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Implementing an Insomnia Assessment and Management Algorithm in a Rural Pirmary Care Clinic
Get PDFInsomnia is the most common sleep complaint and significantly impacts quality of life and productivity. The accumulated total of direct and indirect healthcare costs related to insomnia is estimated to be as high as $100 billion/year and is associated with an increased risk of cardiovascular and cerebrovascular disease. Primary care providers play a critical role in identifying and implementing early interventions to address insomnia. However, this can be time-consuming, and providers may be unaware of the latest treatment guidelines and available resources. This project provided a research-based algorithm to identify and initiate treatment for patients 18+ with chronic insomnia in a rural primary care clinic in central Illinois. The project was implemented starting with a CME provider presentation surrounding researched-based treatment guidelines for insomnia management. An Epic “smart phrase” was created to be utilized in provider notes to guide management. Additionally, patient/provider resources were developed to support the algorithm. A direct referral was facilitated to a clinical psychologist for CBTi for patients with chronic insomnia. There was a 15% increase in Sleep Medicine referrals from the previous year during the same time interval and four direct referrals for CBTi for patients with severe insomnia. Providers noted that they found the education meaningful and adapted recommendations to their practice. The project benefited both providers and patients by delivering safe and efficient care for the substantial number of patients who experience chronic insomnia
Procedural Sedation Training: Competency Verification Through Simulation
No full textA 450-bed tertiary hospital in Central Illinois lacked a standardized process for competency verification for procedural sedation care by registered nurses (RNs). Despite recommendations by many organizations, there are no consistent or standardized guidelines for verifying competency in nursing care of the procedural sedation. This project implemented a Procedural Sedation Training Course which comprised an in-person prelearning lecture, a group simulation learning experience, and an individual verification of competency through simulation.
Fifty-six RNs completed the Procedural Sedation Training Course and demonstrated competency through simulation, and 24 of these RNs completed a procedural sedation within the eight-month pilot period. Qualitative and quantitative data was collected from all 56 of the learners via the National League for Nursing Self-Confidence for Learning in Simulation (NLN) and the Simulation Learning Effectiveness Inventory (SLEI). Documentation compliance reports were reviewed to compare the procedural sedation documentation compliance for nursing-sensitive indicators of the pilot participants and all team member compliance. In addition, hospital safety event reports were reviewed for the pilot period.
RNs were able to effectively validate competence via simulation, and survey results demonstrated high self-confidence, learner satisfaction, and effectiveness in meeting learning objectives. Documentation compliance of study participants when compared with the general team showed consistent compliance rates with a less than 1% difference in any of the three nursing-sensitive indicators. Safety events reported during the pilot period indicated that RNs were able to successfully rescue sedation patients who experienced adverse events
Increasing OB/GYN Clinic Nursing Staff Knowledge and Comfort Level in Providing Breastfeeding Education
Get PDFThere are well known benefits of breastfeeding for both mother and child, yet the educational support from providers during prenatal visits is not consistent or well-documented. An educational presentation discussing guidelines of breastfeeding education, common breastfeeding problems and barriers to breastfeeding was developed and presented to a “Baby Friendly” hospital-based OB/GYN clinic staff at an urban St. Louis hospital. The goal was to increase staff knowledge and comfort providing education and resources surrounding breastfeeding to be used to increase discussion of breastfeeding during prenatal and postpartum visits. Evaluation of pre and posttest data showed an increase in knowledge regarding managing breastfeeding concerns and level of comfort providing education. The project succeeded in showing a need for increasing OB appointment time slots at implementation site to allow adequate time for breastfeeding education opportunities
Evaluating Nurse Comfort Levels Assessing for Depression in an Urban Hospital Setting
