Impacting Neonatal Patient Care: Reducing Needle Sticks, with an Extended Dwell Catheter

2021 ◽  
Author(s):  
Tara M. Daly ◽  
Constance Girgenti
Keyword(s):  
Seldinger Technique ◽  
Nursing Time ◽  
Improvement Project ◽  
Delivery Of Care ◽  
Efficient Delivery ◽  
Days Of Therapy ◽  
Ultimate Result ◽  
Neonatal Patient ◽  
Needle Sticks ◽  
Preterm Newborns

Highlights Abstract Background: The use and efficacy of extended dwell peripheral intravenous catheters (EPIVs) has been extensively described at scientific conferences and in recent literature. The ramifications of repeated needle sticks include damage to vessels and ultimately the need for more invasive and costly access devices, which clearly support the need for reliable forms of vascular access. Methods: This quality improvement project spanned 4 years, 2017 through 2020, and included 128 patients who required a peripherally inserted catheter as their primary or secondary access site for a prescribed therapy. The EPIV utilized was a 4-cm, 22-gauge catheter made of thermosensitive polyurethane inserted using the Seldinger technique. Results: Over the course of 4 years, 128 patients received an EPIV for 2 or more days, totaling 849 days of therapy. Total insertion attempts were 174 or an average of 1.4 per patient. An estimated number of short PIVs needed for 849 days would have been 404 with 1011 attempts. Resultant savings with EPIV are estimated to be $30,686. Conclusions: Reducing the number of patient peripheral intravenous attempts while extending the dwell time results in less patient trauma, reliable longer-term access, reduced infection risk, reduced supply usage, and savings in terms of nursing time. The ultimate result for preterm newborns is more efficient delivery of care with less cost.

Effects of Acuity-Adaptable Rooms on Flow of Patients and Delivery of Care

2004 ◽  
Vol 13 (1) ◽  
pp. 35-45 ◽  
Author(s):  
Ann L. Hendrich ◽  
Joy Fay ◽  
Amy K. Sorrells
Keyword(s):  
Business Case ◽  
Direct Care ◽  
First Year ◽  
Base Number ◽  
Nursing Time ◽  
Financial Measures ◽  
Delivery Of Care ◽  
Hospital Capacity ◽  
Patients Satisfaction ◽  
Sentinel Events

• Background Delayed transfers of patients between nursing units and lack of available beds are significant problems that increase costs and decrease quality of care and satisfaction among patients and staff.• Objective To test whether use of acuity-adaptable rooms helps solve problems with transfers of patients, satisfaction levels, and medical errors.• Methods A pre-post method was used to compare the effects of environmental design on various clinical and financial measures. Twelve outcome-based questions were formulated as the basis for inquiry. Two years of baseline data were collected before the unit moved and were compared with 3 years of data collected after the move.• Results Significant improvements in quality and operational cost occurred after the move, including a large reduction in clinician handoffs and transfers; reductions in medication error and patient fall indexes; improvements in predictive indicators of patients’ satisfaction; decrease in budgeted nursing hours per patient day and increased available nursing time for direct care without added cost; increase in patient days per bed, with a smaller bed base (number of beds per patient days). Some staff turnover occurred during the first year; turnover stabilized thereafter.• Conclusions Data in 5 key areas (flow of patients and hospital capacity, patients’ dissatisfaction, sentinel events, mean length of stay, and allocation of nursing productivity) appear to be sufficient to test the business case for future investment in partial or complete replication of this model with appropriate populations of patients.

scholarly journals 1139. Reducing Collection of Tracheal Aspirate Bacterial Cultures: A Diagnostic Test Stewardship Intervention

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S660-S661
Author(s):  
Kathleen Chiotos ◽  
Giyoung Lee ◽  
Guy Sydney ◽  
Heather Wolfe ◽  
Jennifer Blumenthal ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Bacterial Colonization ◽  
Tracheal Aspirate ◽  
Consensus Guideline ◽  
Broad Spectrum Antibiotic ◽  
Improvement Project ◽  
Bacterial Cultures ◽  
Pdsa Cycle ◽  
Number Of Patients ◽  
Days Of Therapy

