Medicine and Health Sciences Commons^™

Do Premature Babies Who Are Fed Thickened Liquids, Versus Those Fed Standard Feeds, Transition More Quickly To Full Oral Feeds? A Review Of Current Research And Evidence Based Practice, Donna J. Bisbee

Interprofessional Research and Innovations Council

Do Premature Babies who are fed Thickened Liquids, versus those fed standard feeds, transition more quickly to full oral feeds?

A Review of Current Research and Evidence Based Practice

Donna J. Bisbee, MA CCC-SLP, Speech Language Pathologist, MMC,

Department of Rehabilitation Medicine October, 2017

Background/literature : Babies born prematurely (prior to 37 weeks gestational age) experience a greater percentage of medical complications than full term babies. Chronic lung disease and gastro-esophageal reflux are particularly prevalent in this population and can contribute to delays and difficulties in learning to orally feed. Inability to efficiently and safely feed orally frequently contributes to …

Delirium Reduction Strategies For The Critically Ill, June Chaves, Sam Canonico, Will Cheney, Tammy Corey, Gil Fraser, Alex Kowalewski, Jen Low, Cardiac Intensive Care Unit, Haley Pelletier, Cathy Palleschi, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Maine Medical Center

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge.

In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant …

Improving Type And Screen Specimen Collection Prior To Elective Surgery, Nordx Blood Bank Staff, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

Maine Medical Center

To avoid delays in the availability of compatible blood for elective surgery patients requiring transfusion, a type and screen specimen should be completed at least 24 hours prior to surgery. Baseline metrics in an acute care inpatient blood bank demonstrated a significant number of cases with no type or screen completed.

The objective of this KPI was to prevent any delays in providing compatible blood products to scheduled surgical patients. Several internal and external system issues were identified as a result of a root cause analysis and a number of actions were initiated.

Outcomes have been positive. Data collection post …

Improving Cardiology Patient Flow In Nuclear Medicine, Kelly Haar, Hannah Sullivan, Kathryn Laverdiere, Nuclear Medicine Department, Haley Pelletier, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Maine Medical Center

At baseline, a nuclear medicine department found it difficult to complete cardiac stress tests within scheduled times. Using the performance improvement process, a nuclear medicine department looked to improve patient experience related to wait times for this test.

Two goals were identified and a root cause analysis was initiated. After identifying some process issues, two KPIs were developed to address them.

A root cause analysis identified some processing issues and two KPIs were instituted to address them.

As a result, one outcome was to hire an additional physician assistant to address the barrier of inadequate cardiology coverage. Next steps include …

Aligning Opioid Prescribing Pathways, Andrea Lai, Outpatient Pharmacy, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

Maine Medical Center

There is a drug epidemic sweeping the State of Maine and it continues to worsen each passing year. In 2017, the Maine legislature passed Public Law Chapter 488 to strengthen the controlled substance prescription monitoring program. An outpatient pharmacy, located in a large acute care hospital, created a performance improvement project to clarify opioid prescription and resolve any non-compliance with Chapter 488.

After a root cause analysis, several KPIs were established to include tracking the number of phone calls made by pharmacists to non-compliant providers to clarify scripts, provide one on one education and ultimately resolve non-compliance. Repeat offenders were …

Interdepartmental Rounding, Peggy Anderson, Carrie Strick, R3 Med-Surg Unit, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Maine Medical Center Operational Excellence

Maine Medical Center

STRATEGIES FOR IMPROVING COMMUNICATION BETWEEN DOCTORS AND NURSES IN AN ACUTE CARE HOSPITAL

Effective interdisciplinary communication is imperative for safe patient care in an acute care hospital environment.

A surgical unit used their HCAHPs scores to assess how often patients perceived there was good communication between different doctors and nurses during their hospital stays. The data demonstrated that this occurred 22% less often than the national average.

As a result of a root cause analysis, a number of countermeasures were initiated with the goal of achieving scores greater than the national average. Post KPI inception in the second quarter of …

Strategies To Improve Control Of Blood A1c In Diabetics, Jennifer Aronson, Leanne Bellino, Elizabeth Eisenhardt, Diane Bryant, Haley Pelletier, Internal Medicine Team, Adult Outpatient Clinic

Maine Medical Center

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less.

A root cause analysis identified several deficiencies to includelack of essential equipment, variations in

staff education and the absence of daily reminders.

Post KPI implementations, an overall decrease in the percentage of patients with poorly …

Strategies To Improve Interdisciplinary Communication In An Acute Care Inpatient Pediatric Unit, Sarah Thompson, Haley Pelletier, Barbara Bush Children's Hospital-Inpatient, Maine Medical Center, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

Maine Medical Center

Interdisciplinary patient rounding has been shown to improve patient and family satisfaction as well as reduce patient length of stay and readmission rates. In an acute care inpatient pediatric unit, baseline metrics demonstrated that 100% of the time, nursing was not included in these rounds thus resulting in sub optimal communication.

