Karen Montoro, BSN, RN, NE-BC
The impact of value based purchasing on reimbursement based on HCAHPS is a reality that Heath Care Organizations need to address. This Quality Improvement Project was designed by the CNO, Vice president of Nursing and the Nurse Manager to oversee the project. The decision was made to utilize an existing group of frontline staff who were engaged in efforts to improve patient satisfaction. This RN Communication Team met monthly beginning in March 2015.
Marie Wilson, BSN, RN, CCRN, CNRN
The purpose of the Neuroscience Intensive Care Unit is to provide specialized quality care to a high acuity and vulnerable critically ill population with the desired outcome of health improvement. It would appear that the goal for both Neuroscience Intensive Care Units and “sleep” would be one of healing; however it is also well documented that routine sleep disturbances due to either deprivation or disruption in neuroscience critical care units negatively affects patient outcomes.
Further exploration of sleep architecture, physiologic responses that occur during sleep and factors contributing to a lack of qualitative and quantitative sleep in critical care units needs to take place. With an enhanced understanding of these concepts, strategies to guide practice in order to improve quality of sleep in patients recovering in critical care environments can be formulated.
Anne Delengowski, RN, MSN, AOCN; Justine O'Connor, RN, MSN, OCN; Megan Stinsman, RN, BSN, OCN; Kate McHenry, RN, BSN, OCN; Kaitlin Mostak, RN, BSN; JoAnn Silcox, RN, MSN; Colleen Sweeney, RN; Christine Muldoon, RN, BSN, OCN; and Lauren Gilbride, RN, BSN
The purpose of this study was to determine if patients in a structured, monitored walking program experienced less symptom distress than patients receiving the usual standard of care during induction chemotherapy.
The Effect of Breathable Under Pads to Decrease Hospital Acquired Pressure Ulcers: A Nurse Resident Project
Sara Meshino, BSN, RN and Bridget Trefz, BSN, RN
To reduce the rate of hospital acquired pressure ulcers (HAPU), in June 2013, a large urban academic medical center switched from non-breathable to breathable under pads for incontinent patients lying on either a standard bed (low risk patients) or low-air-loss mattress (high risk patients). Standard pressure ulcer prevention measures were maintained. Staff on two oncology units sought to determine the effectiveness of breathable vs. non-breathable under pads in reducing the rate of HAPU and UAPU.
Jennifer Jasmine Arfaa, PhD, MHSA; Cynthia Line, PhD; Nora Kramer, MSN, RN; Karen Montoro, RN; Richard D. Blob,; Maria Francesco; Jaime Stazi, RN; Elisabeth Kunkel, MD; Susan Krekun, MD; Lizanne Mason, RN; Kathy Evans, RN; Lorraine Weikel, RN; Ann D. Clark, MS, OTR/L; Ray Wisniewski; and Teresa Heavens
APPROACH TO PROBLEM SOLVING
High priority index questions from HCAHPS and Press Ganey surveys, including overall ratings, communication with RNs and MDs, hospital environment and response to concerns and complaints, were targeted for improvement. These high priority indices served as the basis for redesigning Patient Services using a multi-faceted approach to improve patients’ experiences.
At Thomas Jefferson University Hospital (TJUH), high performance on the Patient Experiences of Care Survey has been driven by a successful multi-tiered approach to patient services:
·Hospital leadership guided and implemented new approaches to ensure excellence in patient services is an ever-present and obtainable goal
·Physician leaders were recruited as champions for service excellence
·Champions in every department developed inter-departmental relationships to deliver a committed front line response to the voice of the customer
Melissa Ash, Brian Glynn, Silvana Romeo, Zenobia Black, Ashley Adams, Bridget Dutil, Raymond Malloy, and Maribeth Kelly
There are inconsistencies in treating inpatients with community acquired pneumonia (CAP) and providing adequate post discharge follow-up contributing to significant hospital re-admission rates and increased healthcare costs. Will the use of a pneumonia pathway decrease hospital re-admissions and healthcare costs? Our null hypothesis for this study was that the use of a pneumonia care pathway will have no significant effect on hospital readmission rates.
Maribeth Kelly, MSN, RN, PCCN; Raymond Malloy, MHA, RRT; and Brian Glynn, BS, RRT
There are inconsistencies in treating inpatients with community acquired pneumonia (CAP) and providing adequate post
discharge follow-up contributing to significant hospital readmission rates and increased health care costs. Our null hypothesis for this study was that the use of a pneumonia care pathway will have a significant effect on hospital readmission rates.
Elizabeth Avis, MSN, RN, CCRN, PCCN; Marybeth Foy, MSN, RN; Nicholas Collins, BSN, RN, CCRN; Kristine Irvin, RN; and Lois Grant, RN
Poster presented at: UHC Annual Conference 2012, Orlando Florida.
Goal: Redesign RRT to create a permanent team of RNs and an RRT focused on patient care and improving RRT process.
Laura Beans, BSN, RN; Roisin Harvey, BSN, RN; Jonathan Lee, BSN, RN; David Lincul, BSN, RN; Gina Ramos, BSN, RN; and Jodi Schantz, BSN, RN
To educate an urban Chinese community by creating a stroke prevention program that increases awareness of the disease.
To educate an urban Chinese community about stroke risk factors, stroke warning signs, and how to reduce modifiable stroke risk factors.
