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Implementing Evidence-Based Dietary Instruction Strategies in a Specialty Care Clinic
Get PDFCardiovascular disease is a significant health concern that increases risks for stroke, escalates the development of renal disease, and significantly increases morbidity and mortality risk. Dietary changes can significantly reduce complications in patients with heart and vascular disease. This project was designed to effectively implement and sustain provider and cardiovascular staff instructions on dietary modifications to improve hypertension control and lower cholesterol in patients with cardiac disease using staff support. The project facilitated provider evaluation of patients’ dietary habits to promote wellness in a patient population which was not receiving dietary education. Project interventions included establishing structured methods of providing written and verbal education on the Dietary Approaches to Stop Hypertension (DASH) diet, incorporating motivational interviewing to empower the patient, and promoting active patient participation in treatment plans. Following education for the provider and clinical staff on the importance of the outcomes of diet changes on cardiac health and the provision of a structured method for delivering patient education, the physician and clinical staff were followed over a course of 3 months to evaluate adherence to the education process and promote the sustainability of the project. Clinic providers and staff promoted positive health changes in patients with cardiovascular disease by achieving 85% adherence to the provision of structured dietary instruction aimed at improving dietary habits and subsequently overall cardiac health. This intervention enables doctoral-prepared nurse practitioners to impact providers, nurses and other healthcare professionals to be proactive in improving patient health outcomes by promoting dietary improvements through provider and clinical staff education and clinical process changes
Recognizing Delirium at End of Life in the Hospice Setting: A Process Improvement Project
Get PDFDespite advancements in health care, hospice registered nurses and medical professionals caring for patients at end of life lack the required knowledge effectively to care for this patient population. Educational gaps contribute to deficiencies. This process improvement project aimed to increase nurses’ and medical staff’s knowledge and recognition of delirium at end of life through the use of a delirium assessment tool and evidenced-based treatment guideline when managing symptoms. Project implementation occurred at a small hospice company with a patient census of 180, utilizing 2 teams of registered nurses, medical doctors, and a nurse practitioner. A 2-hour educational session had participants (n = 13) complete a pretest with an end of life hospice care focus. The same post-test was administered at project conclusion to re-assess learned knowledge. Chart reviews were conducted pre- and post-intervention. Nurses’ and medical team’s knowledge increased from a cumulative score of 75% to 100%, all new patients were screened for delirium with a 0% to 100% increase, patients with a change of status were screened for delirium with a 0% to 100% increase, and 46% of patients were found to have delirium and treated according to the treatment guideline, thus the latter objective of 100% participation was unmet. Research should continue on improving nurses’ and medical staff’s knowledge of evidence-based end of life care by focusing on knowledge deficits, improving delivery methods, and assessing the potential increase in positive patient outcomes of symptom recognition and management at end of life
Implementing Pneumococcal Vaccination Recommendations for Adults Age 19 and Over in a Family Care Clinic
Get PDFPneumococcal vaccines are essential to children and adults. Having pneumococcal vaccines not only prevents pneumococcal infections but can also potentially lessen the severity of the disease. There are many scholarly articles attesting the herd effect in adults who received pneumococcal vaccines. Therefore, the purpose of this quality improvement project was to raise awareness of the pneumococcal vaccine and increase the vaccination rate in a primary care clinic in Texas. The Centers for Disease Control and Prevention’s pneumococcal vaccination schedule was utilized as guide for vaccine administration. The staff and provider were educated on screening, documenting, and administering the pneumococcal vaccine to patients. Electronic reminders were implemented to flag those who qualified, and patient education was provided, regardless of their decision on receiving the vaccine. Retrospective chart review was conducted between January and May of 2018, to compare the results between pre- and postintervention. SPSS was utilized for statistical analysis. The results showed that out of 362 patients, 53 qualified for the pneumococcal vaccine. Only 21 (39.6%) of those patients received the vaccine, while the remainder 32 (60.4%) refused to be vaccinated. However, a few patients who had initially refused agreed to receive their pneumococcal vaccine during their follow-up visit. In conclusion, there was an increased awareness regarding pneumococcal infections and an increase in total number of patients who received the pneumococcal vaccine between pre- and postintervention. The study suggests that it is vital for providers to educate their patients about vaccinations, and appropriate follow-up is required to increase compliance.
