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Strategies for reducing i.v. drug waste and coping with increased workload.

The amount of i.v. drugs wasted in our centralized i.v. admixture program was initially identified as a problem in 1982. The i.v. drug waste in 1982 was approximately $72,000, which represented 8.8% of the total i.v. drug budget. The i.v. admixture workload had also increased 35% from 1980 to 1982. The pharmacy department decided to approach the i.v. drug waste and increased workload problem by purchasing premixed i.v. solutions. The objective of this study was to evaluate whether premixed i.v. solutions are cost effective by decreasing both drug waste and i.v. preparation time. In addition, pharmacy standardized the doses of various i.v. drugs and instituted an on-call card system for the ordering of selected drug by nursing. By using the above methods, the pharmacy department was able to absorb an additional 37% increase in workload from 196,418 units in 1982 to 269,176 units in 1985. Also, pharmacy was able to reduce the i.v. drug waste from 8.8% of the i.v. budget in 1982, to 2.35% of the 1985 i.v. budget. Both of these goals was achieved without additional staff.

Cost-Benefit Analysis↗

[An analysis system of physical training workload based on Polar Sports Tester].

The polar sports tester made in Finland as one of the most widespread instruments in physical training is of importance for sports training. In this paper, we have developed a set of system for analysis of physical training workload using the measured data of the Polar Sports Tester, and have established a set of analysis indices and reports of the physical training workload, including five categories and 127 quantitative indices. It can reflect the distribution of physical workload and provide a series of parameters for coaches to direct scientific training and raise sport level.

Adaptation, Physiological↗

Workload and stress in horses: comparison in horses ridden deep and round ('rollkur') with a draw rein and horses ridden in a natural frame with only light rein contact.

'Rollkur' or 'overbending' is the low and deep riding of a dressage horse during training or warming up. Lately, this technique has been criticized, and not necessarily objectively, on welfare grounds. To be able to evaluate these criticisms, more needs to be known about the workload and stress of horses being ridden 'rollkur'. The aim of the present study was to compare the workload of eight riding-school horses when being ridden deep and round with a draw rein ('rollkur') and when being ridden in a natural frame with only light rein contact ('free'). Workload (as measured by heart rate and blood lactate concentration) was slightly higher when horses were ridden 'rollkur' than when they were ridden 'free'. There were no differences in packed cell volume, or glucose and cortisol concentrations. No signs of uneasiness or stress could be determined when the horses were ridden 'rollkur'. Subjectively, all horses improved their way of moving during 'rollkur' and were more responsive to their rider.

Animal Husbandry↗

Satisfaction with nursing workload systems: report of a survey of Canadian hospitals. Part A.

Senior nursing executives from a representative sample of Canadian hospitals were surveyed on their attitudes and views of nursing workload measurement systems. In terms of a profile of users and their satisfaction, the survey found that about 50% of hospitals were using a system, and that among those using a system, 70% used information from the system frequently or all the time. The senior nurse respondents were generally satisfied with their current systems; slightly lower levels of satisfaction were reported for staff nurses, with the most common objection being the perception that the systems do not reflect true workload. A subsequent article--Part B--explores senior nurse executives' needs and expectations for nursing workload systems.

Canada↗

Brief report: emergency department workload described.

A review of workload in the ED setting shows trauma still account for the majority of patients, but that non-trauma emergencies nonetheless comprise a sizable proportion (45.2%) of the total workload. Resuscitation patients account for 10.1% of cases and overall 17.3% of patients require admission. Recalls are a very small and decreasing proportion of total workload.

Diagnosis-Related Groups↗

Potentiation of right ventricular function at a reduced workload: a potential pitfall in assessing right ventricular function by exercise radionuclide ventriculography.

