Industrial and Organizational Psychology Commons^™

Evaluating Implementation And Barriers To Sustainability Of An Asthma Clinical Quality Improvement Project, Holly Uphold Phd, Ms, Diane Liu Md, Faap

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Purpose and Objectives

Asthma is an important public health issue in Utah and quality asthma care is essential to addressing the burden of asthma. The purpose of this initiative was to evaluate clinical asthma quality improvement (QI) program delivery formats and identify barriers to sustaining QI processes.

Intervention Approach

The focus of the intervention was to improve clinical asthma care through reducing variation in clinician knowledge about recommended asthma care and facilitating process improvements in asthma care delivery using Academic Detailing (AD) and Learning Collaboratives (LC) QI delivery formats.

Evaluation Methods

A pre/post-test design was used to compare improvements between …

Nurse-Initiated Treatment Reduces Costs For Acute Asthma In A Pediatric Emergency Department, Michael D. Johnson Md, Ms, Minkyoung Yoo Phd, Richard E. Nelson Phd, Amanda K. Nielson Md, Lauren Allen Mas, Nanette Dudley Md, Brandon Andersen Rrt, Amanda Orme Dnp, Cpnp-Ac, Cameron Mcfarland Np-C, Michael Mundorff Mba, Mhsa

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Standardized emergency department (ED) pathways can improve care delivery to children with acute asthma, though their impact on hospitalization and costs is unclear. An Acute Asthma Care Pathway (AACP) that facilitates nurse initiation of treatment was implemented at a tertiary care pediatric ED using standard quality improvement methodology. The impact of implementation was assessed using process control methodology and multivariable time series analyses between pre- and post-implementation periods. Provision of a steroid within 30 minutes and 60 minutes of arrival increased by 21 and 22 percentage points respectively, IV magnesium sulfate administration increased by 30 percentage points, the proportion hospitalized …

Outcomes Of Asthma Quality Improvement In Pediatric Patients, Kathryn M. Murray Md, Faap

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction. The Utah Pediatric Partnership to Improve Healthcare Quality (UPIQ) and Utah Department of Health (UDOH) Asthma Program Learning Collaborative is a quality improvement initiative designed to standardize asthma care in pediatric patients and improve the overall assessment and patient education process for both healthcare providers and patients. The aim of the Asthma QI Project was to improve the diagnosis and management of asthma for patients in the state of Utah by implementing a standardized approach to the identification and treatment of patients with asthma.

Methods. Patients scheduled to see a healthcare provider at our pediatric clinic were screened for …

The Development And Implementation Of Evidence-Based Preanesthesia Assessment Tools For Lvad Patients Undergoing Non-Cardiac Procedures, Tracey Rooney, Casey Weimer, Eileen Giardino, Kerry Shanklin, Pete Pelletier, Audrey Rosenblatt

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Abstract

A university-affiliated tertiary medical center with a newly developed Advanced Heart Failure and Mechanical Circulatory Support program identified the need to implement a more systematic approach to the preanesthesia assessment process for patients with a Left Ventricular Assist Device (LVAD) undergoing noncardiac procedures and standardized guidelines to determine the best blood pressure monitoring system for patients with an LVAD during these noncardiac procedures. A multidisciplinary panel of clinical experts developed an LVAD Preanesthesia Toolkit using standard recommendations identified via evidence-based literature and expert opinion. The Toolkit included an LVAD Preanesthesia Assessment (VaPA) tool and an LVAD Blood Pressure Monitoring …

Physician Assistant Global Advancement Through The Use Of Medical Relief Organizations, Kara Crafts Pa-C, Sarah Mistrot Pa-C, Mary Henningsgaard Pa-C, Kaley Morris Pa-C, Tamarrah Oliver Pa-C, Kevin Tran Pa-C, Trevor Crafts Md

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Objectives: The physician assistant (PA) model has been adopted by many nations to alleviate health care disparities. The objective of the project is to understand how medical relief organizations are utilizing physician assistants and contributing to the advancement of the career globally.

Methods: A search was conducted to create a list of all U.S. based medical relief organizations. An 18-question online survey was sent to 493 organizations that met inclusion criteria.

Results: Total response rate of the survey was 56.2%. 75.6% of organizations reported using PAs on their medical relief projects, and PAs were used in clinic/hospital/and operative settings.

