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Community Health Worker Intervention to Improve HbA1c in Adult Diabetic Patients
Get PDFType 2 Diabetes Mellitus (T2DM) is a disease that disproportionally impacts patients with multiple socioeconomic barriers that are often difficult to address during a primary care visit. Several provider and practice-level barriers also exist including time limitations within the visit and lack of trained staff to help with patient education and case management. Uncontrolled T2DM leads to poor health outcomes and increased healthcare costs. Community Health Workers (CHW) are trained lay persons that can successfully address the patient’s unmet needs and assist with the provider’s recommendations. The purpose of this project was to explore if a CHW led intervention focused on improving diabetic management would decrease the hemoglobin a1c (HbA1c) of adult primary care patients with uncontrolled T2DM in a Community Health Center (CHC). Participating patients received diabetic and self-management education as well as care coordination if needed at least twice during the project. There were several limitations related to the pandemic that impacted participation including staffing, rescheduling of patients, dependence on phone communications, and initial engagement amongst providers. Results from 18 uncontrolled diabetics who received CHWs services showed a decrease in the average HbA1c by 3.04% over a 3-month period. The patient’s benefited by an approval in their HbA1c and the CHC was able to meet their strategic goal to improve HbA1c across the system. Without an additional financial burden to the organization, the proven benefits of the CHW led intervention was shown to be an effective and sustainable program within the CHC
Implementation of Routine Screening with Patient Health Questionnaire 9 (PHQ-9) of Adults with Crohn’s Disease
Get PDFIntroduction: Mild levels of depression have been measured with screening tools at rates of 15-24% in adults with Crohn’s disease (CD). The spectrum of the impact of depressive symptoms is measurable and documented for those with CD. Patient perspectives support the integration of psychological care, and the Patient Health Questionnaire 9 (PHQ-9) is a well validated tool for the measurement of depressive symptoms.
Purpose: Increase depression screening of adult CD patients in the outpatient gastroenterology clinic and evaluate the provider perspectives regarding PHQ-9, depression, and CD.
Conceptual Framework: The Johns Hopkins Nursing Evidence Based Practice (JHNEBP) Model was selected as the conceptual framework to guide this Doctoral project because it is rooted in evidence-based practice (EBP) and composed of inquiry, practice, and learning.
Methods: The total number of PHQ-9, prior to and during implementation, and the provider’s perspective on utility/integration of the PHQ-9 were measured with anonymous online pretest and posttest surveys.
Results: No routine depression screening took place prior to implementation and the total number of PHQ-9 completed after implementation was reported as five. Initial pretest and posttest scoring indicated positivity to neutrality in all areas. Provider perspective revealed a positive provider shift related to depression frequency, provider screening responsibility, and practice integration. The most significant shift was increased provider comfort identifying depression symptoms.
Conclusion: Continued screening of adult CD patients with PHQ-9 will increase depression identification, enhance routine care, and improve patient outcomes
The Implementation of a Mental Health Screening Protocol in an Occupational Health Setting
Get PDFBackground
Occupational injuries are disturbingly common and can occur regardless of employment industry, given that virtually every job in every industry has some degree of risk. Literature suggests that once an injury has occurred, psychosocial factors such as depression can play a pivotal role in the progression of pain, determine whether a subsequent disability develops, and the length of time an employee is off work.
Theoretical Framework
Both pain and depression are hypothesized to follow the same descending pathway in the CNS and have the same biochemical basis, serotonin and norepinephrine. The Biophysical Model of Pain can be used to explain this phenomena.
Methods
Currently in occupational health, patients are not screened for depression, leaving a gap in care. This QI project implemented the PHQ – 9 to screen for depression in patients \u3e 18 years old seen for a work-related injury. All staff were surveyed after implementation to determine if this change was feasible and effective.
Results
Per Likert-scale questionnaire 71.43% “strongly agreed” and 28.57% “somewhat agreed” that it would be feasible to continue utilizing the PHQ – 9 in daily practice. Some things the staff liked about using the PHQ – 9 in their own words “it is a good mental health tool” and “it’s an objective measurement of subjective reports”.