Right ventricular ejection fraction (RVEF) determinations at rest (R) and exercise (E) are a means of demonstrating exercise-induced RV dysfunction. Not all patients are able to maintain peak (P) cardiac workloads during a gated RVEF study or, if a first-pass study is performed, for multiple acquisitions. Reductions from P cardiac workloads have been shown to potentiate LV function; however, the effect on RVEF has not been studied. Supine exercise radionuclide ventriculography was performed on 26 patients: nine normal subjects and 17 patients with coronary artery disease (CAD) (greater than 50% stenosis of one or more coronary artery). Gated RVEF's were obtained from sequential left anterior oblique views obtained at R, P, and at a workload reduced approximately 40% from P work levels postpeak (PP). In normals, RVEFs were at R, P, and PP 27, 38 and 44. In CAD patient RVEFs were 31, 35 and 39, at R, P, and PP, respectively. The conclusions are that RVEF improves from rest to PP exercise levels in normal subjects and in CAD patients and from P to PP levels in normal subjects. This improvement must be considered in interpreting exercise RV studies to aid in the detection of patients with CAD.

Adult↗

An analysis of the multiple approaches to measuring nursing workload.

This article reviews the multiple theoretical approaches to the measurement of nursing workload. A focus on current measurement issues provides direction for future research questions in this area. The underlying assumption is that workload measurement tools must focus on the complexity of the patient situation in determining nursing workload rather than on the traditional focus of tasks in which nurses are involved.

Humans↗

Workload measurement of a clinical pharmacy residency program.

The types of activities performed by four clinical pharmacy residents and the amount of time spent on each activity were studied using a workload measurement system. A workload measurement system was developed to record all activities performed by pharmacy residents. The system included 50 activities that were grouped under 11 general headings; residents' time was divided among 10 major areas of service. The following data were collected and analyzed each month during the six-month study period: units of work, weighted units of work, total productive hours, total service hours, and productivity. The residents participated in 39 of 50 clinical pharmacy activities. Activities performed most frequently included nursing-home-care-unit drug reviews, drug monitoring, and rounds. The most time-consuming activities were clinical education, administration, and drug-use review. Productivity ranged from 80 to 115% and was influenced by residents' assigned rotations. A workload measurement system for quantifying the time spent by residents performing various clinical pharmacy activities provided objective data that were used to restructure a clinical pharmacy residency program.

California↗

A health professions faculty workload plan for a liberal arts setting.

This case study describes an approach to planning the workload and expenditure of allied health faculty effort. The plan is based upon a review of the literature, a survey of other schools in similar settings, and faculty negotiation. It meets the need for faculty accountability, congruence between faculty workloads and institutional goals, faculty staffing determinations, and a means to compare nursing and allied health faculty workloads with those of more traditional liberal arts faculty. The plan may serve as a model for other health professions academic units.

Faculty↗

Assessment of methods for assigning treadmill exercise workloads for lean and obese women.

The use of relative oxygen consumption (% VO2 max) to equate workloads between trained and untrained subjects is considered appropriate. Whether this method (% VO2 max) is correct when testing lean versus obese subjects has not been studied. Using three experimental sessions separated by at least one week we studied seven obese, nondiabetic women weighting 140 +/- 21 kg (mean +/- s.d.) and 10 lean women of similar age weighing 51 +/- 5 kg during treadmill walking. Body fat determined by hydrostatic weighing was 50 +/- 7 and 23 +/- 7 percent in obese and lean groups, respectively (P less than 0.05). Absolute maximal VO2 (VO2 max) in obese women (3.18 +/- 0.28 l/min) significantly exceeded VO2 max for lean women (2.45 +/- 0.31 l/min, P less than 0.05). However, in obese women VO2 max relative to total body weight (TBW) was lower (P less than 0.05) while VO2 max relative to fat-free weight (FFW) was similar to corresponding values for lean women. Submaximal treadmill exercise at 75m/min with 0, 5 and 10 percent inclines resulted in higher VO2 (l/min) and heart rate (HR) in the obese group (P less than 0.05). At each incline VO2 relative to BW was significantly lower in the obese (P less than 0.05) yet significantly higher when expressed relative to FFW (P less than 0.05). The relationship between HR and %VO2 max was similar for lean and obese. Ten minutes of walking at 70% VO2 max resulted in no significant differences between the groups in the 10 min values for HR, total work done, rise in rectal temperature, plasma lactic acid, perceived exertion and oxygen consumption relative to FFW. We conclude that either fixed absolute workloads or fixed oxygen consumption (absolute or relative to BW or FFW) are inappropriate methods for equating workloads when lean and obese subjects are compared. Relative VO2 accurately defines physiologically comparable exercise intensities for these groups and this should be the method of preference when studies are designed to investigate metabolic, endocrine or cardiovascular similarities and/or differences between these groups.

