The Impact of Discharge Teaching on COPD Readmissions

The purpose of this evidenced-based project was to answer the question: Does using a formalized discharge list identifying key educational topics regarding the patient’s disease process decrease readmission risk for COPD patients? This study used all COPD patients admitted over a two-week period who consented to receiving one-on-one detailed COPD education (n=33). Participants were provided education utilizing a COPD educational tool that addressed topics pertaining to the transition from the hospital back home, inhaler techniques and use, common questions to ask the provider before being discharged, smoking cessation, and identifying the warning signs of an exacerbation were among the few topics covered. One-on-one educational sessions were scheduled at minimum for one hour and available seven days a week. Post-implementation of the evidenced-based project, a simple regression analysis was completed to test the variables of length of stay, age, sex, race, smoking status, and payor source. Based on these statistics, length of stay was the only significant variable. Seven patients who participated in this project were readmitted to the hospital. Readmissions were more common among former smokers and males. In conclusion, utilizing a COPD education tool to provide education had little impact on readmissions alone

A Quality Improvement Project to Evaluate Auditor Satisfaction with Different Data Collection Methods for Auditing Compliance with Catheter Associated Urinary Tract Infection (CAUTI) Prevention Standards

Executive Summary A Quality Improvement Project to Evaluate Auditor Satisfaction with Different Data Collection Methods for Auditing Compliance with (CAUTI) Prevention Standards Problem Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infection (HAI) in the United States, representing about 40% of all HAIs (Palmer, Lee, Dutta-Linn, Wroe & Hartmann, 2013). Approximately 25% of indwelling urinary catheters are unnecessary and may potentially lead to CAUTIs if not maintained, cleaned, and cared for appropriately (Nazarko, 2012). Literature suggests that preventing CAUTIs is possible by implementing evidence based prevention standards. The PICO research question for CAUTI prevention and prevention standard data collection is: In a sampling of clinical auditors (P) does implementation of an electronic audit tool to collect data on compliance with CAUTI prevention care standards in addition to education on the electronic audit tool (I) differ from paper form auditing for CAUTI prevention care standards (C) and does it impact auditor satisfaction and/or data collected using the new tool (O). Goal The goal of this project was to assess if there were differences in paper versus electronic audit collection methods by evaluating pre- and post-implementation auditor satisfaction. In addition, an assessment of the two collection methods was completed to evaluate consistency related to number of audits collected and notable changes in compliance, thereby providing insight into if electronic data capture (EDC) is a reliable and efficient method. Objectives Project objectives included determining auditor satisfaction with paper versus electronic data collection methods and evaluation of implications of reliability with data collection methods by maintaining consistency with data. Plan Following Institutional Review Board approval from Regis University, the project was implemented and data were collected retro- and prospectively. There was an organizational transition to EDC, a questionnaire was distributed eliciting feedback from auditors on their satisfaction level, and compliance with the prevention standards was assessed for consistency pre- and post-implementation of the EDC tool. Questionnaire data were coded and entered into a spreadsheet and statistical software was used to determine if there were significant changes in auditor satisfaction. Finally, an assessment of differences in processes used to collect CAUTI prevention standard data was completed. Outcomes and Results Nine clinical auditors and one data analyst were exposed to both paper and EDC tools and completed the questionnaire. While there was not a statistically significant increase in satisfaction, there was a clinically significant increase in auditor satisfaction. There was a statistically significant difference noted between pre- and post- implementation compliance data, but this does not prove a causal relationship due to other confounding factors. There was also a statistically significant decrease in average time it took for auditors to collect audit data

Reducing Preventable Emergency Department Visits by Improving Patient Care Access to Primary Care

