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- ItemClinical News: Improving Warfarin Adherence in Elders(Today's Geriatric Medicine, 2018-07) Brown, Sarah J.Medication adherence is at problematic levels in the geriatric population, and lack of adherence to warfarin therapy is a significant issue. Failure to adhere to the medication guideline for warfarin results in life-threatening adverse events. According to Maloney and Kagan, older patients' adherence to neoplastic oral agents is improved by the patients' knowledge.1 Education is an essential component of medication compliance for geriatric patients on warfarin therapy. Therefore, using education as a tool to increase medication adherence in the geriatric population is imperative to patients' continued well-being. The implementation of a practice change—an individualized education program designed for warfarin patients—will not only improve patients' adherence but also decrease the likelihood of an adverse event occurring due to noncompliance.
- ItemHealth Literacy and Health Outcomes of Adults in the United States: Implications for Providers(Internet Journal of Allied Health Sciences and Practice, 2018) McDonald, Marilyn; Shenkman, LauraThe purpose of this paper is to explore health literacy of adults in theUnited States and review health outcomes as well as provider implications. Limited health literacy is a serious problem in the United States. Approximately 80 million adults in the United States have limited health literacy, which can adversely affect the quality of their health care. Poor health outcomes are associated with being health illiterate. Evidence shows that limited health literacy is associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications properly; poorer ability to interpret drug labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates. Health literacy is essential for patients to be able to take control and manage their own health. The benefits of being health literate include greater patient safety, less hospitalizations, a greater ability to care for oneself, and a greater cost savings to the healthcare system. This paper emphasizes “best practices” recommended by the World Health Organization (WHO),1 The American Medical Association (AMA),2 the Institute of Medicine (IOM),3 the Center for Disease Control (CDC),4 and the Joint Commission (JCAHO) 5 When patients, providers and communities work together to understand and improve health literacy a greater quality of life will result. Today’s health care providers are in a position to make an impact on the health illiteracy epidemic and improve the patient’s understanding about their health and outcomes.
- ItemHypertension Assessment and Dietary Intervention(2021) Bennett-Marsh, MaxineThe purpose of this project was to provide the Dietary Approaches to Stop Hypertension (DASH) diet education as a health intervention to minimize the risk of individuals who were hypertensive or pre-hypertensive from experiencing a heart attack or stroke (Che Wan Mansor et al., 2019). The DASH diet specifically includes fruits, vegetables, nuts, dairy products, chicken, fish, and food low in saturated fat, cholesterol, sugar, sodium, and refined carbohydrates. The project was administered at a faith-based practice setting in Waldorf Maryland for individuals in the population at the faith-based practice setting who were diagnosed with hypertension, or who could have been prehypertensive. In addition, the purpose of this project was to introduce the participants to the DASH diet that could, if followed, improve the likelihood of overcoming the hypertension they were experiencing. Expected outcomes of the project were that the participants would experience a reduction of hypertensive blood levels to a safe range, and they would adopt a healthy diet that would, if followed, contribute to success in blood pressure control. The project 4-week session was held from August 8, 2021 to September 5, 2021. The participants’ blood pressure was measured three times – day 1, day 15, and the last day, and the changes in blood pressure during that time were calculated and evaluated at the end of the project. In addition, the participants were educated about the benefits of the DASH diet as a means of adopting a lifestyle change for successful blood pressure management. The result of the project was that most of the participants experienced reduced blood pressure because of following the DASH diet. In addition, all the participants agreed that monitoring and controlling their blood pressure was very important. All the participants also agreed that the DASH diet was an effective tool for managing their blood pressure.
