomized, controlled trial with a patient allocation plan incorporating randomness with investigator-blinded ascertainment of outcomes. General medical patients were allocated to one of two types of medical wards at a tertiary health care facility, either the intervention (‘new design’) ward, which had been extensively renovated, or the control (‘historic design’) wards, constructed >40 years previously. Because random allocation would not be possible in the setting of high bed occupancy and the need to maintain expedient patient flow through the emergency room, a 2:1 patient allocation plan that incorporated randomness was developed ( 10 , 11 ), using a two-tiered patient allocation process such that when both the new design and the historic design wards had open beds, patients were randomly assigned using a computer-generated randomization sequence with allocation concealment (achieved by maintaining the sequence and allocation assignment envelopes in Admitting) and when only either of the new design or historic design wards were available, the patient was ‘assigned’ to the intervention or control group, respectively. The latter scenario approximated a randomization setting because beds became available in what appeared to be a random manner.

Interventions

The historic design wards (n=5) had predominantly (>80%) four-bed rooms with shared bathrooms, less space and one handwashing sink designated for staff handwashing only in each four-bed room and no hallway handwashing sinks. The new design ward (n=1) had predominantly (>80%) single-bed rooms with private bathrooms, greater space, one hand-washing sink in each room and a hallway handwashing sink between each of the rooms, both of which were designated for staff handwashing only. Alcohol-based hand rub was available at the entry to each of the rooms for both types of wards. The medical wards were otherwise very similar with respect to the patients, acuity of care, medical staff, nursing staff and skills, educational levels, housekeeping and levels of knowledge about infection control practices. Controlling for these other variables, which may otherwise have confounded the outcome, enabled the effect of the differences in design, construction and engineering controls to be studied.

From June 2007 to February 2010, all patients admitted to the general internal medicine service at the authors’ facility from the emergency room, urgent assessment clinic or the community were assessed for eligibility for the present study. Patients were excluded if they were admitted from another health care facility (acute or long-term care), another hospital ward, transferred from the intensive care unit (ICU), required telemetry, were <18 years of age, were admitted to a nonstudy unit, or were preferentially admitted to the new or historic design ward based on clinical grounds according to the attending physician.

Data collection procedures

Patients who were admitted to either the new or historic design ward(s) and remained there for >48 h were monitored for the development of the primary outcome of a hospital-acquired infection or colonization event due to MRSA, VRE or C difficile while remaining on the ward. The definitions for these events (occurring >72 h after admission) were based on the definitions used by the Public Health Agency of Canada ( 12 ). The process of identifying the hospital-acquired events included an active review of a computer-based clinical information system followed by a linkage to the facility’s infection prevention and control database to identify any cases that may have developed after the patients were discharged from the study. Sample size determination was based on the estimated number of events and days of observation for each of the ward designs and, assuming that incident cases followed a Poisson distribution, it was determined that 43 events were required to detect a 60% difference in incidence densities with a power of 80% and an alpha level of 0.05. In an effort to identify additional outcomes, one year into the study, a protocol amendment was introduced to undertake active surveillance for MRSA. Following approval by the Conjoint Research Ethics Board, patients who were admitted into the study were asked to sign a consent form permitting a swab of the nares, axillae and groins for MRSA. MRSA was identified using standard laboratory procedures.

Data were collected on multiple variables: patient demographics (age, sex, date of admission); hospitalization (previous hospitalizations, setting of current admission and number of room changes, length of stay); illness (comorbidities, Charlson Comorbidity Index and International Classification of Diseases, 10th Revision codes from administrative databases); antimicrobial usage (during hospital stay) from the pharmacy’s computer system (Centricity, GE Healthcare, United Kingdom); daily census of patients and workload to staffing ratio from the facility’s administrative databases; and room cleaning from the housekeeping database (BedTracking Version 3.06.0500, TeleTracking Technologies Inc, USA). The Infection Prevention and Control Unit provided information about educational sessions on the wards.

