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Increasing HPV Vaccination in Adolescents
Get PDFHuman papillomavirus virus (HPV) is a sexually transmitted disease that can negatively affect both males and females by leading to cervical, vaginal, vulvar, anal, penile, and oropharyngeal cancer. Vaccinating against HPV using the Gardasil vaccine is an effective method to prevent HPV, however, vaccination rates are still unacceptably low in adolescents ages 11 to 14. Pediatric providers should encourage and strongly recommend HPV vaccines to all adolescents. Addressing and easing parental hesitancy is a key component to improving vaccine acceptance. The setting for the project was a rural pediatric office in southern Illinois where HPV vaccination rates are lower than expected. Implementation included a one-minute video viewed by the patient and guardian, an educational handout highlighting HPV vaccine safety and efficacy, HPV poster in each exam room, and a follow-up conversation with the provider. Providers used the ANNOUNCE method and bundling technique to improve vaccine acceptance rates. Of the 44 participants, 20 received the vaccine (45%), 8 declined the vaccine (18%), and 16 plan to receive the vaccine at the health department due to insurance constraints (36%). The providers and support staff at the clinic will continue to use the educational tools in daily practice. A multifactorial parental education approach, as well as a strong recommendation from the provider, is most effective in increasing HPV vaccination compliance
Vasovagal Syncope During Venipuncture:Alleviating Symptoms Through Leg Muscle Tension and Moving Toes Sequentially
Get PDFVenipuncture is a common medical procedure and is considered safe and routine. However, intermittent cases occur where patients develop symptoms of lightheadedness, nausea, weakness, and occasionally a full syncopal episode due to needle phobia, blood phobia, and pain associated with venipuncture. Vasovagal Reactions (VVR) or Vasovagal Syncope (VVS) during a venipuncture procedure can be distressing for the patient, the clinician, and disruptive to clinic routines. This paper examines whether techniques such as simple leg tensing and wiggling of toes can reduce or abort VVR/VVS completely as the patient undergoes venipuncture. Clinicians were instructed in techniques to use if the patient exhibited any signs of VVR/VVS, or if the patient claimed to have a history of these reactions in the past with venipuncture. Two outpatient lab sites were used for this project. 1200 patients presented for bloodwork, of which 15 exhibited signs of VVR/VVS. Of those patients who did need intervention, all but one experienced modified or no symptoms at all as the exercises were performed. The ability to mitigate VVR/VVS easily during a routine blood drawing or intravenous insertion procedure is beneficial to the patient, decreasing their symptoms and level of anxiety. It is also beneficial to the phlebotomist, who can direct the patient and help manage the problem quickly and easily. Mitigating the problem before it advances to more significant problems also helps to minimize any disruption to clinic operations
Exploring Challenges and Triumphs within the Transgender Community through Comics-Based Research
Get PDFTransgender people are marginalized and pathologized within our society, which leaves transgender individuals vulnerable to numerous negative outcomes. The minority stress model describes the factors experienced by marginalized communities contribute to adverse outcomes (Meyer, 2015). Health care professionals are often not properly equipped to serve the needs of transgender individuals due to marginalization and pathologization. Used to challenge harmful stereotypes, as a form of cultural resistance, and to incite social change comic books and zines have been used as forms of expression for individuals with marginalized identities. Through the creation of a comic book, I aimed to educate others, encourage feelings of empathy, and reduce erasure of transgender people. Findings highlight the necessity of positive transgender representation for trans individuals and how interacting with stories of trans folks can encourage empathy and educate others about transgender individuals and their experiences
Establishing Guidelines to Promote Best Practice for Common Ailments in School-Based Health Clinics
Get PDFThe COVID-19 pandemic exposed the gap in access to medical care of school-age children and identified a need for community-based health clinics to aid in its minimization. Evidence shows the creation of school-based health clinics (SBHCs) in public school districts provides a pathway for students to receive high-quality care in an easily accessible manner. Therefore, patient care guidelines for common ailments seen in SBHCs for a local federally qualified healthcare center (FQHC) were developed in conjunction with the FQHC goal to build and operate a SBHC located in southern Illinois. Eight guidelines were created to analyze the most common chief complaints for patient visits through the use of UptoDate, evidence-based practice available from various sources and in coordination with the regulations for public school attendance in the state of Illinois. All eight guidelines were presented to the Director of Operations for the SBHC’s Mobile Units at the FQHC and consulted medical professionals. Copies of these guidelines were provided for future use to promote project sustainability. A 5-question survey was distributed to collect further feedback surrounding the guidelines, indicating likelihood of use and effectiveness in capturing proper management of common ailments. Future expansion of this project may include all staff education to providers about implementation and use of treatment guidelines once the SBHCs are opperational. This project served as an initial step toward the development of standardized evaluation and treatment of common ailments in school-based health clinics
