RESUMEN
INTRODUCTION: Discharge from hospital is a risk to drug continuity and medication safety. In Germany, new legal requirements concerning the management of patient discharge from the hospital came into force in 2017. They set minimum requirements for the documentation of medications in patient discharge summaries, which are the primary means of communication at transitions of care. Six years later, data on their practical implementation in routine care are lacking. METHODS: Within the scope of an explorative retrospective observational study, the minimum requirements were operationalized and a second set of assessment criteria was derived from the recommendation "Good Prescribing Practice in Drug Therapy" published by the Aktionsbündnis Patientensicherheit e.V. as a comparative quality standard. A sample of discharge summaries was drawn from routine care at the University Hospital Heidelberg and assessed according to their fulfilment of the criteria sets. In addition, the potential influence of certain context factors (e. g., involvement of clinical pharmacists or software usage) was evaluated. RESULTS: In total, 11 quality criteria were derived from the minimum requirements. According to the eligibility criteria (i. e., three or more discharge medications) 352 discharge summaries (42 wards; issued in May-July 2021), containing in total 3,051 medications, were included. The practical implementation of the minimum requirements for documenting medications in patient discharge summaries differed considerably depending on the criterion and defined context factors. Core elements (i. e., drug name, strength, and dosage at discharge) were fulfilled in 82.8 %, while further minimum requirements were rarely met or completely lacking (e. g., explanations for special pharmaceutical forms). Involvement of clinical pharmacists and usage of software were shown to be a facilitator of documentation quality, while on-demand medication (compared to long-term medication) as well as newly prescribed medication (compared to home medication or medication changed during hospitalisation) showed poorer documentation quality. In addition, the documentation quality seemed to depend on the department and the day of discharge. CONCLUSION: To date, the wording of the German legal requirements allows for different interpretations without considering the respective clinical setting and the medication actually prescribed. For future clarification of the requirements, implications of the wording for the clinical setting should be considered.
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Documentación , Humanos , Alemania , Estudios Retrospectivos , Documentación/normas , Alta del Paciente/legislación & jurisprudencia , Alta del Paciente/normas , Resumen del Alta del Paciente/normas , Resumen del Alta del Paciente/legislación & jurisprudencia , Hospitales Universitarios/legislación & jurisprudencia , Hospitales Universitarios/normas , Conciliación de Medicamentos/normas , Conciliación de Medicamentos/legislación & jurisprudenciaRESUMEN
Background Evidence suggests intracerebral hemorrhage survivors have earlier recovery compared with ischemic stroke survivors. The Centers for Medicare and Medicaid Services prospective payment system instituted documentation rules for inpatient rehabilitation facilities (IRFs) in 2010, with the goal of optimizing patient selection. We investigated whether these requirements limited IRF and increased skilled nursing facility (SNF) use compared with home discharge. Methods and Results Intracerebral hemorrhage discharges to IRF, SNF, or home were estimated using GWTG (Get With The Guidelines) Stroke registry data between January 1, 2008, and December 31, 2015 (n=265 444). Binary hierarchical models determined associations between the 2010 Rule and discharge setting; subgroup analyses evaluated age, geographic region, and hospital type. From January 1, 2008, to December 31, 2009, 45.5% of patients with intracerebral hemorrhage had home discharge, 22.2% went to SNF, and 32.3% went to IRF. After January 1, 2010, there was a 1.06% absolute increase in home discharge, a 0.46% increase in SNF, and a 1.52% decline in IRF. The adjusted odds of IRF versus home discharge decreased 3% after 2010 (adjusted odds ratio [aOR], 0.97; 95% CI, 0.95-1.00). Lower odds of IRF versus home discharge were observed in people aged <65 years (aOR, 0.92; 95% CI, 0.89-0.96), Western states (aOR, 0.89; 95% CI, 0.84-0.95), and nonteaching hospitals (aOR, 0.90; 95% CI, 0.86-0.95). Adjusted odds of SNF versus home discharge increased 14% after 2010 (aOR, 1.14; 95% CI, 1.11-1.18); there were significant associations in all age groups, the Northeast, the South, the Midwest, and teaching hospitals. Conclusions The Centers for Medicare and Medicaid Services 2010 IRF prospective payment system Rule resulted in fewer discharges to IRF and more discharges to SNF in patients with intracerebral hemorrhage. Health policy changes potentially affect access to intensive postacute rehabilitation.