Get PDFEvidence shows that a fraction of nurses are uncomfortable assessing patients for depression. When depression assessments are uncomfortable for the clinician, there may be inconsistencies in practice which can negatively affect patient outcomes. An evidence-based survey was developed and distributed to nurses at an urban hospital in Missouri. The survey assessed nurse\u27s confidence, frequency of assessment, and understanding in evaluating patients for depression. Seventy-three nurses took part in the confidential survey. Thirty percent of the participants reported that they sometimes ask about mood and twenty-one percent reported that they rarely ask about mood. Although results showed that nurses were not comfortable assessing for depression, many of the nurses provided positive feedback on the need for future surveys to bring awareness to standards of care
Education for Healthcare Professionals on Protocol for Prostate Cancer Screenings on Inmates
Get PDFCancer is the leading cause of death for incarcerated individuals, prostate cancer awareness and screening guidelines are essential areas of focus for healthcare professionals (Puglisi et al., 2021). Prostate cancer screenings recommend that males between the age of 55-69 be informed of evidence-based guidelines and offered these screenings as a part of routine health maintenance (USPSTF, 2018). In 2019, the Illinois Department of Corrections (IDOC) was ordered to follow these guidelines for incarcerated individuals (Raba, 2021). As of 2021, the IDOC had yet to implement these screenings for incarcerated individuals within the state facilities. Two separate one-hour educational sessions regarding prostate cancer screening guidelines and recommendations were provided to staff members at a maximum-security prison in Southeastern Illinois. The project was quasi-experimental where participating staff completed pre-and post-education surveys. Out of the 16 participants, 12 pre- and post-surveys were received. The pre-and post-educational survey results indicated that the educational session was sufficient in explaining the positive outcomes of early detection of prostate cancer screenings. The overall goal of the project was to provide education surrounding prostate screening protocols for male inmates and reinforce the importance of aligning with the state legislature. In the future, education could be extended to other facilities within the Illinois Department of Corrections
Pneumococcal and Influenza Vaccine Co-Administration in the Incarcerated Population
Get PDFBackground/Significance: Streptococcus pneumoniae is responsible for 20-60% of U.S. bacterial pneumonia cases and has a mortality rate of 10-30%. Invasive pneumococcal disease (IPD) occurs when streptococcus pneumoniae invades otherwise sterile sites. Adherence to immunization guidelines is 60-70% effective at preventing IPD. Co-administration of pneumococcal and influenza vaccines has shown promise at increasing uptake of the pneumococcal vaccine and enhancing immunological response. Population/Setting: A state-run Department of Corrections (DOC) clinic system serving just over 30,000 individuals was the site for this project. Incarcerated individuals present an increased risk of contracting pneumococcal disease due to close living quarters. Other risk factors such as airway disease, immunocompromise, and smoking also compound the disease burden in this vulnerable population. Intervention: To increase pneumococcal vaccine uptake, co-administration of influenza and pneumococcal vaccines was offered during influenza clinics. A video update on the pneumococcal immunization guidelines was shared with staff. Clinic participants were educated with updated infographics in English and Spanish about their eligibility for vaccination and the risk of harm from IPD. Participation was voluntary. Results: The percentage of DOC participants vaccinated against pneumococcal disease increased from 43% (n=500) to 45% (n=523) of those \u3e=65 years of age and those ever offered the vaccine increased from 48% (n=558) to 54% (n=651) during the study period. Comparing pre-and-post survey data, improvements were observed in the percentage of DOC staff stating they feel confident recommending pneumococcal vaccines (8.8% increase) and stating they are knowledgeable about the 2021 updates to the ACIP guidelines (28% increase)
Implementation of a Prediabetes Class in the Primary Care Setting