Conclusions: …

Retention Of Physician Assistants Within A Specialty After Completion Of A Postgraduate Training Program, John Ansiaux Pa-C, Carly Farrell Pa-C, Kathryn Hess Pa-C, Aubrey White Pa-C, Charlotte Peeters Pa-C, Jill Schulten Pa-C, Ryan Krasnosky Mpas, Pa-C, Dfaapa, Drph

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: The advantages of a specialized training program have led to over 84 postgraduate training programs for Physician Assistants (PAs) covering over 25 specialties. Employee lateral mobility is more prevalent within the PA profession, which allows PA providers to switch between medical specialties. The versatility of PAs promotes higher turnover rates compared to physician counterparts. These high turnover rates can result in increased institutional burden. Postgraduate PA programs provide pre-employment exposure to more in-depth medical training, enabling a well-rounded knowledge base of the PA’s roles and responsibilities, minimizing turnover rates.

Purpose: The goal of this survey study is to identify …

Survey Analysis Of Overall Job Satisfaction Of Physician Assistants, Clare Lookian Pa-C, Claire Keaton Pa-C, Kasey Keane Pa-C, Erin Schulte Pa-C, Abby Atchley Pa-C, Edwin Welsh Pa-C, Devon Gersh Pa-C, Jack Carter Pa-C, Ryan Krasnosky Mpas, Pa-C, Dfaapa, Drph

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: Over the last three decades, the physician assistant (PA) profession has seen an increase in the number of women in the profession, a decline in the age of new PA graduates, a movement toward specialty practice, and an exponential growth in the workforce as a whole. Historically, surveys reveal the majority of PAs are satisfied with their career choice and current job. Although a majority of PAs report high job satisfaction, career burnout is still significant within the profession. Career burnout among health care providers continues to rise due to the strains of the US healthcare system, growing patient …

Utilization And Workforce Integration Of Physician Assistants, Tara Harkins Pa-C, Jason Thomas Pa-C, Brian Fontenot Pa-C, Joseph Day Pa-C, Marielle Faraone Pa-C, Alexandra Borden Pa-C, Megan Lomax Pa-C, Darius Dranginis Pa-C, Ryan Krasnosky Mpas, Pa-C, Dfaapa, Drph, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: The healthcare field is experiencing rapid growth in the number of advanced practice providers (APPs) with projections that demonstrate that this trend will only continue. Even though the number of APPs is growing, the development of facility-specific APP management infrastructure often grows at a slower pace. Specific policies and procedures on APP utilization and clinical efficiency metrics are lacking. This can lead to deficiencies in the understanding of the education and practice boundaries of APPs.

Objective: Our study aimed to analyze the growth and utilization of physician assistants (PAs) in several hospitals located within Texas Medical Center (TMC) …

Reducing Pulmonary Function Testing Procedure Times In Pediatric Patients, Kathleen Richards Rrt, Shontae Hill Rrt, Kaylynn Bernardo-Stagg Rrt, Heather Miller Rrt, Daniel Barker Rrt, Kailee Perkins Rrt, Michael Richards Mba, Mha

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Problem. The Pulmonary Function Test Time Project (PFT Project) is a quality improvement (QI) initiative designed to decrease PFT testing time and PFT total time in pediatric patients and improve the overall process for both providers and patients. Patients scheduled to see a pulmonary provider were also scheduled for a PFT prior to the provider’s visit. Data showed that the length of time to perform a pulmonary function test (PFT) was causing: (1) a delay in the pulmonary provider seeing patients at the intended appointment time, (2) a disruption to clinic workflow, resulting in scheduling difficulties, and (3) a decreased …

Incorporation Of Surgical Cadaver Lab Training In A Physician Assistant Fellowship Program, Jacqueline Guarino, Jordan Rodriguez, Ming Zhang Phd, Ryan Krasnosky, Kristina Marsack

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Physician Assistants (PAs) are licensed medical professionals who provide health care under the supervision of and in collaboration with physicians. PAs can specialize in any field of medicine or surgery with additional on-the-job training while some PAs participate in a postgraduate training program in order to increase their knowledge in a certain subspecialty area. This paper describes the incorporation of a cadaver lab curriculum into a postgraduate PA surgical training program. The description of the development, implementation, and evaluation of the cadaver lab experience can assist other programs to implement this hands-on educational experience for a variety of medical providers, …

