Quality Improvement Commons^™

Queer Patients: An Underserved And At Risk Population, Joshua Schmidt

Capstone Showcase

Queer patients in America have faced a history of discrimination as both a community and as individuals. As such, this marginalization acts as a barrier to resources, including healthcare. Clinicians must be aware of said barrier and actively work towards dismantling it within their interactions with queer patients. This article makes a case for increasing sexual health conversations in order to assess queer patients and encourage a stronger patient-provider relationship for a community that is reluctant to seek medical attention, and also more likely to participate in higher risk behaviors.

Planning Patient Safety: Philosophical, Political, And Economic Changes Required For Preventable Death Abolition, Catherine Kiani

CMC Senior Theses

Preventable medical errors are an epidemic. Between 250,000 and 400,000 people die from preventable errors each year in the USA. This investigation questions mechanisms for quality care improvement to eliminate preventable fatalities. I evaluated current patient safety protocols, analyzed their shortcomings, and with additional research recommended actions for better results. Such actions to improve patient safety are explored from three different perspectives: philosophical, economical, and political aspects. In chapter one, improvements within hospitals are reviewed – namely cultural changes needed from both physicians and hospital leadership. Abolishing hierarchical systems which preclude healthy collaboration among medical teams, diverting focus to patient …

A Qualitative Investigation Of Organizational Challenges And Facilitators To Screening Individuals Experiencing Homelessness For Hepatitis C Virus (Hcv) In Houston, Texas, Alane Celeste-Villalvir, J Michael Wilkerson, Christine Markham, Lourdes Rodriguez, Vanessa Schick

Faculty, Staff and Student Publications

BACKGROUND: Individuals experiencing homelessness may be at a disproportionately high risk for hepatitis C (HCV) because they may be more likely to engage in HCV risk behaviors. Community organizations that provide services to these vulnerable individuals can effectively screen, diagnose, and navigate them into HCV care. However, screening people experiencing homelessness for HCV at such organizations is limited by various challenges that remain understudied, including budgetary considerations and strategies to improve teamwork and communication. Accordingly, this study investigated the organizational challenges and facilitators to HCV screening of individuals experiencing homelessness as reported by homeless services providers.

METHODS: Staff (N = …

Characterizing Cancer And Covid-19 Outcomes Using Electronic Health Records, Youngran Kim, Liang Zhu, Huili Zhu, Xiaojin Li, Yan Huang, Chunhui Gu, Heather Bush, Caroline Chung, Guo-Qiang Zhang

Faculty, Staff and Student Publications

PURPOSE: Patients with cancer often have compromised immune system which can lead to worse COVID-19 outcomes. The purpose of this study is to assess the association between COVID-19 outcomes and existing cancer-specific characteristics.

PATIENTS AND METHODS: Patients aged 18 or older with laboratory-confirmed COVID-19 between June 1, 2020, and December 31, 2020, were identified (n = 314 004) from the Optum® de-identified COVID-19 Electronic Health Record (EHR) derived from more than 700 hospitals and 7000 clinics in the United States. To allow sufficient observational time, patients with less than one year of medical history in the EHR dataset before their …

Improving Egypt’S Access To Vaccines And Medicines: Communication During Covid-19 / تحسين إتاحة الوصول إلى اللقاحات والأدوية في مصر: سياسة توعية الجمهور خلال أزمة فيروس كورونا, Alaa Abdel-Rahman, Sarah Attef, Helen Gabrah, Reem El-Sayed, Sarah El-Lithy

Papers, Posters, and Presentations

Since the start of the COVID-19 pandemic, the Egyptian government has been following protocol as best as possible when it comes to responding to the needs of the health and economic sectors amid difficult times. From lockdown measures to the WHO’s recommended practices in terms of isolation of cases and treatments, Egypt has been lauded as one of the fastest and most effective countries in terms of COVID-19 emergency response. Authorities have implemented several awareness campaigns directed at citizens to inform them about the pandemic, how to prevent infection, what to do if infected and how to act accordingly. Authorities …

An Analysis Of The Special Focus Facility Program And Nursing Home Quality, Annie S. Rhodes

Theses and Dissertations

The Special Focus Facility Program is an intensive program meant to rapidly support 88 of the lowest quality nursing homes in the United States, as determined by the Five-Star Quality Ranking system. There are also 435 facility candidates which are similarly low performing but not enrolled in the program. Academic literature has largely ignored this program, and the existing grey literature is more than a decade old and does not include COVID-19 data. Applying a political economy of aging framework and using a case matching methodology, Special Focus Facilities (SFF), Special Focus Facility Candidate (SFFc) nursing homes, and 5-star nursing …

Black Hearts Matter: A Comparative Study Of Sociodemographic, Clinical, And Psychosocial Characteristics In Black And White Persons With Heart Failure, Hannah M Anderson Hughes

