Collaboration to Improve Neuroprotection and Neuropromotion in the NICU: A Quality Improvement Initiative

2021 ◽  
Vol 40 (4) ◽  
pp. 201-209
Author(s):  
Kati Knudsen ◽  
Eileen Steffen ◽  
Lisa Sampson ◽  
Karen Bong ◽  
Mindy Morris
Keyword(s):  
Quality Improvement ◽  
Premature Infants ◽  
The United States ◽  
Quality Improvement Initiative ◽  
Process Change ◽  
Group Approach ◽  
Developmental Care ◽  
Implementation Processes ◽  
Skin To Skin

Implementation of neuroprotective and neuropromotive (NP2) strategies is essential to optimize outcomes for premature infants. Developmental care, once an addition to medical care, is now recognized by the NICU team as foundational to support long-term neurodevelopment of micropremature infants. A group approach to education and sharing implementation processes can result in collaborative and individual center improvements. This article includes examples of quality improvement (QI) education and tools inspired by implementation of NP2 strategies in a consortium of 11 NICUs in the United States and Canada. Process change guided by potentially better practices are key; however, consistency of application must be included to ensure success. Assessment of NP2 practices via use of surveys and practice audits are described. Increases occurred in family NP2 education and provision of support during painful experiences. There were also increases in skin-to-skin holding, 2-person caregiving, and focus on reducing unnecessary painful procedures.

Abstract 388: Quality Improvement in the Outpatient Setting: Observations from the PINNACLE Registry® 2009 Q4-2013 Q1

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Katie Kehoe ◽  
Sherry Shultz ◽  
Fran Fiocchi ◽  
Qiong Li ◽  
Thomas Shields ◽  
...  
Keyword(s):  
South Carolina ◽  
Quality Improvement ◽  
Office Visit ◽  
The United States ◽  
Outpatient Setting ◽  
Quality Improvement Initiative ◽  
The South ◽  
Improvement Program ◽  
Heart Center ◽  
Over Time

Title: Quality Improvement in the Outpatient Setting: Observations from the PINNACLE Registry® 2009 Q4-2013 Q1 Authors: Katie Kehoe BSN, MS 1 ; Sherry Shultz RN, BSN, CIO 2 ; Fran Fiocchi MPH 1 ; Qiong Li PhD 1 ; Thomas Shields 1 ; Charlie Devlin MD FACC, FACP, FASNC 2 ; Nathan T Glusenkamp, MA 1 ; J. Brendan Mullen 1 ; Angelo Ponirakis, PhD 1 ; 1 American College of Cardiology, Washington, DC 2 South Carolina Heart Center, Columbia SC Background: The PINNACLE Registry® at the American College of Cardiology is the first outpatient practice-based quality improvement program in the United States. Begun as a pilot program in 2007, the registry systematically collects and reports on adherence to clinical guidelines in the care of patients with coronary artery disease, hypertension, atrial fibrillation and heart failure. Over time, these reports offer a unique opportunity for Quality Improvement (QI) in the outpatient setting. The current study aimed to assess the effect of QI in the outpatient setting using PINNACLE Registry data. Methods: The South Carolina Heart Center is a cardiovascular practice in Columbia, South Carolina. There are 19 providers, 5 office locations and NextGen EMR. The practice’s Quality Committee and Board meet monthly to review PINNACLE reports and identify areas for QI. This Clinical Quality Improvement Initiative began 10 years ago and consists of physicians, nurses, administrators, medical assistants, a medical record analyst and information systems staff. During this review, providers’ data was not blinded to others. QI Interventions implemented included physician and staff education, improving documentation during the office visit, addition of necessary fields to capture missing data and routine planned internal audits. Between October 1, 2009 and March 31, 2013 a total of 161,873 patient encounters were submitted to the registry. A two-tailed z test was performed to assess the significance in percentage changes between 2009 to 2013. Results: The following table showed significant percentage changes in six performance measures indicating interventions implemented by the practice demonstrate significant quality improvement over time from 2009-2013. Conclusions: Utilizing their PINNACLE Registry reports, the South Carolina Heart Center identified several areas for QI. Implementing multiple interventions, this practice was able to significantly improve their PINNACLE Reports and the quality of care provided.

scholarly journals A Lean Quality Improvement Initiative to Enhance Tobacco Use Treatment in a Cancer Hospital

