scholarly journals Examining trainee awareness of dermatoses and dermatological assessments during acute admissions (A quality improvement project)

2018 ◽  
Vol 17 (3) ◽  
pp. 137-143
Author(s):  
Priya Patel ◽  
◽  
Natalie King ◽  
Keyword(s):  
Quality Improvement ◽  
Elderly Patients ◽  
Skin Care ◽  
Quality Improvement Project ◽  
Psychological Consequences ◽  
Post Intervention ◽  
Improvement Project ◽  
Care Bundles ◽  
Trust Hospital ◽  
Acute Admissions

Studies demonstrate 67% of elderly patients can have dermatoses, which could result in functional and psychological consequences. Elderly presentations are further complicated by comorbidities and polypharmacy. This combined with limited dermatology training at undergraduate and postgraduate levels creates diagnostic challenges. This project investigated dermatology assessments by trainees using the Trust’s acute medical admissions proforma. 100 proforma were reviewed for skin assessments alongside nursing skin care bundles. Subsequently, a skin survey was conducted amongst trainees evaluating knowledge and confidence when diagnosing and managing common dermatoses. Successively, a dermatology teaching series was delivered. Post-intervention the above were reassessed, demonstrating improvements in most areas. The dermatology teaching series will continue alongside a Trust hospital guideline to sustain improvements in dermatological care on admission.

Poster 117: Pain Assessment Survey (PAS) for Assessing Physical Pain in Post-Cerebrovascular Accident (CVA) Patients Post Intervention: Quality Improvement Project

PM&R ◽  
2017 ◽  
Vol 9 ◽  
pp. S172-S172
Author(s):  
Kirill Alekseyev ◽  
Nikhil Verma ◽  
Swathy Sreekumar ◽  
Amarin Suriyakhamhaengwongse ◽  
Malcolm Lakdawala ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pain Assessment ◽  
Cerebrovascular Accident ◽  
Quality Improvement Project ◽  
Physical Pain ◽  
Post Intervention ◽  
Improvement Project ◽  
Assessment Survey

scholarly journals Using quality improvement to standardise and enhance the use of the national early warning score (NEWS) in an old age psychiatry inpatient setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S38-S39
Author(s):  
Fraser MacNicoll ◽  
Mong Sun Tung ◽  
Brion McGowan
Keyword(s):  
Quality Improvement ◽  
Old Age ◽  
Quality Improvement Project ◽  
Assessment Process ◽  
Early Warning Score ◽  
Post Intervention ◽  
Improvement Project ◽  
Physical Deterioration ◽  
Increased Risk ◽  
Old Age Psychiatry

AimsWithin an inpatient old-age psychiatry setting, there is an increased risk of acute physical deterioration secondary to age, comorbidities and reduced physiological reserve. Numerous recent clinical incidents highlighted late recognition of physical deterioration within this population. We assessed the use of the NEWS, a system for scoring physiological measurements, in an old-age psychiatry ward and subsequently attempted to improve performance of obtaining physical health observations in this cohort of patients.MethodRetrospective pre- and post- quality improvement study in a twenty bed Old Age Psychiatry Ward in East Lothian Community Hospital, Haddington, Scotland. Data were collected from 12th October – 16th November, 2020 (pre- period) and from 16th November 2020 to 15th February, 2021 (post- period). The primary process measure was ensuring all patients had at least one full set of physical observations at least once a week, or more frequent as deemed clinically appropriate. Secondary measures included ensuring NEWS scores were accurately calculated and improved documentation. This was tracked using a run chart. Improvement activities focused on increased awareness, effective training, key stakeholder buy-in and reviewing trust policy.ResultThe percentage of NEWS documented for all patients at least once a week improved from a mean of 28.7% (31/108) in the 6 weeks prior to intervention, to a mean of 71.4% (125/175) in the following 13 weeks. The minimum required physical observations required to accurately calculate a NEWS improved from 51.6% (16/31) pre-intervention to 95.2% (119/125) post-intervention and NEWS being calculated correctly increased from 80.6% (25/31) to 96% (120/125). Documentation of a reason why physical observations were not taken increased from 2.5% (2/77) to 62% (31/50) pre- and post- intervention respectively.ConclusionThis quality improvement project highlighted that recording of physical observations and use of NEWS was inadequate in this setting, increasing the risk of a delay in identification of acute physical deterioration and thus increase morbidity and mortality. Introducing simple measures and standardising the NEWS assessment process, along with senior nursing and medical oversight, greatly enhanced acquiring and recording of physical observations and NEWS scores. This quality improvement project has shown that practical solutions and staff education can increase efficacy and are hoping further input can consolidate the gains achieved and lead to continued improvements.

