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A Digital Solution to Improve Safety of Valproate Prescribing in Mental Health
- Ashma Mohamed, Alison Marshall, Nikki Smith, Anna Smith, Barbara Sowa, Sue England, Sarah Long
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S103
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Aims
Valproate is a licensed medicine prescribed within mental health settings for bipolar disorder. It is a known teratogen, affecting approximately 20,000 people and costing the NHS £181 billion. This was a multidisciplinary project involving Surrey Heartlands Medicines Safety Team and Surrey and Borders Partnership NHS Foundation Trust, who developed a solution to reduce human suffering and cost by adhering to the Medicines and Healthcare Products Regulatory Agency (MHRA) valproate regulations through a clinical and digital redesign. The aim was to identify females in primary and secondary care across Surrey who take valproate for mental illness and to implement a pregnancy prevention programme for them by July 2022, using a digital clinical pathway supporting clinicians in the implementation process.
MethodsThe method used was a combination of the Model for Improvement, the sequence for improvement from East London NHS Foundation Trust, UX design, and Agile project management. A valproate working group was formed with professionals from multiple disciplines to identify, understand and solve the problem. The solution was designed through co-production and project management methods that ensured a patient-centric solution.
ResultsA digital registry of all females of childbearing potential who are prescribed valproate was created. A bespoke electronic GP referral form for valproate reviews was implemented. A one-stop valproate dashboard was developed to support documentation. A live digital visualisation feature was added within the secondary care electronic patient record to ensure compliance with MHRA guidelines. Easy-to-read materials for females with learning disabilities and sensitively worded appointment letters that inform patients of the risks and importance of attending annual reviews were created. In addition, collaboration with the National Valproate Patient Safety Officer allowed the implementation of Systematized Nomenclature of Medicine Clinical Terms (SNOMED) codes to simplify the exchange of clinical information between systems.
ConclusionThe project has the potential to reduce harm and improve the patient experience, serving as a template for other medications with strong regulatory controls. Collaboration between primary and secondary care, clinicians, pharmacists and digital colleagues, and co-design with people prescribed valproate were essential to the success of the project. Ongoing work is required to ensure valproate-related materials are available in an accessible format for every person prescribed valproate. Valproate has also been implicated in paternal adverse effects, and this project solution is future-proofed to identify men on valproate. Through this work, people will only be treated with valproate in a way that safeguards the health of unborn children.
4367 Exploratory evaluation of an online educational intervention for JUUL use
- Eleanor L S Leavens, Matthew J. Carpenter, Tracy T. Smith, Nikki Nollen
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- Journal:
- Journal of Clinical and Translational Science / Volume 4 / Issue s1 / June 2020
- Published online by Cambridge University Press:
- 29 July 2020, pp. 30-31
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OBJECTIVES/GOALS: Initiation of JUUL use by young adults is one of the most significant issues of concern within the debate on vaping. Despite the proliferation of products and the surge in prevalence, no studies have investigated individual-level interventions or prevention strategies for pod-mod use. METHODS/STUDY POPULATION: Participants (N = 947) were young adults (<30 years old) recruited from Amazon’s Mechanical Turk based on smoking (never, former, and current smokers) and JUUL use status (never and current users), resulting in 6 use groups. In a pre-post design, participants completed baseline assessments, were presented with a brief JUUL-specific educational intervention, and completed post-assessment measures. The one-page intervention provided basic information about JUUL and stated that JUUL is harmful to non-smokers but could be beneficial to smokers if they completely switch. Primary outcomes were changes in JUUL knowledge, perceived harmfulness, intentions for future use, and motivation to change. RESULTS/ANTICIPATED RESULTS: Participants (Mage = 26.1) were male (57%) and White (75%). Overall, the intervention increased JUUL-related knowledge, risk perceptions, commitment to quitting, and readiness to quit JUUL (ps<.01). Similarly, participants showed decreased interest in future JUUL use, interest in purchasing JUUL, and interest in future regular use (ps<.01). Non-JUUL users showed decreased interest in initiating JUUL use after viewing the intervention (p<.01). There were significant Time X Group interactions for JUUL-related knowledge (p<.001), with never JUUL/never smokers showing the greatest increase in product knowledge following the intervention. However, no other interaction effects were significant. DISCUSSION/SIGNIFICANCE OF IMPACT: The intervention was effective in increasing knowledge and risk perceptions while reducing intentions for future use. The intervention was most effective in increasing knowledge among non-users, suggesting that brief educational interventions may be useful tools for preventing pod-mod initiation. CONFLICT OF INTEREST DESCRIPTION: Dr. Carpenter has received consulting honoraria from Pfizer. All other authors have no conflicts to disclose.
Colostrum avoidance, prelacteal feeding and late breast-feeding initiation in rural Northern Ethiopia
- Nikki L Rogers, Jemilla Abdi, Dennis Moore, Sarah Nd'iangui, Linda J Smith, Andrew J Carlson, Dennis Carlson
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- Journal:
- Public Health Nutrition / Volume 14 / Issue 11 / November 2011
- Published online by Cambridge University Press:
- 21 April 2011, pp. 2029-2036
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Objective
To identify specific cultural and behavioural factors that might be influenced to increase colostrum feeding in a rural village in Northern Ethiopia to improve infant health.