Baseline clinical, demographic and hospital stay characteristics of patients with and without an event for one of the three organisms were compared using a χ 2 test for categorical variables and Student’s t test for continuous variables. For the primary outcome analysis, incidence density was calculated for those with and without an event. Poisson regression analysis was used to calculate incidence rate ratios (IRRs) with 95% CIs for a positive event, adjusting for length of time an individual was at risk. The Poisson regression analyses were adjusted for age, sex and Charlson Comorbidity Index score as well as for admission from a care facility and previous hospitalization within six months. A secondary analysis included the number of outbreaks of ARO events on the wards. All analyses were conducted using SAS version 9.2 (SAS Institute, USA).The study protocol was registered at clinicaltrials.gov ( {"type":"clinical-trial","attrs":{"text":"NCT00563186","term_id":"NCT00563186"}} NCT00563186 ).

Eligibility and allocation

Of 3617 patients assessed for eligibility ( Figure 1 ), 1754 did not meet inclusion criteria, 175 were admitted more than once and one had a ‘spoiled’ randomization, leaving 1687 patients entering the allocation scheme of either being randomly assigned or assigned to one of the two ward designs. Only 10 patients were randomly assigned during the course of the study due to continuous overcapacity difficulties, which limited bed availability. Due to a stay <48 h, 97 and 74 patients allocated to the new design and historic design wards, respectively, were excluded from outcome ascertainment. There were two patients with incomplete data; therefore, 1514 patients were available for analysis, including 910 allocated to the new design ward and 604 allocated to the historic design wards.

CONSORT flow diagram.*Refer to Methods section for details of allocation scheme. LOS Length of stay

Demographic characteristics

Patient and hospital stay characteristics are presented in Tables 1 and ​ and2. 2 . Patients admitted to the new design ward were younger, more likely to be transferred elsewhere within 24 h of admission, had less congestive heart failure, more diabetes without chronic complications, less diabetes with chronic complications, less often had a diagnosis of hemiplegia/paraplegia and metastatic solid tumour, and had significantly fewer comorbidities, as measured by the mean Charlson Comorbidity Index score ( Table 1 ). Patients allocated to the new design ward were also significantly more likely to be discharged home, require isolation, stay in a single-bed room and have a longer duration of antibiotic treatment ( Table 2 ). The mean discharge cleaning time for the new versus historic design wards did not differ significantly among the daytime, evening and night shifts during the course of the study. Similarly, the measurements of nursing workload indexes demonstrated no major differences between the new design versus historic design wards. The coverage by members of the Infection Prevention and Control Unit for the hospital, the number and types of in-service education provided and the patterns of surveillance were similar for both types of wards during the course of the study.

Patient characteristics

Data presented as n (%) unless otherwise indicated.

Characteristics of the hospital stay

Data presented as n (%) unless otherwise indicated. ARO Antibiotic-resisitant organisms; GIM General internal medicine; ICU Intensive care unit

Incidence density of hospital-acquired infections/colonizations

The results of the primary outcomes for the study are presented in Table 3 . There were no significant differences in the primary outcome of the overall incidence density of hospital-acquired infections/colonizations between the new design ward and the historic design wards. Patients admitted to the new design ward versus the historic design wards had a higher number of incident cases of hospital-acquired infections or colonization events (3.1% versus 1.8%, respectively) but the results were not significantly different (P=0.18) whether the events were analyzed together or for each category separately ( Table 3 ). There were no differences in the percentage of events that were determined based on clinical grounds versus those identified by active swabbing of patients. Of the 39 events, 21 were detected clinically (16 C difficile and five MRSA) and 18 were detected on discharge screening (10 MRSA) or from secondary screening (five VRE and three MRSA) according to the a priori protocol.