Improvement in Herpes Zoster Vaccination in Patients with Rheumatoid Arthritis: A Quality Improvement Project

2016 ◽  
Vol 44 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Heena Sheth ◽  
Larry Moreland ◽  
Hilary Peterson ◽  
Rohit Aggarwal
Keyword(s):  
Rheumatoid Arthritis ◽  
Quality Improvement ◽  
Herpes Zoster ◽  
Immunosuppressive Therapy ◽  
Eligible Patient ◽  
Quality Improvement Project ◽  
Post Intervention ◽  
Improvement Project ◽  
Intervention Phase ◽  
Vaccination Rates

Objective.To improve herpes zoster (HZ) vaccination rates in high-risk patients with rheumatoid arthritis (RA) being treated with immunosuppressive therapy.Methods.This quality improvement project was based on the pre- and post-intervention design. The project targeted all patients with RA over the age of 60 years while being treated with immunosuppressive therapy (not with biologics) seen in 13 rheumatology outpatient clinics. The study period was from July 2012 to June 2013 for the pre-intervention and February 2014 to January 2015 for the post-intervention phase. The electronic best practice alert (BPA) for HZ vaccination was developed; it appeared on electronic medical records during registration and medication reconciliation of the eligible patient by the medical assistant. The BPA was designed to electronically identify patient eligibility and to enable the physician to order the vaccine or to document refusal or deferral reason. Education regarding vaccine guidelines, BPA, vaccination process, and feedback were crucial components of the project interventions. The vaccination rates were compared using the chi-square test.Results.We evaluated 1823 and 1554 eligible patients with RA during the pre-intervention and post-intervention phases, respectively. The HZ vaccination rates, reported as patients vaccinated among all eligible patients, improved significantly from the pre-intervention period of 10.1% (184/1823) to 51.7% (804/1554) during the intervention phase (p < 0.0001). The documentation rates (vaccine received, vaccine ordered, patient refusal, and deferral reasons) increased from 28% (510/1823) to 72.9% (1133/1554; p < 0.0001). The HZ infection rates decreased significantly from 2% to 0.3% (p = 0.002).Conclusion.Electronic identification of vaccine eligibility and BPA significantly improved HZ vaccination rates. The process required minimal modification of clinic work flow and did not burden the physician’s time, and has the potential for self-sustainability and generalizability.

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.

scholarly journals Optimal management of children on antiretroviral therapy (ART) in primary care: a quality improvement project

2017 ◽  
Vol 59 (2) ◽  
pp. 49
Author(s):  
Claire Van Deventer ◽  
Lauren Golden ◽  
Erica Du Plessis ◽  
Carien Lion-Cachet
Keyword(s):  
Quality Improvement ◽  
Management Strategy ◽  
Quality Improvement Project ◽  
Hiv Positive ◽  
Post Intervention ◽  
Improvement Project ◽  
Viral Loads ◽  
Primary Health ◽  
Immunodeficiency Virus ◽  
Significant Process

Introduction: With the large volumes of human immunodeficiency virus (HIV) positive patients in South Africa, one clinical management strategy has been to task shift. This means that previously hospi-centric HIV services have devolved to primary health care (PHC) clinics. The referral pattern is true for paediatric patients as well. With the added complexity of managing children, there was a concern in the research district that children were not being optimally managed at PHC level. Method: A quality improvement project was initiated to assess HIV-positive children’s management at PHC clinics and to implement an intervention to improve this care. Results: The initial audits of 624 children in the district revealed that only 66.6% of children had undetectable viral loads (VLs). Other poor indicators were lack of regular blood results, omission of prophylactic isoniazide (INH) and cotrimoxazole etc. Documents were disorganised and not standard across the district. The intervention sought to place the local clinic doctor as the champion in each clinic. A reorganised file was planned where all the care elements would be clearly present. Conclusion: Post intervention, it was clear that where individual doctors took on the challenge of quality improvement there were significant process changes. Results are discussed in detail. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1254928

Implementing a Systematic Process for Consistent Nursing Care in a NICU: A Quality Improvement Project

2018 ◽  
Vol 37 (2) ◽  
pp. 96-104 ◽  
Author(s):  
Renay Marie McCarley ◽  
Donna A. Dowling ◽  
Mary A. Dolansky ◽  
Amy Bieda
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Project ◽  
Single Family ◽  
Post Intervention ◽  
Improvement Project ◽  
Systematic Process ◽  
Percent Increase ◽  
Care Nursing ◽  
Percent Decrease ◽  
Primary Care Nursing

AimThe global aim of this quality improvement project was to develop and implement a systematic process to assign and maintain consistent bedside nurses for infants and families.MethodsA systematic process based on a primary care nursing model was implemented to assign consistent care for a 48-bed, single-family room NICU.ResultsFour PDSA cycles were necessary to obtain agreement from the nursing staff as to the best process for assigning primary nurses. Post-intervention data revealed a 9.5 percent decrease of consistent caregivers for infants in the NICU ≤ 28 days and a 2.3 percent increase of consistent caregivers for infants in the NICU ≥ 29 days.ConclusionAlthough these findings did not meet the goal of the specific aim, a systematic process was created to assign bedside nurses to infants. Further PDSAs will be needed to refine the process to reach the aim.