Implementation of Enhanced Recovery After Surgery for Adult Cervical Spine Fusion Patients: A Quality Improvement Project
Get PDFSpinal surgeries can lead to an increase in costs and complications for patients and hospital organizations. Complications following spine surgery have been identified in 16.4% to 80% of cases for spine surgeries. An Enhanced Recovery after Surgery (ERAS) protocol is a set of guidelines with the goal of improving surgical outcomes and improving a patient’s quality of life. The purpose of this quality improvement project was to implement an ERAS protocol for adult cervical spine surgery patients at a tertiary care teaching center with the goal to reduce hospital length of stay and readmissions. Inclusion criteria included adult patients undergoing cervical spine surgery with a focus on cervical fusion surgeries. The evaluation centered on the comparison of outcome measures prior to the ERAS protocol and post ERAS implementation. Six hundred adult cervical spine fusion cases occurred from May 26, 2022 to August 23, 2022 with 132 cases using ERAS protocol. Patients with the non-ERAS protocol had readmission rates of 4.3, while ERAS protocol patients had a readmission rate of 3.2. Length of stay in non-ERAS patients resulted in 7.2 days, while ERAS patients had a length of stay of 4.7 days. This study resulted in reduced length of stay, hospital readmissions, and overall costs. Few limitations occurred. The ERAS protocol had a positive impact on patient outcomes and practice improvements were achieved
Pediatric Distraction Methods for the Perioperative Period
Get PDFAbstract
Most pediatric patients will experience anxiety to some degree during the perioperative period. Unrecognized and untreated anxiety can lead to complications during induction of anesthesia and may manifest as maladaptive behaviors that can last up to 6 months postoperatively. Multiple modalities are typically utilized to provide the greatest amount of anxiety relief with minimal side effects. Nonpharmacological methods of distraction have been proven effective when used in combination with pharmacological agents, as well as when used alone. The goal of this project was to create and present an educational resource tool regarding pharmacological and nonpharmacological distraction methods for pediatric patients during the perioperative period. Following a brief educational presentation, participants were asked to complete an anonymous and voluntary 10-question survey to evaluate the value and efficacy of the resource tool. Overall, participants expressed an increase in knowledge and preparation in caring for pediatric patients after the presentation. Approximately one-third of the participants were not aware of the negative effects of untreated anxiety, further demonstrating a need for education on this topic. Increasing staff education at the host facility, as well as providing a variety of recommendations for distraction techniques, will better equip anesthesia providers to tailor distraction interventions to individual patient needs, resulting in a more pleasant operative experience for the entire family unit
Intrathecal and Epidural Dexmedetomidine for Obstetric Patients
Get PDFThe use of dexmedetomidine in spinals and epidurals can be beneficial for obstetric patients. The combination of dexmedetomidine with local anesthetics for neuraxial anesthesia potentiates the effect of the blockade while eliminating the undesirable side effects associated with opioid administration. This project used a non-experimental, pre-test/post-test design to assess key stakeholders\u27 current use and intended future use of dexmedetomidine in neuraxial anesthesia for obstetrical patients. The goal of this project was to review current evidence-based literature regarding the use of dexmedetomidine as a neuraxial adjunct for obstetric anesthesia. The aim of this project was to summarize the results of the literature review into a PowerPoint presentation for a group of anesthesia providers at a tertiary medical center in central Illinois. Knowledge of the risks and benefits of dexmedetomidine and willingness to use dexmedetomidine as an adjunct were assessed via anonymous pre- and post-presentation surveys. Evidence via the post-presentation survey demonstrated an increase in provider understanding of the risks and benefits of dexmedetomidine as a neuraxial adjunct, as well as optimal dosing for spinal and epidural anesthesia in the obstetrical population
