Medicine and Health Sciences Commons^™

Inpatient General Cardiology Curriculum, Charoo Iyer, Syed Faiz Abbas, Mallory A. Balmer-Swain

Rochester Regional Health authored publications and proceedings

This curriculum serves as a concise primer for interns starting out on an inpatient general cardiology rotation. Following topics have been included:

• Pre and Post Cardiac Catheterization workflow, including obtaining consent and evaluation of suspected post cardiac catheterization bleeding
• Acute Coronary Syndromes
• Guideline Directed Medical Therapy (GDMT) for Heart Failure
• Introduction to Cardiac Stress Testing

Tips For Teaching Ebm In The Busy Clinical Setting, Sonam Kiwalkar, Basil Verghese

Faculty Development Lunch and Learn

Tips for Teaching EBM in the Busy Clinical Setting. Sonam Kiwalkar, MD, FACP, Associate Program Director, Legacy Salmon Creek IMRP; Basil George Verghese, MD, FACP, FHM, Associate Program Director, Rochester General Hospital IMRP

Discussion:

• What is evidence-based medicine?
• What are the steps to evidence-based medicine?
• Why is it important to teach evidence-based medicine?
• How to teach evidence-based medicine in the busy clinical setting?

A Survey Of Internal Medicine Residents Comparing Virtual Academic Half Day To Traditional Academic Half Day Model, Basil George Verghese, Salem N. Thabet

Advances in Clinical Medical Research and Healthcare Delivery

Introduction. Resident educational activities vary from institute to institute, with daily noon conferences or weekly academic half-day (AHD) models where dedicated protected time is available for resident teaching. The COVID-19 pandemic limited in-person educational activities, forcing residency programs to move toward virtual options, including the academic half-day (AHD). This survey-based cohort study aimed to understand residents' perception of virtual versus in-person AHD for educational activities during residency.

Methods. The survey was emailed to 72 Internal Medicine residency program residents at our institute during the first week of March, 2022. The responses were analyzed using descriptive statistics, Pearson's chi-square test, …

Nurse Led Mobility/Exercise Program, Elizabeth Schneider, Sarah Koopman, Marissa Sharp, Victoria Dempsey, Elizabeth Rudy, Melissa Combs, Dena Chapman

Nursing Research and EBP Day 2023

Question: Can an individualized nurse led exercise/mobility program in hospitalized elderly, age 75 and older prevent functional decline, decrease LOS and prevent institutionalization to SNF?

Hypothesis: Current practice is one mobility champion for 3 or 4 inpatient medical surgical units to ambulate or mobilize patients in a 262/300 bed hospital (NWH/CSH). No formal exercise program is in place unless there is an order for PT. This current practice leaves elderly age 75 and older at risk for functional decline and adverse outcomes. It was hypothesized that a nurse driven mobility program in the patients care plan for mobile, non- mobile …

How To Cru: Submitting A Clinical Research Utilization Form, Susan Stell, Gwendolyn Williams

Nursing Research and EBP Day 2023

To increase nurses’ comfort level with applying research to nursing practice, the Clinical Research Utilization (CRU) Form was created. Most nurses in the Rochester Regional Health system are required to complete one CRU Form every year, and nurses who complete 2 are able to use their second CRU for the clinical ladder. This poster helps provides guidance for nurses who are submitting a CRU Form.

Virtual Distractions From Reality, Mary Grace Nichols, Meghan Guzda, Meghan Dougherty, Louise Toepper, Bailey Hernandez

Nursing Research and EBP Day 2023

Patients in the pediatric emergency room are subject to many painful, stressful, and scary procedures which can lead to a frightened, nervous and uncooperative child. These same procedures can contribute to parental stress and lead to staff dissatisfaction as well. While the literature revealed a plethora of distraction techniques that are implemented in pediatric patients, our project explored studies that implemented virtual reality as a distraction technique across different ages and procedures.