Hospital-acquired infections and colonization events

CDI Clostridium difficile infection; MRSA Methicillin-resistant Staphylococcus aureus ; VRE Vancomycin-resistant enterococcus

Adjusted incidence rate ratios

Results from the Poisson regression analysis are presented in Tables 4 and ​ and5. 5 . The crude IRR for the new design versus the historic design wards was 1.60 (95% CI 0.80 to 3.22) for patients admitted to the new design ward compared with patients admitted to the historic design wards. After adjustment for age, sex and Charlson Comorbidity Index score, the IRR was unchanged at 1.61 (95% CI 0.80 to 3.25) but decreased to 1.52 (95% CI 0.75 to 3.08) after adjustment for age, sex, Charlson Comorbidity Index score, admitted from care facility and previous hospitalization within six months, and to 1.44 (95% CI 0.71 to 2.94) after adjustment for age, sex, Charlson Comorbidity Index score, admitted from care facility, previous hospitalization within six months, isolation requirement and the duration on antibiotics.

Adjusted Poisson regression analysis

Poisson regression analysis

Secondary analyses

The secondary outcome of the number of outbreaks related to the primary events included two small clusters on the new design ward (one each of MRSA and VRE) and an MRSA cluster on one of the historic design wards. Of the 22 cases identified in the secondary clusters, 19 (86%) occurred in multibed rooms, with eight and three secondary MRSA and VRE cases, respectively, in multibed rooms on the new design ward and eight secondary MRSA cases in multibed rooms on a historic design ward.

A secondary restricted analysis on the numbers of events occurring in single-bed versus multibed ‘wings’ within a ward, as opposed to wards, was performed to examine the events occurring where only single-bed rooms existed, which was closest to our original study design, without the inclusion of multibed rooms. Assessing the analysis by wings within all wards, both new design and historic design, and only within the new design ward revealed event incidence densities of 1.89 versus 2.68 (95% CI 0.60 to 3.70; P=0.4) and 1.89 versus 3.47/1000 patient-days (95% CI 0.76 to 4.90; P=0.18) and crude IRRs of 0.70 (95% CI 0.23 to 1.61) and 0.54 (95% CI 0.15 to 1.30), respectively.

We conducted a prospective controlled trial with a patient allocation plan incorporating randomness to assess the outcomes of key markers of hospital-acquired infections/colonizations in patients admitted to a newly designed ward with predominantly single rooms versus historic wards with predominantly multibed rooms. We attempted to control for other variables that may otherwise have confounded the outcomes. Our findings revealed no difference in the incidence density of events for the primary outcome and was not consistent with our original hypothesis. We were unable to find any major differences in nursing workload or housekeeping discharge cleaning parameters that may explain the difference. However, our secondary analysis on the numbers of events occurring in single-bed versus multibed ‘wings’, whether comparing all wards or as a component within the new design ward, revealed that hospital-acquired infections/colonization events occurred 1.4 and almost two times as frequently, respectively, in the setting of multibed wings; although the result is not significant, it suggests a trend favouring single rooms.

To our knowledge, our study was the first prospective controlled trial that addressed this important topic. A systematic review examining the evidence for the effects of interventions to improve hospital design on the occurrence of hospital-acquired infections identified no randomized controlled studies ( 13 ). The majority of the 178 studies identified were expert opinion and consensus statements ( 13 ). Similarly, a recent literature review on this topic found no randomized controlled trials and only three quasiexperimental studies, all of low quality ( 14 ). Two recent prospective before-after cohort studies in hospital ICUs that had multibed rooms converted to private rooms found a 54% decrease of acquisition in combined cases of MRSA, VRE and C difficile ( 15 ) and a 72% decrease in the risk of acquiring any drug-resistant bacteria ( 16 ), respectively. However, an interventional interrupted time-series cohort study that studied the transmission of MRSA in an ICU ( 17 ) showed no benefit from the use of isolation rooms, although this study was less rigorously designed.

Our study extends the existing literature in this area through its use of a stronger study design. Unfortunately, our study had several confounding variables, many of which were beyond our control.

