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Conducting a Root Cause Analysis to Improve Intake Processes and Record Review in Home Health
Get PDFMinimization of adverse events, reduction of inpatient admissions, and prevention of polypharmacy within home health are of importance due to the increasing number of Medicare beneficiaries. In 2019, CMS reported 5,266,931 patients were served by home health agencies, accounting for 7,439,849 episodes of care. It is projected that the number of beneficiaries will rise from 54 million to more than 80 million by the year 2030. Medical errors are now the third-leading cause of death in the United States, surpassing diabetes, Alzheimer’s, and stroke. The Agency for Healthcare Research and Quality identifies a lack of institutional intake processes as the leading cause for medical errors in home health agencies. An evidence-based 5-step root cause analysis was developed to address this concern in a private, Midwestern home health agency. Project objectives included: identifying root causes for the lack of uniform intake processes and access to patient records within the industry, assessing stakeholder knowledge of identified root causes, addressing provider obstacles for implementation and adaptation of new processes, and assessment of stakeholder readiness for change. Project methods included a comprehensive, niche specific PowerPoint presentation delivered to stakeholder leadership, a pre and post Qualtrics survey utilizing a 5-point Likert scale, and qualitative data review. The post-presentation survey resulted in a significant 75% increase in stakeholder knowledge and readiness for change. Outcomes of this project included self-reported feelings of empowerment and immediate follow-up action. Understanding the root causes of current barriers to patient care is recommended for all home health agencies. Newly acquired knowledge will support initiatives to streamline intake processes, decrease adverse patient events, and prepare this agency for a predicted influx of patients
Creditable Civic Engagement? Aligning Work on Civic Activity with Faculty Incentives
Get PDFPolitical scientists frequently study and engage in civic engagement work and the institutions that employ them state that they value these endeavors. Yet, there is a disconnect between valuing and doing this work relative to aligning it with faculty incentives. We discuss our experiences with civic engagement work and how we made it fit into how we are evaluated. We use our experience to motivate recommendations to fellow faculty, institutions, and administrators with respect to how they can do and encourage this work going forward
Strange Alliance: An American, a Nazi, and the Battle of the Bulge
Get PDFOne of the stranger episodes in the history of World War II occurred over a period of 90 hours in the Belgian village of La Gleize in December 1944. During the bloody Battle of the Bulge, Hal McCown, a major in the U.S. 30th Infantry Division, was captured by troops of the Nazi Waffen SS and taken to La Gleize, where Obersturmbannführer (Lieutenant Colonel) Joachim Peiper had established his headquarters. Peiper commanded a battlegroup whose orders were to capture crossings over the Meuse river, thus opening the way to Antwerp, the primary German objective. It was also the battlegroup responsible for the murder of American POWs near the town of Malmédy. Over those 90 hours, McCown and Peiper forged an improbable relationship of mutual admiration and trust that is unique and which this essay analyzes and places in broad historical context
Anticipatory Guidance for Parents/Caregivers of Pediatric Patients Ages 0-12 Months
Get PDFAnticipatory guidance is defined as proactive counseling for caregivers regarding various aspects of childcare and development. This project sought to improve the process and delivery of anticipatory guidance for infants aged 0-12 months at one rural pediatric primary care clinic. An extensive literature review was undertaken to determine current recommendations for anticipatory guidance topics pertinent to pediatric patients aged 0-12 months. Additional research explored the efficacy of various educational formats to provide teaching. Written educational materials were updated and edited to be visually appealing and understandable, and educational videos were created. Written materials and educational videos were provided to parents/caregivers of patients aged 0-12 months during well child visits before seeing the providers. Thirty-two surveys were collected from parents/caregivers to assess their perspectives on the new educational materials and process, and a focus group was held with clinic staff to gather feedback. The proposed goal of the project was to update written educational materials and create educational videos that would introduce a new format to provide anticipatory guidance. These improvements would allow parents and caregivers to view the educational videos prior to seeing the provider, which would allow for a more individualized patient-provider discussion. Overall, patient and clinic staff feedback indicate positive responses toward the new educational materials and process. Ensuring that educational materials are current, engaging, and easily accessible are important for optimizing parent/caregiver education, which leads to improved patient outcomes
Development of a Protocol to Manage Postdural Puncture Headache
