Social determinants of health (SDOH) have been documented to underpin 80% of overall health and are being increasingly recognised as key factors in addressing tertiary health outcomes. Yet, despite the widespread acceptance of the association of SDOH with health outcomes, more than two-thirds of hospitals do not screen for social risk factors that indicate individual-level adverse SDOH. Such screening for social risk factors represents the first step in connecting patients with resources and documents the prevalence of social needs.
View Article and Find Full Text PDFObjective: To implement a perinatal depression care bundle at a midwifery practice to help certified nurse-midwives (CNMs) educate women about perinatal depression and direct those affected to mental health services.
Design: Quality improvement project to implement a perinatal depression care bundle for care of pregnant women between 24 and 29 weeks gestation.
Setting/local Problem: CNMs practicing in a nurse-managed midwifery practice systematically screen all women for perinatal depression during pregnancy and the postpartum period but do not have a consistent method of providing anticipatory guidance about perinatal depression.
Alarm fatigue is the most common contributing factor in alarm-related sentinel events. Researchers have demonstrated a 35% overuse of telemetry, a key factor in alarm fatigue. This project evaluates practice patterns for the ordering and discontinuation of telemetry on medical-surgical units.
View Article and Find Full Text PDFThe cardiovascular thoracic step-down unit of an urban academic medical center had 4 catheter-associated urinary tract infections (CAUTIs) in 2 months compared with 5 in the previous year. The nursing literature showed that the implementation of nurse-driven algorithms for early removal of indwelling urinary catheters (IUCs) decreased the catheter days and risk of CAUTIs. Using the Model for Improvement, the nurse leader performed daily IUC rounds to enforce the removal algorithm and visual management tools to identify IUC removal barriers.
View Article and Find Full Text PDFThe purpose of the Toyota Production System (TPS) Lean 5S methodology project is to improve the efficiency and effectiveness in a process by eliminating identified process waste of (1) defects (errors), (2) overproduction, (3) waiting, (4) confusion, (5) motion/travel, (6) excess inventory, (7) overprocessing, and (8) human potential. The specific aim of this quality improvement project was to evaluate the impact of the TPS 5S tool process, a problem-solving, space-organizing tool, on distractions and interruptions in the neurosurgery operating room (OR) workflow with a goal to decrease neurosurgery craniotomy infection rates in a neurosurgery OR suite within a 3-month period.
View Article and Find Full Text PDFThe purpose of this quality improvement study was to describe the process for workplace aggression (WPA) reporting and the potential failures for this process in a pediatric emergency department. Interviews were conducted with 10 interdisciplinary employees. Findings yielded 7 tasks following WPA: contact security, contact police, contact clinical manager, notify emergency department director, call safety hotline, complete electronic safety form, and complete paper safety form.
View Article and Find Full Text PDFThis project applied a quality improvement design to assess perceived barriers to pediatric overweight and obesity guideline implementation in school-based health centers. An electronic survey was administered to nurse practitioners and licensed practical nurses working in school-based health centers in New York. The most commonly cited primary care-based barriers were lack of patient compliance, family lifestyle, and the poor dietary practices and sedentary behaviors common in America.
View Article and Find Full Text PDFThis quality improvement project used the Model for Improvement including the Plan-Do-Study-Act cycle of change framework to educate pediatric intensive care unit (PICU) nurses on risk factors for pediatric pressure injuries and prevention strategies, improve turning compliance for PICU patients, and implement an electronic trigger to order nutrition consultations on all patients with a Braden Q score less than 16. The quality improvement project decreased preventable patient harm to PICU patients by decreasing the pressure injury incidence rate from 8% to 3% in the 6-week time period.
View Article and Find Full Text PDFNurs Clin North Am
March 2019
Using knowledge gained from the disciplines of nursing, medicine, health care management, and medical and health services research, the quality improvement movement attempts to mobilize people within the health care system to work together in a systematic way using evidence based strategies and tactics to improve the care they provide. In this valuable work, discipline-specific knowledge is combined with experiential learning and discovery to make improvements. Quality improvement provides a knowledge-based framework and methods for the change agent to work toward a more predictable, effective, efficient, reliable, equitable, patient-centered care health care system.
View Article and Find Full Text PDFA multicomponent intervention was attempted in a pediatric emergency department to increase reporting of workplace aggression committed by patients and visitors. Overall reporting decreased from 53% to 47% (P = .06).
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