Reducing Patient Risk for Suicidal Behaviors with a Safety Bundle of Best Practices with Non-Psychiatric Patients

Practice Problem: Suicide is a public health condition that affects people globally. The increased suicidal behaviors of patients in a medical-surgical unit demanded an effective screening protocol to identify high-risk patients. PICOT: In patients 18 years and older on a medical-surgical unit, does the implementation of the Columbia Suicide Severity Rating Scale (C-SSRS) tool and application of a Safety Bundle of Best Practices (SBBP) increase early identification of suicide risk with decreased patient self-harm behaviors, compared to the current standard practice of no assessment tool or safety bundle of best practices within 12 weeks? Evidence: Ten studies served as evidence that assessment of early suicidal-risk behaviors decreased patient self-harm. The evidence supported the implementation of the C-SSRS tool and application of the Safety Bundle of Best Practices for the project intervention. Intervention: The intervention consisted of three phases (pre-intervention, intervention, and post-intervention): a) patients were screened with the Columbia-Suicide Severity Rating Scale (C-SSRS); b) suicidal patients were managed with Collaborative Assessment and Management of Suicidality (CAMS); and c) a Safety Plan Intervention (SPI) was employed to manage suicidal behaviors. Outcome: At the start of the assessment period, pre-intervention data yielded a C-SSRS risk score mean of 0.81; following the eight-week implementation period, post-intervention data yielded a C-SSRS risk score mean of 0.75. There was a marginally significant difference between the means at pre- and post-intervention, showing a lower suicidal risk at post-intervention, p = 0 .07, t-test result (31) = 1.87. Conclusion: The decrease in patient self-harm behaviors with the implementation of the C-SSRS tool and application of SBBP was not statistically significant (SBBP). However, the decrease did indicate a clinically meaningful improvement in suicidal behavior outcomes after implementation of the intervention

Quality of Health Care for Medicare Beneficiaries: A Chartbook

Provides the results of a review of recently published studies and reports about the quality of health care for elderly Medicare beneficiaries. Includes examples of deficiencies and disparities in care, and some promising quality improvement initiatives

Transitional Care for Older Adults with Dementia: Variation Across Patients and Providers

Older adults with dementia are particularly vulnerable to negative outcomes and adverse events when they transition between healthcare settings such as being discharged from the hospital. However, little is known about how healthcare providers help patients prepare for a care transition – known as transitional care – among older adults with dementia. Therefore, this study sought to understand the transitional care currently delivered by hospital healthcare providers to older adults with dementia, how it compared to that received by older adults without dementia, and how it varied across different patient and provider characteristics. Guided by key provider/informant interviews and theory, a medical chart review of older adults with dementia was conducted. Results revealed that while some transitional care actions, such as discharge planning, are delivered to a majority of patients other actions such as patient education are delivered only to a minority. Future research should assess whether this variation is associated with outcomes such as hospital readmission and patient and caregiver satisfaction

Quality Assessment of Healthcare Databases

The assessment of data quality and suitability plays an important role in improving the validity and generalisability of the results of studies based on secondary use of health databases. The availability of more and more updated and valid information on data quality and suitability provides data users and researchers an useful tool to optimize their activities. In this paper, we have summarized and synthesized the main aspects of Data Quality Assessment (DQA) applied in the field of secondary use of healthcare databases, with the aim of drawing attention to the critical aspects having to be considered and developed for improving the correct and effective use of secondary sources. Four developing features are identified: standardizing DQA methods, reporting DQA methods and results, synergy between data managers and data users, role of Institutions. Interdisciplinarity, multi-professionality and connection between government institutions, regulatory bodies, universities and the scientific community will provide the "toolbox" for i) developing standardized and shared DQA methods for health databases, ii) defining the best strategies for disseminating DQA information and results

Effectiveness of User Centered Design for Optimizing an Electronic Documentation Form

