Social Determinants of Health Screening in Hospitalized Pediatric Patients

Abstract Objective: Examine effectiveness of the implementation of a social determinant screening tool for hospitalized pediatric patients. Methods: An adaptation of the WE CARE screening tool produced by Boston Medical Center was used on admission for pediatric patients admitted to an acute care children’s hospital in the southeastern United States. The screening tool was implemented over a three month period from October 2021-January 2022. Based on survey results social work consults were initiated and resource connections made as needed. Disparities identified and resource connections made with the use of the survey was compared to the same three month time period of the year prior. Results:While no statistically significant findings were obtained due to a small project sample size there were several takeaways when analyzing obtained data. When compared to pre-data, there was an increase in determinant screening with the implementation of a standardized screening tool with 100% of patients being screened during implementation compared to 83.3% prior. Further, there appeared to be a reduction in social work referrals made and resource connections secured when comparing post data to pre-data but several factors seemed to influence these results including bias related to sample size and outlying factors to consider for patients in the project sample size. Conclusions: As it is estimated thatmedical care only accounts for 10-20% of overall health, with the remaining 80-90% influenced by social factors, it is of upmost importance to regularly screen for social determinants of health (Magnan, 2017). While the primary care setting is normally the main focus of determinant screening, the AAP recommends screening for social determinants at each patient encounter (AAP, 2020). The acute care setting provides a unique opportunity for social disparity screening as needs can be discovered at admission and may be resolved by discharge. Evidence supports the use of a screening tool for social determinant recognition and after the review of available tools, the WE CARE screening tool was chosen based on delivery method, accessibility, and length (Morone, 2017). The implementation of this tool has the potential to improve management and care of patients in the pediatric population and their families

Reducing Occupational Stress and Improving Coping Strategies among Nursing Home Nurses: Implementation of the BREATHE web-based program.

Objective: The purpose of this quality improvement evidence-based project is to determine the effect of a web-based stress management program called BREATHE on reducing occupational stress and improving coping strategies. This evidence-based web-based program was made available to nurses in a nursing home (NH) in the Southeastern United States who have not participated in any stress management program before. Method: The project provided a web-based stress management educational program to the participants. The program consists of six modules that give nurses an in-depth understanding of stress, how to manage it, and develop coping strategies. The project was carried out in a NH in the Southeastern United States. Measurements: The demographic variables, valid and reliable questionnaires of the Nursing Stress Scale (NSS), and Brief COPE were included. These were created as HIPAA/PHI-compliant surveys in Qualtrics. The pre-survey consisted of questionnaires of demographic variables, NSS and Brief COPE questionnaires while the post and follow-up questionnaires were the NSS and Brief COPE, respectively. Results: This quality improvement EBP project demonstrated that there was a statistically significant increase in the nurse’s coping strategies while there was no significant difference in the nurses’ perception of occupational stress. Linking Evidence to Action: Our findings suggest that although the BREATHE program did not improve occupational stress; it did significantly increase the Brief COPE scores of the participants. An increase in coping strategies suggests that the program is a vital education program to be included in the continuous education module of the NH

Diabetes Management in Preoperative Hospitalized Patients: Improving Quality Measures on an Orthopedic Trauma and Surgical Unit

Objective: Implement nursing education for the staff nurses on an orthopedic trauma and medical surgical unit to improve diabetes management in preoperative patients. Design: Evidence -based practice/quality improvement. Setting/Local Problem: 33-bed orthopedic trauma and surgical unit. Participants: Staff nurses employed on an orthopedic trauma and surgical unit Interventions/Measurements. A pre- and post- was design with an embedded education module to assess for understanding. The aim of this was to improve preoperative diabetes education to have better glycemic control postoperatively and reduce the number of adverse events. Results: Nurses preintervention mean scores were 14.00 and 16.00 after the e-learning module. The educational module provided was statistically significant (pConclusion: The use of an e-learning module to educate staff nurses resulted in a significant increase in perioperative diabetes management knowledge. Nurses play a vital role in perioperative diabetes management and preventing adverse events. The use of e-learning modules has the potential to increase nurses’ knowledge base leading to better patient outcomes

