Peripheral Intravenous Infiltrates: Engaging Staff to Increase Reporting

A large free standing children’s academic hospital aimed to improve patient safety and outcomes by decreasing the overall severity of peripheral intravenous infiltration and extravasations (PIVIEs). A care bundle was developed by creating a PIVIE measurement tool within the electronic medical record (EMR) and integrating the tool into standardized daily practice for nurses. The care bundle included creating a team of clinical leaders consisting of empowered bedside nurses acting as mobilized resources embedded into each unit. The initiative resulted in a large scale increase in reported PIVIEs system-wide within 1 month of education dissemination to bedside RN staff. The QI interventions captured a realistic interpretation allowing for a more global and accurate reflection of the number and severity of PIVIE events system-wide, while creating documentation for the PIVIE tool in the EMR and a clinical leader model. The results reflected a dramatic rise in the number of reported PIVIE events, increase in staff awareness of PIVIEs, increased peripheral intravenous line assessments, and decreased severity of PIVIEs that do occur

Higher Quality at Lower Cost: Community Health Worker Interventions in the Health Care Innovation Awards

Background: Published evidence regarding cost savings, reduced utilization, and improved quality associated with employing community health workers (CHWs) is largely lacking. This paper presents findings from the Centers for Medicare & Medicaid Services Health Care Innovation Awards (HCIA), with a focus on six diverse programs that employ CHWs. We examine outcomes associated with programs incorporating CHWs into care teams for a broad age range of patients with various health issues such as cancer, asthma, and complex conditions. Methods: This mixed-methods study used data from claims and site visits to assess the effectiveness of CHW programs. In difference-in-differences analyses of Medicare fee-for-service and Medicaid claims, we compared utilization and spending for beneficiaries participating in each CHW program with propensity score matched non-participant beneficiaries for baseline (2010 – 2012) and post-intervention (2013 – 2016). We adjusted for geographic area, prior utilization, and clinical and sociodemographic characteristics. We assessed changes in care quality through beneficiary focus groups and interviews with program leadership and staff. Results: Five of the six programs saw a significant reduction in utilization and/or spending relative to a comparison group, and all programs had positive qualitative findings regarding quality of care. In three of the six programs, the adjusted total cost of care was significantly reduced (-$143 to -$2,044 per beneficiary quarter). We hypothesize that some reductions in spending can be attributed to CHWs’ provision of enhanced access outside of regular clinic hours, which facilitated patient adherence to evidence-based treatment pathways and averted unnecessary ED visits and hospitalizations. Culturally competent CHW encounters engaged patients in health care decisions, generated confidence in their decisions, encouraged adherence to treatment pathways, and mitigated social barriers to care. Conclusions: Programs were associated with improved quality and reductions in health care utilization and spending up to $20,000 per patient over the three-year period. Findings suggest a strong business case for the use of CHWs as part of interdisciplinary teams as CHW programs can provide a significant return on investment for payers. Reimbursement policies that do not account for the services of non-clinical staff such as CHWs impede the sustainability and spread of these interventions, despite mounting evidence of CHWs’ effectiveness. Organizations looking to integrate CHWs into care delivery may conduct feasibility assessments of available workforce and the capacity for clinical oversight, physician buy-in, and funding sustainability. Established programs could be leveraged for mentorship

Pediatric Dental Education Improves Interprofessional Healthcare Students’ Clinical Competence in Children’s Oral Health Assessment

Primary care and healthcare providers can facilitate children’s timely referral to a dental home. However, there are few studies of providers’ oral health knowledge and clinical skills. This study aims to improve future healthcare providers’ knowledge, confidence, attitude and clinical competence in assessing children’s oral health. Sixty-five health professional students participated in a 10-week didactic and clinical curriculum on children’s oral health. They completed pre- and post-training questionnaire to assess changes in knowledge, confidence and attitude. Calibrated faculty graded students’ clinical skills on a 24-point grading criterion. Descriptive statistics, paired sample t-test and Pearson correlation were used in data analyses. Students were in dentistry (46%), nursing (28%), medicine (22%), and pharmacy (3%). Students significantly improved in knowledge (t=-7.71, p<.001), confidence (t=-10.30, p=<.001) and attitude (t=-4.24, p=<.001). Students on average scored 83% on clinical competence, with the highest average for fluoride varnish application (96%) and lowest for providing anticipatory guidance (69%). There was a moderate correlation between improvement in knowledge and their clinical skills (r=.39, p=.010). Interprofessional education improves students’ knowledge, confidence, attitude and clinical competence in assessing children’s oral health. Such education is necessary in guiding future providers to gain adequate competence in serving the children’s oral health needs.Keywords: Pediatric Dentistry; Primary Care; Children’s Oral Health; Interprofessional Education; Oral Health Education; Public Health Dentistry; Oral Health Disparity; Access to Care; Clinical Competency; Oral Health Assessmen

