scholarly journals REFINE (Rapid Feedback for quality Improvement in Neonatal rEsuscitation): an observational study of neonatal resuscitation training and practice in a tertiary hospital in Nepal

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rejina Gurung ◽  
Abhishek Gurung ◽  
Omkar Basnet ◽  
Joar Eilevstjønn ◽  
Helge Myklebust ◽  
...  
Keyword(s):  
Quality Improvement ◽  
New Technologies ◽  
Neonatal Resuscitation ◽  
Feedback System ◽  
Tertiary Hospital ◽  
Intervention Package ◽  
Post Intervention ◽  
Improvement Program ◽  
Resuscitation Training ◽  
Simulation Based

Abstract Background Simulation-based training in neonatal resuscitation is more effective when reinforced by both practice and continuous improvement processes. We aim to evaluate the effectiveness of a quality improvement program combined with an innovative provider feedback device on neonatal resuscitation practice and outcomes in a public referral hospital of Nepal. Methods A pre- and post-intervention study will be implemented in Pokhara Academy of Health Sciences, a hospital with 8610 deliveries per year. The intervention package will include simulation-based training (Helping Babies Breathe) enhanced with a real-time feedback system (the NeoBeat newborn heart rate meter with the NeoNatalie Live manikin and upright newborn bag-mask with PEEP) accompanied by a quality improvement process. An independent research team will collect perinatal data and conduct stakeholder interviews. Discussion This study will provide further information on the efficiency of neonatal resuscitation training and implementation in the context of new technologies and quality improvement processes. Trial registration 10.1186/ISRCTN18148368, date of registration-31 July 2018

State-wide quality improvement addressing overutilization of neurokinin-1 receptor antagonists.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 8-8
Author(s):  
Emily R. Mackler ◽  
Kelly Marie Procailo ◽  
Louise Bedard ◽  
Jennifer J. Griggs
Keyword(s):  
Quality Improvement ◽  
Response Rate ◽  
Quality Improvement Intervention ◽  
Receptor Antagonists ◽  
Post Intervention ◽  
Improvement Program ◽  
Neurokinin 1 Receptor ◽  
Order Sets ◽  
Neurokinin 1 ◽  
Order Set

8 Background: The overuse of neurokinin-1 receptor antagonists (NK1-RAs) is a focus of quality measurement within the American Society of Clinical Oncology Quality Oncology Practice Initiative (ASCO-QOPI) and the American Board of Internal Medicine (ABIM) as a Choosing Wisely measure. The Michigan Oncology Quality Collaborative (MOQC) is a statewide collaborative with participation of nearly 100% of oncologists. The purpose of this project was to provide quality improvement practice support for deimplementation of NK1-RAs in the upfront prevention of chemotherapy- induced nausea and vomiting (CINV) for low and moderate emetic chemotherapy regimens (QOPI measure SMT28a) to less than 30% in practices across the State, with lower scores indicating better performance. Methods: In 2018, MOQC added the QOPI SMT28a measure as part of its standard quality measure module for collection by all MOQC practices. A quality improvement intervention was initiated that consisted of 1) baseline assessments of measure performance, prescriber knowledge and beliefs, and pre-populated antiemetic order sets, 2) reporting practice and state-level performance to MOQC practices, 3) state-wide CINV education, and 4) a value-based reimbursement (VBR) related to measure performance. Post-intervention performance was assessed with the Fall 2019 and Spring 2020 QOPI-measurement. Results: Responses from a survey assessing pre-populated antiemetic order sets (32/43, 74% response rate), 23% of practices had a pre-populated order set for NK1-RA and/or olanzapine in moderate emetic regimens. The post-education order set survey found that 48% of respondents (25/43, 54% response rate) either modified or were in the process of modifying their order sets. Conclusions: Deimplementation of unnecessary and low value antiemetics in patients receiving low- or moderate emetic chemotherapy was possible via a state-wide quality improvement program that involved performance reporting to practices, collaborative-wide education, modification of standing order sets, and VBR based on performance. [Table: see text]

scholarly journals Mindset Moderates Healthcare Providers' Longitudinal Performance in a Digital Neonatal Resuscitation Simulator

2021 ◽  
Vol 8 ◽  
Author(s):  
Chang Lu ◽  
Simran K. Ghoman ◽  
Maria Cutumisu ◽  
Georg M. Schmölzer
Keyword(s):  
Healthcare Providers ◽  
Neonatal Resuscitation ◽  
Growth Mindset ◽  
Moderating Effect ◽  
Repeated Measure ◽  
Test Time ◽  
Future Research ◽  
Knowledge Gain ◽  
Resuscitation Training ◽  
Simulation Based

