Engaging Patients to Improve Documentation of Oral Intake on a Cardiac Telemetry Unit: A Quality Improvement Initiative

Background InformationIt is important for patients with heart failure to have awareness of their intake & output to effectively manage their disease. There is evidence that tracking intake & output is a component of missed nursing care resulting in discrepancies between the actual patient intake and what is documented in the patient’s electronic health record (EHR). Aim The aim of this quality improvement project was to engage patients in monitoring their intake by using teach-back and patient engagement techniques to track their own oral fluid intake throughout the day. MethodsThe Plan-Do-Study-Act (PDSA) model was used as the framework for this initiative. Patients meeting inclusion criteria were given a teach-back quiz to evaluate baseline knowledge. If patients were able to pass the teach-back quiz, they were given a tracking sheet with instructions on how to use it. After a period of eight hours, the sheet was collected and fluid intake volumes were compared with those documented in the EHR. ResultsUsing the Wilcox on non-parametric test, the mean difference between volume tracked by patient and volume documented by clinician was significant at pConclusion & Implications for CNL PracticeVariation between oral fluid intake volume documented in the EHR and patient stated volumes indicates that EHR documentation is less reliable than records kept by adequately educated and engaged patients. Implications for CNL practice include identification of opportunities to increase patient engagement and to utilize evidence-based techniques for this purpose. The CNL should explore barriers that contribute to inaccuracy of documentation. The CNL may explore more reliable methods for determining accurate patient fluid balance for at-risk populations

Where there is a wind, there is a way

A shift in USA energy policy from oil or natural gases to thermonuclear fission and solar energy is predicted. A massive diversified energy research and development effort to productively harness the energy in the winds is outlined to develop commercially feasible wind energy conversion systems - considered a form of solar energy - in the near future

Michigan\u27s Cooperative Forest Pest Management Program, A Team Approach to Improving Forest Management

A forest management team was organized in the late 1970\u27s by cooperative efforts of Michigan\u27s universities. the Michigan Department of Natural Resources, and the USDA Forest Service.The goals were to devise new technologies, transfer available technology, and service and management alternatives to forest land managers in Michigan. The program throughout has emphasized forest management rather than pest management for prevention and control of pests. Dissemination of pest management information has been of importance and new research results have gone directly to land managers for immediate use. The team participates in forest compartmental reviews and helps prescribe management plans for land parcels, thus providing for preventative pest management. Services and management recommendations are provided mostly through forest pest specialists located in the field. They feed back results and problems to researchers and extension specialists of the team for further input. Preventive management information used by by local managers in recent years has nearly paid the cost of the program. Plans are to broaden the team effort by cooperating with organizations and in adjacent states through a computer network system and by other means