Get PDFPrediabetes and type 2 diabetes are prominent health concerns with prediabetes progressing to type 2 diabetes if left untreated. This progression and the serious health complications caused by both can be minimized or eliminated if moderate lifestyle interventions are implemented early. Providing an educational intervention can target modifiable risk factors such as weight loss, diet, physical activity, and smoking cessation. While it is ideal for this education to start with the primary care provider, this in-depth information cannot be realistically taught during routine primary care appointments. Nurses play a fundamental role in educating patients. A nurse-led prediabetes class and handouts were developed and implemented in both rural and urban clinics within the same healthcare system in Southern Illinois to address diabetes progression in this population. Eighteen classes were offered over five months with thirty-three class participants. Participants reported the class was beneficial and motivated them to make changes to improve their health. Fifteen participants answered a follow-up questionnaire three months post-intervention. Positive efforts to adopt lifestyle modifications discussed during the class were demonstrated. Areas for future research include other options for content delivery and timeframes
Equipping Home Visiting Staff for High PHQ-9 Scores in the Home
No full textPostpartum depression can have a detrimental effect on a mother\u27s functional capacity, thereby impeding her ability to care for herself and her children and resulting in negative consequences. The PHQ-9 is an evidence-based screening and diagnostic tool for depression. Outcomes of women with postpartum depression are impacted due to inadequate screening, and evidence suggests that screening is only completed 40% of the time. This project was conducted within a home visiting program for mothers and infants within a vulnerable population in Central Illinois over four months. Nurses were given a QR code with mental health resources that would help patients who scored high on the PHQ-9 questionnaire. The primary goal of this initiative was to provide timely and appropriate mental health services to those in need and to enhance nurses\u27 comfort level in discussing mental health. The project results indicated that resources being readily available contributed to positive patient outcomes. Improving access to resources, such as counseling and medication, can positively impact the prognosis of mothers with depression
Hepatitis C Management for Individuals in Custody
Get PDFThe hepatitis C virus (HCV) is a pathogen that spreads through blood and causes hepatitis C disease, a liver infection. Early infection symptoms are rare, making it a silent killer. HCV, the chronic liver disease accounts for half of all hepatocellular carcinoma cases and is the leading cause of liver transplantation in the US. This quality improvement project aimed to create an educational toolkit for the Department of Correction staff working with individuals in custody refusing HCV treatment. The education tools comprised an infographic flyer (English and Spanish) to teach individuals in custody about HCV treatment and a PowerPoint presentation to educate staff who work with this population on how to deal with HCV treatment refusals. The total number of nurses who participated in the intervention was 15, and 100% of them completed the post-survey. Statistical analysis showed that 86.6% of the participants (n=13) strongly agreed that the presentation provided a clear understanding of risks associated with incarceration and HCV, including the impact of untreated HCV. Participants were asked to score their confidence level to assess the effect of the presentation based on the knowledge received; 73.3% of the participants (n=11) felt confident in their knowledge of strategies to address HCV treatment refusals in this population, although only 46.6% (n=7) reported they would be making changes to their current practices as a result of the presentation
Improvement in Patient Compliance for Gynecological Care
Get PDFThis quality improvement project implemented the patient-initiated follow-up (PIFU) pathway in a gynecology clinic setting. PIFU has potential to lead to decreased no-show appointments and increased patient autonomy in outpatient healthcare practices. Barriers that influence compliance with plans of care include lower socioeconomic status, racial and ethnic minorities, and unmet social needs such as food insecurity, healthcare travel and cost, and child/adult care needs. In addition to higher rates of no-show appointments, individuals facing these barriers have increased comorbidities. Prior to implementing the PIFU model, patients between the ages of 18 and 42 completed a patient satisfaction survey to better understand potential barriers resulting in no-show appointments. Based on their answers, the providers selected specific health conditions that would be appropriate to offer PIFU. 11 patients out of 36 that met the criteria for the intervention were offered the option of PIFU or continuing with fixed follow-up provided by the office. All 11 requested to remain in fixed follow-up but appreciated the option of increased autonomy with PIFU. Limitations included lack of electronic medical records and providers’ lack of confidence that patients would follow through with scheduling autonomously. This PIFU model could be implemented in the future in gynecology, primary care, or other specialty offices to aid in the reduction of no-show appointments