scholarly journals Malnutrition Quality Improvement Initiative Supports Delivery of Evidence-Based Care and Drives Improved Outcomes

2019 ◽  
Vol 119 (9) ◽  
pp. S64
Author(s):  
S.M. McCauley ◽  
A.F. Valladares ◽  
M.B. Arensberg
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Improved Outcomes ◽  
Evidence Based Care

A quality improvement project to reduce restrictive interventions in a mental health service

2021 ◽  
pp. 1-12
Author(s):  
Darren Savarimuthu ◽  
Katja Jung
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Positive Impact ◽  
Essential Elements ◽  
Quality Improvement Project ◽  
Psychiatric Ward ◽  
Quality Improvement Initiative ◽  
Successful Implementation ◽  
Evidence Based ◽  
Improvement Project

Background/aims This article describes a quality improvement project that aimed to reduce restrictive interventions on an acute psychiatric ward. In light of a service level agreement and based on a trust-wide target, the purpose of the project was to reduce restrictive interventions by 20% within a period of 6 months. It was also anticipated that a least restrictive environment could have a positive impact on patient experience. Methods Three evidence-based interventions were introduced to the ward during the quality improvement project. These included positive behaviour support, the Safewards model and the productive ward initiative. Results There was a 63% reduction in restrictive interventions over a 6-month period through the successful implementation of a series of evidence-based interventions to manage behaviours that challenge on the mental health ward. Conclusions The project identified collaborative team working, staff training and adequate resources as essential elements in the success of the quality improvement initiative. However, co-production was found to be crucially significant in bringing sustainable changes in ward environment and in addressing restrictive practices.

scholarly journals Evidence-based development of a nephrotoxic medication list to screen for acute kidney injury risk in hospitalized children

2019 ◽  
Vol 76 (22) ◽  
pp. 1869-1874 ◽  
Author(s):  
Elizabeth Goswami ◽  
Richard K Ogden ◽  
William E Bennett ◽  
Stuart L Goldstein ◽  
Richard Hackbarth ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Quality Improvement ◽  
Injury Risk ◽  
Kidney Injury ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Hospitalized Children ◽  
Consensus Definition ◽  
Medication Exposure ◽  
Definition Of

Abstract Purpose Medications are commonly associated with acute kidney injury (AKI). However, in both clinical practice and research, consideration of specific medications as nephrotoxic varies widely. The Nephrotoxic Injury Negated by Just-in-time Action quality improvement collaborative was formed to focus on prevention or reduction of nephrotoxic medication-associated AKI in noncritically ill hospitalized children. However, there were discrepancies among institutions as to which medications should be considered nephrotoxic. The collaborative convened a Nephrotoxic Medication (NTMx) Subcommittee to develop a consensus for the classification of nephrotoxic medications. Summary The NTMx Subcommittee initially included pediatric nephrologists, a pharmacist, and a pediatric intensivist. The committee reviewed NTMx lists from the collaborative and identified changes from the initial NTMx list. The NTMx Subcommittee conducted a literature review of the disputed medications and assigned an evidence grade based on the reported association with nephrotoxicity and the quality of the data. The association between medication exposure and AKI was also determined using administrative data from the Pediatric Health Information Systems database. The NTMx Subcommittee then came to a majority consensus regarding which medications should be included on the list. The subcommittee’s recommendations were presented to the larger collaborative for approval, and consensus was achieved. The list continues to be reviewed and updated annually. Conclusion Formation of a multicenter quality-improvement initiative exposed current limitations as to which medications are considered nephrotoxic in clinical and research settings and presented an opportunity to approach this problem using an evidence-based process. A consensus definition of nephrotoxic-medication exposure was achieved.

scholarly journals Improving Evidence-Based Care in Cystic Fibrosis Through Quality Improvement

2010 ◽  
Vol 164 (10) ◽  
Author(s):  
Gary L. McPhail ◽  
Jeanne Weiland ◽  
James D. Acton ◽  
Mathew Ednick ◽  
Amrita Chima ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Quality Improvement ◽  
Evidence Based ◽  
Evidence Based Care

CLABSI reduction using evidence based interventions and nurse empowerment: a quality improvement initiative from a tertiary care NICU in Pakistan