Implications for Practice
The results of this quality improvement project are promising and suggests it is feasible to utilize the PHQ – 9 to assess the psychological needs of patients injured in a work-related injury. Future work will include implementing routine screening as a protocol
Increasing Obesity Education in an Underserved Latino Population
Get PDFObesity is a rapidly growing health problem in the United States. Certain populations are at high risk for developing obesity including the Latino population and underserved communities. This Quality Improvement project aimed to develop a more patient centered approach for primary care providers use to deliver obesity education to an at-risk Latino population. The project was completed at a clinic in southern Illinois where the majority of the population is underserved and Spanish speaking. Obesity education tools in both Spanish and English were given to the patients in order to decrease the language barrier and improve patient education and understanding about obesity. Nineteen patients were eligible and participated in the quality improvement project based on BMI. Each completed a survey before and after they were provided with the education tools. Results of the project showed that 52.5% of the participants marked the tool as very useful, and 47.4% marked somewhat useful. No participants marked the tool as not useful. All of the participants reported an increase in obesity knowledge
Hypertension Management in Primary Care Using Target:BP; Meeting Patient Goals and Quality Measures
Get PDFHypertensive disease is a global problem impacting millions of individuals aged 18 years and above. Uncontrolled hypertension management can lead to significant complications and death . Primary care providers are challenged to improve patient outcomes in patients with hypertensive disease while complying with clinical quality measures for high blood pressure as outlined by the Center for Medicare and Medicaid Services Merit-based Incentive Payment System (MIP) performance measures. The purpose of this project was to improve high blood pressure in patients diagnosed with primary hypertension utilizing the American Heart Association (AHA) and the American Medical Association (AMA) Target: Blood Pressure (BP) program in conjunction with telemedicine. Telemedicine offered a patient/provider connection to address this global problem and engage in patient education and follow up. The AHA/AMA Target BP program provided a backdrop for patient education, guidance, and standardized tools for primary care providers to improve patient outcomes and (MIP) performance measures as well as the system levels Best in Class Goals for hypertension management. Since project implementation, the overall average improvement in hypertension management comparatively from 2020 to 2021 was 2.8% with improved internal quality reporting Best in Class scores from 1.19 to 1.52 through SMBP and telemedicine visits. By implementing SMBP with the use of telemedicine, providers can improve hypertension management, thus improving patient care and quality measures outlined by the Center for Medicare and Medicaid’s Shared Savings Program
Retention of New Nurses in the Cardiovascular Operating Room
Get PDFBackground
In January of 2020, a hospital in Springfield, Illinois started the year with seven full-time circulating nurses in the cardiovascular operating room (CVOR). Three of those nurses left before the end of the year and an additional four nurses were hired. In January of 2021, the CVOR began the year with eight nurses. Five of these nurses left by the end of the year and seven more were hired, one of which left before the end of 2021. This department has struggled to retain nurses, with a turnover rate of 42.9% in 2020 and 62.5% in 2021.
Purpose
The purpose of this project is to identify dissatisfying factors in the CVOR that are leading to high turnover rates.
Methods
Eight nurses in the summer of 2021 completed the Revised Casey-Fink Nurse Retention Survey. Four of these were new graduates. The other four were experienced nurses without prior operating room experience. Survey results were reviewed and discussed with each nurse to obtain individual feedback.
Results
Surveys found that the top dissatisfying factors were the orientation process and the education provided in CVOR. Nurses described the orientation process as messy, rough, difficult, unorganized, and all over the place. Four nurses said they did not want to be working in the CVOR in five years. Three said they would consider leaving their job if another opportunity presented itself. Three said they had been in their position about as long as they wanted to be. Three nurses were either very dissatisfied or moderately dissatisfied with the orientation process, with one more being neither satisfied nor dissatisfied. One nurse did not feel her preceptor provided her a sound foundation for practice. Many nurses commented the fact their educator is not an operating room nurse, and this made it difficult for her to understand or answer certain questions. Majority of nurses did not have a mentor
The Effect of Dysfunctional Organizational Culture on Burnout in Academic Libraries
Get PDFThis chapter explores the high incidence of dysfunctional organizational cultures among academic libraries and how these cultures accelerate burnout among librarians, particularly newer librarians. Our data show that there are a variety of factors that lead to dysfunctional organizational cultures in libraries, including generational conflict, salary inequities, lack of representation of women and people of color in leadership positions, and poor leadership. In combating dysfunction and burnout, we recognize the idea that individuals are responsible for managing their burnout through various means of self-care or saying “no.” However, in this book chapter, we assert that it is both the organization’s responsibility to nurture an environment that allows librarians to create productive working ecosystems and the individual’s responsibility to proactively address workplace dysfunction by leaving or making needed changes within the organization