Abstract Background Tracheal aspirate (TA) bacterial cultures are often collected in mechanically ventilated children to evaluate for ventilator-associated infections (VAI), including tracheitis and pneumonia. However, frequent bacterial colonization of tracheal tubes results in poor specificity of positive TA cultures for distinguishing bacterial infection from colonization, which contributes to antibiotic overuse for VAI. We performed a quality improvement project to reduce collection of TA cultures through implementation of a consensus guideline to standardize culture ordering, and measured its impact on antibiotic use in a tertiary PICU. Methods A multidisciplinary team including PICU, pulmonary, and ID clinicians developed the consensus guideline in November 2019-February 2020. The first Plan-Do-Study-Act (PDSA) cycle occurred in August 2020 and included provider education, providing a link to the guideline in the TA culture order, and signs and screensavers highlighting key guideline recommendations. The second PDSA cycle occurred in October-December 2020 and included weekly emails to on service PICU clinicians. Statistical process control charts were used to measure the number of TA cultures collected/100 ventilator days and broad-spectrum antibiotic DOT/100 ventilator days. The number of patients treated for VAI/100 ventilator days and guideline compliance were also measured. Results The baseline rate of TA culture collection was 4.58/100 ventilator days. A centerline shift to 3.33 cultures/100 ventilator days occurred in March 2020. Following PDSA 1 and 2 in October 2020, a second downward centerline shift to 2.22 cultures/100 ventilator days occurred (Figure 1). Broad-spectrum antibiotic days of therapy/100 ventilator days decreased in November 2019 coincident with the start of the project, but no further reductions occurred after PDSA 1 and 2 (Figure 2). The number of patients treated for VAI decreased from a baseline of 1.24/100 ventilator days to 0.66/100 ventilator days. Finally, the proportion of TA cultures ordered that were non-compliant with the guideline recommendations was unchanged throughout the study period (Table 1). Conclusion A consensus guideline reduced collection of TA cultures, with a modest reduction in the rate of antibiotic treatment for VAI. Disclosures All Authors: No reported disclosures

Abstract P857: Rapid Cycle Process Improvement During a Pandemic: Changing How Patients at Low Risk for Complications Are Monitored Post Intravenous Thrombolysis

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michelle Whaley ◽  
Rebecca van Vliet ◽  
Leah Farrell ◽  
David Welcom
Keyword(s):  
Patient Safety ◽  
Critically Ill ◽  
Process Improvement ◽  
Nursing Staff ◽  
Intravenous Thrombolysis ◽  
Low Risk ◽  
Nursing Time ◽  
Improvement Project ◽  
Practice Nurses ◽  
Low Intensity

Background: During the initial emergence of the 2019 novel coronavirus (COVID-19) and the subsequent surge of patients requiring critical care, our Joint Commission certified thrombectomy-capable stroke center sought to utilize a low-intensity monitoring protocol in stable, post intravenous (IV) thrombolysis patients in our intensive care unit (ICU). The acuity level in our ICU jumped to an all-time high, with many critically ill COVID-19 patients. Our goal was simple, provide safe patient care, free up precious nursing time, and preserve the personal protective equipment supply. Purpose: The purpose of this study was to use a rapid cycle process improvement project to implement a low-intensity monitoring (LIM) protocol in stable, suspected stroke patients, who are deemed at low risk for complications, in the first twenty-four hours following IV thrombolysis. Methods: We utilized the Plan-Do-Study-Act (PDSA) model to implement this project. Collaboration between physician, nursing, and stroke program leaders occurred during the month of April 2020. Our new process utilized the O ptimal P ost T -pa I v M onitoring in I schemic ST roke (OPTIMIST) protocol. We continued to admit our post IV alteplase patients to the ICU, rather than a step-down unit, in order to accommodate the 3:1 patient to nurse ratio, ensure protocol adherence, and maximize patient safety with this high-risk medication. We used change of shift huddles to educate the ICU nursing staff over a two-week period. Stroke program advanced practice nurses were on-site to ensure compliance. Results: Since implementation of the new protocol, two IV alteplase patients have met protocol criteria; both remained stable throughout the twenty-four-hour LIM period. The protocol’s nursing ratio changes allowed the other, critically ill patients, to be staffed with traditional ICU ratios. Conclusion: Rapid cycle PI projects can be accomplished during times of extreme challenge, as evidenced during the COVID-19 pandemic. Nursing staff was able to adapt and even welcomed the change, while maintaining patient safety. Further study is needed to document the ongoing effect of this protocol.

