Masters theses/dissertations - taught courses

A Change Project to Improve Dental Services Provision to Preschool Children in Primary Care

Maryam Al Araimi — Fri, 03 May 2013 08:42:36 PDT

Dental decay is a troublesome disease that could significantly impact on children’s oral and general health. Early prevention is crucial and despite the public preventive strategies inIrelandthe decay rate in preschool children remains significantly high. The Health Service Executive provides a range of routine dental services to children in priority groups through the School Programme of the Public Dental Service. Preschool children are not routinely covered by this programme and their receipt of dental care is limited to general oral health messages provided through primary care child services. The financial restrictions have reduced children’s access to the public dental clinics which made the problem worse for preschool children. The project was concerned with providing early routine preventive interventions by Public Health Nurses in the form of oral health education for parents and oral health assessment for preschool children within primary care settings. The rationale for change was to optimise the role of primary care team members by integrating oral health services into their routine care for patients. This integration was achieved by implementing a basic dental training programme to assist the Public Health Nurses in delivering the new service more effectively and adequately. The change model used in implementing the project was Young’s meta-model which made the project process more organised and progress with ease. The project evaluation process provided positive results and feedback on the implementation of the change. The future outcomes of children’s oral health depend on the trained nurses’ and their implementation of the change.

The Implementation of a New Information System for the Finance Department in a Private Hospital

Joss D. Watson — Fri, 03 May 2013 07:20:18 PDT

This change management project focused on the implementation of a new electronic information system for the Finance Department. This was carried out primarily to achieve a greater level of accurate, concise and complete billing information for the Finance staff. It was a move away from a system that was reliant on paper and folders to store information. For this project, I utilised Kotter’s (1996) 8 Steps model of change to help me to initiate the change process. I used this change model because I believed the step by step approach would be beneficial to me as I had limited experience of implementing a change process. The sequential steps also ensured attention to detail and on what aspects the change agent was required to focus on at all times. I utilised a Likert scale to ascertain the impact the change had on the Finance staff. The initial findings were favourable, with all staff expressing an opinion that the way information was presented had improved. The throughput of invoicing has also increased. This is based on information extracted from the in house billing system prior to and post change. The training provided for staff to utilise the system was evaluated. The feedback gathered was positive. To conclude, the new information system is now seen as a beneficial support tool for employees to utilise on a daily basis and for Senior Managers when they are agreeing future contracts with Healthcare Providers.

Implementing best practice in medication management in a nursing home

Aderonke Oluwatoyin Agboji — Wed, 01 May 2013 08:49:56 PDT

Medication management is one of the major roles of a nurse leader in any health care setting particularly in the nursing homes. Evidence suggests that errors do occur at any stage of the medication use process (prescribing, documenting/transcribing, dispensing, administering and monitoring) and these might pose significant risks to older people in nursing homes. Thus, this change project was carried out to reduce the incidence of medication errors, ensure resident’s safety and promote compliance with professional and national standards on medication management. A multiple approach using the PDSA cycle and Kotter’s eight steps change model was adopted to guide the change project. Data were collected 4 weeks prior to the implementation of this change project and the following types and frequency of error were detected : error detected through chart review include transcription error (2), omission error (4) and wrong time error (2); error detected through observation include wrong form (crushing medication-4), wrong time (1), wrong patient (2) and wrong dose (5) while medication incident reporting form detected omission error (1) and wrong dose error (1). At the end of 5 months, data were collected through chart review, medication error reporting form and observation. Results showed that there was reduction in errors associated with lack of nurses’ knowledge on medication given resulting in brand name versus generic name confusion leading to transcription error . Wrong dose , wrong time, omission, wrong resident and wrong form errors were also observed to be significantly reduced.

Introducing a Systematic Approach to Clozapine Monitoring in a Community (Adult) Mental Health Service

Izu Nwachukwu — Wed, 01 May 2013 08:13:38 PDT

Change management is now considered a core managerial competency. Under the fiscal and regulatory environment that currently applies, healthcare managers and professionals must be competent in initiating, guiding and managing change to drive efficient and effective delivery of care.

This dissertation describes a successful journey through a planned change effort. An evidence-based approach to monitoring adverse effects of clozapine was implemented in a Community (Adult) Mental health Team. Clozapine has the sole license for treatment-resistant schizophrenia, but has been associated with several potentially life-threatening adverse effects. Accumulating evidence suggests that not enough attention is paid to recognising and addressing these adverse effects, a finding replicated in an internal audit of practice within this service. Additional external regulatory imperatives provided further impetus for change.