Get PDFIn obstetric laboring patients, neuraxial anesthesia is a common form of analgesia. However, neuraxial procedures are not without risk. Accidental dural puncture (ADP) is a potential risk with any epidural procedure. Patients who experience ADP are at a greater risk of developing postdural puncture headache (PDPH). The presentation of PDPH is commonly described as a dull, throbbing, headache worsening upon standing and relieved with supine positioning (Patel et al., 2020). Symptoms of PDPH may range from mild to debilitating and develop within five days of ADP. A variety of treatment options exist for PDPH ranging from conservative to invasive. The purpose of this project was to introduce a standardized evidence-based treatment protocol for patients suffering from PDPH. A comprehensive review of the literature revealed the most recent evidence on contributing factors, prevention, and treatment of PDPH. The project study design utilized a non-experimental pre and post-evaluation method completed by nine anesthesia providers. The post-evaluation was collected following the educational PowerPoint presentation to analyze knowledge gained. Overall participants improved their rates of correct responses. Thus, implementation of the PDPH algorithm was directed at improving patient outcomes and enhancing provider knowledge
Controlling Hypertension: A Self Blood Pressure Monitoring Program plus Health Coaching compared to Health Coaching Alone
Get PDFWhile nearly half of adults in the United States have hypertension, only about one quarter of those adults have adequately controlled hypertension. Providing a nurse-led coaching program in combination with home blood pressure monitoring (HBPM) has been shown to improve blood pressure control. A rural family practice clinic in the Illinois Metro East area proposed a clinical trial to test a nurse-led coaching program in combination with home blood pressure monitoring (HBPM) in decreasing blood pressure long-term. Both intervention and control groups received nurse-led hypertension coaching, while the intervention group also received a home blood pressure cuff. The results showed that a nurse-led coaching is effective in decreasing blood pressure. However, due to significant attrition, meaningful results could not be obtained regarding any additional benefits of adding HBPM to nurse-led coaching
Critical Care Orientation Escape Room
Get PDFNewly licensed nurses often feel unprepared and lack confidence as they transition from academia to practice. Education Specialists who oversee training programs for newly graduated nurses are challenged to create education modalities that are meaningful, engaging, and promote critical thinking. The purpose of this project was to create an Educational Escape Room to reinforce principles of safe medication administration for new nurses entering critical care areas in a large pediatric hospital. Escape Rooms engage learners through gamification and active-learning principles to improve knowledge synthesis and retention. Eighty-three newly hired critical care RNs participated in the Educational Escape Room during house-wide orientation in 2021. Hospital educators and Quality and Safety liaisons identified the Escape Room learning objectives to align with hospital safety metrics and needs. Based on survey data, all learners felt that the Educational Escape Room met the identified objectives including high engagement, utilization of medication error mitigation strategies, and increased confidence in future medication administration. Due to early project success, exposure to the Educational Escape Room was expanded to include all newly hired Registered and Graduate Nurses in the hospital as a part of hospital-wide nursing orientation starting in January of 2022. Educational Escape Rooms are a highly engaging immersive learning modality that can increase confidence and competence in newly graduated Registered Nurses thereby easing their transition from academia to practice. Escape Rooms can also be easily replicated and adapted to help learners negotiate a myriad of learning gaps in a plethora of clinical settings
Implementation of PrEP Protocol in Primary Care
Get PDFHuman immunodeficiency virus (HIV) is an incurable condition that continues to be a public health threat. Approximately 38 million people live with the disease worldwide, and one out of seven are unaware they have the disease. Pre-exposure prophylaxis (PrEP) is a medication that can be prescribed to individuals at risk of acquiring HIV. PrEP can be prescribed by any healthcare provider who deems a patient at risk for HIV. However, a primary care practice in central Illinois previously had no protocol for initiation of PrEP. This quality improvement (QI) project aimed to implement a PrEP protocol in the department of internal medicine and optimize PrEP uptake. The project methods included an educational meeting, packet, brochures, and PrEP protocol. The project was evaluated utilizing the pre-and post-intervention. Overall, among the three providers who completed both pre-and post-intervention surveys, there was an increase in the familiarity and comfort of prescribing PrEP after the intervention. In addition, there was an increase that indicated a higher possibility of the providers not referring patients to infectious diseases for PrEP. The knowledge assessment of the providers did show an increase for the nurse practitioner but not the other two respondents, which indicates further education could be beneficial to the providers. The project\u27s future goals in the primary care office are to increase uptake of prescribing PrEP to patients who are high-risk for HIV and eventually open a designated clinic day just for PrEP patients
Implementation of PHQ-2 Screening Tool in a Telemedicine Based Setting
Get PDFBackground Major depression is one of the most common mental health disorders in the United States, affecting nearly 17.3 million of the population. As cases continue to rise throughout the ongoing pandemic of COVID-19, telemedicine has become a popular modality for accessibility to mental health care. Adequate screening, availability of resources and services, prompt treatment, and simple follow ups can contribute to treatment success rates and higher positive outcomes.
