Doctor of Nursing Practice Project Reports

Permanent URI for this collectionhttps://hdl.handle.net/1969.6/87118

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A quality improvement project to decrease screen use in children aged 0-5 via a parental education program
(2023-12) Ortiz, Pamela Ann
Critical brain development occurs between the ages of zero and five (American Academy of Pediatrics [AAP], 2016). The digitalization of childhood impacts how children experience play, learn, and build relationships (Hutton et al., 2020). The purpose of this QI project was to increase provider use of the “Family Media Plan’” and determine if a parent education would decrease screen-time. This QI project sought to answer the question, will the use of screen-time education, increase provider use of the “Family Media Plan,” increase parent knowledge and decrease screen-time, in children under five years? This QI initiative was reviewed by the Texas A&M University- Corpus Christi Institutional Review Board (IRB) for project/study and approval to proceed was received. The setting for this QI project was a primary care clinic. Participants were a recruited from patients under five, that presented for well visit. Pre-test, post-test design was selected to evaluate efficacy of the intervention. A modified version of the HomeSTEAD survey was selected to measure behavior change. Eight families completed the initial survey and received the educational intervention. A mean of 115.714 minutes was calculated to the question “on average, how much time does the child spend on screened devices per day?” Seven (n-7) families responded to the follow-up telephone interview. A mean of 102.857 minutes was calculated, demonstrating a 12.858-minute decrease and resulting in an 11% decrease from the pre-intervention response. A simple chart review was conducted to identify use of the “Family Media Plan.” Seven of the seven participant EHR had a complete “Family Media Plan.” This study only addressed the amount of time spent with screened media devices and did not differentiate between educational and non- educational programming, nor did it address the varying impact of screen-time versus indoor/outdoor play.
Increasing colorectal cancer knowledge, awareness, and intent to screen in an underserved region
(2023-8) Dahlgren, Kelli N.; Andelman, Dixie; McGarity, Tammy; Pollack, Jennifer
Colorectal cancer (CRC) is a leading cause of cancer-related deaths in the United States that can be identified and prevented through early screening. Current screening rates do not meet existing recommendations, especially in medically underserved areas where there is reduced access to primary care services. A lack of CRC awareness and knowledge have been identified as two of the largest barriers to screening. An inflatable colon tour has been proven an effective intervention to address CRC knowledge and awareness deficits. This DNP project was designed as a community awareness initiative in an underserved area using a pre- and post-survey with the purpose of increasing colorectal cancer awareness, knowledge, and intent to discuss and complete CRC screening. This quasi-experimental study had a QI focus and used a convenience sample in a public setting who completed a pre-and post-survey assessing colorectal cancer awareness, knowledge, and intent to discuss and complete screening (n =185 persons screened with n =85 meeting inclusion criteria). Post-tour CRC awareness scores showed a statistically significant increase in mean scores at p <.001. Colorectal cancer knowledge scores showed a statistically significant increase in post-test scores at p <.001. Post-tour, there was an 82% increase in people who identified as "very likely" or "definitely" willing to discuss CRC screening with their healthcare provider and a 133% increase in people identifying as "very likely" or "definitely" likely to complete CRC screening in the next 6 months. This project is evidence that community events using inflatable models can successfully increase cancer awareness and knowledge in underserved populations.
Implementation of a discharge pathway to decrease infant's postoperative length of stay in a cardiac intensive care unit
(2022-07-08) Buckner, Brenda Rachelle; Loika, Elizabeth; Lee, Kyoung; Davis,Liana
Congenital heart defects (CHDs) are the most prevalent of all birth defects. In the United States there are about 40,000 new cases diagnosed annually. About 25% of those infants have a critical congenital heart defect (CCHD) requiring surgical intervention in the first 30 days of life in order to survive. Discharge from the hospital to home is a major process that, if fragmented, is inconsistent or unstructured can lead to medication errors, treatment delays, increased health care costs, and lower quality of care. Safely transitioning infants with CCHDs from the hospital to home requires planning that begins on admission. The purpose of this quality improvement project was to determine if implementing a standardized discharge pathway for infants with CCHDs could improve the discharge processes and decrease postoperative length of stay in a 22-bed mixed Pediatric Intensive Care Unit (PICU) and Cardiac Intensive Care Unit (CICU). The pathway was initiated on all infants requiring a surgical intervention within the first 30 days of life. The aim of having 100% of participants with a completed checklist by the end of the three-month project and 100% of parents completing the required rooming in period before discharge were met. However, no decrease in PLOS was demonstrated in this quality improvement cycle for STAT 2 and STAT 3 categories and a 0.5 day decrease in PLOS was demonstrated in STAT 5.
