Implementation of a Standardized Medication Reconciliation Protocol in a Psychiatric Stabilization Setting

BACKGROUND: Medication errors are a prevalent patient safety concern across healthcare settings. High-quality medication reconciliation is an intervention and expected standard of care that can help to prevent adverse drug events. This quality improvement project focused on implementing a standardized medication reconciliation protocol on a short-stay psychiatric unit. INTERVENTION: An evidence-based toolkit supported by the Agency for Healthcare Research and Quality (AHRQ), Medications at Transitions and Clinical Handoffs (MATCH) was selected as the framework for developing and implementing this protocol. Congruent with the evidence-based toolkit recommendations, baseline data collection and needs assessment provided context for tailoring the intervention to the unit’s needs. A mixed-methods approach incorporated both qualitative and quantitative, varied sources of data from semi-structured staff interviews, workflow observation, manual retrospective chart reviews, and staff training attendance and pre-post test performance. The intervention included staff education and training on best practices for medication reconciliation and interviewing techniques; training for use of electronic health record features to capture completion; recommendations for policy revisions to support adherence and consistency; provision of a standardized workflow incorporating best practices for medication reconciliation, and a detailed recommendation of how to fully digitize this process to utilize a single source document when the technology becomes available. RESULTS: The educational training sessions were attended by 57% of nurses employed on the unit. Manual retrospective chart reviews were completed at baseline and after providing the interventions. From baseline to post-intervention, there was a 9% decrease in the frequency of medication discrepancies. The results demonstrate a need for continual oversight and reinforcement of the electronic capture of medication reconciliations to support ongoing medication safety. CONCLUSIONS: Persons with severe mental illness are particularly vulnerable for medication errors during periods of transitional care. Short-stay psychiatric admissions provide an opportunity to clarify, educate, and communicate medication regimes across care teams to improve care outcomes. Standardized medication reconciliation protocols during psychiatric stabilization stays can improve medication safety and patient care outcomes

An assessment of the cognitive development of concept of angle in children at the third-grade and fourth-grade levels.

EducationDoctor of Education (Ed.D.

Why Children Still Need a Lawyer

Every day approximately 500,000 children across the United States wake up in foster care, most in foster family homes, though many others in group homes and institutions. These children entered the state foster care system as innocent victims of abuse or neglect occurring in their birth homes. As wards of the state, they depend completely on the government to provide for their essential safety and wellbeing and to reconnect them with a permanent family, hopefully their own. Though state child welfare agencies possess fundamental legal obligations under the United States Constitution and federal and state statutes to provide adequate care to all children in foster care, they are all too often failing in this vital mission. High caseloads, insufficient caseworker training and compensation, a combination of unstable and ineffective agency management, and a lack of resources plague foster care systems from coast to coast. As a result, children who were removed from their homes for basic protection actually suffer continuing harm in state care. The federal government has sought to improve the performance of state foster care systems through legislative reforms that have subjected these systems to the oversight of family court judges and federal auditors. Though well-intended, these federal reform efforts have not achieved the desired result. The same structural impediments that historically have prevented child welfare agencies from delivering quality services similarly have blunted the impact of federal reforms. Child advocates have utilized class action litigation to ignite and sustain systemic reform. These class actions suits, typically involving claims for violation of substantive due process and statutory rights, have resulted in court enforceable consent decrees that have resulted in improved care, services, and permanency outcomes for children by obligating state agencies to undertake essential structural improvements. This Essay will present the disappointing history of the federal reform efforts and the promise that structural reform class actions hold for children in foster care

A method for digital color analysis of spalted wood using scion image software

Color analysis of spalted wood surfaces requires a non-subjective, repeatable method for determining percent of pigmentation on the wood surface. Previously published methods used human visual perception with a square grid overlay to determine the percent of surface pigmentation. Our new method uses Scion Image©, a graphical software program used for grayscale and color analysis, to separate fungal pigments from the wood background. These human interface processes render the wood block into HSV (hue, saturation, value, within the RGB color space), allowing subtle and drastic color changes to be visualized, selected and analyzed by the software. Analysis with Scion Image© allows for a faster, less subjective, and easily repeatable procedure that is superior to simple human visual perception

Are Pink Slips Better Than Flu Shots? The Effects of Employment on Influenza Rates

The seasonal influenza virus afflicts between five and twenty percent of the U.S. population each year, imposing significant costs on those who fall ill, their families, employers, and the health care system. The flu is transmitted via droplet spread or close contact, and certain environments, such as schools or offices, promote transmission. In this paper, we examine whether increases in labor market activities are associated with an increased incidence of the flu. Flu data come from the Centers for Disease Control. We check the robustness of our results using unique data from Google Flu Trends. Using a first-difference two stage least squares estimation approach, we find that a one percentage point increase in the employment rate increases the number of influenza related doctor visits by about 8.1 additional flu-related doctor visits per 1000 doctor visits for all causes. To put this in perspective, on average, 33 additional people out of every 100,000 new employees will have a flu-related doctor visit. The results are robust across several specifications.

Analyzing Seated Pressure on Different Surfaces Using the FSA Pressure Mapping System

Pressure ulcers are a current problem for many individuals, both ambulatory and non-ambulatory. Insurance companies offer few policies and programs for individuals with pressure ulcers who are ambulatory, leaving these individuals minimal options to acquire pressure reliving devices that are covered by insurance. Non-traditional, inexpensive pressure reliving devices may be used as a cost effective alternative to a more expensive cushion. Little research has been conducted to determine if a less expensive device, such as a Homedics Micropedic Therapy pillow, would be effective in relieving pressure while seated. The purpose of this study was to determine if there was a significant difference between sitting pressure when seated on a hard surface, a surface with a built-in cushion, and a Homedics Micropedic Therapy pillow. One benefit of this study is to give physical therapists evidence based information on inexpensive pressure relieving devices in order to educate patients who are ambulatory and who may be at risk for a pressure ulcer. Thirty-five ambulatory subjects between the ages of 23 and 55 sat on the three surfaces. A Force Sensitive Application (FSA) pressure mapping system was used to assess the mean pressure, the number of sensors activated, the variation of pressure, and the standard deviation of pressure for each seated surface. Statistical significance was found in the measurements between all three surfaces, with one exception. When comparing the hard surface to the surface with a built-in cushion, there was no statistical significance in mean pressure. The results from this study showed that the Homedics Micropedic Therapy pillow is statistically significant for reducing seated pressure

Encke-Beta Predictor for Orion Burn Targeting and Guidance

The state vector prediction algorithm selected for Orion on-board targeting and guidance is known as the Encke-Beta method. Encke-Beta uses a universal anomaly (beta) as the independent variable, valid for circular, elliptical, parabolic, and hyperbolic orbits. The variable, related to the change in eccentric anomaly, results in integration steps that cover smaller arcs of the trajectory at or near perigee, when velocity is higher. Some burns in the EM-1 and EM-2 mission plans are much longer than burns executed with the Apollo and Space Shuttle vehicles. Burn length, as well as hyperbolic trajectories, has driven the use of the Encke-Beta numerical predictor by the predictor/corrector guidance algorithm in place of legacy analytic thrust and gravity integrals