Keywords: pneumococcal vaccine, pneumococcal infections, pneumoni
The Impact of the Via Bus System on Food Deserts
Get PDFA variety of different methods have been used to analyze food deserts. One method, Geographic Information Systems (GIS), is particularly useful when trying to better visualize the impact an issue has on a region. GIS is a method of mapping which can be used to map food deserts or other social or medical issues, which allows for a better visualization of which regions are most impacted by such issues. This study used GIS to map all grocery stores, convenience stores, farmers markets, food pantries, WIC clinics, and Mobile Mercados in San Antonio, Texas to determine whether they were within walking distance, defined as ≤ 0.5 miles and ≤ 1 mile, of the bus stops. This was accomplished by placing a half-mile and one-mile buffer region around each bus stop and determining which location of interest fell within the buffer. It was found that the majority of the bus stops were within walking distance of the locations of interest, 95.93% in the half-mile buffer and 97.58% in the one-mile buffer. This indicates that public transportation is likely not a factor affecting the obesity rates in San Antonio, TX meaning that other factors such as socioeconomic status may have a larger impact
Identification of Potentially Inappropriate Medication Utilizing the Beers Criteria Among Elderly Patients
Get PDFBackground: The normal process of aging causes numerous physiological changes that affect pharmacodynamics and pharmacokinetics. Therefore, the geriatric population is more vulnerable to the effects of potentially inappropriate medication. The American Geriatric Society’s Beers Criteria identifies potentially inappropriate medication to be avoided for this population and can be implemented in efforts to avoid risks associated for this population.
Aim and Methods: The purpose of this project was to implement the Beers Criteria to identify potentially inappropriate medications among patients 65 years and older. The objectives were to increase the percentage of charts reviewed for inappropriate medications and to increase the use of alternative treatments based on Beers Criteria recommendations.
Results: During the medication reconciliation process, the Beers Criteria was implemented to assess for inappropriate medications for eligible patients. A checklist was utilized to document the intervention process and the physician’s decision to continue or alter treatment. On a weekly basis, the student determined the percentage of charts reviewed and the percentage of altered treatment. Of the 112 geriatric patients included, 103 (91.3%) patients had their medications reviewed and 59 (57.2%) patients had at least one potentially inappropriate medication identified. However, only 7 (11.8%) patients had the medication altered.
Implications for Practice: The implementation of the Beers Criteria will assist healthcare providers in identifying potentially inappropriate medications, preventing use of these medications, and utilizing alternative treatment to promote medication safety and optimize patient outcomes in geriatric patients
The Implementation of Obesity Guidelines in a Rural Clinic
Get PDFBackground Over 36% of Americans are obese. It is estimated that, by year 2030, 51% of the population will be obese. With the increased prevalence of co-morbidities associated with obesity, it is important to gain control of this disease. Method The aim of this project is to implement the 2013 American College of Cardiology, American Heart Association Task Force on Practice Guidelines, and The Obesity Society Guidelines for the Management of Overweight and Obesity in Adults in order to identify those patients who require treatment for obesity and provide them with appropriate resources. The primary interventions are to provide color-coded cards to help identify patients with obesity, provide a behavior-monitoring calendar to patients with obesity, and provide referrals to appropriate patients. The number of referrals made and the documentation of obesity treatment were monitored during weekly chart reviews to evaluate effectiveness. Results Throughout the implementation period, all three healthcare providers in the clinic increased the frequency of documentation of obesity interventions and a total of three referrals were made. This demonstrates the implementation of the obesity guidelines was appropriate and increased the healthcare providers’ awareness of obese patients and their unique healthcare needs. Implications for Practice Due to obesity being such an ubiquitous disease, it is imperative that primary care clinics develop a strategy to combat this chronic illness. The onus falls on the primary care providers to educate patients, manage and treat the disease, and evaluate effectiveness, making it essential that all clinics have a strategy to identify obesity and an approach to treat it
Assessing Readmission Risks in Adolescent Psychiatric Patients
Get PDFPurpose: Assess risk of readmission of adolescent patients to an inpatient psychiatric unit within 30-days post-discharge by using a clinician-rated behavioral health outcome assessment measure to rate psychiatric patient. Background: In the United States, approximately four million adolescents suffer from mental disorders. When admitted for inpatient psychiatric care, approximately 13% of adolescent mental health patients are readmitted within 30-days, 25% within one year, and 81% within 90-days, of inpatient psychiatric admission. Methods: An evidence-based quality improvement project that utilized the clinician-rated behavioral health outcome assessment tool called the Health of the Nation Outcome Scale for Children and Adolescent (HoNOSCA). The HoNOSCA measures emotional, personal, physical, social and behavioral problems associated with mental illness in children and adolescent. Data on 168 adolescent patients at a children’s’ mental health hospital in South Texas were assessed from February 1, 2018 to March 31, 2018. Outcomes: Following assessment, the 30-day readmission rate for patients admitted in February and March 2018, decreased to 8.3% and 9.3% respectively, from a six month assessment average of 10%. Also, 100% of the registered nurses were trained on using the assessment measure, 80% of admissions were screened, and 50% of patients’ scores were reviewed. Implications for Nursing: Assessing and identifying patients’ readmission risks can help to reduce recurring readmissions and the HoNOSCA is a valid assessment tool suited to assess the type and severity of psychiatric impairment in adolescents that may cause frequent readmissions.
