Quality Improvement Approach to Increase Inpatient Pediatric Secondhand Smoke Exposure Screening

2021 ◽  
Author(s):  
Christine Studenmund ◽  
Jazzmin Williams ◽  
Antonio Hernandez ◽  
Elda Young ◽  
Ying Ying Hui ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Secondhand Smoke ◽  
Outcome Measure ◽  
Resource Distribution ◽  
Safety Net ◽  
Smoke Exposure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Secondhand Smoke Exposure ◽  
Positive Screen

BACKGROUND: Secondhand smoke exposure (SHSe) is highly prevalent among children and has numerous adverse health effects. Consistent screening for SHSe is an essential first step to helping families break the toxic cycle of smoking. METHODS: With this quality improvement project, we evaluated a SHSe screening and cessation resource distribution protocol in a general pediatrics inpatient unit of a safety-net hospital. Our primary outcome measure was the percent of admissions screened for SHSe, with a goal of increasing our documented rate of SHSe screening from 0% to 70% within 6 months of implementation. Our secondary outcome measure was the percent of those who screened positive for SHSe who were offered smoking cessation resources. Process measures included tracking nurse confidence in screening and compliance with new workflow training. Balancing measures were nurse satisfaction and brevity of screening. RESULTS: From May 1, 2019, to April 30, 2020, nurses screened 97.2% of the 394 patients admitted to the pediatric unit for SHSe. Of the patients screened, 15.7% were exposed to cigarettes or other tobacco products, 5.6% to e-cigarettes, and 6.5% to marijuana. Nurses documented offering “Quit Kits” with cessation materials to 45 caregivers (72.6% of positive screen results) and offering 33 referrals to the California Smokers' Helpline (53.2% of positive screen results). CONCLUSION: In this project, we successfully implemented a screening protocol for SHSe to tobacco, e-cigarettes, and marijuana and a workflow for cessation resource distribution in an inpatient pediatric setting that far exceeded goals. Requiring minimal maintenance and using just a simple paper-based format, the workflow could be adopted at other institutions.

scholarly journals Effectiveness of an audit programme for dyslipidaemia management in a primary care setting in Macau: a quality improvement study

2020 ◽  
Vol 8 (1) ◽  
pp. e000222 ◽  
Author(s):  
In Wong ◽  
See Fai Tse ◽  
Chau Sha Kwok
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Statin Therapy ◽  
Health Center ◽  
Care Setting ◽  
Primary Care Setting ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Patient Records

ObjectiveThe objective of this study was to test the effectiveness of an audit programme for dyslipidaemia management in a primary care setting in Macau.DesignA quality improvement study based on an evaluation of a before-after intervention trial was conducted in 2017–2018. Interventions comprising feedback from an audit, general practitioner (GP) training via interactive workshops and one-on-one case discussions were implemented. The primary outcome measure was the proportion of patients with reasonable management of dyslipidaemia, and the secondary outcome measure was the proportion of patients with low-density lipoprotein cholesterol (LDL-C) meeting the target recommended by the Adult Treatment Panel III guidelines.SettingThis study was conducted at the Sao Lourenco Health Center, one of the health centres in the Macau primary care system; this centre provides primary care services to one-tenth of the residents of Macau.ParticipantsAll GPs who worked in the Sao Lourenco Health Center participated in the study. We systematically reviewed 100 patient records from each participating physician’s patient list. In total, 1200 and 1100 patient records were reviewed before and after the intervention, respectively.ResultsAt baseline, 390 (43.5%) patients were eligible for statin therapy, while 411 (47.7%) patients were eligible for statin therapy in the reaudit group (p=0.08). After intervention, the proportion of patients with reasonable management of dyslipidaemia increased from 83.9% to 88.5% (p=0.005), and the proportion of eligible patients with LDL-C levels meeting the target increased from 55.1% to 65% (p=0.004).ConclusionsThe audits and feedback significantly improved dyslipidaemia management in the Macau primary care setting.

