Medicine and Health Sciences Commons^™

An Evidence-Based Teaching Plan For Preventing Wrong-Site Block Placement During Regional Anesthesia, Mark A. Michetti, Kristen E. Newbrough

DNP Scholarly Projects

Wrong-site regional anesthetic block placement is a threat to patient safety and quality perioperative care. The adverse outcomes for patients, providers, and institutions demonstrate safety risks that are linked to inconsistent use of comprehensive guidelines in clinical practice. The purpose of this Doctor of Nursing Practice Project is to create a comprehensive evidence-based Teaching Plan for preventing wrong-site block (WSB) placement during regional anesthetic induction and for use in institutions by anesthesia providers to prevent wrong-site anesthetic block placement. The teaching plan focuses on four main constructs to prevent WSBs, which include the incidence of WSBs, the consequences of WSBs, …

Nurse Efficiency & Ultrasound Guided Intravenous Access: Evidence Based Intervention Benchmark, Jacob D. Frost

MSN Capstone Projects

Gaining IV access is this first step into accurate, timely diagnosis and interventions of patients. Nurses are typically the first medical professional a patient sees. If the nurse can establish IV access as early as possible this will lead to faster interventions faster diagnostic results and better management for patients and ultimately better patient outcomes. Ultrasound guided IV can increase first attempt success rates leading to decreased painful IV insertions by multiple nurses. This would increase patient satisfactions scores leading to higher re-imbursement.

Creating And Implementing A Principal Investigator Tool Kit For Enhancing Accrual To Late Phase Clinical Trials: Development And Usability Study., Kristin A Higgins, Alexandra Thomas, Nancy Soto, Rebecca Paulus, Thomas J George, Thomas B Julian, Sharon Hartson Stine, Merry Jennifer Markham, Maria Werner-Wasik

Kimmel Cancer Center Faculty Papers

BACKGROUND: Accrual to oncology clinical trials remains a challenge, particularly during the COVID-19 pandemic. For late phase clinical trials funded by the National Cancer Institute, the development of these research protocols is a resource-intensive process; however, mechanisms to optimize patient accrual after trial activation are underdeveloped across the National Clinical Trial Network (NCTN). Low patient accrual can lead to the premature closure of clinical trials and can ultimately delay the availability of new, potentially life-saving therapies in oncology.

OBJECTIVE: The purpose of this study is to formally create an easily implemented tool kit of resources for investigators of oncology clinical …

Patients’ Attitudes Toward Deprescribing And Their Experiences Communicating With Clinicians And Pharmacists, Kaylee Marie Lukacena, James W. Keck, Patricia R. Freeman, Nancy Grant Harrington, Mark Huffmyer, Daniela C. Moga

Sanders-Brown Center on Aging Faculty Publications

Purpose: Developing effective deprescribing interventions relies on understanding attitudes, beliefs, and communication challenges of those involved in the deprescribing decision-making process, including the patient, the primary care clinician, and the pharmacist. The objective of this study was to assess patients’ beliefs and attitudes and identify facilitators of and barriers to deprescribing.

Methods: As part of a larger study, we recruited patients ⩾18years of age taking ⩾3 chronic medications. Participants were recruited from retail pharmacies associated with the University of Kentucky HealthCare system. They completed an electronic survey that included demographic information, questions about communication with their primary care clinician and …

Adding Value To The Life Of Terminally Ill Patients Through Legacy Art Projects, Jeannine Millner

2022 Academic Exhibition

Rather than giving up, the terminal patient can be helped to continue living until they die, experiencing a time of personal growth for all involved through the creation of legacy projects.