A quality improvement project to improve screening mammograms among older hispanic women in a primary care clinic
(2022-07-13) Perez, Rosa I.; Walker-Smith, Tammy; Lee, Kyoung; Reinhardt, Kimberly
Background: Breast cancer is a growing health care concern. Based on current incidence rates, 12.9% of women born in the United States today will develop breast cancer at some time during their lives (Howlader et al., 2020). Healthcare providers (HPS) play an important role in managing breast cancer screening mammograms in primary care. Purpose: To implement interventions guided by two evidence-based guidelines to improve health care providers’ (HCP) management of predominantly Hispanic female patients between the ages of 40 and 74. Methods: A pre and post design was used to implement an educational intervention, based on the U. S. Preventive Services Task Force (USPSTF) clinical guidelines, which recommended that older women, ages forty and over, make personal decisions with their health care providers about breast cancer screening frequency. Results: This Quality Improvement (QI) project’s findings reflect a 10% increase overall in a three-month period for mammogram completion rates (67%) compared to pre-intervention mammogram completion rate baseline data for 2019 (57%). Implications: This QI project demonstrated positive outcomes for increasing screening mammogram completion rates and potential early detection of breast cancer where treatment modalities may provide a higher survival rate where quality of life for patients and family members can be achieved with a greater chance for remission with early detection and treatment.
Educational text messaging to improve knowledge and self-care practices among adults with Type 2 Diabetes
(2022-08) Brown, Merlendi; Park, Gloria; Lee, Kyoung; Houlihan, Amy
Poor diabetes knowledge and self-care practices are correlated with impaired glycemic control and vascular complications among patients with type 2 diabetes. Diabetes education interventions are essential to improve diabetes self-management and reduce overall mortality; however, time pressures imposed upon healthcare providers limit the amount and quality of education provided in the primary care setting. The purpose of this project was to determine if an educational text messaging intervention would improve diabetes knowledge and self-care practices among patients with type 2 diabetes in a rural primary care clinic. A pretest-posttest, quasi-experimental design was utilized and twenty patients with type 2 diabetes were recruited for this project. Three distinct educational text messages were disseminated weekly for 12 weeks. Six educational domains were addressed: nutrition, physical activity, foot care, blood sugar management, behavioral support, and general diabetes knowledge. Pre- and post-intervention measures consisted of diabetes knowledge and self-care participation questionnaires. From pretest to posttest, considerable improvements were observed in diabetes knowledge scores (13.3% increase), the number of days per week participants engaged in healthy (general) eating habits (15.7% increase), and the number of days per week participants engaged in foot care practices (21.4% increase). The results of this project indicate that educational text messaging can improve diabetes knowledge, general eating habits, and foot care practices among patients with type 2 diabetes in a rural primary care clinic. Based on these findings, we recommend integrating educational text messaging into clinical practice.
Improving adolescent psychosocial assessment through standardized patient simulation: An interdisciplinary quality initiative
(2022-08) Eaves, Colleen; Monahan, Laura; Watson, Joshua; Malatyali, Ayse; Walker, Benjamin
Prevention of adolescent suicide is possible with early recognition of risk factors; however, many healthcare professionals lack necessary skills to interact effectively with adolescents due to insufficient training in residency. Supplementing traditional clinical experiences with communication focused education utilizing standardized adolescent patients (SP) has proven promising. This interdisciplinary quality initiative (QI) piloted an SP program informed by the Home, Education, Eating, Activities, Drugs, Sexuality, Suicidality, and Safety (HEEADSSS) interviewing process within the physician and nursing residencies of a South Texas pediatric tertiary care center to improve early identification of modifiable risk factors of suicidality among adolescent patients. Thirty-six residents participated in a program comprised of a 45-minute self-study module and a two-hour SP simulation session incorporating adolescent psychosocial interviews with individualized feedback and guided group reflection. Results of the one-group, pretest-posttest QI were favorable. A 13% increase in self-efficacy (M = 8.64, SD = 0.65), p =<.001, d = -1.79, 11% increase in competence (M = 55.83, SD = 7.58), p =<.001., d = -0.56, 17% increase in HEEADSSS use in practice (M = 2.55, SD = 0.69), p = 0.02, rrb = -1, and 89% increase in social work referrals for adolescents presenting with chief complaints not related to mental health were observed. While these improvements satisfied only one of the project’s aims fully, the clinically significant findings are encouraging and warrant the formal incorporation of the adolescent SP program into residency curriculums along with the exploration of utilizing SP methodology within other QI throughout the organization.
