Saudi Cultural Missions Theses & Dissertations
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Item Restricted A cross-sectional clinical audit of rapid tranquillisation practices for elderly patients at Surrey and Sussex Healthcare NHS trust(Saudi Digital Library, 2023-11-01) Almutairi, Bader Awadh; Barrett, RavinaIntroduction: Rapid tranquillisation (RT) is a procedure that is often used in hospitals for confused, agitated, aggressive or violent patients. RT is most commonly used with the elderly, often suffering from delirium or dementia. The goal is to sedate the patient, thus minimising the risk of harm to themselves or others. The procedure in East Surrey Hospital (ESH) (locus of this audit) is governed by Surrey and Sussex Hospital Trust (SASH), as the medications used may require careful selection according to various factors. The aim of this audit was to explore the extent to which SASH adheres to its published RT Policy, specifically concerning the RT of elderly patients (aged 75 and above). Method: The study was a cross-sectional retrospective clinical audit. The inclusion criteria were that the patients were to be aged 75 or older, have received RT at ESH between 1st May 2023 and 14th June 2023. The data were analysed using SPSS software, Version 28. Findings: Overall, an 84% adherence rate was achieved for the 14 standards that were applied. The rate of non-adherence ranged from 0% to 100%. Eight of the standards were met with 100% adherence; one standard and three standards achieved adherence rates between 90 and 99% and between 80 and 89%, respectively; one standard had an adherence rate of 30%; and one standard achieved an adherence rate of 0%. For 25%, 44.7% and 14.9% of the patients, 13, 12 and 11 standards were met, respectively, At least 12 of the 14 standards were met in over 85% of cases. In terms of adherence by the medical and surgical wards, for nine standards, the adherence rates were either identical or very similar; for three standards, the medical wards showed higher compliance; and for one standard, the surgical wards showed a higher rate of adherence. Thus, overall, the two kinds of wards showed very similar levels of adherence. Discussion: The audit was a valuable tool, with significant results that need to be further explored. It was suggested that adherence may have been negatively affected by work overload, the need for training or the clinical situation that presented itself. Five recommendations were made: (1) The findings should be presented to and discussed with the care team; (2) staff should be given training regarding the guidelines; (3) the clinical audit should be repeated annually; (4) an RT care plan should be published, and a computerised system installed to provide alerts when non-adherence occurs; (5) audits should be conducted at different times of the year, When hospital busyness varies. Future research may include longitudinal and qualitative studies. The clinical audit should form part of a hospital’s continuous improvement programme.20 0Item Restricted THE ROLE OF THE PHARMACIST IN IMPROVING ADHERENCE TO INHALED MEDICATION AMONG COPD PATIENTS(Saudi Digital Library, 2023-05-07) Aljahan, Abdullah M; Jordan, Rachel; Hodgkinson, JamesBackground: COPD is not a single health problem, but a spectrum of diseases associated with airway obstruction. Adherence to inhaler medication is critical but remains sub-optimal amongst COPD patients. Intervention studies suggest pharmacists could play an important role in improving patients’ adherence, but there is a lack of integration of pharmacists within primary care. Despite the potential benefits of community pharmacists in improving adherence/inhaler technique amongst respiratory patients, community pharmacists are an untapped resource. In this thesis, I explore the current practice of UK pharmacists in promoting adherence to inhaler medications for COPD patients, and their views, and those of patients and primary healthcare practitioners on how pharmacists might best be involved in their care pathway. Aim: To explore the role of the pharmacist in improving adherence to inhaled medication among COPD patients. Methods: Five studies were conducted to fulfil the aim of this thesis. These involved a) a cross- sectional study to ascertain community pharmacists’ knowledge, attitude and current practice and explore views on their role to improve inhaler adherence among COPD patients; b) three qualitative studies exploring COPD patients’ perspectives on the role of pharmacists in the management of COPD patients, HCPs’ perspectives on the current role of pharmacists and their integration in the management of COPD, and both patients’ and HCPs’ perspectives on COVID-19 and its impact on healthcare services provided to COPD patients; c) a systematic review of pharmacist role in Shared Decision Making (SDM) for patients with long-term conditions. Results: This PhD identified a potential willingness from UK pharmacists to help COPD patients by offering high-quality services as most community pharmacists have a solid foundation of knowledge about inhalers. Many HCPs and patients believe pharmacists would benefit from being more involved in their patients’ treatment plans. However, patients’ and HCPs’ perceptions on the role of pharmacists highlighted their limited capacity, the limited collaboration and communication between HCPs and pharmacists as well as HCPs and patients, and regulatory hurdles such as lack of access to medical records. Conclusion: This PhD highlighted the potential pharmacists’ roles in supporting COPD care delivery. However, the results showed some aspects where barriers must be overcome to facilitate this role. Hence, this PhD proposes that future work should concentrate on these aspects to make it more possible to step up the pharmacists’ roles and eventually improve adherence to inhaled medication among COPD patients within the UK.22 0