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Hemorragia Cerebral/rehabilitación , Reforma de la Atención de Salud , Medicare , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Alta del Paciente/tendencias , Sistema de Pago Prospectivo , Centros de Rehabilitación/tendencias , Instituciones de Cuidados Especializados de Enfermería/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Pacientes Internos , Masculino , Medicare/economía , Medicare/legislación & jurisprudencia , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud/economía , Evaluación de Procesos y Resultados en Atención de Salud/legislación & jurisprudencia , Alta del Paciente/economía , Alta del Paciente/legislación & jurisprudencia , Formulación de Políticas , Sistema de Pago Prospectivo/economía , Sistema de Pago Prospectivo/legislación & jurisprudencia , Sistema de Registros , Centros de Rehabilitación/economía , Centros de Rehabilitación/legislación & jurisprudencia , Instituciones de Cuidados Especializados de Enfermería/economía , Instituciones de Cuidados Especializados de Enfermería/legislación & jurisprudencia , Factores de Tiempo , Resultado del Tratamiento , Estados UnidosRESUMEN
BACKGROUND: The impact of the Florida State law House Bill 21 (HB 21) restricting the duration of opioid prescriptions for acute pain in patients after cesarean delivery is unknown. Our objective was to assess the association of the passage of Florida State law HB 21 with trends in discharge opioid prescription practices following cesarean delivery, necessity for additional opioid prescriptions, and emergency department visits at a large tertiary care center. METHODS: This was a retrospective cohort study conducted at a large, public hospital. The 2 cohorts represented the period before and after implementation of the law. Using a confounder-adjusted segmented regression analysis of an interrupted time series, we evaluated the association between HB 21 and trends in the proportions of patients receiving opioids on discharge, duration of opioid prescriptions, total opioid dose prescribed, and daily opioid dose prescribed. We also compared the need for additional opioid prescriptions within 30 days of discharge and the prevalence of emergency department visits within 7 days after discharge. RESULTS: Eight months after implementation of HB 21, the mean duration of opioid prescriptions decreased by 2.9 days (95% confidence interval [CI], 5.2-0.5) and the mean total opioid dose decreased by 20.1 morphine milligram equivalents (MME; 95% CI, 4-36.3). However, there was no change in the proportion of patients receiving discharge opioids (95% CI of difference, -0.1 to 0.16) or in the mean daily opioid dose (mean difference, 5.3 MME; 95% CI, -13 to 2.4). After implementation of the law, there were no changes in the proportion of patients who required additional opioid prescriptions (2.1% vs 2.3%; 95% CI of difference, -1.2 to 1.5) or in the prevalence of emergency department visits (2.4% vs 2.2%; 95% CI of difference, -1.6 to 1.1). CONCLUSIONS: Implementation of Florida Law HB 21 was associated with a lower total prescribed opioid dose and a shorter duration of therapy at the time of hospital discharge following cesarean delivery. These reductions were not associated with the need for additional opioid prescriptions or emergency department visits.
