Implementation and evaluation of a nurse-administered dysphagia screening tool to identify patient’s at high risk for post-extubation dysphagia

Purpose: Post-extubation dysphagia (PED) occurs in 3% to 62% of intensive care unit patients. Patients with moderate or severe PED are more likely to experience pneumonia, reintubation, or death. Early identification of post-extubation dysphagia is crucial so diet modifications, temporary feeding measures, and/or advanced swallow evaluations and therapies can be implemented. The purpose of this quality improvement project was to implement a nurse-administered dysphagia screening tool (NADST) for post-extubated patients in a 21-bed mixed medical intensive care unit (MICU) at a large academic medical center. Methods: Utilizing quality improvement methods, a modified dysphagia screening tool was trialed in a MICU for two months. Eight Super Users (RNs) were recruited and attended one of three train the trainer sessions taught by a Speech Language Pathologist. The Super Users trained the remaining unit nurses (RNs). A 5-minute video for the unit nurses was created to supplement the trainings. Pre- and post-intervention surveys were administered to measure changes in knowledge, beliefs, and practices around PED screening. Patient electronic health records were reviewed to identify all patients eligible for PED screening and screening dispositions. Results: Of the 59 eligible patients, 34 patients were screened utilizing the NADST. Nurses had a high level of knowledge but varying practices and comfort with dysphagia screening prior to the intervention. The intervention increased the comfort level and screening frequencies for PED. The NADST was found to be useful for improving nursing practice. Conclusions: Through the utilization of a Super User training model, this quality improvement project demonstrated that implementing a standardized PED screening tool does improve PED screening frequencies

Exploring the diagnostic accuracy of the KidFit screening tool for identifying children with health and motor performance-related fitness impairments: A feasibility study

Child obesity is associated with poor health and reduced motor skills. This study aimed to assess the diagnostic accuracy of the KidFit Screening Tool for identifying children with overweight/obesity, reduced motor skills and reduced cardiorespiratory fitness. Fifty-seven children (mean age: 12.57 ± 1.82 years; male/female: 34/23) were analysed. The Speed and Agility Motor Screen (SAMS) and the Modified Shuttle Test-Paeds (MSTP) made up the KidFit Screening Tool. Motor Proficiency (BOT2) (Total and Gross) was also measured. BMI, peak-oxygen-uptake (VO2peak) were measured with a representative sub-sample (n = 25). Strong relationships existed between the independent variables included in the KidFit Screening Tool and; BMI (R2 = 0.779, p < 0.001); Gross Motor Proficiency (R2 = 0.612, p < 0.001) and VO2peak (mL/kg/min) (R2 = 0.754, p < 0.001). The KidFit Screening Tool has a correct classification rate of 0.84 for overweight/obesity, 0.77 for motor proficiency and 0.88 for cardiorespiratory fitness. The sensitivity and specificity of the KidFit Screening Tool for identifying children with overweight/obesity was 100% (SE = 0.00) and 78.95%, respectively (SE = 0.09), motor skills in the lowest quartile was 90% (SE = 0.095) and 74.47% (SE = 0.064), respectively, and poor cardiorespiratory fitness was 100% (SE = 0.00) and 82.35% (SE = 0.093), respectively. The KidFit Screening Tool has a strong relationship with health- and performance-related fitness, is accurate for identifying children with health- and performance-related fitness impairments and may assist in informing referral decisions for detailed clinical investigations

Older patients' prescriptions screening in the community pharmacy: development of the Ghent Older People's Prescriptions community Pharmacy Screening (GheOP3S) tool

Background: Ageing of the population often leads to polypharmacy. Consequently, potentially inappropriate prescribing (PIP) becomes more frequent. Systematic screening for PIP in older patients in primary care could yield a large improvement in health outcomes, possibly an important task for community pharmacists. In this article, we develop an explicit screening tool to detect relevant PIP that can be used in the typical community pharmacy practice, adapted to the European market. Methods: Eleven panellists participated in a two-round RAND/UCLA (Research and Development/University of California, Los Angeles) process, including a round zero meeting, a literature review, a first written evaluation round, a second face-to-face evaluation round and, finally, a selection of those items that are applicable in the contemporary community pharmacy. Results: Eighteen published lists of PIP for older patients were retrieved from the literature, mentioning 398 different items. After the two-round RAND/UCLA process, 99 clinically relevant items were considered suitable to screen for in a community pharmacy practice. A panel of seven community pharmacists selected 83 items, feasible in the contemporary community pharmacy practice, defining the final GheOP3S tool. Conclusion: A novel explicit screening tool (GheOP3S) was developed to be used for PIP screening in the typical community pharmacy practice

Diagnostic value of the Dutch version of the MCclean Screening instrument for BPD (MSI-BPD)

Borderline personality disorder (BPD) often goes unrecognized, and therefore a short but accurate screening tool is desired. The present study investigated the psychometric properties of the 10-item McLean Screening Instrument for BPD (MSI-BPD) in 159 well-diagnosed female participants. The MSI-BPD showed excellent internal consistency (alpha = .90). When compared to BPD diagnoses based on a structured clinical interview (SCID-II), the MSI-BPD showed substantial congruent validity (receiver operating characteristic area under the curve = 0.96). The cutoff point proposed by the developers of the MSI-BPD (7 or more) showed high specificity (.96) and good sensitivity (.71). The optimal cutoff point in the present study (5 or more) showed somewhat lower specificity (.86), but importantly better sensitivity (.94). Taken together, the Dutch version of the MSI-BPD demonstrated good psychometric properties for a screening tool

