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Marshall University Newsletter, March 12, 2024, Office Of Marshall University Communications

Marshall University Newsletter 2023-Current

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Spartan Daily, March 12, 2024, San Jose State University, School Of Journalism And Mass Communications

Spartan Daily, 2024

Volume 162, Issue 20

The Postsecondary Success Of Historically Marginalized Black And Latino Male Students: Examining Factors That Impact College Readiness Preparation And Persistence, Molly Croghan, Ebonie Davis, Janci Finkley, Zehra Khan, Yvette Levy, Evans Mudanya, Lizbeth Roman

Dissertations

This qualitative research study investigates the multifaceted factors influencing the postsecondary success of historically marginalized Black and Latino male students, with a particular emphasis on understanding the impact of college readiness preparation and persistence. Employing a comprehensive research design, the study integrates semi-structured interviews with high school teachers and counselors, and Black and Latino male freshmen and sophomores to provide a holistic exploration of the challenges and opportunities within the educational journey. Situated within an interpretive phenomenological paradigm, this study elucidates the experiential realities and viewpoints of the subjects, thereby illuminating the socio-cultural, institutional, and individual factors shaping their trajectories …

Novel Inhibitors To Mmpl3 Transporter Of Mycobacterium Tuberculosis By Structure-Based High-Throughput Virtual Screening And Molecular Dynamics Simulations, Hetanshi Choksi, Justin Carbone, Nicholas J. Paradis, Lucas Bennett, Candice Bui-Linh, Chun Wu

College of Science & Mathematics Departmental Research

Tuberculosis (TB)-causing bacterium Mycobacterium tuberculosis (Mtb) utilizes mycolic acids for building the mycobacterial cell wall, which is critical in providing defense against external factors and resisting antibiotic action. MmpL3 is a secondary resistance nodulation division transporter that facilitates the coupled transport of mycolic acid precursor into the periplasm using the proton motive force, thus making it an attractive drug target for TB infection. In 2019, X-ray crystal structures of MmpL3 from M. smegmatis were solved with a promising inhibitor SQ109, which showed promise against drug-resistant TB in Phase II clinical trials. Still, there is a pressing need to discover more …

Ursapgx: A New R Package To Annotate Pharmacogenetic Star Alleles Using Phased Whole-Genome Sequencing Data., Gennaro Calendo, Dara Kusic, Josef Madzo, Neda Gharani, Laua Scheinfeldt

Cooper Medical School of Rowan University Departmental Research

Long-read sequencing technologies offer new opportunities to generate high-confidence phased whole-genome sequencing data for robust pharmacogenetic annotation. Here, we describe a new user-friendly R package, ursaPGx, designed to accept multi-sample phased whole-genome sequencing data VCF input files and output star allele annotations for pharmacogenes annotated in PharmVar.

Police Officer Perceptions Of Parenting Experience Changes Following An On-Duty Child Death, Jennifer Sellers

Walden Dissertations and Doctoral Studies

Law enforcement officers (LEOs) work in careers that can be demanding, stressful, and traumatizing. Although researchers have explored vicarious, or secondary, trauma as it relates to a LEO bringing their experiences at work into the home environment, influencing their spouse or partner’s mental and physical well-being, they have not yet investigated how a LEO’s experience of a child death while on-duty might affect their parenting styles. The purpose of this qualitative study was to better understand the parenting styles that LEOs use or change when they have experienced a traumatic incident at work, specifically a child death. The study was …

Organic Food Supply Chain Efficiency Strategies To Reduce Costs For Local Food Businesses, Tonya Keller Adair

Walden Dissertations and Doctoral Studies

The price of organic foods makes consumers unable to reduce risks of specific health issues, including pesticide-related diseases and allergies. Supply chain managers are concerned that the financial barrier to accessing organic foods can exacerbate nutritional inequalities, particularly affecting communities facing food insecurity. Grounded in the resource dependency theory, the purpose of this qualitative pragmatic inquiry was to explore the processes supply chain leaders at four organizations use to supply organic foods to local grocery stores in South Carolina. The data collected from four semistructured interviews were thematically analyzed, resulting in six primary themes: organic certification, food appearance, expensive freight …

Project #50: Utilization Of Pic Score To Reduce Icu Utilization In Patients With Chest Injury, Shanen Beck, Sara Glowzinski, Marianne Franco, Maria Schneider

Quality Expo 2024

Aim: To achieve 10% reduction in ICU utilization for chest injured patients at West Bloomfield Hospital, while maintaining 0% adverse event rate attributable to placement in a lower acuity setting within 12 months of implementation.

