3511 research outputs found
Sort by
A Difficult Vascular Access Algorithm Using Intraosseous Devices in the Elective Pediatric Surgical Population
Get PDFIn pediatric patients undergoing elective surgery, anesthesia is commonly induced via mask inhalation followed by peripheral IV placement before proceeding to airway management. However, IV access is often unpredictable and difficult to obtain in pediatric patients, with attempt success between 35% to 74%. During IV attempts, many dangerous clinical situations can occur amid limited options to deliver necessary medications. Failure to attain IV access may ultimately require extremes such as CVC placement or procedure cancellation. In this project, a difficult vascular access algorithm including intraosseous devices as an alternative was developed based on current evidence, existing algorithms, and implementation site needs. The algorithm was approved as appropriate use by the device manufacturer. Anesthesia providers were educated on intraosseous use, contraindications, and complications for elective pediatric anesthesia and supplied copies of the algorithm. Seven anonymous surveys were then collected, and discussion followed. Although discussion revealed barriers precluding site agreement to implement the project algorithm, this project made a positive impact on the anesthesia group. Providers unanimously reported an increase in knowledge and comfort using intraosseous devices for pediatric elective anesthesia. Providers also reported that they would more rapidly seek IV placement assistance and utilize alternative methods to expedite vascular access
Trauma Informed Care: Paving the Way to Better Patient Outcomes
Get PDFTrauma-informed care (TIC) is an approach that enables healthcare clinicians to understand the effects of trauma and create a safer environment. Providers acknowledge the pervasive nature of trauma but lack proper tools and training to implement. It has been suggested that trauma is the prime determinant of health outcomes. Therefore, providing training and cultivating a change towards a trauma-informed organization, has the capability to change health outcomes.
The purpose of this project was to establish a program at SIU Medicine in which new employees are trained on the importance of TIC. Working closely with the Director of Population and Community Health Integration at SIU Healthcare, we began the project by developing education modules to be presented at new employee orientation. We subsequently presented information at each session throughout the summer. After each presentation, we surveyed new employees to better understand their reception to TIC. Evaluation through survey and focus groups indicated positive trends and a move towards changing culture. Participants were receptive to the information and offered many questions with how TIC will look in their own individual workplaces throughout SIU. Implementing education was the first step to creating a trauma-informed organization which serves many high-risk patients in central Illinois
A Pilot of Prenatal Transitional Care Services in the Urgent Care Setting
Get PDFEstablished prenatal care leads to better outcomes and reduced healthcare expenditures. Inadequate prenatal care is associated with numerous risks. Many women face a variety of barriers that contribute to inadequate prenatal care. The purpose of this project was to create and pilot a new transitional care protocol to improve the referral rate of pregnant patients to establish prenatal care at a midwestern physician services (MPS) women’s health care clinic after a MPS express care visit. An extensive literature review was conducted, and a streamlined referral process linking pregnant patients to obstetric care was created to address identified barriers. The referral process was evaluated by a focus group consisting of the stakeholders. Results showed nine referrals sent resulting in two patients who established prenatal care with the MPS women’s health care. The focus group of stakeholders were happy with the new process and it will be continued as a new referral protocol at all MPS express care locations. Limitations found include the three following themes: staff shortage, inconsistency in the process, and non-applicable referrals. This project was used as a pilot to create a streamlined internal referral process that MPS can easily use to for other specialties across the system
The Development of a Pain Medication Management Protocol
Get PDFImplementation of an organization-wide pain management policy incorporates a multifaceted team approach that could lead to improved patient outcomes. The absence of a standardized opioid prescribing policy within a healthcare organization has led to individual departments adopting their own guidelines. Management of an individual patient’s pain medication is often met with reluctance from providers when a patient is transferred from another department leaving the patient with inadequate care
Computer Based Learning Module: Neuraxial and Peripheral Nerve Blocks
Get PDFNeuraxial and peripheral nerve blocks (PNB) have been present for many years, but recently these pain management techniques are gaining popularity as an alternative to the use of opioids. Neuraxial and PNB reduce the opioid usage during and after the surgery and improve postoperative recovery in terms of pain relief, pain-related sleep disruption, and reduction of side effects, such as nausea and vomiting. Conversely, inadequate pain management after surgery may delay surgical recovery, decreased patient satisfaction, increased length of hospital stay, increased readmissions and healthcare costs (Patacsil, McAuliffe, Feyh, & Sigmon, 2016).