A self-care activity to support stress management and resilience in new graduate nurses: A quality initiative to reduce turnover
(2022-08) Cortez, Kira; DeGrande, Heather; Greene, Pamela; Rueda, Claudia
The transition to practice is challenging and stressful for new graduate nurses which leads to turnover within the first year. New graduate nurse turnover negatively impacts patient outcomes. Self-care programs emerged in the literature as supportive of stress and to build resilience. The purpose of this project was to implement an evidence-based self-care activity to support stress, build resilience and subsequently reduce turnover during the transition to practice and beyond for new graduate nurses. The project conducted a pre and post intervention design with the use of intentional self-care activities. Participants were recruited after successful completion from a healthcare affiliated associate degree registered nursing program. The Perceived Stress Scale and the Connor-Davidson Resilience Scale were used to measure the project specific aims to support stress and build resilience. The intervention consisted of an initial educational session including transition to practice, stress, resilience, self-care, and included active participation of self-care practices. Participants were then assigned a self-care webinar package designed by the American Nurses Association to complete over a 12-week timeframe while actively transitioning to practice. There was a statistically significant reduction in perceived stress scores with little to no change in resilience scores. Barriers to participant engagement in the intervention included lack of time, and confounding variables including the COVID-19 pandemic, preceptor variations, and shift type. Implications from this project suggest self-care as a key component to the orientation phase for new graduate nurses upon hire.
A quality improvement project to improve electrocardiogram competency and confidence in medical-surgical clinical staff
(2022-08) Estrada, Amanda; McGarity, Tammy; Andelman, Dixie; Melrose, Don
Electrocardiogram (ECG) monitoring is used for early detection and recognition of cardiac arrhythmias. There has been an increase in hospitalized patients requiring ECG monitoring which is now a responsibility for medical-surgical nursing staff. Medical-surgical clinical staff (MSCS) must be competent to interpret and recognize ECG arrhythmias. The lack of ECG knowledge from the MSCS has resulted in multiple in-hospital cardiac arrests. The purpose of this DNP project was to determine if just-in-time training could improve ECG competence and confidence for MSCS and reduce adverse patient safety events. Just-in-time training is a teaching methodology that supports workplace training. The project design was a pre- and post-test design measuring the degree of change over time. A convenience sampling method was used. There were forty-three participants. A 3-month just-in-time ECG education program was implemented which included ECG just-in-time education and in-services. Overall results did not reveal increases in ECG competence or ECG confidence, however results show improved competency and confidence for many staff members and there was a 60% decrease in patient safety events. Participants with a bachelor’s or master’s degree and 18-34 years of age self-reported improved ECG confidence. Registered nurses, medical technicians, and continuous telemetry monitor technicians all had a significant increase in ECG competence. Based on the findings, MSCS need additional ECG education and training. It is recommended that MSCS participate in regular formal ECG education and use of just-in-time training to reinforce learning.
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, Yolanda
Childhood 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.
Sbar tailored for mental health intake to improve mental health crisis triage for older adults
(2019-08) Brown, Rhonda; Murphey, Christina; Rinehart, Mark; Fernandez, Jose; Platt, Adrienne
Mental illness is a global crisis. Unfavorable economic, social, and environmental circumstances contribute to lack of quality care in those affected by mental illness. The purpose of this quality improvement (QI) project was to determine if the addition of the Situation Background Assessment Recommendation (SBAR) tool tailored to mental health pre-screening assessment of older adults presenting to the emergency room in mental health crisis improved self-efficacy and communication between the mental health intake professionals and the psychiatrist, and increased accuracy of the preadmission assessments in the geropsychiatric unit at Matagorda Regional Medical Center. The design for this project was a non-randomized, one-group, pre-test/post-test guided design using Plan-Do-Study-Act (PDSA) cycle to improve handoff reporting from the mental health intake professional to the psychiatrist. geropsychiatric admission rate was 50% (n=24) pre-intervention and increased by 13% to 63% post-intervention (n=30). Mental health crisis triage for older adults was improved through the implementation of the SBAR tool tailored to mental health screening and the assessment.
