scholarly journals A Quality Improvement Project to Implement Choking Prevention and First Aid Education in Prader–Willi Syndrome Caregivers

2021 ◽  
Vol 10 (21) ◽  
pp. 4993
Author(s):  
Kathryn S. Obrynba ◽  
Kathryn Anglin ◽  
Amy Moffett ◽  
Tracie Steinke ◽  
Manmohan K. Kamboj
Keyword(s):  
Quality Improvement ◽  
Genetic Disorder ◽  
Heart Association ◽  
First Aid ◽  
Practice Change ◽  
Prader Willi Syndrome ◽  
Prevention Strategies ◽  
Improvement Project ◽  
Education Assessment ◽  
Clinic Appointment

Prader–Willi syndrome (PWS) is a complex neurodevelopmental genetic disorder characterized by hypotonia and hyperphagia. Consequently, individuals with PWS are at high risk of choking, and choking is a leading cause of morbidity and mortality. The aim of this quality improvement (QI) project is to provide choking prevention and first aid education from 0% to 80% of PWS caregivers seen in a multidisciplinary PWS clinic, and to assess the effectiveness of this education program. A QI initiative was developed to standardize and implement choking prevention and first aid education for PWS caregivers. Using a Likert scale, pre- and post-education assessments were conducted to measure caregiver (1) awareness of the PWS choking risk, (2) self-reported knowledge of choking prevention strategies, and (3) comfort in providing choking first aid. The American Heart Association Family and Friends® CPR (Dallas, TX, USA) curriculum was utilized. Education was provided during a regularly scheduled PWS clinic appointment. At project conclusion, 45/52 (87%) of PWS caregivers received education. A post-education assessment revealed an improvement in PWS caregivers’ awareness of choking risk, self-reported knowledge of choking prevention strategies, and comfort in providing choking first aid. This QI project supports a practice change to implement choking prevention and first aid education as standard process within our PWS clinic.

scholarly journals Improving clinical management for consumers with co-existing mentalhealth and substance use disorders

2001 ◽  
Vol 24 (3) ◽  
pp. 118 ◽  
Author(s):  
Margaret J Tobin ◽  
Beth Matters ◽  
Luxin Chen ◽  
Roisin Smith ◽  
Cynthia Stuhlmiller
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Quality Improvement ◽  
Clinical Practice ◽  
Substance Use Disorders ◽  
National Policy ◽  
Practice Change ◽  
Drug Misuse ◽  
Improvement Project ◽  
Clinical Practice Change

Using Quality Improvement project methodology, complex organisational and clinical practice change was broughtabout to improve services for people with co-existing mental health and alcohol and drug misuse. The project describeslocal uptake and adaptation of national and state policy to achieve change that is sustainable within existing resources.Emphasis on engagement of staff and consumers and carers throughout the change was an essential component. Theproject has implications for the introduction of changes in response to other national policy directives.

Standardizing Discharge Furosemide Duration Following Congenital Heart Surgery

2021 ◽  
pp. 215013512110493
Author(s):  
Mira Trivedi ◽  
Carlos Eduardo Diaz-Castrillon ◽  
Evonne Morell
Keyword(s):  
Quality Improvement ◽  
Hospital Discharge ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Average Duration ◽  
Diuretic Therapy ◽  
Total Duration ◽  
Congenital Heart Surgery ◽  
Practice Change ◽  
Improvement Project

Background: Pediatric cardiothoracic surgery has evolved over the last several decades with shorter bypass times and less need for hypothermic arrest. Diuretics have been commonly used in the post-operative period with no guidelines on duration following cardiopulmonary bypass. As a result, we conducted a single-center quality improvement project to reduce overuse of diuretics in post-operative patients without causing an increase in complications. We devised an early diuretic wean protocol that was implemented upon patient discharge. Methods: All patients who underwent uncomplicated congenital heart surgery after November 2018 were considered for the protocol. We defined an early diuretic wean protocol with a total duration of ten days of single diuretic therapy following hospital discharge. Patients were evaluated in clinic two weeks following discharge, after completion of diuretic therapy, to assess for clinical symptoms and development of effusions. Results: Retrospective pre-protocol data found the average duration a patient was on diuretics was 32 days following hospital discharge from uncomplicated congenital heart surgery. Following implementation of the protocol, there was a decrease in the total duration to 14 days, demonstrating a 56% decrease. With this practice change, there was no notable increase in adverse events. Conclusions: With implementation of the protocol, practice variability was minimized and the average post-operative diuretic duration was decreased without an increase in pleural and/or pericardial effusions or readmissiosn rates. Future directions and ongoing changes include expanding to a multicenter quality improvement collaborative focusing on decreasing the average duration of furosemide to less than five days after hospital discharge.