Based on the evidence that was identified, a grant was recently obtained to implement virtual reality into our pediatric emergency department at Rochester General Hospital and we are …

Postoperative Deep Vein Thrombosis Prevention, Jaidin Degraw, Carrie Elliott, Cailey Jeffery, Melina Leone, Amber Mallory

Nursing Research and EBP Day 2023

The prevention of deep vein thrombosis (DVT) remains a primary concern for providers. While prophylactic heparin has been routinely prescribed, other forms of prevention such as early ambulation and pneumatic compression are now being used. This project sought to identify which method of DVT prophylaxis is more effective in providing safe patient care and reducing hospital stay. Based on the literature that was reviewed, the use of dual prophylactic measures may be more beneficial than a single preventative measure. As always, more research is warranted.

Nurse Residency Program: Is This Worth My Time?, Gracie Puls, Sydney Wellspeak, Ashley Ernle, Cheryl Mcgee, Sarah Glor

Nursing Research and EBP Day 2023

Question: The purpose of this evidence-based practice project was to determine in new graduate nurses, how does Nurse Residency Program versus traditional orientation effect confidence and competence in high risk/low volume procedures.

Hypothesis: It was hypothesized that Nurse Residency Program was superior to traditional orientation for improving confidence and competence in high risk/low volume procedures.

Methods: A literature review was conducted using CINAHL with key words “orientation”, “Nurse Residency Program”, “confidence”, “competence”, and “transition”.

Results: The results of the literature search identified two studies that utilized quantitative strategies and found statistically significant results favoring Nurse Residency Programs over orientation alone. …

The Big Picture: Use Of Photography As Standard Documentation, Megan Tebo, Rhianon Lester

Nursing Research and EBP Day 2023

Photos of surgical wounds when included in documentation can assist the clinician in providing appropriate care and help engage the patient in their care. Incorporating photos into documentation provides a consistent timeline of wound changes and can help the clinician identify issues in a timely manner and may provide a method to involve the patient in their care. An additional benefit of wound photos is the prevention of potential legal issues as it demonstrates that the quality of care received is appropriate. If medical malpractice were to result, photos add to proper documentation.

When the decision is made to include …

Restraint Free In 2023, Lindsey Alfred, Kalani Dancoe, Tawo Ewa, Xiomara Figueroa, Willow Finch, Yusnavys Alfonso Flores, Jessica Jones, Kerry Lefebvre, Beka Naylor, Alyssa Umbrino, Jarvis Mcgrath, Elizabeth Duxbury

Nursing Research and EBP Day 2023

This EBP project evaluated if in hospitalized adult patients on Sands 800 does the use of a restraint management bundle decrease the use of restraints during the inpatient admission compared to current restraint practices. In the SICU, restraint usage is an initial response instead of last intervention. This culture of care concerns nurses and providers. It was hypothesized that decrease restraint usage and time in restraints will allow the patient to remain safer by evaluating usage of restraint alternatives, cost savings, patient mobility, and clinical staff understanding of appropriate restraint usage.

The SICU was educated on the least restrictive device, …

Pre-Visit Planning In Primary Care, Suzanne Allman, Melissa Tillman, Breanne Thielges, Melissa Diaz, John Frewing, Susan Bopp, Ozlem Kadar

Nursing Research and EBP Day 2023

Pre-visit planning is the process of collecting and organizing data prior to a patient appointment. The pre-visit planning process requires a team member to call the patient a week before the appointment through the use of a questionnaire form. This helps identify incomplete tests, screenings, immunizations and referrals that are currently outstanding. The pre-visit process results in scheduling needed appointments and lab work as well as gathering necessary information from the patient to streamline their upcoming visit. The use of pre-visit planning may result in improved patient satisfaction and decreased physician time with each patient visit.

Evidence-Based Practice Liaisons: Supporting Ebp Across The Health System, Tami Hartzell, Susan Stell

Nursing Research and EBP Day 2023

The Evidence-Based Liaison Council was formed to sustain evidence-based practice (EBP) at Rochester Regional Health and to support an EBP culture using the Advancing Research and Clinical Practice through Close Collaboration Model (ARCC) (Melnyk & Fineout-Overholt, 2005). Committee members include nursing representatives from a variety of clinical settings and hospitals as well as interdisciplinary team members committed to using and bringing evidence-based practice to the bedside.

