Implementing an in Situ Mock Code Quality Improvement Program

2016 ◽  
Vol 25 (5) ◽  
pp. 393-399 ◽  
Author(s):  
Megan D. Herbers ◽  
Joseph A. Heaser
Keyword(s):  
Quality Improvement ◽  
Nursing Staff ◽  
Response Times ◽  
Improvement Program ◽  
Confidence Levels ◽  
Hands On ◽  
Medical Emergencies ◽  
Mock Codes ◽  
Code Quality

Background The high risk and low volume of medical emergencies, combined with long periods between training sessions, on 2 progressive care units at Mayo Clinic, Rochester, Minnesota, established the importance of transforming how nursing staff are trained to respond to medical emergencies. Objectives To increase confidence levels and improve nursing performance during medical emergencies via in situ simulation. Methods An in situ, mock code quality improvement program was developed and implemented to increase nurses’ confidence while improving nursing performance when responding to medical emergencies. For 2 years, each unit conducted mock codes and collected data related to confidence levels and response times based on the recommendations in the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Results In those 2 years, nursing staff response times for calling for help improved 12%, time elapsed before initiating compressions improved 52%, and time to initial defibrillation improved 37%. Additionally, staff showed an increase in perceived confidence levels. Staff reported their appreciation of the opportunity for hands-on practice with the equipment, reinforcing their knowledge and refining their medical emergency skills. Conclusions In situ mock codes significantly improve response times and increase staff confidence levels. In situ mock codes are a quick and efficient way to provide hands-on practice and allow staff to work as a team.

In Situ Neonatal Mock Codes: Assessing the Impact

2020 ◽  
Vol 39 (1) ◽  
pp. 29-34
Author(s):  
Emily K. Rivera ◽  
Leah M. Siple ◽  
Eunice J. Wicks ◽  
Heather S. Johnson ◽  
Caren M. Skov
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Outcome Measures ◽  
Nursing Staff ◽  
Neonatal Resuscitation ◽  
Confidence Levels ◽  
Mock Codes ◽  
The Impact

PurposeTo assess the impact of a quality improvement (QI) project to increase nursing staff confidence in responding to neonatal emergencies.DesignMandatory neonatal emergency in situ scenarios done quarterly.SampleBedside NICU nursing staff and the subset of NICU nurses that attend all high-risk deliveries and neonatal emergencies on the obstetrics unit.Outcome MeasuresConfidence levels in responding to neonatal emergencies, demonstrating neonatal resuscitation skills, and communicating effectively during an emergency.ResultsSixty-eight NICU nurses completed the pre- and postintervention surveys. Self-reported confidence levels increased in all areas measured. Overall, the percentage of nursing staff that reported confidence in being able to participate in a neonatal emergency increased from 48 percent to 77 percent.

scholarly journals The nursing staff opinion about the continuous quality improvement program of a university hospital

2014 ◽  
Vol 12 (2) ◽  
pp. 211-216 ◽  
Author(s):  
Fernanda Mazzoni da Costa ◽  
Rosangela Maria Greco ◽  
Elena Bohomol ◽  
Cristina Arreguy-Sena ◽  
Vitor Luiz Andrade
Keyword(s):  
Factor Analysis ◽  
Quality Improvement ◽  
Working Conditions ◽  
Nursing Staff ◽  
Continuous Quality Improvement ◽  
Interpersonal Relations ◽  
University Hospital ◽  
Improvement Program ◽  
Continuous Quality ◽  
Quality Program

Objective To analyze the nursing staff opinion about the continuous quality improvement program at a University Hospital.Methods A descriptive study designed as a case study, analyzing the quality program at a University Hospital, with the opinion of a sample stratified by nursing team category through a self-administered questionnaire, from May to July 2012. The answers were submitted to factor analysis, having the dialectical and historical materialism as the theoretical-methodological reference.Results The factor analysis grouped the variables in six factors: working conditions, approval, belongingness, tranquility, interpersonal relations, and private life. With the exception of the factor interpersonal relations, the answers revealed that workers do not have opinion about the proposed questions. Four of the six factors had a predominance of positive answers.Conclusion A high percentage of respondents was not aware of the implications of a quality program. The majority believed that the program influenced positively in their working conditions and in the interpersonal relationships at work and agree with the program; however, they did not feel part of the program, and were not at ease to develop these activities. They did not acknowledge the program interfering in their personal life.

