‘HINTS’ AT THE FRONT DOOR: AN ACUTE STROKE SERVICE QUALITY IMPROVEMENT PROJECT

2019 ◽  
Vol 26 (6) ◽  
pp. 5-5
Author(s):  
Rebecca Rayner ◽  
Chit Hmu
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Hospital Setting ◽  
Medical Setting ◽  
Improvement Project ◽  
Stroke Service ◽  
Early Results ◽  
Bedside Test ◽  
Vestibular Pathology

Background/Aims Differential diagnosis of acute vertigo syndrome is challenging. In the acute medical setting, it is difficult to ascertain whether a person has definite peripheral vestibular pathology or a posterior circulation stroke. Mismanagement of these groups within our service is costly, with regards to correct medical input, MRI scan use and bed use within acute stroke services and the hospital setting. Research has demonstrated that the Head Impulse, Nystagmus, and Test of Skew (HINTS) test is efficacious, specific and sensitive in non-UK countries in determining if acute vertigo patients have dangerous (stroke) or benign (peripheral vestibular) pathology. It is not widely used in the UK. This may be due to well-known themes in implementation evidence such as cultural and clinician factors, as well as the lengthy time it takes to embed research into clinical settings. Methods We have started exploring, using Plan Do Study Act cycles, if the HINTS test can be successfully used in a large acute stroke service and the quality improvement effects this may have for patients (correct diagnosis, education/management and follow-up), financially to the Trust (efficient use of MRI scanning) and to the Stroke Pathway (effective bed use/acute medical management). Results Early results in round one of the quality improvement plan show that HINTS is a feasible bedside test to complete with 100% accuracy in the patients it was used on within the acute stroke pathway. This involved one stroke consultant and the patients' diagnosis with HINTS was assessed against routine follow-up MRI as appropriate. HINTS training has now been provided to all the stroke consultant and registrar team, A&E registrars and A&E advanced clinical practitioners, to senior physiotherapists in the acute stroke pathway and to the stroke alert nurses. Data gathering has commenced for round two, focusing further on bed use effects, as well as consideration of staff satisfaction with HINTS, and development of a recommended pathway for acute vertigo syndrome patients.

scholarly journals Nurses’ Knowledge on Delirium Prevention and Detection in Hospitalized Adults: A Quality Improvement Project

2021 ◽  
Author(s):  
Kayla Deery
Keyword(s):  
Quality Improvement ◽  
Educational Intervention ◽  
Medical Condition ◽  
Hospital Setting ◽  
Chronically Ill ◽  
Measurement Model ◽  
Assessment Method ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Nurses Knowledge

Delirium, recognized as a medical and psychological emergency, is a symptom of an acute medical condition. Despite the prevalence of delirium in the hospital setting, it continues to be unrecognized, resulting in poor patient outcomes, and exorbitant healthcare cost. Patients with dementia who are chronically ill, as well as patients previously diagnosed with delirium, represent a vulnerable population and require closer surveillance due to their predisposing factors. This quality improvement project goal is to increase nurses’ knowledge and understanding of delirium. This was completed through providing education to medical-surgical nurses on the causes of delirium (predisposing and precipitating factors), prevention, use of the confusion assessment method (CAM) screening tool, and detection of delirium. The change in knowledge was measure through an investigator created, 10-question multiple choice, pretest-posttest measurement model. Of the 58 nurses, nine responded and completed the pretest (N=9, 15.5%), while seven completed the educational intervention posttest (N=7, 12%). Results of the quality improvement project yielded a 22.1% increase in nurses’ knowledge after the educational intervention. Despite the low participation rate, this project revealed a positive correlation between the educational intervention and nurses’ knowledge.

