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The Implementation of Fecal Sample Collection Workflow: An Evidence-Based Practice Quality Improvement Project
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Implementing a Cancer Survivorship Screening Tool for Inpatient Bone Marrow Transplant Patients: An Evidence-Based Quality Improvement Project
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Enhancing Care for Underserved Populations: A Quality Improvement Project in a Comprehensive Weight Management Clinic
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Recognizing and Assessing for Delirium Tremens in an Inpatient Psychiatric Hospital: A Quality Improvement Project
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Implementing a Ventilator-Associated Pneumonia (VAP) Prevention Bundle in the NICU: A Quality Improvement Project
No full textVentilator-associated pneumonia (VAP) is the second most common nosocomial infection in newborn intensive care units (NICUs), prolonging hospital stay and increasing healthcare costs (Raycheva et al., 2022). VAP prevention bundles are cost-effective interventions that have proven to reduce VAP in adult models when combined with caregiver education and bundle compliance (Mastrogianni et al., 2023). A level IV NICU is lacking a current evidence-based VAP prevention bundle, potentially contributing to increased length of stay, cost, exposure to antibiotics, and morbidity and mortality rates. This quality improvement project aims to revise, implement, and evaluate an evidence-based VAP prevention bundle to decrease the incidence of VAP in a level IV NICU and to determine the feasibility, useability, and clinician satisfaction of the bundle. Education regarding VAP and the bundle was disseminated to all NICU caregivers trained to provide care for mechanically ventilated patients. This included registered nurses (n=250), respiratory therapists (n=60), and advanced practice providers (n=65). A retrospective chart review was completed to assess VAP incidence pre- and post-implementation. A caregiver pre- and post-implementation survey was used to assess VAP knowledge, VAP prevention practices, and views of standardized care. Key stakeholders contributed to the revision of the NICU-specific VAP prevention bundle. VAP education was disseminated by email and in person check-ins. The bundle was implemented into practice via a printed QR code, attached to every ventilator in use. Plan-Do-Study-Act (PDSA) cycles were used to evaluate and implement necessary changes. Retrospective chart reviews for NICU patients with positive tracheal aspirate cultures and artificial airways were identified for cases of VAP to assess pre- and post-implementation VAP rates. Pre- and post implementation caregiver surveys collected data regarding current ventilatory care practices, VAP knowledge, opinions regarding VAP prevention care, and demographics. Eighty-seven positive tracheal aspirates were identified during the 9-month preimplementation timespan. Of those, 28 (32.2%) were treated for pneumonia and 25 (28.7%) met criteria for VAP. Over the four-month post-implementation timeframe, 28 positive tracheal aspirates were identified. Of those, 11 (39.3%) were treated for pneumonia and met criteria for VAP. Pre- and post-implementation survey data showed insignificant changes in caregiver VAP knowledge scores (mean score of 62.6%, SD ± 23.4 versus 62.4%, SD ± 27.6) and minor changes in caregiver agreement regarding standardized NICU VAP prevention practices (68.3% versus 73.9%). Qualitative analysis of feedback revealed several themes among survey respondents, including the need for more education and time for implementation. Despite 87% of survey participants rating the bundle as easy to use and 91% stating they would continue to use the bundle in future practice, time and resources were significant barriers to implementation. Similar projects have demonstrated poor success in decreasing VAP rates without sufficient implementation time causing low staff buy-in and compliance (Mastrogianni et al., 2023). Further education and dissemination of the bundle over a longer timeframe are required to enable change in caregiver practice and unit culture to ensure the project\u27s success and sustainability
Implementing the Eat, Sleep, Console (ESC) Method for Treatment of Neonatal Opioid Withdrawal Syndrome (NOWS): A Quality Improvement Initiative
