An interdisciplinary model of collaboration between medical staff (MS), hospital quality improvement (QI), and continuing medical education (CME) departments to promote education and practice changes in the prevention of venous thromboembolism (VTE) in cancer patients (pts).

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 215-215
Author(s):  
Lucille A. Leong ◽  
Mary Mendelsohn ◽  
Crystal J. Saavedra ◽  
Robert Morgan
Keyword(s):  
Venous Thromboembolism ◽  
Visual Cues ◽  
Interdisciplinary Approach ◽  
Opinion Leader ◽  
Vte Prophylaxis ◽  
Learning Modules ◽  
Order Sets ◽  
E Learning ◽  
Key Opinion Leader ◽  
And Performance

215 Background: Venous thromboembolism (VTE) is a leading cause of morbidity/mortality in cancer pts. VTE is increasing and is the second cause of death in cancer pts, behind only cancer itself. In 2010 of the 186 unique hospitalized cancer pts at our institution with VTE, 25% were medical and 75% surgical. Gaps in clinician knowledge/practice of VTE prevention were evident. Methods: A interdisciplinary approach across clinical and administrative specialties was undertaken, with collaboration between: medical/surgical oncologists, MS leaders, pharmacists, nursing, and hospital departments of QI, information technology, and CME, to educate a target group of 120 cancer clinicians in VTE prophylaxis. In 2/2013 - 2/2014 multiplatform educational initiatives were utilized to reach physicians, advance practice/ward nurses and pharmacists: didactic lectures, Key Opinion Leader visiting professorships, online vignettes, VTE FAQ emails from MS QI leaders, small group sessions, e-learning modules. System changes such as standardized VTE prophylaxis order sets tailored for each service and strategically placed visual cues were also used. Results: Almost 3 times as many unique learners participated in these activities as were targeted. Learner satisfaction, knowledge acquisition and competency were high. Compliance with use of standardized order sets improved from 65 to 95% among the MS. Claims by clinicians of pt contraindications to prophylaxis were audited and found valid. Despite these improvements, incidence of VTE has not dropped, reflecting a national trend. Conclusions: With intensive and interdisciplinary effort, progressin clinician knowledge and performance in VTE prophylaxis can be made. This effort required considerable input from physician champions (eg., surgical oncologists with overlapping roles of clinician, QI advocate, and departmental leader, and medical oncologists with roles of clinician, CME and MS leader). This is a promising model for other QI initiatives. Supported by Unihealth educational grant.

scholarly journals Antibiotic Stewardship for Nursing: Can E-learning Be a First Step?

2020 ◽  
Vol 41 (S1) ◽  
pp. s118-s118
Author(s):  
Mary T. Catanzaro
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Stewardship ◽  
Antibiotic Stewardship ◽  
Online Survey ◽  
Interdisciplinary Approach ◽  
Healthcare Team ◽  
Learning Modules ◽  
E Learning ◽  
Unit Culture ◽  
Infection Preventionists

Background: The CDC and The Joint Commission have called for an interdisciplinary approach to antibiotic stewardship implementation. The healthcare team should consist of infectious disease physicians, pharmacists, infectious disease pharmacists, infection preventionists, microbiologists, and nurses. The scant literature to date has looked at nurses’ attitudes and beliefs toward participating in antibiotic stewardship and have identified several factors that contribute to the lack of uptake by nurses: lack of education around stewardship, poor communication among healthcare providers, and hospital or unit culture, among others. Additionally, nurses’ lack of interest in what would be more work or not within their scope of work was put forth as an additional factor by infection preventionists and pharmacists as a barrier to implementation. Method: An investigator-developed online survey was used to assess the usefulness of 3 investigator-developed educational e-learning modules that encompassed the role of nurses in antibiotic stewardship, pharmacy and laboratory topics related to antimicrobial stewardship, as well as the nurses’ attitudes toward their participation in such activities. Results: Participants took the survey after review of the 3 e-learning modules. The results indicate that, contrary to what pharmacists and infection preventionists thought, 82% of nurses felt they should contribute to and be part of the antimicrobial stewardship team. Additionally, after completing the modules, 73% felt more empowered to participate in stewardship discussions with an additional 23% wanting more education. 100% felt that they learned information that they could utilize in their everyday work. Barriers to implementation of stewardship activities on their unit included lack of education (41%), hospital or unit culture (27%), with only 4% citing they did not feel it was their job or that they had anything to contribute to a discussion. Also, 24% felt that there were no obstacles to participation. Conclusions: Surprisingly, most nurses who took this educational series and survey felt that they should be part of the antibiotic stewardship team. As cited previously from the literature, education and culture need to be addressed to overcome the nurses’ barriers to stewardship involvement. E-learning can provide an easy first step to educating nurses when time permits and can provide a good springboard for discussion on the units and with physicians and pharmacists. For a copy of the modules, please contact the author.Funding: NoneDisclosures: None

scholarly journals Antibiotic stewardship for nurses: Using e-learning modules to bridge the education gap