Project #48 Advancing Pharmacy Advantage Processes Through Automation, Scott Backman, Zade Shammout, Sweta Patel, Amanda T. Soyad, Dawn Hall

Quality Expo 2024

Aim: It is essential to develop automation at Pharmacy Advantage Specialty Pharmacy on an ongoing basis to enhance business operations. This project aims to assess the impact of several automated solutions put in place at Pharmacy Advantage to help advance our practice. The focus of this project is to reduce costs, errors, and employee time on manual processes. The goals differ among all solutions developed but aim for a significant and sustained reduction from baseline. The timeframe to reach our targets varies for different solutions, but impact is expected immediately. Typically, the data is analyzed every 6-12 months. The intended …

Project #41: Creating A Safe Space To Care And Heal In An Inpatient Psychiatric Hospital, Utilizing Welle And Empowering De-Escalation, A Hands Off Approach To Care, Emily Sexton, Tasmiyah N. Gaskins, Elizabeth Travis, Vahid Pasovic, Mary Rogers, Therese Samarco, Athena Hinojosa, Jackie Harrington

Quality Expo 2024

Incidence of violence often occur in the psychiatric setting during physical management events which include: Physical hold, restraint or seclusion. At Kingswood Hospital the switch from CPI de-escalation and physical management to Welle De-escalation and physical management experienced interruptions and had observed opportunities for expansion, buy-in and development towards improved clinical care. In late 2021 incidence of patient reported abuse after physical holds led to investigation noting team members were not well trained in the correct use of welle techniques and current training did not include hands on training along with advanced welle techniques. Planning began to improve welle training, …

Project #76: Enhancing Visual Communications For Dialysis Team Members, Tiffany Riley, Allyce Haney Smith, Jake Garbutt, Jennifer Holcomb, Nicholas A. Kromrei, Laurie Amburn

Quality Expo 2024

Communication among dialysis teams can be improved through a digital, visual method of information dissemination. This allows dialysis teams to access quality metrics and expand knowledge to improve safety and implement of standards of practice. The current process includes sharing quality metrics, organizational updates, and safety reminders through email, placing postings in break rooms, and during brief team huddles. These practices can cause inconsistent communication across dialysis facilities: (a) clinical team members do not routinely access their company email as it is not part of patient care workflow, (b) posted printed copies of important information can be delayed or out …

Project #37: Outpatient Rehabilitation Fall Prevention: Working Towards A Safer Journey, Laura Agemak, Nicole Robinson, Jill Norander, Vaishnavi Srivatsan, Shailly Prabhakar

Quality Expo 2024

Aim: Patient falls within the Rehab Services outpatient clinics are the primary safety event reported through the Henry Ford Health R/L process. According to the report from the American Physical Therapy Association from September 2023, "The Economic Value of Physical Therapy in the United States" the average cost savings for fall prevention programs is estimated to be $2144 per Episode of Care. For these reasons, fall reduction was set as a goal in the Rehab Services Line Strategic Plan. This project was developed to: Identify patients at higher risk for falls; Improved documentation of fall risk; Enhance communication of fall …

Project #53: Clinical Decision Unit (Cdu), Anna Leszczynski, Elizabeth F. Ashley, Kristina M. Cross, Wendy Butterfield, Ghazwan Atto, Ghassan Atto, Toni Silas, Elizabeth Plemmons, Ryan Spencer

Quality Expo 2024

Aim: Focused action plan to decrease observation patients’ length of stay (LOS) supporting increased hospital bed capacity. The goal is for decision to discharge as observation or admission occurring under 23 hours of placement. This reduction in LOS will result in expanded site capacity, decreasing holding hours for all admitted and observation patients bed placement. Observation LOS at other observation units at Wyandotte Hospital from October 2022-November 2023 average is at 48.14 hours vs. CDU Observation LOS at 16.35 hours. These actions will support nursing/provider satisfaction, increase Emergency Department (ED) capacity to greater serve our community and facilitate more time, …

Project #04: I-C-U Continuing Antipsychotics At Discharge, Joseph A. Gregor, Angela Nguyen, Cassandra Falk, Vince Procopio

Quality Expo 2024

Antipsychotics are often utilized in the intensive care unit (ICU) for acute delirium. These agents are often continued after delirium resolution upon a patient’s transfer to general medicine units or hospital discharge. Unnecessary continuation increases risk of QTc prolongation, anticholinergic side effects, and mortality in elderly patients with dementia. The Confusion Assessment Method for the ICU (CAM-ICU) can be performed periodically to help determine if antipsychotics are still warranted for delirium.

