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Improving Acute Pain Management for Pediatric Patients: Development of a Ketamine Infusion Protocol
Get PDFMultimodal analgesia is a recommended approach for acute pain management for adults and children (ASA, 2012; Chou et al., 2016). This approach is becoming a prominent modality in pain control strategies in the pediatric population. An intravenous anesthetic, ketamine, may be a useful adjunct for acute pain management in children. Development of a pediatric ketamine infusion protocol and its subsequent introduction to the key stakeholders at the host facility in central Illinois were the focus of this project. Research has demonstrated the effectiveness of low-dose intravenous ketamine in acute pain management when used as an adjunct to other medications (Asadi et al., 2016; Cha et al., 2012; Elshammaa et al., 2011; Jabbour et al., 2014; Safavi et al., 2012). This project utilized a non-experimental design which included a verbal educational presentation with subsequent survey dissemination. The results of the survey analysis implied the education improved the participants’ knowledge regarding acute pediatric pain management. Additionally, the assessment demonstrated the staff’s support for implementation of the proposed low-dose pediatric ketamine infusion protocol. Therefore, the application of the pediatric ketamine infusion protocol at the host facility has the potential to improve acute pain outcomes in children
Integration of Mental Heath Screening Protocol in Primary Care for Patients Who Have Experienced Traumatic Events
Get PDFMental health status is not always assessed in patients involved in a physically traumatic event unless the patient expresses concern. Often times, orthopedic injuries are a result from a traumatic event. Routine mental health screening in the primary care orthopedic setting can help identify mental health care needs early so that adequate interventions can be implemented in a more effective manner. The goal of this project was to evaluate the feasibility of incorporating the use of a brief mental health screening tool in a primary care setting to assess the psychological needs of patients who have been involved in a physical traumatic event. The healthcare staff at an urban orthopedic clinic were educated on the use of the Patient Health Questionnaire (PHQ-4). Post-education surveys were collected. The staff noted that there was a need to implement this protocol in their orthopedic-trauma setting and that it would be feasible to implement. An evidence based protocol was developed and provided to the staff delineating what care interventions would be needed according to the patient’s PHQ-4 score. Further work is needed to evaluate if long term implementation would be successful at this site
Increasing Utilization and Awareness of an Existing Patient Portal Application
Get PDFPatient portal applications (PPAs) are secure website or computer/mobile device applications that allow 24-hour access to a patient’s electronic health record (EHR). Patient portal applications are intended to improve quality and access to health care by engaging patients to be more active in managing and monitoring their health. A large Midwest multispecialty organization’s Follow My Healthpatient portal application (FMH app) is underutilized by patients and providers. While evidence supports the use of web-based patient portal applications, only 17% of this organization’s patients use the FMH app, and even less use its direct messaging capabilities.
The purpose of this project was to increase awareness and use of the existing PPA at the clinic. This was accomplished through interviews, assessing patients’ knowledge and usage. Interviews were aimed at educating and raising patients’ awareness of the benefits and key features of the FMH app.
More than half (61%) of the patients who were previously aware of the PPA reported being active users of the application. By contrast, only 39% knew about the PPA but were not users.Results of the quality improvement initiative indicated a technology limitation as the most common reported reason for lack of PPA usage. It was concluded that increasing patient use and awareness of PPAs can be challenging for healthcare providers. Continued research, discussion, and advancement of PPAs will be necessary for portals to fully live up to the capability of empowering patients to manage and track their own healthcare, provide meaningful use of EHRs, and enhance patient–provider communication
Using an Electronic Health Record Alert System to Screen and Manage patients with Diabetes Mellitus Type 2 in a Rural Primary Care Setting
Get PDFDiabetes Mellitus type 2 is the 7th leading cause of death and affects nearly 10% of the US population. Early detection of this condition leads to the initiation of treatment and lowers the risk for complications and better outcomes. Frequent testing of hemoglobin A1Cs in those already diagnosed also leads to better management, glycemic control and improves health outcomes. This project utilized a feature in the electronic health record system of a rural primary care clinic to remind providers to screen at-risk patients and retest those who were either due or overdue for hemoglobin A1C testing. Hemoglobin A1C readings were compared three months prior to implementation and three months post implementation. The overall number of screening and monitoring hemoglobin A1C readings ordered increased and newly identified cases rose nearly 4%. There was an overall decrease in the number of hemoglobin A1C readings above 7%. This clinic enjoyed success with a reminder system and has incorporated it into daily practice. This reminder system can be streamlined to work more efficiently and expanded to other primary care settings to lead to better outcomes for patients with diabetes Mellitus type 2
Adequate Pain Control with Ofirmev to Minimize Narcotics Consumption and its Side Effects
Get PDFTypically, perioperative pain has been managed with opioids, however, the extreme use of opioids has been associated with respiratory depression, excessive sedation, drowsiness, nausea, vomiting, ileus, severe constipation, prolonged hospital stay, addiction, and dependence. The American Society of Anesthesiologists Task Force on Acute Pain Management recommends that patients should always receive non-opioid analgesics like Acetaminophen and NSAIDs as first-line agents so that opioids can be used as adjunctive agents to minimize opioid-related side effects, addiction, and dependence (The American Society of Anesthesiologists, 2011).