Adult↗

Study of trainer/trainee workload with special reference to the care of the elderly.

A study of the workload of trainers and their trainees in general practice, was undertaken throughout East Anglia. Thirty trainer/trainee pairs returned data over a two-week period and follow-up information was obtained from five pairs, eight months later. A simple encounter form was used.Trainee workloads were found to be similar to those of earlier studies, though there was considerable variation between the workloads. Trainees had little experience with elderly patients, and there was a lack of teamwork between members of the practices in providing care for the elderly.

Efficiency↗

Documenting workload to better integrate clinical and distributive services.

Use of workload and work-flow documentation in two pharmacy satellites to evaluate pharmacists' productivity is described. Workload was evaluated during 14 consecutive days in May 1983 and 7 consecutive days in May 1984. All pharmacists and technicians working in the satellites recorded times for their activities on a form that listed every possible activity; interruptions such as answering the telephone, responding to walking requests, replacing stock, and lunches and break times were also recorded. Concurrently, the clinical coordinator observed and evaluated work performed for four-hour time blocks at least once each day. Analysis of workload and work-flow information identified problems with scheduling, priorities, interruptions, and pharmacists' knowledge of clinical pharmacy practice. Based on these observations, the following changes were implemented: pharmacists were scheduled to work either inside or outside the satellites for two-week or one-month time periods, priorities were assigned to certain tasks performed inside or outside the satellites, job assignments were made based on the pharmacist's capabilities and the needs of the patient-care areas, a form for documenting potential problem orders was created, and pharmacists were evaluated monthly and given one-on-one instruction by the clinical coordinator. Documentation of time use identified problems and led to changes in assignments that better integrated clinical, educational, and distributive responsibilities for the purpose of providing more efficient and effective services.

Appointments and Schedules↗

Measurement and scaling of workload in complex performance.

Two groups of paid male volunteers (Groups I, N = 51, tested with identical schedules on two successive days; Group II, N = 43, tested on one day only) performed over nine intervals on various combinations of the six tasks of the CAMI Multiple Task Performance Battery. Two of the tasks involved monitoring static (lights) and dynamic (meters) processes, and four more-active tasks involved mental arithmetic, elementary problem solving, pattern identification, two-dimensional compensatory tracking. Five of the nine intervals provided different complex tasks consisting of concurrent monitoring tasks and two of the active tasks. Other trials provided data on the single active tasks as well as the combined monitoring tasks. The results indicated that all performance measures--a total of 12 for the six tasks--varied significantly as a function of the different task-combination conditions. A standard psychological scaling technique (Thurstone Case V) was applied to the monitoring data (response times for green and red lights, and for meter monitoring) to develop an index of workload for the five complex task combinations. Since better performance was presumed to indicate a lower workload, workload was inferred to increase as performance declined across conditions. The best performances, which were assigned scale values of 0, were found to be associated with single-task performances, as expected. Scale values for the complex task-combination conditions were found to be consistent between groups and between the two days of testing of Group I (r's of 0.947 to 0.993). Although the scale values are specific to the task and task-combination conditions employed, the scaling-procedure application shows promise for cases in which quantitative measures of performance can be acquired with moderately large samples of subjects (N's greater than 50).

Adolescent↗

Stress and workload in pilots.

Several studies have highlighted the increase in physiological activity which occurs in pilots during flight and especially during takeoffs and landings. For example, it has been clearly demonstrated that pilots' heart rates increase during the landing approach to reach a peak at or just before touchdown. These changes have been attributed to workload and to psychological or emotional stress. This paper examines a number of test pilots' heart rate responses recorded during various flight trials involving different types of aircraft. Examples include ramp takeoffs in a VTOL fighter, automatic landings in fog, supersonic flight through monsoon rain, and a sortie in which the pilot developed acute appendicitis. It is concluded that heart rate responses in experienced pilots are influenced almost entirely by workload-related factors and not by emotional stressors, such as risk and anxiety. Because of the emotional overtones of the word "stress," it is suggested that the term workload should be used when referring to the reason for increased cardiovascular activity of pilots.