Problem. The electronic form used by lactation consultants to document assessment findings, interventions, plans and recommendations, did not meet user’s requirements. Purpose: The purpose of this project was to evaluate the effect of optimization through a User Centered Design (UCD) process on information quality, use and user satisfaction. Goals. The goals were to provide information technology (IT) support for the organization’s Baby Friendly initiative and to support collaborative, consistent messaging for breastfeeding families which could, in turn, support exclusive breast milk feeding. Exclusive breast milk feeding is a population health initiative that could positively impact the triple aim of better care, lower costs and better health. Objectives. Information quality, use and user satisfaction affect user adoption and acceptance of IT solutions. The objective of this project was to test the effectiveness of UCD on optimization by measuring the increase in information quality, use and user satisfaction after implementation of an optimized electronic lactation assessment. Plan. Stakeholders were identified and the electronic form was optimized through UCD. A pre-test/post-test quasi-experimental design was chosen to measure the effect of optimization. Instruments included a modified version of the System and Use Assessment Survey (AHRQ, n.d.), a chart audit tool and an electronic data warehouse use query. IRB approval was obtained from COMIRB and Regis University. The pre and post data collection periods were each six weeks in length, allowing for a two week chart audit period and four week survey. The intervention was implemented after the close of the pre-test period. Clinical users were educated following the organization’s usual methods for EHR changes. Five months after the intervention, the study timeline was repeated for the post-test period. After the post-test period, a use query was run to collect data for both pre-test and post-test periods. Data were collected, coded, and entered into electronic spreadsheets for storage and analysis. Outcomes and Results. Although the sample as a whole showed no statistically significant increases in any parameter of information quality, use, or user satisfaction, when survey participants were divided by role, nurses and providers, there was a statistically significant increase in the post-test nursing group for two measures of information quality and one measure of information use. A Mann Whitney U test found a significantly higher perception of completeness of the lactation assessment, U = 200, z = -2.11, p = .035, r = .29 and reported frequency of accessing the lactation assessment from the EHR, U= 233, z = -2.01, p = .044, r = 0.26. A Fishers exact test found a statistically significant increase in the presence of lactation assessments in the post-test chart audit [1, N = 39] = 11.8, p =.001, φ= .39). The outcomes may be explained by differences in how each role uses the EHR. Additional education for providers may be necessary to overcome these differences

A Practice-Based Research Approach to Explore the Relationship of Preoperative Warming to the Incidence of Surgical Site Infection in the Ambulatory Surgical Patient

Surgical site infections are a financial burden to society and are the second most frequently reported Health Associated Infection (HAI) that increases hospital stays and the chief cause of preventable death (Agency of Health Research and Quality [AHRQ], 2009; National Priorities Partnership [NPP], 2008). It is branded as the top national priority for the United States Department of Health & Human Services (DHHS) and the AHRQ. Unplanned perioperative hypothermia (UPH) is associated with a 68 percent increase in the incidence of surgical site infections (Kurz, Sessler, & Lenhardt, 1996; Pikus & Hooper, 2010). The prevention of UPH and promotion of perioperative normothermia has come to the national forefront as a quality measurement designated by the Surgical Care Improvement Program (SCIP) (2005; n.d). The incidence of SSI\u27s in the ambulatory surgical population has not been well researched (AHRQ, 2009; Barie, 2010). Therefore, the PICO question that the researcher is trying to solve is: In adult patients undergoing ambulatory surgery, do patients who are prewarmed during surgery have fewer SSIs than those that are not? Purpose The purpose of this DNP project was to determine the incidence of UPH and SSI in the ambulatory surgery population. In addition, a relationship of Preoperative patient warming to the incidence of UPH (intraoperatively) and SSI in the ambulatory surgery population was determined. The goal of the project was to identify whether the standard of care (the SCIP measures/intraoperative warming methods) was met in an adult ambulatory surgical population and whether there was a relationship between hypothermia occurrence and the subsequent development of an SSI

Use of Health Information Technology in Patient Care Management: a Mixed Method Study in Iran

Introduction: New computerized system, including health information technologies (HITs), plays an important role in the efficacy of management and nursing care services. Objective: This study was aimed to determine the use of HIT in patient care management, in a case study in Iran. Methods: This mixed method study was conducted in 2018 at the Kowsar Hospital of Semnan, Iran. Data collection was performed, using an observational checklist, and a questionnaire, including two main parts, one demographic and other assessment of information technology (IT) application in the care management of inpatients. The researcher prepared the questionnaire and its validity was verified. The data were organized and analyzed in the form of a descriptive analytic report. In the process of data collection 10 participants, including nurses, head nurses, physicians, radiology experts and IT managers were interviewed, and data analysis was performed, using conventional content analysis. Results: Nurses were satisfied with the computerized system and believed it can expedite the job. From the nurse’s viewpoint, the most common use of the HIT was to have access (observation) to patient admission and discharge information (100%), providing medicine and equipment, and transfer of patients (92.3%). The least use of IT was the retrieval of evidence in the care process (0%), and judgment and analysis related to radiological diagnostic procedures (0%). The potential of electronic record is still not applicable. Conclusion: Use of modern information and communication technology in hospitals facilitates access and transfer of information, and also accelerates patient’s admission and discharge process, relation between hospital units, simplifying the administration of current affairs and providing the necessary medical supplies and diagnostic procedures. However, modifying organizational policies improves the infrastructure, and enhances nurses' motivation in documentation of nursing reports, which can be effective in increasing the impact of IT in care management processes, especially in electronic record and nurse’s clinical judgment and evidence-based care