Measuring The Quality Of Postgraduate Physician Assistant Fellowship/Residency Programs With A Surgical Focus, Lesley Davies, Jacqueline Guarino, Caitlin Justus, Cassandra Mueller Pa-C, Ryan Krasnosky, Jordan Rodriguez, Angelo P. Giardino

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction

Postgraduate programs for PAs provide formal postgraduate training for clinical specialty areas. These programs are intended to provide intense specialty training in various fields, as well as to standardize education beyond the entry level. The purpose of this descriptive study was to determine if there are consistent trends or clear differences in program length, approach to training, validation of learning, and accreditation through the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) for postgraduate programs with a surgical focus in the United States.

Methods

This study is a non-experimental and descriptive research design. Program directors were mailed …

"More Accessible And Easier To Deal With": A Qualitative Inquiry Of Leaders' Perceptions Of The Evolving Roles And Responsibilities Of Advanced Practice Providers At Texas Medical Center, Athena Krasnosky Msn, Aprn, Cpnp, Jessie Marcet-Gonzalez Msn, Aprn, Cpnp, Jordan Rodriguez Bs, Natalie Cormier Smith Msn, Aprn, Np-C, Brenda Chesley Msn, Aprn, Cpnp-Ac/Pc, Linda Brock Msn, Aprn, Cpnp, Heena Narsi Prasla Msn, Aprn, Cpnp, Geran Barton

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background. With over 10 million patient encounters a year at Texas Medical Center (TMC), Advanced Practice Providers (APPs) are being incorporated into health care delivery models. Moving beyond the narrow “scope of practice” debates that frequently surface when talking about APPs, this inquiry instead seeks to broaden the discussion and take a more comprehensive view of how APPs are being incorporated into health care delivery models that span across several TMC institutions.

Methods. This study uses a thematic analysis study design to analyze structured interviews collected from a small convenience sample of Advance Practice Provider Program Directors at Texas Medical …

Outcomes Of A Positive Patient Id Campaign At A Pediatric Quaternary Care Center, Taylor Kim Md, Arjun M. Dangre Bds Mph, Andrea L. Davis Mph Cic, Betty J. Reeves Mha, Mt (Ascp), Omobola T. Durojaiye Msn, Rn-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction. Positive patient identification (PPID) is critical to safe and accurate labeling of patient lab specimens. Accurate PPID is also an important priority of The Joint Commission’s National Safety Goals. Inadequate PPID compromises may lead to waste of time and resources, and in the worst-case scenario can lead to significant patient morbidity and mortality. With a focus on PPID, this initiative examined the occurrence of mislabeled and unlabeled lab specimens as well as compliance with wearing ID bands in a cohort of hematology/oncology and bone marrow transplant inpatients at a large pediatric quaternary care center.

Methods. Using the Plan-Do-Study-Act Model, …

Pediatric Wound Care: Establishing A Consensus Group To Develop Clinical Practice Guidelines, Ryan Krasnosky, Geran Barton, Linda Highfield, Sheila Martinez, Stephen Linder, Edward Buchanan, Angelo P. Giardino

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Introduction. Wound care practices for neonatal and pediatric patients have created a lack of standardized evidence-based guidelines for treatments in clinical practices. Unfortunately, published clinical guidelines for the evaluation and management of wounds in pediatric populations is limited. Consensus groups are used to develop clinical guidelines which define key aspects of the quality of health care, particularly appropriate indications for interventions. The aim of this initiative was to conduct the first two steps of the guideline development process, and to report on the findings from the expert consensus group for pediatric wound care.

