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Patient Sleep Quality at Craig H Nielsen Rehabilitation Hospital
No full textThe purpose of this quality improvement study was to identify and subsequently intervene on factors that are causing poor sleep in patients admitted to Craig H. Neilsen Rehabilitation Hospital (NRH). Study Design: Preliminary information was gathered from NRH patients via provider administered surveys to determine what factors were contributing to poor sleep. It was found that the two primary causes affecting sleep were pain and environmental factors such as light and noise. This project is focusing on environmental factors as our data showed that these were reported to be disrupting sleep 20% of the time. Our intervention arm was developed based on this data, which will be a sleep bundle order set. This sleep bundle will include scheduled and as needed medications, sleep hygiene orders, and environmental modifications. Patients will either receive the sleep bundle or the current standard of care. Sleep quality will be measured using the Pittsburgh Sleep Quality Index which will be delivered via QR code in the days prior to discharge for any patient with a cognitive AMPAC (Activity Measure for Post-Acute Care) score of 20 or greater
Improving ICU Outcomes: the Role of K Cards in Reducing CLABSI Rates
No full textTraditional strategies to mitigate central line-associated bloodstream infections (CLABSIs) in intensive care units (ICUs) often involve retrospective chart audits, self-audits, or staff re-education through e-learning and skills days. This quality improvement project explored the feasibility of using Kamishibai cards (K cards), an innovative tool that provides immediate feedback and education to nursing staff, enhancing compliance with evidence-based protocol. Methods: A qualitative approach was employed to assess the practicality of K card implementation in a large urban hospital with high CLABSI rates. Survey data from 23 ICU leaders examined their existing knowledge and perceptions of K cards. Collaboration with the Medical ICU led to the development of a unit-specific K card prototype. Over a four-week pilot, 30 K card audits were conducted to observe staff adherence to CLABSI bundle protocol, identify trends, address knowledge gaps, and provide recommendations to leadership staff. Results: K card interactions highlighted key areas for improvement in bundle protocols. While there was 100% compliance with timely dressing changes, gaps in knowledge were observed regarding chlorhexidine gluconate (CHG) drying time, the proper duration for insertion site cleaning, and the appropriate use of clean gloves instead of sanitizing existing gloves. Compliance with daily CHG bathing was 90%, indicating room for improvement. Although the short duration of the project limited the assessment of long-term impacts on CLABSI rates, the K card audits provided valuable insights into staff practices and educational needs. Conclusions: K cards are a highly practical and evidence-based tool for promoting adherence to CLABSI prevention protocols. Their simplicity, adaptability, and easy integration into routine workflows make them a sustainable solution for long-term compliance. They also offer potential for broader applications, such as patient falls and catheter-associated urinary tract infection prevention. Continued use of K cards is recommended to maintain improvements in clinical practice, but additional research would help clarify guidelines for implementation
Use of 3D Printing for Preoperative Surgical Planning: Converting CT Scan Data to a Printed 3D Model
No full textPatient presents with a history of significant femur deformity requiring surgical revision. Goal is to use 3D printing to create a replica of the femur for preop planning. CT scan data was taken and converted to data compatible for 3D printing. The 3D printed model was then used to test an osteotomy cut to confirm the result prior to surgery
Vivid Dreams Among Patients After Bone Marrow and Stem Cell Transplants: A Scoping Review
No full textA multidisciplinary team consisting of an oncology nurse, a nurse scientist and a clinical librarian looked into the phenomenon of vivid dreams or nightmares in patients who received bone marrow transplants. A preliminary search revealed a knowledge gap that indicated the need for a thorough literature review to identify what is known about the phenomenon of vivid dreams or nightmares among patients receiving stem cell or bone marrow transplants. The team formed a list of search terms related to stem cell and bone marrow treatment recovery and dreams and conducted searches in four bioscience databases. Following the Scoping - PRISMA template, two nurses on the project team independently screened the sources using a standardized protocol. The Scoping Review yielded no articles specifically addressing vivid dreams or nightmares among patients recovering from stem cell or bone marrow transplants, highlighting research implications. Several excluded studies suggested that sleep disturbances and poor sleep quality are common among cancer treatment recipients. The absence of sources discussing vivid dreams or nightmares underscores the need to understand sleep patterns in these populations