The goal of this performance improvement project was to attain increased nursing participation. Data collection demonstrated several reasons for lack of participation and corrective actions were instituted. After undertaking this KPI goal and utilizing operational excellence, 95% of the time, nurses were called to morning rounds with the medical …

Patient Fall Prevention, R9 West Cardiovascular, Cathy Palleschi, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

Maine Medical Center

PATIENT FALL PREVENTION STRATEGIES IN AN ACUTE HOSPITAL

Every year in the United States, hundreds of thousands of patients fall resulting in injury. Injured patients often require prolonged hospital stays and a resultant increase in medical costs.

The purpose of this study was to identify the current state of fall prevention strategies on a hospital inpatient acute care cardiac unit. Through a root cause analysis, some deficiencies were identified and a process improvement plan was implemented.

Several positive outcomes were attained as a result of the countermeasures initiated. Patient falls per month and total waste in dollars saw a decline …

Communication Of Medication Side Effects In An Acute Care Hospital, Deb Bachand, Rachel Caiola, R6 Neurology Med-Surg Unit, Haley Pelletier, Brendan Lilley, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

Maine Medical Center

COMMUNICATION OF MEDICATION SIDE EFFECTS IN AN ACUTE CARE HOSPITAL

Effective patient education of prescribed medication side effects improves patient safety and reduces overall risk. On an acute care hospital unit, nursing staff felt previous attempts at this education had been ineffective as demonstrated by their HCAHPs scores for communication about medications.

A root cause analysis demonstrated some flaws and several countermeasures were instituted. The goal of this KPI project was to attain a higher than national average for the specific HCAHPs score.

Post KPI inception, the unit’s HCAHPs data showed steady improvement. Within one month, the goal of an …

Identification Strategies For The Very High Fall Risk Patient In An Acute Inpatient Psychiatric Unit, P6 Inpatient Geri-Med Psychiatry, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

Maine Medical Center

Patients falling as a result of geriatric and psychiatric impairments are at a much higher risk than the average patient population. An acute care inpatient psychiatric team used baseline metrics to demonstrate increasing fall rates per month that surpassed the unit’s target number. As a result, a quality improvement project around falls was felt to be warranted.

The overall goal of this study was to improve patient safety by reducing falls for their very high risk fall population. A root cause analysis determined that this population was not being properly identified and several tools were developed and employed to better …

Statistical Forecasting Models Used To Predict Daily Patient Volumes In The Emergency Department: A Proposal For A Systematic Review, Jon White

Interprofessional Research and Innovations Council

Background: The existing and projected worldwide shortage of nurses requires numerous distinct solutions to prevent a healthcare crisis. Proposed solutions typically address the situation from different angles, including identifying ways to add new nurses to the workforce, or finding new ways to work with limited resources. This review examines the efficacy of forecasting demand in one area of the hospital, understanding the potential of its uses for short-term resource balancing and projection of need.

This systematic review will provide a current synopsis of the research published since the fall of 2007, expanding on Wargon and colleagues’ A systematic review of …

Development Of A Traumatic Brain Injury (Tbi) Order Set At Maine Medical Center, Sarah Bockian, Emily Esslinger, Martha Weatherhead

Interprofessional Research and Innovations Council

Background: Traumatic brain injury (TBI) occurs when an external force causes brain dysfunction. TBI management in the critical care setting focuses on treating the initial, or primary brain injury, as well as secondary injuries, caused by hypoxia, hypotension, and swelling. Due to the lack of consensus within the literature, in addition to numerous attending and resident physicians at Maine Medical Center (MMC), variability in care often occurs. Nursing staff within the neuro-intensive care unit at MMC noticed this variability, and approached leadership within the surgical-trauma service to create an order set focused on TBI management.

Purpose: In the TBI population, …

Development Of A Traumatic Brain Injury (Tbi) Order Set At Maine Medical Center, Sarah Bockian, Emily Esslinger, Martha Weatherhead

Interprofessional Research and Innovations Council

Development of a Traumatic Brain Injury (TBI) Order Set at Maine Medical Center

Sarah Bockian, RN, SCRN

Emily Esslinger, RN

Martha Weatherhead, RN

Background: Traumatic brain injury (TBI) occurs when an external force causes brain dysfunction. TBI management in the critical care setting focuses on treating the initial, or primary brain injury, as well as secondary injuries, caused by hypoxia, hypotension, and swelling. Due to the lack of consensus within the literature, in addition to numerous attending and resident physicians at Maine Medical Center (MMC), variability in care often occurs. Nursing staff within the neuro-intensive care unit at MMC noticed …

Can Creating A Behavioral Task Force On The Medical And Surgical Floor Increase Staff Satisfaction Rates?, Amy Lee

Interprofessional Research and Innovations Council

Can creating a Behavioral Task Force on the medical and surgical floor increase staff satisfaction rates?

