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A geometric description of the set of stabilizing PID controllers
Get PDFThis article developed a new method to described the set of stabilizing PID control. The method is based on D-parameterization with natural description of the set. It was found that the stability crossing surface is a ruled surface that is completely determined by a curve known as discriminant. The discriminant is divided into sectors at the cusps. Corresponding to the sectors, the stability crossing surface is divided into positive and negative patches. A systematic study is conducted to identify the regions with a fixed number of right half-plane characteristic roots. The crossing directions of characteristic roots for positive patches and negative patches are also studied. As a result, a systematic method is developed to identify the regions of PID parameter such that the system is stabilized
Implementing an Evidence-Based Multifactorial, Multidisciplinary Fall Prevention Program in a Nursing and Rehabilitation Center to Reduce Fall Rates among Patients
Get PDFFalls are the leading cause of morbidity and mortality in the elderly in the United States. Patients in long-term care facilities are at increased risk for falls, accounting for 20 percent of fatal falls that require hospitalization. The economic and social burden of falls and fall-related injuries is significant. Fall-related injuries and their resulting expenditures are expected to increase substantially with the increasing aging population making this a problem of high priority. The literature recommends and supports incorporating evidence-based fall prevention initiatives into long-term care facility safety programs to address this problem. Based on the literature review and the facility\u27s needs, a quality improvement project was implemented at a 180-bed long-term care facility in the north side of Chicago whose fall rate of 12.2 is five times higher than the national average of 2.74-5.48 per 1000 bed days. The project\u27s purpose was to increase patient safety by adding new evidence-based fall prevention interventions to the facility\u27s existing fall precautions to reduce fall incidences over time. The new fall prevention program included staff education, utilization of Morse Fall Score for fall risk assessment, incorporation of post-fall huddles, and creation of multidisciplinary fall prevention team and fall champions. Five weeks after implementing the program, data analysis showed a 40 percent reduction in fall rates, which suggests that adhering to the new fall prevention initiative may decrease the burden of future falls in this facility
Physical Well-being and Healthy Lifestyle Options
Get PDFBackground
The AANA has identified stress management or wellness as a priority for all CRNA programs. The Health and Wellness Initiative put in place by the AANA in 2004 is a model designed for all SRNA programs and intended to address students’ participation in wellness events in order to combat stressors.
The primary purpose of this project was to gain information about the stress faced by SRNAs enrolled at a Midwestern University and to evaluate strategies that could help students properly deal with stress.
Methods and Evaluation
Fifty-five students participated in the survey, data were compared by year in the program. All students reported an increase in stress levels once they entered the CRNA program. The average change in reported stress from prior to anesthesia program entry to during school was a 29% increase for baseline stress levels and a 32% increase for peak stress levels. Students indicated the current Health and Wellness Program was “not very helpful”. The results indicated that the SIUE Wellness Events were most effective. Students would prefer not to have writing assignments, or other learning modules assigned to them which they view as merely “busy work”.
Conclusion
The immediate impact for this project will be to present the findings to the CRNA Program Administrators, it will be recommended that the Health and Wellness Program be revised to a format more conductive to students’ wellness with changes implemented consistent with students’ survey responses such as a self-guided wellness program
Evaluating Unexpected Outcomes with a Change in Practice
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Quality improvement projects improve processes for delivering safe and effective care to patients. Most protocols can be implemented successfully, but what factors lead to an unexpected outcome? This project sought feedback from anesthesia providers after a protocol for administering intranasal midazolam instead of intravenous midazolam in older adults during cataract removal had unfavorable results. Using the concepts developed by Proctor et al. (2010) to analyze the feedback from the anesthesia providers, this project sought to understand why this change in practice elicited these unfavorable results.
The goal of the change in practice was to improve turnover times and reduce resources by eliminating the need of placing an intravenous catheter for a procedure lasting less than 10 minutes. This project examined why this change in practice received unfavorable results by seeking input from anesthesia providers and perioperative nurses using open-ended questions. Upon examination of their feedback, the project investigator found patient dissatisfaction with the route of medication administration and provider’s inability to monitor dosage. Additionally, COVID restrictions imposed at the time provided opportunities for the project investigator to provide a self-evaluation of implementing a project during a very restrictive time that might not otherwise occur. Lessons learned from implementing a project during unconventional times can be invaluable to future DNP students and healthcare providers
Addressing Referral Discrepancies for Hyperglycemia Diagnosis Codes
Get PDFDiabetes mellitus and prediabetes affect 34 million and 88 million Americans, respectively. The early detection and management of elevated blood glucose levels is fundamental to preventing comorbid complications. While other countries have published referral guidelines, the United States is lacking in practice standards. At a central Illinois healthcare institution, the diagnosis code for elevated blood glucose (R73) was noted at a higher rate than endocrinology referrals. The purpose of this retrospective investigation was to explore the root causes of this disproportion through deidentified patient data. The average number of wait days for an endocrinology appointment was investigated and found to be 90 days. The prevalence of R73 codes in family and internal medicine, along with their referral rates to endocrinology were evaluated. There was inconsistency of diagnosis codes, referral rates, and ages of patients between departments, as well as incomplete referrals. Based on the gathered data, evidence-based solutions were identified to improve the referral process to endocrinology. There are numerous implications for future practice: (a) to improve availability and reduce wait times, a cost-benefit analysis can be conducted to determine the benefit of an additional endocrinology provider; (b) to expedite endocrinology referrals, a process analysis can be conducted to address delays, and (c) an algorithm can be created to target at-risk populations to standardize R73 coding and referrals. Long-term implications of these interventions will be improved treatment and reduced morbidity and mortality in this patient population
