Monitoring Prediabetes Screening in Two Primary Care Offices in Rural Appalachia: A Quality Improvement Process

2021 ◽  
pp. JDNP-D-20-00027
Author(s):  
Rebecca T. Clark ◽  
Christine M. Mullins ◽  
Jean C. Hemphill
Keyword(s):  
Quality Improvement ◽  
Nutrition Education ◽  
Healthcare Providers ◽  
Individual Risk ◽  
Evidence Based ◽  
Improvement Project ◽  
Quality Improvement Process ◽  
Patients At Risk ◽  
History Of ◽  
Rural Appalachia

BackgroundOne-third of the U.S. population has prediabetes, but 90% remain undiagnosed because healthcare providers are not screening for this condition.ObjectiveThe purpose of this quality improvement project was to monitor prediabetes screening and identification, and implement evidence-based recommendations including registered dietician referral.MethodsThis project involved using an evidence-based screening tool to measure individual risk of prediabetes. Aggregate data was collected to evaluate screening implementation, evidence-based recommendations offered by providers, and assess patient risk factors.ResultsThe percentage of patients at risk for prediabetes was 41.3% (n = 111). The most frequent risks were identified as overweight, history of hypertension, family history of type 2 diabetes mellitus (T2DM), and older age. Providers offered education on weight loss 68.5% (n = 76) and exercise 76.6% (n = 85) but referred 33.3% (n = 37) patients for nutrition education. The screening rates were 52.3% (n = 176) and 72.5% (n = 244) in clinics A and B respectively.ConclusionsA gap remains in using evidence-based recommendations to decrease risk of prediabetes. Prediabetes screening identified a greater percentage of persons in this population.Implications for NursingThere is a need for consistent practice of evidence-based recommendations. This project set the benchmark for future efforts to educate, encourage, and measure providers successes.

scholarly journals Reducing Use of Restraints in Intensive Care Units: A Quality Improvement Project

2018 ◽  
Vol 38 (4) ◽  
pp. e8-e16 ◽  
Author(s):  
Dannette A. Mitchell ◽  
Teresa Panchisin ◽  
Maureen A. Seckel
Keyword(s):  
Intensive Care ◽  
Quality Improvement ◽  
Intensive Care Units ◽  
Evidence Based Practice ◽  
National Database ◽  
Evidence Based ◽  
Improvement Project ◽  
Quality Improvement Process ◽  
Alternative Product ◽  
Sustained Success

BACKGROUNDUse of physical restrainst is scrutinized in intensive care units today. Usage rates for the 5 intensive care units in the Christiana Care Health Services, Newark, Delaware, were higher than the National Database of Nursing Quality Indicators mean rate of 9.61% to 15.43% for many months during fiscal years 2013 and 2014.OBJECTIVETo reduce and sustain the restraint rates to less than the national database mean rates for all 5 intensive care units.METHODSA quality improvement process was used that included forming a multiunit restraint collaborative; reviewing restraint data, including self-extubation rates; surveying staff nurses to examine alignment with evidence-based practice; and selecting a new restraint-alternative product.RESULTSAll 5 intensive care units were able to successfully decrease restraint rates to less than the national database mean for the majority of the months since the start of the restraint collaborative in September 2012.CONCLUSIONUse of a restraint collaborative with subsequent adoption of restraint alternatives led to a decrease in restraint rates for the 5 intensive care units to less than the national database mean, enabled sustained success, and helped align nurses’ beliefs with evidence-based practice.

scholarly journals Evidence-Based Practice Implementation: Case Report of the Evolution of a Quality Improvement Program in a Multicenter Physical Therapy Organization

2015 ◽  
Vol 95 (4) ◽  
pp. 588-599 ◽  
Author(s):  
Joel M. Stevans ◽  
Christopher G. Bise ◽  
John C. McGee ◽  
Debora L. Miller ◽  
Paul Rockar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Case Report ◽  
Physical Therapy ◽  
Care Quality ◽  
Routine Practice ◽  
Evidence Based ◽  
Implementation Barriers ◽  
Improvement Program ◽  
Improvement Project ◽  
Systems Perspective

