Reducing Antibiotic Use in Pediatric Upper Respiratory Infection: A Multifaceted Parent-Clinician Approach

The goal of this QI initiative was to decrease inappropriate antibiotic for the treatment of pediatric upper respiratory infection (URI) in the retail clinic setting. The approach included the use of a protocol to treat viral upper respiratory illness, a visual aid decision-making tool for guideline adherence, prescription pad for nonprescription remedies, and shared decision-making techniques for providers to involve patients and parents in management plans regarding nonprescription remedies, supportive treatment, and signs and symptoms that would warrant a return visit. An improvement trend during the first 3 months of the initiative showed a shift in antibiotic avoidance from a baseline avoidance rate of 66% to a post intervention rate of 82%. The antibiotic avoidance initiative proved to be an effective approach in reducing the rate of inappropriate antibiotic treatment for pediatric viral upper respiratory conditions

What You Need to Know about Bar-Code Medication Administration

Medication errors are the most common type of preventable error. Bar-code medication administration (BCMA) technology was designed to reduce medication administration errors. Poor system design, implementation and workarounds remain a cause of errors. This paper reviews the literature on BCMA, identifies a gap in the findings and identifies three evidence based practices that could be used to improve system implementation and reduce error. The literature review identified that Bar-code medication administration and system workarounds are well documented and affect patient safety. Based on the critical analysis of 10 studies, we identified gaps in the standardization of BCMA planning, implementation, and sustainability. The themes that emerged from the literature were poor BCMA design and implementation that resulted in workarounds.The three evidence based strategies proposed to address this gap are, evidence based standardization in planning and implementation, the identification and elimination of workarounds and hard wiring. An evidence based checklist evaluates compliance with standard procedures. The LEAN model of Jodoka is used to assure adaptation of the machine to human workflow. Direct observation provides valuable workflow assessment. An effective BCMA implementation involves careful system design, identification of workflow issues which cause workarounds, and adapting the machine to nursing needs

Reducing Medication Errors Through Workflow Redesign

Lack of medication reconciliation at the point of transitions between skilled nursing facilities/nursing homes (SNF/NHs) and acute care hospitals (ACHs) is a common point of origin for medical errors that cause harm to patients. The goal of this quality improvement initiative was to improve medication reconciliation at the point of transition from the SNF/NH to the ACH which in turn would reduce medication errors, adverse drug events, and medication-induced injury to the vulnerable elderly population. We implemented a workflow redesign process to reconcile the accuracy of residents’ medications at the time of transfer from the SNF/NH to the ACH. After the initiation of a medication reconciliation protocol, 72% (n=13/18) of the medication administration records (MARs) had no medication errors

Long subcutaneous tunnelling reduces infection rates in paediatric external ventricular drains

Purpose The aim of this study is to report the efficacy of long subcutaneous tunnelling of external ventricular drains in reducing rates of infection and catheter displacement in a paediatric population. Methods In children requiring external ventricular drainage, a long-tunnelled drain was placed and managed according to a locally agreed guideline. End points were novel CSF infection incurred during the time of drainage and re-operation to re-site displaced catheters. Data were compared to other published series. Results One hundred eighty-one long-tunnelled external ventricular drains (LTEVDs) were inserted. The mean age was 6.6 years (range 0-15.5 years). Reasons for insertion included intraventricular haemorrhage (47 %), infection (27 %), tumour-related hydrocephalus (7.2 %), as a temporising measure (17 %) and trauma (2.2 %). The overall new infection rate for LTEVD was 2.76 %. If the 48 cases where LTEVDs were inserted to treat an existing infection are excluded, the infection rate was 3.8 % (5/133). The mean duration of insertion was 10 days (range 0-42 days). Four LTEVDs (2.2 %) were inadvertently dislodged, requiring reinsertion. Thirteen patients required removal of EVD alone.There was a significant difference (p < 0.05) when comparing our infection rate to 14 publications of infection rates in short-tunnelled EVDs; however, there was no difference when comparing our data to three publications using LTEVDs. Conclusion The use of an antibiotic-impregnated LTEVD, managed according to a predefined guideline, is associated with significantly reduced infection and displacement rates when compared with contemporary series. It is suggested that this reduction is of both clinical and economic benefits

Using Business Modeling to Streamline Cost of Anesthesia in a Cardiopulmonary Laboratory