The change was implemented using the HSE change model as a guiding tool. A range of qualitative and quantitative tools that were used to evaluate the change revealed successful attainment of set objectives, and also identified early signs for long term sustenance and continuous quality improvements.

On reflection, the challenges encountered during this project have had considerable formative impact on the learning and practice of the author. It is hoped that future service evaluations will confirm attainment of its intended long term impact, while also providing objective bases for further continuous quality improvement initiatives.

The development of a reflective portfolio of comprehensive, holistic, patient care as a means of assessing dental undergraduate competence

Philip N. Hardy — Wed, 10 Apr 2013 06:55:12 PDT

In a Dental University Hospital the assessment of clinical competence for senior students (4^th and 5^th year students) prior to this change initiative, was achieved by requiring the students to attain numerical targets for specific clinical procedures. These multiple clinical procedures could be carried out on any number of different patients and the focus of attention was on the procedure and not the patient. Under this system there is no incentive for a student to complete a patient’s treatment once the required numerical target is reached. There is also no reward, or progress toward establishing competence, for a student in treating a patient if that patient does not require any of the specific procedures outlined by the numerical targets. This project in educational leadership traces the change to a paradigm of comprehensive patient care, without numerical targets, for the establishment of dental undergraduate competence. The evidence based support for this patient centred approach will be established and the change process and evaluation outlined as it was carried out.

Under the changed system of competence assessment students will build a reflective portfolio of varied completed patient cases as a means of establishing undergraduate clinical competence in dental science. Having first established that the current literature supports this more patient centred comprehensive care model of assessment, this dissertation will continue on to describe how the Health Service Executive model of change management was used to guide and manage the change process. The rational for this change is to foster and develop a more professional student approach to proving clinical competence where the process demands that provision of comprehensive, holistic care and completion of patient treatment are core values of the process, not numerical targets. The use of the HSE change model to initiate, plan, mainstream and implement the new assessment system is crucial to the success of the change strategy. The ultimate value and achievement of the change will be measured, principally, by focus group interview with a group of five students who are piloting the new system in the current academic year. Feedback from clinical teachers on the pilot group students will also form part of the evaluation. These teachers will not be aware of the participation of these students in the pilot. The results of the evaluation have now been used for evidence in the full implementation of the change for future dental undergraduates.

Irish Emergency Nurses’ Attitudes towards Role Expansion in, and Barriers to, Nurse Prescribing

Michele Clancy — Mon, 25 Jun 2012 04:16:51 PDT

Aim

This study set out to explore Irish emergency nurses’ attitudes towards nurse prescribing and also to elicit their attitudes towards potential barriers to nurse prescribing.

Method

A quantitative descriptive survey was used to answer the research question, a questionnaire was administered to a systematic random sample of Emergency Department nurses. This consisted of a 31 item Likert-type attitudinal scale, previously developed for a similar study.

Background

Traditionally, the prescription of medications fell strictly within the realm of medicine. However, as nursing practice evolves, roles are beginning to change. Nurse prescribing is an expansion of the traditional nursing role, expanding the primary functions of nurses’ and midwives. When nurse prescribing commenced in Ireland it was initially a specialist nurse who undertook training, this is now beginning to change with staff nurses’ actively participating in prescribing training. The Emergency Department is the fastest growing area in nurse prescribing. Therefore, the writer feels that it is timely to specifically ascertain emergency nurses’ views on nurse prescribing. Identifying emergency nurses’ attitudes towards nurse prescribing, as well as the perceived barriers to role expansion, will inform practice and enable service planning to further develop this role within the Emergency Department.

Findings

The findings indicate that overall emergency nurses’ attitudes were positive towards nurse prescribing as a future role expansion. However, in order to successfully implement nurse prescribing the barriers identified need to be addressed in practice.

Conclusion

There is overall support from emergency nurses’ towards nurse prescribing as a future role expansion. Nevertheless, barriers exist in practice and methods to overcome these must be developed. Greater awareness and education is essential to securing support for this role development.