Methods. The goal was to recruit a …

Evaluation Of An Advanced Quality Improvement Program, Arjun M. Dangre Bds Mph, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Texas Children’s Hospital implemented the Advanced Quality Improvement and Patient Safety Program (AQI) in 2009, designed to train clinicians and staff to develop leaders in quality improvement to improve patient care, lower costs, change culture, and lead improvement initiatives at the organization. Evaluations of the AQI programs measured the program’s effectiveness in achieving its goals and objectives. This paper describes the Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety program (AQI,) the program’s evaluation processes, and show the results of the evaluation of the AQI programs using evaluation surveys completed by QI participants over the span of 13 successful …

An Examination Of Student Performance In Pre-Requisite Coursework And Upper Division Nursing Coursework, Jennifer L. Brown, Cheryl M. Smith

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Admission and retention of qualified nursing students are essential in meeting the demands of a rapidly changing health care environment and nursing shortage. The purpose of this exploratory correlational study was to determine the relationship between student performance in quantitative pre-requisite coursework and student performance in upper division nursing coursework in order to identify students at-risk for attrition. A series of descriptive and correlational analyses were conducted using pre-existing institutional data. A moderate relationship existed among the chemistry II and first-year upper division nursing courses (r = .21 to r = .40). These results suggest that prerequisite chemistry course …

Use Of Best Practice Alerts To Improve Adherence To Evidence-Based Screening In Pediatric Diabetes Care, Daniel Desalvo, Sara K. Bartz, Blair Mockler, Rona Y. Sonabend

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Background: Youth with type 1 diabetes (T1D) are at increased risk for comorbid autoimmune conditions and long-term complications. To help with early identification of these complications, the American Diabetes Association (ADA) has published evidence-based screening guidelines. The aim of our quality improvement intervention was to improve and sustain adherence to the ADA recommended screening guidelines to >90% for youth with T1D in the Texas Children’s Hospital (TCH) Diabetes Center by utilizing best practice alerts (BPA) within the electronic medical record (EMR).

Methods: In accordance with the ADA Standards of Care screening guidelines for youth with T1D, we analyzed the database …

What You Need To Know About Bar-Code Medication Administration, Marie E. Mcbee Dnp, Msn, Martha Kuhlmann Dnp, Msn, Rn, Fnp, Pmhcns-Bc, Aprn, Pam Patterson Dnp, Msn, Ne-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Medication errors are the most common type of preventable error. Bar-code medication administration (BCMA) technology was designed to reduce medication administration errors. Poor system design, implementation and workarounds remain a cause of errors. This paper reviews the literature on BCMA, identifies a gap in the findings and identifies three evidence based practices that could be used to improve system implementation and reduce error. The literature review identified that Bar-code medication administration and system workarounds are well documented and affect patient safety. Based on the critical analysis of 10 studies, we identified gaps in the standardization of BCMA planning, implementation, and …

Sustainability In Quality Improvement And Patient Safety Initiatives, Angelo P. Giardino, Eileen R. Giardino

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The question often asked of a quality improvement initiative is whether the improvement process has been sustained within the organization. Rarely is the question answered satisfactorily. The sustainability of an improvement process is important as it justifies the investment of human and financial capital. The term 'evaporation of improvements' addresses the dilemma that between 33% to 70% of all innovations are reportedly not sustained (Fleiszer, Semenic, Ritchie, Richer, & Denis, 2015) . This evaporation of improvement captures the frustrating inability of many institutions to maintain the achieved improvement after the newness of the initial effort wears off (Buchanan, Fitzgerald, & …

Scientific Proceedings Of The Texas Children’S Hospital’S 17th Session Of The Advanced Quality Improvement And Patient Safety Program, Arjun M. Dangre Bds Mph, Kelly Wallin Ms Rn Chse, Gertrude A. Leidich Mba, Rn, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety (AQI) Program is a six month mixed didactic and experiential learning experience designed to improve patient care, lower costs, change the culture, and develop quality leaders. As a part of AQI program participants are grouped into teams and each team completes a healthcare related Quality Improvement (QI) project. Each project demonstrates use of various QI tools including process maps, fishbone diagrams, and key driver diagrams. The projects use ‘Model for Improvement’ as the primary QI methodology to achieve their aim. Three or more Plan-do-study-act (PDSA) cycles are required for each …

Scientific Proceedings Of The Texas Children’S Hospital’S 16th Session Of The Advanced Quality Improvement And Patient Safety Program, Arjun M. Dangre Bds, Mph, Kelly Wallin Ms, Rn, Chse, Gertrude A. Leidich Mba, Rn, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety (AQI) Program is a six month mixed didactic and experiential learning experience designed to improve patient care, lower costs, change the culture, and develop quality leaders. As a part of AQI program participants are grouped into teams and each team completes a healthcare related Quality Improvement (QI) project. Each project demonstrates use of various QI tools including process maps, fishbone diagrams, and key driver diagrams. The projects use the IHI ‘Model for Improvement’ as the primary QI methodology to achieve their aim. Three or more Plan-do-study-act (PDSA) cycles are required …