Lung-Protective Ventilation Across the Lifespan: Implementation of an Intraoperative Protocol for Adults and Pediatrics
Get PDFTraditional ventilation strategies have been shown to lead to the development of lung injury and postoperative pulmonary complications. Lung-protective ventilation (LPV) strategies for adults include low tidal volumes of 6-8 mL/kg based on ideal body weight, moderate levels of positive end-expiratory pressure (PEEP), incremental recruitment maneuvers routinely and as needed, and low fraction of inspired oxygen. Recommendations for pediatrics are similar, with some suggesting a more liberal limit for tidal volumes of less than 10 mL/kg based on predicted body weight. However, adoption of LPV strategies is not universal. Completed objectives of this practice project included thoroughly reviewing literature relating to contemporary intraoperative LPV strategies, synthesis of findings into a list of recommendations, presentation of these recommendations to anesthesia providers at the host facility, programming new recruitment maneuver functions into facility ventilators, and providing a laminated infographic to encourage compliance. After the presentation, 20 staff members voluntarily completed an anonymous questionnaire. Results indicated the educational presentation increased provider knowledge of LPV, and most respondents expressed willingness to support implementation of the strategies. Additionally, a large majority of respondents reported confidence that implementing LPV strategies would improve patient outcomes
Improving Skin Cancer Screening in Primary Care
Get PDFSkin cancer is one of the most common forms of cancer in the United States, with melanoma having the highest rate of mortality of all forms of skin cancer (CDC, 2019). However, there is hesitancy among primary care providers to perform skin cancer screenings (Oliveria et al., 2011). Prevention and early detection of melanoma is key. Melanoma has been known to be highly curable when found early. This makes early detection even more important in order to prevent metastasis and potential mortality (Bruce et al, 2017). The use of targeted screening tools can potentially save lives when utilized in primary care. This project was carried out in a rural, Midwestern public health clinic. The implementation of the SAMScore questionnaire was completed for adult patients seen during office visits from August 24, 2020 through November 25, 2020. Providers involved in the project reviewed survey answers with patients to determine level of risk. Dermatology referrals were recommended to those found to be high-risk. All patients involved in this project were provided education on skin cancer and preventive measures. Of the 19 patients screened, four were found to be high-risk for melanoma with one patient being diagnosed with melanoma after referral to dermatology. This project provided not only an educational opportunity for patients, but it also brought forth a screening method that is quick, concise, and financially feasible. Although this project consisted of a small sample size, future replications can easily be implemented in a larger and more diverse primary care setting
Implementation of a Standardized Care Pathway for Ureteral Stents Patients Across the Continuum of the Acute and Ambulatory Setting: A Quality Improvement Project
Get PDFUreteral stents are one of the most used urologic devices to create and preserve ureteral patency. Side effects after ureteral stent placement have a high prevalence, and stent related pain has been reported to affect over 80% of patients. This Quality Improvement Project aimed to develop a standardized care pathway through education and pharmacological management for patients after ureteral stent placement. Specific goals included reducing readmission rates to the emergency department (ED), reducing the patient’s phone calls to the urology clinic, and improve patient satisfaction. The protocol developed for the project included discharging patients with an alpha- blocker, an anti-cholinergic, pain medications and post-procedure educational material. An educational presentation was provided to the nurses and stakeholders about the protocol. The outcome measures examined were the number of patients returning to the ED and the number of phone calls to the urology clinic after ureteral stent placement. The findings demonstrated a positive trend towards a decreased number of patients returning to the ED and the number of calls to the urology clinic after the procedure. The findings showed that a standardized plan of care can reduce the number of ED returns, reduce the number of phone calls to the urology clinic and improve care
Evaluation of High Fidelity Simulation Debriefing Methods for Nurse Anesthesia Students
Get PDFSimulation for Student Registered Nurse Anesthetists has become an educational tool that provides valuable learning experiences that integrate problem-solving, prioritization, and critical thinking skills. Debriefing is an essential aspect of the simulation learning process. The debriefing period allows the debriefer to direct the students’ self-reflection and provide individualized feedback. Faculty members delivering the simulation curriculum at a midwestern university, with over 75 nurse anesthesia students, sought education regarding the various simulation debriefing methods. After conducting a literature review for the best evidence supporting debriefing methods, faculty education was implemented in the form of an interactive computer-based learning (CBL) module. The debriefing methods included in the CBL have been shown to enhance student learning during high fidelity simulation and are supported by the International Nursing Association for Clinical Simulation and Learning. The CBL proved to be effective based on the average score of 86.6% among the eight participants. All eight participants exceeded the established benchmark score of 80% set by the primary investigators before implementation. Based on a 7-point Likert scale, participants indicated they were most likely to utilize the Plus-Delta model (mean = 6.1) or the Gather, Analyze, Summarize model (mean = 5.7) as their chosen debriefing method. As research develops, the effectiveness of specific debriefing methods should be explored. The educational and training requirements for any recommended debriefing method should be considered before implementing an institution’s standardized debriefing process
Opioid Screening in the Primary Care Setting
Get PDFImplementation of an Opioid Risk Assessment Tool in the Primary Care Setting