Improving Preoperative Cardiac Assessment Efficiency by Using the American College of Cardiology/American Heart Association Guidelines: A Quality Improvement Project

2015 ◽  
Vol 8 (2) ◽  
pp. 164-171
Author(s):  
Marcia A. Zuzul ◽  
Paula Tanabe ◽  
Robert Blok ◽  
Kenneth Snyder
Keyword(s):  
Quality Improvement ◽  
American Heart Association ◽  
American Heart ◽  
Guideline Implementation ◽  
Heart Association ◽  
Noncardiac Surgery ◽  
Assessment Process ◽  
Cardiac Complications ◽  
Evidence Based ◽  
Improvement Project

Background: Patients undergoing noncardiac surgery can experience cardiac complications, which are a major cause of morbidity and mortality in the perioperative period. The goal of this quality improvement (QI) project was to standardize the preoperative assessment process and improve patient-centered care by implementing evidence-based practice guidelines for electrocardiogram (ECG) recommendations prior to noncardiac surgery. Methods: Three steps were used to implement the American College of Cardiology/American Heart Association (ACC/AHA) recommendation for ECG to reduce variance in practice and decrease surgical cancellations. A pre- and postdesign was used to evaluate 2 outcomes: decreased surgical cancellations for lack of a current ECG and surgical loss opportunity cost. All data were retrospectively collected for 60 days during the pre- and postperiods. Results: Evidence-based, preoperative ECG recommendations were implemented in the electronic medical record (EMR). Overall, ECG guideline adherence increased from 50% to 66% (χ2 = 2.19, p = .139) postimplementation. Surgical cancellations because of unmet ECG requirements were reduced from 50% to 34% (χ2 = 2.19, p = .139) post-EMR guideline implementation. There was no statistical difference in the cost associated with loss surgical opportunity minutes between the periods (t = 0.79, p = .43, 95% CI [−6.96, 16.24]). Discussion: We successfully implemented an evidence-based guideline recommending specific preoperative ECG requirements within a busy Veterans Administration hospital. This project stimulated ongoing dialogue between the disciplines with positive trends in decreased surgical cancellations.

CODE FAST: a quality improvement initiative to reduce door-to-needle times

2015 ◽  
Vol 8 (7) ◽  
pp. 661-664 ◽  
Author(s):  
Leslie Busby ◽  
Kumiko Owada ◽  
Samish Dhungana ◽  
Susan Zimmermann ◽  
Victoria Coppola ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Univariate Analysis ◽  
Substantial Reduction ◽  
Heart Association ◽  
Time Of Day ◽  
Quality Improvement Project ◽  
Quality Improvement Initiative ◽  
Improvement Project ◽  
Process Improvements ◽  
Before And After

BackgroundRapid delivery of IV tissue plasminogen activator (tPA) in qualifying patients leads to better clinical outcomes. The American Heart Association has reduced target door-to-needle (DTN) times from 60 to 45 min in the hopes of continued process improvements across institutions.ObjectiveTo start a quality improvement project called CODE FAST in order to reduce DTN times at our institution.Materials and methodsWe retrospectively reviewed data from our internally maintained database of patients treated with intravenous tPA before and after implementation of the CODE FAST protocol. We assessed demographic information, time of day and times of arrival to first image and delivery of tPA in patients from February 2014 to February 2015. Outcomes were assessed based on discharge to home. Univariate analysis was performed to assess for improvement in DTN times before and after implementation of the protocol.ResultsA total of 93 patients (41 pre-CODE FAST and 52 post-CODE FAST) received IV tPA during the study period. Patients were equally matched between the two groups except that in the pre-CODE FAST era patients receiving tPA were younger and more likely to be men. There was a substantial reduction in door-to-imaging time from a median of 16 to 8 min (p<0.0001) and DTN time with a reduction in the median from 62 to 25 min (p<0.0001). In logistic regression modeling, there was a trend towards more discharges to home in patients treated during the CODE FAST era.ConclusionsWe present a quality improvement project that has been overwhelmingly successful in reducing DTN time to <30 min. The template we present may be helpful to other institutions looking to reduce their DTN times and may also reduce costs as we note a trend towards more discharges to home.