A Quality Improvement Initiative to Improve Feeding and Growth of Infants With Cleft Lip and/or Palate

2018 ◽  
Vol 55 (9) ◽  
pp. 1218-1224 ◽  
Author(s):  
Adriane L. Baylis ◽  
Gregory D. Pearson ◽  
Courtney Hall ◽  
Lauren L. Madhoun ◽  
Caitlin Cummings ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Care Delivery ◽  
Academic Medical Center ◽  
Secondary Outcome ◽  
Quality Improvement Initiative ◽  
Secondary Outcome Measure ◽  
Targeted Interventions ◽  
Growth Outcomes

Objective: The purpose of this quality improvement initiative was to improve feeding and growth outcomes in infants with cleft lip and/or palate (CL/P). Design: Institute for Healthcare Improvement quality improvement model. Setting: Large pediatric academic medical center in the Midwestern United States. Participants: One hundred forty-five infants with nonsyndromic CL/P ages 0 to 12 months. Interventions: Key drivers included (1) caregiver education and resources, (2) care coordination and flow, and (3) provider education and training. Interventions were designed around these themes and included targeting improved team communication, increased social work consultations, patient tracking, staff education, improved access to feeding equipment, and the launch of a new cleft palate feeding team. Main Outcome Measure(s): The primary outcome measure was the percentage of new patients with CL/P who met criteria for failure to thrive (FTT) per month. The secondary outcome measure was the frequency of hospitalization for infants with CL/P with a primary reason for admission of feeding difficulties or FTT. Results: The institutional FTT rate for infants with CL/P decreased from 17% to 7% ( P < .003). The frequency of hospitalization for FTT improved from once every 30 days to once every 118 days. Conclusions: Targeted interventions aimed at improving feeding efficiency and effectiveness, as well as changes in care delivery models, can reliably promote improvements in feeding and growth outcomes for infants with CL/P, even with psychosocial risk factors present.

scholarly journals Leveraging the Outpatient Pharmacy to Reduce Medication Waste in Pediatric Asthma Hospitalizations

2019 ◽  
Vol 15 (01) ◽  
pp. 28-34
Keyword(s):  
Quality Improvement ◽  
Asthma Exacerbation ◽  
Outcome Measure ◽  
Insurance Coverage ◽  
Secondary Outcome ◽  
Inpatient Cost ◽  
Secondary Outcome Measure ◽  
Improvement Project ◽  
Medication Waste ◽  
Discharge Medication

BACKGROUND AND OBJECTIVE: Previous local quality improvement focused on discharging patients with inhaled corticosteroids (ICS) “in-hand” decreased healthcare reutilization after hospitalization for an asthma exacerbation. However, as a result of these new processes, some patients admitted for an asthma exacerbation received more than one ICS inhaler during their admission, contributing to medication waste and potential patient confusion regarding their discharge medication regimen. We sought to decrease this waste. METHODS: We conducted a quality improvement project to reduce the prescribing of multiple ICS inhalers to patients at a large academic children’s hospital. Our primary outcome measure was the monthly percentage of patients admitted with an asthma exacerbation who were administered more than one ICS inhaler. A secondary outcome measure evaluated the reliability of the new process of using the hospital-based outpatient pharmacy to supply ICS “in-hand” and verify insurance coverage. After the process map review, we hypothesized a delay in the initial ICS treatment decision would allow for both a finalized discharge medication plan and a standardized process to verify outpatient insurance coverage. | RESULTS: The mean percentage of patients receiving more than one ICS inhaler decreased from our baseline of 7.4% to 0.7%. Verification of outpatient prescription insurance coverage via the outpatient pharmacy increased from 0.7% to 50%. The average inpatient cost (average wholesale price) for ICS decreased by 62% to $90.25. CONCLUSIONS: Our process change to use the outpatient pharmacy to dispense and verify insurance coverage for ICS medication was associated with a reduction in medication waste during admission for an asthma exacerbation.

Cease California: Implementing a Pediatric Clinical Intervention to Reduce Secondhand Smoke Exposure

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 602A-602A
Author(s):  
Jyothi Nagraj Marbin ◽  
Cindy Nelson Purdy ◽  
Gena Lewis ◽  
Kathleen Tebb
Keyword(s):  
Secondhand Smoke ◽  
Clinical Intervention ◽  
Smoke Exposure ◽  
Secondhand Smoke Exposure