In Situ Simulation to Assess Pediatric Tracheostomy Care Safety: A Novel Multicenter Quality Improvement Program

2020 ◽  
Vol 163 (2) ◽  
pp. 250-258
Author(s):  
Sharan J. Shah ◽  
Cristen Cusumano ◽  
Sadia Ahmed ◽  
Anthony Ma ◽  
Farrukh N. Jafri ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Assessment Tool ◽  
Clinical Care ◽  
System Level ◽  
Clinical Environment ◽  
Improvement Program ◽  
In Situ Simulation ◽  
Simulation Performance ◽  
Tracheostomy Tubes

Objectives Our objectives were (1) to use in situ simulation to assess the clinical environment and identify latent safety threats (LSTs) related to the management of pediatric tracheostomy patients and (2) to analyze the effects of systems interventions and team factors on LSTs and simulation performance. Methods A multicenter, prospective study to assess LSTs related to pediatric tracheostomy care management was conducted in emergency departments (EDs) and intensive care units (ICUs). LSTs were identified through equipment checklists and in situ simulations via structured debriefs and blinded ratings of team performance. The research team and unit champions developed action plans with interventions to address each LST. Reassessment by equipment checklists and in situ simulations was repeated after 6 to 9 months. Results Forty-one LSTs were identified over 21 simulations, 24 in the preintervention group and 17 in the postintervention group. These included LSTs in access to equipment (ie, availability of suction catheters, lack of awareness of the location of tracheostomy tubes) and clinical knowledge gaps. Mean equipment checklist scores improved from 76% to 87%. Twenty-one unique teams (65 participants) participated in the simulations. The average simulation score was 6.19 out of 16 points. Discussion In situ simulation is feasible and effective as an assessment tool to identify latent safety threats and thus measure the system-level performance of a clinical care environment. Implications for Practice In situ simulation can be used to identify and reassess latent safety threats related to pediatric tracheostomy management and thereby support quality improvement and educational initiatives.

NSQIP Analysis: Increased Immediate Reconstruction in the Treatment of Breast Cancer

2016 ◽  
Vol 82 (6) ◽  
pp. 540-545 ◽  
Author(s):  
Jennifer Sabino ◽  
Donald J. Lucas ◽  
Craig D. Shriver ◽  
Amy E. Vertrees ◽  
Ian L. Valerio ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Improvement ◽  
Breast Reconstruction ◽  
Treatment Algorithm ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Immediate Reconstruction ◽  
Pedicle Flap ◽  
Surgical Quality

Immediate reconstruction after the surgical treatment of breast cancer has increased in the last decade. The purpose of this study is to use the National Surgical Quality Improvement Program database to analyze long-term trends in breast reconstruction. Women who underwent mastectomy for invasive or in situ breast cancer or prophylaxis between 2005 and 2011 were selected from the National Surgical Quality Improvement Program database. Trends and predictors for reconstruction were explored. In 44,410 women identified, immediate reconstruction increased from 30.0 to 39.6 per cent from 2005 to 2011 ( P < 0.001). This trend persisted after adjustment for patient characteristics using multivariate logistic regression [odds ratio (OR) 1.09/year, 95% confidence interval (CI) 1.07–1.10]. Reconstruction type was 77.9 per cent implant, 13.3 per cent pedicle flap, 5.5 per cent free flap, and 3.3 per cent other. Pedicle flaps decreased from 27.1 to 9.2 per cent ( P < 0.001), implant-based reconstruction increased from 66.3 to 81.3 per cent ( P < 0.001), and free flaps remained stable between 4 and 7 per cent. Independent predictors for reconstruction were young age (stepwise decrease in OR from 1 to 0.02 by decade as age increased from 40 to 80, all P < 0.001), carcinoma in situ (OR 1.51, 95% CI 1.42–1.61), prophylaxis (OR 1.89, 95% CI 1.63–2.19), bilateral resection (OR 2.55, 95% CI 2.42–2.69), and non-Hispanic white race (OR 0.67 for other races, 95% CI 0.64–0.70). Immediate breast reconstruction has steadily increased since 2005 with an associated rise in implant-based reconstruction. Based on these trends, discussion with a reconstructive surgeon should be an early part of the newly diagnosed breast cancer patient's treatment algorithm.

