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Implementation of a Diabetes Education Toolkit for Pain Management Patients: An Evidence-Based Quality Improvement Project
No full textPOSTE
Nurses\u27 Attitudes and Behaviors Toward Sick Leave Usage: A Quality Improvement Needs Assessment
No full textBackground: Nurses in the U.S. healthcare system face challenges related to workplace culture and the absence of legally mandated paid sick leave, contributing to high rates of presenteeism. This behavior, where nurses work while ill, jeopardizes their health and patient safety. Research shows that access to paid sick leave correlates with increased utilization of preventive care services and improved health outcomes. However, Utah nurses experience additional barriers due to staffing shortages and cultural expectations, emphasizing the necessity for a targeted needs assessment. Local Problem: Utah nurses face pressure to work while sick due to the absence of mandatory paid sick leave, staffing shortages, and a pervasive culture of guilt (HB 69, 2020). Research shows that workers without paid sick leave are significantly less likely to access crucial preventive care services, leading to poorer health outcomes and increased healthcare costs. Implementing paid sick leave policies would boost preventive care utilization, enhance overall health, reduce the spread of illness, and improve job satisfaction among nursing staff. Methods: A one-time, anonymous web-based survey was used to assess Utah nurses\u27 attitudes and behaviors regarding paid sick leave. Interventions: This needs assessment investigates the attitudes and perceptions of nurses in Utah regarding their utilization of sick leave, emphasizing how cultural and workplace expectations influence their behaviors. Findings were synthesized into an executive summary to inform stakeholders about policy gaps and opportunities for improvement (Rothstein, 2023a). Results: Using sick leave for acute illnesses was perceived as mutually beneficial for nurses and employers, whereas mental health concerns primarily benefited individuals. Elevated levels of stress about taking sick leave (75%) correlated strongly with presenteeism. Inadequate staffing emerged as one of the barriers to sick leave usage. Conclusion: This needs assessment highlights the urgent need for improved sick leave policies and cultural shifts in Utah\u27s healthcare system. Findings emphasize the importance of separating sick leave from general PTO, addressing staffing shortages, and fostering supportive workplace environments. Evidence-based policies could enhance nurse well-being, reduce presenteeism, and improve patient care quality
Square wave oscillations in Parkinsonism
No full textThis patient presented with complaints of imbalance, and had signs of Parkinsonism on examination (i.e., bradykinesia, postural instability, rigidity). While there were no clear ocular motor or neuroimaging signs to suggest progressive supranuclear palsy (e.g., vertical saccadic or gaze palsy) or multiple system atrophy (e.g., downbeat, gaze-evoked nystagmus, saccadic dysmetria), there were frequent asymptomatic square wave jerks (with an inter-saccadic interval) on his examination, which at times were continuous and consistent with square wave oscillations (SWO). Oscillations such as SWO and macrosaccadic oscillations (which are larger, straddle fixation, and are due to cerebellar disease with associated saccadic hypermetria) may exist on a continuum, with some patients displaying more than one intrusion or oscillation during a single visit. Or, a patient with resolving ocular flutter (where there is no inter-saccadic interval) may transition to another intrusion/oscillation as they recover
Increasing Compliance of Measurement-Based Care (MBC) in an Urban Community Mental Health Clinic
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Effective Referral Strategies between the NICU and Part C Early Intervention: An Evidence-Based Quality Improvement Initiative
No full textBackground: Preterm birth, defined as the delivery of an infant prior to 37 weeks gestation, is a significant risk factor for developmental delays. As such, the timely referral of preterm infants to the Individuals with Disabilities Education Act (IDEA) Part C Early Intervention (EI)) is vital to the successful treatment of developmental delays and the reduction of disabilities later in life. Local Problem: The neonatal intensive care unit (NICU) involved in this initiative has been one of the lowest referring NICUs to EI services despite being one of the largest NICUs in Utah. Upon review, a dysfunctional referral process between this NICU and local EI programs led to over 235 (63%) infant referrals being lost between January 2022 and April 2023. Methods: A six-phase quality improvement implementation process was undertaken to assess the current referral problems and draft a new workflow that would address deficiencies. A series of detailed collaboration meetings with the NICU and the six local EI programs in this hospital\u27s catchment area were undertaken. These meetings worked to analyze the current referral workflow and assess the feasibility of new workflow designs. Workflow success was measured by counting the number of referrals sent by the NICUs compared to the number of referrals received by local EI programs. Staff members were interviewed after implementation to assess usability, feasibility, and satisfaction with new referral processes. Interventions: Based on assessment findings and stakeholder feedback, a new referral workflow was designed and implemented. The new workflow incorporated elements of evidence-based referral strategies, including a standardized presentation of EI services to NICU families followed by a phone call between NICU care managers and local EI programs. Lastly, medical records were faxed to complete the referral process. The final workflow incorporated two phone calls and two faxes: one fax and phone call at admission to the NICU and one fax and phone call at discharge from the NICU. Results: During the six-week project, no referrals were lost between the NICU and the six local EI programs (n=30, 100%). All referrals sent by the NICU were received. However, phone calls were placed by NICU staff only 24% of the time when making a referral. Although individual perceptions of the workflow varied, most NICU and EI program staff members agreed that the phone calls were valuable to the referral process to troubleshoot faxing issues and/or to form relationships between the agencies. However, simplifying the referral process to one phone call and one fax at discharge was preferred. Conclusion: Based on the initial success of this project, the hospital system care management executives decided to implement the same referral workflow across all 24 system hospitals in Utah. Evidence-based referral strategies that incorporate standardized education of families and utilize NICU to EI phone calls decreased lost referrals. This project has the potential to greatly increase referral-based access to EI services for Utah NICU graduates
