Improving Self-Reported Preoperative Anxiety Through a Preoperative Education Program: A Quality Improvement Project

2019 ◽  
Vol 12 (1) ◽  
pp. 117-124
Author(s):  
Jaimie Bell ◽  
Subroto Paul ◽  
Joanna Sesti ◽  
Bradi Granger
Keyword(s):  
Quality Improvement ◽  
Patient Education ◽  
Thoracic Surgery ◽  
Education Program ◽  
Preoperative Anxiety ◽  
Quality Improvement Project ◽  
Preoperative Education ◽  
Improvement Project ◽  
Patient Reported ◽  
Anxiety Levels

Background:Preoperative education is an important component of preparing patients for surgery. Preoperative anxiety is one of the most important problems for patients, because it causes emotional and psychiatric problems as well as physical problems. Anxiety has been associated with several pathophysiological responses such as hypertension and dysrhythmias, which can increase perioperative morbidity. Estimates suggest that between 11% and 80% of adult presurgical patients experience heightened levels of anxiety.Objective:The purpose of this pilot project was to develop a preoperative education program for thoracic surgery patients and to assess the effectiveness of the program in decreasing patient's self-reported anxiety levels using the validated Patient-Reported Outcomes Measurement Information System (PROMIS) tool.Methods:This quality improvement project used a pre- and posttest improvement design to evaluate patient's self-reported anxiety levels at three different timepoints during the preoperative and postoperative period. A total of 15 patients from a thoracic surgery practice participated in the study.Results:The study showed no statistically significant change in patients' self-reported anxiety levels after completion of the preoperative education program (p = .538). Patients reported improvements in parameters such as expectations, pain, and preparedness.Conclusions:Although some studies have found that preoperative patient education decreases anxiety, this study supports others that indicate that anxiety is not affected by or associated with educational preparation prior to thoracic surgery. Though no statistical improvement in anxiety levels was demonstrated in this study, a majority of patients reported improvements in parameters such as expectations, pain, and preparedness.Implications for Nursing:As patient education is largely provided by the nursing profession, this article will help the profession to better understand what is important for patients to know in the preoperative setting. Setting patient expectations has a great impact on the patient's recovery and satisfaction with their surgical experience. As this is a pilot study, the goal is for continued research in the area of decreasing preoperative anxiety and preparing patients for surgery.

scholarly journals Improving heart failure transitional care after hospital discharge: A quality improvement project

2020 ◽  
Vol 10 (11) ◽  
pp. 62
Author(s):  
Janelle N. Akomah ◽  
Lynn Richards-McDonald ◽  
Diana-Lyn Baptiste
Keyword(s):  
Heart Failure ◽  
Quality Improvement ◽  
Education Program ◽  
Hospital Readmission ◽  
Transitional Care ◽  
Health Care Expenditures ◽  
The United States ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Care Clinic

Background and objective: The burden of heart failure is growing, affecting more than 6 million Americans and an estimated of 26 million worldwide. Heart failure is the most common cause of hospital readmission in the United States and is identified as a marker of poor health outcomes. Thirty day readmission contribute to more than $30 billion dollars in health care expenditures, underscoring a need for the development and implementation of programs that reduce readmission and improve outcomes for individuals with heart failure. The purpose of this quality improvement project was to implement a heart failure education program to increase attendance to a transitional care clinic and reduce 30-day readmissions.Methods: We included 22 individuals who received heart failure education, focused on symptom management and transitional care. Descriptive and statistical analyses were performed to examine attendance to the transitional care clinic and 30-day readmission.Results: There was a statistical significance between individuals attending follow-up at the designated transitional care clinic and 30-day hospital readmission (p ≤ .05). Of the (N = 22) participants, 64% were not readmitted into the hospital 30 days after discharge.Conclusions: The findings of this project demonstrate that a nurse-led evidence-based heart failure education program can improve attendance to transitional care programs and reduce 30-day readmissions. A well-designed plan for transitional care remains a critical component of patient care necessary to address complications and optimize continuity of care after discharge.

Improving the referral rate of universal genetic counseling for pancreatic ductal adenocarcinoma (PDAC) at the Cleveland Clinic Taussig Cancer Center: A quality improvement project.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 196-196
Author(s):  
Kanika G. Nair ◽  
Brandie Leach ◽  
Selina Sledge ◽  
Megan Kilbane ◽  
Jennifer Bates ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Genetic Counseling ◽  
Patient Education ◽  
Germline Mutations ◽  
Referral Rate ◽  
Quality Improvement Project ◽  
Tumor Board ◽  
Improvement Project ◽  
Referral Rates ◽  
Germline Testing

196 Background: While most PDAC are sporadic, up to 10% are inherited. In 2018, ASCO and NCCN guidelines were updated to recommend that all patients with PDAC be considered for genetic counseling (GC) and germline testing. Furthermore, interest in treating patients with targeted therapy, such as olaparib, for germline mutations is increasing. We implemented a quality improvement project to identify the referral rate to GC for patients with PDAC, with the goal of improving the referral rate to 60%. Methods: Barriers to GC referral were identified using quality improvement tools developed at the ASCO Quality Training Program. Three “plan, do, study, act” (PDSA) cycles were implemented: 1) updating the electronic order and tumor board template to include GC recommendation (Aug–Oct 2019), 2) physician education (Nov–Dec 2019) and 3) patient education and physician reinforcement (Jan–Feb 2020). Baseline data to evaluate impact of PDSA intervention (from April to June 2019) on documented discussions about GC and placement of the referral order was completed via chart review. Results: Between April 2019 to January 2020, 199 patients with PDAC were seen in medical oncology clinic as new patient visits. Thirteen patients had previously completed GC. For the remainder, baseline discussion and referral rates were 25% and 9%, respectively. Discussion and referral rates improved to 55% and 30% after PDSA 1, to 73% and 33% after PDSA 2, and to 95% and 58% after PDSA 3, respectively. Forty-nine patients were referred at the first visit and 23 were referred at a subsequent visit. Forty-six patients underwent GC. In patients who completed germline testing 8.9% (4/45) were found to have a pathogenic variant in BRCA2, TP53, ATM, and MUTYH. Conclusions: With increased physician and patient education, we were able to improve the GC discussion rate from 25% to 95% and referral rate from 9% to 58%. While we did not meet our aim of 60% GC referral rate, we identified obstacles and outlined an improved process for early GC referrals. Enacting processes to reinforce GC referrals for patients with PDAC is likely to increase detection of germline mutations in this population.

