Reducing Length of Stay and Hospital Readmission for Orthopedic Patients: A Quality Improvement Project

BackgroundTransitioning patients from the hospital to home after a total hip or knee arthroplasty is challenging. Severe pain, comorbidities and complex medication regimes have the potential to delay readiness for discharge, increase length of stay (LOS), and cause readmissions.ObjectiveThe goal of this practice improvement project was to improve patient readiness for discharge after total joint arthroplasty to reduce LOS, prevent emergency department (ED) visits, and prevent hospital readmissions.MethodsThis quality improvement project was guided by the Iowa Model and implemented a prepost program implementation evaluation design. Nurses incorporated the Registered Nurse Assessment of Readiness for Hospital Discharge Scale (RN-RHDS) to guide and evaluate discharge education efforts.ResultsThe focused education cohort demonstrated significantly decreased LOS and decreased readmissions compared to the cohort receiving standard education efforts. ED visits were not significantly different amongst cohorts.ConclusionThis practice improvement project demonstrates successful translation of research into practice.Implications for NursingThe use of focused education and the RN-RHDS tool is recommended for nursing to improve patient readiness for discharge and patient outcomes.

Effects of Self-Monitoring Physical Activity Using Technology in Primary Care: A Pilot Intervention

BackgroundPhysical activity (PA) is a primary factor in reducing the risk of chronic diseases, yet only half of U.S. adults meet recommended levels.ObjectiveTo evaluate a PA self-monitoring pilot intervention using technology in obese adult primary care patients.MethodsThe project had a prospective, single group, pretest/posttest design using an accelerometer with a smartphone app. Obese adult primary care patients (N = 31) were followed over 6 months. Demographic (age, race, sex, marital status, educational level) and PA-relevant (PA, body mass index [BMI], self-efficacy for exercise [SEE]) data were collected at enrollment. PA and BMI were recorded monthly for 6 months. SEE was reassessed at 6 months.ResultsPA and BMI showed gradual improvement; however, changes in PA (p = .130), BMI (p = .326), and SEE (p = .877) at 6 months were not statistically significant. A strong, negative relationship was found between PA and BMI (r = −.727, p < .01). Anecdotal data indicated the smartphone app was acceptable to patients.ConclusionsData-supported clinician-initiated PA self-monitoring with a smartphone app was acceptable and showed favorable trends in improving PA and BMI in obese adult patients.Implications for NursingPrescribing PA self-monitoring using technology may be easily implemented.

Improving the Perception of Patient-Centered Wellness in a Virtual Population During the COVID-19 Pandemic

BackgroundPerceived health-related quality of life (HRQOL) is fundamental to well-being and is a meaningful way to measure physical and mental health.Local ProblemNo standard method exists for measuring perceived HRQOL during the COVID-19 pandemic in participants as they attempt to improve their self-determined wellness goals. An implementation plan that considers the social distancing limitations imposed can be used to predict an individual’s likelihood of long-term success.MethodsDuring the four, 2-week plan-do-study-act (PDSA) cycles, the Social Cognitive Theory model informed the implementation of the four core interventions. To guide iterative changes, the data was analyzed through Excel and run charts.InterventionsThe four core interventions were the shared decision-making tool (SDMT), health mobile app tool (HMAT), wellness tracker tool (WTT), and the team engagement plan.ResultsAmong 28 participants, perceived quality of life increased by 70%, engagement in shared decision-making increased to 82%, app use and confidence increased to 85%, and goal attainment reached 81%.ConclusionsThe SDMT, health app, and wellness tracker created a methodical plan of accountability for increasing participant wellness. The contextual barrier of the COVID-19 pandemic added a negative wellness burden which was mitigated by creating a patient-centered culture of wellness.

