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Development and Implementation of an Enhanced Recovery After Surgery Screening Tool for Orthopedic Patients
Get PDFEnhanced Recovery After Surgery (ERAS) protocols are evidence-based programs utilized by hospitals to improve patient outcomes and decrease perioperative opioid administration, generally associated with abdominal surgeries. With over 850,000 orthopedic surgeries performed in 2016, the volume of operations alone indicates a need for adoption of ERAS protocols within the orthopedic patient population. A review of literature was completed to gather the most current, evidence-based non-opioid components to be included in an ERAS protocol for orthopedic patients at a 460-bed hospital in Missouri. The results showed that Acetaminophen, Celebrex, Gabapentin, and regional anesthesia techniques are the most utilized ERAS adjuncts. With these results, a screening tool was created to determine which components of the ERAS protocol could safely be administered to each patient safely accounting for each patient’s contraindications and comorbidities. Following an ERAS education session for surgical staff and a five-question post-test to assess knowledge levels, the screening tool and a three-question survey measuring staff support for the tool were made available to staff for a period of one-month. Although only four post-tests, 27 screening tools, and three surveys were collected, only 29.6% of patients received all four ERAS components, indicating the importance of screening patients before applying standardized protocols
Implementation of Supplemental Oral Anticoagulant Education to Promote Medication Adherence
Get PDFProper adherence regarding high-risk medications such as oral anticoagulants (OAC) is essential for reducing the incidence of adverse events such as thrombosis or major bleeding when dosages are missed or inappropriately administered.
The goal of this project was to reduce these events by supplementing current educational practices at a metropolitan cardiac electrophysiology office with new medication education protocols, the development of specific medication informational handouts, and provider training. Providers and staff were provided with medication specific education for Vitamin K Antagonists (VKA) such as warfarin and Non-Vitamin K Agonists (NOACs) such as dabigatran, rivaroxaban, and apixaban for those patients initiating anticoagulant therapy and the associated medication handouts.
Formal interviews conducted post implementation revealed that while the education was practical and beneficial for their patients, altering the office culture to include the supplemental education as a standard of care was a major barrier. Further follow up and analysis would need to be conducted to evaluate the long-term impact of this intervention. While small in number, early indicators reveal the cancellations of patient procedures relative to questionable anticoagulation status has decreased. Expansion of this project to other commonly prescribed medications may be helpful in improving medication adherence and reduction of adverse events
Implementation of a Depression and Domestic Violence Screening Protocol in an Internal Medicine Setting
Get PDFDepression is a widespread problem in the United States, yet only 35% of sufferers seek help for their symptoms. Additionally, almost 25% of women and 14% of men report experiencing some form of domestic violence. Both of these conditions can impact short-term and long-term health and overall function. Early detection, treatment, services, and support can improve patient outcomes.
This project initiated the use of two standardized screening tools, the PHQ-2 for depression and the PVS for domestic violence, in an internal medicine practice where no formal screening process had been in place. During the 3-month implementation period, patients of the nurse practitioner provider were screened, so that further assessment and interventions could begin. After this period, staff completed a questionnaire regarding the process. Over 150 unique patients had been screened, and patients who screened positive were offered appropriate treatment and referrals. There did seem to be an increase in patients who were discovered to need intervention for depression and/or domestic violence; however this project was not approved to include specific patient results. Staff reported strong positive opinions about the project.
The screening process has continued at this practice for patients seeing the nurse practitioner. Ideally, the two physician providers in the practice will eventually choose to use this with their patients as well. With willing providers, this project should be easily replicated in other practices
Drag Artist Interviews, 2019
Get PDFThis public dataset contains transcripts of 22 in-depth semistructured interviews with drag artists. Students conducted these interviews during Spring 2019
Preoperative Assessment of Patients in an Enhanced Recovery Program
Get PDFAll patients undergoing surgery are at risk for perioperative morbidity and mortality (Gabriel et al, 2018) and a patient’s physical status plays a key role in patient outcomes (Hopkins et al, 2016). Enhanced recovery programs are intended to improve perioperative outcomes, facilitate postoperative recovery, and reduce loss of functional capacity (Feldheiser et al, 2016). Preoperative assessment allows for identification of risk factors which can be modified, with the aim of decreasing perioperative complications. A small community hospital had no standardized preoperative evaluation tool to use for their enhanced recovery patients. The purpose of this project was to create and implement a surgical preassessment tool which would be easy to use and would identify patient risk factors that could be optimized prior to the patient’s elective surgery. Based on the literature and in collaboration with stakeholders, an evidence based surgical preassessment tool was developed and revised via modification of a preexisting enhanced recovery assessment tool. The surgical preassessment tool was introduced to appropriate staff, was positively received, and now continues to be regularly used at least four weeks prior to surgery via telephone interview
Patient Assessment and Provider Education Regarding Antibiotic Use in the Treatment of Viral URIs in the Urgent Care Setting
Get PDFImproving Antibiotic Stewardship Through the Use of Patient Assessment and Provider Education Regarding Treatment of Viral URIs in the Urgent Care Setting
Candra Kronewitter and Ashlee Schoby
Date of Award
Spring 5-2020
Document Type
DNP Project
Project Team Faculty Member
Mary Zerlan, CRNA, DNP, APN
Project Team Faculty Member
Kay Gaehle, PhD
Keywords
Antibiotics, Antibiotic stewardship, URIs, Upper respiratory infections, Urgent care, ABUSE screening tool
Abstract
Antibiotic-resistant bacteria is a growing problem in the United States. The misuse or overuse of antibiotics is being considered the leading cause. Nearly 2-million individuals are infected with resistant bacteria yearly, and antibiotics prescribed for URIs accounted for three-quarters of all antibiotic prescriptions.