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Cesárea , Control de Medicamentos y Narcóticos/legislación & jurisprudencia , Antagonistas de Narcóticos/uso terapéutico , Manejo del Dolor , Dolor Postoperatorio/prevención & control , Pautas de la Práctica en Medicina/legislación & jurisprudencia , Programas de Monitoreo de Medicamentos Recetados/legislación & jurisprudencia , Adulto , Cesárea/efectos adversos , Prescripciones de Medicamentos , Utilización de Medicamentos/legislación & jurisprudencia , Femenino , Florida , Regulación Gubernamental , Hospitales Públicos , Humanos , Dolor Postoperatorio/etiología , Alta del Paciente/legislación & jurisprudencia , Embarazo , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
This article examines the legislation and practice of compulsory treatment in China. Part I traces the Chinese history of criminal commitment law, explains the research methodology, and highlights some general empirical findings. Part II provides a comprehensive empirical analysis of compulsory treatment law in China, it covers both substantial issues such as criteria of compulsory treatment and procedural issues such as the commitment hearing, enforcement, and discharge of compulsory treatment. It also explores the compulsory treatment law from the human rights protection perspective. Our primary objective is to present the empirical findings to enable the legislative and other involved government agencies to make informed decisions about the future evolution of Chinese law in this area.
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Internamiento Obligatorio del Enfermo Mental/legislación & jurisprudencia , Derecho Penal , Investigación Empírica , Tratamiento Psiquiátrico Involuntario/legislación & jurisprudencia , Tratamiento Psiquiátrico Involuntario/organización & administración , Internamiento Obligatorio del Enfermo Mental/historia , Conducta Peligrosa , Historia del Siglo XX , Derechos Humanos/legislación & jurisprudencia , Humanos , Rol Judicial , Aplicación de la Ley , Alta del Paciente/legislación & jurisprudenciaRESUMEN
Discharges from hospital are internationally recognised as a dangerous time in the care pathway of a patient, posing a risk to both their physical wellbeing and dignity. This article examines the effectiveness of risk-based regulation as a tool to address patient safety incidents linked to the hospital discharge process within the English National Health Service. It examines how the risk of this process is identified, conceptualised, and prioritised amongst the relevant statutory regulators, and argues that the risk is neither uniformly recognised by the statutory regulators within the English NHS, nor sufficiently addressed. Professional regulators in particular appear to have a poor awareness of the risk and their role in addressing it. Until these issues are resolved, patients leaving hospitals will continue to be exposed to patient safety incidents which should be avoidable.
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Alta del Paciente/legislación & jurisprudencia , Alta del Paciente/normas , Seguridad del Paciente/legislación & jurisprudencia , Seguridad del Paciente/normas , Gestión de Riesgos/legislación & jurisprudencia , Gestión de Riesgos/normas , Inglaterra , Humanos , Programas Nacionales de SaludRESUMEN
People being held in jails and prisons are entitled under the U.S. Constitution to necessary medical care, including mental health care. Whether such a duty includes planning for care after release has been less clear, despite widespread professional recognition of discharge planning as an integral component of correctional mental health treatment. A recent decision of a federal court of appeals considered the constitutional status of discharge planning for people detained in correctional facilities. The court concluded that a failure to offer discharge planning in the face of serious medical needs is an adequate basis for finding a constitutional violation.
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Instalaciones Correccionales/legislación & jurisprudencia , Psiquiatría Forense/legislación & jurisprudencia , Enfermos Mentales/legislación & jurisprudencia , Alta del Paciente/legislación & jurisprudencia , Trastornos Psicóticos/terapia , Humanos , Masculino , Persona de Mediana Edad , Trastornos Psicóticos/tratamiento farmacológico , Estados UnidosRESUMEN
BACKGROUND AND OBJECTIVES: The Commonwealth of Pennsylvania passed the Caregiver Advise, Record, Enable (CARE) Act on April 20, 2016. We designed a study to explore early implementation at a large, integrated delivery financing system. Our goal was to assess the effects of system-level decisions on unit implementation and the incorporation of the CARE Act's three components into routine care delivery. RESEARCH DESIGN AND METHODS: We conducted a multisite, ethnographic case study at three different hospitals' medical-surgical units. We conducted observations and semi-structured interview to understand the implementation process and the approach to caregiver identification, notification, and education. We used thematic analysis to code interviews and observations and linked findings to the Promoting Action on Research Implementation in Health Services framework. RESULTS: Organizational context and electronic health record capability were instrumental to the CARE Act implementation and integration into workflow. The implementation team used a decentralized strategy and a variety of communication modes, relying on local hospital units to train staff and make the changes. We found that the system facilitated the CARE Act implementation by placing emphasis on the documentation and charting to demonstrate compliance with the legal requirements. DISCUSSION AND IMPLICATIONS: General acute hospitals will be making or have made similar decisions on how to operationalize the regulatory components and demonstrate compliance with the CARE Act. This study can help to inform others as they design and improve their compliance and implementation strategies.