Impact of a Standardized Beta-Lactam Allergy Questionnaire on Aztreonam Use

2018 ◽  
Vol 32 (4) ◽  
pp. 399-403 ◽  
Author(s):  
Kacie E. Clark ◽  
Mary E. Briand ◽  
Om Kapoor ◽  
Ameen Pirasteh
Keyword(s):  
Group Versus ◽  
Pharmacy Education ◽  
Inpatient Service ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Improvement Project ◽  
Days Of Therapy ◽  
Quasi Experimental ◽  
Baseline Characteristics ◽  
Education Tool

Methods: This quasi-experimental study compared the aztreonam utilization in patients with self-reported beta-lactam allergies admitted to an inpatient service between two study periods (pre- and post-implementation). Post-implementation followed the initiation of a standardized beta-lactam allergy questionnaire, a student pharmacist–driven performance improvement project for beta-lactam allergy documentation. Interviews clarified the allergy, reaction history, and any previous tolerance of beta-lactams. If receiving aztreonam at the time of the questionnaire, recommendations were made for changes in therapy if deemed appropriate by the pharmacist. Results: A total of 95 patients were included in the pre-implementation group versus 65 patients in the post-implementation group. Baseline characteristics were similar. The average number of aztreonam doses per 1000 patient-days in the post-implementation group was decreased (21.23 vs 9.05, P = .003). The average number of days of therapy per 1000 patient-days in the post-implementation group was decreased (8.79-4.24, P = .016). An increase in the number of aztreonam de-escalations was observed post-implementation ( P = .003). A total of 122 questionnaires were completed with 114 allergy documentation updates. There were no reported instances of adverse events. Conclusion: Utilization of a standardized beta-lactam allergy questionnaire as a pharmacy education tool resulted in a statistically significant decrease in aztreonam utilization, based on doses, days of therapy, and de-escalations.

scholarly journals P36 Numeta G13% preterm neonatal parenteral nutrition solution – a licensed all-in-one triple chamber, ready to use and terminally sterilised parenteral nutrition for preterm newborn infants

2020 ◽  
Vol 105 (9) ◽  
pp. e25-e25
Author(s):  
Mar Moreno ◽  
Kenny McCormick ◽  
Lindsey Macfarlane ◽  
Alexandra Scrivens
Keyword(s):  
Patient Safety ◽  
Parenteral Nutrition ◽  
Standard Deviation Score ◽  
British Association ◽  
List Type ◽  
Central Administration ◽  
Nursing Time ◽  
Perinatal Medicine ◽  
Improvement Project ◽  
Safety Alert

AimsWe aim to evaluate the efficacy and safety of Numeta G13%E preterm neonatal parenteral nutrition (PN) in our neonatal population.In September 2017 a National Patient Safety Alert (NPSA) highlighted the risk of harm to babies when lipid was mistakenly run at the rate intended for the aqueous component resulting in significant lipid overdose.Although we have worked to implement many of the alert’s recommendations, we feel we can avoid this risk further by using an all-in-one PN solution.1Numeta meets current nutritional guidelines as per British Association of Perinatal Medicine (BAPM) but this project allows comparison of outcomes important to both patient and service between those achieved with our current regimen and those with the all-in-one regimen.2MethodsWe carried out a quality improvement project from April 2018 to April 2019. We collected data from 330 babies in our neonatal unit during six months before (154 babies) and after (176 babies) the adoption of the all-in-one solution.Our previous PN regimen consisted of a ‘menu’ of aqueous bags (starter, maintenance, ‘light’ and bespoke) and a separate lipid solution. All of them were suitable for peripheral or central administration. Numeta came with similar choices: starter, maintenance -for central administration only- and ‘lite’ and Numeta peripheral, suitable for peripheral administration. Bespoke bags were also available if clinically indicated. We set out our desired outcomes and measured parameters accordingly:Patient outcomesMetabolic stability: electrolyte, glucose, bilirubin and lipid measurements summarised by the need to change from standard PN regimen and/or requirement for insulin.Fluid balance summarised by the lowest weight during the first two weeks of life and time taken to regain birth weight.Growth summarised by change of standard deviation score of weight and head circumference between birth and discharge or transfer back to local hospital.Liver tolerance of lipid solutions summarised by incidence of cholestasis (>25 μmol/l conjugated fraction of serum bilirubin)Days and type of PNSepsisService outcomesNursing time taken to prepare PNCostWastageAccess to productResultsAlthough we finished collecting the data in April 2019, we are still in the process of analysing it and evaluating the final results. There have been no cases of lipid overdose and our neonates (including the preterm ones) have so far tolerated well the new parenteral nutrition solution. Average nursing time preparing Numeta went down from 18.5 minutes to 8 minutes and comparison of cost came in favour of Numeta. PN wastage was higher with Numeta (4.7% Maintenance, 10% ‘light’, peripheral 50%) especially in the first month during the transition phase. There was no significant increase of bespoke bags when Numeta was introduced.ConclusionsIn summary, so far we have not identified significant clinical differences between the first six months of the project -using our old standardised nutrition regimen- and the last months -on the new all-in-one solution. We have continued with Numeta preterm solution on the basis of assumed safety.ReferencesRisk of severe harm and death from infusing total parenteral nutrition too rapidly in babies. NHS improvement patient safety alert September 2017.The Provision of Parenteral Nutrition within Neonatal Services – A Framework for Practice. British Association of Perinatal Medicine (BAPM) April 2016 www.bapm.org