Geriatric Trauma Patients in the Emergency Department: Length of Stay, Intensity of Care, and Post ED Destination"
Elanor Gates, Doris Warner, Meg Bourbonniere, and Patricia Williams
Background & Purpose: Research on emergency department length of stay (EDLOS) suggests that increased LOS may result in worse patient outcomes and increased overall LOS. Additional research suggests that increased age may not only result in lower intensity of care for some patients but might also increase EDLOS. For geriatric trauma patients, intensity of care and EDLOS may be different from non-geriatric patients. Given the nature of geriatric traumatic injury, it is important to understand if improvements can be made in geriatric trauma services.
Study/Project Design: A retrospective descriptive study utilizing the hospital’s trauma registry data was completed, including patient demographics, injury information, EDLOS, post ED destination information, and consultations during ED stay. Patient aged 65 and older were compared to patients less than 65 years of age.
Setting: This study was conducted at a large urban hospital with a level I trauma center.
Sample: Five years of data (2006-2010) were culled from the hospital’s trauma registry. Preliminary data analysis was completed for two years of data (n= 1,997). Preliminary data analysis included descriptive statistics and independent samples Mann-Whitney U test.
Procedures: Patients were divided according to age (<65 years and>65+ years) to create two groups for comparative analysis. Preliminary data analysis included descriptive statistics and independent samples Mann-Whitney U test.
Findings/Results: Among trauma patients analyzed, nearly two-thirds (62.8%) were <64 years of age. The post-ED destination for patients also differed by age group with patients><64 years of age moving to step down>/intermediate units (39%), followed by operating rooms (22.2%). For patients >65 years of age, patients moved to step down/intermediate units (51%), followed by ICU/critical care units (30.3%). The average EDLOS for patients <64 years of age 405.66 minutes compared to 495.79 for patients>65 years of age. Interestingly, average time from ED admission to ED Neurosurgery consult was longer by almost 10 minutes for patients <64 years of>age, but time from ED admission to ED orthopedics consult was nearly 10 minutes longer for patients >65 years of age. An independent sample Mann-Whitney U Test was conducted only for patients who received a neurosurgery or orthopedics consult in the ED. Results indicated a significant difference across the age groups for average EDLOS.
Discussion/Conclusions/Implications: Preliminary analysis for two years of data indicates there may be significant differences in average EDLOS by age. Differences in EDLOS are important as they can affect patient outcomes, patient satisfaction, and patient flow management in the hospital.
Dula F. Pacquiao, EdD, RN, CTN
This program is designed to increase culturalcompetence and awareness for nursing educators regarding ESL and under-represented minority students.
Target Audience: Professional nurses, nursing faculty, and otherhealthcare providers.
Faculty: Dula F. Pacquiao, EdD, RN, CTN, Professor and Director,Center for Multicultural Education and Research and Practice Universityof Medicine and Dentistry of NJ School of Nursing, Newark, NJ
Presentation: 1 hour, 16 minutes
Diane Abisaleh, RN, BSN, MSN
- Cancer is the 2nd most common cause of death, accounting for 26% of all deaths.
- Chemotherapy errors can potentially lead to significant harm or death
- 1 out of every 50 chemotherapy orders, results in serious death
- Lack of HIT support for workflow increases error
Barbara Alpini, RN, CGRN and Elise Dorr-Dorynek, RN, BSN, CRRN, CGRN
Research on rounding among hospital providers demonstrated the fundamental value in the practice. If rounding is of value in surgical, medical, and other areas, it is logical to hypothesize that structured rounds would be useful for other nursing units, such those performing special procedures. Structured rounding between GI nurses and colleagues on inpatient units could enhance preparation and efficient care of patients, decrease same day cancellations, and increase RN satisfaction with communication. Analysis using a Z-test demonstrated some support for a reduction in canceled procedures. Nurses also reported satisfaction with this new rounding procedure.
Robin Fry, BSN, RN, CNRN; Marie Wilson, BSN, RN, CCRN, CNRN; and Carey Heck, MS, MSN, RN, ACNP-CS, CCRN, CNRN
With 795,000 people suffering strokes and more than 140,000 deaths annually, stroke is the third leading cause of death in the United States.
Dysphagia screening can reduce stroke complications, such as aspiration, and can decrease delays in nutritional support. Decreasing nutritional support delays can improve patient outcomes.
Partnership Between University Clnical Skills/Simulation Center and Nursing Staff Development-New Products
Mary Bent Mangano, MSN, RN, CNS and John J. Duffy, RN, MSN, CCRN, CNRN
There is a growing evidence in the nursing literature about the effectiveness of clinical simulation as a powerful teaching/learning strategy. This wealth of research attributes simulation's effectiveness to its design that creates an environment where "students become active learners, abandoning memorization for accessing knowledge, and thinking and applying learning in context rather than providing answers to fact-based test" (Jeffries, 2007). A simulation suite provides a "safe, supportive environment that allows students to learn a variety of complex skills in a stress-free environment" (Ghiglieri, Ruiz, & Vasudevan, 2007). Creating this environment requires meticulous planning to details. The learner must have a high degree of believably that the clinical setting is authentic. The clinical simulation suite should be a mirror image of a similar clinical room in the hospital, with all the equipment and products identical to one another. A learner in this simulated patient care scenario can easily transfer lessons learned to the real life patient in the hospial setting. The benefits of simulation as a teaching strategy will have direct improvement on patient safety, increased knowledge and increased compliance with nursing policy and procedures, increased staff and patient satisfaction and increased student/future employee clinical confidence.
Rachel Behrendt, DNP, RN, ACONS and Donna Molyneaux PhD, RN
PowerPoint presentation given at 2010 National Magnet Conference in Phoenix Arizona.