College of Nursing and Health Science
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Browsing College of Nursing and Health Science by Author "Baldwin, Sara"
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Item Anticholingeric burden screening and reduction for older adults in long-term care(2019-08) Arredondo, Derek; Garcia, Theresa; Baldwin, Sara; DeGrande, HeatherAnticholinergic (ACH) medication use amongst older adults has been associated with cognitive decline, development of dementia, counteraction of cholinergic dementia treatments, numerous adverse effects and subsequent prescribing cascades. Older adults in long-term care facilities (LTCF) are exceptionally vulnerable to these adverse effects. This quality improvement project implemented an evidence-based ACH cognitive burden screening and reduction program for adults aged 60 and older (N=31) in a south Texas LTCF to maximize cognitive function. Based on ACH medication screenings, reduction recommendations were made to prescribers for 19 residents. A three-group comparative design was used. The 3 groups included: those without recommended ACH reductions (n=12), those with recommendations for reduction which were approved by their prescribers (n=11) and those with recommendations which were not approved (n=8). Cognitive function was measured with the Short-Blessed Test (SBT) and ACH use with the Anticholinergic Cognitive Burden (ACB) scale. The group with approved reduction recommendations had a decreased mean (M ) ACB score (0.73 points lower, p=0.233) and a lower M SBT score (1.82 points lower, p=0.051) at 60-days post-intervention when compared to pre-intervention. Overall, the 31 participants had a significant decrease in M SBT (by 1.06, p=0.026) and a decrease in M ACB (by 0.23, p=0.422) in the same period. Those without any ACH reduction recommendations (n=12), were found to have a significantly increased M ACB, from 0.42 to 1.08 at the conclusion (p=0.013). The application of an evidence-based ACB screening and reduction program decreased ACB and was associated with clinically improved cognitive function in the residents of this facility. These findings were clinically significant and may also provide useful clinical outcome data to support research into, and improvement of, prescribing practices in LTCFs.Item Implementing an antibiotic stewardship program to decrease antibiotic overuse in a primary care clinic(2021-08) Sigdel, Sabita; Garcia, Theresa; Baldwin, SaraBackground: Antibiotic overuse is one of the largest threats to global health. Nearly 50% of antibiotics prescribed in outpatient settings are unnecessary. The overuse of antibiotics is associated with antibiotic resistance, unnecessary adverse drug effects, and increased healthcare costs. Purpose: This quality improvement (QI) project aimed to increase patients’ knowledge and improve their attitude toward appropriate antibiotic use in acute respiratory tract infections (ARTIs) and decrease antibiotic over-prescription by providers through the implementation of an antibiotic stewardship program in a North Texas primary care clinic. Methods: This is a before and-after design QI project that implemented Centers for Disease Control and Prevention’s (CDC) antibiotic stewardship educational intervention. A convenience sample (N=20) was recruited from all interested English-speaking patients who were 18 years or above. Patients’ knowledge and attitude towards antibiotic use was assessed before and after an educational intervention. The second part of the project entailed provider education using a training activity from Stanford University (N=2). Pre- and post-training retrospective chart review was done to determine changes in antibiotic prescription rate. Results: There was a significant increase in patients’ knowledge and their attitude towards appropriate antibiotic use in ARTIs (p < .001) after the educational intervention. Secondly, there was a 15% reduction in antibiotic prescription rate in 2021 compared to the same months in 2020. Conclusion: Provider and patient educational interventions are effective strategies in promoting antibiotic stewardship in outpatient settings and improving inappropriate antibiotic use in ARTIs. Further research is needed to explore innovative educational strategies incorporating inexpensive technology.Item Improving cancer caregiver support through a focused caregiver preparedness program(2020-08) George, Jincy; Baldwin, Sara; Garcia, Theresa; Thomas, Tincy; Sanders, JanaBackground: It is estimated that there are four million cancer caregivers (CG) in the United States. A majority (69.1%) of them experience various emotional burdens. Cancer CGs face various unmet emotional and psychological