Improving hand hygiene compliance among dental health workers in 3 dental clinics in Khartoum State

Elmuez Eltayeb Ahmed — Wed, 29 Feb 2012 02:18:35 PST

Abstract Health care associated infections affect hundreds of millions of people around the world and it is a major global issue for patient safety. Moreover, the most common way that micro-organisms (germs), particularly bacteria, are spread and cause infection is by being carried on people‘s hands. Hand hygiene is the most important measure to avoid the spread of harmful germs and to prevent ill health. Regular and thorough hand hygiene is always important when working in an environment or organization where health care is provided. So, having clean hands helps to protect patients, particularly the most vulnerable, as well as health care workers. This change project proposed to improve hand hygiene compliance among dental health care workers in three dental clinics in Khartoum State. This included increasing compliance to hand washing, as well as introducing another simple, quick and effective procedure of hand hygiene which is using alcohol hand rub. The hand hygiene compliance rate showed gradual improvement over time, starting from below standard hand hygiene at base line assessment (44%), to reach its maximum at 3 weeks post intervention assessment (94%). These results indicate that the systematic application of the change model and WHO multimodal strategies is associated with improvement in hand hygiene compliance of dental healthcare workers and thus it could result in a sustained positive impact. Doctors were found to have a better compliance to hand hygiene compared to nurses in all the assessment periods, which might reflect the need to intervene further specifically for nurses thus warranting the issue with further study and analysis. Although hand washing was found to be the preferred method for hand hygiene at 3 weeks into the intervention, yet the preference was reversed in the 3 weeks post intervention assessment to alcohol hand rub. In general, the literature suggests healthcare workers are possibly more concerned about their own safety than transmitting infection to patient. So we would expect to find better hand hygiene after patient contact compared to before patient contact. Yet in this project, they are found to be indifferent to the two indications with similar levels of compliance at baseline and post- intervention..

Improving the Assessment and Triage of Patients with Mental Illness attending the Emergency Department

Jacqueline de Lacy — Mon, 05 Dec 2011 09:01:19 PST

Since the amalgamation of mental institutions with acute hospitals there has been an increase in presentations of patients with mental illness to the Emergency Department. The first point of contact for the patient attending the Emergency Department is typically triage. It is the point where emergency care begins with the nurse assessing the patient and assigning a triage category that best suits the patient’s clinical need. Traditionally triage had its origins in assessing patients presenting with a physical injury or illness and did not consider those with a psychological illness. Present-day triage has improved but not to the extent that is required for best practice. Furthermore staff in the Emergency Department may have received no formal training in the speciality that is Mental Health. Specialised training is necessary to provide a consistent and high standard of nursing care and assessment. The purpose of this study was the implementation of a change management project. This was initiated in a large Emergency Department in Dublin. The project involved the introduction of a mental illness triage tool, a computerised pop-up screen in triage and nursing assessment documentation specifically designed to manage the care of the patient attending the emergency department with a mental illness.

Implementation of Safe Surgery Saves Lives initiative in Ahmed-Gasim’s Cardiac Center

Ahmed Abdallah — Mon, 07 Nov 2011 07:23:04 PST

Aim: This paper reports on the implementation of a Safe Surgery Saves Lives, in Ahmed-Gasim‟s Cardiac Center in 2011 using a change management framework.

Background: Medical errors and incidence of traumatic injuries in surgical care services were recognized as a proportion of the total global burden of disease. Surgical care and procedures can potentially affect the lives of millions of people worldwide. Studies done by WHO found that wrong person, wrong procedure, and wrong site surgery is a preventable adverse event, and defined a core set of minimum standards that can be applied universally across borders and settings, and developed a Surgical Safety Checklist as a tool to ensure safety culture, teamwork, communications, information handoff, patient involvement, and systematic check of processes.

Methods: A Users' Guide to Managing Change in the Health Service Executive, HSE change model with major four phases; initiation, planning, implementation, and mainstreaming, was used to guide the implementation of the Safe Surgery Saves Live Initiative through using the WHO Surgical Safety Checklist in Ahmed-Gasim‟ Cardiac Center (AGCC).

Results: Implementation of a surgery checklist improved safety culture, memory recall, communication, team work, systematic check process, and decrease medical errors, such as wrong patient, wrong site, and wrong procedure. Implementation of a surgery checklist did not delay cases or increase load of work.

