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The Mosakowski Institute for Public Enterprise Five Year Report

This report contains the highlights of the first five years of Clark University’s Mosakowski Institute for Public Enterprise. It includes a description of the Institute’s founding, its commitment to use-inspired research, transformational educational experiences, and community connectedness, the Institute’s leadership and finances, and a listing of projects undertaken and faculty partners

Comparison of Usual Versus Best Practice in Preventing and Managing Low Back Pain

Musculoskeletal disorders contribute to 34% of work-related injuries in the United States that result in missed days from work (Bureau of Labor Statistics, 2013). Healthcare workers are at a particularly high risk of injuring themselves in the hospital setting. Low back pain (LBP) has a significant public health impact as back injuries have the highest rate of occurrence out of all musculoskeletal disorders. Risk factors for LBP include obesity, joint disease, poor posture, and poor lifting techniques. Two frequently used treatments for LBP, with some evidence of effectiveness, are chiropractic and massage therapy. Prevention is critical to reducing the incidence of LBP. Exercise programs that incorporate aerobic and strength-training have proven effective at preventing LBP (Hasan et al., 2010). Evidence-based guidelines for managing LBP include prescribing acetaminophen, educating the client, and treating in a primary care setting (Williams et al., 2010). / This project is being conducted at a local hospital in rural eastern North Carolina. This hospital has experienced a high incidence of work-related LBP. The purpose of this project is to compare usual practice with best practice for the prevention and management of LBP among hospital workers. Collaboration and policy development and enforcement are two public health interventions used in this project. This project is a collaborative partnership with an interdisciplinary team including the staff development nurse, employee health nurse, rehabilitation specialist, physical therapist, occupational therapist, and insurance coordinator. The two project objectives are 1) to interview and observe the work of 5-7 key informants who are involved in LBP prevention and management, and 2) to make 2-4 recommendations, based on findings, to the hospital administration on the prevention and management of LBP. In this program evaluation, data generated from key informants will be organized in a matrix to identify gaps between usual and best practice. In collaboration with the staff development nurse this data will be analyzed and interpreted to provide recommendations in the prevention and management of LBP by February 26, 2014.

Implementation of a Post-Fall Medication Reconciliation Assessment Tool

Older adult patients are often prescribed potentially inappropriate medications (PIMs) in the acute care hospital setting. Reducing falls in older adults requires a multi-faceted approach, including thoughtful consideration of medication regimens in this at-risk population. Two medical units in a Charlotte-area hospital experienced a combined 47 falls in older adult patients out of 97 total falls in 2019. Without a process to address PIMs, the Doctor of Nursing Practice project team developed the Post-Fall Medication Reconciliation Assessment Tool. The tool was used specifically for patients 65 and older who fell on Unit A or Unit B to evaluate for PIMs administered within 24 hours of their falls, based on comparing their medication records with the 2019 Beers Criteria. After identification, the nurses were instructed to communicate with the patient’s physician to consider PIM discontinuation. During the 11-week implementation phase, 11 falls occurred on the two units, and only 10% of the tools were fully completed. However, for each patient that fell, they were administered an average of 2.4 medications that matched the Beers Criteria. Only one tool indicated a conversation occurred between a nurse and physician. While the project did not directly eliminate PIMs in these older adult patients, there is evidence in the literature that reducing PIMs can improve patient outcomes, reduce health care expenditures, and enhance patient care.D.N.P