A quality improvement initiative to reduce hospital-acquired pressure injuries (HAPI) in an acute inpatient setting by improving patient education and seating

Hospital-acquired pressure injuries (HAPI) are a significant cause of morbidity and mortality, and represent a major health concern worldwide. Patients suffering from HAPI report a poor quality of life on several dimensions of health. Moreover, HAPI is reported to lengthen in-hospital stay in the acute setting, posing significant healthcare resource utilisations and costs. Given the clinical and economic burden of HAPI, recent best practice guidelines provide recommendations to reduce the prevalence of pressure injuries. Humber River Hospital (HRH), a large community hospital in Toronto, Canada, has a daily census of approximately 500 patients. The aim of this project was to reduce the prevalence of HAPI within the intensive care unit (ICU) and non-ICU setting at HRH within a 1-year period. Using the International Pressure Injury/Ulcer Prevalence (IPUP) Survey we established a baseline prevalence of HAPI of 27.6% (n=315) for non-ICU and 30% for ICU (n=33) patients at our institution in 2015. Using the Plan-Do-Study-Act (PDSA) method for quality improvement, we implemented a multifaceted approach aimed at improving equipment, digital documentation and education on risk assessment, prevention and treatment strategies. Over multiple PDSA cycles, our prevalence of HAPI reduced to 16% for non-ICU patients with no changes to the HAPI prevalence in ICU patients in 2016. Sustainability continues with HAPI prevalence currently at 10% in 2017 for non-ICU patients, which outperforms the Canadian prevalence (13.7%) by census size for 2017. However, the prevalence of HAPI in the ICU increased to 45% in 2017 despite multiple quality improvement initiatives, suggesting critically ill patients represent a unique challenge for reducing HAPI for these patients at our institution.

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Identifying and Addressing Barriers to Systemic Thrombolysis for Acute Ischemic Stroke in the Inpatient Setting: A Quality Improvement Initiative

Mayo Clinic Proceedings Innovations Quality & Outcomes ◽

10.1016/j.mayocpiqo.2020.07.009 ◽

2020 ◽

Vol 4 (6) ◽

pp. 657-666

Author(s):

Andrew R. Pines ◽

Devika M. Das ◽

Shubhang K. Bhatt ◽

Harn J. Shiue ◽

Sara Dawit ◽

...

Keyword(s):

Quality Improvement ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Quality Improvement Initiative ◽

Inpatient Setting ◽

Systemic Thrombolysis

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Initial steps to measurement and improvement of family-centered communication during the pediatric patient journey of bone marrow transplantation

Knowledge Management & E-Learning: An International Journal ◽

10.34105/j.kmel.2020.12.027 ◽

2020 ◽

pp. 488-504

Keyword(s):

Quality Improvement ◽

Healthcare System ◽

Health Care Providers ◽

Quality Improvement Initiative ◽

Inpatient Setting ◽

Care Providers ◽

Patient Journey ◽

Family Centeredness ◽

Centered Care ◽

Family Centered

Often, pediatric patients' caregivers feel like they are not being heard or consulted by the healthcare system they have entrusted for their loved ones’ care. These difficulties are well known to the healthcare system, and significant research has been conducted to understand how to provide what’s come to be known as patient- and family-centered care (PFCC). PFCC is grounded in mutually beneficial partnerships among health care providers, patients, and families. In 2019 we started a quality improvement initiative, partnering with families to increase our family-centeredness, initially focusing on communication. We report our quality improvement initiative's initial steps to understand communication between patients and caregivers in the inpatient setting. We report variables identified as barriers to PFCC, and our initial interventions, including small tests of change, to implement and improve PFCC in the inpatient setting. We hope that our experience will inspire others to undertake similar initiatives at their institutions.

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Deprescribing benzodiazepines among hospitalised older adults: quality improvement initiative

BMJ Open Quality ◽

10.1136/bmjoq-2018-000539 ◽

2019 ◽

Vol 8 (3) ◽

pp. e000539 ◽

Cited By ~ 2

Author(s):

Frances Carr ◽

Peter Tian ◽

Jeffrey Chow ◽

Jennifer Guzak ◽

Jean Triscott ◽

...

Keyword(s):

Quality Improvement ◽

Patient Education ◽

Medication Review ◽

Primary Outcome Measure ◽

Primary Objective ◽

Quality Improvement Initiative ◽

Education Intervention ◽

Potentially Inappropriate Medications ◽

Patient Counselling ◽

Education Material

Benzodiazepines are recognised as being potentially inappropriate medications for seniors due to their considerable side-effect profile, yet they are commonly prescribed and infrequently discontinued (deprescribed). The study’s primary objective was the deprescription or the dose reduction of benzodiazepines among newly hospitalised seniors using a patient education intervention. A 3-month duration quality improvement study based on the plan–do–study–act model was conducted across two units (3C and 4D) in the Glenrose Rehabilitation Hospital to improve benzodiazepine deprescribing among newly admitted seniors (65 years or older) who were using benzodiazepines. The primary outcome measure was the number of eligible patients who had benzodiazepine deprescribing initiated. A patient education intervention comprising a structured medication review, written patient education (the Eliminating Medications Through Patient Ownership of End Results (EMPOWER) brochure) and at least one brief supportive counselling session by the clinical pharmacist or physician was applied to all eligible patients. All 12 eligible patients consented to benzodiazepine deprescribing; however, only 11 of them (92%) initiated benzodiazepine deprescribing. Six of the 11 patients (55%) had their benzodiazepines discontinued, with the 5 remaining patients (45%) achieving greater than 50% dosage reduction. Seven patients (64%) experienced side effects during the deprescribing process, with over half (57%, n=4) of these seven patients experiencing worsening anxiety symptoms. Five of the 11 patients (45%) required benzodiazepine substitute medications. The use of a structured patient education intervention involving the use of a structured medication review, written patient education material and one-on-one patient counselling can promote benzodiazepine deprescribing. Although worsening anxiety was frequently observed, this was easily managed by the substitution of a more appropriate and clinically indicated medication, which was well tolerated and acceptable by all of our participants. Targeted screening for the presence of anxiety would help to guide the deprescribing process and the need for medication substitution.

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