We believe the new ward design intervention was compromised in its potential to prevent hospital-acquired infections. A major factor that may have influenced the risk for a hospital-acquired event occurring on the new design ward was the significant reduction of the ward’s ability to function as a predominantly single-bed ward. Due to capacity issues, the regional administration converted three of the single rooms on the ward to multibed rooms shortly after our study began; thus, the ability of the ward to function as a predominantly single-bed ward was significantly compromised. Two of the three distinct wings that radiate out from the central nursing station functioned as multibed units following this administrative decision. Beds in these converted rooms were in close proximity (1 m), which placed patients at a significant risk for hospital-acquired infections ( 16 ). Almost 50% of the patients on the new design ward experienced a stay in a multibed room following the introduction of the administrative changes. Less than 20% of the patients were anticipated to stay in a multibed room on the new design ward according to the original study design. The secondary outcomes of the clusters of hospital-acquired infections or events occurring almost exclusively in multibed rooms and the finding of a definite trend toward a higher incidence density of events when the results were analyzed using a single-bed versus multibed wing rather than ward as the focus of analysis suggests that patients within multibed settings may be at higher risk for hospital-acquired infection or colonization events.

Another factor that may have influenced the occurrence of hospital-acquired infections on the new design ward was the use of the ward as an ‘isolation’ centre for the hospital, given that it had the largest number of single-room beds within the hospital. In the univariate and adjusted analysis, the requirement for isolation was a significant risk factor for the occurrence of a hospital-acquired event. Thus, a greater burden of patients with infections for which isolation was required were admitted to the new design ward, increasing the potential for exposure and transmission.

Despite the strength of our study design, with prospective allocation of patients, we acknowledge our study has several limitations and confounders. We only studied three hospital-acquired pathogens and, thus, did not attempt to detect other relevant hospital-acquired organisms. In addition, we introduced an active process to identify individuals colonized with MRSA after the study began and, thus, may have missed some previous colonization events. There was no active screening for VRE and it is possible that the five cases of VRE attributable to the new design unit were acquired elsewhere, although we consider this to be less likely given the attribution after 72 h and the majority of cases occurred after two weeks. Furthermore, it is uncertain whether our findings are generalizable beyond a population of general medical patients. Our study was likely compromised by the ability of the ward to function as a predominantly single-bed ward with the unanticipated conversion of single rooms to multibed rooms due to capacity stresses. In addition, due to chronic overcapacity issues throughout the course of the study, we were able to truly randomly assign only a small number of patients, and required a greater allocation of patients based on bed availability rather than true random allocation. Although we believe this process was near-random, it may have introduced a selection bias for more severely ill patients on the new design ward.

We believe the results of the study are, nonetheless, highly relevant for policy makers, hospital planners, industrial engineers, architects, medical and nursing personnel, and governmental organizations. Although the primary outcome analysis revealed no differences, when we consider the compromised state of the new design ward’s ability to function as originally planned, the adjusted Poisson regression analysis and the secondary analyses collectively suggest that there may be a true difference in hospital-acquired infection rates arising from room design.

We are not in a position to recommend whether hospital wards should or should not be configured to be predominantly single-bed rooms to prevent hospital-acquired infections on the basis of the present study. However, a lesson learned is that research of this type in a functioning health care system is inherently difficult and health system stressors would always take precedence over study design issues. Nonetheless, we have demonstrated that it is possible to perform controlled trials to study the effects of hospital ward design on the outcome of hospital-acquired infection and colonization. We have also provided a framework with which to undertake further studies and would encourage other investigators to design methodologically rigorous trials in an effort to produce new evidence in this challenging area.

Acknowledgments

The authors acknowledge the cooperation all of the nursing staff and Nursing Unit Managers for the study wards at the Foothills Medical Centre. The authors also thank Drs S Majumdar and Dr F McAlister of the University of Alberta for their contributions to the patient allocation design, and Dr M Mah of the University of Calgary for helpful contributions to the overall design of the study. The authors are indebted to the Calgary Health Region Administration for their support throughout all phases of the study. Financial support for the conduct of this study was provided by the Canadian Institutes of Health Research and the Alberta Heritage Foundation for Medical Research, along with contributions-in-kind from the former Calgary Health Region in the Partnerships for Health System Improvement Program. William Ghali is funded by an Alberta Innovates – Health Solutions Senior Health Scholar Award.

