Development of a Professional Practice Model for Neuro-oncology Advanced Practitioners at an Academic Medical Center: A Quality Improvement Project

Abstract BACKGROUND Neuro-oncology advanced practitioners (APs - nurse practitioners, physician assistants) require specialization beyond the scope of population-based generalist training and education. There are no specialty standards or certifications for neuro-oncology APs, no formal training programs, and no literature that addresses the competency requirements of neuro-oncology APs. The burden of AP turnover at an academic medical center ambulatory neuro-oncology practice was as high as 50%. This quality improvement project’s purpose was to develop a professional practice model (PPM) to support the professional development and retention of APs. METHODS Using the Focus, Analyze, Develop, Execute and Evaluate (FADE) quality improvement methodology the authors (1) reviewed literature and relevant professional organizations to identify possible professional competencies for neuro-oncology APs, (2) analyzed data to develop evidenced-based practice domains, (3) used purposive sampling to recruit a team of neuro-oncology experts, (4) conducted a Delphi study with the experts to gain consensus on practice domains and professional competencies, and finally (5) utilized the Delphi study results to create a PPM for neuro-oncology APs. RESULTS The authors recruited twenty-three participants (39% were physicians, 57% were APs, and 4% were administrators) for the Delphi study, which was executed via electronic transmission using Qualtrics. Participants reached consensus on six domains of practice (Medical Knowledge, Interprofessional Collaboration/Communication, System-based Practice, Professionalism, Practice-based learning, Patient/family-centered care) and fifty corresponding competency statements after two rounds of the Delphi. With the implementation of the PPM and the development of standardized onboarding, the AP turnover rate decreased from 50% to 12% in just two years. CONCLUSION This QI project successfully created a PPM for a neuro-oncology AP team. The PPM supports neuro-oncology APs by validating their unique skill set that combines several specialties. The PPM provided the framework to standardize orientation/training, evaluate performance, and promote job satisfaction and retention.

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A Quality Improvement Initiative to Decrease Inappropriate Intravenous Acetaminophen Use at an Academic Medical Center

Hospital Pharmacy ◽

10.1177/0018578719841054 ◽

2019 ◽

Vol 55 (4) ◽

pp. 253-260

Author(s):

Linda P. Nguyen ◽

Lam Nguyen ◽

Jared P. Austin

Keyword(s):

Quality Improvement ◽

Medical Center ◽

Academic Medical Center ◽

The United States ◽

Quality Improvement Initiative ◽

Improvement Project ◽

Academic Medical ◽

Effective Manner ◽

Intravenous Acetaminophen ◽

Oral Ibuprofen

Background: Following availability in the United States in 2011, intravenous acetaminophen (IV APAP) was added to many hospital formularies for multimodal pain control. In 2014, the price of IV APAP increased from $12/g to $33/g and became a top 10 medication expenditure at our institution. Objective: To promote appropriate IV APAP prescribing and reduce costs. Design, Setting, Participants: Quality improvement project at a 562-bed academic medical center involving all inpatient admissions from 2010 to 2017. Interventions: Using Plan-Do-Study-Act (PDSA) methodology, our Pharmacy & Therapeutics (P&T) committee aimed to reduce inappropriate use of IV APAP by refinement of restriction criteria, development of clinical decision support in the electronic medical record, education of clinical staff on appropriate use, and empowerment of hospital pharmacists to enforce restrictions. Measurements: Monthly IV APAP utilization and spending were assessed using statistical process control charts. Balancing measures included monthly usage of IV opioid, IV ketorolac, and oral ibuprofen. Results: Five PDSA cycles were conducted during the study period. Monthly spending on IV APAP decreased from the highest average of $56 038 per month to $5822 per month at study conclusion. Interventions resulted in an 80% annual cost savings, or an approximate savings of $600 000 per year. Usage of IV opioids, IV ketorolac, and oral ibuprofen showed no major changes during the study period. Conclusions: IV APAP can be restricted in a safe and cost effective manner without concomitant increase in IV opioid use.

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Abstract TP380: Improving Outcomes for Stroke Patients at Risk for Cognitive and Mood Impairments

Stroke ◽

10.1161/str.48.suppl_1.tp380 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sanny Djoeva ◽

Melissa N Lara-Angulo

Keyword(s):

Quality Improvement ◽

Cognitive Decline ◽

Medical Center ◽

Academic Medical Center ◽

Quality Improvement Project ◽

Provider Education ◽

Stroke Patients ◽

Post Intervention ◽

Improvement Project ◽

Referral Compliance

Background: Improved survival rates of stroke patients have resulted in a rise in disability within this population. Research demonstrates that stroke patients are at high risk for cognitive decline and depression. Neuropsychological intervention can improve outcomes for this population. At an academic medical center in the Midwest, the process in which stroke patients are screened for these impairments and subsequently referred to a neuropsychologist is ineffective. Purpose: The purpose of this quality improvement project was to critically appraise the process in which stroke patients are screened for cognitive decline and depression and to improve the process using a multi-disciplinary approach of nursing, medicine, rehabilitation and neuropsychology. Methods: A total of 231 patient charts were reviewed in this quality improvement project. The Plan-Do-Study-Act model was utilized. Process changes included: provider education on order placement of neuropsychology referrals, occupational therapist education on correct progress note use, and improvement of visibility of the stroke patient list to screening staff. Pre- and post-intervention data were examined to assess for changes in screening compliance and consultations. Results: Baseline data collected December 2016 showed 64% compliance with Montreal Cognitive Assessment (MoCA) screening, 50% compliance with Patient Health Questionnaire (PHQ-2) screening, and 50% compliance with neuropsychology referral. After new processes were implemented, April 2016 data showed 100% MoCA compliance, 95% PHQ-2 compliance, and 100% neuropsychology referral compliance. Although these numbers look promising, we will continue to gather and analyze data to ensure this positive compliance trend continues. Conclusion: Multidisciplinary education and increased visibility of stroke patients requiring a screening may increase compliance of cognitive decline and depression screening as well as subsequent referral to neuropsychology. The increase in screening compliance will ultimately lead to appropriate referrals and further resources for the stroke population.

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