2022 ◽  
Vol 2 (1) ◽  
Author(s):  
Mary T. Catanzaro
Keyword(s):  
Antibiotic Stewardship ◽  
Interdisciplinary Approach ◽  
Front Line ◽  
Learning Modules ◽  
Time Investment ◽  
Specimen Collection ◽  
Stewardship Program ◽  
E Learning ◽  
Education Gap ◽  
Unit Culture

Abstract Objective: The Centers for Disease Control and Prevention has called for an interdisciplinary approach to antibiotic stewardship implementation that includes front-line nurses. The literature to date has identified key factors preventing uptake by nurses: lack of education, poor communication among providers, and unit culture. Three e-learning modules were developed to address the nurses’ education regarding the roles nurses play in antibiotic stewardship, antibiotic resistance, allergy assessment, medication side effects and interactions, pharmacokinetics–pharmacodynamics, culture interpretation, specimen collection, and the antibiogram. A survey was used to assess whether nurses felt more prepared to participate after finishing the modules. Setting: Front-line staff nurses in acute care were assigned e-learning modules as part of their pharmacy’s introduction of an antibiotic stewardship program for nurses. Methods: Nurses viewed the modules and completed a survey designed to rank their usefulness and to assess their attitudes. Results: Overall, 81% of nurses felt that they should be part of the antibiotic stewardship team. After completing the modules, 72% felt more empowered to participate in stewardship discussions and an additional 23% requested more education. Also, 97% felt that the information they learned could be utilized in everyday work regardless of the new program. The most cited barriers to stewardship activities were lack of education (45%) and hospital and/or unit culture (13%). Conclusion: Education and culture need to be addressed to overcome the barriers to nurses’ involvement in antimicrobial stewardship. E-learning can provide a simple and effective first step to educate nurses, with minimal time investment.

Initiating a Standard Venous Thromboembolism Prophylaxis Order Set Designed to Improve Patient Outcomes at Los Angeles County + University of Southern California

2016 ◽  
Vol 82 (10) ◽  
pp. 1000-1004 ◽  
Author(s):  
Daniel Gardner ◽  
Andrew Liman ◽  
Victoria Autelli ◽  
Casey O'Connell ◽  
Nicholas Testa ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Los Angeles ◽  
Patient Outcomes ◽  
Los Angeles County ◽  
Southern California ◽  
Safety Net ◽  
University Of Southern California ◽  
Vte Prophylaxis ◽  
Safety Net Hospital ◽  
Order Sets

Improving patient safety is vital for all hospitals due to increasing public reporting and pay-for-performance reimbursement. Venous thromboembolism (VTE) remains a leading cause of preventable mortality accounting for 5 per cent of inpatient deaths. The purpose of this study was to outline the process of implementing standard VTE prophylactic order sets in a 600-bed academic safety net hospital and assess the resulting change in patient outcomes. Outcomes were assessed by comparing the rate that eligible inpatients receive VTE prophylaxis and the rate of preventable VTE's compared with total VTE's. From 2011 to 2015, random samples of 60 Los Angeles County+University of Southern California inpatients were generated monthly to examine compliance rates by comparing ICD-9 diagnostic codes to ordered VTE prophylaxis. All inpatient VTE's are retrospectively analyzed. Baseline-ordered VTE prophylaxis was 37 per cent in 2010. The target of 85 per cent was exceeded by the second quarter of 2012 to 2013 when compliance reached 88 per cent, a 51 per cent increase from baseline ( P < 0.01). These results suggest VTE protocols are effective though standardization across service lines is often difficult. Despite these challenges, after implementing standard order sets, we saw compliance increase significantly. Ongoing analysis to determine whether VTE rates have significantly decreased is presently underway.