2020 ◽  
pp. archdischild-2019-318779
Author(s):  
Ali Shabbir Hussain ◽  
Anjum Mohyuddin Ahmed ◽  
Saba Arbab ◽  
Shabina Ariff ◽  
Rehan Ali ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Neonatal Intensive Care ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Central Line ◽  
University Hospital ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Post Intervention ◽  
Nurse Empowerment

ObjectiveCentral line associated bloodstream infection (CLABSI) is an important cause of morbidity and mortality in the neonatal intensive care unit (NICU). We designed a CLABSI Prevention Package (CPP) to decrease NICU CLABSI rates, using evidence-proven interventions.DesignThis was a quality improvement (QI) project. Data collection was divided into three phases (pre-implementation, implementation and post implementation). SQUIRE2.0 guidelines were used to design, implement and report this QI initiative.SettingA tertiary care level 3 NICU at the Aga Khan University Hospital (AKUH), Karachi, Pakistan.PatientsAll patients admitted to the AKUH NICU from 1 January 2016 to 31 March 2018 who had a central line in place during their NICU admission.InterventionsCPP used evidence-based interventions focusing on hand hygiene, aseptic central line insertion techniques and central line care, prevention of fungal infections and nurse empowerment.Main outcome measuresCLABSI rates pre and post intervention were recorded. Secondary outcomes were risk factors for CLABSI, device (central line) utilisation ratio, CLABSI related mortality and micro-organism profile.ResultsCLABSI rates decreased from 17.1/1000 device days to 5.0/1000 device days (relative risk (RR)=0.36, CI=0.17–0.74). Device (central line) utilisation ratio declined from 0.30 to 0.25. Out of 613 patients enrolled in our study, 139 (22.7%) died. Mortality was higher in CLABSI group (n=20, 44%) as compared with non CLABSI group (n=119, 21.1%) (p<0.001). Gestational age of <27 weeks was an independent risk factor for CLABSI (RR=4.45, CI=1.10–18.25, p=0.03). A total of 158 pathogens were isolated among which 68 were associated with CLABSI. Gram-negative bacteria 31 (47.7%) were the most common cause of CLABSI. Ninety-seven (61%) micro-organisms were multi-drug resistant.ConclusionsCPP was effective in decreasing NICU CLABSI rates and can be used as a model to decrease NICU CLABSI rates in low or middle-income countries.

scholarly journals Utilization of an Electronic Medical Record–integrated Dashboard Improves Identification and Treatment of Anemia and Iron Deficiency in Pediatric Inflammatory Bowel Disease

2020 ◽  
Author(s):  
Jessica Breton ◽  
Char M Witmer ◽  
Yuchen Zhang ◽  
Maura Downing ◽  
Jamie Stevenson ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Quality Improvement ◽  
Iron Deficiency ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Bowel Disease ◽  
Care Pathway ◽  
Evidence Based ◽  
Inflammatory Bowel ◽  
Evidence Based Care

Abstract Background Iron deficiency (ID) and anemia are one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD), usually complicating the course both in ulcerative colitis and Crohn’s disease. Despite their high prevalence and significant impact on patients, this particular aspect is still underestimated by clinicians. Although guidelines have been recently published to address this problem, these recommendations do not address pediatric specific concerns and do not provide guidance as to how implement these guidelines in clinical practice. The aims of this quality improvement (QI) initiative were to improve the rates of detection and treatment of anemia in children with IBD. Methods After the creation of a multidisciplinary team of skateholders in IBD and anemia, we launched a multifaceted QI strategy that included the development of a pediatric evidence-based care pathway, utilization of an electronic medical record (EMR)-integrated dashboard to track patients, and generation of an automated provider-based monthly report. Data were collected and graphed into statistical process control charts. Results These key strategies resulted in improved rates of ID screening from 31.7% to 63.6%, in increased treatment rates from 38.2% to 49.9%, and in decreased prevalence of anemia from 35.8% to 29.7%, which was reflected by a greater decline in patients with quiescent disease. Conclusions Quality improvement strategies incorporating the creation of a pediatric evidence-based care pathway with an EMR-supported electronic dashboard were the foundation of a successful intervention in the management of ID and anemia in pediatric IBD. Our positive results demonstrate the potential of QI initiatives using automated technology to assist clinicians in their commitment to provide evidence-based IBD care and enhance patient outcomes.