scholarly journals Appropriate utilisation of cardiac telemetry monitoring: a quality improvement project

2019 ◽  
Vol 8 (2) ◽  
pp. e000560
Author(s):  
Ky B Stoltzfus ◽  
Maharshi Bhakta ◽  
Caylin Shankweiler ◽  
Rebecca R Mount ◽  
Cheryl Gibson
Keyword(s):  
Quality Improvement ◽  
Patient Care ◽  
Kansas City ◽  
Heart Association ◽  
The United States ◽  
Quality Improvement Project ◽  
Appropriate Use ◽  
Academic Medical Centre ◽  
Improvement Project ◽  
Number Of Patients

For hospitals located in the United States, appropriate use of cardiac telemetry monitoring can be achieved resulting in cost savings to healthcare systems. Our institution has a limited number of telemetry beds, increasing the need for appropriate use of telemetry monitoring to minimise delays in patient care, reduce alarm fatigue, and decrease interruptions in patient care.This quality improvement project was conducted in a single academic medical centre in Kansas City, Kansas. The aim of the project was to reduce inappropriate cardiac telemetry monitoring on intermediate care units. Using the 2004 American Heart Association guidelines to guide appropriate telemetry utilisation, this project team sought to investigate the effects of two distinct interventions to reduce inappropriate telemetry monitoring, huddle intervention and mandatory order entry. Telemetry utilisation was followed prospectively for 2 years.During our initial intervention, we achieved a sharp decline in the number of patients on telemetry monitoring. However, over time the efficacy of the huddle intervention subsided, resulting in a need for a more sustained approach. By requiring physicians to input indication for telemetry monitoring, the second intervention increased adherence to practice guidelines and sustained reductions in inappropriate telemetry use.

Improving Labor Neuraxial Analgesia by Reducing Anesthesia Provider Practice Variance Involving Routine Platelet Counts: A Quantitative Quality Improvement Project

2015 ◽  
Vol 8 (1) ◽  
pp. 110-116
Author(s):  
Paul M. Johnson ◽  
Thomas R. Walter ◽  
Stephanie R. Fugate ◽  
James F. Titch
Keyword(s):  
Quality Improvement ◽  
Diffusion Of Innovations ◽  
Standard Operating Procedure ◽  
Clinical Decision ◽  
Practice Change ◽  
Improvement Project ◽  
Neuraxial Analgesia ◽  
Anesthesia Providers ◽  
Provider Practice ◽  
Ebp Implementation

For this quality improvement (QI) project, the desired outcomes were the reduction of the incidences of withheld neuraxial analgesia (NA) for healthy parturients and the adoption of evidence-based practice (EBP) by the anesthesia providers (APs). The practice change was designed using the diffusion of innovations in health service organizations change model. The 3 interventions used to achieve the outcomes of the project were (a) revision of the anesthesia service’s standard operating procedure (SOP) to incorporate recent recommendations addressing platelet count limits for parturients, (b) addition of a clinical decision reminder in the patient’s electronic medical record (EMR), and (c) educating obstetrical APs about the new SOP and updated EMR.Outcomes were measured using pre- and postimplementation surveys of the staff who work on the labor and delivery ward to evaluate AP practice variance and a modified EBP Implementation Scale to measure the adoption of the evidence by the APs. The QI project was successful in reducing practice variance and resulted in fewer incidences of withheld NA for healthy parturients, and 57.1% of the APs reported changing their practice by adopting the evidence for this project.

Abstract WP401: Code Fast: a Quality Improvement Initiated to Reduce Door to Needle Times

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Leslie N Busby ◽  
Kumiko Owada ◽  
Samish Dhungana ◽  
VIctoria Coppola ◽  
Rebecca Ruban ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Univariate Analysis ◽  
Substantial Reduction ◽  
Heart Association ◽  
Time Of Day ◽  
Quality Improvement Project ◽  
Night Time ◽  
Improvement Project ◽  
Process Improvements ◽  
Information Time

