Nursing Advocacy and Long Acting Injectables to Reduce High Readmission Rates: Quality Initiative

2019 ◽  
Vol 26 (4) ◽  
pp. 389-393
Author(s):  
Bernard Vonderhaar ◽  
Marsha Snyder
Keyword(s):  
Nursing Education ◽  
Admission Rate ◽  
Academic Detailing ◽  
Inclusion Criteria ◽  
Chart Audit ◽  
Readmission Rates ◽  
Nursing Advocacy ◽  
Schizophrenia Spectrum ◽  
Chart Audits ◽  
Long Acting

INTRODUCTION: Nonadherence to medications for schizophrenia relates to frequent readmissions. Long-acting injectable (LAI) medications are shown to increase adherence and reduce admissions. AIMS: (1) Identify frequent readmissions to psychiatry. (2) Improve nursing advocacy for patients appropriate for LAIs through in-service. METHODS: Chart audits were employed for data collection. Academic detailing and dashboards were used for voluntary nursing education. The chart audit spanned 90 days pre and post in-service. All admissions to psychiatry were screened; patients with readmissions under 30 days (with the same admitting diagnosis), a schizophrenia spectrum diagnosis, and nonadherent with oral antipsychotics were included. Results: Forty-four patients met criteria and amassed 49 frequent readmissions. For inclusion criteria, the admission rate decreased by 53% and LAI prescriptions increased by 9%. Three patients from the first audit group and one from the second were initiated on LAIs. CONCLUSIONS: Attitudes toward LAIs may be improving based on RN advocacy and collaboration.

scholarly journals Hospital Admission and Readmission Among US Patients Receiving Umeclidinium/Vilanterol or Tiotropium as Initial Maintenance Therapy for Chronic Obstructive Pulmonary Disease

2021 ◽  
Author(s):  
David Slade ◽  
Riju Ray ◽  
Chad Moretz ◽  
Guillaume Germain ◽  
François Laliberté ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Maintenance Therapy ◽  
Pulmonary Disease ◽  
Index Date ◽  
Inhaled Corticosteroids ◽  
Admission Rate ◽  
Chronic Obstructive ◽  
Readmission Rates ◽  
Obstructive Pulmonary Disease ◽  
Long Acting

Abstract Introduction Patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations are at risk of further readmissions, increased treatment costs, and excess mortality. This study evaluated inpatient admissions and readmissions in patients receiving initial maintenance therapy with umeclidinium/vilanterol (UMEC/VI) versus tiotropium (TIO). Methods This retrospective, matched cohort study identified patients with COPD who initiated maintenance therapy with UMEC/VI or TIO from Optum’s de-identified Clinformatics Data Mart database between January 1, 2013, and December 31, 2018 (index date defined as earliest dispensing). Eligibility criteria included: ≥ 1 medical claim for COPD pre-index or on the index date; ≥ 12 months of continuous eligibility pre-index; age ≥ 40 years at index; no pre- or post-index asthma diagnosis; and no pre-index claims for medications containing inhaled corticosteroids, long-acting β2-agonists, or long-acting muscarinic antagonists. Outcomes included time to first on-treatment COPD-related inpatient admission, rate of on-treatment COPD-related admissions, and rate of all-cause and COPD-related readmissions within 30 and 90 days. Propensity score matching was used to adjust for potential confounders. Results Matched UMEC/VI and TIO cohorts each included 7997 patients and were balanced on baseline characteristics (mean age 70.9 years; female 47.1–47.6%). Over 12 months, patients initiating UMEC/VI had significantly reduced risk (hazard ratio [95% CI]: 0.87 [0.79, 0.96]; p = 0.006) and rates (rate ratio [95% CI]: 0.80 [0.72, 0.92]; p = 0.008) of COPD-related inpatient admissions compared with TIO. While all-cause readmission rates were similar between treatment cohorts, readmission rates among patients with an initial admission length of stay of 1–3 days were numerically lower for UMEC/VI versus TIO (30-day readmissions: 10.5% vs. 12.4%; 90-day readmissions: 15.5% vs. 19.8%). Similar patterns were observed for COPD-related readmissions. Conclusions These findings highlight the real-world benefits of dual therapy with UMEC/VI versus TIO in reducing inpatient admissions and readmissions in patients with COPD, which may translate to lower healthcare costs.