Addressing Traumatic Stress in the Acute Traumatically Injured Patient

Psychological injuries after an acute traumatic event are commonly overlooked. Currently within United States, there is no consistently utilized screening process that addresses traumatic stress within the acute trauma population. Roy\u27s Adaptation Model guided this project, focusing on the idea that bedside nurses are at the frontline of providing early identification through nursing assessment. The purpose of this pilot study was to evaluate whether the implementation of the Primary Care-Posttraumatic Stress Disorder (PC-PTSD) screening tool by bedside nurses would result in identifying more patients at risk for traumatic stress after an acute trauma as compared with the use of no screening method. This descriptive survey study took place over a 6-week period at a Midwest Level 1 trauma hospital. The results revealed that the tool did not increase the number of health psychology consults when compared with the same 6-week period a year prior when no tool was used. Nonetheless, use of the PC-PTSD tool did trigger 28% of the patients to receive a health psychology consult. Forty-five percent of patients who received a health psychology consult were recommended outpatient therapy. Utilization of this tool by bedside nurses did not adversely increase a number of inappropriate health psychology consults. These results agree with the literature and further suggest that there are a clinically significant number of acute trauma patients who are at risk for traumatic stress. With this screening tool, nurses accurately assessed patients and connected them with timely psychological treatment

Portinari: A Data Exploration Tool to Personalize Cervical Cancer Screening

Socio-technical systems play an important role in public health screening programs to prevent cancer. Cervical cancer incidence has significantly decreased in countries that developed systems for organized screening engaging medical practitioners, laboratories and patients. The system automatically identifies individuals at risk of developing the disease and invites them for a screening exam or a follow-up exam conducted by medical professionals. A triage algorithm in the system aims to reduce unnecessary screening exams for individuals at low-risk while detecting and treating individuals at high-risk. Despite the general success of screening, the triage algorithm is a one-size-fits all approach that is not personalized to a patient. This can easily be observed in historical data from screening exams. Often patients rely on personal factors to determine that they are either at high risk or not at risk at all and take action at their own discretion. Can exploring patient trajectories help hypothesize personal factors leading to their decisions? We present Portinari, a data exploration tool to query and visualize future trajectories of patients who have undergone a specific sequence of screening exams. The web-based tool contains (a) a visual query interface (b) a backend graph database of events in patients' lives (c) trajectory visualization using sankey diagrams. We use Portinari to explore diverse trajectories of patients following the Norwegian triage algorithm. The trajectories demonstrated variable degrees of adherence to the triage algorithm and allowed epidemiologists to hypothesize about the possible causes.Comment: Conference paper published at ICSE 2017 Buenos Aires, at the Software Engineering in Society Track. 10 pages, 5 figure

Implementation of a Large System-Wide Hepatitis C Virus Screening and Linkage to Care Program for Baby Boomers.

BackgroundWe implemented and evaluated a large health system-wide hepatitis C virus (HCV) screening and linkage to care program for persons born between 1945 and 1965 ("baby boomers").MethodsAn electronic health record (EHR) clinical decision support (CDS) tool for HCV screening for baby boomers was introduced in August 2015 for patients seen in the outpatient University of California, Los Angeles healthcare system setting. An HCV care coordinator was introduced in January 2016 to facilitate linkage to HCV care. We compared HCV testing in the year prior (August 2014-July 2015) to the year after (August 2015-July 2016) implementation of the CDS tool. Among patients with reactive HCV antibody testing, we compared outcomes related to the care cascade including HCV ribonucleic acid (RNA) testing, HCV RNA positivity, and linkage to HCV specialty care.ResultsDuring the study period, 19606 participants were screened for HCV antibody. Hepatitis C virus antibody screening increased 145% (from 5676 patients tested to 13930 tested) after introduction of the CDS intervention. Screening increased across all demographic groups including age, sex, and race/ethnicity, with the greatest increases among those in the older age groups. The addition of an HCV care coordinator increased follow-up HCV RNA testing for HCV antibody positive patients from 83% to 95%. Ninety-four percent of HCV RNA positive patients were linked to care postimplementation.ConclusionsIntroduction of an EHR CDS tool and care coordination markedly increased the number of baby boomers screened for HCV, rates of follow-up HCV RNA testing, and linkage to specialty HCV care for patients with chronic HCV infection

Implementation of the Vermont Mini-Cog

Cognitive impairment screening is important for early detection, diagnosis, and treatment of cognitive impairment and dementia. Additionally, screening is mandated as part of the Medicare Annual Wellness Visit. Colchester Family Medicine providers were surveyed about their current screening behaviors and then provided a training session on cognitive impairment screening and the Vermont Mini-Cog screening tool. Post-training, providers were surveyed about their likely future screening practices.https://scholarworks.uvm.edu/fmclerk/1540/thumbnail.jp