- ItemImplementation of Stroke Protocols in the Pediatric Practice Setting(2021) Tilton, VickyBackground: A large amount of work and research has been completed by many teams to show the impact of stroke along with the increased incidence of stroke diagnosis within the pediatric population. There is a critical need for guidelines and established protocols to support standardized care delivery expectations within the pediatric population. A process improvement project aimed at early diagnosis of stroke, rapid testing indications, and well-defined treatment regimens was the focus for a pediatric setting that had no established standardized practice to care for the pediatric stroke patient. Methods: The project work took place in a 260-bed acute care pediatric hospital and the practice setting was the Emergency Department. The patient population focused on included newborn to 21 years of age and further defined by the patient encounters in which initial assessment focused on altered mental status, changes in behavior, sluggishness, slurred speech, delayed response times, seizure, and changes in personality. Through the incorporation of a step-by-step protocol guided by policy allowed for early recognition, rapid testing to aid in diagnosis, neurology consultation, and implementation of treatment plan applicable to diagnosis. A systematic review and extensive literature review were completed along with a randomized control trial conducted. Data collection occurred through a pre- and post- education survey, summative survey, and review of emergency department patient encounters data. Results: Stroke is a major cause of morbidity and mortality in children. Centers that focus on streamlining protocols inclusive of imaging minimize diagnosis delays, enhance recognition, and have led to fostering improved patient outcomes. Prior to the implementation of pediatric stroke protocols the organization encountered 60-80 patients a year (2015-2019) diagnosed with pediatric stroke. Of these identified patients, 100% were transferred out to a higher level-of-care facility. Over the course of 2020, timing related to radiological testing was greater than 2 hours with neurology consults occurring only 25% of the time. With the implementation of pediatric stroke protocols in 2021, over the course of just 3 months (April-June), the timing of assessment, provider consult, and radiological testing in now completed under 2 hours. The average response time for the Emergency Department provider is 7 minutes. The average radiological test is now 60 minutes and the pediatric intensivists response time is under 30 minutes. From April 2021 to June 2021, there were a total of 9 patient encounters in the emergency department with a diagnosis of stroke. Of these patients, 50% were transferred to a higher level-of-care facility and 50% were admitted and treated within the practice setting. Prior to education amongst clinicians, 37% of surveyed staff were unfamiliar with standardized stroke care and recognition of stroke in the pediatric patient. Following focused education along with implementation of pediatric stroke protocols, 100% of surveyed staff are now confident in distinguishing stroke and in managing care. Conclusions: Implementing pediatric stroke protocols has led to improved safety, efficiency, quality, and decreased disparity. The protocols built and implemented have allowed for standardized practice amongst the providers and clinicians. Additionally, the close collaboration and communication with the entire multidisciplinary team throughout the course of the project has led to sustained practice and enhanced relationships based on trust and respect. Ongoing education is indicated and has been incorporated into staff onboarding and training. The ability to recognize stroke in pediatrics is life saving and life changing.
- ItemImplementation of Telemedicine Medication Management Protocol to Improve Medication Management for Children with Attention Deficit Hyperactivity Disorder (ADHD) Children in a General Pediatrics Clinic(2021) Hinck, BryanaIn general pediatric offices across the country, frustration with controlled medication refill processes for patients with Attention Deficit Hyperactivity Disorder (ADHD) is felt by both parents and healthcare providers. This frustration stems from governmental restrictions on the amounts that can be prescribed at a time as well as office policies on timing on refills. Due to the nature of controlled medications, prescriptions can only be written for 3 months at a time with medication review appointments every 6 months. There are many telephone calls to and from a pediatrics office regarding refills which includes medication side effects, dosing, effectiveness of medications, and pharmacy locations, which, if all information is gathered at one time would decrease the time it takes to refill the medications. The purpose off the Doctor of Nursing Practice (DNP) project was to implement and evaluate a protocol to significantly decrease telephone calls to and from a general pediatrics office regarding controlled medication refills for patients with ADHD. 175 patients were contacted during the 4 months of this protocol implementation. The data used was length of call, how many calls went to and from the office for each patient, who made the call, and any qualitative data from patient caregivers regarding the process. Evaluation of the protocol was completed after the implementation phase for effectiveness, ease of use, and continued use within the clinic. The data was collected on log sheets to track incoming and outgoing calls which ensured that patients who were not on the master list of the clinic were tracked. As a population health project, the primary goal was to improve the medication refill process and minimize interruptions in therapeutic medication management of ADHD symptoms. After the 4-month implementation of this project, there was a significant decrease in the number of calls to and from the clinic with an incidental finding of increased scheduling of medication review appointments in advance. The project was adopted by the clinic due to the promising data of a significant decrease in calls regarding medication refills. With the success of the protocol within a short timeline, the opportunity for application to other specialties is available.