A discharge protocol initiative to decrease hospital readmission following amputaton in adults with type 2 diabetes
(2021-08) Vasquez, Jennifer; Zhao, Meng; Park, Gloria; Gobert, Melissa; Watson, Joshua
Introduction: In the United States, lower limb amputations are more common in patients, than in those without diabetes, and can result in infections and unplanned hospital readmissions, that cost the U.S. billions of dollars annually. However, very few hospitals focus on amputation discharge education to prevent such readmissions. The purpose of this quality improvement project is to improve the quality of diabetic amputee discharge education by implementing a Diabetes-Amputation Protocol, with the intent of reducing infection related hospital readmissions. Methods: A Quality Improvement (QI) project conducted in an acute care, nonprofit hospital. A one group, pre-and-post design was used to conduct this project. Inclusion criteria: Participants >21 years of age, with T2DM, with initial amputation received the Diabetes-Amputation Protocol. Paired sample t-tests were used to compare patient knowledge, pre-and-post education. Descriptive statistics were used to calculate monthly percentages of patients who were readmitted and received the protocol. Results: The total number of participants was 30, with a mean age of 59.7 years. Findings from the DWCK questionnaire scores showed a statistically significant positive change from pre-to-post knowledge scores, with t(29) and p <0.01. The readmission rate decreased significantly from 20% to 7%, and 100% of participants received the Diabetes-Amputation Protocol. Conclusion: Improved the discharge material and individualized discharge information based on patient needs can improve patient knowledge, increase independent self-care and reduce hospital readmissions.
A change initiative to prevent critical care nurse burnout implementing a sacred pause following patient death
(2021-08) Volek, Nicole Brion; DeGrande, Heather; Keys, Yolanda
Background: Critical care nurses are increasingly challenged by the complex work environment of the critical care unit. The nature of a critical care nurse’s job can be especially stressful because of the high patient morbidity and mortality, challenging daily work routines, and regular encounters with traumatic and ethical issues. Burnout concerns are particularly important when critical care nurses serve patients who die under their care, which can exacerbate general burnout. Purpose: This evidence-based change initiative aims to prevent burnout and thereby promote resilience in the critical care nurse by using an intentional sacred pause following a patient death. Methods: This change initiative project is a pre-test/post-test design. Burnout was measured pre-and post-intervention (the sacred pause) with the intention to prevent critical care nurse burnout and thereby promote nurse resilience. The Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS-MP) was used to measure nurse burnout. Conclusion: The MBI-HSS-MP inventory scores were similar on both pre-and postintervention assessments indicating prevention of nurse burnout. This evidence-based practice change initiative was well received by the staff members in the hospital and demonstrated clinical significance. Participation in the intervention was documented. The use and progressive implementation of the sacred pause following patient death was naturally implemented by the nurses. Critical care nurses are a vulnerable population susceptible to burnout. Further research around multi-modal health-promoting interventions such as the sacred pause will be beneficial for this population. Supporting critical care nurses to adopt health-promoting behaviors may promote resilience and prevent the risk of burnout that often results in many nurses leaving the profession
Use of a multifactorial fall protocol in primary care to reduce falls in community dwelling older adults
(2021-08) Smith, Deborah Ann; Garcia, Theresa; McGarity, Tammy
Background: Falls among older community dwelling adults 65 years and older claim at least one life every twenty minutes in the United States. Falls occur in 28% of community dwelling older adults and result in seven million injuries per year and costs projected to rise above $100 billion within this decade. Primary care practice should implement fall risk screening with multifactorial fall assessments and interventions to avert unnecessary injuries and enhance quality of life. Purpose: The purpose of this quality improvement (QI) project was to improve management of falls through implementation of an evidence-based multifactorial fall risk protocol in a primary care clinic aimed at decreasing fall rates among community dwelling adults 65 years and older. Method: This QI project used a one-group pretest posttest and retrospective chart review comparison and correlation design to implement the STEADI fall protocol in a primary care clinic. Staff and providers were educated regarding fall risk assessment and preventative interventions guided by the STEADI algorithm. Aims included increasing provider and staff knowledge and decreasing community dwelling patient fall rates. Results: The STEADI fall prevention protocol was used in over 90% of patients 65 years and older. Fall assessments increased by 48% from prior review, and an increase in appropriate referrals as an intervention was associated with high fall risk patients (r = .209, p < .01). Fall rates decreased by 13.4% from pre-implementation (28.8%) to post-implementation (15.4%). Implications: Use of the STEADI fall risk protocol in this primary care clinic improved provider and staff assessment and management of fall risk and decreased fall rates for patients aged 65 and older.