DISCLOSURES: None of the authors have any conflicts of interest involving the work under consideration for publication in this article. With respect to financial disclosures, John Conly has received honoraria from the Canadian Agency for Drugs and Technologies in Health for work as an expert reviewer and clinical expert, respectively, for projects on the role of rapid polymerase chain reaction testing for MRSA in hospitalized patients, and the use of vancomycin or metronidazole for treatment of C difficile colitis within the past three years. He has also received speaker’s honoraria related to new antibacterial agents from Janssen-Ortho and Pfizer during the past three years. He has received financial support for MRSA research activities from the Alberta Heritage Foundation for Medical Research, the Canadian Institutes for Health Research and Pfizer. John Conly and William Ghali, as principal and co-principal investigators, respectively, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors made substantial contributions to data acquisition, data analysis, interpretation of results, writing of the manuscript and/or revision of the final draft. Detailed author contributions are as follows: J Ellison was responsible for day-to-day data collection, data acquisition, data cleaning, partial data analysis and interpretation, and manuscript writing and revision; D Southern was responsible for data acquisition, data cleaning, detailed data analysis and interpretation, and manuscript writing and revision; P Faris, J Wallace, B Henderson and D Holton were responsible for components of the grant proposal writing, study planning, data interpretation, manuscript writing and general supervision for each of their respective components of the study. J Conly and W Ghali were responsible for the original project conception and refinement, grant proposal writing, data collating, interpretation, manuscript writing and overall general supervision of the study. The findings from this study were presented, in part, in abstract form at the Infectious Diseases Society of America Annual Meeting (Abstract 475), San Diego, California, October 17 to 21, 2012. Trial Registration: ClinicalTrials.gov , National Institutes of Health Registration number: {"type":"clinical-trial","attrs":{"text":"NCT00563186","term_id":"NCT00563186"}} NCT00563186 URL: http://clinicaltrials.gov/ct2/show/ {"type":"clinical-trial","attrs":{"text":"NCT00563186","term_id":"NCT00563186"}} NCT00563186

Study record managers: refer to the Data Element Definitions if submitting registration or results information.

Search for terms

• Advanced Search
• See Studies by Topic
• See Studies on Map
• How to Search
• How to Use Search Results
• How to Find Results of Studies
• How to Read a Study Record

• Learn About Studies
• Other Sites About Studies
• Glossary of Common Site Terms

• Submit Studies to ClinicalTrials.gov PRS
• Why Should I Register and Submit Results?
• FDAAA 801 and the Final Rule
• How to Apply for a PRS Account
• How to Register Your Study
• How to Edit Your Study Record
• How to Submit Your Results
• Frequently Asked Questions
• Support Materials
• Training Materials

• Selected Publications
• Clinical Alerts and Advisories
• Trends, Charts, and Maps
• Downloading Content for Analysis

• ClinicalTrials.gov Background
• About the Results Database
• History, Policies, and Laws
• ClinicalTrials.gov Modernization
• Media/Press Resources
• Linking to This Site
• Terms and Conditions
• Search Results
• Study Record Detail

Double-blind, Placebo-controlled, Randomized Study of the Tolerability, Safety and Immunogenicity of an Inactivated Whole Virion Concentrated Purified Vaccine (CoviVac) Against Covid-19 of Children at the Age of 12-17 Years Inclusive"

• Study Details
• Tabular View
• No Results Posted

Recruitment of volunteers will be competitive. A maximum of 450 children aged 12 to 17 years inclusive will be screened in the study, of which it is planned to include and randomize 300 children who meet the criteria for inclusion in the study and do not have non-inclusion criteria, data on which will be used for subsequent safety and immunogenicity analysis.