Project #61: Vasopressin Is #1: Optimization Of Vasopressin Use With A Multidisciplinary Health System Approach, Zach Smith, Patrick Long, Kristin M. Griebe, Nicole Morearty, Jessica Buchanan, Vince Procopio, Amanda Roberts, Gay Alcenius, Kimberly Corpus, Diana Kostoff, Charles T. Makowski, Carolyn Fascetti, Rachel Eklund, Jennifer Swiderek, Daniel R. Ouellette, Michael Peters, Jayson Zebari

Quality Expo 2024

Introduction: Each year the pharmacy enterprise reviews the top 25 inpatient medication expenditures to assess for optimization in medication use. In 2022 vasopressin, a vasopressor agent used in critically ill patients, was the #1 inpatient medication expenditure with a total cost of $2.7 million USD. A multi-pronged approach was developed to optimize the use of vasopressin in critically ill patients in a cost-efficient manner, that would not impact patient outcomes or the ability to prescribe vasopressin in clinical practice. Methods: This was a quality improvement initiative that compared vasopressin expenditure for inpatient use in the 2022 and 2023 calendar year …

Project #34: Initial Clostridioides Difficile Testing, Tatiana Assenova, Cathleen Mccloskey, Sarah Prascius, Alex K. Wells

Quality Expo 2024

Problem Statement: First Floor GPU (General Practice Unit) at Henry Ford West Bloomfield Hospital experienced an increased number of hospital acquired Clostridioides difficile infections in Q1 and Q2 of 2023. Many of those cases occurred because there was a delay in testing due to length of time between stooling and testing within the first three days of hospital admission, which is the community onset window. Improvement Statement: Design new stool collection protocol to decrease missed opportunities to test for Clostridium difficile within community onset window.

Project #69: Improving The Documentation And Utilization Of Alteplase As A Declotting Agent For Specific Central Lines At Henry Ford Hospital, Kiera Kaiser, Sharron Alejandria, Cindy Quinn, Robin Williams, Swati Verma, Teresa M. Eiben

Quality Expo 2024

Aim: To improve the documentation and utilization of Alteplase as a declotting agent for patient with specific central lines: Peripherally Inserted Central Catheters (PICCs), Central Venous Catheters (CVCs), and Hemodialysis Catheters (HD).

Project #63: Supporting New Nurses Transition To Practice, Betty Bear, Jodie M. Cole, Tara Govan, Astacia Hahn, Mary Kravutske, Lauren Lowell, Michael Mannina, Kim M. Meeker, Hannah N. Rice, Debra Temrowski, Brenda Vanwallaghen, Leni Ward, Bernadette M. White

Quality Expo 2024

Problem Statement: Henry Ford Wyandotte Hospital (HFWH) 2022 annualized 1st year Nurse Resident (NR) turnover data was the highest amongst all Henry Ford Health hospitals. The results illuminated the need for priority focus and intervention. An overwhelming amount of literature indicates that lack of an effective transition to practice program for graduate nurses in a hospital setting can lead to issues such as: Inadequate Skill Development; Increased Stress and Burnout; Patient Safety Concerns; Communication Breakdowns; Retention Challenges; Negative Impact on Organizational Reputation. Improvement (Goal) Statement: To convene a multidisciplinary group of key stakeholders within HFWH and throughout Henry Ford Health …

Project #70: Use Of Virtual Monitoring To Prevent Inpatient Hospital Falls, Diane Wyatt, Jodie Cole, Lily Paciorkowski, Caleb Ashley, Rebecca Conti

Quality Expo 2024

Problem Statement: Limited in-person patient safety assistants (PSA) for fall risk patients contributing to our high fall rates: Fall rates higher than NDNQI target of 2.70 x 2 years; Fall with injury rates below NDNQI target of 0.58 and 0.60, but trending up; Staffing challenges with PSAs and nursing staff; Higher acuity patients; Nursing assistants (NA) removed from patient care to fulfill PSA duties when not available. Improvement Statement: Implement virtual monitoring platform throughout our progressive and general practice units to allow for 24/7 monitoring of high fall risk patients to reduce total fall and fall with injury rates by …