No full textOpioid use in pregnant women has increased in recent years, leading to a 48% increase in number of infants diagnosed with neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS) (Anbalagan et al., 2024). Current NOWS treatment consists of using the neonatal withdrawal inventory (NWI), which directs pharmacologic management based on signs of withdrawal. Pharmacologic treatment can lead to a prolonged length of stay (LOS), relying on a medication-weaning protocol to guide discharge eligibility. Many facilities are having success after implementing the Eat, Sleep, Console (ESC) method of treatment for NOWS, with decreased LOS and reduced morphine use. Local Problem: A Women and Newborn Department of a community hospital in an urban area of the Intermountain West desires to use an evidence-based method of NOWS treatment. Methods: A team consisting of stakeholders in the Women and Newborn service line created an implementation plan within the NICU, Pediatric, and Mom/Baby units to adopt the ESC method for treatment of NOWS. Interventions: Key stakeholders within the Women and Newborn service line performed a literature review, which identified a predominant support for the ESC treatment method. We conducted a retrospective chart review for infants with NOWS. The team administered a pre-intervention staff survey to identify staff attitudes, satisfaction of current NOWS treatment, and potential barriers for implementing ESC. After compiling survey results, the team created plans to address the possible barriers. The team then created multimodal educational materials and distributed them to staff in preparation for implementation. An executive summary was created using the Situation, Background, Assessment, and Recommendation (SBAR) framework. Results: We performed a retrospective chart review of 140 infants with NOWS from 2020 to 2024 and discovered an average hospital LOS of 18 days (2-102) and an average morphine count of 28.5 doses (0-266). We distributed a pre-intervention survey to 183 staff and providers working within the Women and Newborn service line at the project site facility, each of whom received the pre-intervention survey link by email. Of those, 46 (25.1%) completed the survey, with the majority being from the NICU (n=33, 71.7%). The breakdown of respondents were registered nurses (n=31, 67.4%), advanced practice providers (n=6, 13%), management/shared leaders/educators (n=4, 8.7%), ancillary staff (n=2, 4.3%), and patient care technicians (n=2, 4.3%). The survey respondents listed the following as the most likely potential barriers to implementing the ESC method at the project site facility: lack of parental involvement (n=44, 95.7%), lack of staff buy-in (n=27, 58.7%), and lack of staff education (n=18, 39.1%). Conclusion: The ESC model of NOWS treatment is a well-supported, evidence-based approach for this population. Facilities using this method have seen a decrease in hospital LOS and a reduction in morphine exposure without an increase in readmission. The successful implementation of ESC will depend on encouraging parent involvement, addressing potential barriers, and evaluating the method\u27s usability, feasibility, and satisfaction
Implementing a Cancer Survivorship Screening Tool for Inpatient Bone Marrow Transplant Patients: An Evidence-Based Quality Improvement Project
No full textCurrently, 16.9 million Americans aged 65 and older have a history of cancer, including 11.9 million cancer survivors. Bone marrow transplant (BMT) survivors experience symptoms, which encompass fatigue, sleep disturbances, neuropathy, mental health challenges, and chronic pain. Implementation of comprehensive screening processes, based on the National Comprehensive Cancer Network (NCCN) guidelines, facilitates the identification of unresolved healthcare needs in cancer survivors. A chart review from a quality improvement (QI) initiative at an academic cancer hospital in Utah conveyed a deficit in screening processes for BMT patients\u27 posttreatment to identify unmet physical, emotional, and psychosocial needs. This project aimed to implement a cancer survivorship screening tool to improve the identification of unmet needs in BMT patients and increase referrals to cancer survivorship resources. A qualitative analysis of electronic health records (EHR) evaluated current screening processes to identify unmet needs of BMT patients. Thirty-two BMT inpatient nurses completed a presurvey to assess current cancer survivorship practices. After implementing the NCCN cancer survivorship screening tool, the same nurses evaluated the feasibility, usability, and satisfaction of the tool through a postsurvey. Nurses distributed the NCCN-adapted cancer survivorship screening tool for BMT patients at inpatient discharge for six weeks (October 27, 2024-December 8, 2024). Patients who checked ‘yes\u27 on at least one question were considered positive screens and some were referred to cancer survivorship resources. The implementation was adjusted based on weekly check-ins and feedback from BMT nurses. Adjustments included placing paper reminders at nurse stations and having charge nurses remind staff to distribute the screening tool during shift safety briefings. Postimplementation of the NCCN cancer survivorship screening tool showed that out