Improving provider obesity management for Latino adolescents through a clinic-community program partnership
(2021-08) Sitienei, Esther; Garcia, Theresa; Greene, Pamela
Background: Obesity prevalence in children aged 5-19 dramatically rose from 4% in 1975 to over 18% in 2016. Rising obesity rates are linked to adverse health outcomes such as cardiovascular diseases and diabetes, which disproportionately threaten Latino youth in Texas, where obesity prevalence is higher in Latino children (19%) compared to Caucasian children (10%). Objective: This quality improvement initiative used a clinic-community program partnership and the Pediatric Obesity Algorithm to improve health care providers' obesity management skills, and Latino adolescents’ weight, Body Mass Index (BMI), and healthy behaviors. Method: A before-and-after design was used to facilitate a partnership between a family practice in central Texas and a community outreach program providing a free online coaching exercise program to overweight and obese adolescents referred by their providers. Adolescents screened and diagnosed with overweight, or obesity (n=15) received a 5-2-1-0 Let’s Go! instructional guide, monthly provider visits, pedometer, healthy habits log, and an online access code to the exercise program. Adolescents’ weight, BMI percentile, and self-reported daily health habits log, and providers’ screening and referral rates were collected at baseline and monthly for three months. Results: Post-intervention, adolescents’ weight (p = .003) and BMI (p = .023) decreased and 95% reported improved health habits. Provider obesity screening (100%) and referral (73%) rates also improved. Conclusion: Creating a primary clinic-community resource partnership improved providers’ obesity management, and adolescents’ health habits and significantly decreased weight and BMI for Latino adolescents in this central Texas clinic.
Implementing an antibiotic stewardship program to decrease antibiotic overuse in a primary care clinic
(2021-08) Sigdel, Sabita; Garcia, Theresa; Baldwin, Sara
Background: 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.
Reducing postoperative narcotic use in opioid naive patients utilizing a standardized opioid titration protocol
(2021-08) Schoolcraft, Mary Katherine; Lee, Kyoung Eun; Walker-Smith, Tammy
Background: Due to the current opioid crisis, physicians and policymakers are increasingly focusing on ways to decrease opioid overuse and misuse in the United States. Surgeons are noted to be some of the highest prescribers of opioids. When prescriptions are issued for acute postoperative pain management to opioid naive patients, the risk for acute opioid use progressing to chronic use can become problematic. Objective: To implement an evidence-based standardized opioid titration protocol postoperatively to improve clinical practice and reduce long-term postoperative opioid exposure in the orthopedic clinic. Method: To improve quality of care, we developed and implemented a standardized opioid titration protocol and applied it to 25 postoperative patients over a six-week period. The protocol consisted of a four-step process, which allowed opioid narcotics to be systematically weaned down consistently over a six-week process. We evaluated patient pain levels and prescription refills biweekly to determine efficacy. Results: 98% (n=24) of patients experienced satisfactory pain relief by week 6, 71% (n=17) of patients stopped opioid use by week 2, and 100% (n=25) of patients did not require further refills after 4 weeks. When compared to prior prescribing practices, overall refill rates were found to be significantly decreased by 10% (p= 0.025). Implications: Implementation of a standardized opioid titration protocol was associated with fewer opioid pills being prescribed, fewer requests for opioid prescription and fewer refills, in addition to lower pain scores.