Project #11: Clinical Evaluation And Cost Impact Of Sugammadex Utilization At Henry Ford Health Hospitals, Fatimah Cheaito, Petar Puskar, Frank Julian, Raymond Yost, Gladys Dabaja

Quality Expo 2024

Introduction: Sugammadex is a widely adopted neuromuscular reversal agent (NMBA) for rocuronium and vecuronium-induced paralysis. There is mixed evidence regarding the impact of sugammadex on PACU length of stay and time from NMBA reversal to operating room exit. Concerns excess usage could lead to higher overall costs with negligible benefits led to an exploration of use at Henry Ford Health (HFH). HFH policy indicates neostigmine/glycopyrrolate is the cost-effective standard of care for NMB reversal which is preferred over sugammadex, except in defined situations. This medication use evaluation conducted within HFH hospitals aims to: Assess the use of sugammadex in accordance …

Project #28: Does Anyone Really Know What Time It Is?, Christian Keller, Amanda Poxon, Suzanne Celmer-Harter, Frank Morden, Jacob Potterpin, Jessica A. Burke

Quality Expo 2024

Problem Statement: Due to the increased amount of QuantiFERON®-TB Gold Plus testing, the number of timers alarming in the lab is disruptive to accessioning and leaves room for errors. Specimens are being pulled too early or left in the incubator for too long, which invalidates the testing, resulting in patients having to be called back. Improvement (Goal) Statement: Since QuantiFERON®-TB Gold Plus specimens can incubate at 37°C for anywhere between 16-24 hours, if we batch them every 8 hours for removal, we can have them coming out of the incubator consistently at designated times, three times per day. Using color-coded …

Project #75: Serious Safety Event Stat Huddle Improving Employee And Patient Safety, A. Renee Richards, Jane Ziemba, Megan E. Prochazka, Brooke M. Buckley, Kim M. Meeker, Thomas Mckeown, Rand O'Leary

Quality Expo 2024

Aim: Safest Care and Best Outcome Opportunity: Reduce delays in awareness and declaration of serious safety events to: expedite immediate actions to ensure patient and employee safety; understanding what is preventable at the time of harm occurrence; addressing immediate needs of patient, family, and caregivers; chartering Root Cause Analysis team to focus on process opportunities may have led to contributed to the serious safety event.

Project #30: Reduction In Use Of Cxr For Children With Asthma, Bronchiolitis, And Croup, Elizabeth Plemmons, Trisha Ribitch, Zoe Kaps, Asma Engelbrecht

Quality Expo 2024

Problem Statement: Respiratory illnesses particularly asthma, bronchiolitis and croup are among the top diagnoses for which children visit the emergency department. Chest x-rays are frequently used by emergency providers in children presenting with these conditions, yet they rarely reveal information that contribute to changes in management and can lead to excess cost, radiation exposure, & overtreatment with antibiotics.

Improvement (Goal) Statement: Reduce the use of chest x-rays in children who present to the ED with croup, asthma, and bronchiolitis to 20% or less by the end of 2023.

Project #09: Potential Cost Savings In The Reversal Of Doac Associated Bleeding, Carolina Orzol, Lindon Nikolaj, Vince Procopio, Norm Buss

Quality Expo 2024

Background: Direct oral anticoagulants (DOACs) are a cornerstone of therapy in treatment and prevention of deep vein thrombosis, pulmonary embolism and other thromboembolic disorders. Despite their favorable safety profile, patients are still at an increased risk of intracranial hemorrhages (ICH), gastrointestinal (GI) and/or fatal bleeding. Two agents commonly used in DOAC associated bleeding include andexanet-alfa and four factor prothrombin concentrate complex (4F-PCC). Reversal agent selection is determined by clinical presentation, cost, and institutional preference. 4F-PCC costs $9,099 per patient compared to $12,310 and $22,158 for low dose and high dose of andexanet-alfa respectively. Objectives: To evaluate adherence to Henry Ford …

Project #71: Creating A Pressure Injury Prevention (Pip) Rounding Team To Reduce Healthcare Acquired Pressure Injuries (Hapis), Diane Wyatt, Andrea Sheldrake, Maria Masongsong, Maria Toscano, Yvette Toscano, Julie Metzger, Tonya M. Layow, Paula Majors, Caleb Ashley, Brenda Vanwallaghen

