scholarly journals Nurse’s Knowledge of Early Ambulation of the Post Operative Patient and Complication Prevention: A Quality Improvement Project

2021 ◽  
Author(s):  
Meghan Carides
Keyword(s):  
Quality Improvement ◽  
Patient Outcomes ◽  
Nursing Intervention ◽  
Educational Programs ◽  
Quality Improvement Project ◽  
Complication Rates ◽  
Improvement Project ◽  
Nursing Knowledge ◽  
Early Ambulation ◽  
The Mean

Ambulation is the single most important nursing intervention in the prevention of postoperative complications. It is also a key component in maintaining optimal patient outcomes. Current literature has revealed that when ambulation is initiated early there is a marked decrease in pain, length of hospital admission, and overall complication rates. However, even with this depth of evidence early postoperative ambulation on the two surgical units at a teaching hospital in Rhode Island, patient ambulation continues to be inconsistent. The purpose of this quality improvement project is to improve nursing knowledge regarding early ambulation after surgery for the prevention of post-operative complications. This project utilized a pretest, educational in-service intervention, and posttest design. Seventeen out of a possible 22 surgical nurses participated in this project (N= 17, 77%). The educational in-service sessions combined information from an extensive literature review in the form of a 10-minute Power Point presentation. Pre and post tests were made up of 5 knowledge-based and 5 opinion-based questions. The mean scores for the pretest were 74% while the mean scores for the posttest were 95.2%. There was a 35% increase in overall scores following the educational intervention. APRNs play a pivotal role in establishing and implementing educational programs. This project aimed to recognize a need for ongoing education about postoperative ambulation for the surgical unit nurses. Educational programs about postoperative ambulation and complication prevention should be routinely incorporated in future trainings to ensure improved nursing knowledge and patient outcomes.

Please reconcile, not wait a while

2019 ◽  
Vol 105 (2) ◽  
pp. 122-126
Author(s):  
Ashifa Trivedi ◽  
Sadhna Sharma ◽  
Richa Ajitsaria ◽  
Nicola J Davey
Keyword(s):  
Quality Improvement ◽  
District General Hospital ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Acute Setting ◽  
Paediatric Department ◽  
Medicines Reconciliation ◽  
The Mean ◽  
Patient Safety Incidents ◽  
Main Factor

A quality improvement project to increase the rate of paediatric medicines reconciliation was carried out in a district general hospital between April and July 2018. Baseline data collected from our paediatric ward shows that medicines reconciliation by doctors is only accurately completed 50% of the time. Evidence shows that medicines-related patient safety incidents are more likely when medicines reconciliation happens more than 24 hours after a person is admitted to an acute setting. The aim of this quality improvement project was therefore to ensure that 100% of paediatric patients have their regular medications prescribed by mid-day the day after admission. The paediatric pharmacy team reviewed all paediatric inpatient drug charts from Monday to Friday for 12 weeks. The number of regular medications and the number of medicines reconciled was recorded each day. The effectiveness of various interventions were reviewed using Plan–Do–Study–Act cycles. On average, 40 patients were reviewed each week. The mean reconciliation rate was 79%, and the worst rate was 0%. 100% reconciliation was achieved on 34 occasions and was achieved continuously for the last 3 weeks of data collection. A repeat audit carried out in September 2018 found the reconciliation rate was maintained at 100%. Multiple interventions occurred during this quality improvement project: teaching sessions for doctors, posters to raise awareness and questionnaires for parents/children to complete about their regular medications. The main factor for success in this project has been involving all members of the paediatric department including children and their parents.

scholarly journals Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre

2019 ◽  
Vol 28 (11) ◽  
pp. 939-948 ◽  
Author(s):  
Soffien Chadli Ajmi ◽  
Rajiv Advani ◽  
Lars Fjetland ◽  
Kathinka Dehli Kurz ◽  
Thomas Lindner ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Outcomes ◽  
Treatment Protocol ◽  
Team Training ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
In Situ Simulation ◽  
Simulation Based ◽  
Stroke Thrombolysis