Impact of the Standardized Surgical Checklist on Communication and Teamwork Among Interdisciplinary Surgical Team Members

2017 ◽  
Vol 10 (2) ◽  
pp. 88-95
Author(s):  
Regalado A. Valerio ◽  
Rodolfo Amaya ◽  
Kari Cole ◽  
Cristina C. Hendrix
Keyword(s):  
Los Angeles ◽  
Medical Center ◽  
Surgical Care ◽  
Care Team ◽  
Current Evidence ◽  
Improvement Project ◽  
Delivery Of Care ◽  
Good Communication ◽  
Surgical Checklist ◽  
The Impact

Traditional timeouts done ineffectively before surgical procedures can result in late blood product requests, inadequate preparation of needed intraoperative apparatus, improper administration of required antibiotics, and operating room (OR) time delays. This clinical concern is important to address because based on current evidence, implementing a Standardized Surgical Checklist (SSC) during timeout can impact patient safety by reducing complications following surgery and can promote good communication and teamwork among the care team. This quality improvement project is aimed to develop, implement, and evaluate the impact of SSC on communication and teamwork among an interdisciplinary surgical care team at Los Angeles County and University of Southern California Medical Center (LAC + USC). The design of this project was a pre- and postinnovation survey. The participants were the members of the interdisciplinary care team who participated in the surgical timeout before and after the innovation was implemented. The surveys consisted of 219 participants. Results from an independent t test demonstrated that the mean improvement score for both communication (t = −3.704, df = 190, p < .001) and teamwork (t = −3.028, df = 184, p = .003) were significantly higher in the postinnovation group than in the preinnovation group. These results indicate that SSC can improve communication and teamwork among providers inside the OR which can potentially lead to a safer delivery of care.

Sedating critically ill patients: factors affecting nurses' delivery of sedative therapy

2001 ◽  
Vol 10 (3) ◽  
pp. 156-165 ◽  
Author(s):  
CR Weinert ◽  
L Chlan ◽  
C Gross
Keyword(s):  
Critical Care Nurses ◽  
Future Research ◽  
Surgical Intensive Care Unit ◽  
Focus Group Interviews ◽  
Surgical Intensive Care ◽  
Delivery Of Care ◽  
Factors Affecting ◽  
Efficient Delivery ◽  
Group Interviews ◽  
Intensive Care Unit Nurses

BACKGROUND: Critical care nurses often have wide discretion in managing the sedative therapy of patients receiving mechanical ventilation. Little is known about the factors and processes that influence sedative practice. OBJECTIVES: To determine if nurses' personal beliefs about and attitudes toward critical illness and their goals for sedation influence the nurses' sedative practice, to discover whether social factors influence sedative therapy, and to describe the processes that nurses use to assess patients' need for sedative therapy. METHODS: Audiotapes of focus group interviews with 5 groups of 34 experienced medical and surgical intensive care unit nurses from 2 hospitals were transcribed verbatim. Two investigators independently analyzed the verbatim text, and a sample of the participants validated the category summaries and interpretations. RESULTS: Patients' family members can affect sedative practice directly or indirectly, and demands for efficient delivery of care can influence sedative therapy. Primary indications for sedation included patients' comfort and amnesia and prevention of patients' self-injurious behaviors. Conflicts between physicians and nurses arose when explicit and shared goals for sedation were lacking. Participants noted that numerous factors impede routine use of sedation protocols even though use of the protocols may improve communication and promote uniformity of sedative practice. CONCLUSION: Social, personal, and professional factors influence sedative therapy. Future research should establish the relative importance of these factors and determine whether their impact is attenuated when sedation protocols are implemented.

