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https://www.readbyqxmd.com/read/29740196/quality-improvement-initiative-to-improve-inpatient-outcomes-for-neonatal-abstinence-syndrome
#1
Elisha M Wachman, Matthew Grossman, Davida M Schiff, Barbara L Philipp, Susan Minear, Elizabeth Hutton, Kelley Saia, Fnu Nikita, Ahmad Khattab, Angela Nolin, Crystal Alvarez, Karan Barry, Ginny Combs, Donna Stickney, Jennifer Driscoll, Robin Humphreys, Judith Burke, Camilla Farrell, Hira Shrestha, Bonny L Whalen
OBJECTIVES: To improve Neonatal Abstinence Syndrome (NAS) inpatient outcomes through a comprehensive quality improvement (QI) program. DESIGN: Inclusion criteria were opioid-exposed infants ≥36 weeks. QI methodology including stakeholder interviews and plan-do-study-act (PDSA) cycles were utilized. We compared pre- and post-intervention NAS outcomes after a QI initiative that included: A non-pharmacologic care bundle, function-based assessments consisting of symptom prioritization and then the "Eat, Sleep, Console" (ESC) Tool; and a switch to methadone for pharmacologic treatment...
May 8, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29727232/improving-consent-in-patients-undergoing-surgery-for-fractured-neck-of-femur
#2
Gajendiran Thiruchandran, Andrew R McKean, Branavan Rudran, Mohamed A Imam, Keefai Yeong, Abdel Hassan
Background Neck of femur fractures and their subsequent operative fixation are associated with high rates of perioperative morbidity and mortality. Consenting in this setting is suboptimal with the Montgomery court ruling changing the perspective of consent. This quality improvement project assessed the adequacy of consenting against British Orthopaedic Association-endorsed guidance and implemented a series of changes to improve the documentation of risks associated with surgery for fractured neck of femur...
May 2, 2018: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29719873/ward-round-template-enhancing-patient-safety-on-ward-rounds
#3
Niall Gilliland, Natalie Catherwood, Shaouyn Chen, Peter Browne, Jacob Wilson, Helena Burden
Introduction and aims: Concerns had been raised at clinical governance regarding the safety of our inpatient ward rounds with particular reference to: documentation of clinical observations and National Early Warning Score (NEWS), compliance with Trust guidance for venous thromboembolism (VTE) risk assessment, antibiotic stewardship, palliative care and treatment escalation plans (TEP). This quality improvement project was conceived to ensure these parameters were considered and documented during the ward round, thereby improving patient care and safety...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29718515/optimizing-nclex-rn-pass-rate-performance-using-an-educational-microsystems-improvement-approach
#4
Brant J Oliver, Mimi Pomerleau, Mertie Potter, Andrew Phillips, Susan Carpenter, Steve Ciesielski, Eleanor Pusey-Reid, Alexia Marcous, Pat Grobecker
BACKGROUND: Improvement methods were applied to optimize NCLEX-RN first-attempt pass rates in an Accelerated Bachelor of Science in Nursing (ABSN) program. METHOD: An improvement team was formed comprising nursing faculty, a student, faculty leading a course in the ABSN program involved in preparing students for NCLEX-RN, and a faculty expert in improvement science. Two Plan-Do-Study-Act (PDSA) cycles aimed at increasing practice and mastery were conducted. Effects were assessed using inferential statistics and statistical process control analyses...
May 1, 2018: Journal of Nursing Education
https://www.readbyqxmd.com/read/29692477/use-of-plan-do-study-act-cycles-to-decrease-incidence-of-neonatal-hypothermia-in-the-labor-room
#5
Subhash Chandra Shaw, Amit Devgan, Sushila Anila, Neha Anushree, Himadri Debnath
Background: Body temperature of a neonate continues to be under-documented, under-recognized, and under-managed, even though studies have shown that neonatal hypothermia increases mortality and morbidity. We aimed to reduce neonatal hypothermia (body temperature <36.5 °C) at 1 h following normal vaginal delivery in term and late preterm neonates in delivery room from 50% at baseline to less than 10% by 6 weeks. Methods: We implemented a quality improvement (QI) initiative using the rapid-cycle Plan-Do-Study-Act approach (PDSA) improvement model and the project was conducted from 15 Jan 2017 to 25 Feb 2017...