Improving Pharmacy Dispensing Performance Through Time Management

Mohamed Shaat — Fri, 21 Oct 2011 09:04:57 PDT

The aim of this project was to carry out a change model in one of Family Medicine Clinic’s Pharmacy in Abu Dhabi. While, the objectives of the project were to improve patient satisfaction through improving patient waiting time for medications collection, improving patient’s knowledge about the pharmacy services and then generalize the implemented change in all other six clinic’s pharmacies. The change was happened because of current system of dispensing patient’s prescription ‘in turn’, which created a discomfort among many patients as well as some patients were not taking a proper counseling over medications use, because of the need to finish all taken prescriptions without any delay. The change that was introduced in the pharmacy categorized the prescriptions into two categories; one for three or less medications prescription (directed to fast track window) and the second for more than three medications prescription (a ticket number was given for the patient to wait). Kotter eight step change model was used to initiate the change, which started by a crucial step in any change: creating a strong sense of urgency. This model provided the opportunity to create a vision and strategy to align people in the change process and underpin change efforts. The model ended with anchoring the new practices in the change to be as new culture to work with it. On the other hand, change evaluation was done through a variety of tools like: patient satisfaction survey (81.93% of patients were overall satisfied with the pharmacy services raised from 53%), waiting time data (average waiting time was reduced by 63% for category 1 and by 41.3% for category 2, giving the overall reduction by 50.3%), process mapping, staff interview (all staff are satisfied) and number of waiting time complaints (dropped dramatically by 67.25%). One of the most powerful impacts of the change on organization was the creation of a change committee to undertake all change projects in the department, take care of newly implemented change and generalize the change in other six pharmacies. In conclusion, robust collaborating of well defined and very important key elements in the change process can ultimately result in well managed and successful change.

Developing Service User Involvement in the Mental Health Department of a Paediatric Hospital

Julie Howley — Fri, 21 Oct 2011 08:48:10 PDT

This dissertation traces the development and implementation of a Quality Improvement Plan (QIP) in the area of Service User Involvement within the mental health department of a paediatric hospital. The change management project described focused specifically on the setting up and initial meetings of two Service User panels – one for parents/carers and their representatives and one for young people and their representatives. The dissertation sets out the rationale for this change project drawing on a number of key health policy publications of the last decade and on the literature base generally in this particular policy area. The HSE change model was used as a framework for the design and implementation of the change project. The formative stage of the development of service user involvement described in this dissertation was evaluated using a multi-source feedback questionnaire. The findings from this evaluation are discussed and recommendations are made for the next phase of this work. The project was successful in achieving its aims and the main conclusion from the process to date is the need for further work to mainstream the change within the culture, processes and structures of the mental health department.

Enhancing Operating Theatre Efficiency of Private Hospital in Kuwait; Business Management Approach

Ali Al-Saffar — Fri, 21 Oct 2011 07:49:50 PDT

Enhancing operating theatre efficiency in a dedicated for high standard clinical care before profitability private hospital was observed as an urgent issue after reviewing the financial reports which reflected amplified revenue nevertheless decreased profit. Reviewing literature supported categorising the problems into four domains and accordingly our prompt efforts were targeting four domains; the first domain is scheduling triggered by complaints of surgeons reporting conflicting schedules, blocked theatres, cancelled or postponed cases. Supply management, the second domain, noted lack of monitoring mechanisms, uncontrolled consumption, non-moving and expired stocks, primitive system processes and instruments management. The third domain is patient safety which alerted for the unsafe practices while documentation and data management as a fourth domain identified absence of indicators to assist in monitoring efficiency. Following the health service executive (HSE) model the initiation phase included emerging the teams and developing a common vision. The planning phase described the assessment and the development of initiatives to improve performance utilising SWOT analysis (Strength, Weaknesses, Opportunities, Threats). The implementation phase targeted the changes within the domains and these changes included developing scheduling and standardized practice policies and guidelines to steer schedule development were structured, surgical practices aimed at standardising use of supplies and instruments. In supply management, inventories of instruments, medications, and supplies were done; check lists developed to monitor utilisation and inventory standards created. Patient safety implemented safety regulations and set systematic monitoring of compliance, while data management worked on revising and devising new forms integrating essential fields to capture indicator related data. The evaluation phase described the monitoring tools and measured outcomes. The change reflected a noticeable improvement in most of the domains however further monitoring is needed to collect enough data to evaluate progress in relation to operating theatre efficiency.