Hourly Rounding To Reduce Patient Falls - A Quality Improvement Project, Shelley L. Lloyd

MSN Capstone Projects

Patient falls are devastating. They can result in injury and even death. They also result in extra costs for the patient as well as they facility. Hourly rounding is a simple process that can help reduce the number of patient falls within an acute care facility. Purposeful hourly rounding will help meet the needs of the patient as well as allow the staff member to asses the environment for safety issues. Rounding should happen every hour during the day and every two hours at night. During these rounds, staff will ask the patient about pain, bathroom needs, comfort, peacefulness of …

The Joy Of Cooking With Ots: A Visual Guide, Sarah Baker

WWU Honors College Senior Projects

Access to the full guide found here: https://mixam.com/share/60bf9e1ed250502f2e67534e

Occupational therapy (OT) is an allied healthcare profession that is uniquely situated at the intersection of art and science. OT seeks to improve quality of life by addressing occupations, or daily activities that are meaningful and purposeful (Nelson, 2014). In order to accomplish these goals, occupational therapists (OTs) must use design thinking through the lens of evidence-based practice. This artistic creativity paired with well-researched scientific findings mimics the visual nature of this guide, which prioritizes this need for alternative representation of the sciences.

This visual guide focuses on the interconnectivity of culture, …

Epidemiological Characteristics, Ventilator Management, And Clinical Outcome In Patients Receiving Invasive Ventilation In Intensive Care Units From 10 Asian Middle-Income Countries (Provent-Imic): An International, Multicenter, Prospective Study, Luigi Pisani, Anna Geke Algera, Ary Serpa Neto, Areef Ahsan, Abigail Beane, Kaweesak Chittawatanarat, Abul Faiz, Rashan Haniffa, Seyed Mohammadreza Hashemian, Madiha Hashmi

Department of Anaesthesia

Epidemiology, ventilator management, and outcome in patients receiving invasive ventilation in intensive care units (ICUs) in middle-income countries are largely unknown. PRactice of VENTilation in Middle-income Countries is an international multicenter 4-week observational study of invasively ventilated adult patients in 54 ICUs from 10 Asian countries conducted in 2017/18. Study outcomes included major ventilator settings (including tidal volume [V T] and positive end-expiratory pressure [PEEP]); the proportion of patients at risk for acute respiratory distress syndrome (ARDS), according to the lung injury prediction score (LIPS), or with ARDS; the incidence of pulmonary complications; and ICU mortality. In 1,315 patients included, …

Community Perspectives On The Creation Of A Hospital-Based Doula Program, Laura B. Attanasio, Marisa Decosta, Reva Kleppel, Tiki Govantes, Heather Z. Sankey, Sarah L. Goff

Health Promotion and Policy Faculty Publication Series

Objective: Racial and ethnic inequities in perinatal health outcomes are pervasive. Doula support is an evidence-based practice for improving maternal outcomes. However, women in lower-income populations often do not have access to doulas. This study explored community perspectives on doula care to inform the development of a hospital-based doula program to serve primarily low-income women of color.

Methods: Four focus groups and four individual interviews were conducted with: (1) women who were pregnant or parenting a child under age 2 (n=20); (2) people who had provided support during a birth in the previous 2 years (n=5); …

Risks To Healthcare Organizations And Staff Who Manage Obese (Bariatric) Patients And Use Of Obesity Data To Mitigate Risks: A Literature Review, Kim Mcclean, Martyn Cross, Sue Reed

Research outputs 2014 to 2021

This literature review explores obesity risks to healthcare staff and organizations that manage and caring for obese (bariatric) patients. These risks are anticipated to increase due to Australian population obesity rate projections increasing from 31% in 2018 to 42% by the year 2035, which will result in increased hospital admissions of patients with obesity. Literature searches were conducted through the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Scopus, and Web of Science. Thirty studies met the inclusion criteria and were tabulated and critiqued using appropriate appraisal techniques. High risk of injury to healthcare staff was identified relating …

Improving Health Care Accessibility Among Geriatric Patients In Rural Communities, Capriana Calvachi

Honors Projects

The following literature review and analysis compiles information regarding ways to improve rural geriatric healthcare accessibility through the use of interprofessional care and outreach. I also wish to bring to light the various deficiencies often seen in this realm of care, and the reasons behind the inadequate rural physician retention rates. Using this background information, I compiled various collaborative approaches which seek to ease the strain faced by the healthcare system and its elderly patients.

Improving healthcare accessibility through the use of interprofessional care and outreach is an essential facet in geriatric medicine. By exploring the deficiencies of geriactric healthcare …

Wellness Through Answers News V.35:No.4 September-October 2020, Wendy Urciuoli

Articles - Patient Care

No abstract provided.