April 2018: Medical Journal, Armed Forces India
https://www.readbyqxmd.com/read/29682618/multidisciplinary-approach-to-improve-the-quality-of-below-knee-plaster-casting
#6
John Teudar Williams, Marta Kedrzycki, Yathish Shenava
Problem: In our trauma unit, we noted a high rate of incorrectly applied below-knee casts for ankle fractures, in some cases requiring reapplication. This caused significant discomfort and inconvenience for patients and additional burden on plaster-room services. Our aim was to improve the quality of plaster casts and reduce the proportion that needed to be reapplied. Methods: Our criteria for plaster cast quality were based on the British Orthopaedic Association Casting Standards (2015) and included neutral (plantargrade) ankle position, adequacy of fracture reduction and rate of cast reapplication...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29678304/improving-postoperative-neonatal-nutritional-practices-in-an-intensive-care-unit-using-the-pdsa-cycle
#7
Jennifer Newcombe, Eileen Fry-Bowers
Quality Improvement models offer a framework for health care professionals to follow in implementing process improvement changes. Use of these models promotes a systematic approach to problem solving, keeps providers from eliminating important steps, facilitates team work, and provides a clear plan for ongoing communication. This paper describes use of the Plan-Do-Study-Act model to implement a unit-based quality improvement project that focused on improving postoperative nutritional practices for neonates with critical congenital heart disease following complex cardiac surgery...
April 17, 2018: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/29656835/trauma-quality-improvement-reducing-triage-errors-by-automating-the-level-assignment-process
#8
David P Stonko, Dillon C O Neill, Bradley M Dennis, Melissa Smith, Jeffrey Gray, Oscar D Guillamondegui
BACKGROUND: Trauma patients are triaged by the severity of their injury or need for intervention while en route to the trauma center according to trauma activation protocols that are institution specific. Significant research has been aimed at improving these protocols in order to optimize patient outcomes while striving for efficiency in care. However, it is known that patients are often undertriaged or overtriaged because protocol adherence remains imperfect. The goal of this quality improvement (QI) project was to improve this adherence, and thereby reduce the triage error...
April 12, 2018: Journal of Surgical Education
https://www.readbyqxmd.com/read/29648922/reducing-wait-time-between-admission-and-chemotherapy-initiation
#9
Arjun Gupta, Jenny Li, Bernard Tawfik, Thao Pham, Sudarshan Pathak, Prabhjyot Singh, Esmaeil Porsa, Navid Sadeghi, Hsiao C Li
PURPOSE: Reducing the length of stay is a high-priority objective for all health care institutions. Delays in chemotherapy initiation for planned preadmissions lead to patient dissatisfaction and prolonged length of stay. PATIENTS AND METHODS: A multidisciplinary team was formed as part of the ASCO Quality Training Program. We aimed to reduce the time to initiation of chemotherapy from patient arrival at Parkland Hospital from a median of 6.2 hours at baseline to 4 hours over a 6-month period (35% reduction)...
April 12, 2018: Journal of Oncology Practice
https://www.readbyqxmd.com/read/29615157/implementing-a-systematic-process-for-consistent-nursing-care-in-a-nicu-a-quality-improvement-project
#10
Renay Marie McCarley, Donna A Dowling, Mary A Dolansky, Amy Bieda
AIM: The global aim of this quality improvement project was to develop and implement a systematic process to assign and maintain consistent bedside nurses for infants and families. METHODS: A systematic process based on a primary care nursing model was implemented to assign consistent care for a 48-bed, single-family room NICU. RESULTS: Four PDSA cycles were necessary to obtain agreement from the nursing staff as to the best process for assigning primary nurses...