scholarly journals The Process and Implication of Inter-Professional Education: A Systematic Review

2018 ◽  
Vol 7 (2) ◽  
pp. 104
Author(s):  
Dewi Prabawati
Keyword(s):  
Systematic Review ◽  
Nursing Education ◽  
Nursing Students ◽  
Professional Education ◽  
Focus Group Interview ◽  
Clinical Settings ◽  
Inclusion Criteria ◽  
Group Problem ◽  
Group Problem Solving ◽  
Social Networking Website

Background: The practice of inter-professional education (IPE) is expanding rapidly especially in the developing countries.  The goal of IPE is to develop knowledge, skills, and attitudes that result in effective Inter-professional (IP) team behaviors and competency. Therefore, it is essential to understand more about the activity, other professional’s involvement and its implications for nursing students and institutions.Purpose: This paper aimed to review the process and other professional’s involvement in IPE’s nursing education, and describe the implication after implementing IPE for nursing students and institution.Methods: A comprehensive multi-step search of the literature in IPE using ProQuest, EBSCO and Cengage databases was performed. Samples of 19 studies met the inclusion criteria and were used in this study.Results: None of the studies reported findings from developing country, while there were only two studies conducted in Asia. IPE programs utilize a variety of combinations of interactive learning methods, such as group problem solving, focus group interview, social networking (website), and simulated patient or simulated based training (SBT) which is becoming the most common methods employed.  IPE gives benefits for the students, such as improving communication skills, recognizing the role and responsibilities, understanding the value and ethics and also increasing teamwork and team-based care.Conclusion: Despite the limitations, this systematic review found a number of activities and other professionals that can be involved with nursing in the IPE implementation.  It also found out that IPE applied in a variety of clinical settings is well received by the students and enable them to learn the knowledge and skills for collaborative learning.

Chart Audit of Spiritual Care Documentation: Continuous Quality Improvement

2020 ◽  
Vol 74 (4) ◽  
pp. 280-289
Author(s):  
Vivian B. Stang ◽  
Mary Jane Beavis ◽  
Geneviève Côté
Keyword(s):  
Quality Improvement ◽  
Electronic Health Record ◽  
Acute Care ◽  
Continuous Quality Improvement ◽  
Spiritual Care ◽  
Health Record ◽  
Chart Audit ◽  
Continuous Quality ◽  
And Performance ◽  
Chart Audits

Eight spiritual care practitioners at an acute care teaching hospital undertook a systematic chart audit of their documentation practices in the patient electronic health record. The purpose was to evaluate their practices using the standards of their professional association and regulatory college. A preliminary “mock audit” was essential for the overall success of the audit. Plans for ongoing chart audits will lead to continuous quality improvement. A limitation was that their manager acted as both improvement coach and performance evaluator.

Effect of home-based follow-up intervention on readmissions and mortality in heart failure patients: a meta-analysis

2019 ◽  
Vol 15 (5) ◽  
pp. 377-386 ◽  
Author(s):  
Aaqib H Malik ◽  
Senada S Malik ◽  
Wilbert S Aronow ◽  
Keyword(s):  
Heart Failure ◽  
Discharge Planning ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Readmission Rates ◽  
Randomized Controlled ◽  
Home Based ◽  
Home Based Intervention ◽  
The Impact