of 88 patients discharged over the 6-week implementation period, 35 patients were screened, and 19 were referred to the Wellness and Integrative Health Center based on positive screens. There were 32 positive screens, and 19 of those patients were referred. Referral limitations occurred due to issues with the complexity of orders being placed before discharge. Fifteen percent of nurses reported the screening tool significantly improved the quality of cancer survivorship care, 60% noted it moderately improved quality, and 25% revealed no change. One hundred percent of nurses indicated this tool was feasible, easy to use, and satisfactory. This QI project increased screening for BMT patients\u27 unmet psychosocial, emotional, and physical needs and referrals to cancer survivorship resources. Nurses who participated in administering the screening tool found it useful, feasible, satisfactory, and easy to use. Further research to identify specific cancer survivorship resources can help with the unique needs of cancer survivors. Additionally, exploring the addition of this tool to other inpatient cancer units at the hospital can benefit all cancer survivors\u27 care
Enhancing Childhood Immunization Rates: Implementing an Evidenced-Based Provider Toolkit & Training in Pediatric Primary Care
No full textThe World Health Organization identifies vaccine hesitancy as a top ten global health threat. Growing hesitancy has decreased childhood immunization rates, significantly threatening public health and increasing the risk of vaccine-preventable disease outbreaks. The COVID-19 pandemic has exacerbated this issue by amplifying distrust in healthcare providers. At a suburban pediatric clinic in Utah, providers lacked standardized approaches and up-to-date tools for addressing vaccine hesitancy. Despite serving a population with increasing rates of vaccine exemptions, providers felt unprepared to effectively communicate with vaccine-hesitant parents. This quality improvement project utilized the Johns Hopkins Evidence-Based Practice Model. Pre- and post-implementation surveys assessed providers\u27 confidence in addressing vaccine hesitancy. Retrospective chart reviews compared vaccination rates for children aged 0-6 years. Weekly Plan-Do-Study-Act (PDSA) cycles tracked toolkit usage and gathered real-time feedback, enabling refinement. Interventions: Based on evidence-based research, a comprehensive vaccine hesitancy toolkit was developed, incorporating communication strategies and supporting materials. A mixed-media training program, including presentations of key concepts, interactive exercises, and scenario-based practice sessions, was implemented. Six healthcare providers (four Pediatricians, one Family Nurse Practitioner, and one Physician Assistant) participated in the training. Post-intervention, providers reported improvements in communication confidence (33% to 67% feeling "confident") and comfort discussing vaccine risks and benefits (33% to 83%). Implementation assessment demonstrated high acceptability, with 83% of providers agreeing that the toolkit added value. Vaccination rates showed mixed results, with improvements in some age groups (12-month Hepatitis A rates increased by 15% and MMR/Varicella by 23.2%) while others declined significantly (4-6-year-old DTaP/IPV decreased by 62.7% and 4-6-year-old MMRV decreased by 60.3%). Primary barriers were parental vaccine hesitancy, provider time constraints, and ingrained practice habits. This quality improvement project demonstrated the feasibility of implementing an evidence-based vaccine hesitancy toolkit in pediatric primary care. While providers reported increased confidence, the intervention did not consistently increase immunization rates across all age groups, highlighting the need for comprehensive, multi-level approaches to address vaccine hesitancy
Implementing a Diabetes Education Referral Toolkit: An Evidence-Based Quality Improvement Project
No full textDiabetes affects over 38.4 million Americans, with significant disparities in healthcare access and outcomes among racially and ethnically diverse populations. Despite the benefits of diabetes education, only 6.8% of patients receive it within the first year of diagnosis. Barriers such as provider time constraints, unclear referral processes, and insurance complexities hinder referrals for diabetes education. Addressing these challenges is essential to improving diabetes management and outcomes. In Salt Lake City, the diabetes prevalence rate is 9.1%, with economically disadvantaged and racially diverse populations experiencing a higher burden of the disease. At an academic family health clinic in Salt Lake City serving a diverse patient population, diabetes education referral rates were lower than desired. Barriers to referral included a cumbersome referral system, limited provider awareness of