Assessing Provider Confidence of Acute Otitis Media Diagnosis and Treatment with an Optical Coherence Tomography Device in the Urgent Care Setting
Get PDFAcute otitis media (AOM) is one of the most common causes of pediatric infection worldwide at approximately 350 million visits per year, as well as one of the most challenging illnesses to diagnose for providers (Tong et al., 2018). This dilemma leads to antibiotics being inappropriately prescribed, at a rate of approximately 75% (Islam & Hassinger, 2018). This project sought to explore the impact of implementing an optical coherence tomography (OCT) device in an urgent care setting when assessing otalgia in patients 0 to 17 years of age. The three main objectives of the project were to increase provider confidence in both acute otitis media (AOM) and otitis media with effusion (OME) diagnoses, provide patient/parent satisfaction, and decrease unnecessary antibiotic prescribing to patients with complaints of otalgia. A cohort of 12 Urgent Care Advanced Practice Providers (APPs) were invited to participate in OCT device education and utilization, as well as complete an anonymous survey in the pre-implementation phase and subsequently every 30 days to assess the first two objectives based on a four-point Likert scale. At the end of the six-month project, provider confidence scores averaged 2.86 for AOM and 3.19 for OME, and patient/parent satisfaction averaged 3.28. Aggregate data on antibiotic prescribing rates was collected during both pre-implementation and evaluation phases to assess the final objective and found a 17.6% improvement in antibiotic prescribing rates. Device implementation in other specialties, trial of other OCT devices, and longer training periods are recommended for future studies
Improving no show rates in a GI Endoscopy outpatient lab
Get PDFNo show rates in outpatient health care settings can negatively impact patient outcomes as well as physician and nursing practice. Many procedural areas face an average no show rate between 14%-16% annually. Insufficient procedure preparation, socioeconomical issues including lack of transportation, illness on the day of the day of the procedure, and lack of educational awareness surrounding the importance of needing the procedure have been linked to patient’s canceling scheduled procedures. High no show rates contribute to significant financial losses as well as unused resources for procedural departments. The negative impact of these losses can create issues with staff department productivity and impact other patients due to delayed procedure times. The purpose of this project was to implement a verbal pre-call assessment by the RN schedulers on patients scheduled for endoscopy procedures. The pre-call assessment included pre-procedural education, review and confirmation of required appointment resources in order to minimize barriers. The pre-call assessment afforded the patients the opportunity to cancel procedures far enough in advance to allow another patient to be scheduled in their spot, reducing financial loss and maintaining department productivity. Since the projects implementation in July 2021, 6,625 patients have completed the pre-assessment form resulting in a 1-2% decrease in cancelation rates. Pre project implementation cancelation/no-show rate was 15% to 18% with a post project implementation of 13%-14%. Limitations of this project included challenges related to the pandemic which created unforeseen cancelations due to a mandatory decrease in elective surgeries and cancelations related to symptomatic COVID patients with minimal lead time. This project has created a sustainable practice while improving no show and cancelation rates
Implementation of a Tele-Triage Protocol in an Emergency Department Setting
Get PDFNationwide, the volume of emergency department (ED) visits has steadily increased over the last several decades. This steady increase in volume frequently causes ED crowding and considerable delays in patient evaluation and treatment. Recently, teletriage has been used in emergency departments to evaluate less emergent patient needs while freeing up in-house providers to care for more critical patients. The goal of this DNP project was to develop a protocol for the utilization of teletriage in an Emergency Department in a level 1 trauma center in central Illinois using nurse practitioners to assess patients in the waiting room and order appropriate tests to improve patient outcomes. After educating staff on the protocol, a four-week trial of the tele-triage protocol was conducted on Mondays and Thursdays. Following the trial, staff were surveyed to evaluate the process to determine what improvements could be made. Data was collected pre and post implementation regarding the average door-to-provider time, number of patients who left without being seen and overall length of stay. A decrease in door-to-provider time, decrease in overall length of stay, and a decrease in the number of patients who left without being seen was found. Staff feedback indicated that additional staffing was needed and a separate room for the process would be beneficial for long term success. Future expansion of this project might include adapting the protocol to allow providers to treat and discharge patients via the tele-triage process