This poster highlights how EBP facilitates value-added care, improves clinician satisfaction, and enhances the patient experience. Sharing our accomplishments demonstrates the ways in which the Council has contributed to increasing nurses’ knowledge and use …

Standardization Tools In Rrh Triage: A Nursing Based Review, Makayla Boff, Julie Voelkl, Cynthia Garofono, Colin Dewyea, Heather Farren

Nursing Research and EBP Day 2023

Long wait times to be seen in outpatient clinics has led to an increase of triage messages for nurses within RRH. Could standardizing nursing triage protocol improve efficiency of patients care while building confidence and satisfaction among nurses? If protocols and standardizations tools are implemented to nursing staff then collectively we should see triage messages being answered in a more timely fashion, providing quicker care to patients as nurses will become more confident in the care they provide due to more precise guidelines being set out for them to follow.

Within RRH ambulatory offices surveys were created and distributed among …

Re-Evaluating Mobilization Practices And Their Impact On Hapis, Erin Christopher, Mary Prochaska, Luna Pierre, Lindsay Santucci, Kenny Van Ryn, Francheska Santiago

Nursing Research and EBP Day 2023

Hospital acquired pressure injuries (HAPIs) contribute to longer length of stay, poor clinical outcomes and increased healthcare costs.

A literature review showed that the implementation of visual cues to identify patients who require assistance with mobility and positioning in addition to the implementation of scheduled turn teams could have a positive health impact for the patients at RGH and reduce HAPIs incidence. Research suggests that educating unlicensed staff to recognize patient Braden Scale scores and to provide daily care based on risk factors for skin breakdown may lead to improved clinical outcomes.

Are Non-Slip Socks The Best Way To Prevent Falls?, Grace Buonaugurio, Gabriella Coraggioso, Yana Gerasimovich, Alysia Negron, Zara Reilly

Nursing Research and EBP Day 2023

The purpose of this Evidence Based Research Project was to examine if the common fall prevention intervention of patients wearing non-slip socks while in the hospital the most beneficial way to prevent inpatient falls? It was hypothesized that in hospitalized adults over the age of 65 the use of non-slip socks compared to other footwear would not decrease the risk of falls. To test this hypothesis, a literature review was conducted, and articles related to the specific intervention of non-slip socks on the hospitalized older adult and its effect on falls were reviewed.

Previous studies have associated mobilization in foot …

Retention Among New Graduate Rns With And Without Transition To Practice Nurse Residency Programs, Grace Newman, Calie Ferraina, Amanda Burling

Nursing Research and EBP Day 2023

Question: Does a structured nurse residency program affect the rate of retention among newly graduated RNs?

Hypothesis: A structured nurse residency program will impact the retention of new graduate RNs.

Methods: Articles reviewed for RN retention rates for nurses with and without nurse residency programs.

Results: Research supports that transition to practice (TTP) programs have been successful in new graduate RN retention rates. TTP programs help the new graduate develop skills to cope more effectively with their transition and lead to healthier, more balanced careers. Typical TTP programs were generally 12 months in length, had a dedicated program coordinator and …

Severe Covid-19 Following Rituximab And Nirmatrelvir/Ritonavir Treatment In A Patient With Mctd, Case Report, Rohail A. Baig, Faieja Chowdhury, Omar Siddiqui, Adnaan Sheikh, Varun Mehta, Pranjali Dakwale

Advances in Clinical Medical Research and Healthcare Delivery

This is an article about how the use of medications such as nirmatrelvir/ritonavir can cause rebound COVID-19 and how the use of Rituximab, a biologic agent, can prolong the duration and increase severity of symptoms of COVID-19 in patients with pre-disposed autoimmune diseases that are on chronic pharmacotherapy.

Median Arcuate Ligament Syndrome: A Rare Cause Of Abdominal Pain That Is Difficult To Identify, Mark E. Eskander, Matthew Thrall, Joel P. Thompson

Advances in Clinical Medical Research and Healthcare Delivery

Median arcuate ligament syndrome (MALS) is a rare disease that occurs when the celiac artery is compressed by the median arcuate ligament. Patients with MALS typically present with non-specific symptoms that overlap with more common diseases. As a result, patients may undergo extensive workup and unnecessary treatments before being properly diagnosed with MALS. In this case we present a 23-year-old female with chronic postprandial abdominal pain that persisted despite undergoing a cholecystectomy. This case highlights the symptoms and imaging findings needed to diagnose MALS and thus prevent unnecessary surgical interventions.