Amy Lee, RN

Abstract

Background. The medical and surgical units within Maine Medical Center have seen an influx of patients with behavioral disturbances. Staff voice concerns regarding lack of knowledge and lack of support while treating patients with a medical condition and dual diagnosis of a psychiatric disorder with behavioral disturbances.

Purpose (PICOT). In adult patients on R5 with behavioral disturbances, how does the implementation of a Behavioral Task Force compared to the current practice affect staff knowledge and satisfaction?

Method. This quality improvement …

What Are The Barriers And Facilitators To Nurses’ Utilization Of A Nurse Driven Protocol (Ndp) For Indwelling Urinary Catheter (Iuc) Removal?, Brenda Clark

Interprofessional Research and Innovations Council

What are the barriers and facilitators to Nurses’ utilization of a Nurse Driven Protocol (NDP) for Indwelling Urinary Catheter (IUC) removal?

By Brenda Clark, BSN, RN, CMSRN

Background: Urinary tract infections (UTIs) are recognized as a major cause of morbidity and mortality in hospitalized patients; 80% of UTIs are related to using indwelling urinary catheters.

Reducing these infections is recognized as a National Patient Safety Goal (NPSG) by the Joint Commission; the American Nurses Association (ANA) has classified catheter associated urinary tract infections (CAUTIs) as one of the nurse-sensitive indicators that reflect the quality of nursing care. Centers for Medicare …

Does Medication Safety And Diversion Education Improve Medication Securement Practices In Scu Compared To Current Practice?, Natasha Stankiewicz

Interprofessional Research and Innovations Council

This safety quality improvement project began as newly hired SCU2 team members saw an opportunity to improve our medication safety practices and culture. The convenience of having certain medications directly available at bedside was priority. There was a lack of awareness and interest in securing medications within the department. However, the risk to our patients, families, visitors and colleagues when medications are left out, available and unsecured was apparent to new staff and others. Prior to our education, the accepted practice of unsecured medications was rampant: medications were left drawn up or exposed, setting in various open areas at bedside …

Does Medication Safety And Diversion Education Improve Medication Securement Practices In Scu Compared To Current Practice?, Natasha R. Stankiewicz

Interprofessional Research and Innovations Council

Does medication safety and diversion education improve medication securement practices in SCU compared to current practice?

Abstract

Natasha R. Stankiewicz, MS, RN, NE-BC, CCRN-CMC

This safety quality improvement project began as newly hired SCU2 team members saw an opportunity to improve our medication safety practices and culture. The convenience of having certain medications directly available at bedside was priority. There was a lack of awareness and interest in securing medications within the department. However, the risk to our patients, families, visitors and colleagues when medications are left out, available and unsecured was apparent to new staff and others. Prior to …

Can Creating A Behavioral Task Force On The Medical And Surgical Floor Increase Staff Satisfaction Rates?, Amy Lee

Interprofessional Research and Innovations Council

Abstract

Background. The medical and surgical units within Maine Medical Center have seen an influx of patients with behavioral disturbances. Staff voice concerns regarding lack of knowledge and lack of support while treating patients with a medical condition and dual diagnosis of a psychiatric disorder with behavioral disturbances.

Purpose (PICOT). In adult patients on R5 with behavioral disturbances, how does the implementation of a Behavioral Task Force compared to the current practice affect staff knowledge and satisfaction?

Method. This quality improvement study began in May 2017 and is on-going. In May, a pre-implementation survey was given to all nurses and …

Evidence Based Nutritional Management Of Adult Patients With Severe Burns, Ashley Lazarz, Samantha Waller

Interprofessional Research and Innovations Council

Clinical Scholars Abstract 2017

Title: Evidence based nutritional management of adult patients with severe burns.

Presenters: Ashley Lazarz RD, LD and Samantha Waller MS, RD, LD

Background/Literature: It is estimated that more than 2 million people suffer burns in the United States annually, resulting in approximately 3400 deaths. Burns cause pathological alterations in nearly every system of the body and changes in both metabolism and immunity in the burned patient contribute to adverse outcomes. (1) Hyper-metabolism leads to severe catabolism and loss of lean body mass in the severely burned patient making nutrition intervention critical. (2) Literature indicates that enteral …