Improving the Screening of Intimate Partner Violence Among Women: A Quality Improvement Project in a Primary Care Setting

PURPOSE The purpose of this project was to improve the screening rate and the detection of positive screens for intimate partner violence among women by 50% over three months at UT Physicians International District, Houston, Texas, by developing a process that will enhance the safety of victims. BACKGROUND Intimate partner violence is a significant social problem affecting women and minorities in the United States. However, many patients are not screened due to a lack of staff training, fear of patient reactions, reluctance to disclose, and absence of effective screening methods. This project employs the Plan-Do-Study-Act (PDSA) cycle to test and enhance IPV screening processes. The project was implemented with a clinical staff of 25 people at a primary care clinic. METHODOLOGY The project involves educating healthcare staff using a targeted presentation, adopting the HARK screening tool in the patient intake processes, and incorporating these procedures in the EHR system. The screening results are calculated before and after the intervention to determine the effectiveness of the changes. RESULTS Post-intervention data showed an increase from a baseline of 25% to 77% in screening rates. Pre-education and post-education surveys indicated significant improvement in the staff\u27s ability to handle IPV cases, with the majority being able to name two indicators of IPV and accurately reflect the clinic’s screening policy. IMPLICATIONS: By effectively identifying and addressing barriers to IPV screening, this project aims to enhance patient safety and support within the clinic and serves as a model for similar interventions in other healthcare settings, potentially leading to widespread improvements in IPV management. The project successfully enhanced IPV screening rates and staff competency in IPV management. The methods used in the study can be adapted and implemented in other UT Healthcare systems struggling with IPV screening and management. Future quality improvement projects should focus on detecting positive screens to improve patient safety

The Impact of Structured Family Meetings in the Intensive Care Unit

The Impact of Structured Family Meetings in the Intensive Care Unit (ICU) Purpose Train providers at an academic institution in a large metropolitan area to conduct family meetings using a structured approach and evaluate this intervention\u27s impact on family satisfaction with communication in the ICU. Background Inadequate communication between families and healthcare teams leads to lower family satisfaction, heightened feelings of guilt, and diminished capacity for making clinical decisions. Methodology VitalTalk training was utilized to improve providers’ communication skills. Structured family meetings were conducted for Surgical and Thoracic ICU patients with an ICU length of stay of \u3e 5 days or a predicted mortality rate over 25% within 5 days of ICU admission, and then every 5-7 days afterward. Patients’ families completed a survey on their satisfaction with communication using part 2 of the FS-ICU 24 survey. Baseline scores were gathered from the Medical and Neurological ICUs. Results Ten questions, using a 5-point Likert scale plus one open-ended question, addressed family satisfaction with communication. Based on the Mann-Whitney U test, the post-intervention (n=101) scores were higher than baseline (n=85) for 9 of 10 questions, with statistical significance and a 9.8% mean improvement in family satisfaction. Quantitative and qualitative data revealed a significant convergence in family perceptions post-intervention, with several complementary themes. Implications Training providers to conduct “Structured Family Meetings” in the ICU increases family satisfaction with decision-making regarding caring for their critically ill loved one

Improving the Quality of Bone Marrow Specimen Collection Through Powered Bone Marrow Device Simulation and Supervised Procedures

Improving the Quality of Bone Marrow Specimen Collection Through Powered Bone Marrow Device Simulation and Supervised Procedures Purpose This quality improvement (QI) project aimed to implement powered bone marrow simulation training and supervised procedures for the Advanced Practice Provider (APP) proceduralists to increase proceduralists\u27 use of powered bone marrow devices and reduce poor bone marrow sampling. Background This project was implemented within the Bone Marrow Aspiration Clinic (BMAC) of an academic cancer center in Houston, Texas. Methodology Five APP proceduralists completed powered bone marrow device simulation training on the Bone Marrow (BM) Skills Simulator, followed by supervised procedures. Data were collected for six weeks post-intervention. Results Results showed that the poor BM sampling mean post-intervention decreased by 4.82% (mean=22.16%, median=22.5%, n=20). The pre-intervention\u27s mean was 26.98% (median=27.93%, n=44). Post-intervention use of powered bone marrow devices had a mean of 6.42% (n=7) with a baseline of 0%. Implications Powered bone marrow device simulation training using a BM Skills Simulator and supervised procedures can enhance APP proceduralists\u27 ability to collect better quality samples and improve BMAC patient outcomes by reducing unfavorable consequences related to poor BM sampling. Additional participants, time for intervention, and data collection are needed to mitigate the project\u27s limitations and provide better insight into the effectiveness of this intervention

