scholarly journals The Use of Tailored Interventions to Prevent Falls: A Quality Improvement Project in the Telemetry Unit

2020 ◽  
pp. 1-77
Author(s):  
Roda Galag

Background: Every year in the United States, hundreds of thousands of patients fall in hospitals with 30 to 50 percent resulting in injury. In Texas, the fall rate in adult patients is 33.9 percent, and in one teaching hospital in South Texas, patient fall rates have been above the national benchmark for two years (2017-2019), despite increased use of sitters for patient safety and multiple fall prevention strategies. The annual direct care cost of all fall events in the United States for individuals more than 65 years old is about $34 billion. Practice problem: The objectives of the fall initiative program were increasing adherence to documentation of data from the Morse Fall Assessment and tailored interventions in the electronic health record. The goal of the project was to promote patient safety by decreasing the fall rate per 1000 patient days to below the national benchmark of 3.44/1000 patient days. Intervention: The project was piloted in two telemetry units over 12 weeks using the Iowa Model of Evidence-based Practice. Telemetry staff received one-on-one education from the educator in the unit using a tailored intervention poster. The Nurse Champion observed 58 rooms and conducted chart documentation to ensure universal fall precautions were carried out during every shift. Incidence of falls was tracked daily, and post fall huddles were conducted after any incidents. Outcome: The average monthly fall rate after implementation was 2.47/1000 patient days, which was below the national benchmark. Conclusion: The fall assessment documentation in two telemetry units at DHR Health can be adapted or implemented hospital-wide. The results showed a statistically significant correlation between the Morse fall score assessment on EHR and monthly fall events (p=0. 0078). Champions were able to identify interventions and areas that needed to be improved such as education, patient engagement and stakeholder buy-in.

2020 ◽  
Vol 68 (6) ◽  
pp. 257-262
Author(s):  
Julia Blocker ◽  
Janice Lazear ◽  
S. Lee Ridner

Background: Smoking is the leading cause of preventable deaths in the United States. The rates of smoking remain elevated in rural, low income populations in comparison with the rest of the United States. Thus, prompting the process improvement project of implementing the Ask–Advise–Connect (AAC) method to the national quitline in a nurse practitioner–managed clinic for an automotive manufacturing plant in rural Tennessee. Methods: Ask–Advise–Connect method was added to the current smoking cessation program. The employees who utilized the clinic were assessed for smoking status at each visit and subsequently counseled on cessation. Individuals interested in cessation were connected to the national quitline with the AAC method. Pharmaceutical options and nicotine replacement therapy was also offered at no cost to the employee. Findings: In the 4-month period, the clinic provided 102 tobacco cessation counseling visits to workers who smoke. Twenty-four employees enrolled in the cessation program. The participants reported a cessation rate of 12.5% and 21% had a significant decrease in the number of cigarettes smoked. Of the participants, 12.5% ( n = 3) engaged in behavioral counseling with the quitline. Conclusion/application to practice: The addition of the AAC method as part of the smoking cessation program had limited success. As smoking cessation is difficult to achieve, any success greater than 7% can be considered an achievement. The 12.5% cessation rate of the participants was above the national average. Thus, demonstrating the benefit of having a workplace cessation program and incorporating the AAC method to the current smoking cessation program.


2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Hanadi Hamadi ◽  
Shalmali R. Borkar ◽  
LaRee Moody DHA ◽  
Aurora Tafili ◽  
J. Scott Wilkes ◽  
...  

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1679-e1685
Author(s):  
Dianne Frankel ◽  
Amanda Banaag ◽  
Cathaleen Madsen ◽  
Tracey Koehlmoos

ABSTRACT Introduction Diabetes is one of the most common chronic conditions in the United States and has a cost burden over $120 billion per year. Readmissions following hospitalization for diabetes are common, particularly in minority patients, who experience greater rates of complications and lower quality healthcare compared to white patients. This study examines disparities in diabetes-related readmissions in the Military Health System, a universally insured, population of 9.5 million beneficiaries, who may receive care from military (direct care) or civilian (purchased care) facilities. Methods The study identified a population of 7,605 adult diabetic patients admitted to the hospital in 2014. Diagnostic codes were used to identify hospital readmissions, and logistic regression was used to analyze associations among race, beneficiary status, patient or sponsor’s rank, and readmissions at 30, 60, and 90 days. Results A total of 239 direct care patients and 545 purchased care patients were included in our analyses. After adjusting for age and sex, we found no significant difference in readmission rates for black versus white patients; however, we found a statistically significant increase in the likelihood for readmission of Native American/Alaskan Native patients compared to white patients, which persisted in direct care at 60 days (adjusted odds ratio [AOR] 11.51, 95% CI 1.11–119.41) and 90 days (AOR 18.42, 95% CI 1.78–190.73), and in purchased care at 90 days (AOR 4.54, 95% CI 1.31–15.74). Conclusion Our findings suggest that universal access to healthcare alleviates disparities for black patients, while Native America/Alaskan Native populations may still be at risk of disparities associated with readmissions among diabetic patients in both the closed direct care system and the civilian fee for service purchased care system.


2000 ◽  
Vol 124 (11) ◽  
pp. 1674-1678 ◽  
Author(s):  
Ronald L. Sirota

Abstract Context.—During the past several years, more attention has been focused on the topics of medical error and patient safety than in the past. At the end of 1999, the Institute of Medicine (IOM) published a seminal report concerning medical error in the United States; this report will have sweeping implications for all disciplines of medicine, including pathology. Objective.—To review the major findings of the IOM report on medical error and to discuss their implications for the field of pathology. Methods.—Review of the IOM report on medical error and discussion of other relevant literature on medical error. Results.—The IOM report on medical error highlights an unacceptable rate of medical error in the United States and mandates a 50% reduction in medical error during the next 5 years. It recommends regulatory solutions to this problem, as well as organizational approaches to error reduction. It proposes both mandatory and voluntary systems for reporting of medical error. The report suggests that systems should be examined for latent flaws and that individual culpability for error should not be overemphasized. The report recommends that error-reduction strategies that have been applied to other industries should be studied and that known concepts of error reduction should be applied to medicine. Strategies that the IOM suggests can be applied to pathology. Conclusions.—Medical error occurs at an unacceptably high rate. Recommendations made in the IOM report on medical error and patient safety should be applied to the practice of pathology.


2022 ◽  
pp. 251604352110700
Author(s):  
Doug Wojcieszak

Surveys were sent to 68 American state medical boards, including territories of the United States, inquiring how they handle—or will handle—cases involving disclosure and apology after medical errors. Surveys were not sent to specialty boards. Thirty-eight state medical boards ( n  =  38, 56%) responded to the survey, with 31 completing the survey (46% completion rate) and seven boards ( n  =  7) providing explanations for nonparticipation and other thoughts; 30 boards did not respond in any manner. Boards that completed the survey indicated that disclosure and apology and other positive post-event behavior by physicians are likely to be viewed favorably and disclosing physicians will not be easy targets for disciplinary measures, though boards also stressed they view each case on the merits and patient safety is their top priority. Recommendations are made for policy makers and other stakeholders.


BMJ ◽  
2012 ◽  
Vol 344 (mar20 2) ◽  
pp. e1717-e1717 ◽  
Author(s):  
L. H. Aiken ◽  
W. Sermeus ◽  
K. Van den Heede ◽  
D. M. Sloane ◽  
R. Busse ◽  
...  

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