Effectiveness of Standardized Venous Thromboembolism Prophylaxis Order Sets in Patients Undergoing Abdominal or Pelvic Surgery for Cancer

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4248-4248
Author(s):  
Molly Weidner Mandernach ◽  
Richard Lottenberg ◽  
Thomas Johns ◽  
Elaine Speed ◽  
Russell L Findlay ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Risk Stratification ◽  
Pelvic Surgery ◽  
Vte Prophylaxis ◽  
Order Sets ◽  
Pharmacologic Prophylaxis ◽  
The Mean ◽  
Length Of Hospitalization ◽  
Order Set

Abstract Abstract 4248 Background: In our tertiary academic medical center, standardized pre-printed physician order sets were implemented in 2008 for inpatient venous thromboembolism (VTE) risk stratification and prophylaxis on the day of admission. Electronic medical records were not utilized during the study period. Recommendations for pharmacologic prophylaxis were derived from the 2008 American College of Chest Physicians (ACCP) guidelines. Patients undergoing abdominal or pelvic surgery for cancer were specifically identified in the highest risk category with enoxaparin, fondaparinux, or warfarin (goal INR 2–3) provided as options for pharmacologic VTE prophylaxis. Sequential compression devices (SCDs) were also recommended. This retrospective analysis evaluates adherence to risk stratification and recommendations for pharmacologic VTE prophylaxis in patients undergoing abdominal or pelvic surgery for cancer. Methods: Using the hospital administrative database, all patients ≥ 18 years hospitalized between January 1, 2009 and December 31, 2010 were identified by ICD-9 codes for cancer and surgery performed. Patients undergoing an abdominal or pelvic surgery for cancer lasting >45 minutes were included. Exclusion criteria were age >90 years, patients requiring therapeutic anticoagulation, length of hospitalization <24 hours or >30 days, transplant recipients, patients requiring multiple visits to the operating room during hospitalization, laparoscopic or transurethral procedures, and esophagectomy. Primary outcomes included adherence to order set risk stratification and pharmacologic VTE prophylaxis recommendations, and timing, type, and dose of pharmacologic VTE prophylaxis prescribed. Chart review of physician orders for mechanical and pharmacologic prophylaxis for each day of hospitalization was completed on all patients. Operative reports, medication administration records, and progress notes were reviewed if clarification of physician orders was required. Administration of the prescribed medication during hospitalization was not verified. Results: A total of 773 hospital admissions representing 767 patients met inclusion criteria. The mean length of hospitalization was 7 +/− 5 days during the study period. The mean age was 62 +/− 12 years and 51% were female. Pharmacologic prophylaxis was prescribed 5645 of 6147 patient days (91.8%). Enoxaparin was prescribed 630 (9.8%) patient days, and fondaparinux in 15 patient days (0.002%). Although not indicated as an option for this patient population in our order set, low dose unfractionated heparin (LDUH) was prescribed 4991 (81.2%) of the patient days and was to be dosed every 8 hours (80%) or every 12 hours (19.8%). Warfarin was not prescribed. Mechanical thromboprophylaxis with SCDs was ordered 93.7% of the patient encounters on the day of surgery. The standardized pre-printed physician order set was utilized for prescribing prophylaxis at the time of admission for 630 (82.1%) patient encounters. Clinicians risk stratified only 350 (45.3%) of these patient encounters per the order set guidelines. Of those, 131 (37.4%) were appropriately deemed high risk based upon “abdominal/pelvic cancer undergoing operative procedure”. In the high risk group, LDUH was prescribed in 90 (68.7%) patient encounters, and enoxaparin as recommended in 30 (22.9%). Eleven (8.4%) were not prescribed pharmacologic prophylaxis on the day of admission. Conclusion: Completion of standardized pre-printed physician order sets with appropriate risk stratification in patients undergoing major, open abdominal or pelvic surgery for cancer is underutilized in our institution. Although pharmacologic prophylaxis is prescribed for the majority of inpatient days, LDUH is primarily ordered despite preferred recommendations in favor of enoxaparin or fondaparinux. Thus, an opportunity exists to implement an educational intervention to improve adherence to evidence based order set risk stratification and pharmacologic VTE prophylaxis recommendations. Disclosures: No relevant conflicts of interest to declare.

