LAIR: Lenoir-Rhyne Academic Institutional Repository
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198 research outputs found
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Developing a Multifaceted Fall Prevention Strategy in the Emergency Department
Get PDFAbstract Despite systemwide efforts to reduce patient falls, this problem continues to be a significant patient safety concern in the emergency department. The ED is a high acuity, fast-paced, crowded and unpredictable environment making fall prevention a challenging task (Stoeckle et.al., 2019). This unique healthcare environment requires interventions tailored to meet the specific needs of an ED (Townsend et.al., 2016). The goal of this quality improvement project was to determine if a multifactorial fall prevention program tailored to the unique emergency department environment will decrease the total number of adult patient falls. The primary outcome of this quality improvement project was to reduce the total number of patient falls. After performing retrospective root cause analysis and data review, a multifaceted fall prevention strategy was created and implemented in a large, tertiary emergency department. Initial results did not reveal an overall decrease in the total number of falls or fall rate in the emergency department. However, vital information was gained about significant barriers and gaps to fall prevention. This has been a catalyst to unit and system wide changes in fall prevention measures. Keywords: falls, prevention, risk, emergency department, quality improvemen
Developing an ED Discharge Team to Incorporate the Re-Engineered Discharge (RED) Toolkit in a Rural Emergency Department
Get PDFBackground: The 72-hour return rate represents an important quality indicator and benchmark for Emergency Department (ED) care to determine if high quality and safe care is being delivered at a particular facility. The RED toolkit was created by Boston Medical University to aide in improving the discharge process and reducing hospital readmission rates and ED return rates (Adams et al, 2014). This quality improvement project utilized the RED components 2 and 11 from the RED toolkit and the project is referred to as Project Red. Component 2 is aimed at securing post-discharge follow-up appointments and Component 11 is aimed at transmission of discharge summaries to the PCP seen for follow-up. Objective: The primary goal of this quality improvement (QI) project was to establish an ED discharge team in order to improve the discharge process for patients meeting Emergency Severity Index (ESI) Level 3 criteria. The secondary outcome measure of this QI project was to preschedule post-discharge follow-up appointments with the PCP within the recommended time frame in an effort to reduce the 72-hour return rate. Methods: While the goal of this project was reduction in 72-hour return rates, the target population was the ED nursing staff and the ED administrative personnel. Patients meeting the project criteria were tracked by the principal investigator (PI) through the electronic medical record (EMR) with a concurrent log of staff compliance with the Project Red guidelines regarding recommended time frame of follow-up and if the appointment with the PCP was completed. Comparison of pre- and post-implementation of 72-hour return rates were measured. Results: Analysis of utilization of the Project Red guidelines showed 80.95% of patients received an appointment to follow-up with a PCP within the recommended time frame. Project RED had a positive effect on the 72-hour return rate. While 19 participants were identified and participated in Project RED, 82 patients were found to meet qualifications but were not identified by the ED staff resulting in a 7.3% 72-hour return rate for those 82 patients, while the 19 who were identified had a zero percent 72-hour return rate. Conclusion: The target population of the QI project was the ED nursing staff and the ED administrative personnel. The project had 95% participation of the nursing staff and 100% participation of the administrative personnel. This QI project proved to have a positive impact on the follow-up of patients with an ESI Level 3 classification. The secondary outcome of decreasing the 72-hour return rate was met as none of the Project RED participants returned and 7.3% of the patients who qualified but did not participate returned during the intervention period. Keywords: 72- hour return rate, emergency department, quality improvement, RED Toolki
mHealth Strategy for Adult Primary Care Weight Management
Get PDFObesity contributes to higher healthcare costs and risk for disease. Obesity management is labor and resource intensive in the primary care setting, requiring patient education, reeducation, and frequent clinician assessment for comorbidities. Mobile health (mHealth) applications allow behavioral modification, though evidence suggests few applications (apps) on e-commerce platforms are grounded in theory or sustainable lifestyle change. Smartphone technologies are widely available, accepted by the public, and can encourage equitable care delivery. This quality improvement (QI) project created an online system for primary care providers (PCP) to offer adult females seeking clinically assisted weight management at a women's primary care clinic. The PCP performed the initial patient evaluation for weight management and offered the system's brochure with detailed instructions for viewing the system's quick response codes (QR codes) linked to online materials via a personal smartphone or tablet. A post-intervention questionnaire was thematically coded and assessed by context analysis to determine the impacts of a mHealth program on streamlining care delivery. The program had modest utilization but was received favorably by the provider, staff, and patients
Global Initiative of Chronic Obstructive Lung Disease: Primary Care Integration
Get PDFProblem: COPD is a public health challenge and accounts for significant morbidity and
mortality worldwide. Management of COPD in primary care is inconsistent and known factors
are inconsistent use of COPD terminology, lack of standard diagnostic measurements, and poor
patient assessment. Practice guidelines are updated annually based on the current evidence based
(EB) research. However, only 25% of providers report adhering to guidelines.