Neuraxial Anesthesia for Total Joint Arthroplasty
Get PDFThis quality improvement doctoral nursing project sought to provide a sustainable and data-driven change process at a critical access hospital in Illinois. The main objective of this project was an improvement in postoperative pain scores and implementation of best practice guidelines regarding total joint arthroplasty. Total joint arthroplasty is one of the most common surgical procedures performed in the United States. Future figures predict exponential growth due to our aging patient population, the obesity epidemic, and continued improvements in technique. Despite advances, orthopedic surgeries continue to be taxing on the body and can produce significant complications. General anesthesia for these procedures has been associated with increased postoperative complications, including enhanced risk for deep vein thrombosis, blood loss, and postoperative nausea and vomiting. In direct comparison, neuraxial anesthesia has demonstrated superior outcomes, including reduced blood loss, DVT and PONV risk, as well as a reduced need for postoperative opioid consumption due to enhanced pain control. As such, neuraxial anesthesia has become regarded as the superior anesthetic technique for total joint arthroplasty, in addition to the utilization of local infiltration anesthesia and peripheral nerve blockade. An initial retrospective chart review was conducted to identify anesthetic modality and most notably postoperative pain scores for total joint arthroplasties conducted at the institution. Following the review, a change process towards utilization of neuraxial anesthesia as the main anesthetic modality for total joint arthroplasty where eligible was stressed. A prospective chart review was then conducted to compare and contrast the obtained data. Final statistically analyzed data was then presented in PowerPoint form to all available anesthesia and surgical staff. A completion survey was conducted to validate the efficacy of the change process. Principally, this project demonstrated superior results concerning reduced postoperative pain scores when neuraxial anesthesia was provided for total joint arthroplasty procedures. Despite barriers to the implementation of this project, both the survey results and the chart review figures demonstrated the relevance and applicability of continuing this process change at the facility at hand
Physician Use of the RAPID3 to Guide Rheumatology Follow-Up: A Retrospective Examination
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The Quality Improvement Team of a rheumatology clinic was seeking ways to deal with the long intervals for an available follow-up appointment. The use of standardized disease activity assessment tools as a part of patient care is an evidence-based practice that is not employed by over one third of rheumatologists. One of the many uses of these tools is to guide treat-to- target care. Treat-to-target care uses the disease assessment tool score to guide treatment decisions and follow up interval. This project examined the use of a standardized disease assessment tool, the Routine Assessment of Patient Index Data 3 (RAPID3), as recommended by the American College of Rheumatology (ACR) to guide follow-up interval. In this retrospective study the data from one physician’s use of the RAPID3 was analyzed to determine how closely follow-up appointments adhered to the ACR recommendations for the RAPID3 score of 30 new patients. Results demonstrated that provider knowledge of the RAPID3 score alone is not sufficient to ensure use of the evidence-based practice of basing follow-up on RAPID3 scores. Outcomes of this project include a recommendation for implementation of a follow-up protocol for the rheumatology clinic based on the RAPID3 score, facilitation of RAPID3 use though a method for electronic completion of the RAPID3 by rheumatology patients before each appointment, and an educational presentation for providers on the validity and ease of the RAPID3 tool to encourage use of the score once obtained
Exploring the Use of Telehealth in a School-Based Health Center
Get PDFThe benefits of remote telehealth assessment kits and their use in school-based settings were explored in this Quality Improvement project. The primary goal was to examine rural school-based settings and explore options to fulfill healthcare care gaps. A secondary objective was to explore telehealth systems and identify one that provided thorough diagnostic evaluation abilities. A tertiary objective was to educate potential users of the identified system and assess the perceived ease of use and practicality. A cohort of 58 doctoral candidates and 11 staff members from a local school district were educated on the advantages of using telehealth and received a demonstration of TytoCare’s medical exam kit. In the pre-survey, only five (7.25%) respondents reported being very familiar with the process of telehealth. However, 53 (76.81%) reported being very or somewhat familiar of the benefits of telehealth. After the interactive demonstration, the post-survey revealed 53 (91.38%) participants felt comfortable using telehealth in their future practice. Furthermore, 56 (96.55%) participants felt confident they could use the demonstrated skills in future practice. The use of telehealth may be a viable option to meet healthcare gaps in rural settings. However, the adoption of these practices would require support from healthcare providers and their respective clinics. An option for project continuation would be to perform a cost-analysis of the difference between using these telehealth systems versus implementing an in-person clinic. Additionally, a future project could implement this system in an underserved area to identify the advantages and disadvantages of use in practice