Improving Suicidal Ideation Screening and Suicide Prevention Strategies on Adult Nonbehavioral Health Units

BackgroundSuicide is a risk in hospitalized patients within and outside of behavioral health units. Williams et al. (2018). Incidence and method of suicide in hospitals in the United States. Williams et al. (2018), suicides occur annually in hospitals, 14%–26% of occurrences outside of a behavioral health unit.ObjectivesThe purpose of this project was to improve compliance with universal patient suicide ideation screening and targeted actions for patients screening positive admitted to nonbehavioral health units.MethodsElectronic medical record (EMR) changes to support screening and targeted patient safety measure documentation were implemented. Nursing education was provided to support these changes. Pre- and postassessments were used to measure knowledge gained from the education. A compliance report was generated from the EMR to measure compliance with universal screening and patient safety measures.ResultsIn a 4-month period, screening compliance improved by 20.6%, bedside safety companion use was 100%, suicide precautions, documentation 82.5%, and a behavioral health social work note documented 76% of the time.ConclusionsUniversal screening improvement is feasible and has the potential to improve patient safety. Implementation should be considered across health care organizations.Implications for NursingProviding nursing education and easier EMR workflows for nursing documentation of suicide screening and prevention strategies improves patient safety.

Correct Execution of the Nasopharyngeal Swab: A Fundamental Method to Improve Diagnosis of SARS-CoV-2 Infection

BackgroundSevere acute respiratory infection Coronavirus 2 (SARS-CoV-2) infection has spread all over the world since December 2019. Treatment of the syndrome represents an important challenge for all physicians. Spread prevention relies on a correct diagnosis which is performed with nasopharyngeal swabs.ObjectiveTo describe the proper execution of the swab with a few simple steps.MethodsFigures and video recording.Results:A few simple steps are presented within this paper in order to perform easily nasopharyngeal swab for SARS-Cov-2 diagnosis and for other possible infectious diseases of the airways tract.Conclusions and Implication for NursingNasopharyngeal swab may be performed in an easier way than usually thought. This method may also be used for any other microorganism detection. By following simple steps, a correct diagnosis can easily be obtained.

Nursing Students' Perception Regarding Community Health Nursing Practical Modules Experience, at the Faculty of Nursing, [Institution MASKED], Egypt

BackgroundLearning depends not only upon how teachers have designed and structured their subjects and courses but also upon how their students perceive and understand this design and structure. Understanding student's level of perception with their clinical education forms a basis of determining the quality of nursing education.ObjectiveAssess nursing students' perception of their learning experience with community health nursing practical modules.MethodsCross-sectional descriptive study, the convenience sample included 149 students studying a community health nursing practical course at the Faculty of Nursing affiliated to [Institution MASKED]. Three tools were used; (a) interviewing questionnaire regarding demographic characteristics. (b) Undergraduate modules experience questionnaire and (c) Student evaluation of clinical education environment inventory.ResultsStudents' total perception mean scores regarding the practical modules experience questionnaire was (79.82%), and different community clinical learning environment, family health centers (82.01%), schools (76. 83%), and geriatric homes (79. 29%) with statistical significance differences p ≤ .042. Furthermore, significant relationship was found between students' academic achievement and total perception of the Undergraduate Modules Experience Questionnaire (UMEQ) and its subscales, Good Teaching, Intellectual Motivation (p ≤ .01), Clear goals and standards and Generic Skills (p ≤ .04), Appropriate Assessment and Overall Satisfaction (p ≤ .05).ConclusionNursing students revealed a higher positive perception of community health nursing practical modules experiences. However, there was few areas are required for improving quality of the practical modules.Implications for nursing educationIncreasing period of students' clinical training exposure, teaching the skills of effective time management as well as increasing number of the academic staff in the community health nursing department are recommended strategies for improving quality of community health nursing practical modules.

Survey of Nursing Faculty Preparation for Guiding DNP Quality Improvement Projects

BackgroundQuality improvement (QI) projects comprise the majority of University of Maryland School of Nursing (UMSON) Doctor of Nursing Practice (DNP) projects.MethodsAn online survey was completed by 51% (n = 38) of faculty, who teach or mentor DNP students, and was analyzed using quantitative and descriptive methods.ResultsFaculty were somewhat or not familiar with developing a QI charter 68.4%, human error theory and error proofing 63.2%, driver diagrams 60.5%, characteristics of high-reliability organizations 60.5%, and Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines 55.3%. The faculty were most interested in learning more about (n = 97 responses) were human error theory and error proofing (28.9%), SQUIRE guidelines (26.3%), statistical process control (21.1%), and implementation strategies and tactics (21.1%). The most commonly identified challenges included identifying QI projects (24%), project time constraints (16%), keeping up-to-date on QI concepts, methods, and tools (12%), and balancing professional workload (10%).ConclusionsGaps in self-reported QI knowledge indicate there is a need for further development of DNP and PhD prepared faculty at the UMSON.