Background: Simulation education can benefit healthcare providers (HCPs) by providing opportunities to practice complex neonatal-resuscitation tasks in low-stake environments. To our knowledge, no study investigated the role of growth mindset on longitudinal performance on neonatal resuscitation before and after simulation-based training.Objectives: This study examines whether 1) the RETAIN digital/table-top simulators facilitate HCPs' neonatal resuscitation knowledge gain, retention, and transfer and 2) growth mindset moderates HCPs' longitudinal performance in neonatal resuscitation.Methods: Participants were n = 50 HCPs in a tertiary perinatal center in Edmonton, Canada. This longitudinal study was conducted in three stages including 1) a pretest and a mindset survey, immediately followed by a posttest using the RETAIN digital simulator from April to August 2019; 2) a 2-month delayed posttest using the same RETAIN neonatal resuscitation digital simulator from June to October 2019; and 3) a 5-month delayed posttest using the low-fidelity table-top neonatal resuscitation digital simulator from September 2019 to January 2020. Three General Linear Mixed Model (GLMM) repeated-measure analyses investigated HCPs' performance on neonatal resuscitation over time and the moderating effect of growth mindset on the association between test time points and task performance.Results: Compared with their pretest performance, HCPs effectively improved their neonatal resuscitation knowledge after the RETAIN digital simulation-based training on the immediate posttest (Est = 1.88, p < 0.05), retained their knowledge on the 2-month delayed posttest (Est = 1.36, p < 0.05), and transferred their knowledge to the table-top simulator after 5 months (Est = 2.01, p < 0.05). Although growth mindset did not moderate the performance gain from the pretest to the immediate posttest, it moderated the relationship between HCPs' pretest and long-term knowledge retention (i.e., the interaction effect of mindset and the 2-month posttest was significant: Est = 0.97, p < 0.05). The more they endorsed a growth mindset, the better the HCPs performed on the posttest, but only when they were tested after 2 months.Conclusions: Digital simulators for neonatal resuscitation training can effectively facilitate HCPs' knowledge gain, maintenance, and transfer. Besides, growth mindset shows a positive moderating effect on the longitudinal performance improvement in simulation-based training. Future research can be conducted to implement growth-mindset interventions promoting more effective delivery of technology-enhanced, simulation-based training and assessment.

scholarly journals Strategies to sustain a quality improvement initiative in neonatal resuscitation

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Carlien Van Heerden ◽  
Carin Maree ◽  
Elsie S. Janse van Rensburg
Keyword(s):  
Quality Improvement ◽  
Neonatal Mortality ◽  
District Hospital ◽  
Neonatal Resuscitation ◽  
World Health ◽  
Quality Improvement Initiative ◽  
Neonatal Deaths ◽  
Early Neonatal Mortality ◽  
District Hospitals ◽  
Resuscitation Training

Background: Many neonatal deaths can be prevented globally through effective resuscitation. South Africa (SA) committed towards attaining the Millennium Development Goal 4 (MDG4) set by the World Health Organization (WHO). However, SA’s district hospitals have the highest early neonatal mortality rates. Modifiable and avoidable causes associated with patient-related, administrative and health care provider factors contribute to neonatal mortality. A quality improvement initiative in neonatal resuscitation could contribute towards decreasing neonatal mortality, thereby contributing towards the attainment of the MDG4.Aim: The aim of this study was, (1) to explore and describe the existing situation regarding neonatal resuscitation in a district hospital, (2) to develop strategies to sustain a neonatal resuscitation quality improvement initiative and (3) to decrease neonatal mortality. Changes that occurred and the sustainability of strategies were evaluated.Setting: A maternity section of a district hospital in South Africa.Methods: The National Health Service (NHS) Sustainability Model formed the theoretical framework for the study. The Problem Resolving Action Research model was applied and the study was conducted in three cycles. Purposive sampling was used for the quantitative and qualitative aspects of data collection. Data was analysed accordingly.Results: The findings indicated that the strategies formulated and implemented to address factors related to neonatal resuscitation (training, equipment and stock, staff shortages, staff attitude, neonatal transport and protocols) had probable sustainability and contributed towards a reduction in neonatal mortality in the setting.Conclusion: These strategies had the probability of sustainability and could potentially improve neonatal outcomes and reduce neonatal mortality to contribute toward South Africa’s drive to attain the MDG4.