The Time Driven Activity Based Costing (TDABC) measurement system, a model used in the business arena, can capture clinical processes and costs that other costing models often overlook. Use of this system permitted tying costs to time and resources and identified areas of inefficiency such as depleted supplies and health care and emergency supplies placed inconveniently. A multidisciplinary team developed an anesthesia checklist for use in a remote cardiopulmonary laboratory. The compliance rate for checklist completion was approximately 85%. Checklist implementation translated to a decrease in case delays and time expenditure in patient care by 58% with a cost savings of 2.5% per patient

Optimizing Emergency Department Throughput Using Best Practices to Improve Patient Flow

Emergency Department (ED) crowding and bottle necks are the reality of hospitals across the country. Patients seeking care and needing inpatient beds via the emergency rooms are facing delays with attaining the right level of care. Orchestrating a patient through an ED admission requires a multidisciplinary effort to provide safe, effective and efficient care. This quality improvement project conducted in a tertiary acute care hospital focused on Centers for Medicare and Medicaid metrics to measure Emergency Department (ED) throughput. This multidisciplinary initiative focused on reducing time stamps for patient arrival to the ED through departure to hospital or home. Outcomes showed a significant decrease in the time frame for patient arrival to being seen by a qualified provider, left without being seen rates, ED diversion, and ancillary department turnaround times. The interventions can be applied at other hospital based emergency departments

2020 Graduates Project Abstracts by Cizik School of Nursing at UTHealth

The Cizik School of Nursing at UTHealth proudly presents the DNP Project abstracts for the 2020 Class of DNP Graduates.https://digitalcommons.library.tmc.edu/dnp/1006/thumbnail.jp

Nurse Practitioner Autonomy in Georgia: Exploring Barriers to Full Practice Authority

Background: There is a significant shortage of primary care physicians in Georgia, with the greatest needs in rural communities. The evidence suggests that nurse practitioners (NPs) improve the quality of care for patients with chronic diseases and may be the solution to the physician shortage. However, the scope of practice for Georgia NPs is among the most restricted in the United States. Purpose: This policy review project explored the barriers to full practice authority for nurse practitioners in the state of Georgia and assessed the impact of current policy on NPs opening independent practices in rural Georgia. The goal of the project was to build a consensus for legislative change to current NP scope of practice. Methodology: A quantitative design was used to collect data from a large nursing organization in Georgia via convenience sampling. One hundred and seventy-nine NPs responded. However, only 135 participants (N=135) consented. Participants completed an online survey in thirty minutes or less. Some questions required free text responses. One-way ANOVA and correlational analysis were used to determine differences between variables. There were no significant differences between NP characteristics (such as race, age, education level, etc) and the likelihood of opening an independent practice. Results: Most NPs (77%) reported a desire for full scope of practice, 80% believed removal of practice barriers would be an advantage to Georgia NPs, and a significant number said if autonomous practice was granted, they were likely or very likely to open an independent practice in rural Georgia

Summarized Guidelines Aid Providers in Caring for Patients with Otitis Media with Effusion

Otitis media with effusion (OME) is a disorder that can cause hearing loss in children, which can lead to speech and language delay. There are recommendations within the OME guideline and primary care providers are aware of these guidelines but do not follow them. For this project a suburban outpatient pediatric medical practice with 8 providers (4 MD’s and 4 NP’s) was studied. The 8 providers were educated and presented with an algorithm, designed by the author, organizing the OME recommendations in a flowchart. Over a 2-month period, providers referred to the algorithm and used the recommendations in practice. Then 3 interviews were completed, and providers’ answers were analyzed. There was an 87% approval rating by providers using the recommendations in practice and referring to the algorithm. Providers acknowledged that being educated on the OME guideline and using the algorithm in practice improved management of patients with OME. Educating providers on the OME guideline recommendations and supplying them with the recommendations organized in an algorithm maintains consistency and efficiency when treating patients with OME

Practice Matters: Screening and Monitoring Hyperlipidemia

Abstract The purpose of this article is to provide Faith Community Nurses with current information on hyperlipidemia, a chronic disease responsible for the leading cause of death worldwide. Current guidelines for cholesterol screening and a risk calculator resource for estimating cardiovascular risk are provided. Myths and truths are presented for review with patients. Suggestions and resources for lifestyle modifications and patient education are included. Faith Community Nurses are at the center of community health and actively involved with improving health outcomes related to chronic disease