2020 ◽  
Vol 17 (6) ◽  
pp. 2165 ◽  
Author(s):  
Colleen Meyer ◽  
Sara Mitra ◽  
Ellen Ruebush ◽  
Laurel Sisler ◽  
Kyle Wang ◽  
...  
Keyword(s):  
North Carolina ◽  
Quality Improvement ◽  
Tobacco Use ◽  
Treatment Effectiveness ◽  
Cancer Recurrence ◽  
Improve Patient Care ◽  
The United States ◽  
Quality Improvement Initiative ◽  
The North ◽  
Cancer Hospital

Sustained tobacco use after cancer diagnosis decreases treatment effectiveness while increasing treatment side effects, primary cancer recurrence, and the occurrence of secondary cancers. Delivering tobacco use treatment to fewer patients due to inefficient workflow represents missed opportunities to deliver life-saving care. In 2017, the National Cancer Institute initiated the Cancer Cessation Initiative (C3I) to push new tobacco cessation resources into cancer centers across the United States. This grant allowed the University of North Carolina Tobacco Treatment Program (UNC TTP) to dramatically expand tobacco use treatment (TUT) services to patients at the North Carolina Cancer Hospital (NCCH). With this push, the team saw an opportunity to utilize Lean Six Sigma, a set of quality improvement (QI) tools, to streamline their processes and uncover the root causes of program inefficiencies. A 12-month QI project using the Lean A3 problem-solving tool was implemented to examine the team’s workflow. The study team mapped out the processes and, as a result, developed multiple “experiments” to test within the NCCH to address workflow efficiency and clinical reach. Outcome measures from the baseline to follow-up included: (1) the number of new patient referrals per month, and (2) the number of counseling sessions delivered per month. From the baseline to final state, the team’s referrals increased from a mean of 10 to 24 per month, and counseling sessions increased from a mean of 74 to 84 per month. This project provided a deeper understanding of how workflow inefficiencies can be eliminated in the clinical setting, how technology can be harnessed to increase reach, and finally, that soliciting and using feedback from NCCH leadership can remove barriers and improve patient care.

Short- and Long-term Impact of an Inpatient Quality Improvement Initiative

2013 ◽  
Vol 33 (4) ◽  
pp. 212-219 ◽  
Author(s):  
Randal J. Thomas ◽  
Kashish Goel ◽  
Marwan Jumean ◽  
Charles Mullany ◽  
Brian Lahr ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Initiative ◽  
Short And Long Term ◽  
Long Term Impact

Quality Improvement Initiative to Reduce the Necrotizing Enterocolitis Rate in Premature Infants

PEDIATRICS ◽  
2016 ◽  
Vol 137 (5) ◽  
pp. e20151119-e20151119 ◽  
Author(s):  
M. M. Talavera ◽  
G. Bixler ◽  
C. Cozzi ◽  
J. Dail ◽  
R. R. Miller ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Quality Improvement Initiative

Factors Affecting the Sustainment, Sustainability, and Spread of Practice Changes in Canadian Long-Term Care Homes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 413-414
Author(s):  
Lauren MacEachern ◽  
Yuting Song ◽  
Liane Ginsburg ◽  
Malcolm Doupe ◽  
Adrian Wagg ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Social Dynamics ◽  
Long Term Care ◽  
Care Homes ◽  
Quality Improvement Initiative ◽  
Term Care ◽  
Factors Affecting ◽  
Quality Improvement Interventions ◽  
Facility Level

Abstract Our understanding of the post-implementation sustainment, sustainability, and spread (SSS) of complex quality improvement interventions is limited. We explored factors that influenced the SSS of a care aide-led quality improvement initiative (Safer Care for Older Persons (in residential) Environments [SCOPE]) implemented in 6 Manitoba long-term care homes two years after the conclusion of SCOPE in 2017. We analyzed small group interview data collected from all unit- and facility-level managers who participated in SCOPE and were still working in these facilities. We asked about SCOPE implementation, post-SCOPE quality improvement activities, factors that influenced them, and about inter-unit spread of SCOPE following the project’s conclusion. The interviews were audio-recorded, transcribed verbatim, de-identified, and analyzed using thematic analysis. Five of the 6 facilities reported sustained SCOPE quality improvement activities, tools, and facilitative structures. In the same 5 facilities, SCOPE benefits (e.g., increases in care aide empowerment and self-efficacy, manager belief in care aide capacity) continued post-implementation. Spread beyond the original SCOPE units had occurred in 3 facilities. Factors that influenced the SSS of SCOPE were related to the team (e.g., care aides' quality improvement capacity), to the unit and facility (e.g., culture of innovation and change), and to the long-term care system (e.g., competing imperatives). Some factors influencing SSS differ from factors known to influence implementation. The identified factors affecting SSS highlight the influence of social dynamics (i.e., interactions, communication, relationships) among staff on SSS. Further research is warranted to explore interactions among these influencing factors and how they lead to SSS.