Decreasing Blood Culture Contamination Rates in the Emergency Department

Introduction: Blood cultures (BCs) are a vital diagnostic tool for sepsis in patients with a suspected infection. Emergency departments are the primary place where BCs are drawn, but the BC contamination rates in emergency departments are the highest and most varied in healthcare. This project’s goal was to decrease the BC contamination rate below 3% (the national benchmark for BC contamination) in an ED in the Southeastern region through the implementation of a blood culture collection toolkit. Methods: The best practices for reducing the BC contamination rate in the emergency department was determined through a thorough literature review. A cost-effective, evidence-based plan was formed to utilize emergency department resources more effectively to decrease the BC contamination rate. The BC toolkit consisted of nursing education on proper BC collection, monthly aggregate level feedback in the ED, and packaged BC collection kit. Results: The monthly contamination rates were 3.6%, 1,7%, and 2.1% respectively during the 3-month implementation of the project. This emergency department had not had two consecutive months with contamination rates less than 3% in 3 years prior to this project. When compared to the corresponding 3 months from the previous year, there was a statistically significant decrease in the BC contamination rates during implementation. There was a clinically significant decrease in the BC contamination rates when compared to the 3 months immediately before implementation. Discussion: As evidenced by the results of this project, emergency departments can decrease BC contamination rates to meet the national benchmark of 3% through a well-structured strategy. Further, this can be accomplished at no additional cost to the emergency department. The cost-effective nature of this project combined with a strong sense of teamwork will lead to sustainable change in emergency departments to consistently improve the quality of care given to patients

Adverse Childhood Experiences Screening Among Adults in an Inpatient Behavioral Health Unit

Adverse childhood experiences (ACEs) are common amongst people of all ages, races, and socio-economic statuses. The consequence of ACEs impact ones mental and physical health and life span. High ACE scores lead to increased risk of suicide, depression, anxiety, and substance abuse. The purpose of this project was to screen adults admitted to an inpatient psychiatric hospital for ACEs. This project sought to determine if there is a relationship between overall ACEs score and impact on health versus length of stay. Ultimately, the aim is to reduce negative health outcome for patients as measured by length of stay. The results indicated that overall ACEs score and the impact on health results did not impact length of stay. However, the results were significant in confirming that higher ACE scores are correlated with more significant impact on health

Educational Intervention to Increase Confidence and Knowledge of Pediatric Nurses Caring for Pediatric Mental Health Patients

Background: Given the rise in the mental health crisis, there is an increase of non-psychiatric nurses caring for pediatric mental health patients. This crisis leads nurses to experience feelings of doubt, hopelessness, stress, and insecurities in caring for this population. These feelings, combined with a lack of support and training, create a powerlessness loop of care. Local problem: In a Pediatric ICU, there is a lack of training and resources available to the nurses caring for pediatric mental health patients. Despite the lack of training, 35% of total admissions in 2020 were pediatric patients experiencing an acute mental health crisis. This patient population has been continually identified as an area of significant burnout, identified need, and frustration. Methods: Educational modules were assigned and included training on behavioral health communication, crisis management skills, therapeutic communication, assessment skills, mental health diagnoses, and psychotropic medications. A modified Behavioral Health Care Competency Tool was used to measure nurses’ confidence and knowledge at three timepoints. Results: There was a statistically significant improvement in nurses’ confidence and knowledge caring for mental health patients from pre- to post-intervention (M = 0.87, 95% CI [0.57, 1.160], p \u3c .001) and pre-intervention to one-month post-intervention (M = 1.11, 95% CI [0.71, 1.51], p \u3c .00). Conclusions: Providing educational training to nurses aids in increasing their confidence and knowledge in caring for mental health patients in non-psychiatric settings. Despite increases in confidence and knowledge, future implications include the need for pediatric-focused education, resources, and practice

Improving Human Papillomavirus Vaccination Rates in Adolescents: A Quality Improvement Project

Abstract Objective: The purpose of this quality improvement (QI) project was to implement an evidence-based intervention to improve the HPV vaccine series completion rates in the pediatric primary care setting. The goal of the project was to increase HPV series completion rates in adolescents aged 11 to 12 by 10% within 3 months of implementation of the intervention. Methods: A multicomponent intervention was implemented at a pediatric primary care office that included a chart review of 11- and 12-year-old adolescents who had received their first and second dose of the HPV vaccine from June 2019 to June 2020 and patients from June 2020 to June 2021 that only received their first dose of the HPV vaccine. Patients who had only received their first dose between June 2020 and June 2021 and was in the timeframe to receive their second dose was contacted via telephone to schedule an appointment for their vaccine. At the time of scheduling the appointment, verbal consent was obtained to send a follow-up text message reminder two to three days prior to the scheduled appointment date. Results: HPV vaccine series completion rates increased by 12.5% during the 3-month project period. However, the collection data size varied significantly between the number of patients used for the pre-data and post-data collection. Conclusions: An evidence-based intervention can have a significant impact on improving the HPV vaccine series completion rates within adolescents with minor practice changes. Key Words: Human papillomavirus, HPV, adolescent, vaccination, vaccines, compliance, text messages reminders, phone call reminder

Vascular Health in American Football Players: Cardiovascular Risk Increased in Division III Players