Assessment of the impact of patient/family video visitation on depression severity scores at a hospital-based skilled nursing facility
(2021-08) Robison, April Lynn; Loika, Elizabeth
Background: The COVID-19 global pandemic resulted in regulations severely restricting patient visitation in Skilled Nursing Facilities (SNF). Lack of family visitation can have a negative impact on patients such as loneliness, social isolation, and feelings of depression. Therefore, prompting this facility act to reduce the barriers for this, often fragile, patient population, at high risk for depression. Purpose: The purpose of this quality improvement (QI) project was to improve the resources provided by a hospital based SNF to prevent or lessen depression in patients, related to restricted family visitation, through implementation of a patient family video visitation initiative. Methods: This QI project used a before and after design to implement a technology-based patient/family video visitation initiative aimed at preventing or decreasing depression severity in patients cared for in a hospital-based SNF during the COVID 19 pandemic. Video visitation was implemented using an I-pad and the Microsoft Teams platform to allow for face-to-face visitation. PHQ-9 scores and patient/family satisfaction with video visitation were measured before and after the intervention. Conclusion: The initiation of a technology-based, patient-family visitation resource by the SNF resulted in patients scoring in the minimal depression category before and after the intervention, supporting the use of video visitation to prevent depression or worsening depression due to prolonged isolation of patients. The initiative illuminated the organizational and feasibility factors to be considered and mitigated when introducing new technology and processes into an already strained health care setting. Lessons learned and similar positive outcomes, can be expanded to many health settings faced with long lengths of patient stays where family members have regulatory, organizational, or personal barriers to visitation
Reducing ER overuse through a primary care provider health literacy awareness initiative
(2021-08) Miller, Emily Abigail; Benham-Hutchins, Marge; Loika, Elizabeth; Gordon, Cheryl
Background: Health literacy (HL) is a significant indicator of patient health status. Research has shown that a substantial number of patients seeking care in the emergency room (ER) have limited HL. Primary care providers (PCPs) serve a pivotal role in improving patient health, but are often underprepared, unaware, and/or overestimate their ability to address patient HL. Purpose: This quality initiative (QI) aimed to improve PCP knowledge about patient HL, self-perceived communication practices relating to HL, and reduce ER overutilization in a South Texas clinic providing indigent care. Methods: This QI project was a cross-sectional study. A single group, pre- and post-test design was conducted to evaluate provider knowledge about patient HL and self-perceived communication practices before and after a provider in-service. A third focus was to reduce ER overutilization after provider education and patient enrollment into a population health program, measured by a paired t-test for the preceding 90 days compared to the post intervention rates at 90 days. The sample consisted of five PCPs and six patients identified as ER overutilizers. Results: Provider knowledge about patient HL and provider self-perceived communication skills improved after an educational in-service. Patient participants had a statistically significant reduction in ER use post provider education. Conclusion: Health literacy training for PCPs improved provider knowledge and self-perceived communication practices, and reduced ER overutilization in this South Texas clinic. Research is needed to evaluate the long-term effects related to provider HL knowledge and communication practices.
Quality initiative to inform dialysis modality selection for veterans with advanced kidney disease
(2021-08) Mathews, Betcy Babu; Murphey, Christina; Fomenko, Julie
Chronic kidney disease (CKD) is the ninth leading cause of death in the United States. Approximately two million people worldwide suffer from kidney failure requiring dialysis, and the number of patients diagnosed with the disease continues to increase at a rate of 5-7% per year. Despite the significant benefits of home-based dialysis (HBD) over in-center dialysis, HBD continues to be an underused modality worldwide. Underutilization is largely the result of an existing knowledge gap regarding dialysis options in advanced kidney disease patients. The purpose of this quality improvement project was to determine if a structured educational program implemented in a nephrology clinic serving veterans increased patients’ awareness and knowledge of the different dialysis modalities, increased informed selection of the HBD modality and improved provider adherence to providing the education. A before-after design structured clinical education was used to deliver a three-session educational program using interactive PowerPoint presentations, videos, and online educational tools. Thirteen patients received the educational program either in person or via phone call or telehealth visit over the three-month project period. Post-intervention, participants’ Kidney Knowledge Survey (KiKS) score significantly increased (t (12) = -12.84, p = <.001, d= 3.08); participants selecting HBD as their modality choice increased 46%; and providers’ adherence to education delivery reached 81%. Planned and timely discussions educating advanced kidney disease patients and their families about all dialysis modalities, including HBD, should be consistently provided to maximize informed decisions and quality of life.
Using video debriefing to improve performance of the interprofessional trauma resuscitation team
(2021-08) Lyell, Cassie Ann; McGarity, Tammy; Baldwin, Sara
In 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.

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