Digital Commons Network^™

Show Us The Money: How Patchwork State Freedom-Of-Information Laws Impede Accountability In High School Athletics, Frank D. Lomonte, Harrison O'Keeffe

New Mexico Law Review

High school sports have evolved into a large, complex business enterprise, complete with seven-figure broadcast contracts and $60 million stadiums rivaling collegiate facilities. Some 8 million Americans take part in school-sponsored competitive athletics each year, and their health and safety is of undeniable public concern. Because of their popularity and outsized cultural significance, interscholastic sporting events regularly become theaters of combat for the political and social issues of the day, from desegregation to women's equality to LGBT rights. Yet despite the intense public interest in interscholastic sports, the public's ability to stay informed about how sporting events are organized and …

In The Matter Of Anhayla H.: The Nexus Between The “Reasonable Efforts” Requirement And Incarceration, Brent Chapman

New Mexico Law Review

State proceedings that initiate and effect involuntary termination of parental rights occur only in egregious circumstances. In New Mexico, before an abusive or neglectful parent’s rights may be terminated, the state must prove, among other requirements, that it made “reasonable efforts” to provide assistance to the involved parent to remedy the causes and conditions that led to the subject abuse. Courts continue to grapple with precisely what constitutes reasonable efforts to this day because it is not concretely defined. Special cases, such as when parents have become incarcerated after an adjudication of abuse or neglect, are particularly vexing because parents …

Death Marks The Spot: Where Presumptions Against Pretrial Release Live In New Mexico Law, And Where They Should Move, Andrew J. Pavlides

New Mexico Law Review

Like other jurisdictions that have abolished the death penalty, New Mexico no longer has true capital offenses, where the potential of execution is still a legal punishment. The state has also undertaken cash bail reforms by enacting a constitutional amendment that seeks to detain individuals who pose a risk of flight or dangerousness, while never detaining anyone simply because they are financially incapable of posting bond. But, unlike many of the jurisdictions that have ceased the use of the death penalty and shifted away from cash bail, New Mexico approaches the pretrial release process uniformly, making no distinctions between felony …

20200313_Hslic Is Available, Far And Near, Tamara Wheeler

HSLIC Blog Post

No abstract provided.

Illuminating The Dark Corners: The New Mexico Inspection Of Public Records Act’S Law Enforcement Exception, Nicholas T. Davis

New Mexico Law Review

The New Mexico’s Inspection of Public Records Act is a sunshine law created to allow the public access to its government’s operations. From its inception, the IPRA has been interpreted broadly towards disclosure of documents to keep government agents accountable for their conduct. While there are enumerated exceptions to the IPRA, they are narrowly construed and specific. However, of late government agencies have been pressing to enlarge the construction of these exceptions. A series of cases have been brought under the IPRA to challenge the use of the Law Enforcement Exception by New Mexico’s Department of Public Safety as a …

20200311_Running Medicine Presents, Tamara Wheeler

HSLIC Blog Post

No abstract provided.

2020-03-09 A Message From Chancellor Roth, Paul B. Roth

HSC Messages from the Chancellor

No abstract provided.

University Of New Mexico (Unm) Internal Medicine Triage Hospitalist Pilot, Kristen Baca, Charles Pizanis, Grant Scott, Christopher Barlett

Quality Improvement/Patient Safety Symposium

Introduction

At UNM Hospital, ~50% of patients are admitted to the Internal Medicine (IM) service. Significant delays occur at the time of admission. These delays contribute to numerous downstream consequences, including poor patient care, increased hospital complication rates, decreased patient and provider satisfaction, and increased patient length of stay. IM admission times are calculated as the time between the ED “Consult to Inpt Medicine” order and the IM “Admit/Observation Order” (for which the IM “Bed Request” can serve as a surrogate). Median and average admission times are 4 hours 42 minutes and 5 hours 50 minutes, respectively. According to Hospital …

Emergency Department Provider Satisfaction With Ems Turnover Reports In Critical Trauma Patients, Paul Ratmeyer, Zachary Potts, Joy Crook

Quality Improvement/Patient Safety Symposium

Introduction:

Trauma accounts for 23% of all emergency department (ED) visits and is a leading cause of morbidity and mortality.^1,2 Many critical trauma patients arrive to the ED by emergency medical services (EMS). EMS-ED handoff quality affects patient safety and quality of care.^3-6 However, there is a scarcity of literature examining trauma patient handoffs and hospital staff satisfaction. The goal of this study was to investigate the relationship of specific information given during EMS handoffs with hospital staff satisfaction.