Implementing Delirium Screening in an Intermediate Care Unit

BackgroundDelirium occurs in as many as 82% of hospitalized patients. Use of a valid and reliable tool allows for early detection and management to mitigate adverse effects, including a decrease in patient falls.ObjectiveTo conduct a quality improvement project to implement the confusion assessment method (CAM) tool in an intermediate care unit and measure delirium screening compliance, feasibility of the tool, and the effect on reported patient falls.MethodsWeb-based training using a 14-item pre–post assessment for knowledge comprehension. The CAM tool was added to the electronic health record (EHR), and documentation compliance was measured for eight weeks. Afterwards, a nurse perception survey was distributed, and 60-day pre- and post-intervention patient falls were compared.ResultsForty-seven nurses completed the training. Post-test averages were higher than the pre-test (p = .16); five answers showed significant improvement (p < .02). Screening and documentation compliance were 79.1%. Twenty-one nurses completed the perception survey, demonstrating agreement that delirium CAM screening is a feasible intervention. Patient falls were reduced by 57%.ConclusionAddition of the CAM tool into the EHR-enhanced screening compliance.Implications for NursingEarly delirium detection may reduce patient falls. The CAM is a feasible instrument and delirium screening is a worthwhile intervention.

Implementing an Evidence-Based Bundle to Reduce Early Labor Admissions and Increase Adherence to Labor Arrest Guidelines: A Quality Improvement Initiative

BackgroundAt many hospitals, the cesarean birth rate among nulliparous term singleton vertex (NTSV) pregnancies is higher than World Health Organization benchmarks. Reducing NTSV cesarean birth is a national quality imperative. The aim of this initiative was to implement an evidence-based bundle at an urban community teaching hospital in at least 50% of labors in 60 days in order to reduce early labor admissions and increase adherence to evidence-based labor management guidelines shown to decrease cesarean birth.MethodsChart audits, root-cause analysis, and staff engagement informed bundle development. An early labor triage guide, labor walking path, partograph, and pre-cesarean checklist were implemented to drive change. Four Rapid Cycle Plan Do Study Act cycles were conducted over 8 weeks.ResultsThe bundle was implemented in 58% of births. The bundle reduced early labor admissions labor from 41% to 25%. Team knowledge reflecting current guidelines in labor management increased 35% and 100% of cesareans for labor arrest met criteria. Patient satisfaction scores exceeded 98%.ConclusionsImplementing an evidenced-based bundle was effective in reducing early labor admissions and increasing utilization of and adherence to labor management guidelines.Implications for NursingImplementation of evidence-based bundles has the potential to achieve meaningful quality improvements in maternity care.

Improving Holistic Care Skills for Advanced Practice Registered Nurses: Integration of a Complementary and Alternative Medicine Course into a Doctor of Nursing Practice Curriculum

BackgroundComplementary alternative medicine (CAM) is an expanding domain of healing practices harmonized with Western medicine to provide comprehensive treatment of individuals as holistic beings. Patients and healthcare providers worldwide are increasingly inviting and employing CAM practices into healthcare delivery routines. Implementation of courses to introduce CAM into Advanced Practice Registered Nurse (APRN) programs exposes future practitioners to current best practices for integrative treatment strategies and encourages consideration when developing a holistic patient-centered care plan.Objective/MethodsA case presentation of an interprofessional CAM course delivered to military graduate nursing students with a pretest posttest course survey to evaluate student’s confidence and knowledge of CAM theory and practices. The format included online modules, evidence-based literature critique, knowledge checks, and an immersive hands-on immersion experience.ResultsA total of 240 pre-/postcourse surveys were completed by military graduate nursing students (N = 140) participating in a CAM course. Statistically significant increases in CAM knowledge, communication, and skills confidence levels were found. Following participation in the course, nearly all students (97%) agreed CAM is important and benefits future advanced practice.Conclusion/Nursing ImplicationsCAM is a compendium of holistic healing modalities increasingly being utilized by patients worldwide with similar requests for alternative care techniques from healthcare providers. Military APRN students participating in a CAM course increased knowledge and confidence, and garnered appreciation for an expanded skill set to augment future practice. Case presentation is compelling for standard inclusion of CAM and similar graduate interprofessional courses into all APRN programs.