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Benchmark Study of Early Palliative Care in End-Stage Liver Disease
Get PDFPatients with ESLD in general have high rates of healthcare utilization, resulting in more than 250,000 hospitalizations at $9.8 billion annually in the United States (Ufere et al., 2019). Liver disease is a rising cause of death worldwide, affecting younger people, but palliative care is largely absent for these patients (Kimball et al. 2018). Early readmissions are common for patients with ESLD and in the U.S. alone, over 25% of patients are readmitted within 30 days of their initial diagnosis, rates that now exceed those seen for patients with CHF and COPD (Ufere et al. 2019). Evidence shows that early palliative intervention in severe chronic illness has been successful in decreasing readmission rates with effective outpatient symptom burden management. The Hospital Readmissions Reduction Policy (HRRP) aims to reduce unnecessary hospital readmissions by improving care coordination, and healthcare communication and improving patient and caregiver engagement in discharge planning (Hospital Readmissions Reduction Program (HRRP) Archives | CMS, n.d.). Reducing hospital readmission rates is an important health policy goal and as we know, Medicare payments are tied directly to hospital quality of care as evidenced by readmissions within 30 days. Studies show that the implementation of a nurse-driven palliative care program early in the ESLD diagnosis was effective in improving care coordination, anticipatory care planning, and quality of life for people with advanced liver disease and their caregivers. Coordination of care between hepatology and palliative care can greatly improve quality of life and decrease unnecessary hospital readmissions by proactively addressing the outpatient symptom burden of patients and caregivers by utilizing effective communication, education, and collaborative care planning and treatment (Kimball et al, 2018)
America Heart Association Guidelines on Telemetry Monitoring to Reduce Alarm Fatigue and Improve Patient Outcomes
Get PDFThe excessive use of telemetry monitoring in healthcare has become a widespread concern, leading to increased healthcare costs and alarm fatigue among providers. These issues threaten patient safety and negatively impact patient outcomes. To address these issues, the American Heart Association (AHA) has published guidelines for telemetry monitoring to reduce alarm fatigue and improve patient outcomes.
A three-month benchmark project was conducted using evidence-based methods to implement the AHA guidelines for telemetry monitoring in a medical-surgical unit. The project aimed to serve as a model for others with similar issues. By following the AHA guidelines, patient safety can be enhanced, traditional clinical methods can be improved, and costs can be reduced.
The project reviewed the literature supporting the AHA guidelines for telemetry monitoring and outlined the implementation plan, including evaluation and cost/benefit analysis. The results demonstrated the positive impact of aligning with AHA guidelines in reducing unnecessary telemetry monitoring and alarm fatigue in clinicians and improving patient outcomes.
The AHA guidelines provide recommendations for appropriate telemetry use, including limiting its use to patients who meet specific clinical criteria, educating staff on the proper use of telemetry, and implementing an alarm management protocol. By following these guidelines, healthcare facilities can enhance patient safety, reduce alarm fatigue, lower costs, and ensure quality care.
In conclusion, healthcare facilities should adopt AHA guidelines for telemetry monitoring to address the widespread concerns of excessive telemetry use, alarm fatigue, and negative impact on patient outcomes. The implementation of evidence-based methods can improve patient care, reduce healthcare costs, and enhance traditional clinical methods. This benchmark project serves as a model for others with similar issues and highlights the importance of aligning with AHA guidelines for telemetry monitoring
Patient-Defined Plan of Care Goals to Increase Patient Satisfaction and Communication: A Benchmark Study
Get PDFOver the last two decades, patient-centered care has been identified as a core principle for healthcare (McKeown et al., 2023). Patient-centered care has been shown to reduce overall healthcare costs, improve patient outcomes, and increase patient satisfaction (Figueroa et al., 2016; Köberich et al., 2016; McKeown et al., 2023; Araki, 2019; Morgan & Yoder, 2012). Although patient-centered care is universally recognized as an essential aspect of healthcare, there is no universally defined definition of it or how to implement it (Rassouli, et al., 2020).
Studies have shown that most patients, if given the opportunity, overwhelmingly want to be involved in their daily plan of care decisions (Araki, 2019; Jerofke-Owen & Bull, 2018; Morgan & Yoder, 2012). Some patients may be too sick to participate in the plan of care choices, while others may be unwilling to do so (Castellà‐Creus et al., 2019; Jerofke-Owen & Bull, 2018).