Methods:

This study observed handoffs of patients sustaining major trauma at the University of New Mexico (UNM) Hospital, the …

Watching Hands In The Cookie Jar: A Project For Improving Medication Charge Capture In The Operating Room, Casey Luce, Connie Huynh, Tim Petersen, Jack Srouji, Christ Arndt

Quality Improvement/Patient Safety Symposium

Introduction: With the high cost of healthcare in the United States, there have been attempts to identify waste (1). In our anesthesia department, vials or syringes of non-controlled medications are not checked out individually from a pharmacist. Rather, they are removed from a medication housing machine (BD Pyxis Anesthesia Station ED™) before and during a case based on an honor system. The provider logs into the Pyxis system and then has access to any medication in that reservoir. When an individual medication is removed, a button has to be pressed on a screen to register its removal. Anyone who has …

Dictation Templates For Surgical Learning And Improved Operative Reporting, K Lauren Barnes

Quality Improvement/Patient Safety Symposium

Introduction

Precise operative reporting is important to patient care, accuracy in billing, and trainee education. Although operative reports are the best way to understand the type of procedure a patient has had in the past, inaccurate transcription, incomplete information, and delayed completion of these reports often hampers the quality of the medical record. Hospital billing also relies on these records, so revenue may be lost if required components are missing. From an educational standpoint, trainees use dictated reports to learn the steps of procedures prior to performing them. If errors, inaccuracies and omissions are present, learning may suffer. Past studies …

Improving The Quality And Delivery Of Substance Use Disorder Resource List, Tenzin Desel, Monica Goodman, Susie Pham, Andrew Sanchez, Madeline Starkweather, Jennifer Thompson, Eva Angeli, Leonard Noronha, Reed Otten, Mary Lacy

Quality Improvement/Patient Safety Symposium

Introduction

The state of New Mexico has numerous organizations that help individuals with substance use disorders (SUDs). University of New Mexico Hospital (UNMH) social workers had previously started a list of these resources; however, it was neither updated nor used often. We aim to improve the quality, awareness, and delivery of this list on UNMH internal medicine (IM) inpatient units.

Methods

To improve the quality of the list we developed a concise SUD resource document using the pre-existing list as a template. We modified the list after feedback from patients, providers and literacy specialists. The final list was organized alphabetically …

Development Of A Tool To Qualitatively Access Impact Of Customized Patient Education Materials On Patient Satisfaction During Labor And Delivery Experience, Austin Graham, Kylee Greider, Timothy Petersen, Katherine M. Seligman

Quality Improvement/Patient Safety Symposium

The Painless Push (www.thepainlesspush.com) is an engaging and interactive patient education website that is tailored to the New Mexican population to provide patients evidence-based information about pain relief options for labor and delivery. We hypothesized that having an increased knowledge base and understanding of pain relief options during labor and delivery may help patients feel more prepared for delivery, more comfortable with their various pain relief options, and overall more satisfied with the experience of child birth. In review of the current literature, it was identified there has not been a validated tool developed to analyze this experience

In a …

Image Quality Improvement For Panorex Imaging In A Hospital Radiology Department, Miranda J. Mares, Andrew K. Griner

Quality Improvement/Patient Safety Symposium

Background/Conceptual framework

Panoramic Imaging is a popular method of imaging dental anatomy. This type of imaging is not only done in dental offices but also within hospital radiology departments. Although mandible imaging using a Panorex machine seems pretty straight forward and simple to perform, we discovered various issues leading to image distortion and overall poor quality. Our Technologists were unhappy because they lacked the knowledge to fix the issue and our Radiologists were unhappy because we were provided non-diagnostic imaging.

Purpose of the project/Innovation

Radiology Panorex imaging at our hospital was less than proficient. Technologists avoided doing Panorex exams due …

Ultrasensitive Rna In Situ Hybridization For Kappa And Lambda Light Chain Mrna In Marginal Zone Lymphoma Demonstrates Comparable Performance To Flow Cytometry, Michael M. Franklin, Chelsey Deel, Mohammad A. Vasef

Quality Improvement/Patient Safety Symposium

Objectives:

Evaluation of light chain restriction is critical to establish clonality in B cell lymphoproliferative disorders (LPDs). Immunohistochemistry (IHC) or in situ hybridization (ISH) are commonly used to assess light chain restriction in formalin fixed, paraffin embedded (FFPE) tissues. However, except for cases with plasma cell differentiation, these techniques often fail to identify immunoglobulin light chains. An ultrasensitive technique, RNAscope, has been recently introduced which can identify light chains in cases of B cell LPDs. We analyzed the utility of this ultrasensitive method in detection of clonality and correlated with flow cytometry results when available.