scholarly journals Effect of a multimethod quality improvement intervention on antipsychotic medication use among residents of long-term care

2021 ◽  
Vol 10 (2) ◽  
pp. e001211
Author(s):  
Heather M Hanson ◽  
Tova Léveillé ◽  
Mollie Cole ◽  
Lesley JJ Soril ◽  
Fiona Clement ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antipsychotic Medication ◽  
Long Term Care ◽  
Medication Use ◽  
Implementation Fidelity ◽  
Audit And Feedback ◽  
Quality Improvement Initiative ◽  
Term Care ◽  
Antipsychotic Medications

BackgroundAntipsychotic medications are used to address neuropsychiatric symptoms associated with dementia. Evidence suggests that among older adults with dementia, their harms outweigh their benefits. A quality improvement initiative was conducted to address inappropriate antipsychotic medication use in long-term care (LTC) in the province of Alberta.MethodsWe conducted a multimethod evaluation of the provincial implementation of the project in 170 LTC sites over a 3-year project period incorporating a quasi-experimental before–after design. Using a three-component intervention of education and audit and feedback delivered in a learning workshop innovation collaborative format, local LTC teams were supported to reduce the number of residents receiving antipsychotic medications in the absence of a documented indication. Project resources were preferentially allocated to supporting sites with the highest baseline antipsychotic medication use. Changes in antipsychotic medication use, associated clinical and economic outcomes, and the effects of the project on LTC staff, physicians, leaders and administrators, and family members of LTC residents were assessed at the conclusion of the implementation phase.ResultsThe province-wide initiative was delivered with a 75% implementation fidelity. Inappropriate antipsychotic medication use declined from 26.8% to 21.1%. The decrease was achieved without unintended consequences in other outcomes including physical restraint use or aggressive behaviours. The project was more expensive but resulted in less inappropriate use of antipsychotics than the pre-project period (incremental cost per inappropriate antipsychotic avoided of $5 678.71). Accounts from family, organisational leaders, and LTC staff were supportive of the project activities and outcomes.ConclusionThis quality improvement initiative was successfully delivered across an entire delivery arm of the continuing care sector. Quality of care in LTC was improved.

scholarly journals Obstetric ultrasound (US) quality improvement initiative: Long-term results of a quality assurance protocol

2022 ◽  
Vol 226 (1) ◽  
pp. S554-S555
Author(s):  
Noor Joudi ◽  
Stephanie A. Leonard ◽  
Barbora Pugh ◽  
Jane Chueh ◽  
Yair J. Blumenfeld
Keyword(s):  
Quality Assurance ◽  
Quality Improvement ◽  
Long Term Results ◽  
Quality Improvement Initiative ◽  
Obstetric Ultrasound

scholarly journals Improving anticoagulation of patients with an implantable left ventricular assist device

2018 ◽  
Vol 7 (4) ◽  
pp. e000250 ◽  
Author(s):  
William Sage ◽  
Amulya Gottiparthy ◽  
Paul Lincoln ◽  
Steven S L Tsui ◽  
Stephen J Pettit
Keyword(s):  
Quality Improvement ◽  
Significant Risk ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Quality Improvement Initiative ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Improvement Project ◽  
Left Ventricular Assist

Patients supported with implantable left ventricular assist devices (LVAD) have a significant risk of bleeding and thromboembolic complications. All patients require anticoagulation with warfarin, aiming for a target international normalised ratio (INR) of 2.5 and most patients also receive antiplatelet therapy. We found marked variation in the frequency of INR measurements and proportion of time outside the therapeutic INR range in our LVAD-supported patients. As part of a quality improvement initiative, home INR monitoring and a networked electronic database for recording INR results and treatment decisions were introduced. These changes were associated with increased frequency of INR measurement. We anticipate that changes introduced in this quality improvement project will reduce the likelihood of adverse events during long-term LVAD support.

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