This benchmark study will provide simple, concrete steps to improve patient-centered care in inpatient hospital units. It will facilitate communication between patients and staff and empower them to partner in their care. Instead of broadly discussing patient-centered care, this project will provide specific steps to help nurses better include patient-centered care objectives as part of the daily plan of care formulation
The Importance of Family Presence at the Bedside of Critically Ill Patients
Get PDFThe purpose of this paper is to discuss the visitor restrictions on patients and their families during the COVID-19 pandemic. At the beginning of the pandemic, visitation was highly restricted with only telecommunication as a means of “visiting” with your loved one who were hospitalized, especially in the ICU settings. During my research of keeper studies for my capstone project, the articles discussed different forms of communication. The articles discussed interventions such as electronic (e-visits) for physician offices and diaries kept in the ICU for communication between family and staff. Some discussed the effects of visitor restrictions and how it related to the care, grieving process, and dying process on the family members as well as the patients and healthcare workers. The design methods varied from systemic reviews, randomized control trials, and qualitative studies. The results from almost all of these studies did show that there is much more needed research to be done
CEREBRAL VASOMOTOR REACTIVITY TO ASSESS BRAIN DYSREGULATION IN POST COVID NEUROLOGICAL SYNDROME
Get PDFBackground: COVID-19 has wide-ranging physiological effects, with many patients complaining of persistent asthenia following recovery from the acute phase of the infection. The frequent term for this is Long Haul COVID (LHC). While we have tools to measure effects on general physiology in human subjects, a metric for cerebral dysregulation is lacking. Cerebral blood flow (CBF) is closely regulated in the healthy young person. Dysregulation has been well described in many conditions, including Posterior Reversible Encephalopathy Syndrome (PRES), and is associated with neurological deficits. Cerebral Vasomotor Reactivity was used as a tool to assess this dysregulation.
Methods: Transcranial Doppler (TCD) study for CVR was performed under the influence of Carbogen gas. A questionnaire collected prior to the procedure provided additional details on subjects demographics and COVID history. Cases and controls were recruited using self-reported questionnaire. Statistics involved assessing the reproducibility of the test as well as discovering differences between cases and control groups.
Results: CVR was assessed for 26 subjects. CBF velocity in the left MCA was analyzed at baseline, at peak Carbogen exposure, and in hypercapnic phase. The reproducibility of the test was established within the longitudinal repeated measures data. The cases and control groups were insignificant in difference at base level but significant when controlled for confounders. CVR was found to increase by 3.76 units in cases compared to controls. Confounders like BMI, gender and age was found significantly different between cases and controls. Number of COVID episodes and symptom severity was significant for CVR.
Conclusion: This simple bedside test was found to be to be effective in producing a reactivity among all the subjects and was homogenous in its effect irrespective of baseline subject differences. As a preliminary test, the test showed differences among cases and control groups. The sample for the test lacked sufficient power and observations. A bigger sample size and a subsequent longitudinal follow up may help better understand the use of CVR to screen high-risk population for cerebrovascular anomalies
Teacher Efficacy and Intentionally Designed Learning Spaces
Get PDFIn 2022, the state department released new standards and a competency-based education curriculum. Simultaneously the Toledo Creek School District has experienced an unprecedent shift in the student population demographics. The shift has resulted in two distinct zones, east and west, with income averages on the two extremes of the income spectrum. Given the shift in both the curriculum and demographics, the superintendent in consultation with stakeholders decided to implement project-based learning (PBL) as the district’s instructional model. PBL has a significant research-based supporting implement for authentic learning as intended by the new standards and better supporting deeper learning among all students. One barrier to implementation is the existence of aging facilities. The poor quality of the facilities has caused tension among the district’s stakeholders. This case study aims to promote an understanding of issues related to school facilities, and bond and facilities planning for the intentional design and purposeful use of learning spaces aligned with a constructivist instructional model, in this case PBL. How can conflicting views be leveraged to engage stakeholders in productive discourse about school facilities that results in the equitable use of financial and physical resources
STRATEGIES FOR PREVENTING SURGICAL SITE INFECTIONS
Get PDFPost-surgical site infection has continued to remain a significant public health concern. Amid the prominent hospital-acquired infection, surgical site infections contributed to a considerable rate of death, severe morbidity, increased cost of therapy, disability, prolonged hospital stay, higher insurance payment, complications in patient healing, an increase in healthcare cost as well as treatment expenses (Allaf & Navyashree, 2022). Although seemingly relatively low in occurrence, about 10% of the infections are related to healthcare-associated infections. (Allaf & Navyashree, 2022). Knee reconstructive procedures are most common among older patients, who have a higher risk of developing complications.