Keywords: HoNOSCA; Risk of readmissio
Fashion Patternmaking Book Instructions in Spanish
Get PDFThis study explored participants’ perceptions of the need for a fashion patternmaking book in Spanish to be used by native Spanish-speaking students in U.S. institutions of higher education. There is no previous research demonstrating the need for a patternmaking book in Spanish for native Spanish speakers. This study provided insight into how educators perceive the need for a fashion patternmaking book in Spanish to assist non-English speaking students.
A survey was sent via e-mail using Survey Monkey®. Participants were members of the International Textiles and Apparel Industry and faculty who teach fashion design in Mexico. The responses of 17 participants were collected and analyzed.
The study revealed that when an educator had a native Spanish-speaking student who was not English proficient, step-by-step instructions demonstrations help students understand the class. Based on the information analyzed, a fashion patternmaking book in Spanish for native Spanish speaking students could be suggested to students as a help guide while they get used to the new language and terminology.
This study provides insight into how educators perceive the need for a fashion patternmaking book in Spanish. Further research is needed in the area of a fashion patternmaking book in Spanish
Assessing the Effectiveness of a Quality Improvement Intervention to Decrease Missed Opportunities for Human Papillomavirus Vaccination at a Nurse Managed Health Center
Get PDFPurpose: To decrease the number of missed opportunities for human papillomavirus vaccine eligible patients seeking healthcare in a Nurse Managed Health Center. Background & Significance: Human papillomavirus genital infection has inflicted nearly 79 million Americans. Annually, about 14 million newly infected individuals are identified, with noted predominance in teens and young adults, and of this number approximately 19,200 females and 11,600 males receive a cancer diagnosis as a result of the human papillomavirus infection. The incidence of infections can be reduced with a human papillomavirus vaccine, but only about 63% of females and even fewer males initiate the human papillomavirus vaccine. Methods: A Nurse Managed Health Center assisting the underserved population, in a major southwestern metropolitan city was chosen to implement a Qualified Patient Prompter tool used to screen for human papillomavirus eligibility in all patients seeking healthcare in this Nurse Managed Health Center. A reminder card strategy was used at the end of the accepted human papillomavirus vaccine visit. Results: 334 patient records were reviewed and 135 were eligible to receive the human papillomavirus vaccine; 60 opted to receive it and 75 declined. Conclusion: A 100% of all patients seen were evaluated for human papillomavirus vaccine eligibility. The intervention decreased missed opportunities by 100%. Continued efforts will focus on increasing human papillomavirus vaccine acceptance rates. The Nurse Managed Health Center fully support the continued use of the Qualified Patient Prompter, which was effective within this population
Initiating HPV Co-testing for Women Aged 30-65 in an Ob/Gyn Practice Setting
Get PDFThe purpose of this project was to improve the rate of successful human papilloma virus (HPV) screening in a small Texas based Women\u27s Health clinic through a co-testing method. The intended goal was to increase the rate of HPV screening, from a 73% baseline, to 95% over a 10-week period for women between the ages of 30-65 years old. Approximately 79 million American women are currently infected with HPV, and 14 million people contract it every year. Seventy percent of cervical cancers today are caused by HPV, leading to approximately 12,820 new diagnoses of invasive cervical cancer predicted for 2017, with 4,210 women projected to die from of it. Women between the ages of 30-65, are 8 times more likely to contract invasive cervical cancers through HPV than women less than 30 years. Therefore, the project incorporated multiple interventions which included: increased patient screening appointments, the initiation of quality improvement meetings, and the use of the HPV co-testing protocol. At project completion, 107 patients between the ages of 30 and 65 had been successfully co-tested for HPV, with 104 patients having negative screening results and 3 patients with positive results. There was statistically significant improvement in HPV screening rates, from 73% to 93%. Implementing the co-testing method had a positive impact on HPV screening rates