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Cuidadores/educación , Documentación , Hospitales Generales/legislación & jurisprudencia , Alta del Paciente/legislación & jurisprudencia , Atención a la Salud , Registros Electrónicos de Salud , Personal de Salud , Servicios de Salud , Humanos , PennsylvaniaRESUMEN
Involuntary detention is used internationally to detain and treat people who are deemed to have a mental disorder. In England and Wales, approved mental health professionals (AMHPs) co-ordinate Mental Health Act assessments which allow for patients to be detained. AMHPs have legal duties to identify, inform and consult with a patient's nearest relative (NR), who are, in turn, given powers to initiate or challenge detention. Our study takes an original approach through examining how AMHPs interpret their duties towards nearest relatives. We adopted a two-stage design, which involved an online questionnaire with 55 AMHPs and focus group discussions with 33 AMHPs. The research was conducted in England between 2017 and 2018. Our questionnaire found that a high proportion of AMHPs reported that they had spoken to NRs for background information when assessing patients under the Mental Health Act. However, AMHPs were less likely to ask patients about their views of involving the NR prior to assessment. Focus group findings showed that AMHPs saw the NR role as offering an important 'safeguard' on the basis that NRs could provide information about the patient and advocate on their behalf. AMHPs identified practical difficulties in balancing their legal obligation towards NRs and patients; particularly where issues of potential abuse were raised or where patients had identified that they did not want NR involvement. While AMHPs stated that they sought to prioritise patient wishes regarding confidentiality, their accounts identified that patient consent about information sharing was sometimes implied rather than sought explicitly. Our findings reinforce conclusions by the recent Independent Review of the MHA, which states that current NR provisions are 'outdated, variable and insufficient'. We identify that current practice could be improved using advanced choice documents and outline implications for AMHP practice.
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Internamiento Obligatorio del Enfermo Mental/legislación & jurisprudencia , Competencia Mental/legislación & jurisprudencia , Trastornos Mentales/enfermería , Defensa del Paciente/legislación & jurisprudencia , Inglaterra , Humanos , Salud Mental , Evaluación de Necesidades/legislación & jurisprudencia , Alta del Paciente/legislación & jurisprudencia , Medición de Riesgo/legislación & jurisprudencia , GalesRESUMEN
The objective of this nationwide survey was to evaluate whether there has been a change in the practice regarding hospital release of differentiated thyroid cancer patients treated with 131I since the publication of Nuclear Regulatory Commission Regulatory Issue Summary 2011-01 addressing patient release. Methods: A survey was emailed to approximately 25,000 members of ThyCa: Thyroid Cancer Survivors' Association, Inc., and was available online from March to August 2018. Responses were included from adult patients regarding their most recent 131I therapy received between 2011 and 2018 ("after 2011"). Responses to this survey were compared with those of a similar previous survey for 131I therapies received between 1997 and 2009 ("before 2009"). Results: Of the 2,136 responses, 1,111 met the inclusion criteria. A similar percentage (â¼98%) of patients were given oral or written radiation safety instructions (RSIs) after 2011 and before 2009, with a shift away from nuclear medicine physicians providing instructions after 2011 (43%) in comparison with before 2009 (54%; P < 0.001). More patients were able to discuss and individualize the RSIs after 2011 (67%) than before 2009 (29%; P < 0.001). However, 2% of patients do not recall ever receiving RSIs after 2011. After 2011, more patients were treated as outpatients (87%) than before 2009 (66%; P < 0.001). For outpatients, more patients were discharged within 30 min after receiving 131I therapy after 2011 (78%) than before 2009 (72%; P = 0.002). The same percentage (0.6%) of patients traveled more than 2 h with at least 2 occupants in the vehicle within approximately 1 m of the patient after 2011 and before 2009. Immediately after therapy, a similar percentage of patients stayed in a nonprivate residence after 2011 (4%) and before 2009 (5%; P = 0.28). Of the 27 outpatients released within 30 min to nonprivate residences, 2 patients received 5.55-11.1 GBq (150-299 mCi) of 131I. Conclusion: This survey suggests that since publication of the Nuclear Regulatory Commission Regulatory Issue Summary 2011-01 on patient release after radioiodine therapy, there have been improvements in some radiation safety practices on release of outpatients, as well as improvements in patient compliance on travel and lodging.