A Qualitative Exploration To Understand Hospitalists’ Attitude Toward The Patient Experience Scoring System, Ankur Segon, Yogita Segon, Vivek Kumar, Hirotaka Kato

Internal Medicine Faculty Publications

Patient’s perception of their inpatient experience is measured by the Center for Medical Services’ (CMS) administered Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) survey. There is scant existing literature on physicians’ perceptions toward the HCAHPS scoring system. Understanding hospitalist knowledge and attitude toward the HCAHPS survey can help guide efforts to impact HCAHPS survey scores by improving the patient’s perception of their hospital experience. The goal of this study is to explore hospitalists’ knowledge and perspective of the physician communication domain of the HCAHPS survey at an academic medical center. Seven hospitalists at an academic medical center were …

Wellness Through Answers News V.35:No.3 July-August 2020, Wendy Urciuoli

Articles - Patient Care

No abstract provided.

Understanding The Dimensions Of Medical Crowdfunding: A Visual Analytics Approach, Jie Ren, Viju Raghupathi, Wullianallur Raghupathi

Publications and Research

Background: Medical crowdfunding has emerged as a growing field for fundraising opportunities. Some environmental trends have driven the emergence of campaigns to raise funds for medical care. These trends include lack of medical insurance, economic backlash following the 2008 financial collapse, and shortcomings of health care regulations.

Objective: Research regarding crowdfunding campaign use, reasons, and effects on the provision of medical care and individual relationships in health systems is limited. This study aimed to explore the nature and dimensions of the phenomenon of medical crowdfunding using a visual analytics approach and data crawled from the GoFundMe crowdfunding platform in 2019. …

Strengthening Safety Culture By Leveraging The Daily Management System, Suneela Nayak, Mark Parker, Erin Graydon Baker, Amy Sparks, Ruth Hanselman, Stephen Tyzik, Sydney Green

Operations Transformation

STRENGTHENING SAFETY CULTURE BY LEVERAGING THE DAILY MANAGEMENT SYSTEM

There is abundant evidence that links a strong culture of safety with improved patient and staff experience. However, there has been no clear avenue identified as to how to achieve this metric.

A team in a large academic tertiary teaching hospital set about leveraging their daily managing system (DMS) to attain improvement in their institution’s safety. The goals of this quality improvement project were to use DMS to identify and report safety concerns and increase frontline team knowledge and comfort with reporting safety concerns during Gemba walks.

A root cause analysis …

A Coaching And Team Performance Evaluation Model To Build Capacity For High-Impact Lean Improvement, Ruth Hanselman, Mark Parker, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operations Transformation

There is abundant evidence that links a strong culture of safety with improved patient and staff experience. However, there has been no clear avenue identified as to how to achieve this metric.

A team in a large academic tertiary teaching hospital set about leveraging their daily managing system (DMS) to attain improvement in their institution’s safety. The goals of this quality improvement project were to use DMS to identify and report safety concerns and increase frontline team knowledge and comfort with reporting safety concerns during Gemba walks.

A root cause analysis identified 5 areas for improvement and several countermeasures were …

Increase Staff Utilization Of Occlusive Interface In Micro-Preemie Babies On Bcpap, Deborah A. Igo, Kimberly Kingsley, Faythe Henry, Misty Melendi, Amy Mcbee, Valerie Cook, Christopher Woods, Angela Rojecki, Lauren Walley, Amy Sparks, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Operations Transformation

Premature neonates born before 26 weeks gestation present many care challenges as they need special precautions to be taken to overcome their fragility. Intubation is often needed for this patient population as their lungs are not fully developed. However, due to their high susceptibility for skin breakdown invasive ventilation often can create subsequent problems. A respiratory therapist team in an academic tertiary medical center wanted to explore the use of an occlusive interface for intubation while providing various forms of non-invasive ventilation in their NICU with the hopes for fewer complications.

The objective of this project was to reduce the …

Increasing Advanced Care Planning In An Ambulatory Care Setting, Jennifer Aronson, Elizabeth Eisenhardt, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operations Transformation

Maine is experiencing an increasing percentage of its population being over 65 years old. Advanced Care Planning (ACP) is an important part of this aging population medical care so those ends of life preferences are known well in advance. An adult internal medicine clinic in a large academic tertiary medical center decided to create a performance improvement project that addressed ACP with embedded workflows.