Theoretical Framework
The expanded collaborative chronic care model theoretical framework translates to this project in that it approaches management of patients with a team approach for those who screen positive for major depressive disorder in a telemedicine setting.
Methods
Over the course of 3 months, all incoming telemedicine calls were screened using the PHQ-2 by a team of physician assistants and one nurse practitioner. Any positive screenings were further evaluated with a diagnostic PHQ-9 tool and treatment planned following evidence-based guidelines.
Results
Approximately 162 patients were screened and 18 were treated during the 3 months screening process. Staff involved with the process reported positive opinions related to the project, including ease of use and quality of patient care.
Implications for Practice
The screening process continues to be part of the telemedicine practice today, and the mental health branch has grown in direct relation to recognizing the growing volume. The telemedicine now incorporates a team of psychiatric nurse practitioners and therapists to support those who screen positive and may need additional treatment
Communities Moving Past the Daddy Daughter Dance: Adapting Gender-Exclusive Events for the 21st Century
Get PDFExecutive Summary
Parent-child community events like father-daughter dances are a celebrated tradition in many communities. However, when these events specify the gender of who can participate, they exclude many families. They also tend to reinforce gender stereotypes (e.g., a dance for girls and a sports event for boys), and are legally questionable for public school and associated P.T.A./P.T.O. sponsors that may be violating federal Title IX requirements and for local governments that may be violating the 14th Amendment to the U.S. Constitution’s Equal Protection Clause.
Contemporary U.S. society is made up of families that come in diverse forms and structures. Two-parent households may have a working mother and stay-at-home father or two parents of the same gender. Some children live with only one parent, sometimes due to factors such as deployment, death, divorce, and incarceration. Excluding families from these events prevents them from participating in community events meant to foster and celebrate family bonds, ultimately adding unnecessary stressors and stigmatizing these families and children.
To address these concerns, over the past decade a growing number of communities across the United States have adapted their family events to make them gender inclusive. From Rhode Island to North Carolina to Wisconsin to Oregon, schools, local governments, and other sponsors of gender-exclusive parent-child events have adapted their events to be welcoming and inclusive. These communities strive to ensure the whole community is represented, and that they bring families in the community together, providing equal access to community events. Daddy Daughter Dances become Family Dances or Spring Flings. Me and My Son Bowling becomes a Bowling Bonanza. These events have been expanded to preserve the opportunity for parents and children to bond, including for fathers with their daughters, while also ensuring that girls who like bowling, boys who like dancing, nonbinary children, widowed parents otherwise considered the “wrong” gender, and other community members are able to participate in events that are designed for the community of which they are a part.
A number of organizations, from the American Civil Liberties Union (A.C.L.U.) to the American Association of University Women (A.A.U.W.) to PFLAG National to the National Coalition for Women and Girls in Education (N.C.W.G.E.), support communities making these events gender inclusive. However, these changes have not occurred without resistance, often rooted in an attachment to tradition, a desire to enforce values and normative gender roles in our society, and a fear that inclusive policies are part of a cultural politics they find troubling. However, public institutions have responded that they should serve their entire constituency, regardless of any staff or politician’s personal views. Regardless of who lives in their community, communities that have adapted their events seek to serve all the children and families who live there.
Being inclusive does not mean ending a tradition; it means finding a way to continue a tradition and bring more people into the celebration. A family dance that used to be a Daddy Daughter Dance still welcomes fathers and daughters to attend together. Families and community leaders seeking change want to be able to participate in community traditions with their family and for these events to be welcoming to their neighbors.
Across the country, gender-exclusive community events are being challenged. Some have changed and become gender inclusive. Others continue to exclude members of the public. Advocates, community leaders, and decision-makers in communities with gender-exclusive events seeking to create equal access to these community events can advocate for and adopt changes to specific events or broader inclusive policies that requires these events be inclusive. Community leaders can work to create inclusive policies that represent their whole community and bring families of all kinds together