Venous thromboembolism in a general hospital. An update with low molecular weight heparin prophylaxis

VASA ◽  
2007 ◽  
Vol 36 (1) ◽  
pp. 17-22
Author(s):  
Schulz ◽  
Kesselring ◽  
Seeberger ◽  
Andresen
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Low Molecular Weight ◽  
Trauma Patients ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Patients At Risk ◽  
Hospital Stays ◽  
Event Rates

Background: Patients admitted to hospital for surgery or acute medical illnesses have a high risk for venous thromboembolism (VTE). Today’s widespread use of low molecular weight heparins (LMWH) for VTE prophylaxis is supposed to have reduced VTE rates substantially. However, data concerning the overall effectiveness of LMWH prophylaxis is sparse. Patients and methods: We prospectively studied all patients with symptomatic and objectively confirmed VTE seen in our hospital over a three year period. Event rates in different wards were analysed and compared. VTE prophylaxis with Enoxaparin was given to all patients at risk during their hospital stay. Results: A total of 50 464 inpatients were treated during the study period. 461 examinations were carried out for symptoms suggestive of VTE and yielded 89 positive results in 85 patients. Seventy eight patients were found to have deep vein thrombosis, 7 had pulmonary embolism, and 4 had both deep venous thrombosis and pulmonary embolism. The overall in hospital VTE event rate was 0.17%. The rate decreased during the study period from 0.22 in year one to 0,16 in year two and 0.13 % in year three. It ranged highest in neurologic and trauma patients (0.32%) and lowest (0.08%) in gynecology-obstetrics. Conclusions: With a simple and strictly applied regimen of prophylaxis with LMWH the overall rate of symptomatic VTE was very low in our hospitalized patients. Beside LMWH prophylaxis, shortening hospital stays and substantial improvements in surgical and anasthesia techniques achieved during the last decades probably play an essential role in decreasing VTE rates.

Promoting Hybrid Learning through an Open Source EBook Approach

2010 ◽  
Vol 14 (3) ◽  
Author(s):  
Xin Bai ◽  
Michael B. Smith
Keyword(s):  
Open Source ◽  
Building Blocks ◽  
Educational Technologies ◽  
Just In Time ◽  
Learning Modules ◽  
Learning Content ◽  
Long Run ◽  
E Learning ◽  
Teaching Efficiency ◽  
Content Design

Educational technology is developing rapidly, making education more accessible, affordable, adaptable, and equitable. Students now have the option to choose a campus that can provide excellent blended learning curriculum with minimal geographical restraints. We proactively explore ways to maximize the power of educational technologies to increase enrollment, reduce failure rates, improve teaching efficiency, and cut costs without sacrificing high quality or placing extra burden on faculty. This mission is accomplished through open source learning content design and development. We developed scalable, shareable, and sustainable e-learning modules as book chapters that can be distributed through both computers and mobile devices. The resulting e-learning building blocks can automate the assessment processes, provide just-in-time feedback, and adjust the teaching material dynamically based upon each student’s strengths and weaknesses. Once built, these self-contained learning modules can be easily maintained, shared, and re-purposed, thus cutting costs in the long run. This will encourage faculty from different disciplines to share their best teaching practices online. The end result of the project is a sustainable knowledge base that can grow over time, benefit all the discipline, and promote learning.

scholarly journals The Impact of Narrative Feedback, E-Learning Modules and Realistic Video and the Reduction of Misconception

2021 ◽  
Vol 11 (4) ◽  
pp. 158
Author(s):  
Abdul Halim ◽  
Elmi Mahzum ◽  
Muhammad Yacob ◽  
Irwandi Irwandi ◽  
Lilia Halim
Keyword(s):  
Biology Education ◽  
Free Fall ◽  
Percentage Reduction ◽  
Significant Treatment ◽  
Learning Modules ◽  
Physics Courses ◽  
Learning Platform ◽  
Quasi Experimental ◽  
E Learning ◽  
The Impact

Physics learning in universities utilized the Moodle-based e-learning media as an online learning platform. However, the effectiveness of remediating misconception using online media has not been widely researched. Therefore, this study was set to determine the level of misconception percentage reduction through the use of narrative feedback, the e-learning modules, and realistic video. The study was a quantitative approach with a quasi-experimental method involving 281 students who were taking basic physics courses in the Department of Physics, Chemistry, and Biology Education. The data collection used a three-tier diagnostic test based on e-learning at the beginning of the activity and after the treatment (posttest). The results of the data analysis with descriptive statistics show that the most significant treatment in reducing misconception percentage on the topic of free-fall motion was in the following order: narrative feedback, e-learning modules and realistic video. The misconception percentage reduction in the sub-concept of accelerated free- fall was effective for all types of the treatments.

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