Pedagogy Of Problems, Ryan Babineau

Advances in Clinical Medical Research and Healthcare Delivery

No abstract provided.

Metastatic Testicular Cancer Patient With Synchronous Oral Squamous Cell Carcinoma Presented With Gastrointestinal Bleeding: A Case Report, Manar F. Ashour, Sundus Nasim, Hallas M. Kadhim, Maan Faraj, Sylvia E. Eshak

Advances in Clinical Medical Research and Healthcare Delivery

Testicular cancer is a curable oncologic disease of males mostly aged 15-44 years. Most of the patients are successfully treated with radical orchiectomy. However, a delayed presentation may lead to a dismal prognosis. There are several risk factors including cryptorchidism, a first-degree relative with testicular cancer, hypospadias, childhood inguinal hernia, and military pollutant exposure, among others. The distant metastasis of testicular carcinoma to the lung, liver, and brain are widely described. We present a unique case of a 28-year-old male who presented with gastrointestinal (GI) bleeding. Later, it was discovered that he had a metastatic testicular carcinoma synchronous with an …

The Safe Stay Program: For Care Of The Pediatric Patient Boarding In The Emergency Department, Kellie Rorke

Nursing Research and EBP Day 2022

The purpose of this evidence-based project was to explore alternative methods to address the process for admitted patients boarding in the pediatric emergency department. It was hypothesized that creating an intentional program of vigilance for safe care of the boarding pediatric patient via a pediatric admission care RN (PAC-RN), supported by interventions including on time medication administration, monitoring, and admission process education. Could reduce adverse events, total inpatient length of stay, morbidity and mortality and improve overall patient/family satisfaction.

A systematic literature search to review patient boarding in the emergency department was conducted. The literature reviewed supported the implementation of …

Ehealth@Home: Avoiding Readmissions For Heart Failure Patients, Krysta Harrington

Nursing Research and EBP Day 2022

The purpose of this evidence-based project was to reduce readmission rates for congestive heart failure (CHF) patients. It was hypothesized that targeted, nursing led care would reduce readmission rates. To test the hypothesis, we engaged patients post-discharge to enroll in eHealth@Home. eHealth@Home is a program at Rochester Regional Health (RRH) that serves high need CHF patients with frequent acute care utilization. These patients receive intensive monitoring and follow-up from a dedicated eHealth nurse, nurse practitioner and community health worker who work in tandem with a patient’s RRH provider to ensure that seamless and quality care is delivered. Visits were done …

Immune-Related Adverse Event Management For Oncology Patients, Mary Beth Casselbury, Lori Davis, Sharon Wilson

Nursing Research and EBP Day 2022

Rapid advances in cancer immunotherapy using Immune Checkpoint Inhibitors have led to significantly improved survival of patients. Immunotherapy is also associated with multiple immune-related adverse events (irAE’s). The purpose of this research is to determine if reinforced patient education regarding early recognition/management of side effects/adverse events decreases serious immune-related events. It is hypothesized that utilizing a patient education plan may determine if these interventions can manage immune-related adverse events and thereby decrease the severity of these events.

Our team reviewed literature addressing follow-up care for Oncology patients receiving Immunotherapy. To promote efficient management of immune-related adverse events several major oncology …

Rn Managed Warfarin Therapy Improves Patient Outcomes, Beth Ormsby, Stacee Marvin, Viktoria Leblanc, Ashley Harris

Nursing Research and EBP Day 2022

Warfarin, an oral anticoagulant, is a “high-risk” medication with narrow therapeutic range and risks for serious complications if not carefully managed. Therapeutic effect is determined using a blood test called the International Normalized Ratio (INR). Evidence shows a higher percentage of Time in Therapeutic Range (TTR) decreases the risk of adverse events including bleeding, hemorrhagic stroke, and death. An optimal TTR is 60 – 70% or higher. Improving TTR by 2.5 - 5% could significantly impact outcomes.

It was hypothesized that an algorithm based approach to Warfarin management by a consistent team of RN’s would improve TTR and outcomes.