Theses and Dissertations

Heart failure (HF) is a chronic, progressive, debilitating illness that disproportionately affects Black individuals, often leading to poor quality of life (QOL). Various sociodemographic, clinical, and psychological characteristics are related to QOL in patients with HF. Because most studies do not include representative Black samples or report findings from racial subgroup analyses, these relationships and any existing racial differences are not well understood. The purpose of this descriptive, comparative study was to explore the relationships among sociodemographic, clinical, and psychological characteristics and QOL in patients with HF and to determine if there were racial differences between Black and White individuals. …

Interprofessional Education Activities And New Practitioner Competence: Implications For Practice In Nutrition And Dietetics Education, Stephanie N. Petrosky

UNF Graduate Theses and Dissertations

Interprofessional education (IPE) and interprofessional collaborative practice (IPCP) are associated with improved perception, values, attitudes towards collaborative practice, and therefore benefits patients, practitioners, and health care systems. Notable organizations have long promoted standardized guidelines for best practices in interdisciplinary team-based learning to improve patient safety and health outcomes. The state of IPE in nutrition and dietetics practice was recently addressed by the Nutrition and Dietetic Educators and Preceptors (NDEP) practice group of the Academy of Nutrition and Dietetics. The authors generated a call to action to engage in IPCP while pushing the boundaries of leadership in teaching, research, and practice. …

Nurse Managers' Patient Safety Communication, Christine Deatrick

Electronic Theses and Dissertations, 2020-2023

Medical errors are a continuing issue for healthcare organizations and can lead to patient harm or death. To bring about organizational learning and therefore reduce medical errors, information must successfully flow through an organization. Nurse managers play an essential role as the conduit of information between frontline staff and the organization. The primary purpose of this study is to describe the decision-making process of how nurse managers actively select and transmit information on patient safety concerns. A qualitative constructivist grounded theory approach was used. Nineteen unit-level nurse managers, working full-time in an acute care hospital with a minimum of one-year …

An Evidence-Based, Structured, Expert Approach To Selecting Essential Indicators Of Primary Care Quality, Sylvia J Hysong, Kelley Arredondo, Ashley M Hughes, Houston F Lester, Frederick L Oswald, Laura A Petersen, Lechauncy Woodard, Edward Post, Shelly Deperalta, Daniel R Murphy, Jason Mcknight, Karin Nelson, Paul Haidet

Faculty, Staff and Students Publications

BACKGROUND: The purpose of this article is to illustrate the application of an evidence-based, structured performance measurement methodology to identify, prioritize, and (when appropriate) generate new measures of health care quality, using primary care as a case example. Primary health care is central to the health care system and health of the American public; thus, ensuring high quality is essential. Due to its complexity, ensuring high-quality primary care requires measurement frameworks that can assess the quality of the infrastructure, workforce configurations, and processes available. This paper describes the use of the Productivity Measurement and Enhancement System (ProMES) to compile a …

Pharmacy-Led Medication Reconciliation Program Reduces Adverse Drug Events And Improves Satisfaction In A Community Hospital, L. Hayley Burgess, Joan Kramer, Carley Castelein, Joseph M. Parra, Victoria Timmons, Samantha Pickens, Sarah Fraker, Christopher Cameron Skinner

HCA Healthcare Journal of Medicine

Background

Pharmacy-led medication reconciliation identifies and corrects medication errors that can potentially cause moderate to severe harm. This research sought to identify the impact of pharmacy-led medication reconciliation on patient outcomes and describe the changes in healthcare workers’ perceptions of the program.

Methods

A pharmacy-led admission medication reconciliation program pilot started in July 2019, and a discharge medication reconciliation proof of concept was tested in September 2020 at a 432-bed hospital. The following periods were compared: August 2018 to February 2019 (pre-program implementation) and August 2019 to February 2020 (post-program implementation). Endpoints included patient outcomes, workforce productivity and interdisciplinary healthcare …

Hormone Therapy For Treatment Of Depression, Johna Beard

Master of Science in Nursing Family Nurse Practitioner

No abstract provided.

Discharge Process Optimization, Erin M. O’Neal

Doctor of Nursing Practice Projects

As the demands of the nurse become increased with higher acuity and documentation requirements, the delivery of discharge instructions is often one of the most, and at times, only, formal education opportunities between the nurse and the patient. It is imperative to modify the discharge process to ensure patients have the ability to confidently care for themselves after they leave the hospital. The aim of this project was to create a nursing discharge workflow that meets the educational needs of the patients. This project was a quality improvement project designed to change the nursing workflow to provide a better discharge …

Patient Placement Matters: The Impact Of Unnecessary Lateral Movement On Patients, Jacqueline Strinden

Doctor of Nursing Practice (DNP) Projects

Patient Placement Matters: The Impact of Unnecessary Lateral Movement on Patients

Abstract

Background: National trends to decrease the number of licensed beds have created inpatient capacity constraints which have resulted in increased unnecessary lateral patient movement events, which contribute to decreased patient safety and quality of care. The incidence of adverse events increases significantly when multiple unnecessary lateral relocations result from secondary efforts to relieve hospital capacity constraints and improve efficiency.