BackgroundIn eligible patients with acute ischaemic stroke, rapid revascularisation is crucial for good outcome. At our treatment centre, we had achieved and sustained a median door-to-needle time of under 30 min. We hypothesised that further improvement could be achieved through implementing a revised treatment protocol and in situ simulation-based team training sessions. This report describes a quality improvement project aiming to reduce door-to-needle times in stroke thrombolysis.MethodsAll members of the acute stroke treatment team were surveyed to tailor the interventions to local conditions. Through a review of responses and available literature, the improvement team suggested changes to streamline the protocol and designed in situ simulation-based team training sessions. Implementation of interventions started in February 2017. We completed 14 simulation sessions from February to June 2017 and an additional 12 sessions from November 2017 to March 2018. Applying Kirkpatrick’s four-level training evaluation model, participant reactions, clinical behaviour and patient outcomes were measured. Statistical process control charts were used to demonstrate changes in treatment times and patient outcomes.ResultsA total of 650 consecutive patients, including a 3-year baseline, treated with intravenous thrombolysis were assessed. Median door to needle times were significantly reduced from 27 to 13 min and remained consistent after 13 months. Risk-adjusted cumulative sum charts indicate a reduced proportion of patients deceased or bedridden after 90 days. There was no significant change in balancing measures (stroke mimics, fatal intracranial haemorrhage and prehospital times).ConclusionsImplementing a revised treatment protocol in combination with in situ simulation-based team training sessions for stroke thrombolysis was followed by a considerable reduction in door-to-needle times and improved patient outcomes. Additional work is needed to assess sustainability and generalisability of the interventions.

Abstract 34: Kentucky Stroke Encounter Quality Improvement Project Statewide Collaboration to Improve Alteplase Utilization, Decrease Door to Needle Times, and Impact Outcomes: A 10 Year Review

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kari D Moore ◽  
Lynn Hundley ◽  
Polly Hunt ◽  
Bill Singletary ◽  
Allison Merritt ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Best Practices ◽  
Best Practice ◽  
Systems Of Care ◽  
Quality Improvement Project ◽  
Complication Rates ◽  
Improvement Project ◽  
Face To Face ◽  
Data Tracking ◽  
Stroke Systems Of Care

Background: Evidence shows systems change interventions improve care and outcomes for stroke patients. Geopolitical boundaries have been a barrier to improving regional systems of care. Despite efforts nationally, regionally, and locally alteplase use for ischemic stroke has remained low and door to needle (DTN) times exceeded 60 minutes. Kentucky created the Stroke Encounter Quality Improvement Project (SEQIP) in 2009 to share best practices and improve stroke systems of care across the Commonwealth. Purpose: The aim was to utilize and share best practice models among 23 SEQIP hospitals in KY to improve tPA utilization, decrease DTN times, and improve outcomes. Methods: Hospitals implemented a statewide quality improvement plan focused on identifying barriers, removing barriers, and implementing best practice strategies regarding thrombolytic therapy. Accountability was achieved with ongoing GWTG data tracking, teleconferences, and face to face meetings from January 2009 through December 2018 sharing strategies and solutions for best practice. Results: SEQIP’s participating hospitals achieved significant improvement in thrombolytic administration over 10 years. The percent of all AIS patients receiving tPA increased from 4.61% in 2009 to 8.80% in 2018 (OR=2.0, p <0.0001). Alteplase use in eligible patients arriving by 2 hours and treated by 3 hours improved from 59.6% to 88.5% (OR=5.2, p <0.0001). Alteplase use in eligible patients arriving by 3.5 hours to 4.5 hours increased from 24.9% to 55.1% (OR=5.0, p <0.0001). Median DTN times decreased from 74 minutes to 49 minutes (p<0.0001). Complication rates of symptomatic hemorrhage were consistent with NINDS data and < 6% from 2009-2018. The tPA in-hospital mortality rate in 2009 was 11.7% and by 2018, decreased to 3.6% (p=0.00016). In 2009, 28.4% of tPA patients were discharged home and by 2018, that had increased to 47.9% (p <0.00001). In 2009, 32.1% of tPA patients were able to walk independently at d/c and by 2018 had increased to 43.6% (p = 0.00359). Conclusions: Geopolitical boundaries can be overcome and collaboration can be sustained among competing hospitals through sharing of best practices to safely increase utilization of tPA in eligible patients, decrease DTN times, and improve outcomes.

scholarly journals Early Ambulation in Patients with External Ventrical Drains: Results of a Quality Improvement Project

JHN Journal ◽  
2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Syed Shah ◽  
Jacqueline Kraft ◽  
Nethra Ankam ◽  
Paula Bu ◽  
Kristen Stout ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Early Ambulation

