3511 research outputs found
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Development and Evaluation of Enhanced Recovery After Surgery protocols for General Abdominal and Orthopedic Surgery with Focus on Preoperative Hydration and Multimodal Management in Preoperative and Postoperative Phases
Get PDFEnhanced Recovery After Surgery (ERAS) is described as an evidence-based, patient-centered, interdisciplinary team developed protocol utilized to decrease the patient’s stress response to surgery, maintain preoperative physiologic function, and expedite recovery (American Association of Nurse Anesthetists [AANA], 2017). Existing evidence displayed the benefits of utilizing ERAS protocols in various surgical procedures, including general and orthopedic cases. Studies showed one must employ the preoperative, intraoperative, and postoperative components of the ERAS protocols to achieve maximum benefits. A critical access hospital in Illinois utilized some components of ERAS protocols, mainly the intraoperative portions, but lacked the full utilization. Goals of the review included obtaining current evidence-based practices regarding preoperative hydration and multimodal analgesic management for general abdominal surgery and orthopedic surgery. A voiceover PowerPoint and protocol summarizing fluid management and multimodal analgesic management findings and implications for practice was emailed to the designated providers. Once providers viewed the information, the providers evaluated via an anonymous survey. The goal of improving the knowledge of the healthcare providers regarding these topics was proven successful via the post-implementation survey. The evidence displayed the tremendous impact ERAS protocols can have on practice
Perioperative Tube Feeding Guidelines for the Pediatric Burn Patient
Get PDFPediatric burn patients require an astronomical amount of nutritional support to promote wound healing and prevent unwanted side effects. These patients often require multiple surgeries, and consequently, when following standard NPO guidelines, these patients go for hours without any nutritional support. For this reason, a protocol was implemented on how to administer tube feedings throughout the perioperative process safely. The purpose of this project was to give a PowerPoint presentation to the providers that tested their current knowledge on how to manage tube feedings in the operative setting best. A single group design consisting of CRNA’s and an anesthesiologist was given an evidence-based protocol on managing perioperative tube feedings for this patient population. The results of the post-presentation survey concluded that the providers gained new knowledge on how to manage tube feedings in the perioperative setting best and were willing to implement the protocol if hospital policy allowed them. A limitation was getting the cooperation of each department head to go along with the protocol. In conclusion, if the protocol can get the support of each medical team, it can then be implemented in an actual surgical case. From there, its effectiveness can be evaluated for improved patient outcomes
Improving Healthcare Team Communication with Limited English Proficiency Families in the NICU
Get PDFLanguage barriers are common in healthcare settings, creating disparities in care between individuals with limited English proficiency and those with English proficiency. In the NICU setting, professional medical interpreters have been shown to improve parent/staff communication and increase parent satisfaction by allowing parents to ask questions and form trusting relationships with staff. Solid parent-provider communication can result in better health outcomes by increasing parental empowerment and participation in their child’s care. Despite the acknowledged advantages of using professional interpreters in healthcare settings, they are frequently under-utilized, even when readily available. The purpose of this project was to improve communication with limited English proficiency families using professional interpreters in a 65 bed, university-affiliated level IV NICU in St. Louis, Missouri. Practice guidelines and staff education were created based on the results of an extensive literature review. Five (5) limited English proficiency families were identified during the implementation period and all three interpreter modalities (phone, video, and in-person) were used. Barriers to interpreter use were availability of interpreters in the family’s preferred language, families declining an interpreter, lack of time, and uncertainty about how to access an interpreter. Staff members appreciated education on available interpreter modalities and found communication with LEP families to be effective and especially convenient with the newly available video remote interpreting tablet. Daily communication using professional interpreters was improved overall, and NICU staff now recognize it as an essential component of high-quality, family-centered care
Establishing Care with a Primary Care Provider
Get PDFEstablished primary care leads to continuity of care, improved patient outcomes, and increased quality of life. There is also an improvement in the unnecessary usage of urgent care resources. The purpose of this project was to pilot a new process within the urgent or emergent care setting to ensure that patients who are not established with a primary care provider (PCP) have an appointment set before they are discharged. Staff were educated and trained in how to schedule primary care appointments for at-large patients. There are a high number of individuals who do not have a primary care provider. When an individual does not have a primary care provider, there is an increased rate of morbidities and mortalities along with decreased urgent/emergent care wait times and decreased pressure on health care providers. Results showed that primary care appointments were made for 44 patients, and 23 of them were compliant. Twenty percent of these patients previously had a PCP but were non-compliant. All but two of these patients re-established care. Overall, staff within the clinic were pleased with the process and the decrease in clinic congestion. Some limitations included primary care offices not having adequate appointment slots and staff scheduling visits incorrectly