Abstract Inadequate access to primary care creates a concern to receive comprehensive medical care. Improving access to a consistent source of care can help to obtain high quality of care, continuity of care, and reduce preventable emergency department (ED) visits. The aim of this project is to reduce preventable ED visits by improving patient care access to primary care. Comparing preventable ED visit rates between patients with access to primary care against those without access to primary care services, essentially focusing on those without access to primary care, which live in a medically undeserved community. The data collected was analyzed from ED visits occurring in a three-month time period, for one hospital located in a metropolitan region (a total of approximately 10,000 ED visits). The main outcome measure was ED visit rates among those without patient care access (an average of 140 daily ED visits, 45% of those visits without access to a medical home). Root cause analysis (RCA) was utilized to examine causes for recognizing those without access to primary care services. Patients without access to primary care are more likely to visit the ED for medical care than those with access to primary care. There was higher ED visit rates for those without access to primary care. Therefore, a system was developed to connect patients to a Federally Qualified Health Center (FQHC) for primary care services in that county. The lack of access to a medical home is associated with higher ED visit rates; FQHCs can possibly reduce preventable emergency department (ED) visits for the primary care safety net for those in the community

Public Accounting vs. Private Accounting: Student Intentions

Most accounting students are faced with a big decision as they near the end of their undergraduate career. Will they work toward the Certified Public Accountant license and enter public accounting or will they will choose private accounting? Both fields have their pros and cons which makes this a difficult decision. This research indicated that students more focused on extrinsic rewards, such as compensation, are more likely to choose public accounting, while students more focused on lifestyle factors, such as work-life balance, are more likely to choose private. These findings were derived from surveys distributed to accounting students at Bryant University. The results are analyzed and discussed in an attempt to help both students seeking top notch jobs, and recruiters looking to attract top talent to their companies

Emergency Nurses\u27 Knowledge of Pediatric Complaints

Each year there are more than 25 million pediatric emergency department (ED) visits, with 37-60% of the complaints being non-urgent (Brosseau, Hoffman, Nattinger, Flores, Zhang and Gorelick, 2007). Injury is the number one reason children present to the ED and is strongly associated with a complaint of pain (AHRQ, 2013). While pain is a high volume reason for visiting the ED, there are other presentation causes that may pose a high risk to pediatric patients. Nausea and vomiting is not typically viewed as a high risk complaint, yet there are some high risk etiologies resulting in nausea and vomiting that require urgent intervention. One high risk diagnosis that frequently presents with nausea and vomiting is the child with Medium-chain acyl-CoA dehydrogenase (MCADD) deficiency. These children need immediate care to avoid further clinical deterioration. Pediatric emergency nurses in an academic setting need to be knowledgeable about a broad range of clinical issues. As mentioned previously a chief complaint of pain is encountered often in the ED. Despite the commonality of the complaint, evidence suggests that pediatric pain is often under-treated. Assessment of pediatric pain is an inherent aspect of pain management. Recognizing the need to understand how pediatric pain is assessed provides the framework for partial fulfillment of the capstone. The first capstone manuscript is an integrative review regarding nursing knowledge of pediatric pain assessment in the acute care setting. The review begins with current practice recommendations and provides an overview of research from 2007-2014 regarding pediatric pain assessment, as well as knowledge and attitudes of nursing staff regarding this subject. It also includes current gaps in research and the need for additional study. The second capstone manuscript highlights a 2013 investigation: “Emergency Nursing Knowledge of Pediatric Pain Assessment in the Acute Care Setting”. A survey with established reliability and validity (the PNKAS survey) was sent to all emergency nurses working at an academic medical center over a 3-week period. The results indicated that there is a knowledge deficit regarding pediatric pain assessment among ED nurses, regardless of increased experience or advanced degree. These findings provide an opportunity to change current emergency nursing practice. The final capstone manuscript focuses on the high risk issue of nausea and vomiting in the child with MCADD. In the study setting, it was identified that emergency nurses needed education about the importance of this complaint, current guidelines for treatment, and initial management of these children. “Triage of the Pediatric Patient with Nausea and Vomiting” addressed the clinical presentation of MCADD and has been published in the Journal of Emergency Nursing (Blackburn, 2013)