available resources, and challenges related to insurance coverage, preventing timely access to diabetes education for patients. A quality improvement initiative guided by the Johns Hopkins Evidence-Based Practice model was implemented. A pre-intervention survey assessed provider knowledge and referral practices, and a retrospective chart review established baseline referral rates. The intervention involved developing a diabetes education referral toolkit, conducting provider training, and evaluating its impact through post-intervention surveys and referral data analysis over a 12-week period. The diabetes education referral toolkit included a workflow algorithm, billing guide, pre-written electronic health record (EHR) templates, and a dot phrase (.diabetesresources) for quick access to referral information. An in-person training session introduced the toolkit, emphasizing its benefits and the referral process. Toolkit materials were provided in both print and electronic formats. Baseline referral rates for diabetes education were 5.64%. Post-intervention, the referral rate decreased slightly to 5.33%, with no statistically significant change (p = 0.77). Most providers (80%) reported the toolkit was easy to use, and satisfaction was high (80%). The EHR templates and dot phrase were identified as the most helpful components. Provider feedback indicated increased awareness of the referral process and insurance requirements but highlighted ongoing challenges with patient engagement and insurance complexities. Although the toolkit did not significantly increase referral rates, it was well received by providers and improved clarity around the referral process. Positive feedback suggests potential for longer-term benefits if supported by ongoing training and provider engagement. Future efforts should focus on sustainability, addressing patient-related barriers, and exploring strategies to enhance provider perceptions of their role in promoting diabetes education
Improving Protocols for Assessing and Reporting Non-recent Child Abuse: A Quality Improvement Project
No full textMandated reporters, including mental health clinicians, are legally required to report suspected child abuse, including non-recent abuse if a current minor could be at risk. Despite this requirement, underreporting child abuse is prevalent due to factors such as insufficient knowledge, fear of repercussions, and unclear guidelines. Local Problem: An urban outpatient mental health clinic primarily staffed by students and novice clinicians lacked formal training and protocols for assessing and reporting non-recent child abuse. This absence of clear guidelines left clinicians ill-equipped to respond sensitively and knowledgeably to disclosures of non-recent abuse. A structured approach was needed to address this gap. This quality improvement (QI) project utilized the Johns Hopkins Evidence-Based Practice (JHEBP) Model and the Plan-Do-Study-Act (PDSA) cycle. The intervention involved developing and implementing a non-recent abuse reporting tool at the clinic. Interventions: Current child abuse reporting laws in Utah were sourced from The Rape, Abuse & Incest National Network (RAINN) website and combined with findings from a comprehensive literature review. Input from the clinic co-director, project sponsor, and content expert was incorporated into the tool\u27s design. The intervention was conducted in four phases: (1) preimplementation survey to assess baseline knowledge, confidence, and satisfaction; (2) creation of the reporting tool; (3) introduction of the tool; and (4) post-implementation survey to evaluate outcomes. Tool usability was monitored bi-weekly, and feedback was collected throughout the implementation period. Results: The project included 10 participants comprising students and clinicians. Pre-survey results from nine respondents indicated low confidence levels in assessing and reporting non-recent child abuse and an average knowledge score of 79%. Following tool implementation and training, post-survey results from seven participants revealed improved confidence levels, with all respondents reporting moderate to high confidence. The average knowledge score increased to 87%, reflecting an 8% improvement. All participants found the tool easy to use, feasible, and satisfactory. Additionally, 85% expressed intent to use the tool for future disclosures of nonrecent abuse, suggesting its potential for sustained impact on clinical practice. The implementation of an evidence-based reporting tool significantly enhanced clinicians\u27 confidence and competence in addressing disclosures of non-recent child abuse. This project underscores the importance of clear protocols and targeted training in equipping clinicians to navigate complex reporting requirements effectively, ultimately contributing to improved protection for at-risk minors