The 1-minute preceptor to improve diagnostic reasoning in a primary care nurse practitioner residency program.

Background: The One-Minute Preceptor (OMP) model to teach diagnostic reasoning and Reporter, Interpreter, Manager, and Educator (RIME) framework to measure progress are used in physician training. Little is known about the use of these tools in nurse practitioner (NP) training.

Local Problem: Precepting NP trainees at the Veterans Affairs (VA) is not standardized.

Triggering goals of care conversations in heart failure patients.

Background: Goals of care conversations (GoCCs) are essential discussions, for those with chronic diseases, to identify a health care surrogate, initiate and review advance directives, and refer for palliative care. Prognosis with pulmonary hypertension (PH) related to heart failure (HF) remains challenging due to variation in trajectory of disease progression. The Gagne Combined Comorbidity score, an electronic prognostication score (E-Gagne), can be used to identify patients with high (>10%) 1-year mortality.

Improving heart failure care and guideline-directed medical therapy through proactive remote patient monitoring-home telehealth and pharmacy integration.

To address ambulatory care sensitive hospitalisations in heart failure (HF), we implemented a quality improvement initiative to reduce admissions and improve guideline-directed medical therapy (GDMT) prescription, through proactive integration of remote patient monitoring-home telehealth (RPM-HT) and pharmacist consultations. Each enrolled patient (n=38) was assigned an RPM-HT registered nurse (RN), cardiology licensed independent provider (provider), and, if referred, a clinical pharmacy specialist (pharmacist). The RN called patients weekly and for changes detected by RPM-HT, while the pharmacist worked to optimise GDMT.

An evidence-based, structured, expert approach to selecting essential indicators of primary care quality.

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.

An Overview of Quality Improvement Processes and Data Analysis in Perioperative Nursing Practice.

AORN sets quality improvement (QI) standards that nurses can use to collect and interpret data. There are a variety of benchmarks available from national organizations and regulatory bodies: AORN provides evidence-based guidelines for perioperative practice, whereas The Joint Commission and the Centers for Medicare & Medicaid Services specify patient care requirements. Nurses can use the subject, objective observations, analysis, and plan (SOAP) format to assess, diagnose, plan, and communicate information related to the QI process to key stakeholders.

Leveraging telemedicine for management of veterans with heart failure during COVID-19.

Background: Telemedicine and telemonitoring have become invaluable tools in managing chronic diseases, such as heart failure (HF). With the recent pandemic, telemedicine has become the preferred method of providing consultative care.

Local Problem: This rapid paradigm shift from face-to-face (F2F) consultations to telemedicine required a collaborative approach for successful implementation while maintaining quality of care.

Holding firm: Use of clinical correlation to improve Clostridioides difficile testing.

A project involving 3 Plan-Do-Study-Act cycles was undertaken to improve testing for Clostridioides difficile at a Veterans Administration medical center. The Plan-Do-Study-Act process facilitated stakeholder engagement and allowed each successive intervention to build on the prior, resulting in a decline in the rate of hospital-onset C difficile infection.

Reducing the rare event: lessons from the implementation of a ventilator bundle.

The ventilator-associated event (VAE) is a potentially avoidable complication of mechanical ventilation (MV) associated with poor outcomes. Although rare, VAEs and other nosocomial events are frequently targeted for quality improvement efforts consistent with the creed to 'do no harm'. In October 2016, VA Greater Los Angeles (GLA) was in the lowest-performing decile of VA medical centres on a composite measure of quality, owing to GLA's relatively high VAE rate.

Reducing Rejected Fecal Immunochemical Tests Received in the Laboratory for Colorectal Cancer Screening.

Background: Colorectal cancer (CRC) screening decreases CRC incidence; however, many patients are not successfully screened.

Purpose: To improve screening rates at our institution by decreasing the rate of rejected fecal immunochemical tests (FITs), a means of CRC screening, from 28.6% to <10% by December 2017.

Measuring a veteran's quality of healthcare managed by a nurse practitioner in a VA facility using professional practice evaluation and core performance measures.

Purpose: Quality of care provided by nurse practitioners (NPs) has been measured for the last 40 years; however, no known program measuring quality of care in an NP practice on an ongoing basis was found in the published literature. The purpose of this article is to describe the implementation of an ongoing professional practice evaluation (OPPE) program at a Veterans Health Administration facility.

Data Sources: An evidence-based review was conducted to assess, evaluate, and report findings from outcomes research, systematic reviews, and meta-analyses, and interventions regarding standards and oversight of NP practice in the following databases: PubMed, Google®, Cumulative Index of Nursing and Allied Health, Agency for Healthcare Research and Quality, Institute of Medicine, and ".