Secondhand Smoke exposure and risk of Obstructive Sleep Apnea in Children

2020 ◽  
Vol 130 ◽  
pp. 109807
Author(s):  
Rajeev Subramanyam ◽  
Ignacio E. Tapia ◽  
Bingqing Zhang ◽  
Janell L. Mensinger ◽  
Annery Garcia-Marcinkiewicz ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Secondhand Smoke ◽  
Smoke Exposure ◽  
Secondhand Smoke Exposure ◽  
Obstructive Sleep

scholarly journals Cardiovascular disease risk factors of ultra-Orthodox Jewish women in Israel: a comparison study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Leiter ◽  
K L Greenberg ◽  
M Donchin ◽  
O Keidar ◽  
S Siemiatycki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
General Population ◽  
Secondhand Smoke ◽  
Smoke Exposure ◽  
Orthodox Jewish ◽  
Minority Population ◽  
Secondhand Smoke Exposure ◽  
Community Based ◽  
Increased Risk

Abstract Background Women from low socio-economic, culturally insular populations are at increased risk for cardiovascular disease (CVD). The ultra-Orthodox Jewish (UOJ) community in Israel is a difficult to access, rapidly growing low socio-economic, insular minority with numerous obstacles to health. The current study investigates CVD-related risk factors (RF) in a sample of OUJ women, comparing sample characteristics with the general population. Addressing the questions, 'Are UOJ women at increased risk for CVD?', 'Which RFs should be addressed beyond the general population's?', this study can inform public health initiatives (PHI) for this and similar populations. Methods Self-administered questionnaires completed by a cluster randomized sample of 239 women from a UOJ community included demographics, fruit, vegetables, and sweetened drink consumption, secondhand smoke exposure, physical activity (PA) engagement, and BMI. Population statistics utilized for comparison of demographic and cardiovascular risk factors were obtained from government-sponsored national surveys. Results Compared with the general population, UOJ women were less likely to consume 5 fruits and vegetables a day (12.7% vs. 24.3%, p&lt;.001) and more likely to consume &gt; 5 cups of sweetened beverages a day (18.6% vs. 12.6%, p=.019). UOJ women also reported less secondhand smoke exposure (7.2% vs. 51.4%, p&lt;.001) and higher rates of PA recommendation adherence (60.1% vs. 25.6%, p&lt;.0001) than the general population. Obesity was higher in UOJ women (24.3% vs. 16.1%, p&lt;.0001). Conclusions This study suggests that PHIs in this population target healthy weight maintenance, nutrition, and PA. As a consequence of this study, the first CVD prevention intervention has been implemented in this population, targeting the identified RFs. Utilizing a mixed methods and community-based participatory approach, this innovative 3-year intervention reached over 2,000 individuals. Key messages This study identified nutrition risk behaviors and high levels of obesity in a difficult to access, minority population. This study informed the planning and implementation of a community-based PHI.

scholarly journals Smoke-Free Home Rules and Association with Child Secondhand Smoke Exposure among Mother–Child Dyad Relationships

2021 ◽  
Vol 18 (10) ◽  
pp. 5256
Author(s):  
Westley L. Fallavollita ◽  
Elizabeth K. Do ◽  
Julia C. Schechter ◽  
Scott H. Kollins ◽  
Junfeng (Jim) Zheng ◽  
...  
Keyword(s):  
North Carolina ◽  
Secondhand Smoke ◽  
Smoke Exposure ◽  
Future Research ◽  
Secondhand Smoke Exposure ◽  
Black African ◽  
Smoking Behaviors ◽  
Salivary Cotinine ◽  
Household Members ◽  
Smoking Mother

Smoke-free home rules restrict smoking in the home, but biomarkers of secondhand smoke exposure are needed to help understand the association between smoke-free homes and child secondhand smoke exposure. Participants (n = 346) were majority Black/African American mother–child dyads from a longitudinal study in North Carolina. Mothers completed questionnaires on household smoking behaviors and rules, and child saliva samples were assayed for secondhand smoke exposure. Regression models used smoke-free home rules to predict child risk for secondhand smoke exposure. Children in households with smoke-free home rules had less salivary cotinine and risk for secondhand smoke exposure. After controlling for smokers in the household, home smoking rules were not a significant predictor of secondhand smoke exposure. Compared to children in households with no smokers, children in households with at least one smoker but a non-smoking mother (OR 5.35, 95% CI: 2.22, 13.17) and households with at least one smoker including a smoking mother (OR 13.73, 95% CI: 6.06, 33.28) had greater risk for secondhand smoke exposure. Results suggest smoke-free home rules are not sufficient to fully protect children from secondhand smoke exposure, especially in homes with smokers. Future research should focus on how household members who smoke can facilitate the prevention of child secondhand smoke exposure.

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