March 1, 2018: Neonatal Network: NN
https://www.readbyqxmd.com/read/29610771/enhancing-the-performance-of-gastrointestinal-tumour-board-by-improving-documentation
#11
Roaa Saleh Alsuhaibani, Hajer Alzahrani, Ghada Algwaiz, Haneen Alfarhan, Ashwaq Alolayan, Nafisa Abdelhafiz, Yosra Ali, Abdul Rahman Jazieh
Tumour board contributes to providing better patient care by using a multidisciplinary team approach. In the efforts of evaluating the performance of the gastrointestinal tumour board at our institution, it was difficult to assess past performance due to lack of proper use of standardised documentation tool. This project aimed at improving adherence to the documentation tool and its recommendations in order to obtain performance measures for the tumour board. A multidisciplinary team and a plan were developed to improve documentation...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29610770/reducing-the-number-of-invalid-surgical-consents-in-the-day-surgery-unit
#12
Wesley Chong, Allan Chee Yang Fong, Yi Lin Yeo, Angie Puay Hong Ng, Eileen May Lin Neo, Veronica Li Ee Sam, Jessica Kai Jun Ong, Loh Huey Peng
Aim: To reduce the number of invalid surgical consents in the Singapore National Eye Centre Day Surgery Unit over a period of 6 months. Methodology: A multidisciplinary team involving doctors, nurses, day surgery unit, operating theatre, listing and clinical audit staff looked into the listing process and the root causes of the high number of invalid consents. A Pareto chart detailing the top causes of invalid consents was drawn, and with a prioritisation matrix, feasible yet effective changes were identified and effected...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29610769/improving-driving-advice-provided-to-cardiology-patients-on-discharge
#13
Amoolya Vusirikala, Mark Backhouse, Sarah Schimansky
Certain cardiac conditions can limit patients' ability to drive. It remains the doctors' responsibility to advise patients of any driving restrictions and is particularly important after certain diagnoses or procedures. We identified that the quality of documented advice was variable and frequently no written driving advice was recorded on discharge. It was apparent that there was a lack of awareness and knowledge of the current Driving and Vehicle Licensing Agency (DVLA) guidance among junior doctors. We therefore designed a quality improvement project using Plan-Do-Study-Act (PDSA) methodology to improve the provision of driving advice on discharge from a cardiology ward by focusing on staff education...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29554354/application-of-lean-principles-to-neurosurgical-procedures-the-case-of-lumbar-spinal-fusion-surgery-a-literature-review-and-pilot-series
#14
Jesse J Liu, Jeffrey S Raskin, Fran Hardaway, Katherine Holste, Sarah Brown, Ahmed M Raslan
BACKGROUND: Delivery of higher value healthcare is an ultimate government and public goal. Improving efficiency by standardization of surgical steps can improve patient outcomes, reduce costs, and lead to higher value healthcare. Lean principles and methodology have improved timeliness in perioperative medicine; however, process mapping of surgery itself has not been performed. OBJECTIVE: To apply Plan/Do/Study/Act (PDSA) cycles methodology to lumbar posterior instrumented fusion (PIF) using lean principles to create a standard work flow, identify waste, remove intraoperative variability, and examine feasibility among pilot cases...
March 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29525499/a-quality-improvement-project-incorporating-preoperative-warming-to-prevent-perioperative-hypothermia-in-major-burns
#15
A D Rogers, M Saggaf, N Ziolkowski
BACKGROUND: Patients with extensive burn injuries are susceptible to a host of accompanying adverse effects should they develop perioperative hypothermia, which occurs in up to ¼ of all major burn cases. This quality improvement project aimed to reduce the incidence of perioperative hypothermia to below 10% of cases in patients with major burn (Total Body Surface Area [TBSA] >15%), within a one year period. METHODS: A baseline diagnostic phase was undertaken to provide a greater understanding of the incidence, natural history and risk factors of perioperative hypothermia...