Integration of HeartSmart Kids into Clinical Practice: A Quality Improvement Project

Presented to the Faculty of the University of Alaska, Anchorage in partial fulfillment of requirements for the degree of MASTER OF SCIENCE, FAMILY PRACTICE NURSEIn 2009, the Centers for Medicare & Medicaid (CMS), established “Meaningful Use” regulations through an incentive program, as part of the American Recovery and Reinvestment Act of 2009 (Gance-Cleveland, Gilbert, Gilbert, Dandreaux, & Russell, 2014). Meaningful Use (MU) is tied to reimbursement and focuses on how the Electronic Health Record (EHR) is being used (Center for Disease Control and Prevention, 2012). The goal of MU is to transform the use of the EHR from a documentation tool, to a data reservoir which allows for meaningful reviews and interpretations of the quality of care (Gance-Cleveland et al, 2014).Project / Background / Significance / Review of Literature / Problem Overview / Problem Statement / Purpose / Design / Method / Plan Do Study Act (PDSA) / Ethical Considerations / Significance to Nursing / Dissemination / Conclusion

Systems of Care Coordination for Children: Lessons Learned Across State Models

Outlines features of successful systems that refer children for developmental interventions, help coordinate care, offer support and follow-up, and give providers feedback, including maximum efficiencies and partnerships, as well as policy implications

Pediatric Nurses\u27 Perspectives on Medication Teaching in a Children\u27s Hospital

Purpose To explore inpatient pediatric nurses\u27 current experiences and perspectives on medication teaching. Design and Methods A descriptive qualitative study was conducted at a Midwest pediatric hospital. Using convenience sampling, 26 nurses participated in six focus groups. Data were analyzed in an iterative group coding process. Results Three themes emerged. 1) Medication teaching is an opportunity. 2) Medication teaching is challenging. Nurses experienced structural and process challenges to deliver medication teaching. Structural challenges included the physical hospital environment, electronic health record, and institutional discharge workflow while process challenges included knowledge, relationships and interactions with caregivers, and available resources. 3) Medication teaching is amenable to improvement. Conclusion Effective medication teaching with caregivers is critical to ensure safe, quality care for children after discharge. Nursing teaching practices have not changed, despite advances in technology and major changes in hospital care. Nurses face many challenges to conduct effective medication teaching. Improving current teaching practices is imperative in order to provide the best and safest care. Practice Implications This study generated knowledge regarding pediatric nurses\u27 teaching practices, values and beliefs that influence teaching, barriers, and ideas for how to improve medication teaching. Results will guide the development of targeted interventions to promote successful medication teaching practices

Focal Spot, Fall/Winter 1999

https://digitalcommons.wustl.edu/focal_spot_archives/1083/thumbnail.jp

The Promise of Health Information Technology: Ensuring that Florida's Children Benefit

Substantial policy interest in supporting the adoption of Health Information Technology (HIT) by the public and private sectors over the last 5 -- 7 years, was spurred in particular by the release of multiple Institute of Medicine reports documenting the widespread occurrence of medical errors and poor quality of care (Institute of Medicine, 1999 & 2001). However, efforts to focus on issues unique to children's health have been left out of many of initiatives. The purpose of this report is to identify strategies that can be taken by public and private entities to promote the use of HIT among providers who serve children in Florida

How Registries Can Help Performance Measurement Improve Care

Suggests ways to better utilize databases of clinical information to evaluate care processes and outcomes and improve measurements of healthcare quality and costs, comparative clinical effectiveness research, and medical product safety surveillance