DesignBackground interviews were conducted with six community health workers and two traditional birth attendants. A semi-structured tape-recorded interview was conducted with twenty mothers, most with children under the age of 5 years. Variables were: parental age and education; mother's ethnicity; number of live births and children's age; breast-feeding from birth through to weaning; availability and use of formula; and descriptions of colostrum v. other stages of breast milk. Participant interviews were conducted in Amharic and translated into English.
SettingKossoye, a rural Amhara village with high prevalence rates of stunting: inappropriate neonatal feeding is thought to be a factor.
SubjectsWomen (20–60 years of age) reporting at least one live birth (range: 1–8, mean: ∼4).
ResultsColostrum (inger) and breast milk (yetut wotet) were seen as different substances. Colostrum was said to cause abdominal problems, but discarding a portion was sufficient to mitigate this effect. Almost all (nineteen of twenty) women breast-fed and twelve (63 %) reported ritual prelacteal feeding. A majority (fifteen of nineteen, 79 %) reported discarding colostrum and breast-feeding within 24 h of birth. Prelacteal feeding emerged as an additional factor to be targeted through educational intervention.
ConclusionsTo maximize neonatal health and growth, we recommend culturally tailored education delivered by community health advocates and traditional health practitioners that promotes immediate colostrum feeding and discourages prelacteal feeding.
6 - Preparation for rapid sequence induction and tracheal intubation
- Edited by Jonathan Benger, Jerry Nolan, Mike Clancy
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- Book:
- Emergency Airway Management
- Published online:
- 22 August 2009
- Print publication:
- 06 November 2008, pp 51-58
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Summary
Objectives
The objectives of this chapter are to understand how to:
prepare thoroughly for rapid sequence induction (RSI) and tracheal intubation
position patients optimally to maximize the success of laryngoscopy and intubation
assemble and check the equipment and drugs required for RSI and tracheal intubation
use appropriate monitoring and know its strengths and limitations
reassess the patient rapidly and ascertain all the required information before undertaking RSI
identify and use team resources appropriately to maximize team co-operation and understanding.
Introduction
Making the decision that a patient requires a rapid sequence induction (RSI) is the entry point to the sequence of preparation for this procedure. While there may be times when intubation of the patient needs to be achieved immediately, there are very few instances in which placement of the tracheal tube is so time critical that these basic preparatory steps cannot be followed. With a systematic approach and good team working, this will take only a few minutes and avoid many possible problems and complications.
The PEACH approach (Box 6.1) provides a useful mnemonic.
Positioning
Correct positioning of the patient's head and neck improves the view of the larynx at laryngoscopy and the likelihood of successful intubation. Alignment of the oral, pharyngeal and laryngeal axes during laryngoscopy provides a clear view from the incisors to the laryngeal inlet (see Chapter 4).
Approximately 20% of RSI undertaken in the emergency department require stabilization of the cervical spine: in almost all other cases the patient should be placed in the optimum intubating position, unless spinal deformity or arthritis makes this impractical or inadvisable.
7 - Rapid sequence induction and tracheal intubation
- Edited by Jonathan Benger, Jerry Nolan, Mike Clancy
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- Book:
- Emergency Airway Management
- Published online:
- 22 August 2009
- Print publication:
- 06 November 2008, pp 59-66
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Summary
Objectives
The objectives of this chapter are to understand:
the importance of pre-oxygenation
the technique of rapid sequence induction (RSI) of anaesthesia and tracheal intubation
the confirmation of successful intubation
the importance of immediate review of patient physiology after intubation.
Introduction
Rapid sequence induction of anaesthesia (RSI) involves injecting an anaesthetic induction drug to achieve hypnosis, rapidly followed by a neuromuscular blocking drug to produce complete paralysis. To prevent inflation of the stomach, the lungs are not usually ventilated between induction and intubation, and the airway is protected by applying cricoid pressure to prevent regurgitation of gastric contents. The time from loss of consciousness to securing the airway is minimized because the patient's stomach is assumed to be full.
Pre-oxygenation
Effective pre-oxygenation replaces the nitrogen in the alveoli with oxygen, which increases the oxygen reserve in the lung. Pre-oxygenation maximizes the time before desaturation occurs following the onset of apnoea. This provides more time for intubation to be attempted before having to stop to re-oxygenate the patient's lungs (see Chapter 2). Whenever possible, give 100% oxygen for three minutes before induction of anaesthesia. A patient who is breathing inadequately may not achieve enough alveolar ventilation to replace nitrogen in the lungs with oxygen. These patients may therefore require assisted ventilation to achieve adequate pre-oxygenation before RSI.
The time to desaturation is related not only to the effectiveness of the pre-oxygenation phase, but also to the age and weight of the patient and their physiological status.
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