March 7, 2018: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/29496651/experiences-of-indian-health-workers-using-whatsapp-for-improving-aseptic-practices-with-newborns-exploratory-qualitative-study
#16
Parika Pahwa, Sarah Lunsford, Nigel Livesley
BACKGROUND: Quality improvement (QI) involves the following 4 steps: (1) forming a team to work on a specific aim, (2) analyzing the reasons for current underperformance, (3) developing changes that could improve care and testing these changes using plan-do-study-act cycles (PDSA), and (4) implementing successful interventions to sustain improvements. Teamwork and group discussion are key for effective QI, but convening in-person meetings with all staff can be challenging due to workload and shift changes...
March 1, 2018: JMIR Medical Informatics
https://www.readbyqxmd.com/read/29447405/the-representation-of-vulnerable-populations-in-quality-improvement-studies
#17
Asaph Rolnitsky, Maksim Kirtsman, Hanna R Goldberg, Michael Dunn, Chaim M Bell
Purpose: A mapping review to quantify representation of vulnerable populations, who suffer from disparity and often inequitable healthcare, in quality improvement (QI) research. Data sources: Studies published in 2004-2014 inclusive from Medline, Embase and Cochrane databases for English language research with the terms 'quality improvement' or 'quality control' or 'QI' and 'plan-do-study-act' or 'PDSA' in the years 2004-2014 inclusively. Study selection: Published clinical research that was a QI-themed, as identified by its declared search terms, MESH terms, abstract or title...
May 1, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29444853/interprofessional-teamwork-innovation-model-itim-to-promote-communication-and-patient-centred-coordinated-care
#18
Jing Li, Preetham Talari, Andrew Kelly, Barbara Latham, Sherri Dotson, Kim Manning, Lisa Thornsberry, Colleen Swartz, Mark V Williams
BACKGROUND: Despite recommendations and the need to accelerate redesign of delivery models to be team-based and patient-centred, professional silos and cultural and structural barriers that inhibit working together and communicating effectively still predominate in the hospital setting. Aiming to improve team-based rounding, we developed, implemented and evaluated the Interprofessional Teamwork Innovation Model (ITIM). METHODS: This quality improvement (QI) study was conducted at an academic medical centre...
February 14, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29444816/quality-improvement-effort-to-reduce-hypothermia-among-high-risk-infants-on-a-mother-infant-unit
#19
Christine Andrews, Colleen Whatley, Meaghan Smith, Emily Caron Brayton, Suzanne Simone, Alison Volpe Holmes
BACKGROUND AND OBJECTIVE: Neonatal hypothermia is common in low birth weight (LBW) (<2500 g) and late-preterm infants (LPIs) (34 0/7-36 6/7 weeks' gestation). It can be a contributory factor for newborn admission to a NICU, resulting in maternal-infant separation and increased resource use. Our objective was to study the efficacy of a quality-improvement bundle of hypothermia preventive measures for LPIs and/or LBW infants in a mother-infant unit. METHODS: We conducted plan-do-study-act (PDSA) cycles aimed at decreasing environmental hypothermia for LPIs and/or LBW infants in a mother-infant unit with no other indications for NICU-level care...
February 14, 2018: Pediatrics
https://www.readbyqxmd.com/read/29402291/evaluating-a-dementia-learning-community-exploratory-study-and-research-implications
#20
Rod Sheaff, Ian Sherriff, Catherine Hagan Hennessy
BACKGROUND: Access times for, the costs and overload of hospital services are an increasingly salient issue for healthcare managers in many countries. Rising demand for hospital care has been attributed partly to unplanned admissions for older people, and among these partly to the increasing prevalence of dementia. The paper makes a preliminary evaluation of the logic model of a Dementia Learning Community (DLC) intended to reduce unplanned hospital admissions from care homes of people with dementia...
February 5, 2018: BMC Health Services Research
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