Deprescribing benzodiazepines among hospitalised older adults: quality improvement initiative

Benzodiazepines are recognised as being potentially inappropriate medications for seniors due to their considerable side-effect profile, yet they are commonly prescribed and infrequently discontinued (deprescribed). The study’s primary objective was the deprescription or the dose reduction of benzodiazepines among newly hospitalised seniors using a patient education intervention. A 3-month duration quality improvement study based on the plan–do–study–act model was conducted across two units (3C and 4D) in the Glenrose Rehabilitation Hospital to improve benzodiazepine deprescribing among newly admitted seniors (65 years or older) who were using benzodiazepines. The primary outcome measure was the number of eligible patients who had benzodiazepine deprescribing initiated. A patient education intervention comprising a structured medication review, written patient education (the Eliminating Medications Through Patient Ownership of End Results (EMPOWER) brochure) and at least one brief supportive counselling session by the clinical pharmacist or physician was applied to all eligible patients. All 12 eligible patients consented to benzodiazepine deprescribing; however, only 11 of them (92%) initiated benzodiazepine deprescribing. Six of the 11 patients (55%) had their benzodiazepines discontinued, with the 5 remaining patients (45%) achieving greater than 50% dosage reduction. Seven patients (64%) experienced side effects during the deprescribing process, with over half (57%, n=4) of these seven patients experiencing worsening anxiety symptoms. Five of the 11 patients (45%) required benzodiazepine substitute medications. The use of a structured patient education intervention involving the use of a structured medication review, written patient education material and one-on-one patient counselling can promote benzodiazepine deprescribing. Although worsening anxiety was frequently observed, this was easily managed by the substitution of a more appropriate and clinically indicated medication, which was well tolerated and acceptable by all of our participants. Targeted screening for the presence of anxiety would help to guide the deprescribing process and the need for medication substitution.

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Use of video education in post-operative patient counselling: A quality improvement initiative

Canadian Urological Association Journal ◽

10.5489/cuaj.7240 ◽

2021 ◽

Vol 15 (12) ◽

Author(s):

Luke D.E. Witherspoon ◽

Ailsa M.L. Gan ◽

Rodney H. Breau ◽

Ginette Saumure ◽

Jacqueline Shea ◽

...

Keyword(s):

Quality Improvement ◽

Patient Satisfaction ◽

Discharge Rate ◽

Intervention Group ◽

Quality Improvement Initiative ◽

Discharge Process ◽

Post Intervention ◽

Data Repositories ◽

Patient Counselling ◽

Video Education

Introduction: This quality improvement study examined if a video-based resource could reduce delayed discharges after robotic prostatectomy while maintaining high levels of patient satisfaction. Methods: From April 2018 to February 2020, all patients undergoing robotic-assisted radical prostatectomy (RARP) were asked to complete an anonymous survey evaluating their perioperative experience. The quality improvement (QI) intervention started in March 2019 with a series of six educational videos being shown to all patients. The videos were used to supplement postoperative instruction. The discharge times of all patients were obtained from The Ottawa Hospital Data Repositories. A run chart analysis was used to detect change in discharge time (outcome measure). Patient satisfaction (balancing measure) was analyzed using Chi-squared analysis and descriptive statistics. Results: A total of 425 robotic prostatectomies (199 pre-intervention, 226 post-intervention) were available. Analysis of the run chart revealed non-random change favoring earlier discharge in the intervention group (p<0.05), with a pre-intervention late discharge rate of 64% and a post-intervention late discharge rate of 55%. A total of 140 surveys (59 pre-intervention, 81 post-intervention) assessing patient satisfaction were completed, corresponding with a response rate of 29.6% and 35.8%, respectively. Median score on a 10-point scale for overall satisfaction was equal between the intervention and non-intervention groups (9 [interquartile range (IQR 8–10) vs. 10 [IQR 8-10], p=0.92). Conclusions: Patient satisfaction with care and education was high for all patients and was not negatively impacted by this intervention. Video education tools may be one method to help improve the discharge process following RARP.

