Establishing Community Connections for a Mobile Health Clinic

Within the United States, there are many healthcare disparities. The supply and demand for mobile health have increased since the start of the COVID-19 pandemic. This project\u27s purpose was to improve and develop partnerships between communities and a new mobile health clinic with the intention of increasing healthcare services availability. The new mobile health clinic is an extension of a well-established university brick-and-mortar clinic. A survey was sent to county housing authority residents to determine community healthcare needs for various services including preventative and acute care services. Residents filling out the survey provided information about the targeted patient population and what patients\u27 needs are within that community. Residents were provided with information regarding the mobile health clinic and services that could be offered. The intention of the mobile health unit is to decrease disparities for the patients, who may not have access to regular health care, and for those who may feel more comfortable with health care services being provided within their community. The connections with community partnerships have substantial positive impacts on communities within the United States. Based on surveys, services that are desired include: diabetes care, management of hypertension, depression, allergies, headaches, anemia, anxiety, arthritis, bladder infections, kidney disease, sleep disorders, low energy, poor circulation, gout, alcohol consumption, water retention, skin disorders, high cholesterol, menopausal, Alzheimer\u27s, osteoporosis, smoking, acne, ADHD, COPD, lupus, thyroid management, heartburn, and calcium deficiency

Implementation of Menstrual Cycle and Fertility Awareness Education for Community Healthcare Providers Serving Guatemalan Women

Research indicates that lack of reproductive knowledge, literacy & academic attrition, lack of educator support, poverty, religion, gender inequality, and decreased access to electronic devices contribute to high numbers of teenage pregnancies in Guatemala. Educating United States (U.S.) healthcare providers and Guatemalan volunteers/workers about fertility awareness using Standard Days Method® (SDM) and CycleBeads® has the potential to empower young Guatemalan women and encourage them to make independent, informed reproductive decisions. In December 2023, a quality improvement project was implemented in a Guatemalan rural health clinic. Likert scale questionnaires were utilized to assess knowledge and comfort levels regarding fertility awareness. Analysis of results focused on the views of U.S. healthcare providers who travel to Guatemala, along with locals who live and interact with young Guatemalan women needing further education. U.S. healthcare providers had minimal changes in scores between pre- and post-education questionnaires. Indigenous providers were unable to complete a post-education questionnaire due to time constraints during the global service trip. This lack of data prevented statistically significant conclusions regarding SDM and CycleBeads® use from being drawn. However, indigenous provider buy-in was evident via observation and social media pictures posted showing indigenous providers and other Guatemalan women teaching each other how to make CycleBeads®. The success of other research studies and the positive reception indicates teaching the SDM, specifically with CycleBeads®, is an educational trend that could continue being taught in other countries around the world

Educating Anesthesia Providers on the Physiological Effects and Anesthesia Implications of Cannabis

In the U.S., currently 37 states have legalized cannabis for medicinal use prescribed by qualified medical professionals (National Conference of State Legislatures [NCSL], 2022). In 2012, the legalization of recreational cannabis began; as of 2022, 19 states have legalized the recreational use of marijuana (NCSL, 2022). This project aimed to optimize care for patients using cannabis by increasing anesthesia provider knowledge about cannabis. The project\u27s aim was accomplished through a thorough review of the current medical literature and implementation of education to anesthesia providers about the physiological effects and anesthesia implications of cannabis. Thirteen CRNAs took a pre- and post-quiz to test their knowledge about cannabis before and after an educational PowerPoint presentation was provided. Results demonstrated most providers have a knowledge deficit about cannabis. Comparative analysis of the pre and post-quiz results revealed significant improvement, indicating education to anesthesia providers can improve their knowledge about the physiological effects and anesthesia implications of cannabis. Using these results, one can hypothesize that with improved knowledge, providers can offer a safer anesthetic to patients presenting for surgery using cannabis