Intervention: A COPD template was developed with 3 major components of EB guidelines and
implemented in a primary care setting (PCS).
Methods: Descriptive statistics evaluated the percent of tool usage and intervention adherence
by the provider, and assessed population demographics. Secondary outcomes were measured by
chi-square analysis to evaluate for a correlation between the number of pharmacological
treatment that met GOLD recommendations and if pharmacological treatment could be changed
based on symptom assessment and exacerbation history.
Findings: The COPD tool was successfully implemented in a PCS at 100%. There was an
association between current medications that met GOLD recommendations and if medications
could be changed.
Conclusion: This quality improvement project provided a simple process using GOLD
recommendations for COPD management in the PCS. The project is sustainable due to its simple
assessment process
Psychology & Behavioral Sciences Collection
Get PDFPsychology & Behavioral Sciences Collection is a primarily full text journal database published by EBSCO Publishing Inc. for use
by mental health practitioners, behavioral science researchers, and students at the undergraduate and graduate levels. Holdings include nearly 600 titles of which the vast majority are peer-reviewed and/or full-text. This database is touted for offering 290 full-text journals which are indexed in APA PsycInfo and which have the capability of being linked to results in PsycInfo for subscribing institutions. The EBSCOhost platform is intuitive and user-friendly with a variety of authentication methods and compatible browsers. In comparison to such competitive products as APA PsycArticles and ProQuest Psy chology Database, Psychology & Behavioral Sciences Collection of fers sufficient unique content and number of full-text journals indexed in PsycInfo to justify its purchase either in addition to these products or as a standalone database. All three products are cross-searchable
with PsycInfo with a subscription. Those institutions seeking more extensive historical content, greater depth of coverage of a range of subjects in the behavioral sciences, access to APA published journals or the specialized Thesaurus of Psychologist Index Terms, or who prefer the ProQuest or APA PsycNet platform may consider PsycAr ticles and/or Psychology Database as alternative subscription options
The effects of positive reinforcement on participation of pediatric clients receiving occupational therapy
No full textOccupational therapy has been one of the main factors in helping children with Cerebral Palsy and patients with many other disorders and setbacks to live their fullest potential in life. Since therapy is a major influence on the lives of these people, it was hypothesized that having an increased level of motivation from positive reinforcement will have positive outcomes on patient’s participation levels. To collect this data, researchers put a survey on social media for occupational therapists. There were 4 questions. 2 of them pertained to verbal positive reinforcement and the other 2 pertained to physical positive reinforcement. When all data was received, a 2-tailed t-test of sample means assuming unequal variance with 95% confidence was performed to evaluate the outcome difference between verbal and physical positive reinforcement. There was no statistically significant difference between verbal and physical positive reinforcement (p=0.717). The data found that 100% of participants used verbal positive reinforcement 76-100% of the time and found that it slightly or significantly improved outcomes in patients. Physical positive reinforcement is not used as much, however, when it is used, research shows that it also slightly or significantly improves the outcomes of patients. The hypothesis could not be denied from the data received in this study
VAPE: A Program Designed to Screen and Educate Pediatric Patients about Electronic Cigarettes
Get PDFThe purpose of this project was to determine if a quality improvement (QI) project, known as the Vaping Assessment and Provider Education (VAPE) program, could improve assessment and education about vaping in the pediatric population. The QI project involved using a vaping screening tool at every well-child visit for patients 11-18 years old. To examine providers’ views on vaping and the effectiveness of the screening tool, they were also interviewed. A retrospective chart review was done before VAPE was introduced to determine the number of children ages 11-18 years who were assessed for and educated about vaping. Providers were educated about short- and long-term health effects, and how to use the screening tool. The tool was implemented at each well-child visit among those who met the criteria. Following implementation of the tool, providers were interviewed. The primary outcome was for providers to utilize a system-wide screening tool to identify the risk behavior (vaping in children ages 11-18). The secondary outcomes were to increase the number of children assessed for vaping, increase the number of children educated about vaping, and use content analysis to analyze providers’ views on the tool and vaping. The QI project resulted in a statistically significant increase in the number of children assessed for vaping, as well as those educated about e-cigarettes and their harmful effects