A protocol was developed to help providers use Ofirmev effectively and efficiently. The goals of this project are to provide a reference tool and education for providers at a southern Illinois hospital about the effective use of IV Tylenol. The ultimate goal is to incorporate its use clinically and therefore minimize the perioperative use of opioids/narcotics and its associated side effects.
The protocol and a PowerPoint presentation regarding the benefits, risk, cost, dosing, re-dosing intervals, and contraindication regarding the use of IV Tylenol was given to the providers. Pre and Post surveys served as evaluation tools
Language documentation in the aftermath of the 2015 Nepal earthquakes: A guide to two archives and a web exhibit
Get PDFWe describe two institutionally related archives and an online exhibit representing a set of Tibeto-Burman languages of Nepal. These archives and exhibit were built to house materials resulting from documentation of twelve Tibeto-Burman languages in the aftermath of the 2015 Nepal earthquakes. This account includes a detailed discussion of the different materials recorded, and how they were prepared for the collections. This account also provides a comparison of the two different types of archives, the different but complementary functions they serve, and a discussion of the role that online exhibits can play in the context of language documentation archives
Building a Diverse Curriculum: The Role of Diversity Across Communication Coursework
Get PDFThe present study utilizes student essays about diversity to examine ways in which students are exposed to diversity as communication majors throughout their coursework. Four themes emerged from this analysis. First, students became more aware and open-minded. Second, their understanding of different viewpoints and cultural differences increased. Third, they learned about diversity in an array of courses. Finally, their communication curriculum became more connected and relevant to their use and evaluation of media, journalism, and film
Heart Failure Knowledge among CNAs in a Skilled Nursing Facility: A Pilot Project
Get PDFHeart failure (HF) is one of the leading causes of hospitalization among patients over the age of 65 years. Many are transitioned to skilled nursing facilities (SNF) following hospital discharge. HF-specific SNF staff education was designed for early detection of changes and improved management of this patient population. Computer-based education modules and hands on skill demonstration stations were created to provide basic HF knowledge and specific guideline recommended care measures for the SNF environment. A pretest, post-test, and skill demonstration were implemented and included weight assessment, application of compression stockings, volume status monitoring, and low sodium diet recommendations. Pretest scores ranged from 4 to 10 (M = 7.8, SD 1.4) and post-test scores ranged from 6 to 10 (M = 8.9, SD 1.0). This demonstrated a significant improvement in knowledge (p \u3c .000). This pilot study demonstrated that a sustainable staff education intervention will improve knowledge based on current guidelines and skill in the SNF environment. This is necessary for quality care delivery and decreased HF related rehospitalization. Further study is warranted that explores implementation of this educational program in other SNFs and assessment of long-range outcomes
Update of blood transfusion protocols at a regional hospital in rural Illinois
Get PDFThe chief nursing officer (CNO) at a small regional hospital in rural Illinois requested an update to their blood transfusion policy and protocol based on current evidence-based information. These documents were updated with current information on safe assembly and delivery, identification of transfusion reactions, and appropriate responses to these reactions. In collaboration with the CNO and Quality Improvement Committee (QIC), drafts of a new policy and protocol and a Blood Transfusion Skills Checklist were developed. These documents were presented at a hospital-wide Skills Lab Day to registered nurses employed at the facility. A Likert Scale evaluation survey was presented to assess the quality of the informational presentation and the feasibility of the Skills Checklist. The majority of responses indicated that the nurses found the presentation and Skills Checklist were presented in an easy to understand fashion and the information will benefit future practice. Overall, the project was successful in its goal to educate nurses about blood transfusion procedure and safety. Changes to the policy and protocol were supported by the QIC but were not yet officially approved. Future work could include the development and implementation of a simulation experience based on symptoms that present during a blood transfusion reaction
Implementation of Provider Education for a Subanesthetic Ketamine Infusion for Acute Analgesia in Opioid Tolerant Postpartum Patients
Get PDFThe current opioid epidemic demands the development of new management policies and staff education to increase awareness of issues and improve care of patients with Opioid Use Disorder (OUD). A recent dramatic increase in OUD during pregnancy has paralleled the epidemic observed in the general population. The combination of OUD and cesarean delivery, place both the mother with OUD and neonate at risk for increased postoperative complications. The purpose of this project was to evaluate and increase staff knowledge regarding OUD in obstetrics. An analysis of staff knowledge was performed via surveys both pre and post dissemination of evidence. The survey results demonstrated the education positively impacted participant knowledge related to OUD in parturients in addition to ketamine pharmacokinetics and pharmacodynamics. A subsequent policy was developed involving a subanesthetic intravenous (IV) ketamine infusion as part of a multi-modal, low-opioid pain management regimen for the opioid tolerant patient, intraoperatively and post cesarean section. The evidence supports subanesthetic ketamine as an ideal, non-opioid, potent analgesic medication with little to no negative side effects. The evidence has demonstrated low-dose ketamine in conjunction with a multi-modal approach, reduced overall perioperative opioids and pain scores for up to six weeks while maintaining cardiovascular and respiratory stability