Assessing Corporate Sustainability Through Ratings: Challenges and Their Causes

Assessing corporate sustainability is increasingly practice-relevant, not least because the capital market and other markets have been paying growing attention to the topic. Recently, ratings have become an important assessment approach and nowadays a variety of organizations and financial service providers conduct their own ratings. Yet, despite their growing popularity, ratings are criticized in research and practice. Thus, the purpose of this paper is to systematize the challenges that corporate sustainability ratings face: lack of standardization, lack of credibility of information, bias, tradeoffs, lack of transparency, and lack of independence. Furthermore, the paper discusses the causes of these challenges and suggests possible ways to improve the reliability of ratings

Anxiety in Children: Intervention Strategies

Three occupational therapy graduate students at the University of Puget Sound partnered with a practicing pediatric occupational therapist to investigate effective interventions for anxiety in children in the literature. A Critically-Appraised-Topic (CAT) was performed on the research question: Which interventions geared towards school-aged children between 5 and 18 with anxiety and related disorders are effective in reducing symptoms and increasing participation in school and meaningful occupations as compared to no intervention? Cognitive Behavioral Therapy (CBT) was found to have the strongest research base and the strongest positive outcomes. Gains were maintained following CBT even 10-26 weeks post-treatment. Other promising interventions with positive outcomes included social skills training, yoga, deep pressure, and play-based and occupation-based groups, although much more research is needed in these areas. Decision support tools were created by the graduate students to aid the partnering clinician and her clinic translate knowledge from the research into practice. The students created tables listing interventions and assessments for anxiety in children found in the literature, and listed additional details such as cost, time to administer, and targeted diagnoses and ages to help the clinicians decide which interventions and outcome measures from the research to incorporate into practice. The clinicians ultimately decided to purchase several books, such as the social stories program “Dominique’s Handy Tricks”, to use in treatment of anxiety of children at their clinic. Clinicians reported the knowledge translation tools strengthened their evidence-based practice by allowing them to easily choose interventions and tools that had positive outcomes in the literature and that best fit the clinic’s needs

Integrating Public Health into Planning: Promising Practices for Regional Planning Councils

This Capstone project was designed to provide technical expertise to Greater Portland Council of Governments (GPCOG) for their 2017 strategic planning process. GPCOG is the Regional Planning Council (RPC) for Cumberland County, Maine. Also known as Councils of Government (COGs) and simply Regional Councils – these municipal and regional planning organizations were established in the U.S. in the 1960s. They are multi-service entities with state-defined boundaries that deliver a variety of federal, state, and local program supports. They provide planning and technical assistance to their member municipal governments. RPCs are accountable to their members and are partners with the state and federal governments. RPCs usually work closely with the Metropolitan Planning Organization (MPO) and other planning groups. This is the case with GPCOG and the Portland Area Comprehensive Transportation System (PACTS) which are legally separate organizations, but are co-located, sharing office space and staff. GPCOG is currently working with its member municipalities and stakeholders to examine its identity and refine its role in the region. Executive Director Kristina Egan sees the strategic planning process as an ideal time to present the opportunity for integrating public health into the agency’s transportation and land use planning. GPCOG’s member towns and cities are looking for data-driven strategies and are open to new approaches. GPCOG’s leadership wants to ensure the organization has access to the resources and tools of the public health sector. In short, GPCOG wants to be ready with answers when towns ask “how do we incorporate public health?” This project explores how communities in the U.S. are integrating public health practices into planning. Specifically, it examines efforts to integrate public health into planning within RPCs. The project identifies tools and approaches that leading RPCs are using to successfully integrate public health into planning in their regions, in response to two questions posed by GPCOG: 1. What are the promising practices for embedding public health in the community planning and development efforts of regional planning councils? 2. How can this be done in a way that is financially sustainable