The current practice of scrubbing the morning prior to surgery seems not to be the best practice. In order to prevent a post-surgical site infection, training staff on the prevention of surgical site infection involves educating them on the best practices for infection control, including proper hand hygiene, surgical site preparation, and the use of sterile techniques. Staff members must also be trained in the proper use of personal protective equipment such as gloves, masks, and gowns, as well as the proper disposal of contaminated materials. Effective training programs should be comprehensive and ongoing, covering all aspects of infection prevention and control. Training should be provided to all staff members involved in the surgical process, including surgeons, nurses, anesthesiologists, and other support staff. Therefore, it is recommended that a pre-surgical wash be performed the night before the procedure and the day of the procedure could lower the risk of surgical site infection as well as other surgical site infection prevention which could include antimicrobial prophylaxis like cefotaxime, ceftriaxone, and amikacin (Allaf & Navyashree, 2022)
Technology-Mediated Diabetes Prevention Program (DPP) Benchmark Project
Get PDFThis benchmark project intends to broaden access to the Diabetes Prevention Program (DPP) by offering technology-mediated content at the primary care level because the Primary Care Physician (PCP) predominantly diagnoses prediabetes due to the recommendation by The U.S. Preventive Services Task Force (USPSTF) that nonpregnant overweight or obese adults aged 35 to 70 be screened for prediabetes and type 2 diabetes (Davidson et al., 2021). Thus, the primary care setting is the first opportunity to impact the conversion from prediabetes to type 2 diabetes. Of the 84 million people in the United States (U.S.) with prediabetes, they are estimated to convert to type 2 diabetes at a rate of 5-10% per year (Almeida et al., 2020). The PICOT question guiding this benchmark project is as follows: In prediabetics (P), how does participating in a technology-mediated Diabetes Prevention Program (DPP) and implementing lifestyle interventions in the future (I) compared to not attending DPP and implementing lifestyle interventions (C) affect the development of type 2 diabetes (O) over one-year (T)? This benchmark project intends to delay or prevent prediabetics from progressing to type 2 diabetes in the future due to the burden and cost type 2 diabetes places on the healthcare system. This will be accomplished by a PCP practice partnering with a technology-mediated DPP to engage and enroll their prediabetic patients in DPP. Traditional in-person DPP is one-year in length with the first 6 months consisting of weekly 1-hour group classes and the latter 6 months consisting of monthly 1-hour group classes. Though the CDC-recognized National DPP has demonstrated over 50% risk reduction in progression to type 2 diabetes, its attendance has been underwhelming due to the rigorous schedule of traditional in-person classes. The technology-mediated DPP is much easier for participants to access and engage in during their own time without having to go somewhere for weekly/monthly in-person classes. Its potential for large scalability and dissemination should appeal to PCPs aiming to decrease incident type 2 diabetes among a prediabetic population
Targeted Temperature Management Following Cardiac Arrest
Get PDFCardiac arrest is often associated with the death of brain tissue resulting from the lack of oxygen supply caused by the interruption of blood circulation. For this reason, good neurological outcome following cardiac arrest is difficult to achieve. Targeted temperature management, formerly known as therapeutic hypothermia, is the maintenance of specific body temperature parameters after the return of spontaneous circulation (ROSC) following cardiac arrest (Donnino et al., 2015). The goal of therapy is to improve neurological status and facilitate healing by reducing the metabolic requirement of the brain. (Saigal et al., 2015). Therefore, the question arose, in adult patients who remain comatose following a non-traumatic cardiac arrest (P), how does implementation of targeted temperature management (I) compared to normal core temperature (C) affect neurologically intact discharge rates (O) during a three-month period (T)? A benchmark project was completed to address this topic
ALZHEIMERS DISEASE STAGES ARE CLASSIFIED BASED ON BIOMARKERS FOUND IN CEREBROSPINAL FLUID USING MACHINE LEARNING CLASSIFIERS
Get PDFThe inability of the current techniques to identify patients in the preclinical stage of Alzheimer\u27s disease, which can persist up to ten years before clinical symptoms appear, makes early detection of the condition difficult. Several studies have shown the potential of the cerebrospinal fluid biomarkers amyloid beta 1-42, T-tau, and P-tau in the early stages of Alzheimer\u27s disease. Based on the levels of these cerebrospinal fluid biomarkers, we employed machine learning models in this study to categorize various phases of Alzheimer\u27s disease. The National Alzheimer\u27s Coordination Centre database of 537 patients\u27 electronic health records was examined, and the patients were separated into groups based on their mini-mental state scores and cognitive dementia ratings. To find significant differences between the Alzheimer\u27s stages, statistical and correlation studies were conducted. Then, to categorize the stages of Alzheimer\u27s disease, machine learning classifiers such as KNearest Neighbor, Ensemble Boosted Tree, Support Vector Machine, Logistic Regression, and Naive Byes classifiers were used. According to the results, Ensemble Boosted Tree has the highest accuracy for binary classification, while Ensemble Bagged Tree offers superior accuracy for multiclassification. The results of this study should assist doctors in making an informed choice regarding the early diagnosis of Alzheimer\u27s disease based solely on cerebrospinal fluid biomarkers, monitoring the illness\u27s course, and putting the right intervention measures in place