Problem: At a 352 acute care hospital, 12,906 patient movement events were evaluated over a baseline period of three months resulting in an average of 1.48 unnecessary lateral patient …

Improving Medication Administration Safety In A Correctional Facility With An Electronic Medication Administration System, Rosalinda Salazar

Master's Projects and Capstones

Problem: According to the World Health Organization (2020), medication errors are one of the leading causes of injury and avoidable harm in health care globally.

Context: The county jail houses approximately 700 inmates/patients on a daily basis, and the potential for error when administering medications is high as medications are prepared manually using a paper medication administration record.

Interventions: The jail began using an electronic health record/barcode administration system on October 19, 2020.

Measures: Unusual occurrence reports related to medication errors were reviewed. The time frame included 6 months before electronic implementation, and 6 months after implementation.

Results: Unusual occurrence …

Reducing The Postpartum Readmission Rate With Standardized Discharge Teaching, Darlene Day-Herzog

Master's Projects and Capstones

Problem: Hospital readmission rates are one of the quality metrics that matter for hospital reimbursements. In a large Northern California healthcare system, the postpartum readmission rate is often above the national average.

Context: The hospital designated as the main location for high-risk deliveries within a 30-mile radius has an Acute Care Obstetric postpartum population where twenty percent of the patients are at an increased risk for readmission.

Interventions: The project implemented the use of a standardized discharge teaching script and educational materials to be used by nursing staff throughout the patient’s hospital stay to see if multimodal standardization leads to …

Enhanced Recovery After Surgery: Necessity Of Real Time Tracking In Quality Measures And Outcomes, Emily Owens

Master's Projects and Capstones

Abstract

A High Reliability Organization (HRO), such as this Northern California Medical Center, holds itself to high standards of performance in the areas of recognition, ranking, and accreditation. The commonality between these high-scored and valuable acknowledgements is the pillars of Quality Outcomes. As benchmarking and reporting allow this facility to measure outcomes against self and other plans, it greatly strengthens the internal focus for continual improvement and goal setting in direct patient care and outcomes. A deeper layer of the Quality Department includes the bundle “ERAS – Enhanced Recovery After Surgery”, which is compiled of principles aiming to minimize opioid …

Development And Implementation Of An Evidence-Based Practice Mentor Fellowship, Stacy L. Alves

Doctor of Nursing Practice (DNP) Projects

Background: The Institute of Medicine (2008) set a goal that 90% of healthcare decisions would be based on the best evidence possible by 2020, yet many challenges remain. Common barriers include clinicians’ beliefs about the value of evidence-based practices, their competency to implement it, and systems issues such as time, resources, and organizational value and preparedness (Melnyk et al., 2017).

Local Problem: A hospital within an integrated health care system sought to increase the use of EBP for clinical decision making. A gap analysis revealed a lack of sufficient EBP mentors to lead efforts to promote system-wide EBP implementation.

Context: …

Feasibility Of A “Network Of Champions” In Implementing A Program To Address Physician Well-Being, Kerri Palamara, Sara Poplau, Cheryl Rusten, Maria L. Walter, Cynthia D. Smith, Clare Sipler, Susan Hingle, Mark Linzer

Journal of Wellness

Introduction: Healthcare leaders have been challenged to mitigate burnout and foster well-being among physicians. Professional societies are beginning to address this in a systematic manner.

Methods: In 2014, the American College of Physicians (ACP) endeavored to improve well-being for its 160,000 members of internists and trainees through a Well-being Champion (WBC) program based in the majority of its 85 national and international chapters. The program was supported by an evidence-based curriculum, chapter volunteers who served as champions, and in-person and virtual trainings. Training included a 1-2 day program in 2018 and 2019, focused on educating champions on causes …

Self-Measured Blood Pressure Monitoring: A Patient Empowerment Project, Alison Cusmano

Doctor of Nursing Practice Final Manuscripts

Hypertension is a public health issue estimated to affect 112 million adults by 2030. Primary care patients in an outpatient clinic in Southern California with elevated blood pressure readings in the office did not have an organized system for close follow-up. The purpose of this evidence-based project (EBP) was to educate patients on self-measured blood pressure monitoring (SMBP), Dietary Approaches to Stop Hypertension (DASH), diet interventions, and healthy weight loss to improve hypertension rates. Through these interventions, patients developed an understanding of their systolic and diastolic blood pressure goals. Nurse practitioners, medical assistants, and licensed vocational nurses screened for high …