scholarly journals Mother’s Own Milk Feeding in Preterm Newborns Admitted to the Neonatal Intensive Care Unit or Special-Care Nursery: Obstacles, Interventions, Risk Calculation

2021 ◽  
Vol 18 (8) ◽  
pp. 4140
Author(s):  
Nadja Heller ◽  
Mario Rüdiger ◽  
Vanessa Hoffmeister ◽  
Lars Mense
Keyword(s):  
Gestational Age ◽  
Mode Of Delivery ◽  
Improvement Project ◽  
Targeted Interventions ◽  
Skin Contact ◽  
Published Evidence ◽  
Modifiable Factors ◽  
Mother’S Own Milk ◽  
Preterm Newborns

Early nutrition of newborns significantly influences their long-term health. Mother’s own milk (MOM) feeding lowers the incidence of complications in preterm infants and improves long-term health. Unfortunately, prematurity raises barriers for the initiation of MOM feeding and its continuation. Mother and child are separated in most institutions, sucking and swallowing is immature, and respiratory support hinders breastfeeding. As part of a quality-improvement project, we review the published evidence on risk factors of sustained MOM feeding in preterm neonates. Modifiable factors such as timing of skin-to-skin contact, strategies of milk expression, and infant feeding or mode of delivery have been described. Other factors such as gestational age or neonatal complications are unmodifiable, but their recognition allows targeted interventions to improve MOM feeding. All preterm newborns below 34 weeks gestational age discharged over a two-year period from our large German level III neonatal center were reviewed to compare institutional data with the published evidence regarding MOM feeding at discharge from hospital. Based on local data, a risk score for non-MOM feeding can be calculated that helps to identify mother–baby dyads at risk of non-MOM feeding.

The effects of COVID-19 on self-harm in a high-secure psychiatry hospital

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Alexander Challinor ◽  
Kathryn Naylor ◽  
Patrick Verstreken
Keyword(s):  
Psychiatric Hospital ◽  
Prison Population ◽  
Psychological Impact ◽  
High Risk Group ◽  
Therapeutic Interventions ◽  
Improvement Project ◽  
Content Type ◽  
Delivery Of Care ◽  
Self Harm ◽  
The Impact

Purpose Self-harm, including death from suicide, remains a significant public health challenge. The prison population is known to be a high-risk group for self-harm and suicide. The purpose of this study is to explore the trends in the frequency of self-harm over the course of the COVID-19 pandemic within a high-secure hospital. The authors hypothesised that the pandemic could adversely affect the mental health of patients, which could increase the rates of self-harm. Reasons for changes in the frequency of self-harm and the strategies used in response to the pandemic were also investigated. Design/methodology/approach This paper encompasses findings from a quality improvement project that investigated self-harming behaviours from February 2020 to February 2021 in a high-secure psychiatric hospital. Incidents of self-harm were recorded based on the hospital’s ward structure. Data was collected on the incidence of self-harm rates over the COVID-19 pandemic, with a focus on how the pandemic may have had an effect on self-harm. Findings This paper found an increase in the incidents of self-harm during the initial stages of the pandemic. The first national lockdown period yielded a rise in self-harm incidents from pre-COVID levels. The frequency of self-harm reduced following the first lockdown and returned to pre-COVID levels. The authors explored the psychological effects of COVID, isolation, interpersonal dynamics and changes in the delivery of care as reasons for these trends. Practical implications This study demonstrates the substantial challenges of the COVID-19 pandemic to secure psychiatric services. Having an awareness of how the pandemic can impact on self-harm is important, as it allows the correct balance of restriction of our patients’ liberty to a degree deemed necessary to control the pandemic and the delivery of effective patient care. The key clinical implications include the importance of direct face-to-face patient contact, effective communication, therapeutic interventions and activities, the psychological impact of quarantine and the influence the pandemic can have on an individual’s function of self-harm. Originality/value This paper is the first, to the authors’ knowledge, to explore the impact of COVID-19 in a high-security psychiatric hospital. The authors also explore possible explanations for the changes in the trends of self-harm and include the consideration of strategies for improving the prevention and management of self-harm in high-secure settings during a pandemic.

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