101 Use of Blood Cultures to Detect Bacteraemia in Surgical Patients: A Prospective, Closed Loop Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C Osborne
Keyword(s):  
Quality Improvement ◽  
Blood Culture ◽  
Early Recognition ◽  
Blood Cultures ◽  
Quality Improvement Project ◽  
Surgical Patients ◽  
Post Intervention ◽  
Improvement Project ◽  
Continued Education ◽  
Threatening Condition

Abstract Introduction Sepsis is a complex, life-threatening condition, posing a significant burden to both NHS resources and society in general. Bacteraemia is a common presentation in surgical pathology and requires prompt investigation and treatment. Blood cultures remain the gold standard for detecting bacteraemia and providing targeted antibiotic therapy. We aimed to improve the overall use of blood cultures in pyrexial surgical patients. Method A three-loop, prospective quality improvement project was performed. Patients identified as being pyrexial were reviewed to determine when it was recorded and whether blood cultures were taken. Following a departmental presentation, two further audit cycles were performed at two months and seven months post-intervention to determine long-term response. Result A total of 56 patients were included over the three audit cycles. Blood culture adherence improved from 58.7% at baseline to 65% at 7 months. Most notably, out-of-hours compliance improved from 44.4% to 66.6%. 2-month compliance was 85%, however, this comprised of only 7 patients. Conclusions Early recognition and management of sepsis remains a key area of improvement. Whilst overall and out-of-hour blood culture compliance improved, continued education is needed to further increase this.

scholarly journals P059: Who will be ready to fly? Characteristics of successful and unsuccessful geriatric discharges from the Nanaimo Regional General Hospital emergency department through the ED2Home program

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S77-S78
Author(s):  
E.E. Hack ◽  
A. Rashidi
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Elderly Patients ◽  
General Hospital ◽  
Retrospective Chart Review ◽  
The Elderly ◽  
Chief Complaint ◽  
Quality Improvement Project ◽  
Living Situation ◽  
Improvement Project

Introduction: As the baby-boomer generation ages, the number of elderly patients with complex health issues visiting emergency departments (EDs) will continue to increase. Evidence suggests elderly patients often have better health outcomes if they can be managed at home with appropriate community and primary care supports in place, rather than being admitted to hospital. ED2Home is a program that launched March 1, 2016 in the Nanaimo Regional General Hospital (NRGH) ED. It aims to assess admitted patients aged 70 and over and discharge them with community supports and follow-up. The aim of this Quality Improvement project was to evaluate how many patients were successfully discharged by the ED2Home program in its first few months, and to characterize which patients were more likely to be successfully discharged versus bounce back to the ED. Methods: This Quality Improvement project audited the charts of 87 patients discharged by ED2Home from June-Sept 2016. Variables examined included the following: age, gender, chief complaint, mobility status, living situation, which ED2Home health care provider (RN vs MD) to facilitate discharge, whether patient had a family physician, and resources used (ex. pharmacy, physiotherapy, occupational therapy, etc.) to help facilitate discharge. Our evaluation was conducted by means of a retrospective chart review. Descriptive statistics were derived for variables of interest. Results: There were 87 patients discharged home by the ED2Home whose charts were reviewed. 48 (55%) of these patients were successfully discharged home without revisit to the NRGH ED within 30 days of discharge. 29 patients returned to the NRGH ED within 30 days of original discharge for the same original chief complaint. Patients successfully discharged were similar to those who bounced back in terms of gender and mean age. Patients who bounced back to the ED were more likely to have chief complaints of dyspnea and confusion compared to those successfully discharged. Patients who were successfully discharged had a higher proportion of patients with social admissions compared to those who bounced back to the ED within 30 days. A higher proportion of patients successfully discharged had been evaluated by the ED2Home physician (versus nursing alone) compared to patients who bounced back within 30 days. Conclusion: ED2Home appears to be successful at discharging patients and preventing revisit to the ED and re-hospitalization, similar to other transitional programs for the elderly that have been reviewed in the literature. Patients presenting with more complex issues, such as dyspnea and confusion, may not be as suitable for rapid discharge from the ED through this program as patients presenting with issues helped by additional allied health care supports, such as failure to thrive/social admission. Additional Quality Improvement iterations of the ED2Home program should be undertaken in the future, using these suggestions.

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