Screening for Suicide in Veterans with Cancer

Veterans are at a higher suicide risk than the general population. Veterans with cancer are at a 47% higher risk for suicide. The Veterans Health Administration has an annual suicide screening requirement, but no requirement for more frequent assessment in this high-risk population. Clinical staff may also be hesitant due to fear and anxiety, serving as a barrier to screening. The objective of this project was to educate oncology clinical staff about risk factors for suicide in veterans with cancer, the use of the Columbia-Suicide Severity Rating Scale (C-SSRS), referral processes, and local resources, and intended to increase the number of suicide screenings performed. The primary outcome measured was the number of suicide screenings performed after the education of staff. Data was reviewed for sixty days, both pre-education and post-education. No screenings (n=0) were performed by the educated staff during the post-education period. Education did not affect the number of screenings performed. The secondary finding was that mandatory annual suicide screening was not being performed consistently. Mandatory annual suicide screenings must be addressed by the facility before implementing additional screenings within the oncology department for veterans with cancer. The Cancer Care Navigation Team is a potential solution in performing these screens since the team is responsible for managing cancer cases with complex treatment plans and evaluating veterans for psychosocial issues, making referrals as appropriate

Implementing the Edinburgh Postnatal Depression Scale in the Emergency Department and Family Care Settings

Postpartum depression affects approximately 10% to 20% of patients who have given birth in the year prior and can detrimentally affect maternal-child relationships. Postpartum depression (PPD) is a mood disorder following birth, whereas postpartum psychosis (PPP) is a severe mental illness and a medical emergency. If untreated, both disorders can have long-term harmful effects on mothers, infants, and families. Utilizing screening tools, providers can identify these disorders in applicable patients. The Edinburgh Postnatal Depression Scale (EPDS) is an effective method of recognizing patients most at risk, with a positive score of \u3e/=10 indicating the likelihood of depression. [SB1] The purpose of this quality improvement project was to increase the number of patients identified and screened for PPD using the EPDS in two settings, the emergency department and a family care clinic. Staff training, education, and EMR hard stops were utilized to guide staff through the initiative. Three of the twelve patients screened in both facilities had positive scores, with two receiving interventions of medication, counseling, and/or hospitalization. A survey of all staff was completed post-initiative, with an overwhelming majority indicating the iimportance of screening patients in these settings. Project limitations were identified as a need for additional time that the screening and charting required,as well as a lack of knowledge about the disorders. Implementing the EPDS screening tool in the ED and family care settings could positively affect patient care and safety by allowing the opportunity to mitigate the negative outcomes commonly associated with these disorders

A Behavioral Intervention Checklist to Reduce Re-Hospitalizations in Residents with Mental Illness

Skilled nursing facilities are an essential component of the continuum of care and, with the rapidly aging population, represent an increasing cost to the healthcare system. The policies beginning in the 1960s promoting the deinstitutionalization of mental health institutions have resulted in increasing numbers of individuals with serious mental illnesses now residing in skilled nursing facilities. The complex needs of individuals with mental illness have been associated with an even greater cost of care, deficient quality, and safety concerns. This quality improvement project analyzed the impact of an evidenced-based, structured behavioral intervention checklist on rehospitalization rates in individuals with mental illness residing in a skilled nursing facility. The checklist was designed to allow nurses to use an algorithmic methodology to deescalate the manifestations of mental illness to prevent rehospitalization. Staff were provided with education on the management of residents with mental illness and the use of the checklist throughout the process. Data was collected pre- and post-implementation of the checklist to measure 90-day rehospitalization rates with a secondary measure reviewing lost census days to hospitalizations. The checklist showed limited improvement in 90-day rehospitalization rates (p \u3c 0.04). Lost census days to hospitalization showed a more robust improvement (p \u3c 0.01). While more research would appear warranted, the implications of these findings suggest that checklists or algorithms may be a viable care improvement tool in complex care environments such as skilled nursing facilities

EMR Templates for Age-Appropriate Well-Child Pediatric Visits

The world of pediatric medicine is continually evolving. The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) regularly update guidelines to have the most current information available to providers and their patients. The overwhelming majority of primary care offices have transitioned to electronic medical records (EMRs) for charting purposes. Templates included in EMRs ease the workflow and documentation process for providers. In the primary care setting, templates include essential information discussed at well-child visits, such as developmental milestones, vaccination schedules, and anticipatory guidance. The project’s purpose was to update the age-specific well-child templates at a private suburban Midwest primary care office to ensure patients and their families receive the best quality care. After the updated templates were implemented, a chart review was completed to compare the accuracy and completeness of provider documentation on the new templates compared to the previous templates. The updated templates were found to have more patient education and anticipatory guidance documented in each visit. A questionnaire was also given to the providers for feedback about usability and provider satisfaction. Overall, the providers were satisfied with the updated templates and information included, but agreed there were limitations to being unable to upload the new templates to the EMR. The templates overall provided the patients and families with the most recent age-specific information