A Quality Improvement Project to Optimize Patient Outcomes Following the Maze Procedure

2009 ◽  
Vol 24 (2) ◽  
pp. 160-165 ◽  
Author(s):  
Linda L. Henry ◽  
Niv Ad ◽  
Lisa Martin ◽  
Sharon Hunt ◽  
Pamela Crippen
Keyword(s):  
Quality Improvement ◽  
Patient Outcomes ◽  
Quality Improvement Project ◽  
Maze Procedure ◽  
Improvement Project

Utilizing Assessment Tools in Decreasing Fall Risk Among Community-Dwelling Adults: A Quality Improvement Project

2021 ◽  
pp. 108482232110347
Author(s):  
Justin Fontenot
Keyword(s):  
Risk Assessment ◽  
Quality Improvement ◽  
Home Care ◽  
Fall Risk ◽  
Community Dwelling ◽  
Quality Improvement Project ◽  
Assessment Tools ◽  
Post Intervention ◽  
Improvement Project ◽  
The Mean

Although there are standardized fall risk assessment tools in home care clinical practice, there are no standardized tools to reduce fall risk. This quality improvement project aims to test the adaptability of the Fall TIPS (Tailoring Interventions for Patient Safety) tool among the community-dwelling adult population by measuring the impact of the tool’s implementation on client fall risk. Participants included n = 54 clients enrolled in home care and n = 14 members of the clinical team. This project used a quantitative method with a quasi-experimental pre-and post-intervention design. The quality improvement project implemented the Fall TIPS tool, and fall risk was measured using the Morse Fall Risk Assessment (MFRA). The Fall TIPS tool was provided to participants by visiting staff, and interventions were selected based on the participant’s assessment. Participants’ fall risk was scored during in-person home visits, and the results were recorded in the electronic health record. A dependent 2-tailed t-test measured the variance of means between the pre-and-post groups. The pre-intervention MFRA score mean was 63.43 ± 22.52; p = .000 and the mean score in the post-intervention group was 58.15 ± 22.49; p = .000. The mean difference between the pre-and post-groups was 5.28. Implementing the Fall TIPS toolkit in the home care clinical setting reduced fall risk post-intervention and offered tools for future evaluation in home care settings.

Implementation of Lean Daily Management: A Vascular Access Team Quality Improvement Project to Enhance Nurses’ Workflow and Patient Outcomes

2020 ◽  
Vol 25 (3) ◽  
pp. 18-27
Author(s):  
Michele Schlauch ◽  
Pam Rogers ◽  
Rhonda Pyne ◽  
Cathy Tomchik ◽  
Carol Ellis ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Outcomes ◽  
Vascular Access ◽  
Cost Savings ◽  
Central Line ◽  
Quality Improvement Project ◽  
Fiscal Year ◽  
Substantial Cost Saving ◽  
Improvement Project ◽  
Clabsi Rate

Highlights Abstract Background: The process for patients to receive a peripherally inserted central catheter (PICC) has been unclear, allowing for delays in care and discharge and increased costs. To address these problems, a vascular access team implemented the Lean process. The purpose was to evaluate the effect of an ultrasound initiative to insert peripheral intravenous lines (IVs) and midlines and modification of PICC insertion hours on the nurses’ workflow and patient outcomes. Methods: This quality improvement project used retrospective data analysis. Patients’ data from fiscal year (FY) 2010 to FY 2019 was analyzed using descriptive statistics, independent t tests for continuous data, and a Poisson regression for count data. Results: After the ultrasound initiative, the volume of PICC insertions decreased by 20%, which represents a significant reduction. The mean cost also decreased from $171,681 to $147,620. Although there was no substantial cost saving, the total cost was reduced by 14%. After implementation of ultrasound guidance for peripheral IV and midline access, the central line–associated bloodstream infection (CLABSI) rate dropped by 70%. The estimated treatment cost for CLABSI significantly decreased from $481,600 to $156,800. After implementation, the total estimated cost savings was $1,624,000. Modified PICC insertion hours resulted in significantly reduced mean hours from order time to insertion. Conclusions: Standard work and process improvements using the Lean process were effective. The ultrasound initiative decreased unnecessary PICC insertions, reduced cost, and decreased the CLABSI rate. Modified PICC insertion hours enhanced the nurses’ work by reducing the average time from PICC order to placement.

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