The goal of this project was to have a minimum of 40% of patients 65 or older have an Advanced Care Directive or Serious Illness Conversation documented in EPIC.

Baseline metrics demonstrated that ACP discussion rates …

Retrospective Evaluation Of Weight Loss In Maine Medical Center Cancer Institute (Mmcci) Patients Receiving Radiation Treatment For Head And Neck Cancer, Julian Johnson, David Debartolo-Stone, Jessica Moore, Ruth Hanselman, Stephen Tyzik, Suneela Nayak, Amy Sparks

Operations Transformation

Treatment for head and neck cancer often results in weight loss as a side effect. One option to mitigate this weight loss is placement of a percutaneous endoscopic gastrostomy (PEG) tube placement. Radiation oncologists at a academic tertiary medical center discuss the option of PEG placement during patient consultation.

A retrospective evaluation of weight loss in patients receiving radiation was conducted over a two-year period. The goal of this data collection was to create a standard for oncology consultations regarding PEG tube placement.

Baseline metrics and a root cause analysis drove subsequent data collection steps. After analyzing the raw data, …

Barriers To Patient Electronic Portal Usage, Debbie Hoza

Applied Research Projects

This paper focuses on the barriers that patients have as to why they do not use their electronic patient portal. The literature suggests that the age and socioeconomic status of the individual has a big impact on the use of the electronic portals. A review of the literature showed that all populations have not been represented. This study surveys a broader range of patients including all ages, genders, education and socioeconomic statuses to see what barriers that this broader range of patients has to using their electronic portals.

Effectiveness Of Quality Incentive Payments In General Practice (Equip-Gp): A Study Protocol For A Cluster-Randomised Trial Of An Outcomes-Based Funding Model In Australian General Practice To Improve Patient Care, Gregory Peterson, Grant Russell, Jan Radford, Nicholas Arnold Zwar, Danielle Mazza, Simon Eckermann, Judy Mullan, Marijka Batterham, Athena Hammond, Andrew D. Bonney

Illawarra Health and Medical Research Institute

Background There is international interest in whether improved primary care, in particular for patients with chronic or complex conditions, can lead to decreased use of health resources and whether financial incentives help achieve this goal. This trial (EQuIP-GP) will investigate whether a funding model based upon targeted, continuous quality incentive payments for Australian general practices increases relational continuity of care, and lessens health-service utilisation, for high-risk patients and children. Methods We will use a mixed methods approach incorporating a two-arm pragmatic cluster randomised control trial with nested qualitative case studies. We aim to recruit 36 general practices from Practice-Based Research …

The Exercise And Sports Science Australia Position Statement: Exercise Medicine In Cancer Management, Sandra C. Hayes, Robert U. Newton, Rosalind R. Spence, Daniel A. Galvao

Research outputs 2014 to 2021

Objectives: Since Exercise and Sports Science Australia (ESSA) first published its position statement on exercise guidelines for people with cancer, there has been exponential growth in research evaluating the role of exercise pre-, during and post-cancer treatment.

Design and Methods: The purpose of this report is to use the current scientific evidence, alongside clinical experience and exercise science principles to update ESSA’s position statement on cancer-specific exercise prescription.

Results: Reported in this position statement is a summary of the benefits accrued through exercise following a cancer diagnosis and the strengths and limitations of this evidence-base. An exercise prescription framework is …

Health Care's Market Bureaucracy, Allison K. Hoffman

All Faculty Scholarship

The last several decades of health law and policy have been built on a foundation of economic theory. This theory supported the proliferation of market-based policies that promised maximum efficiency and minimal bureaucracy. Neither of these promises has been realized. A mounting body of empirical research discussed in this Article makes clear that leading market-based policies are not efficient — they fail to capture what people want. Even more, this Article describes how the struggle to bolster these policies — through constant regulatory, technocratic tinkering that aims to improve the market and the decision-making of consumers in it — has …