The impact of an intervention package promoting effective neonatal resuscitation training in rural China

Resuscitation ◽  
2014 ◽  
Vol 85 (2) ◽  
pp. 253-259 ◽  
Author(s):  
Tao Xu ◽  
Huishan Wang ◽  
Limin Gong ◽  
Hongmao Ye ◽  
Renjie Yu ◽  
...  
Keyword(s):  
Rural China ◽  
Neonatal Resuscitation ◽  
Intervention Package ◽  
Resuscitation Training ◽  
The Impact

scholarly journals Obtaining an accurate maternal blood pressure: A quality improvement initiative to improve nursing knowledge and confidence

2021 ◽  
Vol 12 (4) ◽  
pp. 30
Author(s):  
Matthew K. Wagar ◽  
Jacquelyn H. Adams ◽  
Amy Godecker ◽  
Kathleen Frigge ◽  
Michele Schroeder ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Quality Improvement ◽  
Maternal Blood ◽  
Ordinary Least Squares ◽  
Post Intervention ◽  
Improvement Program ◽  
Educational Initiative ◽  
Nursing Knowledge ◽  
Primary Nursing ◽  
Maternal Blood Pressure

Background: Inaccurate assessment of maternal blood pressure (BP) contributes to misdiagnosis of hypertension, unnecessary or missed interventions, and maternal morbidity. This study examines obstetric nursing knowledge and confidence in proper assessment of maternal BP before and after an institutional quality improvement project.Methods: We implemented an online educational initiative in our women’s health unit based on the American Heart Association’s Blood Pressure Improvement Program. Simultaneously, a standard assessment of BP cuff sizing by arm measurement was implemented. We conducted a pre- and post-intervention assessment of nursing knowledge and confidence of BP measurement. Responses were analyzed using the χ2 test, two-sample t test, ordinary least squares and logistic regression.Results: A total of 145 nurses completed the pre- and 68 completed the post-intervention assessments. Participants answered 62% of pre- and 73% of post-intervention questions correctly (p < .001). Before implementation, 86.9% of participants reported feeling very or extremely confident in obtaining an accurate BP measurement, increasing to 98.5% following (p = .007). 73.8% of pre-intervention respondents reported feeling very or extremely confident in choosing an appropriate BP cuff compared to 96.3% post (p < .001). Following implementation, confidence levels were similar irrespective of years in practice, years of experience at our hospital, and primary nursing unit.Conclusions: A BP educational initiative and standardized BP cuff assessment increased nurses’ knowledge and confidence in selecting the correct cuff size and obtaining accurate readings. Increased knowledge and confidence may lead to greater adherence to standardized BP assessment during peripartum admission, more accurate BP measurements, and improved management of hypertensive disorders in pregnancy.

scholarly journals 2735. Improving Uptake of Maternal Immunizations in the Obstetric Care Setting Through an Adaptation of the CDC’s Immunization Quality Improvement Program (AFIX)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S962-S963
Author(s):  
Sean T OLeary ◽  
Mallory Ellingson ◽  
Christine Spina ◽  
Sarah E Brewer ◽  
Lori Quick ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Private Insurance ◽  
Obstetric Care ◽  
Vaccine Uptake ◽  
Post Intervention ◽  
Improvement Program ◽  
Vaccination Rates ◽  
Immunization Rates ◽  
Study Staff ◽  
Tdap Vaccine

Abstract Background Influenza and Tdap vaccines are recommended for pregnant women in every pregnancy. However, vaccine uptake remains suboptimal. Obstetrics practices need quality improvement models to improve their vaccination delivery programs. CDC’s AFIX program has been shown to be effective at increasing vaccination uptake in primary care settings. Our objective was to adapt and evaluate CDC’s AFIX program in the obstetrical setting (AFIIX-OB). Methods An average of 40 charts per practice were randomly reviewed pre- and post-intervention. Baseline immunization rates and vaccine administration practices were collected in the Assessment phase. Feedback was provided at meetings conducted by study staff where baseline immunization rates were shared and practices selected quality improvement measures to implement. Practices were required to implement either standing orders for influenza and Tdap vaccines or improve their vaccine documentation. As an Incentive, providers could receive continuing medical education and maintenance of certification part IV credit. After implementing the practice specific measures for 6 months, practice-wide vaccine rates were assessed and a post-intervention meeting was held with providers and staff at each practice to eXchange the results. Results AFIX-OB was implemented in 11 obstetric practices: 5 in Georgia and 6 in Colorado. Practices were primarily urban, their patients largely Caucasian and African American and most patients carried private insurance. Baseline practice-level immunization rates ranged from 10% to 82.9% for influenza vaccine and 12.5% to 97.6% for Tdap. 4 practices implemened standing orders, 6 improved their vaccine documentation and 1 did both. After the 6 month follow-up period, all 11 practices saw improvements in their overall Tdap vaccine acceptance (3 with statistically significant increases, P < 0.05) with final rates ranging from 25% to 100%. 9 practices either maintained or improved their influenza vaccination rates (4 with statistically significant increases, P < 0.05) with final rates ranging from 32.5% to 85.0%. Conclusion The AFIX-OB model provides a promising intervention to improve maternal immunization uptake that can be administered widely but still be tailored to the needs of individual clinics. Disclosures All authors: No reported disclosures.