Reducing Errors Through Implementation of Standardized Electronic Order sets in the Intensive Care setting
Get PDFHealthcare facilities are constantly chasing through striving to meet interoperability and meaningful use requirements while still advancing the field through the concepts of evidence-based practice and value-based delivery modules. Healthcare facilities can encourage the healthcare team by utilizing computerized physician order entry using standardized ordersets. An orderset is a series of recommended orders based on different diagnoses, conditions, or treatments. It was noted that several errors and delays of care were occurring related to the paper process at a small Midwestern hospital. The purpose of this quality improvement project was to convert the remaining paper ordersets to electronic ordersets in the form of powerplans. After an extensive literature review was created, an interdisciplinary team was created to review the current paper ordersets, update and make changes as necessary and then build electronically. An orderset and protocol committee was the final approval process for the electronic validation before going live.
Along with this project, the medical staff was re-educated on the use and intention of powerplans. Ultimately three paper ordersets were converted from paper to electronic. Two were placed on hold due to staffing and resourcing, and the Induced Hypothermia orderset was discontinued as it was found this is no longer a best practice treatment. Unusual occurrences were reviewed pre and post-implementation and found that delays of care, absence of orders, and errors were reduced when the paper was eliminated
An Extended Literature Review Exploring How Relational Cultural Therapy and Emotion Recognition Impact the Therapeutic Alliance
Get PDFThis research explores existing literature involving the role of Relational Cultural Therapy and emotion recognition on the therapeutic alliance. This exploration is accomplished through an extended literature review focusing specifically on emotion recognition, RCT, and the therapeutic alliance, with an additional focus on art therapy. The themes discussed center around emotional expression and recognition, rupture and repair in the therapeutic relationship, and connection, disconnection, and mutual empathy through a relational-cultural lens. Themes and patterns were identified within this area of study and how this field of research has developed over time. This study found support for therapist emotion recognition abilities and the use of an RCT framework in creating and strengthening therapeutic alliances. In regard to art therapy, foundational information was found in incorporating emotion recognition and RCT in the building of alliances in the art therapy process
Creating a guideline for STI testing in the pediatric population
Get PDFSexually transmitted infection (STI) prevention, education, screening, and management in pediatric primary care settings are of importance due to the increasing number of cases yearly. Almost half of the 26 million new STIs that occurred in 2018 were among young people 15-24. An opportunity existed in a rural pediatric primary clinic, for improved adherence to Centers for Disease Control and Prevention (CDC) or American Academy of Pediatrics (AAP) recommendations to screen/test patients. An evidence-based project (EBP) was developed to address this concern. Project objectives included: developing STI screening guidelines for pre-teen to young adults, developing a screening algorithm, providing alternative testing options, improving provider knowledge on STI testing/treatment, and increasing STI surveillance. A STI screening/testing guideline was developed/implemented in this facility. Project methods included a pre-and post-implementation survey, PowerPoint presentation, and data collection. In June-August 2020, two patients were tested for STIs based on symptom presentation. Since STI guideline implementation, 40 patients were screened in July 2021-September 2021, with 7 patients tested via CDC guidelines. The post-evaluation survey showed significant improvement in overall confidence/ knowledge the providers/staff felt regarding STI screening/testing. Outcomes of this project included a 250% increase of STI testing, improvement in provider/staff knowledge of STI screening, and increased staff comfort with STI conversations. We encourage pediatric providers to implement STI screening protocols in their practice as screening can lead to earlier detection/diagnosis of STIs and improved patient outcomes
Implementation of Written Discharge Instructions for Common Diagnoses in the Urgent Care Setting
Get PDFAbstract
Discharge instructions are an important tool providers use to communicate information to patients about their medical diagnosis after they return to their home environments. When patients understand and follow discharge instructions there are improved outcomes, fewer callbacks, and decreased return visits. The purpose of this quality improvement project were (a) to develop and distribute discharge instructions at or below a sixth-grade reading level, (b) on common diagnoses appropriate for a rural community, (c) decreased the need for subsequent office visits, and (d) decreased call volumes at a rural walk-in clinic. A large-scale literature review was conducted to determine the most appropriate literacy level for patient summaries, to examine the benefits of providing written instructions in conjunction with verbal instructions, and to investigate potential barriers to patient adherence and follow up. Pre and post surveys were conducted with both the practitioners utilizing the summaries and with patients who received the written instructions who had previously been evaluated in the clinic and given verbal instructions only. Results demonstrated patients liked the new summaries, found them easy to read, helpful, and referred to the summaries after going home. Practitioners utilizing the new written discharge instructions felt comfortable using and locating the sheets in the internal hard drive. Providers also felt the summaries were beneficial and easy to read. Limitations included the small sample size and inability to incorporate the summaries into the electronic medical record [EMR].