Quality Expo 2024

Problem statement: Patients were lacking application of pressure injury prevention interventions leading to HAPIs: Newer staff who had less experience with wounds and wound prevention; Auditing showed few interventions in place and lack of Q2 hour turns. Improvement Statement: Implement a multidisciplinary PIP rounding team comprised of leaders, certified wound care nurses, HAPI & PIP committee members, skin champions, and new nursing staff monthly to provide education to staff, place interventions in real time to therefore reduce patient’s risk of HAPIs. The PIP rounding team was created to provide real time audits and interventions with opportunities to educate staff and …

Project #13: Developing And Implementing An Agitation Response Team (Code Art) In An Urban Academic Emergency Department, Leslie Strugnell, Namita Jayaprakash, Michelle Slezak, Sudhir Baliga, Kamal Sayej, Casey L. Boyer, Hilja Compian, Caroline Dowers, Justin Bright, Rebecca Lenz, Elizabeth Gonzalez, Michelle Thompson, Ronald Franco, Jennifer Peltzer-Jones

Quality Expo 2024

Problem Statement: The acute presentation of patients with psychiatric emergencies, altered mental status, substance use, and cognitive delays creates a safety risk to employees working in the triage area. A lack of standardized responses impacts response time and increase risk of injury to employees. Project Goal: Implementing multidisciplinary agitation response team to provide safer care for the acutely agitated patient, promote a safer environment for ED staff, and promote dignity for the acutely agitated patient that arrives to the ED’s triage area. AIM Statement: Decrease the number of employee assaults occurring within 2 hours of patient arrival to HFH ED …

Project #07: Msqc Abdominal Hernia Project, Miranda Adams

Quality Expo 2024

Aim: To improve the care of patients undergoing an abdominal hernia surgery. Project goal is to improve multidisciplinary discussions, standardize & improve documentation and implement best practices, therefore improving patient care. Physician driven, smart phrase templet, was developed to standardize documentation preoperatively, intraoperatively and postoperatively. Improve postoperative patient outcomes starting in 2021 and continuing into 2024 by encouraging patient to make healthy lifestyle choices and help prevent complications.

Project #43: Combating Workplace Violence: The Implementation Of A Behavioral Emergency Response Team, Jessica Schmidt

Quality Expo 2024

Workplace violence, patient, and staff safety continue to be a top priority and concern for Henry Ford Jackson Health (HFJH). Evaluating the current process at HFJH, there was no formal process to support clinical staff members to maintain patient and staff safety during acute behavioral health crises on medical inpatient units prior to the activation of a “Security Assistance”, or security personnel response to situations involving an actual or potential physical threat to patients, staff, visitors, or property. Violence against health care workers is 20% higher than violence amongst other professions and is estimated to be exceptionally underreported. It is …

Project #10: Less Chaff, More Wheat: Clinical Decision Support Governance, David Allard, Donna S. Summers, Brian M. Church, Lori Doyle, Michael Eichenhorn, Pam Ferguson, Matt George, Christopher Gortat, Mary Griffin, Salim Hamadeh, John Joseph, Tanya Larocque, Ronnel G. Miranda, Rajika L. Munasinghe, Lance K. Podsiad, Martin Ratusznik, Ilan Rubinfeld, Jonathan Sykes, Glenn Tokarski, Rachel Tshiamala, Cynthia Valerio, Adrienne Vaught, Linda Vergilio-Panek

Quality Expo 2024

Aim: Use governance structures to establish guidelines for effective use, oversight, approval and post-implementation assessment of clinical decision support tools Improve the sophistication of team in designing and implementing effective decision support. Use five rights of decision support (the right information, to the right person, in the right format, through the right channel, at the right time in the workflow) as guiding framework for design and review. Minimize impact on clinician efficiency. Reduce the number of interruptive Best Practice Alerts (BPAs).

Project #47: Centralization Of Clinical Trial Budgeting Has Resulted In Optimization, Jennifer Fowler, Karie Gignac, Tiffany Pearce

Quality Expo 2024

Introduction: Fee schedules used to negotiate clinical trials budgets across the health system have historically been very different. Clinical care fees are standardized based on the hospital charge master, however administrative fees for staff time and effort have been extremely variable due to a decentralization approach. This has resulted in sub-optimal budget negotiations for clinical trials due to multiple factors: Under-estimation of costs; Lack of trained staff in each Department to review and negotiate clinical trial budgets; Hindered negotiations secondary to established precedence with sponsors.