Group 1 - 150 volunteers who will be vaccinated with the Nobivac vaccine twice with an interval of 21 days intramuscularly.

Group 2 - 150 volunteers who will receive a placebo twice with an interval of 21 days intramuscularly.

In case of withdrawal of volunteers from the study, their replacement is not provided.

Inclusion Criteria:

• Volunteers must meet the following inclusion criteria:

Type of participants • Healthy volunteers.

Age at the time of signing the Informed Consent

• from 12 to 17 years inclusive (12 years 0 months 0 days - 17 years 11 months 30 days).

Paul • Male or female.

Reproductive characteristics

• For girls with a history of mensis - a negative pregnancy test and consent to adhere to adequate methods of contraception (use of contraceptives within a month after the second vaccination). Girls should use methods of contraception with a reliability of more than 90% (cervical caps with spermicide, diaphragms with spermicide, condoms, intrauterine spirals).
• For young men capable of conception - consent to adhere to adequate methods of contraception (use of contraceptives within a month after the second vaccination). Young men and their sexual partners should use methods of contraception with a reliability of more than 90% (cervical caps with spermicide, diaphragms with spermicide, condoms, intrauterine spirals).

Research procedures

• Written Informed consent of a volunteer (14 years and older) and one of the parents to participate in a clinical trial.
• Volunteers who are able to fulfill Protocol requirements (i.e. answer phone calls, fill out a Self-observation Diary, come to control visits).

Non-inclusion criteria:

• Volunteers cannot be included in the study if any of the following criteria are present:

SARS-CoV-2 infection

• A case of established COVID-19 disease confirmed by PCR and/or ELISA in the last 6 months.
• History of contacts with confirmed or suspected cases of SARS-CoV-2 infection within 14 days prior to vaccination.
• Positive IgM or IgG to SARS-CoV-2 detected on Screening.
• Positive PCR test for SARS-CoV-2 at Screening / before vaccination.

Diseases or medical conditions

• Serious post-vaccination reaction (temperature above 40 C, hyperemia or edema more than 8 cm in diameter) or complication (collapse or shock-like condition that developed within 48 hours after vaccination; convulsions, accompanied or not accompanied by a feverish state) to any previous vaccination.
• Burdened allergic history (anaphylactic shock, Quincke's edema, polymorphic exudative eczema, serum sickness in the anamnesis, hypersensitivity or allergic reactions to the introduction of any vaccines in the anamnesis, known allergic reactions to vaccine components, etc.).
• Guillain-Barre syndrome (acute polyradiculitis) in the anamnesis.
• The axillary temperature at the time of vaccination is more than 37.0 ° C.
• Positive blood test for HIV, syphilis, hepatitis B/C.
• Acute infectious diseases (recovery earl

Exclusion Criteria:

- • Withdrawal of Informed consent by a volunteer and/or a parent of a volunteer;

• The volunteer was included in violation of the inclusion/non-inclusion criteria of the Protocol;
• Availability of inclusion/non-inclusion criteria before vaccination;
• Any condition of a volunteer that requires, in the reasoned opinion of a medical researcher, the withdrawal of a volunteer from the study;
• The established fact of pregnancy before the second vaccination;
• Taking unauthorized medications (see section 6.2);
• The volunteer's incompetence with the study procedures;
• The volunteer refuses to cooperate or is undisciplined (for example, failure to attend a scheduled visit without warning the researcher and/or loss of communication with the volunteer), or dropped out of observation;
• For administrative reasons (termination of the study by the Sponsor or regulatory authorities), as well as in case of gross violations of the protocol that may affect the results of the study.
• For Patients and Families
• For Researchers
• For Study Record Managers
• Customer Support
• Accessibility
• Viewers and Players
• Freedom of Information Act
• HHS Vulnerability Disclosure
• U.S. National Library of Medicine
• U.S. National Institutes of Health
• U.S. Department of Health and Human Services

The family of a Tiwi Islands woman who died at an acute mental health facility have performed an emotional tribute to their much-loved family member on the final day of a coronial inquest into her death.