Methods:

A tissue microarray (TMA) …

A Model For Improving And Assessing Outpatient Antibiotic Stewardship Interventions For Common Upper Respiratory Tract Infections And Uti, To Improve Appropriate Outpatient Antibiotic Prescribing In Order To Improve Patient Safety, Patient Cost, And Reduce Antimicrobial Resistance In Accordance With The Joint Commission Goal Of Reducing Outpatient Antibiotic Prescriptions For 2020., Jennifer Garcia, Jasmina Demirovic, Melinda Montoya, Niraj Ganjawala, Michael Palestine, Abhishek Tomar, William Bowen

Quality Improvement/Patient Safety Symposium

Aim statement:

Reduce inappropriate antibiotic use by 20% for upper respiratory tract infection (bronchitis, sinusitis, pharyngitis) and UTI from December 2018-March 2019 compared to December 2019-March 2020.

Methods:

A single center before and after intervention study using a quasi-experimental design utilizing the electronic medical records system to identify patients diagnosed with URIs or UTI in six main ambulatory care settings.

• Inclusion criteria
  • Diagnosis of bronchitis, sinusitis, or UTI
  • Timeframe: December 1, 2018 through March 31, 2019

• Exclusion criteria
  • Requirement for antibiotics for other indication(s)
  • Immunocompromising conditions
  • Presence of COPD, cystic fibrosis or bronchiectasis

• The following data points were analyzed
  • Total …

Stop Testing The Patience Of Our Patients – Optimizing Workflow At A Cancer Center Infusion Suite, Shenthol Sasankan, Zoneddy Dayao, Bernard Tawfik, Andrea Cox, Candy Okino, Sandra Peacock, Janet Abernathy, Branda Chaleunphonh, Ron Kittson, Nick Crozier, Richard Lauer, Neda Hashemi

Quality Improvement/Patient Safety Symposium

Introduction

Nationwide, cancer centers experience challenges with infusion center efficiency while maintaining high safety standards, with some patients facing wait times as long as 102 minutes¹. This leads to decreased patient satisfaction and inability to provide optimal care. Lack of standardization among cancer centers results in a wide variation of infusion wait times for patients. In this study, we initiated five interventions at UNM Comprehensive Cancer Center to reduce the wait times for our patients and optimize workflow of the Infusion suite

Materials and Methods

A multidisciplinary working group was formed consisting of the infusion floor physician lead, …

Colon Cancer Screening: Flu-Fobt, Kavitha Kirubanandan, Michael Mckinney, William Bowen, Luis Rigales, Theresa Gonzales

Quality Improvement/Patient Safety Symposium

The Flu-FOBT Program is an innovative and effective way to increase colorectal cancer screening in primary care settings.

Improving Recognition Of Malnutrition At Unmh, Jens Langsjoen, Anthony Worsham, Alyse Raboff, Samantha Paltrow-Krulwich

Quality Improvement/Patient Safety Symposium

Introduction: Protein calorie malnutrition is the most common form of nutritional deficiency among patients who are hospitalized in the U.S. Malnutrition is a significant indicator for severity of illness and expected mortality measures. Previous audits have shown that malnutrition at UNMH is grossly under-recognized, with 4.7% of inpatients diagnosed at discharge compared with a national inpatient malnutrition prevalence of 20-50%. To improve the ultimate coding of a diagnosis of malnutrition, an interdisciplinary process has been developed. The nurse intake malnutrition screening assessments has been updated to be more sensitive, local consensus guidelines have been developed for malnutrition diagnosis and severity …

The Implementation Of The New Unm Operating Room Emergency Manual, Kar-Wei Leung, John R. Rask, Frank Jaime, Tim Petersen

Quality Improvement/Patient Safety Symposium

Introduction

Here we present the implementation of a new UNM Operating Room Emergency Manual (EM) as an improvement process conducted by the Department of Anesthesia in partnership with the operating room and surgical services. Emergency situations can occur in high risk environments such as the operating room. Cognitive aids such as an emergency manual have been demonstrated to facilitate the ease and speed of life saving actions during emergency situations. To improve and standardize our handling of emergency situations we decided to upgrade our operating room emergency manual.