scholarly journals Using Electronic Data Collection Platforms to Assess Complementary and Integrative Health Patient-Reported Outcomes: Feasibility Project (Preprint)

2019 ◽  
Author(s):  
Jolie N Haun ◽  
Amy C Alman ◽  
Christine Melillo ◽  
Maisha Standifer ◽  
Julie McMahon-Grenz ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Reported Outcomes ◽  
Primary Care Providers ◽  
Quality Improvement Project ◽  
Care Providers ◽  
Secure Messaging ◽  
Web Based ◽  
Improvement Project ◽  
Integrative Health ◽  
Patient Reported

BACKGROUND The Veteran Administration (VA) Office of Patient-Centered Care and Cultural Transformation is invested in improving veteran health through a whole-person approach while taking advantage of the electronic resources suite available through the VA. Currently, there is no standardized process to collect and integrate electronic patient-reported outcomes (ePROs) of complementary and integrative health (CIH) into clinical care using a web-based survey platform. This quality improvement project enrolled veterans attending CIH appointments within a VA facility and used web-based technologies to collect ePROs. OBJECTIVE This study aimed to (1) determine a practical process for collecting ePROs using patient email services and a web-based survey platform and (2) conduct analyses of survey data using repeated measures to estimate the effects of CIH on patient outcomes. METHODS In total, 100 veterans from one VA facility, comprising 11 cohorts, agreed to participate. The VA patient email services (Secure Messaging) were used to manually send links to a 16-item web-based survey stored on a secure web-based survey storage platform (Qualtrics). Each survey included questions about patient outcomes from CIH programs. Each cohort was sent survey links via Secure Messaging (SM) at 6 time points: weeks 1 through 4, week 8, and week 12. Process evaluation interviews were conducted with five primary care providers to assess barriers and facilitators to using the patient-reported outcome survey in usual care. RESULTS This quality improvement project demonstrated the usability of SM and Qualtrics for ePRO collection. However, SM for ePROs was labor intensive for providers. Descriptive statistics on health competence (2-item Perceived Health Competence Scale), physical and mental health (Patient-Reported Outcomes Measurement Information System Global-10), and stress (4-item Perceived Stress Scale) indicated that scores did not significantly change over time. Survey response rates varied (18/100, 18.0%-42/100, 42.0%) across each of the 12 weekly survey periods. In total, 74 of 100 participants provided ≥1 survey, and 90% (66/74) were female. The majority, 62% (33/53) of participants, who reported the use of any CIH modality, reported the use of two or more unique modalities. Primary care providers highlighted specific challenges with SM and offered solutions regarding staff involvement in survey implementation. CONCLUSIONS This quality improvement project informs our understanding of the processes currently available for using SM and web-based data platforms to collect ePROs. The study results indicate that although it is possible to use SM and web-based survey platforms for ePROs, automating scheduled administration will be necessary to reduce provider burden. The lack of significant change in ePROs may be due to standard measures taking a biomedical approach to wellness. Future work should focus on identifying ideal ePRO processes that would include standardized, whole-person measures of wellness.

The Effect of Education on Chlorhexidine Use in a Neonatal Intensive Care Unit

2017 ◽  
Vol 22 (3) ◽  
pp. 115-123 ◽  
Author(s):  
Janet Delong Pettit ◽  
Elizabeth Li Sharpe
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Neonatal Intensive Care Unit ◽  
Bloodstream Infection ◽  
Education Program ◽  
Neonatal Intensive Care ◽  
Central Line ◽  
Quality Improvement Project ◽  
Improvement Project

Abstract Background: Neonates are at greater risk for central-line-associated bloodstream infection due to prolonged vascular access for nutrition and medications. Skin antisepsis using chlorhexidine gluconate (CHG), particularly the formulation with alcohol (CHG/alcohol), during central line insertion and maintenance activities is a key clinical care process associated with central line-associated bloodstream infection reduction. One area of ongoing confusion for many clinicians is whether to adhere to the manufacturer's recommendations that CHG remain on the skin following the procedure to promote persistent microbicidal effects, or to foster product removal in hopes of preventing skin-related complications. Purpose: Determine the effect of a targeted education program on the knowledge and attitudes of nurses who place peripherally inserted central catheters in the neonatal intensive care unit regarding the use and removal of CHG antiseptic. Methods: A quasiexperimental presurvey/postsurvey quality improvement project recruited participants from the electronic mailing list of a national neonatal nursing organization. Results: There was a statistically significant deficiency in knowledge or misinformation related to the use of CHG/alcohol on the presurvey assessment. Eight questions reflecting knowledge consistent with most recent evidence were answered correctly only 11.4%–25.7% of the time, all of which were considered statistically significant. Following completion of the education program, a nearly 100% correct response rate on all but 3 postsurvey questions resulted. Conclusions: This quality improvement project demonstrated success in the ability to change knowledge surrounding the removal of CHG/alcohol from the skin of babies in a neonatal intensive care unit following completion of a targeted education program, and the effectiveness of targeted web-based educational programs.

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