Keywords patient discharge instructions, after-visit summaries, family practice, ambulatory care, urgent care, health literacy, compliance, adherenc
Implementation of Routine Screening to Detect Early Cases of Depression and Anxiety in Hispanic Adolescents in the Primary Care Setting
Get PDFDepression and anxiety are among the leading causes of illness and disability in adolescents and are two of the most prevalent mental health conditions in Latino youth. If left unrecognized and untreated, these conditions can lead to decreased quality of life and increased rates of suicide. Researchers recommend early mental health screening to occur in the primary care setting. Through routine screening using evidence-based screening tools (PHQ-9 and GAD-7), the primary goal of this quality improvement project was to increase early detection of depression and anxiety in primary care and initiate early treatment. Project methods included implementation of new workflow, developing a referral toolkit, and staff education through PowerPoint presentation. Project evaluation assessed pre- and post- survey results and quantitative data from pre- and post- implementation screening. Results indicate all staff (N=2) strongly agreed there was a need for routine screening in their practice, routine screening would help identify early cases of depression and anxiety, and confidence in sustainability. Three-months pre-implementation, screenings were performed during 11 of 38 visits (28.94%); post implementation screenings were performed during 64 of 70 visits (91.43%). Post implementation mental health referrals were provided during 10 of 13 positive PHQ-9 assessments, one patient refused referral and three were missed. All nine positive GAD-7 cases were provided referrals, three patients refused. Routine screening in primary care can facilitate early identification of adolescents who are at risk, leading to early interventions and treatment. Early interventions and treatment can help improve and/or resolve symptoms in the Hispanic population
Mental Health Resources for the Pediatric and Adolescent Populations in the Rural Setting
Get PDFCognitive behavioral therapy (CBT) is a mainstay of treatment for problems such as anxiety and depression. However, access to this form of psychotherapy treatment is limited in rural areas, especially in pediatrics. The purpose of this project was to increase access to CBT through the use of smart phone CBT applications for patients at one rural midwest pediatric clinic. An extensive literature review revealed that mobile cognitive behavioral therapy (CBT) applications can be an effective option for adjunct therapy when provider access is limited. Two CBT mobile applications were selected for the project and training was provided to clinic providers. Patient “CBT homework” sheets were provided as adjunct therapy to patients who presented with anxiety and depression over a three-month period in 2020. Providers assigned seventeen CBT homework sheets over the course of the project, of which twelve patients followed up in clinic and eleven reported using the CBT application. A post project interview with stakeholders and clinic staff found that the “CBT homework” instructions had to be simplified based on the reading level of the parents and patient maturity level. Limitations of the project included inconsistent follow up by patients, choosing the right application for school aged children, decreased follow up due to COVID-19, and limited options for applications for patients to use. For future use, CBT homework sheets should be simplified and include a rationale for how particular techniques work. Future projects should seek to simplify CBT homework sheets and video instructions for the patients