Perioperative nurses are instrumental during the post-operative period in assessing and monitoring the patient’s various blocks to prevent complications and improve outcomes. Therefore, it is important that education be provided for perioperative nurses to enhance their understanding of these blocks. This project aimed to implement a computer-based learning (CBL) about neuraxial and PNB for perioperative nurses. Total of 257 perioperative nurses participated in completing the CBL. The results of this project indicated the CBL improved 209 perioperative nurses understanding of neuraxial and PNB. Developing a survey to gain insight into the quality of the CBL is recommended for the future projects
Implementation of Crisis Checklist for Local Anesthetic Systemic Toxicity (LAST) in the Parturient Patient
Get PDFThe chief anesthesiologist at a large hospital in Illinois requested education and a checklist on the treatment of Local Anesthetic Systemic Toxicity for the medical team involved in the care of parturient patients. The implementation of The Stanford Anesthesia Cognitive Aid Group checklist for LAST and an educational session was completed for all staff involved in the care of the parturient patient. A PowerPoint presentation was utilized to educate on the early recognition and treatment of LAST. The presentation was implemented at the obstetrics department staff meetings and the monthly anesthesia department meeting. A pretest was completed prior to education and results were compared to the posttest distributed after the information session. This project assessed the impact of education on LAST and the implementation of a standardized checklist. The results revealed the staff had a solid, basic knowledge of local anesthetic systemic toxicity which improved after the education. A survey completed by the staff reflected, they feel confident implementing the checklist, if needed, and that the education improved their knowledge of LAST. It is imperative that nurses are aware of the early signs and symptoms of LAST to potentially prevent a fatal situation. The implementation of a standardized checklist improves practitioner practice by enhancing the safety for mother and fetus. The knowledge gained by the staff is empowering patients benefit in the long-term. Future work could include yearly education on recognizing the signs and symptoms of LAST and review of the checklist
Optimizing Data Accessibility to Impact BCMA Compliance
Get PDFBackground: The integration of health information technology (HIT) is an expectation during the healthcare delivery process to ensure quality and accuracy. Data generated from HIT can help facilitate quality initiatives. HIT such as Barcode Medication Administration (BCMA) has been successfully introduced in the healthcare industry with a demonstrated positive impact on patient safety. A small test of change was implemented on a Medical Surgical (MS) and Intensive Care Unit (ICU) which included automated daily BCMA compliance reports sent to leadership compared to the current standard process.
Objectives: To examine impact of reports on the BCMA compliance data. To examine leadership perception of reports on accessibility and usability of BCMA compliance data.
Methods: Daily automated reports were developed and sent to nursing leadership. A detailed weekly report was developed and disseminated at leadership request. The System Usability Scale (SUS) was used to evaluate the daily and weekly report’s perceived usability from nursing leadership.
Results: BCMA compliance showed slight improvement in both units (0.40%-1.61%). MS compliance improved during daily automated reports while ICU improved showed after detailed, weekly reports. Results of the SUS showed large range in variation of usability scores for daily (42.5-90) and weekly (57.5-92.5) reports per leader. Both reports scored average usability (daily=60, weekly=79.16).
Conclusions: Preliminary results of this test of change showed a small increase in BCMA compliance, which can translate to thousands of additional scans annually. Perceived usability scores increased when more detailed data was made available in weekly reports for trending analysis
Implementing Quality into Practice: Nurse Driven Protocol to Reduce Unnecessary Telemetry Use
Get PDFAbstract
Background: As part of the American Board of Internal Medicine\u27s Choosing Wisely initiative, the Society of Hospital Medicine issued the recommendation to reduce unnecessary use of continuous telemetry monitoring in the inpatient setting. Outside of its primary purpose continuous telemetry monitoring rarely positively impacts clinical decision making and overuse can lead to unnecessary and costly diagnostic work-ups, cause alarm fatigue, lead to emergency department congestion, and increase institutional financial burden.
Objective: Pilot an evidenced based nurse driven protocol for discontinuation of continuous telemetry monitoring to reduce unnecessary telemetry use among adult patients hospitalized outside of the intensive care unit.
Methods: The project setting was 19-bed medical/surgical acute care unit. Inclusion criteria included adult patients admitted to the project site with a provider order for continuous telemetry monitoring. A nurse driven telemetry discontinuation protocol was developed using the AHA Monitoring Practice Standards and existing hospital policy. Charge nurses used the protocol to determine patient eligibility for discontinuation of continuous telemetry without requiring provider consultation. The primary outcomes measure was total number of telemetry monitors discontinued during the 92-day project period.
Results: In the 90-day project period, 45 telemetry monitors were discontinued using the nurse driven protocol. Based on the estimated average cost of 3,709.80 and 30 hours of nurse time.
Conclusion: A nurse driven telemetry discontinuation protocol was effective in decreasing unnecessary telemetry use
Lexical complexities in the St. Louis dialect island
Get PDFThe Greater St. Louis “dialect island” poses interesting problems for dialect documentation, partly because Greater St. Louis is a transitional area where many overlapping linguistic influences have left their mark, and also because is an area with new immigrant communities, racial divides, and an aging population.Using a sample from survey and interview data from 815 participants over a seven-year period, we examine lexical diversity in Greater St. Louis, comprising counties both in Missouri and Illinois. We discover that both age and place are robust indicators of lexical selection in Southern Illinois and St. Louis. Our findings provide a concurring rationale with phonologically-based studies that supports the existence of a unique dialect island in Greater St. Louis
Improving Outcomes for Patients with OSA Receiving Anesthesia
Get PDFObstructive Sleep Apnea (OSA) is a dangerous sleep disorder that is rising in prevalence, afflicting 29.4 million Americans or 12% of the U.S. population (AASM, 2017). Although OSA has the ability to negatively impact postoperative outcomes, numerous patients remain undiagnosed, unidentified, and improperly treated for OSA at the time of surgery (Baugh, 2013; Opperer et al., 2016). Evidence supports the STOP-BANG questionnaire as an effective, easy to use, and highly sensitive tool for screening patients for OSA (Chiu et al., 2016; Dolezal et al., 2011; Lakdawala, Dickey, & Alrawashdeh, 2018).
A 137-bed hospital had no standing preoperative protocol for the assessment of OSA. Using evidence-based materials, the staff was provided the education needed to identify patients with undiagnosed OSA by using the STOP-BANG questionnaire during surgical assessments. An evaluation survey was provided to the staff to evaluate the effectiveness of the training; the results were positive. Although training was completed, and staff was supportive, full implementation of the questionnaire did not occur due to lack of leadership support, unreliable inter-professional communication, and inconsistent staff and work schedules. The STOP-BANG questionnaire is not currently in use, and to date, no patients have been evaluated for OSA