WARNING: Aboriginal and Torres Strait Islander readers are advised that this article contains the name and image of a person who has died, used with the permission of their family.

Pukumani Alimankinni, as she is known for cultural reasons, died in August 2021, about a day-and-a-half after she was admitted to Royal Darwin Hospital's (RDH) secure mental health ward, the Joan Ridley Unit (JRU).

Her death has been the subject of a five-day coronial inquest at the Darwin Local Court, which has heard testimony from 13 witnesses including family members, medical experts, and nurses who provided care in hospital.

Outside the courtroom on Wednesday, family members and Munupi men and women painted their faces before performing a number of songs, led by senior Munupi man Mr Tungatalum — including the kookaburra song, in honour of Pukumani's totem.

Coroner Elisabeth Armitage thanked Pukumani's family members, some of whom had travelled from the remote Tiwi Islands community of Wurrumiyanga, for their participation in the coronial process.

"I want to thank Pukumani's family for bringing so much warmth, joy, culture, country, and family to Pukumani's inquest," she said.

"I have learned from you that Pukumani was very much-loved by her family and community, that you all loved and grieve her passing."

Coroner hears closing submissions

Inside the courtroom, family members cried as each of the parties delivered their closing submissions.

The lawyer representing NT Health, Tom Hutton, acknowledged the "considerable shock and anguish" that had been caused by Pukumani's death, and said the department took "full responsibility" for the failings that had contributed to her preventable death .

Counsel assisting the coroner, Beth Wild, canvassed several issues and failings the coroner is expected to consider when making her final recommendations.

Among the key issues she highlighted were bed blocking at the RDH mental health ward and the range of medications and anti-psychotics given to Pukumani while she was in the emergency department.

Ms Wild also noted the failure of staff to conduct "the required prescribed observations of Pukumani overnight and, with that, the non-commencement of CPR for seven minutes after she was found unresponsive".

She asked the coroner to consider recommending additional training for staff in the JRU to handle emergency medical situations.

Counsel representing the family, Hannah Donaldson, suggested the coroner consider making a recommendations to NT Health for an alternative model for the prescription of medications in the ED.

"Your Honour might consider a recommendation to NT Health … that a review be undertaken into if or how it might be possible to have a central prescriber who has control of prescribing medication in certain circumstances, namely where there are multiple medications required and a patient has a relevant comorbidity," she said.

Bed blocking in mental health ward a focus

Ms Wild particularly underlined bed block at the JRU as a significant issue.

She told the inquest that had "prevented Pukumani from receiving the appropriate care in a therapeutic environment", and "may have potentially, but almost certainly in my submission, have added to the need for further medication and sedation".

The coroner interrupted her counsel assisting to point out that the issue of bed shortages within mental health units has been an identified issue throughout multiple inquests in the NT in the past.

She said inquests were "being used as an opportunity, again and again, to outline the need and the impact of that need not being met on individuals, on family and staff at the hospital".

Ms Wild urged the coroner to acknowledge and advocate for additional funding for mental health beds, as well as additional staff to monitor those beds, in her recommendations.

That submission was also reinforced by other parties, with Mr Hutton telling the court that work to expand the mental health unit was already underway.

"Further beds are in the process of being constructed … that is not to say more does not need to be done," he said.

NT Health will provide further written submissions in coming weeks.

• X (formerly Twitter)

Related Stories

'it should never have happened': nt health apologises for death of patient.

'This death was preventable': Coroner examines death of mental health patient at Darwin hospital

• Courts and Trials
• Mental Health

NEWS... BUT NOT AS YOU KNOW IT

Teacher killed herself after loss of newborn baby

Share this with

A grieving teacher left devastated by the death of her newborn baby killed herself just months after being released from a psychiatric hospital despite multiple suicide attempts.