Adaptation, Physiological↗

When surgical rates change. Workload and turnover in Manitoba, 1974-1978.

This research analyzes the changes in individual physician surgical workload and accompanying changes in surgical rates in Manitoba, Canada between 1974 and 1978. Data covering essentially all operations on provincial residents age 25 years and older were analyzed using information from the health insurance data base. The most dramatic change was a 50% rise in outpatient surgery. An overall pattern of increased specialization seemed to be emerging; surgeons' surgical workloads were gradually growing while those of general practitioners were slowly declining. Changes in the frequency of several common surgical procedures were due much more to changes in workload of physicians remaining in the same hospital service area throughout the 1974-1978 period than to turnover (older physicians leaving practice and newer physicians coming in).

Adult↗

Inflight measurement of pilot workload: a panel discussion.

A group of U.S. scientists engaged in inflight measurements of pilot workload discussed the problems and aspects of workload; the techniques used for inflight measurements; the various workload models, such as design-oriented, operational, psychological, and physiological concepts; different experimental approaches; and experiences, results and further plans, during the 48th Annual Scientific Meeting of the Aerospace Medical Association in Las Vegas, Nv, on May 10, 1977. The contributions by the chairman and the five panel members are summarized.

Aerospace Medicine↗

Effect of a call-in prescription refill system on workload in an outpatient pharmacy.

The effect of a computer-assisted call-in prescription refill system on the workload of an outpatient pharmacy was investigated. After installation of a telephone-answering device and a dedicated telephone line in the pharmacy, patients were able to call 24 hours a day and request a prescription refill. A computer system was used to screen the patient's record for drug interactions, print a new label, and update the patient's profile. Data were collected on the number of prescriptions processed per hour and per day before (period 1) and after (period 2) the system was implemented. The workload was assessed by the number of new prescriptions, refills, call-in refills, and total prescriptions processed. The mean number of prescriptions processed per hour ranged from approximately 10 to 178 during both periods. During period 2, the pharmacists processed a mean of 172 and 161 prescriptions per hour for the first and second hours of the day, respectively; for period 1, these means were 112 and 135 prescriptions, respectively. The numbers of refill prescriptions and total prescriptions dispensed during period 2 were significantly greater than those of period 1. Overall, there was a 16.9% increase in prescription volume. The computer-assisted call-in refill system had an effect on the workload and gave pharmacy management some control over the hourly work flow.

Drug Prescriptions↗

Adaptation of the circulatory system to frequently repeated submaximal workloads in the light of left ventricular contraction analysis.

In two groups of healthy men aged 20-22 years the left ventricular systolic time intervals were evaluated by the method of Weissler et al. during frequently repeated workloads and restitution. Each exercise was carried out on a Zimmerman cycle ergometer during 10 minutes, and was repeated five times at 50-minutes intervals from 8.00 o'clock a.m. Group I (15 subjects) performed the exercise at a stable workload which produced during the first exercise heart rate acceleration to 170/min, but gave a successive further rise in the heart rate during consecutive exercises. Group II (11 subjects) performed all exercises to a stable rise in heart rate to 170/min with decreasing workloads. It was found that successive exercises caused in both groups a similar decrease of the left ventricular ejection time index (LVETI), pre-ejection period (PEP), isovolumetric contraction time (ICT), and decrease of the PEP/LVET index (p less than 0.05). Each successive exercise began with higher values of LVETI, PEP, ICT and PEP/LVET than the first one. No significant differences were found in the values of left ventricular systolic time intervals in both groups (p greater than 0.05). The duration of restitution of normal values of the left ventricular systolic time intervals after successive exercises was not changing but the tolerance of these exercises measured by heart rate increase and work performed decreased successively.

Adult↗