To …

Assessing Primary Care Rns Impact On Quality Patient Care, Elizabeth Carreira

Nursing Research and EBP Day 2022

The purpose of this work was to examine how a large multi-site primary care based organization established an organizational structure that supported the determination, definition, measurement, and reporting of nursing sensitive indicators (NSIs) specific to ambulatory care nursing. NSIs capture the value of care provided by nurses and are a critical component of ANCC Magnet designation. The organization considered that successful pursuit of Magnet designation in an all ambulatory organization would involve establishing a framework to report NSIs that included defining nursing units and NSIs meaningful to the organization.

A multidisciplinary team led by nursing was established to examine and …

Licensed Practical Nurses Working To Maximum Scope Of Practice, Lindsey Sippel, Lauren Sicker, Jessie Schiffhauer, Kristee Aliten

Nursing Research and EBP Day 2022

BACKGROUND: Nurses on 4800, a medical-surgical unit, were feeling overwhelmed by an increasing patient load due to Registered Nurse (RN) vacancies. No not only was staff morale at a low, but the staff was concerned about the impact on patient care. Nursing staff on 4800 consists of RNs as well as Licensed Practical Nurses (LPNs). As the team contemplated the high nurse:patient ratio, they identified that LPNs were not working to the full scope of their practice. The team began to wonder if ensuring that LPNs could work at the highest level of their scope of practice if this would …

Experiences Of Nurses And Nurse Leaders During The First Year Of The Covid-19 Pandemic: An Integrative Review, Jessica Powell

Nursing Research and EBP Day 2022

This research aimed to examine the experiences of nurses and nursing leadership who worked through the COVID-19 pandemic. Understanding their experiences will help better support those suffering from burnout. An integrative review was done by searching three databases in February 2022. Search terms included: burnout, compassion fatigue, Nurs*, leadership, and COVID-19. A total of 288 studies were retrieved, with 11 eligible for review. Seven themes were identified: information, safety, psychological and physical impacts on nurses, patient needs vs. pandemic needs, acknowledgment, protective factors and positive things from their experience, and changes in responsibilities. Understanding the nurses’ and nurse leaders’ experiences …

Lost In Translation: Mitigating The Effects Of Language Barriers On Patient Outcomes, Megan R. Van Dorp

Nursing Research and EBP Day 2022

The purpose of this research was to describe the development, implementation, timeline, and future evaluation of an evidence-based initiative to improve the outcomes of limited English proficiency patients. It was hypothesized that bridging the communication gap between patients of lesser English proficiency and their healthcare providers would increase patients' participation and understanding of their hospital stay. Improving discharge instructions and ensuring comprehension would promote well-being and health as patients are adequately equipped at discharge to assume their own healthcare needs. To test the hypothesis, a literature search was conducted of professional databases. Fifteen scholarly articles contributed to the research base …

Development And Implementation Of An Ambulatory Nursing Shared Governance Council, Patricia K. Fioravanti, Maria Larner

Nursing Research and EBP Day 2022

The purpose of this work was to research, develop, and implement an ambulatory nursing shared governance council (ANSGC) to support the pursuit of Magnet designation within the Primary Care and Specialty Institute (PCASI) ambulatory care nursing environment at Rochester Regional Health. PCASI is comprised of over 115 practices located throughout 8 counties. Literature supports shared governance as a mechanism to increase nurse engagement, nurse retention, improve patient outcomes and promotes partnership between front line nurses and administration. Nursing Shared Governance is a pillar of the American Nurses Credentialing Center (ANCC) Magnet culture and a critical component of Magnet designation.

PCASI …

A Depression Screening Protocol For Acute Stoke Patients: A Quality Improvement Project, Celia Mcintosh

Nursing Research and EBP Day 2022

Background: Depression after stroke is common and is associated with poor functional recovery, suicidal ideation, decreased quality of life, and increased mortality. Despite this knowledge, poststroke depression (PSD) is often underdetected and thus undertreated. PSD is clinically important for the caregiver, the family, and the stroke survivor. Inconsistencies in screening and treatment practices may further contribute to these negative outcomes.

Purpose: The purposes of this evidence-based clinical scholarship project were to (1) determine the efficacy of an evidence-based depression screening protocol in improving early detection and treatment of PSD and (2) identify if there were any relationships between the protocol …