needs and are often expected to manage cancer patient symptoms for which they are largely unprepared. Since they are an integral part in cancer patients’ treatment planning and care, it is important to reduce CG emotional burden and improve their self-efficacy. The purpose of this quality initiative is to determine if a structured treatment specific program can reduce emotional burden, improve self-efficacy for patient care demands, and improve CG support group enrollment among CGs of patients receiving brain radiation treatments at CNS-RO clinic at MDACC. Design and methods: CGs were screened and enrolled followed by administration of a pre-intervention assessment of the CG burden and selfefficacy using Zarit Burden Interview and CG Self-Efficacy Scale respectively. During the intervention phase, the project director provided interactive teaching sessions regarding patient symptom management, coping strategies, and CG support group enrollment. After the intervention, each CG received an assessment of CG burden, self-efficacy, and CG group enrollment. Findings: CGs had significant reduction of burden (p = 0.0004), improvement of self-efficacy (p = 0.0152) and improvement in CG support group enrollment. While the sample size is considered small, the clinical results support using a standardized treatment-specific CG preparedness program to ensure best possible care for both the patient and the cancer CG.Item Improving child obesity screening and management provider practices in a South Texas pediatric clinic(2019-08) Pesina-Garcia, Ashley; Garcia, Theresa; Ajisafe, Toyin; Baldwin, Sara; Keys, YolandaChildhood obesity is an epidemic in the United States (US) and affects nearly one in five school-aged children. Inconsistent provider practice patterns, which often do not adhere to current clinical practice guidelines, can decrease the quality of childhood obesity screening and management. This quality improvement (QI) project implemented a provider education, reminder, screening and referral program to improve screening and management of overweight and obese children, aged 6-12 years old, attending a South Texas pediatric clinic. A comparative two-group, retrospective chart review and descriptive survey design guided the project. Eleven parents were surveyed and 126 charts (from 3 providers) were reviewed (pre-education: n=71; post-education: n=55). Provider practice post-education and reminder system was significantly improved on the use of overweight and obesity diagnosis codes (χ2 (1, N = 126) = 12.77, p<.001), overweight and obese labs ordered by provider (χ2 (1, N=126) = 9.49, p=.002), overweight and obese healthy behavior counseling (χ2 (1, N=126) = 14.14, p<.001), and follow-up visit recommendation (χ2 (1N=126) = 15.88, p<.001). There was no significant difference between groups in provider referrals to a fitness program. The parental survey indicated a significant improvement in child activity and nutrition behaviors patterns pre-provider education compared to post-provider education (Z=-2.805, p=.005, r=.25). A provider education program improved the screening and management practices of providers for children with overweight and obesity in a small pediatric clinic in South Texas.Item Nurse education to improve use of BIS protocol for patients on neuromuscular blocking agents: a Quality initiative(2021-08) Abraham, Sunitha; Monahan, Laura; Baldwin, Sara; Melrose, DonBackground: Bispectral index (BIS) monitoring measured sedation levels of patients on neuromuscular blockers (NMB) in the intensive care unit (ICU) setting but monitoring lacked efficiency due to nurses’ unfamiliarity with the associated BIS protocol. Sedation effectiveness was highly dependent on nurse-related factors such as knowledge, skill, experience, and confidence. Objective: The objective of this quality improvement project was to improve ICU nurses’ level of knowledge and perception on BIS monitoring and increase the use of BIS protocol for management of patients receiving NMB agents. Methods: Educational intervention included a pretest and posttest method of evaluation. The project included theoretical and clinical sessions on NMB agents, BIS monitoring, and BIS sedation protocol. Effects were measured using the Knowledge Questionnaire (KQ) at baseline and four months after the intervention. BIS sedation protocol usage was assessed monthly from 1/1/2021 - 4/28/21. Results: N= 52 ICU nurses. Project was conducted in a large metropolitan hospital in Texas. KQ’s post-educational intervention demonstrated improvements (Mdn = 25, Range = 13[14-27]) which were higher than pre-educational levels (Mdn = 19.5, Range = 6 [21-27]; t= 16.954, p <. 