Introduction: Rapid delivery of intravenous t-PA in qualifying patients leads to better clinical outcomes. The American Heart Association has reduced target door to needle (DTN) times from 60 to 45 minutes in the hopes of continued process improvements across institutions. We thus started a quality improvement project called CODE FAST in order to reduce DTN times at our institution. These results were recently reported and published. Materials and Methods: We retrospectively reviewed data from our internally maintained database of patients treated with intravenous t-PA prior to and after implementation of the CODE FAST protocol. We assessed demographic information, time of day and times of arrival to first image and delivery of t-PA in patients from February 2014- February 2015. Outcomes were assessed based on discharge to home. Univariate analysis was performed to assess for improvement in DTN times prior to and after implementation of the protocol. We will present the latest data from February 2014- January 2016. Results: We previously reported 93 patients (41 pre-CODE FAST and 52 post-CODE FAST) received IV t-PA during the study period. We showed a substantial reduction in door to imaging time from a median of 16 to 8 minutes (p<0.0001) and DTN time with a reduction in the median from 62 to 25 minutes (p<0.0001). In logistic regression modelling, there was a trend towards more discharges to home in patients treated during the CODE FAST era. From March 2015-July 2015 an additional 57 patients have received t-PA under the CODE FAST protocol. The median door DTN remains 27 minutes. We will report further analysis comparing day and night time analysis and further strategies to further reduce DTN times. Conclusions: We present a quality improvement project that continues to be an overwhelmingly success in reducing DTN to less than 30 minutes. Further opportunies exist to reduce time further and improve discharge outcomes.

scholarly journals Increasing Nurses' Knowledge and Confidence Using the Teach-back Method to Teach Fall Prevention Strategies to Residents in Long Term Care

2018 ◽  
Author(s):  
Christine Nichols
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Fall Prevention ◽  
Long Term Care ◽  
Role Playing ◽  
Prevention Strategies ◽  
Term Care ◽  
Improvement Project ◽  
Nurses Knowledge

Fall prevention in health care settings, either acute care or long-term care, has been identified as an area of focus for quality improvement. The Joint Commission and the Centers for Medicare and Medicaid have developed goals and recommendations for all areas of health care to follow to decrease falls and improve patient and resident quality of life. Direct care nurses are relied upon to provide the education and to assist in preventing falls, but often do not measure the retention of the information provided. The purpose of this quality improvement project was to provide education on the teach-back method to nurses working in a small, family owned long-term care facility. Benner’s skills acquisition theory and Kellogg’s Logic Model were used as the theoretical framework for developing the project and education. The aim was to increase knowledge and confidence using the teach-back method. An educational program was developed to provide education to the nurses. The education was followed by the opportunity to practice using the teach-back method in a role-playing scenario. Pre and post education tests were provided to determine if the education increased the nurses’ knowledge of the method. Thirty-three percent (N=10) of the nurses employed at the facility participated. Prior to the education, 40% (n=4) of the participants felt the teach-back method was not a practical method for teaching fall prevention strategies to the residents, as compared to 80% (n=8) in the post test. With a greater focus by regulatory agencies on fall prevention programs in long-term care settings, the advanced practice registered nurse can take on the role of leader in guiding nurses through the process of improving education and resident outcomes.

Effects of Simulation Video on Parental Recall of Seizure First Aid: A Quality Improvement Project

2020 ◽  
Vol 35 (13) ◽  
pp. 908-911
Author(s):  
Xinran Maria Xiang ◽  
Daniella Miller
Keyword(s):  
Quality Improvement ◽  
Action Plan ◽  
First Aid ◽  
Emergency Department Visits ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Face To Face ◽  
Counseling Group ◽  
Video Group ◽  
Parental Recall

Many parents of children do not recall anticipatory guidance on acute seizure management, which can lead to unnecessary emergency department visits. This quality improvement project evaluated if adding a video simulation of seizure first aid improved parental recall. Parents of children with seizures were randomized to standard verbal counseling or video group, which were shown a video simulation of seizure first aid. All families also received a standardized written action plan. Eighty-three patients were randomized from July to October 2018. Overall, 53% of families who received standard counseling accurately recalled seizure first aid compared with 31% in video group (χ2 = 3.24, P = .07). Among families without baseline knowledge of seizure first aid, 43% in the standard counseling group recalled accurately compared with 16% of video group (χ2 = 4.52, P = .03). These results underscore the importance of face-to-face patient education despite the popularity of video-based media. Future Plan-Do-Study-Act cycles will include piloting a hands-on seizure first aid simulation with mannequins.

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