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Agencias Gubernamentales/legislación & jurisprudencia , Radioisótopos de Yodo/uso terapéutico , Alta del Paciente/legislación & jurisprudencia , Políticas , Encuestas y Cuestionarios , Neoplasias de la Tiroides/radioterapia , Humanos , Pacientes Ambulatorios/legislación & jurisprudenciaRESUMEN
Facilitating factors and barriers to breast milk feeding (BMF) for preterm infants have been mainly studied in very preterm populations, but little is known about moderate preterm infants. We aimed to analyze hospital unit characteristics and BMF policies associated with BMF at discharge for infants born at 32 to 34 weeks' gestation. EPIPAGE-2, a French national cohort of preterm births, included 883 infants born at 32 to 34 weeks' gestation. We investigated kangaroo care in the first 24 hr, early involvement of parents in feeding support, volume of the unit, BMF information given to mothers hospitalized for threatened preterm delivery, protocols for BMF, presence of a professional trained in human lactation, unit training in neurodevelopmental care, and regional BMF initiation rates in the general population. Multilevel logistic regression analysis was used to investigate associations between unit policies and BMF at discharge, adjusted for individual characteristics and estimating odds ratios (ORs) and 95% confidence intervals (CIs). Overall, 59% (490/828) of infants received BMF at discharge (27% to 87% between units). Rates of BMF at discharge were higher with kangaroo care (adjusted OR 2.03 [95% CI 1.01, 4.10]), early involvement of parents in feeding support (1.94 [1.23, 3.04]), unit training in a neurodevelopmental care programme (2.57 [1.18, 5.60]), and in regions with a high level of BMF initiation in the general population (1.85 [1.05, 3.28]). Creating synergies by interventions at the unit and population level may reduce the variability in BMF rates at discharge for moderate preterm infants.
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Lactancia Materna , Unidades de Cuidado Intensivo Neonatal , Alta del Paciente , Atención Posnatal , Adulto , Estudios de Cohortes , Femenino , Promoción de la Salud , Humanos , Recién Nacido , Recien Nacido Prematuro/fisiología , Unidades de Cuidado Intensivo Neonatal/legislación & jurisprudencia , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Alta del Paciente/legislación & jurisprudencia , Alta del Paciente/estadística & datos numéricos , Atención Posnatal/legislación & jurisprudencia , Atención Posnatal/estadística & datos numéricos , Embarazo , Adulto JovenRESUMEN
No disponible
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Servicio de Urgencia en Hospital , Terminología como Asunto , Alta del Paciente/legislación & jurisprudencia , Alta del Paciente/normas , Humanización de la AtenciónRESUMEN
The CARE Act, law in 40 states and territories in the United States, requires hospitals to identify and include family caregivers during admission and in preparation for discharge. Although the number of family caregivers has been steadily increasing, health care providers are ill-prepared to address their needs, and caregiving remains a neglected topic in health care providers' education. A market analysis was performed to explore the availability of and interest in interprofessional courses and programs focused on preparing health professionals to support family caregivers. Although nurses and chief nursing officers agreed on the importance of supporting caregivers, they were less likely to endorse formal educational preparation for this complex role. The current study elucidates a gap between what caregivers report they need and the preparation of health care professionals to advance family-centered approaches to care. [Journal of Gerontological Nursing, 45(3), 7-11.].