Implementation of an Interdisciplinary Scar Board
No full textOur Burn team provides evaluation & management of burn scars. Occasionally, it is necessary to involve the plastic surgery team for reconstructive procedures and we noted an opportunity to improve communication. Leaders of these teams met to create the Scar Board (SB), modeled after interdisciplinary tumor boards. Goals: 1) Improve communication 2) Improve coordination of care 3) Increase efficiency of referrals; SB includes members of the Burn MD/APC/RN teams, Plastic Surgery MD team & Burn OT/PT staff. Identified patients are presented bi-monthly at a SB meeting. Patient cases are presented and include patient information, images and/or videos highlighting areas of concern. Patients are reviewed; referrals are placed & appointments are scheduled with the appropriate team. Members of SB were given a survey to address satisfaction with the process. Pre-screened patients 177, Presented patients 53, successful referrals to plastics 32. The survey found 87.5% of participants strongly agreed/ agreed bi-monthly SB meetings improved communication between teams. One hundred percent of participants strongly agreed/agreed SB meetings improved care of burn patients requiring reconstructive surgery. 100% of participants strongly agreed/agreed SB meetings increase efficiency of burn referrals to the plastic surgery team. Participants ranked satisfaction of SB meetings on a scale of 1-5 with one being very dissatisfied & five being very satisfied, the average rank was four. SB has improved communication, coordination & efficiency of placing referrals. Survey results demonstrate participants support this patient care model. This patient review model can be utilized in other institutions to improve communication between service teams
Bridging the Divide: Bringing Research to Reality in Oncology Nursing Through Clinical Trials Liaison
No full textAs advancements in cancer research have accelerated, the demand for innovative treatment options through clinical trials has increased. However, many nurses and providers face challenges in understanding and adhering to these intricate protocols. Recognizing this, the Clinical Trials Office (CTO) and nursing department at an academic cancer institute identified the need for a dedicated position to facilitate clear communication between research and clinical operations. Consequently, the role of a Clinical Trials Liaison (CTL), who was also a trained oncology nurse, was established to bridge this divide
Prolonged saccadic latency in Huntington\u27s disease
No full textProlonged saccadic latency in Huntington\u27s diseas
Square wave jerks in cerebellar ataxia
No full textWhen frequent square wave jerks (SWJ) are noted on examination (especially in a patient of advanced age), the examiner should look for signs of Parkinsonism as well as cerebellar ataxia. Patients who have SWJ with ocular motor signs such as gaze-evoked nystagmus (seen in this video), saccadic smooth pursuit, downbeat nystagmus, and/or saccadic dysmetria are likely to have a cerebellar localization
Ocular flutter
No full textThis patient was diagnosed with a cerebellar pilocytic astrocytoma, and underwent surgical resection and radiation therapy. Oscillopsia developed, which was both horizontal and transient (due to ocular flutter) as well as vertical and constant (due to upbeat nystagmus). Although the flutter (back-to-back saccades) occurred spontaneously, it could also be triggered by convergence or following saccades. There was encephalomalacia of the caudal cerebellum and dorsal brainstem (dorsal medullary involvement would explain the upbeat nystagmus), although the origin of the ocular flutter was less clear, but presumably involving the saccadic pathways connecting inferior olive to contralateral dorsal vermis to ipsilateral fastigial nucleus to contralateral paramedian pontine reticular formation and excitatory (and inhibitory) burst neurons
Test Your Knowledge
No full textThis submission is a "Test your knowledge" case question crafted around a specific part of the Bony Anatomy of the skull. This question is centered around the anterior cranial fossae and a pathology associated with that specific part of the skull.OpenStax. "Figure 7.6: Cranial Fossae." Anatomy and Physiology. OpenStax, https://anatomytool.org/content/openstax-anatphys-fig76-cranial-fossae-english-labels. Licensed under CC BY 4.0.AnatomyTOO