Collaboration with a local Urgent Care system was created, to implement a program designed to help decrease the amount of unnecessary antibiotics prescribed for viral illnesses. Implementation included a needs assessment tool, used for evaluation of patient care, development of an educational pamphlet for patients, and providing continued education to providers, to promote antibiotic stewardship. The ABUSE (Antibiotic-Use Screening Evaluations) tool was used in the assessments.
During evaluation, 26 patient surveys were completed and 88% did not report asking for an antibiotic during the visit. Compliance with recommended treatment was 81%. Provider evaluation indicated, 54% of antibiotics were prescribed based on patients’ expectations and attitudes, and 31% - 35% would forget or neglect proper antibiotic education.
Half of the surveys, completed by providers, specified verbal education, the educational pamphlet, and the patient knowledge pre-assessment aided in a positive outcome of the visit, and positively impacted their further practice for patient care.
Recommended Citation
Kronewitter, Candra., Schoby, Ashlee. “Improving Antibiotic Stewardship Through the Use of Patient Assessment and Provider Education Regarding Treatment of Viral URIs in the Urgent Care Setting” (2020). Doctor of Nursing Practice Projects.
https://spark.siue.edu/dnpprojects
Hepatitis C Screening Protocol in a Rural Primary Care Setting
Get PDFCurrent evidence indicates a need for Hepatitis C Virus (HCV) screening, as the virus can lead to complications if not detected early. Screening is determined by population-based risks, behavioral-based risks, and healthcare-based risks. After criteria are met, patients can be screened by a venous laboratory test. A gap existed in a rural primary healthcare clinic, as providers were not following Centers for Disease Control and Prevention (CDC) or U.S. Preventative Services Task Force (USPSTF) recommendations to screen patients. An HCV screening protocol was developed and implemented in this healthcare facility. The providers opted to only implement screening for population-based risk patients; therefore, the providers focused on screening those born between 1945-1965. During initial implementation, a chart review was conducted. Of the 67 patients who met criteria, 27 patients were offered HCV screening. A major limitation to screening appropriate patients included lack of pre-visit planning within the healthcare facility. Even with this limitation, we encourage other providers to implement HCV screening protocols in their practice as screening can lead to earlier diagnosis of HCV and improved patient outcomes
CVD Screening Protocol for History of Hypertension in Pregnancy
Get PDFThe American College of Obstetricians and Gynecologists (ACOG) and the American Heart Association (AHA) recommend women with a history of hypertension during pregnancy receive annual blood pressure monitoring, weight check, and lipid screening; remain in the optimal body mass index (BMI) range; and obtain education on future risks for cardiovascular disease (CVD). At a small, Midwestern primary care clinic, there is not a current process in place to ensure patient education and screenings are provided for patients who meet this criterion. For this project, two check boxes were added to the providers’ annual exam template in the electronic health record (EHR) to indicate history of hypertension in pregnancy and indication that education was provided. Providers were introduced to the practice change by PowerPoint presentation. To evaluate the project, data was collected and provided by the clinic’s Quality and Data Analyst RN, including provider participation, percent of total women screened, and compliance with practice change. Only 20% of providers utilized the documentation changes; therefore, all other data analysis was insignificant. We recommend an on-site project team or individual who can encourage compliance, monthly auditing, and feedback to each provider regarding their individual performance
Dedicated Preceptors Improve Nurse Residency
Get PDFResearch and evidence support the use of dedicated preceptors during new nurse residency programs to increase nurse retention after the orientation period. A small rural Illinois hospital introduced a nurse internship program in 2017 without the use of dedicated preceptors. The program continued throughout 2018 and nurse retention did not improve as anticipated by the hospital leadership. In early 2019, this author collaborated with the education department to implement a new nurse orientation program that introduced the use of dedicated preceptors. An education bundle was developed and presented to the dedicated preceptors outlining expectations and an orientation checklist. Pre-implementation focus groups were conducted to identify shared themes expressed by both the dedicated preceptors and new nurse orientees. In March 2019, the hospital merged with a larger hospital corporation. The leadership of the larger hospital was not in alignment with the use of dedicated preceptors because of financial considerations. In May of 2019, in response to high nurse turn over and a shortage of nurses, this author implemented the new nurse residency program using dedicated preceptors as a doctoral project. However, by May 2019, many new graduate nurses finished orientation and did not remain with the organization. The nurse residency program with dedicated preceptors was developed and implemented but was unable to be operationalized due to financial considerations and difficulty coordinating the work schedules of new graduates and dedicated preceptors. As a result, no positive or negative impact on the retention of new nurse graduates resulted. In spring 2020, the hospital administration will reimplement a newly developed nurse residency program using dedicated preceptors that was developed during the doctoral project. Statements from the pre- and post- project focus groups indicated support for dedicated preceptors. Utilization of the comments collected during the focus groups resulted in identification of common themes and will provide a base for an innovative pathway for onboarding new nurse graduates
A Kaczmarz algorithm for sequences of projections, infinite products, and applications to frames in IFS 2 spaces
No full textWe show that an idea, originating initially with a fundamental recursive iteration scheme (usually referred as “the” Kaczmarz algorithm), admits important applications in such infinite-dimensional, and non-commutative, settings as are central to spectral theory of operators in Hilbert space, to optimization, to large sparse systems, to iterated function systems (IFS), and to fractal harmonic analysis. We present a new recursive iteration scheme involving as input a prescribed sequence of selfadjoint projections. Applications include random Kaczmarz recursions, their limits, and their error-estimates