- ItemImplementing an Oral Care Protocol in a Hospital Setting to Reduce Non-Ventilator Hospital Acquired Pneumonia(2021-05-11) Simmons, JessicaOral care is a modifiable risk factor for NV-HAP yet oral care provision at the selected facility was inconsistent due to inaccessible or unavailable oral care supplies, possible low priority with nursing staff, and lack of a standard oral care protocol. An oral care protocol was implemented within the hospital setting to reduce NV-HAP. The protocol included all inpatient adult units, excluding labor and delivery along with the centers for mental health units. Evaluation of the project was conduction through pre and post intervention comparison of ICD-10 codes, nursing documentation of oral care, oral care prevalence survey, and nursing knowledge survey. Post implementation evaluation data showed an increase in oral care practice based on nursing documentation, availability and use of oral care supplies. Improved understanding of providing oral care to prevent HAP, made oral care a higher priority for nursing staff. While data was limited, a decrease in NV-HAP was noted the month following the oral care protocol implementation.
- ItemImproving Acute Care Provider Communication(2021-02-23) Buchanan, Joan M.Communication is translated in a variety of methods and modalities and can have many positive outcomes when performed effectively. The acute care inpatient hospitalists must communicate with a plethora of specialty consults to ensure the safest quality care is provided. Not all providers communicate effectively impacting the patient outcomes, provider job satisfaction, and organizational bottom line. Requiring an online professional communication development course be completed during the onboarding process for providers and general orientation for all other staff can ensure all staff begins their employment life cycle receiving the same information concerning the organization’s mission, vision, values, and standards of respect with each other as well as patients. This project will educate the acute care inpatient hospitalists first then mushroom out to all other providers and staff after appropriate modifications have been made based on feedback from the pilot group and acute care inpatient hospitalists. The return on investment for the organization after the project will include improved patient outcomes as shown by improved comments during nurse manager rounds and on the HCAHPS survey, and fewer complaints submitted through the grievance and complaint process. An additional return on investment will be a more positive word of mouth in the community from patients and their support system and an increase in job satisfaction of staff.
- ItemA Policy for Change, Health Education, and Childhood Obesity Prevention(2021-05-11) Lewis, Holly A.The rate of overweight and obese children continues to rise; it becomes apparent that there is a gap in healthcare regarding childhood obesity. Overweight and obese children have more health issues. Methods: A policy was created for the local area community healthcare clinic based on the AAP’s Algorithm for assessment and management of childhood obesity in patients 2 years old or older. The algorithm implemented the EBP into the organization. The policy was customized to the community health clinics’ unique population of culturally diverse, lower socioeconomic status, under-insured, uninsured, and under-served patient population. Findings: Overall results were that 81.82% of providers felt the policy helped educate children, 90.91% of providers felt the policy assisted with providing consistent care, 100% of the providers felt that having policy in EHR made following and documenting care easier, 90.91% of providers found the policy in the EHR valuable to practice, and 27.27% of the providers notice a reduction in patient’s BMI. Discussion: Implementation of EBP in the form of a policy and policy implementation for treating and educating overweight and obese children, showed to be effective in assisting providers and provider’s patient populations. This project occurred during the COVID-19 and potentially has larger implications during non-pandemic conditions. Application to Practice:The use of EBP and a policy could significantly improve practices that do not have this in place already.