001), Cohn’s d 2.35). The mean scores on BIS perceptions were higher post-education, between 4 to 6 on all five subscales. Protocol usage in January was 33.3%, February was 62.5%, March was 54.5 %, and April was 66.6 %. Conclusion: This educational intervention demonstrated effectiveness in improving overall ICU nurses’ knowledge levels. While not at 100%, this protocol demonstrated improvements over the four-month period. Continued education and newer strategies need to be adopted to achieve 100% usage.Item A primary care initiative using smartphone technology to improve antihypertensive medication adherence in indigent Hispanic men(2021-08) Cisneros, Maria Priscilla; Walker-Smith, Tammy; Baldwin, Sara; Gordon, CherylBackground: Approximately 108 million adults in the United States (U.S.) have hypertension (HTN) of which only 24% have adequate control. Men have a higher incidence of HTN than women and only 25% of Hispanic males have adequate control compared to 32% of non-Hispanic white males. The purpose of this quality improvement initiative (QI) was to improve medication adherence screening by providers and adherence to antihypertensive medication in indigent, adult Hispanic males (25 – 64 years of age) with uncontrolled hypertension (HTN) at a large primary care clinic in South Texas, using a smartphone application (Medisafe) and the Hill Bone Medication Adherence Scale (Hill-Bone Scale). Method: A before and after design was used to institute a hypertension protocol including the Hill-Bone Medication Adherence Scale in the clinic and the Medisafe medication reminder smartphone application by patients for a 3-month trial. Results: Utilization of the Medisafe application resulted in increased number of medication adherence days, improved self-reported medication adherence scores as well as improved overall mean systolic and diastolic blood pressure. Discussion: Self-reported medication adherence screening and utilization of the Medisafe medication reminder application has the potential to improve adherence and outcomes among patients with uncontrolled hypertension.Item A prospective quality improvement project using a mammography risk assessment tool to increase screening mammogram use with low-income Hispanic women(2018-08) Walker-Smith, Tammy L.; Walker-Smith, Tammy L.; Baldwin, Sara; Murphy, Christina; Dyess, Susan; Murphey, Christina; Dyess, SusanMurphy, Christina; Dyess, SusanBreast cancer is the second leading cause of cancer mortality among U.S. women. Hispanic women experience a lower 5-year survival rate of 79% compared to 91% among non-Hispanic White women. The purpose of this DNP project was to design an evidence-based quality improvement (QI) project to improve the screening mammogram completion rates by implementing concurrent educational and clinic referral tool systemic strategies in a primary care clinic. Medline, CINAHL, and the Cochrane Collection, databases were used to identify key studies between 2013-2018 that addressed the disparity of low-income Hispanic women, and evidence-based practice breast cancer risk assessments based on risk factors and current screening guidelines. The evidence-based tools used were the Breast Cancer Risk Assessment Tool and the National Health Interview Survey, available in English and Spanish. Once the tools triggered a nurse referral, health providers determined if a screening mammogram order was needed. This provided a systematic change process for early detection and improved screening mammogram rates for women between the ages of 50-74. The QI project findings addressed evidence-based interventions that improved screening mammogram rates 7.21% in a three-month period. The outcomes discussed in this report provide guidance for new policy considerations and clinical protocols.Item A quality initiative implementing CDC STAT toolkit to prevent prediabetes progression in primary care(2020-08) Isah, Charlotte; Baldwin, Sara; Walker-Smith, Tammy; Garcia, Theresa; Ivy, DianaBackground: Untreated prediabetes (pre-DM) has the potential to progress to type 2 diabetes (T2D). Among the 33.9% of U.S. adults living with pre-DM, 70% are unaware of their diagnosis. The purpose of this DNP project was to design an evidence-based quality improvement (QI) project to improve provider adoption of the STAT (Screen/Test/Act Today) toolkit to prevent progression of pre-DM to T2D. This detailed toolkit was developed to identify, screen, and refer at-risk patients to community diabetes prevention programs (DPPs). Design and methods: A quality improvement initiative to determine if the use of the CDC pre-DM STAT toolkit improved provider adoption of patient screening, testing, management and referral to a community DPP with the goal of preventing progression of pre-DM to