Aim: We investigated whether the home-based intervention (HBI) for heart failure (HF), restricted to education and support, improves readmissions or mortality compared with usual care. Patients & methods: We searched PubMed and Embase for randomized controlled trials that examined the impact of HBI in HF. A random-effects meta-analysis was performed using R. Result: Total 17/409 articles (3214 patients) met our inclusion criteria. The pooled estimate showed HBI was associated with a reduction in readmission rates and mortality (22 and 16% respectively; p < 0.05). Subgroup analysis confirmed that the benefit of HBI increases significantly with a longer follow-up. Conclusion: HBI in the form of education and support significantly reduces readmission rates and improves survival of HF patients. HBI should be considered in the discharge planning of HF patients.

scholarly journals A novel approach to cardiovascular disturbances in patients with schizophrenia spectrum disorders treated with long-acting injectable medication

2019 ◽  
Vol Volume 15 ◽  
pp. 349-355 ◽  
Author(s):  
Minodora Andor ◽  
Liana Dehelean ◽  
Ana-Maria Romosan ◽  
Valentina Buda ◽  
Gabriela Radu ◽  
...  
Keyword(s):  
Schizophrenia Spectrum Disorders ◽  
Novel Approach ◽  
Schizophrenia Spectrum ◽  
Spectrum Disorders ◽  
Long Acting

Balloon Sinuplasty Utilization in the Pediatric Population: A National Database Perspective

2019 ◽  
Vol 161 (4) ◽  
pp. 683-687 ◽  
Author(s):  
Gerard Thong ◽  
Natasha D. Dombrowski ◽  
Kosuke Kawai ◽  
Michael J. Cunningham ◽  
Eelam A. Adil
Keyword(s):  
Chronic Rhinosinusitis ◽  
Pediatric Population ◽  
Health Information System ◽  
Sinus Surgery ◽  
National Database ◽  
Inclusion Criteria ◽  
Readmission Rates ◽  
Balloon Sinuplasty ◽  
Before And After

Objective Balloon sinuplasty (BS) is a surgical management option in the treatment of chronic rhinosinusitis. The purpose of this study was to examine BS utilization among children with a national database. Study Design Retrospective review. Setting National pediatric database. Subjects and Methods All cases of children aged ≤18 years who underwent BS or traditional endoscopic sinus surgery (ESS) 5 years before and after the introduction of BS billing codes were studied with the Pediatric Health Information System database. We evaluated overall trends, demographics, performing physicians, readmissions, and cost data. Results A total of 14,079 patients met inclusion criteria: 13,555 underwent traditional ESS and 524 had a BS procedure. There was no significant increase in BS rates between 2011 and 2016. BS was more commonly performed among younger children than ESS (median age [interquartile range], 6 years [4-10] vs 9 years [6-13]; P < .001). There were 23 (4.4%) readmissions within 30 days in the balloon cohort versus 474 (3.5%) in the ESS cohort. The median cost of balloon maxillary antrostomy (US $6560 [$5420-$8250]) was higher than that of traditional maxillary antrostomy (US $5630 [$4130-$7700], P < .001). Physicians who performed BS had a larger volume of ESS procedures when compared with those who did not perform BS. Conclusion Rates of BS performance in the pediatric population have not increased over time. Results showed no difference in readmission rates between BS and ESS. BS was associated with higher costs as compared with ESS. The role of BS in the pediatric chronic rhinosinusitis population remains unclear.

scholarly journals Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness

QJM ◽  
2020 ◽  
Author(s):  
K Jusmanova ◽  
C Rice ◽  
R Bourke ◽  
A Lavan ◽  
C G McMahon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Admission Rate ◽  
Readmission Rates ◽  
Specialist Service ◽  
Admission Rates ◽  
Potential Benefits ◽  
Bed Days ◽  
The Mean ◽  
The Impact

Summary Background Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. Aim To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. Design Pre- and post-cohort study. Methods Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). Results There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P &lt; 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4–24.0] days compared to 18.2 (95% CI 14.6–21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030). Conclusion This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