Optimizing Emergency Department Throughput Using Best Practices To Improve Patient Flow, Puneet Freibott Dnp, Rn, Nea-Bc, Ccrn-K'S

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Emergency Department (ED) crowding and bottle necks are the reality of hospitals across the country. Patients seeking care and needing inpatient beds via the emergency rooms are facing delays with attaining the right level of care. Orchestrating a patient through an ED admission requires a multidisciplinary effort to provide safe, effective and efficient care. This quality improvement project conducted in a tertiary acute care hospital focused on Centers for Medicare and Medicaid metrics to measure Emergency Department (ED) throughput. This multidisciplinary initiative focused on reducing time stamps for patient arrival to the ED through departure to hospital or home. Outcomes …

Using Business Modeling To Streamline Cost Of Anesthesia In A Cardiopulmonary Laboratory, Johnny Dang Dnp, Crna, Kristen Starnes-Ott Phd, Crna

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The Time Driven Activity Based Costing (TDABC) measurement system, a model used in the business arena, can capture clinical processes and costs that other costing models often overlook. Use of this system permitted tying costs to time and resources and identified areas of inefficiency such as depleted supplies and health care and emergency supplies placed inconveniently. A multidisciplinary team developed an anesthesia checklist for use in a remote cardiopulmonary laboratory. The compliance rate for checklist completion was approximately 85%. Checklist implementation translated to a decrease in case delays and time expenditure in patient care by 58% with a cost savings …

Protocol To Increase Administration Of Herpes Zoster Vaccine In A Long-Term Care Facility, Stephen Mbola Dnp, Rn, Anp-Bc

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Although the herpes zoster (HZ) vaccine to decrease the incidence of Shingles was licensed for use in 2008, little coverage for HZ vaccination has occurred and stands nationally at 16%. At a targeted nursing home and assisted living facility, a protocol for including HZ along with state-mandated vaccinations was devised and used in screening incoming residents. Baseline data from chart reviews (n=122) showed that despite treatments given for the infection in the preceding 12 months, no vaccinations had occurred. During a 6-month implementation period, all new residents meeting eligibility criteria were offered the HZ vaccination. In this period, four residents …

Quality Improvement And Safety In Healthcare: Reflections On Essential Frameworks To Guide Applied Scholarship That Promotes Transformation And Innovation, Angelo P. Giardino Md, Phd, Mph

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The publication of the inaugural issue of the Journal of Nursing and Interprofessional Leadership in Quality and Safety (JONILQS) is a unique milestone that is the culmination of visionary leadership, scholarly effort, and keen attention to the many tasks necessary to launch a journal. The University of Texas Health Science Center at Houston’s School of Nursing launches this journal to address the focus on quality and safety initiatives and research that helps to make the health care we provide safer and better. This journal seeks to highlight practical work from the field that will change things for the better for …

Developing The Improving Post-Event Analysis And Communication Together (Impact) Tool To Involve Patients And Families In Post-Event Analysis, Madelene J. Ottosen Phd, Rn, Emily W. Sedlock Mph, Aitebureme O. Aigbe Drph, Jason M. Etchegaray Phd, Sigall K. Bell Md, Thomas H. Gallagher Md, Eric J. Thomas Md, Mph

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The analysis of harmful errors is typically led by a team within the hospital and includes clinicians and staff who were involved at the time of the event. However, the patient and family are often left out of this process and are not asked to participate in the investigation. Because little guidance is available for facilitating patient input, an interprofessional team convened to develop a semi-structured tool to be used in eliciting patient feedback. Some 72 persons who had experienced adverse events were interviewed. Using a thematic analysis approach, the team learned that 51% of the interviewees preferred to participate …

From The Editors-In-Chief, Joanne V. Hickey Phd, Rn, Acnp, Faan, Fccm, Eileen R. Giardino Phd, Rn, Aprn, Fnp

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The Co-editors in chief welcome The Journal of Nursing & Interprofessional Leadership in Quality and Safety to state what the purpose of the journal is and why it is important for this journal to start.