T2D. The EHR triggered the pre-DM risk assessment at annual visits, PCP reviewed scores with patients with moderate to high risk, BMI and A1C are measured and patients referred to community DPP. Pretest and posttest were used to analyze patient knowledge pre and post intervention, while paired t-test measured changes in AIC and BMI. Findings: Sample included 2 females and 5 males, over 21 and less than 75 years old. During the 3-month implementation, screening and referral rates doubled with 75% of participants showing an average 3% reduction in A1C from baseline to 3 months. In this primary care setting, the CDC pre-DM STAT toolkit provided an efficient, detailed clinical reference to increase patient screening for pre-DM, improving referral to DPPs. Due to COVID-19 barriers, reduced progression of pre-DM to T2D could not be measured in this QI project’s limited timeframe.Item Reduce Overflow Incontinence to Prevent Pressure Ulcers in Individuals with Spina Bifida(2019-08) Schumann, Donna Kay; Peck, Jessica; Garcia, Theresa; Baldwin, SaraOverflow incontinence has been directly linked to the development of pressure ulcers in individuals with Spina Bifida (SB). The implementation of a bladder diary and educational session to increase awareness of pressure ulcers and decrease overflow incontinence episodes was selected. This Quality Improvement (QI) project was a quasi-experimental design with pre- /post-intervention evaluation. The setting was Camp That Love Built summer camp at Camp For All in Burton, Texas. The participants included 45 campers with SB, five to 60 years old and 16 staff members. Eligibility was dependent on necessity for intermittent catheterization and attendance of camp for the entire week. All participants received an educational session focused on pressure ulcer prevention. Campers were given a bladder diary to document catheterizations and to assist with adherence to a prescribed catheterization schedule. Staff provided verbal reminders to campers to perform catheterizations. The measurement tools included PUKAT 2.0 pre- and post-test, PUAS, and a bladder diary. PUKAT results yielded score increase more than 10% in 35 of the 61 participants. Overflow episodes recorded on the bladder diary decreased by 81% from 37 episodes on day two to seven episodes on day five. PUAS scores increased 2% from pre- to post- intervention. Educational sessions and implementation of a bladder diary decreased the episodes of urinary incontinence.Item Using video debriefing to improve performance of the interprofessional trauma resuscitation team(2021-08) Lyell, Cassie Ann; McGarity, Tammy; Baldwin, SaraIn trauma centers, failures in teamwork account for 87.9% of preventable errors. Errors made during the primary assessment cause up to 91% of preventable deaths. Video review of trauma resuscitations has been shown to improve teamwork, communication, confidence, leadership, and timeliness of care. This quality improvement project aimed to improve trauma team performance through video analysis and a Trauma Video Debriefing Conference (TVDC). Between February and May 2021, highest-tier trauma activations were recorded and variability in (1) primary assessment completion and (2) nontechnical skills were measured. Videos demonstrating learning opportunities were shared in a TVDC. Variabilities in (1) and (2) were measured utilizing the Advanced Trauma Life Support (ATLS) Primary Assessment Completion Tool (PACT) and the Trauma Nontechnical Skills (T-NOTECHS) instruments, respectively. To assess the impact of the TVDC interventions across time, we performed a simple linear regression, with the item of interest as our outcome variable. Pre- and post-TVDC teamwork perception was measured by the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ). To assess the provider survey items across the pre- and post- TVDC intervention, the chi-square or Fisher’s exact test was used where appropriate; the Wilcoxon Mann-Whitney U test was performed on the average module scores. During the initial project cycle, 66 trauma activations were measured, and 10 videos were reviewed across seven TVDCs, focused on team education and performance improvement. Progressive and statistically significant improvement in team performance was demonstrated, as evidenced by improved PACT (p = .0128) and T-NOTECHS (p = .0027) scores. Perception of teamwork, as measured by the T-TPQ, remained unchanged after project implementation. Implementation of a TVDC can contribute to improvement in both the technical and nontechnical performance of a TRT and is an effective tool for targeted education and quality improvement. Perception of teamwork should be studied in dependent groups in upcoming project cycles.