Safety and Efficacy of Supratherapeutic Doses of Clobazam

2019 ◽  
Vol 34 (12) ◽  
pp. 735-738
Author(s):  
Sravya Gedela ◽  
Daniel A Freedman ◽  
Satyanarayana Gedela ◽  
Peter Glynn ◽  
Ann Salvator ◽  
...  
Keyword(s):  
Seizure Control ◽  
Care Utilization ◽  
Retrospective Data ◽  
Limited Data ◽  
Inclusion Criteria ◽  
Safety And Efficacy ◽  
Significant Difference ◽  
The Us ◽  
Long Acting ◽  
Therapeutic Doses

Clobazam is a commonly used long-acting benzodiazepine approved by the US Food and Drug Administration (FDA) to treat seizures associated with Lennox Gastaut syndrome. The FDA approved maximum dosage of clobazam is 1 mg/kg/d or a total of 40 mg a day. Many providers exceed this dosage but there is limited data on the safety, tolerability, and efficacy of supratherapeutic doses. We reviewed retrospective data at our institution and compared patients on supratherapeutic doses to patients on therapeutic doses. A total of 133 patients met inclusion criteria (65 supratherapeutic, 67 therapeutic). There was no statistically significant difference in terms of seizure control, health care utilization, or side effects between patients on supratherapeutic doses and those on therapeutic doses. This study lends further support to the safety and tolerability of supratherapuetic doses of clobazam.

A Review of Competencies Developed for Disaster Healthcare Providers: Limitations of Current Processes and Applicability

2010 ◽  
Vol 25 (5) ◽  
pp. 387-395 ◽  
Author(s):  
Elaine Daily ◽  
Patricia Padjen ◽  
Marvin Birnbaum
Keyword(s):  
Public Health ◽  
Nursing Education ◽  
Disaster Preparedness ◽  
Core Competencies ◽  
Public Health Emergency ◽  
Professional Organizations ◽  
Healthcare Personnel ◽  
Inclusion Criteria ◽  
Manual Search ◽  
Nursing Competencies

AbstractIntroduction:In order to prepare the healthcare system and healthcare personnel to meet the health needs of populations affected by disasters, educational programs have been developed by numerous academic institutions, hospitals, professional organizations, governments, and non-government organizations. Lacking standards for best practices as a foundation, many organizations and institutions have developed “core competencies” that they consider essential knowledge and skills for disaster healthcare personnel.Problem:The Nursing Section of the World Association for Disaster and Emergency Medicine (WADEM) considered the possibility of endorsing an existing set of competencies that could be used to prepare nurses universally to participate in disaster health activities. This study was undertaken for the purpose of reviewing published disaster health competencies to determine commonalities and universal applicability for disaster preparedness.Methods:In 2007, a review of the electronic literature databases was conducted using the major keywords: disaster response competencies; disaster preparedness competencies; emergency response competencies; disaster planning competencies; emergency planning competencies; public health emergency preparedness competencies; disaster nursing competencies; and disaster nursing education competencies. A manual search of references and selected literature from public and private sources also was conducted. Inclusion criteria included: English language; competencies listed or specifically referred to; competencies relevant to disaster, mass-casualty incident (MCI), or public health emergency; and competencies relevant to healthcare.Results:Eighty-six articles were identified; 20 articles failed to meet the initial inclusion criteria; 27 articles did not meet the additional criteria, leaving 39 articles for analysis. Twenty-eight articles described competencies targeted to a specific profession/discipline, while 10 articles described competencies targeted to a defined role or function during a disaster. Four of the articles described specific competencies according to skill level, rather than to a specific role or function. One article defined competencies according to specific roles as well as proficiency levels. Two articles categorized disaster nursing competencies according to the phases of the disaster management continuum. Fourteen articles described specified competencies as “core” competencies for various target groups, while one article described “cross-cutting” competencies applicable to all healthcare workers.Conclusions:Hundreds of competencies for disaster healthcare personnel have been developed and endorsed by governmental and professional organizations and societies. Imprecise and inconsistent terminology and structure are evident throughout the reviewed competency sets. Universal acceptance and application of these competencies are lacking and none have been validated. Further efforts must be directed to developing a framework and standardized terminology for the articulation of competency sets for disaster health professionals that can by accepted and adapted universally.

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