69. A Quality Improvement Project to Increase Larc Follow-Up for Adolescents and Young Adults

2020 ◽  
Vol 66 (2) ◽  
pp. S36
Author(s):  
Sarah Pitts ◽  
Carly Milliren ◽  
Grace Berg ◽  
Danielle McPeak ◽  
Amy DiVasta
Keyword(s):  
Young Adults ◽  
Quality Improvement ◽  
Quality Improvement Project ◽  
Adolescents And Young Adults ◽  
Improvement Project

A Successful Quality Improvement Project for Detection and Management of Acute Stroke in Hospitalized Patients

2020 ◽  
Vol 52 (4) ◽  
pp. 186-191
Author(s):  
Carol J. Droegemueller ◽  
Bhavani Kashyap ◽  
Roberta L. Huna Wagner ◽  
Hannah Shibeshi ◽  
Mitchell W. Clayton ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Hospitalized Patients ◽  
Quality Improvement Project ◽  
Improvement Project

An Interdisciplinary Clinical Approach for Workplace Violence Prevention and Injury Reduction in the General Hospital Setting: S.A.F.E. Response

2018 ◽  
Vol 25 (4) ◽  
pp. 280-288
Author(s):  
Barbara E. Lakatos ◽  
Monique T. Mitchell ◽  
Reza Askari ◽  
Mary Lou Etheredge ◽  
Karen Hopcia ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Nursing Staff ◽  
Workplace Violence ◽  
Hospital Setting ◽  
Incidence Rates ◽  
Health Concern ◽  
Clinical Approach ◽  
Educational Training ◽  
Private Industry ◽  
Improvement Project

BACKGROUND: Workplace violence is a major public health concern. According to the U.S. Bureau of Labor Statistics, from 2002 to 2013, incidents of serious workplace violence (those requiring days off) were four times more common in health care than in private industry. AIMS: An interprofessional committee developed, implemented, and evaluated a quality improvement project from 2012 to 2016 to reduce workplace violence and prevent staff injury. The initiative termed S.A.F.E. Response stands for Spot a threat, Assess the risk, Formulate a safe response, Evaluate the outcome. METHOD: An institutional review board–approved quality improvement survey was implemented and evaluated. The data were analyzed using descriptive statistics. An interprofessional committee developed and implemented a comprehensive program to prevent injury, which included (a) a mandatory eLearning educational training, (b) a S.A.F.E. Response with standardized interventions for the clinical conditions affecting safety, and (c) a clinical debriefing process. A reduction in nursing staff assault incidence rates was identified as a success. RESULTS: Nursing staff injury rates decreased an average of 40%. CONCLUSIONS: A reduction in nursing staff assault incidence rates was notable. Clinicians equipped with knowledge, skills, and resources can identify and defuse unsafe situations to prevent violence. This clinical approach shifts the focus from crisis intervention to crisis prevention, which reduces injury.

scholarly journals A Clinical Training Program for Hybrid Closed Loop Therapy in a Pediatric Diabetes Clinic

2019 ◽  
Vol 14 (2) ◽  
pp. 290-296 ◽  
Author(s):  
Cari Berget ◽  
Sarah E. Thomas ◽  
Laurel H. Messer ◽  
Katelin Thivener ◽  
Robert H. Slover ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Training Program ◽  
Clinical Training ◽  
Insulin Pump ◽  
Improvement Project ◽  
Quality Improvement Process ◽  
Pediatric Diabetes ◽  
Clinical Training Program

Background: Hybrid closed loop (HCL) therapy is now available in clinical practice for treatment of type 1 diabetes; however, there is limited research on how to educate patients on this new therapy. The purpose of this quality improvement project was to optimize a HCL education program for pediatric patients with type 1 diabetes (T1D). Methods: Our multidisciplinary team developed a novel HCL clinical training program for current insulin pump users, using a quality improvement process called the Plan-Do-Study-Act model. Seventy-two patients participated in the HCL training program, which included (1) an in-person group class to reinforce conventional insulin pump and CGM use on the new system, (2) a live video conference class to teach HCL use, and (3) three follow-up phone calls in the first 4 weeks after HCL training to assess system use, make insulin adjustments, and provide targeted reeducation. Diabetes educators collected data during follow-up calls, and patients completed a training satisfaction survey. Results: The quality improvement process resulted in a training program that emphasized education on HCL exits, CGM use, and optimizing insulin to carbohydrate ratio settings. Patients successfully sustained time in HCL in the initial weeks of use and rated the trainings and follow-up calls highly. Conclusions: Ongoing educational support is vital in the early weeks of HCL use. This quality improvement project is the first to examine strategies for implementation of HCL therapy into a large pediatric diabetes center, and may inform best practices for implementation of new diabetes technologies into other diabetes clinics.

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