scholarly journals Performance of health workers on neonatal resuscitation care following scaled-up quality improvement interventions in public hospitals of Nepal - a prospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dipak Raj Chaulagain ◽  
Mats Malqvist ◽  
Olivia Brunell ◽  
Johan Wrammert ◽  
Omkar Basnet ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Workers ◽  
Clinical Performance ◽  
Newborn Infants ◽  
Neonatal Resuscitation ◽  
Public Hospitals ◽  
Intervention Package ◽  
Helping Babies Breathe ◽  
Resource Limited ◽  
Before And After

Abstract Background High-quality resuscitation among non-crying babies immediately after birth can reduce intrapartum-related deaths and morbidity. Helping Babies Breathe program aims to improve performance on neonatal resuscitation care in resource-limited settings. Quality improvement (QI) interventions can sustain simulated neonatal resuscitation knowledge and skills and clinical performance. This study aimed to evaluate the effect of a scaled-up QI intervention package on the performance of health workers on basic neonatal resuscitation care among non-crying infants in public hospitals in Nepal. Methods A prospective observational cohort design was applied in four public hospitals of Nepal. Performances of health workers on basic neonatal care were analysed before and after the introduction of the QI interventions. Results Out of the total 32,524 births observed during the study period, 3031 newborn infants were not crying at birth. A lower proportion of non-crying infants were given additional stimulation during the intervention compared to control (aOR 0.18; 95% CI 0.13–0.26). The proportion of clearing the airway increased among non-crying infants after the introduction of QI interventions (aOR 1.23; 95% CI 1.03–1.46). The proportion of non-crying infants who were initiated on BMV was higher during the intervention period (aOR 1.28, 95% CI 1.04–1.57) compared to control. The cumulative median time to initiate ventilation during the intervention was 39.46 s less compared to the baseline. Conclusion QI intervention package improved health workers’ performance on the initiation of BMV, and clearing the airway. The average time to first ventilation decreased after the implementation of the package. The QI package can be scaled-up in other public hospitals in Nepal and other similar settings.

scholarly journals Evaluating the use of high-fidelity simulators during mock neonatal resuscitation scenarios in trying to improve confidence in residents

2018 ◽  
Vol 6 ◽  
pp. 205031211878195 ◽  
Author(s):  
Deena Hossino ◽  
Christina Hensley ◽  
Karen Lewis ◽  
Marie Frazier ◽  
Renee Domanico ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Neonatal Resuscitation ◽  
Venous Catheter ◽  
Respiratory Arrest ◽  
High Fidelity ◽  
High Fidelity Simulation ◽  
Post Intervention ◽  
Self Confidence ◽  
Simulation Based ◽  
Multiple Scenarios

Objective: The purpose of this study was to investigate the effect of the use of high-fidelity simulators with multidisciplinary teaching on self-reported confidence in residents. Methods: A total of 26 residents participated in a session led by a pediatric faculty member and a Neonatal Intensive Care Unit transport nurse using a high-fidelity pediatric simulator. Multiple scenarios were presented and each resident took turns in various roles. Pre-intervention surveys based on a 5-point Likert-type scale were given before the scenarios and were compared to the results of identical post-intervention surveys. Results: Statistically significant (p < 0.05) pre to post gains for self-confidence were observed. Improvements in confidence were analyzed using the mean difference. The largest improvement in confidence was seen in the ability to treat neonatal respiratory arrest. This was followed by the ability to supervise/run a code, and the ability to place an umbilical venous catheter. Conclusion: These results revealed that high-fidelity simulation-based training has significant positive gains in residents’ self-reported confidence.

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