Background and Purpose Our nation's suboptimal health care quality and unsustainable costs can be linked to the failure to implement evidence-based interventions. Implementation is the bridge between the decision to adopt a strategy and its sustained use in practice. The purpose of this case report is threefold: (1) to outline the historical implementation of an evidence-based quality improvement project, (2) to describe the program's future direction using a systems perspective to identify implementation barriers, and (3) to provide implications for the profession as it works toward closing the evidence-to-practice gap. Case Description The University of Pittsburgh Medical Center (UPMC) Centers for Rehab Services is a large, multicenter physical therapy organization. In 2005, they implemented a Low Back Initiative utilizing evidence-based protocols to guide clinical decision making. Outcomes The initial implementation strategy used a multifaceted approach. Formative evaluations were used repeatedly to identify barriers to implementation. Barriers may exist outside the organization, they can be created internally, they may result from personnel, or they may be a direct function of the research evidence. Since the program launch, 3 distinct improvement cycles have been utilized to address identified implementation barriers. Discussion Implementation is an iterative process requiring evaluation, measurement, and refinement. During this period, behavior change is actualized as clinicians become increasingly proficient and committed to their use of new evidence. Successfully incorporating evidence into routine practice requires a systems perspective to account for the complexity of the clinical setting. The value the profession provides can be enhanced by improving the implementation of evidence-based strategies. Achieving this outcome will require a concerted effort in all areas of the profession. New skills will be needed by leaders, researchers, managers, and clinicians.

A quality improvement project to reduce restrictive interventions in a mental health service

2021 ◽  
pp. 1-12
Author(s):  
Darren Savarimuthu ◽  
Katja Jung
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Positive Impact ◽  
Essential Elements ◽  
Quality Improvement Project ◽  
Psychiatric Ward ◽  
Quality Improvement Initiative ◽  
Successful Implementation ◽  
Evidence Based ◽  
Improvement Project

Background/aims This article describes a quality improvement project that aimed to reduce restrictive interventions on an acute psychiatric ward. In light of a service level agreement and based on a trust-wide target, the purpose of the project was to reduce restrictive interventions by 20% within a period of 6 months. It was also anticipated that a least restrictive environment could have a positive impact on patient experience. Methods Three evidence-based interventions were introduced to the ward during the quality improvement project. These included positive behaviour support, the Safewards model and the productive ward initiative. Results There was a 63% reduction in restrictive interventions over a 6-month period through the successful implementation of a series of evidence-based interventions to manage behaviours that challenge on the mental health ward. Conclusions The project identified collaborative team working, staff training and adequate resources as essential elements in the success of the quality improvement initiative. However, co-production was found to be crucially significant in bringing sustainable changes in ward environment and in addressing restrictive practices.

scholarly journals Evidence-based practice ‘on-the-go’: using ViaTherapy as a tool to enhance clinical decision making in upper limb rehabilitation after stroke, a quality improvement initiative

2019 ◽  
Vol 8 (3) ◽  
pp. e000592 ◽  
Author(s):  
Nicola J Hancock ◽  
Kathryn Collins ◽  
Charlie Dorer ◽  
Steven L Wolf ◽  
Mark Bayley ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Upper Limb ◽  
Stroke Rehabilitation ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Improvement Project ◽  
Upper Limb Rehabilitation ◽  
Community Rehabilitation ◽  
Limb Rehabilitation

Recovery of upper limb function after stroke is currently sub-optimal, despite good quality evidence showing that interventions enabling repetitive practice of task-specific activity are effective in improving function. Therapists need to access and engage with such evidence to optimise outcomes with people with stroke, but this is challenging in fast-paced stroke rehabilitation services. This quality improvement project aimed to investigate acceptability and service impact of a new, international tool for accessing evidence on upper limb rehabilitation after stroke—‘ViaTherapy’—in a team of community rehabilitation therapists. Semi-structured interviews were undertaken at baseline to determine confidence in, and barriers to, evidence-based practice (EBP) to support clinical decision making. Reported barriers included time, lack of access to evidence and a research-practice disconnect. The clinicians then integrated use of ‘ViaTherapy’ into their practice for 4 weeks. Follow-up interviews explored the accessibility of the tool in community rehabilitation practice, and its impact on clinician confidence, treatment planning and provision. Clinicians found the tool, used predominantly in mobile device app format, to be concise and simple to use, providing evidence ‘on-the-go’. Confidence in accessing and using EBP grew by 22% from baseline. Clinicans reported changes in intensity of delivery of interventions, as rapid access to recommended doses via the tool was available. Following this work, the participating health and social care service provider changed provision of therapists’ technology to enable use of apps. Barriers to use of EBP in stroke rehabilitation persist; the baseline situation here supported the need for more accessible means of integrating best evidence into clinical processes. This quality improvement project successfully integrated ViaTherapy into clinical practice, and found that the tool has potential to underpin positive changes in upper limb therapy service delivery after stroke, by increasing accessibility to, use of and confidence in EBP. Definitive evaluation is now indicated.

Identifying Geriatric Patients at Risk for Malnutrition: A Quality Improvement Project

2019 ◽  
Vol 38 (2) ◽  
pp. 115-129
Author(s):  
Lauren C. Mays ◽  
Jennifer W. Drummonds ◽  
Summer Powers ◽  
David R. Buys ◽  
Penni I. Watts
Keyword(s):  
At Risk ◽  
Quality Improvement ◽  
Geriatric Patients ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Patients At Risk
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