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Road to Recovery for Craniotomy patients
Get PDFComplications from craniotomy surgery can range from 8-33%, leading to prolonged hospital stays, increased costs, increased risks for complications, and decreased satisfaction. An extensive literature was conducted highlighting Enhanced Recovery After Surgery (ERAS) protocol enhances patient outcomes by emphasizing education, early mobilization, pain management, and proper medication use before surgery. This quality improvement project focused on implementing preoperative and postoperative education in a tertiary hospital outpatient setting targeting adults undergoing craniotomy surgery. The process was implemented by a preoperative checklist and education materials to aid in educating patients on ERAS protocol to decrease the length of stay and increase patient education on their recovery. The 20 patients who were given the preoperative ERAS education pamphlets were also given an evaluation of the pamphlet, indicating an average score of greater than 90% were satisfied and indicated that the education aided in their recovery. Results found that the previous length of stay averaged 3.6 days before implementation, and recent results of 2.8 days were based on metrics obtained from the Epic system. The limitations acknowledged included a small sample size and short implementation and retrieval of information. However, the results indicated an overall decrease in length of stay and satisfactory results indicating that patient education helped aid their recovery. The project discusses the critical role of ERAS principles in patient education to help reduce hospital stays and improve patient satisfaction
A Modified DBT-Informed Art Therapy Group Curriculum with a Focus on Neurodiversity Acceptance
Get PDFHistorically, therapy methods made to support neurodivergent individuals have been focused on reducing “challenge behaviors” and modifying behavior to societal standards. Simultaneously, many behavior modification therapies neglect the emotional well-being of the individual. As neurodiversity grows to be accepted as an aspect of diversity, so too must therapy methods change to promote skill building in line with the cultural values and strengths of neurodivergent individuals and promote social-emotional well-being. This group therapy curriculum poses as one such possibility to this change by utilizing DBT and Art Therapy in a group psychoeducation format
Improving Depression Remission Screening Compliance
Get PDFDepressive disorders are widespread in the United States and are diagnosed and treated in the primary care setting. In 2019, there were an estimated 19.4 million adults that had at least one major depressive episode. The purpose of this project was to improve follow up and depression remission assessment for patients with a diagnosis of depression at a metropolitan family care practice clinic. The Patient Health Questionnaire (PHQ–9) was utilized for remission assessment. Front desk staff and providers were trained and granted access to the quality information system (QIS) in the electronic medical records (EMR) system which allowed easy identification of patients with depression due for depression remission screening. A gap report from May 2022 indicated a total of 15 patients due for remission screening and only 9 receiving it; a compliance rate of 60%. During implementation, a total of 27 patients were due for depression remission screening and of these patients 24 were screened ,thus improving the compliance percentage to 88%, an improvement of 28% from baseline. Training support staff on how to identify patients with depression due for remission screening though the QIS and having them distribute the PHQ-9 at appointment check in helped increase compliance. Making sure patients with depression have proper assessment and follow up is imperative due to the high levels of impairment in occupational, social, and physical functioning.
Keywords: depression remission screening, depression screening tools, depression screening compliance, depression remission screening in primary care, depression screening compliance in primary car
Advance Care Planning in Primary Care
Get PDFAdvance care planning (ACP) is the process of preemptively making choices regarding medical preferences for end-of-life care, while still having decision-making capacity. Many patients don’t have an advanced directive (AD), or documentation of these decisions. This planning improves the individual’s perception of quality of life, a good death, and autonomy over their healthcare. The discussion regarding ACP can take place in primary care at wellness visits for patients over 18 years old, while healthy and able to discuss their wishes with a trusted medical provider. Providers have tools to aid patients in completing AD; however, barriers include lack of knowledge, inexperience with the requirements of AD documentation, and lack of accountability. This project encouraged providers to engage in a continuing AD education resource provided by the Centers for Disease Control’s Health Aging Program at a Midwest family practice clinic. Questionnaires were given to the patients of the participating provider to evaluate their preexisting knowledge of ACP. If interested, more information was given to the patients by the provider. Out of the 53 patients surveyed in a 6-week time, 21% of the patients surveyed had an AD, and 54% elected for additional education regarding ACP
Implementing an EMR System in a Small Psychiatric Practice
Get PDFElectronic medical records (EMRs) can aid in improving surveillance, monitoring, adherence to practice guidelines, improving communication, and reducing medical errors. The adoption of EMRs in psychiatry and mental health settings has been slow despite the offered benefits. This project aimed to develop an implementation and training plan to successfully transition from paper charts to EMRs in a psychiatry practice. An extensive literature review was conducted on the adoption of EMRs in mental health settings, and a guideline for implementation was created to overcome identified barriers. Implementation guidelines included a planning phase, staff training plan, and rollout using a phase-in approach. The planning phase consisted of assessing the staff\u27s awareness and understanding, organizational needs, and training needs to minimize errors. The staff training plan was created based on the user skills assessment and practice needs to support workflow procedures to be done as intended. The phase-in rollout approach was selected to allow for a more focused area of implementation and reduce strain on the support time. A recovery plan was developed for system failure or power outages. Successful EMR implementation in mental health settings requires a proper implementation plan. Pre-implementation testing was conducted to minimize errors before go-live. Post-implementation feedback was collected and used to continue to improve workflows, efficiency, and user satisfaction. The clinic continues making improvements to increase acceptance and adoption of the EMR
Short Term Medical Mission GERD and Ulcer Treatment Guideline
Get PDFThe United States conducts over 6,000 international medical mission trips each year. The short-term nature of these trips, unfamiliarity with the patient population, language barriers, limited resources, and inadequate staff training are just some of the factors that make it challenging to provide quality care. One way to avoid doing harm is to follow evidence-based guidelines when treating common conditions. This quality improvement project sought to provide an evidence-based protocol for short-term medical missions (STMMs), guiding providers and pharmacy staff on the treatment of GERD and peptic ulcer. This project was implemented in a rural health clinic at the Land of Hope in Escuintla, Guatemala. A short pre and post-test were utilized to assess provider and pharmacy staff knowledge on the clinical presentation and treatment of GERD and peptic ulcer. At the end of the trip, a post-implementation survey was administered to providers and pharmacy staff volunteers to assess the protocol’s effectiveness and ease of use. The average score on the pretest was 56%, with a range of 7% to 93%. The average score on the post-test was 88%, with a range of 54% to 100%. All post-implementation survey respondents agreed that the training was helpful, the protocol was easy to use, and the protocol helped ensure consistent, evidence-based care was provided to patients. This protocol can serve as a blueprint for future protocols that address commonly seen diseases on STMMs.