Assessing Adherence to Audiologic Parameters of Care for Children With Cleft Palate: A Quality Improvement Initiative

2021 ◽  
pp. 105566562110295
Author(s):  
Ursula M. Findlen ◽  
Jonathan Grischkan ◽  
Sandra Alston ◽  
Lauren Durinka ◽  
Adriane Baylis
Keyword(s):  
Quality Improvement ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Team Communication ◽  
Care Protocol ◽  
Management Protocol ◽  
Key Drivers

Objective: To evaluate and increase adherence to an evidence-based audiologic management protocol for children with cleft palate. Design: Prospective, multidisciplinary quality improvement initiative. Setting: Tertiary pediatric hospital. Patients, Participants: Children with cleft palate (with or without cleft lip) between the ages of 0 and 5 years (n = 205). Interventions: A multidisciplinary team identified key drivers for nonadherence to recommended audiological follow-up and implemented interventions to improve adherence. Key drivers included provider practices and preferences, clinic logistics and flow, and patient/family awareness and education. Several interventions were implemented between 2016 and 2020, including developing an evidence-based audiologic protocol, maximizing access to audiologic clinic visits across multiple departments, cleft team education, and improved team communication. Main Outcome Measure(s): Completion of recommended audiologic assessment at 5 separate care milestones. Results: After implementation of interventions between 2016 and 2020, adherence to recommended audiologic follow-up increased from 59% to 84%. Analysis of individual care milestones revealed that increased access to audiologic testing during team clinics resulted in the largest increase in adherence to recommended follow-up. Additionally, cause-effect analysis revealed that nonadherence due to provider-related causes decreased over the project period to a greater extent than patient/family-related causes. Conclusions: Implementation of an evidence-based audiologic care protocol and improvements in access to early hearing care are feasible in a high-volume multidisciplinary cleft clinic. Adherence to recommended audiologic management can be improved by establishing strategies to improve access to care, team member and family education, and enhanced team communication.

scholarly journals Care transition from rehabilitation to home: A QI project using the RED Toolkit to decrease readmission rates

2021 ◽  
Vol 10 (1) ◽  
pp. 46
Author(s):  
Jennifer R. Bernard ◽  
Eileen L. Creel ◽  
Rhonda K Pecoraro
Keyword(s):  
Quality Improvement ◽  
Hip Fracture ◽  
Healthcare Providers ◽  
Inpatient Rehabilitation ◽  
Care Plan ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Discharge Process ◽  
Post Discharge ◽  
Post Intervention

Objective: This quality improvement (QI) project’s aim was to lower 30-day healthcare reutilization for patients aged 50 or older with hip fracture using an evidence-based discharge process method, the Re-Engineered Discharge (RED) Toolkit.Methods: The QI project of a revised patient discharge process to lower healthcare reutilization of Baton Rouge Rehabilitation Hospital (BRRH) hip fracture patients was implemented as an evidence-based quality improvement initiative. Inpatient and outpatient discharge process revisions were implemented at an inpatient rehabilitation facility (IRF) based on Re-Engineered Discharge (RED) Toolkit recommendations. Inpatient revisions included patient barrier identification with associated documentation changes to the IRF interdisciplinary team form. Outpatient modifications consisted of an After-Hospital Care Plan (AHCP), and two post-discharge Telephone Follow-Up (TFU) calls.Results: Healthcare reutilization and thirty-day hospital readmission for this project were measured at 8.5% and 5.7%, respectively. A decrease in healthcare reutilization of at least 1.6% was observed for the IRF. Most participants scored at a high level (88.6%) of “patient knowledge of self-management” post intervention. Out of participants who did not attend their first Primary Care Provider (PCP) appointment, 33.3% experienced healthcare reutilization. This result emphasized the importance of seeing one’s PCP post-discharge. Patient satisfaction increased by 5% and 6.73%, measured by Hospital Consumer Assessment of HealthCare Providers and Systems (HCAHP) scores for nursing care and physician care, respectively.Conclusions: Implementation of a RED Toolkit-based discharge process at an IRF positively impacted all three study outcomes and associated healthcare costs in lowering preventable readmissions.

Sign in / Sign up

Export Citation Format

Share Document