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Improving Follow-Up of Tests Pending at Discharge

Hospital Pediatrics ◽

10.1542/hpeds.2021-006000 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1363-1369

Author(s):

Andrew R. Shriner ◽

Richelle M. Baker ◽

Andrew Ellis ◽

Rebecca Dixon ◽

Michele Saysana

Keyword(s):

Quality Improvement ◽

Quality Care ◽

Retrospective Chart Review ◽

Primary Outcome Measure ◽

Quality Improvement Initiative ◽

Average Percentage ◽

Ensure Patient Safety ◽

Discharged Patients ◽

Quality Improvement Interventions

BACKGROUND AND OBJECTIVES Follow-up on results of inpatient tests pending at discharge (TPAD) must occur to ensure patient safety and high-quality care continue after discharge. We identified a need to improve follow-up of TPAD and began a quality improvement initiative with an aim of reducing the rate of missed follow-up of TPAD to ≤20% within 12 months. METHODS The team used the Plan-Do-Study-Act method of quality improvement and implemented a process using reminder messages in the electronic health record. We collected data via retrospective chart review for the 6 months before the intervention and monthly thereafter. The primary outcome measure was the percentage of patients with missed follow-up of TPAD, defined as no documented follow-up within 72 hours of a result being available. The use of a reminder message was monitored as a process measure. RESULTS We reviewed charts of 764 discharged patients, and 216 (28%) were noted to have TPAD. At baseline, the average percentage of patients with missed follow-up was 80%. The use of reminder messages was quickly adopted. The average percentage of patients with missed follow-up of TPAD after beginning the quality improvement interventions was 35%. CONCLUSIONS We had significant improvement in follow-up after our interventions. Additional work is needed to ensure continued and sustained improvement, focused on reducing variability in performance between providers and investing in technology to allow for automation of the follow-up process.

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MP11: A quality improvement initiative to decrease the rate of solitary blood cultures in the emergency department

CJEM ◽

10.1017/cem.2017.177 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S68-S69

Author(s):

J. Choi ◽

S. Ensafi ◽

L.B. Chartier ◽

O. Van Praet

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Control Charts ◽

Best Practice ◽

Blood Cultures ◽

Quality Improvement Initiative ◽

Relative Reduction ◽

Education Intervention ◽

Statistical Process ◽

Forcing Function

Introduction: Best practice guidelines recommend that at least two sets of blood cultures be sent when blood cultures are required. However, high rates of solitary blood cultures are still common in the emergency department. The aim of this study was to evaluate the efficacy of different quality improvement initiatives aimed at reducing the rate of solitary blood cultures being sent to the lab on patients ultimately discharged from our emergency department. Methods: This was a multi-centre, multi-phase, prospective study evaluating a comprehensive education-based intervention and a second intervention that combined a computerized forcing function along with a brief education-based intervention. The results were analyzed using segmented regression analysis, as well as statistical process control charts. Results: The baseline rate of solitary sets of blood cultures was 41.1%. The education intervention reduced this rate to 30.3%. The introduction of a forcing function with a brief educational intervention further reduced the rate to 11.6%. This represents an absolute reduction of 29.5% from baseline (relative reduction of 71.8%). According to segmental regression analyses, the education intervention alone did not produce a statistically significant change when factoring possible background time-related trends (P=0.071). However, the forcing function produced a statistically significant improvement (P < 0.0005), which was maintained for 6 months. Conclusion: The combination of a brief education-based intervention and a computerized forcing function was more effective than education alone in reducing solitary blood culture collection in our emergency department in this time series study. Forcing functions can be a powerful tool in modifying behaviours and processes in the clinical setting.

