Be Seen and Heard Being Clean: A Patient-Centered Approach to Hand Hygiene at Concord Hospital

Background: Regular hand washing is recognized as the most effective means to combat the spread of infectious illness; however hand washing behavior amongst health care workers (HCW’s) is inconsistent. Furthermore, measurement of hand washing behavior is subject to bias. Aim: This quality improvement project aimed to remove the Hawthorne effect and improve the behavior of HH at Concord Hospital. Methods: A quasi-experimental, pre-posttest design was used to evaluate HH rates on a 32 bed med-surge unit at Concord Hospital. Baseline data was collected for 30 days by asking patients if they had seen or heard staff cleaning their hands. Using Lewin’s change theory and the hospitals quality improvement model, data were presented to staff, motivating them to seek out new ways to improve HH on the unit. “Be SEEN and HEARD Being Clean,” was implemented, followed by post intervention data collection. Results: Sixty-five percent of patients reported seeing or hearing staff perform HH before the intervention, and 93% reported observations of HH after the intervention (p \u3c.001). Staff reported being more aware of personal HH behavior after the intervention. Conclusion and Implications for the CNL: To our knowledge, this is the first study to modify the behavior of HCW HH in an inpatient setting through incorporating a verbal message. Incorporating an auditory cue may lead to a memory formation and increased ability to recall events at a later date. This multimodal approach to HH; 1) engages the patient, while removing the burden placed on them to question HCW’s behavior, and 2) increases staff awareness of personal HH behavio

Implementation of Point-of-Care Tick-Borne Disease PowerPlan™ and algorithm for early detection and treatment of tick-borne diseases

Abstract Local Problem: The Concord Hospital system, serving 30+ communities, is situated in the heart of New Hampshire surrounded by densely wooded forests, lakes, and mountains and is a mecca for camping, vacationing, and sightseeing, doubling its population of 1.6 million residents during spring, summer, and fall months. Despite the serenity, there is a predator that lingers among the hiking trails and lake shorelines. From January 2021 through August 2022 there were a total of 41 hospitalizations from tick-borne diseases, some with life threatening symptoms. Unfortunately, nearly half (43%) of patients presented to their primary care provider first where the diagnosis was missed. Background: Despite their minute size, ticks including the black-legged tick Ixodes Scapularis, are known to harbor a plethora of bacterial and parasitic disease states. As diseases such as Babesiosis are on the rise not only in locally but nation-wide, it is imperative that front-line providers not only understand various clinical presentations but have point-of-care tools to accurately diagnose and promptly treat patients, as delays in care may have lethal consequences. The global aim of this quality improvement project was to improve provider recognition of symptoms, appropriate diagnostic testing, and treatment associated with tick-borne illness. Specifically, we aimed to increase provider awareness by 20%. Additionally, our second specific aim was to develop, and improve upon point-of-care resources for clinicians, increasing overall PowerPlan™ utilization by 40%. Methods: Utilizing the six aims of a healthcare system quality improvement initiative put forth by the Institute of Medicine (IOM) and backed by the Agency for Healthcare Research and Quality (AHRQ), as well as Kurt Lewin’s Change Theory, and the Plan Do Study Act (PDSA) method of quality improvement, we evaluated baseline clinician knowledge of tick-borne diseases prior to delivering education and point-of-care resources for providers. Interventions: A lunch and learn educational PowerPoint™ presentation was delivered to providers at three practice locations, and one student group at Concord Hospital Laconia. A pretest and posttest format was utilized to assess the baseline knowledge of tick-borne disease symptoms, appropriate diagnostics, and treatment prior to the presentation. Edits were made to the existing Tick-Borne Disease PowerPlan™ and a user-friendly tick-borne disease algorithm was created as point-of-care tools for providers to utilize with patients meeting potential illness criteria. Utilization of the PowerPlan™ was queried pre-post intervention. Results: Total aggregate data sample size was 13, although for statistical analysis using Wilcoxon signed rank testing, only seven pairs were able to be matched for comparison. Despite a small sample size, there was a statically significant change in test scores prior to the educational session when compared to after, z=2.379, p=0.017. When specific disease states were analyzed, there was a statistically significant increase in knowledge of Babesiosis, z= 2.232, p=0.026. Statistical significance was also observed with respondents ordering correct laboratory studies when presented with a tick-borne disease case presentation, z= 2.0, p=0.046. Despite partial data from March 2023, there was an increase in PowerPlan™ utilization with 83 access points compared to 64 in March 2022. Conclusion: The key finding of our quality improvement project was incongruencies between perceived knowledge and actual knowledge of various tick-borne illnesses both in pre-licensure 3rd year medical students and practicing clinicians. Through enhanced educational interventions utilizing emerging epidemiologic trends, as well as creating an accurate and trusted point-of-care algorithm, we were able to decrease this knowledge gap. By providing interactive educational training and user-friendly point-of-care resources for front-line clinicians nation-wide, they will be poised to accurately diagnose and treat complex tick-borne diseases at the first symptom, preventing the potential grim sequela of a missed diagnosis

Acquisition from Storybooks

For young children, storybooks may serve as especially valuable sources of new knowledge. While most research focuses on how extratextual comments influence knowledge acquisition, we propose that children's learning may also be supported by the specific features of storybooks. More specifically, we propose that texts that invoke children's knowledge of familiar taxonomic categories may support learning by providing a conceptual framework through which prior knowledge and new knowledge can be readily integrated. In this study, 60 5-year olds were read a storybook that either invoked their knowledge of a familiar taxonomic category (taxonomic storybook) or focused on a common thematic grouping (traditional storybook). Following the book-reading, children's vocabulary acquisition, literal comprehension, and inferential comprehension were assessed. Children who were read the taxonomic storybook demonstrated greater acquisition of target vocabulary and comprehension of factual content than children who were read the traditional storybook. Inferential comprehension, however, did not differ across the two conditions. We argue for the importance of careful consideration of book features and storybook selection in order to provide children with every opportunity to gain the knowledge foundational for successful literacy development

Can babies learn to read? A randomized trial of baby media

argeted to children as young as 3 months old, there is a growing number of baby media products that claim to teach babies to read. This randomized controlled trial was designed to examine this claim by investigating the effects of a best-selling baby media product on reading development. One hundred and seventeen infants, ages 9 to 18 months, were randomly assigned to treatment and control groups. Children in the treatment condition received the baby media product, which included DVDs, word and picture flashcards, and word books to be used daily over a 7-month period; children in the control condition, business as usual. Examining a 4-phase developmental model of reading, we examined both precursor skills (such as letter name, letter sound knowledge, print awareness, and decoding) and conventional reading (vocabulary and comprehension) using a series of eye-tracking tasks and standardized measures. Results indicated that babies did not learn to read using baby media, despite some parents displaying great confidence in the program’s effectiveness