Increasing HPV Vaccination Rates of Patients Nine and Ten-Years-Old at Pediatric Clinic Using Pre-Visit Phone Calls and Motivational Interviewing

Purpose: This quality improvement project aimed to increase the initiation rates of human papillomavirus (HPV) vaccination of nine- and ten-year-olds at the pediatric clinic by making pre-visit calls and using motivational interviewing (MI). Background: In 2022, the HPV vaccination rate for adolescents at this pediatric clinic was 93%, surpassing the Healthy People 2030 goal of 80%. In this same clinic, however, the 2022 HPV vaccination rates among children aged 9 and 10 years old were significantly lower at 32 %. This project aimed to increase the HPV rate by 3% after intervention at the pediatric clinic. Methodology: Staff completed online motivational interviewing (MI) training. Parents of nine- and ten-year-olds received pre-visit calls to advise of the visit and the opportunity for HPV vaccination. MI was utilized to focus parents on the goal of HPV vaccination. PDSA cycles were conducted monthly. Changes in MI were made based on feedback. Vaccination rates were calculated by comparing the number of those vaccinated with the number of those eligible for vaccination. Results: In 2024, vaccination initiation rates had dropped to 27.69 % pre-intervention and 53.84 % post-intervention. Results revealed a 26.15 % increase in HPV vaccination initiation rates. Implications: The results of this quality improvement project demonstrated a significant increase in HPV vaccination initiation rates and suggest that pre-visit phone calls and MI may improve these rates. This improves the health outcomes for individual children and contributes to broader public health goals of reducing the cancer burden. Key words: Adolescent, Primary Care Provider, Papillomavirus Vaccines, HPV Vaccin

Fall Prevention in a Medical Intermediate Care Unit (MIMU) Through Use of a Collaborative Fall Bundle

PURPOSE This DNP project focused on reducing the fall rate in a medical intermediate care unit by half, from 1.81 falls per 1000 patient days to 0.91 falls per 1000 patient days. BACKGROUND The number of patient falls poses a significant concern in a medical intermediate care unit. The fall rate goal is zero. METHODOLOGY The Collaborative Fall Bundle includes implementing the Fall TIPS Toolkit, an 11 x 17 bedside poster informing patients and staff of their fall risk factors and interventions to counteract; an alarm buddy system pairing two nurses to answer each other\u27s call lights and assist with ambulation-required tasks; and a zoning approach requiring nurses to complete charting at an assigned zone, enabling timely responses to bed alarms. The project was guided by the Plan-Do-Study- Act model. Anonymous electronic surveys evaluated staff opinions of each element. The primary project measure was the fall rate. RESULTS The fall rate decreased from 1.81 to 0.89 falls per 1000 patient days. Surveys revealed non- compliance with certain elements of the bundle such as zoning staff within the unit and the alarm buddy system, while the Fall TIPS toolkit was widely favored. IMPLICATIONS The project duration limited the sample size. While the project yielded positive results, a year-long project may better assess the impact of the Fall TIPS toolkit alone in reducing falls. This project effectively reduced falls by 50%, and with the staff’s satisfaction with the Fall TIPS toolkit, improvements appear sustainable

Improving CPR Quality in the Emergency Department by Implementing Data Driven Debriefs

Purpose The purpose of the quality improvement project was to evaluate the effectiveness of implementing a data driven debrief tool to improve the average compressions in target in adult cardio-pulmonary resuscitation (CPR) events. Results In FY23 prior to implementation the average compressions in target was only 1.65%. During the implementation phase of the project the average compressions in target reached 41% (n=3). In addition, the staff provided positive feedback regarding the tool and the integration in the workflow. Background The project was completed in a tertiary academic medical center emergency room. All adult CPR events within the emergency department utilizing the Zoll R series defibrillator were included. Implications The data driven debrief tool will continue to be utilized within the department and data will continue to be tracked. Results during the implementation phase suggest a positive impact from incorporating data into debriefs. Methodology The plan, do, study, act method was utilized for project implementation. The unit multidisciplinary staff were introduced to the debrief tool in unit huddles and staff meetings. The charge nurses were taught how to complete the tool when there was not nursing leadership on site ensuring twenty-four-hour implementation. The debrief tool was developed to include the team going over the compression data to include the average compression in target