Studies report that football players have high blood pressure (BP) and increased cardiovascular risk. There are over 70,000 NCAA football players and 450 Division III schools sponsor football programs, yet limited research exists on vascular health of athletes. This study aimed to compare vascular and cardiovascular health measures between football players and nonathlete controls. Twenty-three athletes and 19 nonathletes participated. Vascular health measures included flow-mediated dilation (FMD) and carotid artery intima-media thickness (IMT). Cardiovascular measures included clinic and 24 hr BP levels, body composition, VO2 max, and fasting glucose/cholesterol levels. Compared to controls, football players had a worse vascular and cardiovascular profile. Football players had thicker carotid artery IMT (0.49 ± 0.06 mm versus 0.46 ± 0.07 mm) and larger brachial artery diameter during FMD (4.3 ± 0.5 mm versus 3.7 ± 0.6 mm), but no difference in percent FMD. Systolic BP was significantly higher in football players at all measurements: resting (128.2 ± 6.4 mmHg versus 122.4 ± 6.8 mmHg), submaximal exercise (150.4 ± 18.8 mmHg versus 137.3 ± 9.5 mmHg), maximal exercise (211.3 ± 25.9 mmHg versus 191.4 ± 19.2 mmHg), and 24-hour BP (124.9 ± 6.3 mmHg versus 109.8 ± 3.7 mmHg). Football players also had higher fasting glucose (91.6 ± 6.5 mg/dL versus 86.6 ± 5.8 mg/dL), lower HDL (36.5±11.2 mg/dL versus 47.1±14.8 mg/dL), and higher body fat percentage (29.2±7.9% versus 23.2±7.0%). Division III collegiate football players remain an understudied population and may be at increased cardiovascular risk

Carotid Artery IMT, Blood Pressure, and Cardiovascular Risk Factors in Males and Females

International Journal of Exercise Science 9(4): 482-490, 2016. Previous studies have investigated carotid artery intima-media thickness (IMT) and blood pressure and found a direct correlation between the two. It is known that adult females have better cardiovascular health than males until a certain stage of life, yet limited research has examined gender differences in vascular function. Thus, the purpose of this study was to investigate vascular structure and function, blood pressure, and blood glucose/cholesterol levels in relation to gender differences in young healthy adults. On three separate days, 44 adults (26.30 ±11.9yrs; 24M, 20F) completed a carotid IMT ultrasound, a flow-mediated dilation (FMD), a fasted glucose and cholesterol test, a 24hr ambulatory blood pressure monitoring, a VO2max test, and a body composition measurement. Females had lower systolic blood pressure, lower diastolic blood pressure, lower LDL/HDL ratios, lower body mass index, a higher HDL count, and lower plasma glucose levels than males (p \u3c 0.05 for all), all of which suggest better cardiovascular health. However, we found no gender differences in vascular health measures, IMT and FMD. Our results suggest that while young adult females have better cardiovascular health than males, endothelial function may not yet be affected in the young adult years

Vascular Health in American Football Players: Cardiovascular Risk Increased in Division III Players

Studies report that football players have high blood pressure (BP) and increased cardiovascular risk. There are over 70,000 NCAA football players and 450 Division III schools sponsor football programs, yet limited research exists on vascular health of athletes. This study aimed to compare vascular and cardiovascular health measures between football players and nonathlete controls. Twenty-three athletes and 19 nonathletes participated. Vascular health measures included flow-mediated dilation (FMD) and carotid artery intima-media thickness (IMT). Cardiovascular measures included clinic and 24 hr BP levels, body composition, VO2 max, and fasting glucose/cholesterol levels. Compared to controls, football players had a worse vascular and cardiovascular profile. Football players had thicker carotid artery IMT (0.49 ± 0.06 mm versus 0.46 ± 0.07 mm) and larger brachial artery diameter during FMD (4.3±0.5 mm versus 3.7±0.6 mm), but no difference in percent FMD. Systolic BP was significantly higher in football players at all measurements: resting (128.2±6.4 mmHg versus 122.4±6.8 mmHg), submaximal exercise (150.4±18.8 mmHg versus 137.3±9.5 mmHg), maximal exercise (211.3±25.9 mmHg versus 191.4±19.2 mmHg), and 24-hour BP (124.9±6.3 mmHg versus 109.8±3.7 mmHg). Football players also had higher fasting glucose (91.6±6.5 mg/dL versus 86.6±5.8 mg/dL), lower HDL (36.5±11.2 mg/dL versus 47.1±14.8 mg/dL), and higher body fat percentage (29.2±7.9% versus 23.2±7.0%). Division III collegiate football players remain an understudied population and may be at increased cardiovascular risk