Establishing a Contingency Plan to Improve Patient Comfort During Peripherally Inserted Central Catheter Insertions: A Quality Improvement Effort

Highlights Abstract Background: Negative outcomes can occur when painful experiences related to needle procedures are not addressed. Patients at the institution in this study were not demonstrating sufficient levels of comfort during peripherally inserted central catheters (PICC) placements, so formal assessment of discomfort or distress began via the Pediatric Sedation State Scale (PSSS), and an enhanced approach to comfort planning, built around the Comfort Promise, was implemented. Over 1 year, we aimed to increase the percent of patients meeting sufficient comfort during PICC insertions by our Vascular Access Team (VAT) from 54% to 65%. Methods: Initially, VAT staff were educated on use of the PSSS and began routinely charting the highest score obtained during each PICC placement. Interventions were delivered concurrently and included (1) changing the VAT culture, (2) process development, (3) consensus building and scale up, and (4) information system modifications. Results: During the project period, 421 PICC insertions were completed. From baseline to the last 8 months, the percent of patients rated as experiencing sufficient comfort (PSSS = 2–3) during PICC placement increased from 54% to 74%, with the percent of patients experiencing significant discomfort or distress (PSSS = 4–5) decreasing from 45% to under 7%. Conclusions: Success in this project required a culture change. Building consensus by engaging others and integrating with the processes, preferences, and priorities of each area was key. Future work will focus on increasing use of all Comfort Promise bundle elements, identifying patients at risk for escalation, and taking a long-term view to comfort planning, as well as applying lessons learned to other needle procedures.

Optimal Return Policies and Micro-Plastics Prevention Based on Environmental Quality Improvement Efforts and Consumer Environmental Awareness

Consumers initiating returns online may produce secondary packaging, while most of the packages are produced by plastics. The more products are returned, the more plastics are used. Existing research indicates that the plastic packages can contribute to the micro-plastics pollution of the environment. As consumer environmental awareness (CEA) improves, more and more consumers are willing to pay extra fees to change the materials of packages from plastics to others in order to protect the environment, prompting enterprises to adjust to their return policies. In this context, this paper takes environmental quality improvement effort and the environmental coefficient as decision variables, and compares the manufacturer’s optimal decisions under with and without return policy. Our results show as follows: (1) There is a positive correlation between CEA and environmental quality improvement effort and the environmental coefficient; that is, environmental quality improvement effort and the environmental coefficient increase with an increase in CEA; (2) When CEA is high (k≤τ≤d), there is a threshold for manufacturers to invest in environmental effort. However, when CEA is low (0≤τ≤k), regardless of the return policy the manufacturer implements, its profit increases with the promotion of CEA, and when the manufacturer allows consumer returns, the relationship is more obvious; (3) The manufacturer should adopt an appropriate return policy according to the changes in CEA. When CEA is low (0≤τ≤k), the manufacturer should adopt a without return policy; when CEA is high (k≤τ≤d), the manufacturer should adopt a full refund (r=p) return policy, which is the optimal profit, and increase investment in environmental protection. From the above conclusions, we suggest that the government should increase the publicity of environmental protection, consumers should establish the awareness of green consumption, and enterprises should increase investment in environmental quality improvement to achieve sustainable development.

Increasing Skin-to-Skin in a Level IV NICU: A Quality Improvement Project

Purpose To evaluate the effect of a bundled intervention on the number of skin-to-skin (“kangaroo care”) events occurring in a level IV NICU. Design A quality improvement effort centering around the introduction of an intervention bundle intended to safely increase the rate of skin-to-skin holding. Rates of unplanned extubations were recorded as a balancing measure to estimate safety. Sample All infants admitted to the NICU from December 2017 through September 2019 were included. The “preintervention” period was the 6 months prior to the initiation of the intervention bundle (December 2017–May 2018). Results The absolute number of skin-to-skin holds increased from the preintervention phase (range 7–28 holds/month, median 11 holds/month) to the postintervention phase (range 16–100 holds/month, median 55 holds/month). The total unplanned extubations showed no significant change between the preintervention and postintervention periods.

Two-phase deteriorated supply chain model with variable demand and imperfect production process under two-stage credit financing

In this article, an imperfect production inventory model consisting of a manufacturer and a retailer with quality improvement effort and the promotional effort sensitive demand pattern is investigated under a two-tier credit policy. We study the model for deteriorating items where the deterioration occurs at different rates in the manufacturer’s and the retailer’s level considering a fixed lifetime of the product. Discussing the six possible cases of credit policy analytically, we analyze the behavior of the model under an integrated system concerning production lot-size, quality effort and promotional effort such that the integrated average profit is maximum. To obtain the optimal solutions of the model, we design an operative solution algorithm. A numerical example is provided to test feasibility of the model, and the effect of the variation of the key parameters is also studied. The outcomes of this proposed model show that the manufacturer and the retailer have to be more careful about their offered credit periods in aspect of the profit. It is observed that the integrated profit is maximum when both credit periods provided by the manufacturer and the retailer belong to the manufacturer’s cycle. Moreover, we identify that the extended product lifetime does not meet with higher profit all times. This study directs that quality effort and promotional effort stimulate the market demand while it is not always economically profitable for the supply chain.

A conceptual model to guide research on the activities and effects of innovation champions

Background: The importance of having a champion to promote implementation efforts has been discussed in the literature for more than five decades. However, the empirical literature on champions remains underdeveloped. As a result, health organizations commonly use champions in their implementation efforts without the benefit of evidence to guide decisions about how to identify, prepare, and evaluate their champions. The goal of this article is to present a model of champion impact that draws upon previous literature and is intended to inform future research on champions and serve as a guide for practitioners serving in a champion role. Methods: The proposed model is informed by existing literature, both conceptual and empirical. Prior studies and reviews of the literature have faced challenges in terms of operationalizing and reporting on champion characteristics, activities, and impacts. The proposed model addresses this challenge by delineating these constructs, which allows for consolidation of factors previously discussed about champions as well as new hypothesized relationships between constructs. Results: The model proposes that a combination of champion commitment and champion experience and self-efficacy influence champion performance, which influences peer engagement with the champion, which ultimately influences the champion’s impact. Two additional constructs have indirect effects on champion impact. Champion beliefs about the innovation and organizational support for the champion affect champion commitment. Conclusion: The proposed model is intended to support prospective studies of champions by hypothesizing relationships between constructs identified in the champion literature, specifically relationships between modifiable factors that influence a champion’s potential impact. Over time, the model should be modified, as appropriate, based on new findings from champion-related research. Plain language summary An innovation champion is an individual who works within an organization and who dedicates themselves to promoting a change within the organization, such as implementing a new intervention or a new quality improvement effort. Health organizations commonly rely on innovation champions, and existing literature on champions suggests they are important for successful organizational change. However, many questions remain about what effective champions do and what types of support they need to perform their champion role well. The goal of this article is to present a model of champion impact that draws upon previous literature and is intended to serve as a guide for future research on champions. In doing so, the model could support coordinated research efforts that answer questions about the characteristics, activities, and impacts of champions. Ultimately, this research could lead to development of useful guidance and tools for health system leaders to support champions within their organizations.