Keywords: Short term medical missions, GERD, peptic ulcer, evidence-based, guidelines, protocol, treatment
Enhancing Communication Pathways Between Care Environments to Improve Patient Outcomes
Get PDFConducting hand-off communication among healthcare providers can impact patient outcomes. Lack of communication between healthcare entities at the time of care transition can produce patient harm and lead to adverse events such as medication errors, hospital readmission, and unnecessary emergency department visits. The project goal was to evaluate the impact of communication between acute care and primary practice nurses using a standardized, electronic communication tool within the EHR upon patient discharge from a community-hospital based setting. During implementation, forty-two patients were included in the project based on primary practice follow-up location. Of the 42 eligible patients, the acute care nurses successfully transmitted electronic hand-off communication on 36 patients to the appropriate primary care practices. After the adoption of the electronic hand-off communication tool, only one patient (2%) was readmitted within 30 days of hospital discharge. In addition, only one of the 42 patients visited the emergency department during the project implementation period. Nursing engagement supporting the use of an electronic hand-off communication tool was apparent during implementation based on participating feedback from nurses recommending continued use of the standardized, electronic communication tool. By using an electronic communication tool, care transition was enhanced at the time of hospital discharge. Adverse outcomes, such as hospital readmission, can be prevented through hand-off communication between the acute care and primary practice settings at the time of patient discharge
A Community Health Outreach Project Focused on Developing and Implementing a Culturally Competent Tobacco Cessation Education Toolkit
Get PDFTobacco use disorder is a public health problem with a heavy economic burden as tobacco users are more likely to suffer from premature death and debilitating diseases. Literature supports clinicians engaging their patients in smoking cessation conversation with each visit. However, the lack of appropriate training as well as the lack of a handy toolkit on smoking cessation makes this difficult. The challenge of engaging in smoking cessation conversations is more apparent with specific vulnerable populations such as the underserved community of East St Louis. This DNP project utilized evidence-based guidelines with best practice research, the Five A\u27s framework, and cultural competence to create an educational PowerPoint training for the staff at the We CARE Clinic in East St. Louis. In addition, the project involved the development of an educational pamphlet to engage with patients and provide education. The Staff was surveyed utilizing pre- and post-implementation surveys to test the effectiveness of our education on assisting the staff in engaging their patients on smoking cessation. On the post-test, 100% of respondents agreed they feel comfortable initiating a culturally competent conversation using the Five A\u27s framework compared to 40% on the pre-test. While limitations included a small respondent pool of five, this data shows a favorable result of the toolkit and the potential for further project expansion
Management of Ineffective Epidural for Cesarean Section
Get PDFIn the United States, epidural anesthesia is used for approximately 29-44% of cesarean sections (Carvalho, 2012). A failed or inadequate labor epidural is challenging to manage, especially when a cesarean section is imminent. A failed labor epidural is defined as insufficient pain relief within 45 min after placement, accidental dural puncture, re-siting or abandoning the procedure, and patient dissatisfaction at follow-up (Ismail et al., 2021). This project examined established best practices for managing a parturient with an ineffective labor epidural that requires a cesarean section. The literature review provided zero practice guidelines for the management of failed epidural for cesarean section. Anesthesia providers usedifferent approaches to manage an ineffective epidural. If the epidural catheter adjustment or top-up dosing does not provide sufficient anesthetic conditions and time permits, replacing the epidural catheter or performing a spinal is safe, but the appropriate dose of LA must be considered based on the level of the current block (Bauer et al., 2012)
First Review of Equilibrium Landscape of Ingress/Egress Channels and Gating Residues of the Cytochrome P450 3A4
Get PDFThe review document and changes made to Equilibrium Landscape of Ingress/Egress Channels and Gating Residues of the Cytochrome P450 3A4