Methods and Materials

This new manual was adapted from the Stanford Emergency …

Can Referrals To A Pediatric Osteopathic Manipulative Medicine (Omm) Clinic Be Increased Through Provider Education?, Arpita Sinha, Elizabeth Yakes Jimenez

Quality Improvement/Patient Safety Symposium

Purpose:

Many pediatricians in the U.S. have trained in osteopathic medicine and have a Doctor of Osteopathy degree. However, other members of the health care team are often unaware of what osteopathic manipulative medicine (OMM) is or its indication in pediatrics. This quality improvement (QI) project aims to increase the average number of referrals to the University of New Mexico Hospital’s (UNMH) pediatric OMM clinic by 25% by May 2020.

Methods:

The QI project was designed based on the Model for Improvement. As the first Plan-Do-Study-Act (PDSA) cycle, health care provider trainings on pediatric OMM were implemented in November 2019. …

Reducing Telemetry Alarm Fatigue, Karla B. Almaraz, Richard Snider, Theresa Mccarty, Amber Rymarz-Freitas, Emily Salmon, Gerald Charlton

Quality Improvement/Patient Safety Symposium

Introduction:

Cardiac Telemetry plays an important role in acute care, appropriate utilization can provide useful and critical information such as fatal arrhythmias and ischemia. Alarms are essential in telemetry, they alert the medical staff with critical patient’s needs, and if not managed appropriately it can compromise the patient’s safety. There are nearly 200,000 alarms generated during one month period, data suggest that about 99% of these alarms are clinically irrelevant or nonactionable. This results in considerable frustration for the telemetry nurses/techs, naturally developing alarm fatigue, becoming annoyed, desensitized and stop paying attention. Desensitization is concerning because clinically important alarms such …

Project Discharge: Implementing An Effective, Patient-Centered Discharge Process In Obstetrical Triage In An Urban Academic Medical Center, Noelle Borders, Amy Stuart, Beth Brown, Trish Mondragon, Gillian Burkhardt, Nicole Yonke, Gabrielle Rivera

Quality Improvement/Patient Safety Symposium

Background: An effective, patient-centered discharge process is the standard of care for any patient discharged from a hospital unit, including obstetrical triage units.

Local Problem: University of New Mexico Hospital’s obstetrical triage unit had no standardized discharge process for pregnant and postpartum women presenting for care. The aim of this quality improvement project was to discharge 65% of patients from OB Triage over an eight-week period using an effective, patient-centered discharge process by harnessing team and patient engagement and a discharge checklist and summary.

Methods: A quality improvement model involving four rapid-cycle plan-do-study-act (PDSA) cycles was utilized. …

Diagnostic Stewardship Interventions For Clostridioides Diffcile Infection, Luke A. Yeager, M E. Lacy

Quality Improvement/Patient Safety Symposium

Background:Our institution’s rate of hospital acquired Clostridioides difficile (C. diff) infection (CDI) is higher than expected based on documented severity of illness of our patients. The C. diff testing algorithm at our institution utilizes a multi-step approach. It begins with two tests (antigen EIA and toxin A/B EIA). If the results of these two tests are indeterminate, the algorithm then reflexes to a third test (NAAT-PCR). Non-toxin producing C. diff colonization can result in a positive C. diff test in the absence of active infection. ^{1, 2} Up to 20% of hospitalized patients are asymptomatic carriers of C. diff. …

Comparing Tdap In Pregnancy Rates Between Unm-Based Clinics: A Quality Improvement Project, Amber Lalla, Katarina Leyba, Taryn Mccue, Sarah Friedburg, Jody Stonehocker, Melissa Martinez

Quality Improvement/Patient Safety Symposium

Background: The American College of Obstetrics and Gynecology (ACOG) recommends the Tdap vaccine during 27-36 weeks of pregnancy protect the neonate from pertussis between birth and their first DTaP vaccine. Nationally the rate of Tdap vaccination in pregnant women is 48-55% with lower rates for women of color, uninsured, and non-English speakers. The Maternity and Family Planning (MFP) clinics at UNM are a federally funded clinics that provide comprehensive prenatal and postnatal care for women, especially low-income and/or at-risk pregnant women. The MFP clinics at UNM do not have Tdap vaccines on site and refer women to the Department of …