Evaluating the Impacts of COVID-19 Stay at Home Orders on the Physical, Mental, and Social Wellbeing in Participants in YMCA SilverSneakers Programming
Get PDFMaster of Public Health Capstone ProjectNorth Carolina Executive Orders placed in March 2020 encouraged families and individuals to stay in their homes and to only leave their homes to perform essential services for survival and work. This Executive Order prohibited the operation of any businesses, organizations, or other establishments to which people may travel or congregate. The increased risk of complications due to COVID-19 infections for those that are age 60 and older lead to most shelter-in-place orders in U.S. states to be longer and more critical for this population which may have increased feelings of isolation The purpose of this study is to determine the
effects of COVID-19 shelter in place orders on the physical activity, mental, emotional, and social well-being of adults ages 60 and older. The study will determine the lifestyle changes that occurred as the result of shelter-in-place orders and how they influenced the daily lives of YMCA members that participate in SilverSneakers programmin
Electronic Health Record Template Improves Quality and Delivery of Healthcare for Patients with Type 2 Diabetes
Get PDFThe goal of this project was to determine if a primary care-based quality improvement project could enhance provider documentation reflecting national guidelines of care through the use of a charting template and improve quality of care through identification of appropriate community resources for patients with Type 2 Diabetes Mellitus (T2DM). Objective: The primary outcome measure was increased documentation of key aspects of T2DM care management using the charting template. The secondary outcome measure was the utilization of community resources to aid in patient care management. Methods: This project was a 3-month prospective, mixed-method, quality improvement study that provided a charting template to increase charting of care management for patients with Type 2 Diabetes Mellitus. Results: Participants in the study demonstrated significant improvement in documentation of necessary national standards of care management for patients with Type 2 Diabetes with the use of the charting template during the 3-month implementation period. Conclusions: Full utilization of the electronic health record to streamline care and increase provider compliance with charting is possible through the creation of charting templates for patients with T2DM. Implications for Nursing: Gaps in care of patients with T2DM can be filled through provider utilization of templates within EHR formulated based on national standards of care
Bringing the Clinic Home Through Technology: A Quality Improvement Project
Get PDFBackground: According to the Centers for Disease Control (2019), childhood obesity affects more than 13.7 million children in the United States. Childhood obesity can lead to chronic illness and early mortality. Unfortunately, current treatment plans for childhood obesity have been unsuccessful. This quality improvement project aims to determine whether the use of technology, specifically online website modules, can improve outcomes and the quality of care for patients attending a specialty clinic for childhood obesity.
Methods: A prospective designed mixed-method study was performed in a pediatric clinic specializing in treating pediatric patients who were overweight and obese. The primary investigator created evidence-based, interventional online modules for patients to access outside of clinic hours. The measured outcomes were module views, caregiver satisfaction with the online modules, provider adherence to electronic health record documentation and their satisfaction with online modules. Module views were tracked through Google Analytics. Questionnaires were dispersed after the implementation to gage provider and caregiver satisfaction with the clinic. A retrospective chart review was performed to track provider compliance with the electronic health record for quality measures.
Results: There was insufficient participation in the quality improvement project; thus, no significant data results are reportable.
Conclusion: The aim was to improve compliance and attrition at a pediatric weight management clinic. The quality improvement project was unsuccessful for several reasons. Further recommendations include performing a similar project after a global pandemic, increase availability of internet resources, and an increase in education of how to utilize technology for providers