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Implementation of Emergency Severity Index Training to Improve Accuracy of Triage Levels
Get PDFThis quality improvement project was created to help increase knowledge of the Emergency Severity Index (ESI) in the Emergency Department (ED), a form of triage used to categorize patients by their acuity. Proper ESI use shortens the length of stay times, door to provider times and reduces the number of patients that leave without being seen.
The goal of this project was to develop an online learning module that would increase the nurses’ knowledge of triage to enhance triage accuracy. Nineteen (19) emergency department nurses were given a pretest, an ESI educational presentation, and a follow-up post-test.
Data analysis indicated increased test scores after the educational presentation from a mean score of 13.89/25 points to an average of 17.44/25 points. Pre-and post-chart reviews showed an improvement in accuracy of triage scores from 67.67% to 81.99%, demonstrating an increased knowledge of the ESI and practice improvement. Additionally, results indicate that an APN could be an asset to the ED as the accuracy of triage improved
Labor Management Protocol for Parturients on Buprenorphine
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Opioid dependence during pregnancy may lead to negative outcomes for both the parturient and the fetus. Opioid dependent parturients are often prescribed buprenorphine, a form of medication- assisted therapy. The use of buprenorphine within the parturient population is a relatively new practice and anesthesia providers are encountering difficulties in managing this population during the peripartum period. Literature has demonstrated anesthesia providers may best serve this population by utilizing a multimodal approach when providing analgesia (Jones et al., 2008; Meyer et al., 2010; Reddy et al., 2017). A combination of oral, intravenous and neuraxial modalities, in conjunction with the daily dose of buprenorphine is the recommended analgesic regimen. This project aimed to educate anesthesia and obstetric providers at a tertiary care center in central Illinois with regards to pain management for parturients on buprenorphine. The results of this project suggested the providers increased their knowledge of buprenorphine and also enhanced their ability to manage parturients on buprenorphine during the peripartum period
Improving Acute Postoperative Pain Management for the Pediatric Patient: Guidelines on the Use of Intravenous Dexmedetomidine
Get PDFInadequately treated surgical pain in children leads to risky complications, such as longer recovery times, infection, prolonged hospitalizations, readmissions, altered pain sensitivity, neurophysiological changes, and cognitive-behavioral abnormalities (Campbell, 2013; Ibrahim, Jones, Lai, & Tan, 2016). Review of the literature indicated intravenous dexmedetomidine, as an adjunct, may lead to improved outcomes and a reduction in postoperative pain in children undergoing surgical intervention. An evidenced-based educational presentation introduced intravenous dexmedetomidine in children to anesthesia professionals, pharmacy staff, and the pediatric care team at a tertiary care center. Concluding the educational presentation, participants completed a voluntary survey evaluating the effectiveness of the presentation. Results suggested the educational presentation increased the knowledge and likelihood anesthesia providers will use dexmedetomidine in children during the perioperative period, potentially improving postoperative pain management. This project can be expanded upon through education of the post-anesthesia recovery unit, as well as the pediatric intensive care unit to promote dexmedetomidine as an adjunct to a multimodal pain management protocol
Treating Acute Bronchitis in Primary Care
Get PDFThere has been a significant rise in inappropriate antibiotic prescribing in the United States with at least 30 percent of antibiotics prescribed deemed unnecessary (Fiore, Fettic, Wright, & Ferrara, 2017). Overprescribing antibiotics for viral illnesses such as acute bronchitis leads to antimicrobial resistance. Based on current treatment guidelines, most upper respiratory infections do not respond to antibiotics but rather require supportive measures. Antibiotic prescribing trends for a Midwestern rural clinic were obtained through a retrospective and prospective chart review. Patients were frequently receiving antibiotics for acute bronchitis. To approach the problem a quality improvement (QI) evidence-based project was proposed. A decision flowsheet for the diagnosis and treatment of acute bronchitis was implemented from 11/1/2018-2/28/2019. Unfortunately, the decisional flowsheet was not used to the full extent and negatively impacted project outcomes. Statistical analysis could not performed as providers admitted to using “acute sinusitis” in order to prescribe antibiotics when the diagnosis may have been acute bronchitis. Barriers to change were identified, including attitude of providers, pressure of productivity, high volume of patients, and lack of investment in students. Changing antibiotic prescribing practices for acute bronchitis and other diagnoses remains a high priority for federal, state, and local health care (AHRQ, 2019). Discussion among prescribers, identification of champions for QI, university affiliation in QI, and public expectations of antibiotic prescriptions are future priorities as lessons learned
Presidents’ Vetoes and Audience Costs
Get PDFVeto threats may offer presidents bargaining leverage, but such leverage will be diminished if they and those with whom they transact business view a veto as hurting the president’s approval rating and his party’s prospects in the next election. How concerned must presidents be about the audience costs associated with a veto? Political science research suggests that they should be in that the public does not like vetoes and punishes presidents when they exercise this authority. In this article we test this argument with survey responses during times after presidents have issued a veto threat but before an actual veto. While on average, respondents register opposition to a veto, this preference varies greatly with the specific policy in question and with respondents’ party identification and presidential approval. The results suggest that opposition to a veto comes disproportionately, may be limited to politically distant respondents, and thus may not be as costly as the net negative numbers suggest