Improving Communication To Reduce Patient Falls In A 48-Bed Medical-Surgical Unit, Christian Gella

Nursing and Health Professions Faculty Research and Publications

Abstract

Problem: Patient falls has been associated with increased morbidity, mortality and decreased quality of life. The increase in total patient falls for 2018 relative to 2017, and a spike of 10 patient falls for the month of June 2018 from a baseline of 5.3 falls per month has gained greater attention to reduce patient harm from falls while hospitalized. Prevention of falls minimizes patient exposure to the possibility of being injured. Despite efforts to curtail patient falls, improvement in communication is essential to address the safety issues surrounding improving quality of care practices, and consequentially reduce un-reimbursable hospital costs …

Increasing Bedside Medication Safety In An Intensive Care Setting, Natasha Stankiewicz, Jonathan Archibald, Scu 2, Mark Parker, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

A PERFORMANCE IMPROVEMENT PROJECT FOR INCREASED BEDSIDE MEDICATION SAFETY

The convenience of having certain medications directly available at bedside has long been a priority for a medical intensive care nursing team in an academic tertiary medical center.

However, it was apparent to new staff and leadership that there was a lack of awareness and interest in securing medications within the department. This posed a risk to patients, families, visitors and colleagues.

Baseline metrics on patient safety were collected and a root cause analysis was conducted. Countermeasures included increased education of medication safety as well as a instituting a KPI which …

Consistently Using A Transportation Department For Patient Discharge To Sustain Nursing Staffing Levels, Victoria Boutin, Joseph East, Stephen Tyzik, Joy Moody, Mark Parker, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

IMPROVING PATIENT FLOW BY UTILIZING A HOSPITAL TRANSPORTATION DEPARTMENT FOR DISCHARGES

Using a transportation department for transporting patients for discharge is the industry standard. At a large urban hospital, inconsistent use of this department has resulted in frontline caregivers (RNs) having to pick up this function, resulting in potentially unsafe staffing levels on the floor.

The goal of this quality improvement project was to improve the percent of discharges with the transport department from ≤10% to 70% by the end is fiscal year 2018 in an academic tertiary medical center.

Baseline metrics demonstrated the current state and a root cause …

Using Theories And Models For Operationalization Of Patient Trust In Doctors In Chronic Disease Response In Low Income Africa: ‘Best Fit Approach’, Kahabi Isangula

School of Nursing & Midwifery, East Africa

Background: Recent evidence suggest that improved patient trust in doctors can facilitate their healthcare seeking, adherence and continuity with care. With the growing burden of chronic disease in low income Africa (LIA) characterized by challenges of poor patient healthcare seeking, non-adherence and poor continuity with care, trust forms an important entry point for addressing these challenges. However, the topic of trust has generally received weaker attention among researchers in LIA contexts. To date, there has been no attempts to generate a clear guide for theory-driven inquiries as a means of operationalization of trust as a public health lens for chronic …

Patient Acceptance Of Remote Scribing Powered By Google Glass In Outpatient Dermatology: Cross-Sectional Study, Sandra Odenheimer, Deepika Goyal, Veena Jones, Ruth Rosenblum, Lam Ho, Albert Chan

Faculty Publications

Background: The ubiquitous use of electronic health records (EHRs) during medical office visits using a computer monitor and keyboard can be distracting and can disrupt patient-health care provider (HCP) nonverbal eye contact cues, which are integral to effective communication. Provider use of a remote medical scribe with face-mounted technology (FMT), such as Google Glass, may preserve patient-HCP communication dynamics in health care settings by allowing providers to maintain direct eye contact with their patients while still having access to the patient’s relevant EHR information. The medical scribe is able to chart patient encounters in real-time working in an offsite location, …

Everyone Is Responsible For A Culture Of Safety, Linda Paradiso

Publications and Research

Whether you’re a direct-care nurse or a leader, you’re responsible for speaking up and taking action to keep patients safe. As front line workers, direct care nurses are error identifiers. The organizations where they work are responsible to create systems that are safe. Nurse leaders are responsible to develop environments that encourage speaking up and are free of punitive response. In a perfect world, discipline is based on the behavioral choice a person makes not the injury to the patient.