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Cuidadores/educación , Cuidadores/legislación & jurisprudencia , Personal de Salud/educación , Admisión del Paciente/legislación & jurisprudencia , Admisión del Paciente/normas , Alta del Paciente/legislación & jurisprudencia , Alta del Paciente/normas , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados UnidosRESUMEN
In March 2017, Rhode Island released treatment standards for care of adult patients with opioid use disorder. These standards prescribe three levels of hospital and emergency department treatment and prevention of opioid use disorder and opioid overdose and mechanisms for referral to treatment and epidemiological surveillance. By June 2018, all Rhode Island licensed acute care facilities had implemented policies meeting the standards' requirements. This policy has standardized care for opioid use disorder, enhanced opioid overdose surveillance and response, and expanded linkage to peer recovery support, naloxone, and medication for opioid use disorder.
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Sobredosis de Droga , Servicio de Urgencia en Hospital/legislación & jurisprudencia , Trastornos Relacionados con Opioides , Alta del Paciente/legislación & jurisprudencia , Sobredosis de Droga/prevención & control , Sobredosis de Droga/terapia , Servicio de Urgencia en Hospital/economía , Costos de Hospital , Humanos , Naloxona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Trastornos Relacionados con Opioides/prevención & control , Trastornos Relacionados con Opioides/terapia , Salud Pública , Rhode IslandRESUMEN
Under section 23 of the Mental Health Act 1983 a person can be discharged by the managers of the hospital from compulsory care. The limited evidence indicates that the section 23 power is normally delegated to a specially appointed panel who hold a hearing. Unfortunately, notwithstanding the implications for the liberty, autonomy, and dignity of the compelled person, very little is known about how this process operates. Nonetheless, since 1996 there has been a sustained effort to abolish the power. In view of this, the proposal to reform the 1983 Act contained in the Queen's Speech January 2017, and the subsequent establishment of the Independent Review of the Mental Health Act in October 2017, I critique the claims made in the abolition debate, and establish the conceptual gaps therein. I argue that a much more developed understanding of the power is required before any change is made to the law in this area.
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Reforma de la Atención de Salud , Administradores de Instituciones de Salud/legislación & jurisprudencia , Servicios de Salud Mental , Alta del Paciente/legislación & jurisprudencia , Reforma de la Atención de Salud/historia , Reforma de la Atención de Salud/legislación & jurisprudencia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Reino UnidoRESUMEN
No disponible
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Humanos , Servicio de Urgencia en Hospital/organización & administración , Alta del Paciente/legislación & jurisprudencia , Derechos del Paciente , Discusiones Bioéticas/legislación & jurisprudencia , Negativa del Paciente al Tratamiento/legislación & jurisprudencia , Servicio de Urgencia en Hospital/ética , Servicio de Urgencia en Hospital/legislación & jurisprudencia , Negativa del Paciente al Tratamiento/éticaRESUMEN
After adjudication by the courts that an individual is not criminally responsible for the offense committed, forensic psychiatrists/psychologists are tasked with evaluating an acquittees' ongoing risk of violence. These findings determine whether an acquittee is retained in a forensic hospital or transferred to a civil psychiatric setting or into the community. Better understanding of risk factors that affect decisions to retain or release acquittees from secure forensic facilities would increase clarity in decision-making, assist evaluators in identifying who may be successful outside of secure settings, and potentially assist in the development and implementation of targeted treatments to address risk factors before and after transfer. The current study evaluated which risk factors of the Historical-Clinical-Risk Management 20, Version 3 differentiated acquittees whom clinicians opined to have a dangerous mental disorder and required retention from those whom clinicians opined to be ready for transfer to a less secure setting. Results indicated that the Clinical and Risk Management scales predicted opinions regarding readiness for transfer, even after accounting for acts of violence in the hospital. These findings suggest clinicians are attuned to relevant and current risk factors in evaluations, rather than disproportionately focused on historical factors. Implications for practice and future research are discussed.