Co-Development And Execution Of A Group Qi Project To Meet Acgme Qips Requirements In The Department Of Pediatrics, Kelsey Fath, Lanier Lopez, Anjali Subbaswamy, Alfonso Belmonte, Rebecca Craig, Adam Cross, Anna Duran, Maria Heubeck, Stephen Lunderman, Elizabeth Yakes Jimenez

Quality Improvement/Patient Safety Symposium

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) requires quality improvement and patient safety (QIPS) education for trainees, and faculty development in QIPS for residencies. We describe the process of co-developing and executing a group quality improvement project in the Department of Pediatrics to meet these requirements.

Materials/methods: Over the course of four Resident School lectures and several continuity clinic interactions, residents are being provided with an introduction to quality improvement topics and tools, including the Model for Improvement, Key Driver diagrams, Cause and Effect Diagrams, PDSA cycles and run charts, and are actively engaging with applying QI concepts …

Waste Anesthetic Gases Cost Unmh Money And Contribute To Our Institutional Carbon Footprint, Joe J. Freeman, Karyn M. Nunez

Quality Improvement/Patient Safety Symposium

Introduction: Waste anesthetic gases (WAGs) contribute to climate change. There is a national initiative to reduce greenhouse gas emissions from hospitals and specifically operating rooms and associated anesthetic gases. Various gases currently used have vastly different impacts (see table). Clinicians’ knowledge of these differences and attention gas flow rates and gas type choice can significantly reduce hospital costs and environmental impacts.

Methods: We started with baseline data of purchased anesthetic gases before intervention. Next we started an ongoing informational campaign to alert all members of our department about the effect of gas choice and flow rate. We aim to measure …

Overcoming Resistance In Learning: Bridging The Gap Between Educator And Learner, Phase 3, Alisa Illescas, Patrick Rendon, Rebecca Williams

Quality Improvement/Patient Safety Symposium

Background: Resistance in learning (RIL) defines a set of attitudes or behaviors demonstrated by learners in an educational setting that result in decreased learning. Literature describes the etiology as multifactorial, including learning environment, characteristics of the learner, and teaching style. In conjunction with a team of academic hospitalists, we are using quality improvement methodology to address an educational problem within Phase I of medical school- resistance in learning. We are conducting a series of PDSA cycles to identify types of RIL during the Phase I pre-clinical years of medical school with the goal of implementing and evaluating an informed intervention …

Lost Revenue And Subsequent Documentation Improvement Strategy In The Department Of Psychiatry, David Earl, Christopher Gaudiot, Elizabeth Richardson, Mario Cruz, Joshua Corbin, Donna Sigl, Leslie Montgomery, Ali Nakip, Kyle Foley, Shawn Hazlewood, Julia Nguyen, Mauricio Tohen

Quality Improvement/Patient Safety Symposium

Introduction

The department of psychiatry has been having ~30% of its bills down-coded because of missing elements in documentation. Review of down-coded documents revealed that the history of present illness (HPI), review of systems (ROS), and mental status exam(MSE) were the most common areas resulting in down-coding. Leadership in the department tasked the department’s quality improvement (QI) leaders to find a solution to the issue.

Materials/Methods

Department QI leaders established a committee that comprised of department leadership, billing and coding, compliance, trainees, and faculty. After multiple meetings, the issue of what was being downcoded was deciphered and a plan to …

Implementation Of An Enhanced Recovery After Surgery (Eras) Pathway For Benign Gynecologic Surgery, Brenna Mcguire, Tasha Serna Gallegos, Kate Meriwether

Quality Improvement/Patient Safety Symposium

Introduction:

Enhanced Recovery after Surgery (ERAS) protocols have gained traction in the surgical field as evidence-based interventions aimed at speeding functional recovery. These protocols are designed to minimize the physiological changes and stress associated with surgery, and have been demonstrated in other surgical settings such as Gynecologic Oncology and Colorectal Surgery to decrease medical costs and improve patient outcomes. Recently, ERAS protocols have been refined and adopted in the field of benign gynecology by various institutions following an important endorsement of ERAS protocols by the American College of Obstetricians and Gynecologists (ACOG). However, there is a sparsity of research looking …