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Effect of Early Family Meetings and Patient Education in Adults With Cystic Fibrosis: A Quality Improvement Initiative

CHEST Journal ◽

10.1016/j.chest.2017.08.610 ◽

2017 ◽

Vol 152 (4) ◽

pp. A580

Author(s):

Muhammad Khan ◽

Nauman Chaudary

Keyword(s):

Cystic Fibrosis ◽

Quality Improvement ◽

Patient Education ◽

Quality Improvement Initiative ◽

Family Meetings ◽

Early Family

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A quality improvement initiative to reduce hospital-acquired pressure injuries (HAPI) in an acute inpatient setting by improving patient education and seating

Wound Practice and Research ◽

10.33235/wpr.29.4.198-205 ◽

2021 ◽

Vol 29 (4) ◽

Author(s):

Sascha Holbrook ◽

Colleen OBrien-Malone ◽

Annette Barton ◽

Kristie Harper

Keyword(s):

Quality Improvement ◽

Patient Education ◽

Quality Improvement Initiative ◽

Inpatient Setting ◽

Hospital Acquired

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Assurance of Myeloid Growth Factor Administration in an Infusion Center: Pilot Quality Improvement Initiative

Journal of Oncology Practice ◽

10.1200/jop.2017.023804 ◽

2017 ◽

Vol 13 (12) ◽

pp. e1040-e1045 ◽

Cited By ~ 2

Author(s):

Pamela Maree Ramirez ◽

Barry Peterson ◽

Christine Holtshopple ◽

Kristina Borja ◽

Vincent Torres ◽

...

Keyword(s):

Quality Improvement ◽

Quality Of Care ◽

Six Sigma ◽

Hospital Costs ◽

Safety Net ◽

Primary Objective ◽

Lean Six Sigma ◽

Quality Improvement Initiative ◽

Six Sigma Methodology

Purpose: Four incident reports involving missed doses of myeloid growth factors (MGFs) triggered the need for an outcome-driven initiative. From March 1, 2015, to February 29, 2016, at University of California Irvine Health Chao Infusion Center, 116 of 3,300 MGF doses were missed (3.52%), including pegfilgrastim, filgrastim, and sargramostim. We hypothesized that with the application of Lean Six Sigma methodology, we would achieve our primary objective of reducing the number of missed MGF doses to < 0.5%. Methods: This quality improvement initiative was conducted at Chao Infusion Center as part of a Lean Six Sigma Green Belt Certification Program. Therefore, Lean Six Sigma principles and tools were used throughout each phase of the project. Retrospective and prospective medical record reviews and data analyses were performed to evaluate the extent of the identified problem and impact of the process changes. Improvements included systems applications, practice changes, process modifications, and safety-net procedures. Results: Preintervention, 24 missed doses (20.7%) required patient supportive care measures, resulting in increased hospital costs and decreased quality of care. Postintervention, from June 8, 2016, to August 7, 2016, zero of 489 MGF doses were missed after 2 months of intervention ( P < .001). Chao Infusion Center reduced missed doses from 3.52% to 0%, reaching the goal of < 0.5%. Conclusion: The establishment of simplified and standardized processes with safety checks for error prevention increased quality of care. Lean Six Sigma methodology can be applied by other institutions to produce positive outcomes and implement similar practice changes.

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The sustainability of a quality improvement initiative

Healthcare Management Forum ◽

10.1177/0840470420913055 ◽

2020 ◽

Vol 33 (5) ◽

pp. 195-199

Author(s):

Veronica Belostotsky ◽

Catherine Laing ◽

Deborah E. White

Keyword(s):

Quality Improvement ◽

Elderly Population ◽

Functional Decline ◽

Cost Effective ◽

The Elderly ◽

Primary Objective ◽

Quality Improvement Initiative ◽

Cross Sectional ◽

One Year

Functional decline in seniors admitted to hospital is due in part to lack of mobilization. Many Quality Improvement (QI) initiatives targeting mobilization of the elderly population in acute care exist; however, their long-term effectiveness is not well-documented. Mobilization of Vulnerable Elders (MOVE) was a grant-funded initiative that started in Ontario and spread to Alberta. The primary objective of this project was to ascertain the sustainability of the MOVE project 1 year post implementation at two hospital sites in Alberta, Canada. Qualitative and quantitative cross-sectional data were gathered from multidisciplinary healthcare professionals. Our findings suggest MOVE was not well-sustained one year post implementation. Examination of specific survey questions provided an indication of strengths and weaknesses of the MOVE QI. Sustainable and cost-effective QI targeted at this elderly patient demographic could alleviate some of the demand on the healthcare system. Modifications to improve the sustainability of MOVE are summarized.

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