Kath Brace, 32, was found dead in the woods near the Stonebow Unit in Hereford in October 2022- just nine hours after she was granted leave.

She and her fiancé Dan Berry were left heartbroken when their son Otis passed away just a day after he was born in March 2022, and family members said her mental health began to severely deteriorate following the tragedy.

The former teacher spent four weeks in hospital in May following the loss and was detained for a further 10 days in June after an overdose attempt.

Yet despite this she was still granted unescorted leave from the facility a few months later, and was found dead within hours of her release.

Kath’s family said they had tried several times to raise concerns about Kath’s care and risk assessment but felt they were not listened to, and an inquest has since ruled the NHS Trust’s failings were ‘contributory factors in the lead up to Kath’s death’.

Speaking about the ordeal for the first time, her mum Angie Brace said: ‘When Kath found out she was expecting Otis she felt so blessed, and she and Dan were facing the future with so much hope and excitement.

‘However, sadly that all changed when Otis tragically passed away.

‘Kath went from being the optimistic and upbeat person we all knew to one who really struggled with her mental health.

‘Each time we tried to raise any concerns with the Hospital Trust when Kath was either detained or at home, we felt like we weren’t really listened to.

‘We tried and tried to make our voice heard, especially around Kath absconding previously on unescorted leave, but we felt shut out and not involved in the process of trying to get her the help she needed.

‘The promises made by one of Kath’s responsible clinicians were broken. Kath even needed to rely on support from charities, like Sands, to feel heard and listened to.

‘It’s almost impossible to find the words to describe what the last year or so and coming to terms with what happened has been like.

‘Kath had so much to give and it breaks all our hearts she’s no longer with us. Our family will forever remain heartbroken.

‘The world is a much darker place without her.’

Kath and Dan, who met in 2010, had been delighted when they found out they were expecting in the autumn of 2021, but her mental health began to seriously deteriorate after baby Otis died from complications.

Following an overdose attempt on June 17 Kath was detained in the Mortimer Ward under the Mental Health Act for 10 days, and continued to struggle after she was released.

She and Dan postponed their wedding that August having already postponed on two previous occasions because of Covid, and on September 24, after she was granted unescorted leave from Mortimer Ward, Kath took an overdose and attempted to hang herself, the Hospital Trust report said.

On October 9, Kath was granted unescorted leave and she told staff she planned to go into Hereford to buy a coffee and would return in time for a visit by her mum.

However, Kath did not return, and police were called before her body was found later that day.

A report by the Trust found their risk assessment of the situation was below par, and ‘significant risk-related information’ held by Kath’s loved ones was not properly documented.

An inquest jury also found shortcomings in how Kath’s risk was assessed when she was granted leave from the unit, and that the Trust’s communication with Kath’s family ‘could have been better’.

The jury returned a narrative conclusion, endorsing the findings of the Trust’s own report that these failings were contributory factors in the lead up to Kath’s death.

Aimee Brackfield, a specialist public law and human rights lawyer at Irwin Mitchell representing Kath’s family, said: “This is a truly tragic case which has left Kath’s family devastated.

‘Understandably for the past 18 months they’ve had a number of questions and concerns about the care Kath received and the events leading up to her death.

‘While nothing can make up for their loss, we’re pleased that we’ve at least been able to provide them with the answers they deserve.

‘However, the inquest and the Hospital Trust’s own report have identified worrying issues in Kath’s care.

‘It’s vital that lessons are learned to improve patient safety for others.’

Get in touch with our news team by emailing us at [email protected] .

For more stories like this, check our news page .

MORE : British aid workers’ cause of death confirmed after Israeli airstrikes in Gaza

MORE : Doctor who slept with patient says he’s as addicted to sex as Matthew Perry was to drugs

MORE : How exactly does sending asylum seekers to Rwanda ‘stop the boats’?

Sign Up for News Updates

Get your need-to-know latest news, feel-good stories, analysis and more.

Privacy Policy

Get us in your feed