Challenges in Hospital-Associated Infection Management

2015 ◽  
Vol 26 (3) ◽  
pp. 252-261
Author(s):  
Kathleen M. Stacy
Keyword(s):  
Quality Improvement ◽  
Nursing Staff ◽  
Organizational Support ◽  
Leadership Team ◽  
Improvement Program ◽  
Equipment And Supplies ◽  
Continuous Quality ◽  
Hospital Associated Infections ◽  
Unit Culture ◽  
Huge Challenge

Maintaining a successful unit-based continuous quality improvement program for managing hospital-associated infections is a huge challenge and an overwhelming task. It requires strong organizational support and unit leadership, human and fiscal resources, time, and a dedicated and motivated nursing staff. A great deal of effort goes into implementing, monitoring, reporting, and evaluating quality improvement initiatives and can lead to significant frustration on the part of the leadership team and nursing staff when quality improvement efforts fail to produce the desired results. Each initiative presents its own unique set of challenges; however, common issues influence all initiatives. These common issues include organization and unit culture, current clinical practice guidelines being used to drive the initiatives, performance discrepancies on the part of nursing staff, availability of resources including equipment and supplies, monitoring of the data, and conflicting quality improvement priorities.

Residency Training and Hand Surgery Practice Patterns: A National Surgical Quality Improvement Program Database Analysis

2020 ◽  
Author(s):  
James J. Drinane ◽  
Brian Drolet ◽  
Ashit Patel ◽  
Joseph A. Ricci
Keyword(s):  
Quality Improvement ◽  
Residency Training ◽  
Practice Patterns ◽  
Hand Surgery ◽  
Soft Tissue Coverage ◽  
Improvement Program ◽  
Surgical Quality ◽  
Orthopedic Surgeons ◽  
Procedural Volume ◽  
General Surgeons

Abstract Introduction Fellowship-trained hand surgeons may have residency training in either orthopedic, plastic, or general surgery, generating significant variability in education background. To study the effect of different training backgrounds on practice pattern variations, we utilized the NSQIP (National Surgical Quality Improvement Database) database to assess hand surgery volumes and case variety by specialty. Materials and Methods NSQIP years 2008 to 2017 was queried with hand surgery current procedural terminology codes defined by the American Board of Orthopedic Surgery. Procedures were grouped according to type and specialty, and relative rates calculated. Hand society membership data were used to determine if procedural volume for each specialty in each category and overall contribution to the volume of hand surgery performed nationally was distributed in accordance with membership data. Results A total of 145,015 hand surgeries were performed; 13,267 (9.1%) by general surgeons, 28,402 (19.6%) by plastic surgeons, and 103,346 (71.3%) by orthopedic surgeons. Orthopedic surgeons performed significantly more bone, fracture, joint, and tendon cases. General surgeons and plastic surgeons performed higher than expected numbers of soft tissue coverage and cases overall with respective excesses of 183 and 22%. Conclusion Hand surgery is an available fellowship pathway from multiple residencies. Fellowship training does not level the field of real-world practice patterns. Residency training experiences significantly impact practice.

Upper Extremity Free Flap Transfers: An Analysis of the National Surgical Quality Improvement Program Database

2020 ◽  
Author(s):  
George A. Beyer ◽  
Karan Dua ◽  
Neil V. Shah ◽  
Joseph P. Scollan ◽  
Jared M. Newman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Upper Extremity ◽  
Free Flap ◽  
Quality Improvement Program ◽  
Readmission Rates ◽  
Improvement Program ◽  
Surgical Quality ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Reoperation Rates

Abstract Introduction We evaluated the demographics, flap types, and 30-day complication, readmission, and reoperation rates for upper extremity free flap transfers within the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods Upper extremity free flap transfer patients in the NSQIP from 2008 to 2016 were identified. Complications, reoperations, and readmissions were queried. Chi-squared tests evaluated differences in sex, race, and insurance. The types of procedures performed, complication frequencies, reoperation rates, and readmission rates were analyzed. Results One-hundred-eleven patients were selected (mean: 36.8 years). Most common upper extremity free flaps were muscle/myocutaneous (45.9%) and other vascularized bone grafts with microanastomosis (27.9%). Thirty-day complications among all patients included superficial site infections (2.7%), intraoperative transfusions (7.2%), pneumonia (0.9%), and deep venous thrombosis (0.9%). Thirty-day reoperation and readmission rates were 4.5% and 3.6%, respectively. The mean time from discharge to readmission was 12.5 days. Conclusion Upper extremity free flap transfers could be performed with a low rate of 30-day complications, reoperations, and readmissions.

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