Implementation of Prenatal and Postpartum Depression Screening for a Telehealth Company

Abstract Depression is a leading mental health disorder. Depression occurring during the perinatal and postpartum periods has become highly prevalent throughout the world, impacting 5-10% of women during (van de Loo et al., 2018) and 9-23.5% postpartum (Bauman et al., 2020). Proper diagnosis and treatment of perinatal and postpartum depression (PPD) is crucial, as depression can lead to poor outcomes including relationship complications and negatively affect child development (Slomain, 2019). The implementation of screening tools can help identify women at risk based on their signs and symptoms of PPD (Bauman et al., 2020). The primary goal of this project was to implement a standardized tool at a telehealth company for all providers to use to screen for perinatal and PPD and to provide further education to these providers regarding PPD. Pre and post-intervention questionnaires were utilized to assess the change in providers\u27 knowledge and attitudes regarding PPD following an educational session on PPD. Prior to the educational sessions, 36% of participants felt strongly comfortable in addressing mental health concerns with this population, and 73% felt strongly comfortable in the post-survey. Additionally, there was an improvement in identifying signs and symptoms of depression, as well as increased comfortability with treating this patient population. Education on PPD and the introduction of evidence-based screening guidelines provide valuable tools for providers to use when caring for populations impacted by postpartum depression. The implementation of a postpartum depression screening tool can help providers deliver high-quality and holistic care to both new and expecting mothers

Establishing Routine Multiple Micronutrient Supplementation During Pregnancy in an Impoverished Guatemalan Community

Pregnant and breastfeeding women in impoverished settings face heightened nutritional demands, placing them and their children at increased risk of inadequate nutrition\u27s detrimental effects. Existing literature suggests that supplementing with multiple micronutrients (MMS) may offer superior protection against morbidity and mortality compared to traditional iron and folic acid (IFA) formulations. This research is set in the Land of Hope (LOH) clinic, located in Escuintla, Guatemala, a community served by the non-profit organization ER Abroad. The study aims to assess the feasibility of standardizing MMS provision to pregnant women at LOH, coupled with supplementary education on pregnancy and nutrition. The team distributed 84 bottles of MMS, sufficient for an entire pregnancy, to on-site community health workers, accompanied by education on supplementation, nutrition, hydration, and basic maternal and infant care. Post-implementation interviews with staff, conducted 1 month after the intervention, revealed the distribution of 58 MMS bottles to pregnant women with minimal challenges. This initiative contributes to standardizing prenatal supplementation practices at LOH and disseminating critical knowledge about the significance of nutrition during pregnancy. The project\u27s ultimate goal is to foster better birth outcomes through consistent MMS use and improved nutrition practices, thereby positively impacting the health of current and future generations in this underserved community

Recommendations for Sugammadex Administration in Standard and Special Populations

The purpose of this project was to collect evidence-based information regarding sugammadex administration in both standard and selected special populations. Special populations included renal failure, breastfeeding, pregnancy, and pediatrics. The objectives of the project were to collect and present current research to the host facility, define barriers to the use of sugammadex, and assess the participants’ knowledge of sugammadex use in special populations. A guideline for sugammdex administration was created and presented to the host facility through a poster presentation and quick reference guide. A voluntary post-implementation survey was implemented, and the results were recorded, analyzed, and displayed in the final dissemination. Results showed an overall increase in provider knowledge in the use of sugammadex in special populations, improved confidence in use of medication, and found the quick reference guide to be user friendly. The small sample size and use of a convenience sample limited the ability to generalize the results to the larger population. Additional long-term research is still required for the use of sugammadex in special populations. However, current evidence shows sugammadex to be superior for prevention of postoperative pulmonary complications in standard populations. Sugammadex is a useful drug in clinical anesthesia practice requiring additional education for providers to ensure best practice