This Place is a Hellhole: Popular Culture and the Racial Othering of East St. Louis, Illinois
No full textDespite its small population, East St. Louis, Illinois, a suburb of St. Louis, Missouri, is, because of its poverty and racial makeup, often described as the inner city. East St. Louis often gets coded as a Black Place, and its problems are explained in radicalized terms, especially in popular culture depictions of the community. This article examines popular culture depictions of East St. Louis, and popular cultures attempts to mark East St. Louis as a Black place with Black problems
Black Curativeness: Understanding Black Voter Selection through an Assessment of Racially-charged Districts
Get PDFSince the passage of the Voting Rights Act of 1965 most scholarship on Black voter selection explains who Black voters select as opposed to why they select them. This study seeks to deepen understandings of Black voter selection beyond descriptive explanations through an assessment of a racially-charged district. Racially-charged districts can be used as microcosms for understanding political thought and behavior of racial minorities, particularly Black voter selection. These locales, where proven racial inequity propels race and racism as the overarching themes for all political and social concerns, are important in understanding why Black voters show positive affect towards viable Black candidates. Using data from the 2016 University of Missouri-St. Louis Exit Poll, this research provides evidence towards explaining why a candidate’s race is a prominent factor in vote choice for Black voters. The study concludes a substantial segment of the Black voting demographic view the election of Black officials as paramount and remedial to enduring institutional discrimination on the basis of race—a notion of Black curativeness
Hand-off Tool Implementation in Post-Anesthesia Care
Get PDFThe issues surrounding the safety of patients and improving patient care outcomes in the pre-operative and post-operative environment, is one of ongoing focus and development. Post-operative, hand-off report is one aspect in the continuity of patient care that has affected patient outcomes. Clear, concise, and accurate communication concerning patients and their postoperative status is one way that providers and caregivers may ensure patient safety. There are many various organizations that emphasize the importance of clear, effective communication, in the form of a standardized hand-off tool to maximize patient safety. The purpose of the project was to standardize clear, concise, effective communication from post-anesthesia care. A hand-off tool was developed and implemented to assist in the standardizing process of post-anesthesia communication to intensive care and medical-surgical floors. A survey was used to evaluate the effectiveness and delivery of the hand-off tool. A power point presentation regarding the importance of the hand-off tool, and the results of the survey were shared with the anesthesia providers of the facility
Introducing Enhanced Recovery After Surgery for Colorectal Procedures: Development of an Enhanced Recovery After Surgery Protocol
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The prevalence of colorectal surgery is increasing due to the surgical demand of an aging population with various comorbidities (Ralph & Duff, 2017). Consequences include an increased burden on clinical and financial resources from perioperative costs, length of stay (LOS), complications, and readmissions (Nelson et al., 2016). Enhanced recovery programs were created to improve patient outcomes and decrease financial strain. Objectives of this practice project included researching current evidence-based literature to determine the effectiveness of ERAS implementation in open and laparoscopic colorectal procedures, developing a customized ERAS protocol, and introducing the pathway to members of anesthesia, pharmacy, and the perioperative team. Results of the study indicated the educational module increased provider knowledge of ERAS and its application in the surgical arena. Additionally, staff members demonstrated a strong level of support for adoption of the customized ERAS protocol. Patient care may be improved by further educating anesthesia providers and staff members about the utilization of the customized ERAS protocol. Thus, implementation was directed at improving patient outcomes and reducing the financial expenditure of those requiring colorectal surgery at a rural hospital in southern Illinois
Development of a Guideline to Reduce Spinal Induced Hypotension and Related Nausea and Vomiting In Patients Undergoing Scheduled Cesarean Section
Get PDFCesarean sections performed under spinal anesthesia frequently involve spinal-induced hypotension and can result in intraoperative nausea and vomiting for the patient. This project involved the development of a guideline to combat this problem using lower sequential devices, co-loading of crystalloid fluids, and prophylactic administration of intravenous ondansetron. The guideline was presented to anesthesia providers at a tertiary care facility in Southwestern Illinois. Evaluation of the project included pre and post-tests as well as post-implementation surveys of the providers. The pre-test results indicated a need for further education among providers to address the problem. The post-test scores achieved the goal of educating providers while the post-implementation surveys show a decrease in the use of vasopressors, a decrease in hypotensive episodes, and a decrease in intraoperative nausea and vomiting as reported by anesthesia providers. Although the sample size does not allow for generalizability of data, the interventions applied show positive results that should continue to be used to produce a larger sample and allow for further analysis