Ambulatory Clinic Research Articles

The devil's in the defaults: An interrupted time-series analysis of the impact of default duration elimination on exposure to fluoroquinolone therapy.

To determine whether removal of default duration, embedded in electronic prescription (e-script), influenced antibiotic days of therapy. Interrupted time-series analysis. The study was conducted across 2 community hospitals, 1 academic hospital, 3 emergency departments, and 86 ambulatory clinics. Adults prescribed a fluoroquinolone with a duration <31 days. Removal of standard 10-day fluoroquinolone default duration and addition of literature-based duration guidance in the order entry on December 19, 2017. The study period included data for 12 months before and after the intervention. The study included 35,609 fluoroquinolone e-scripts from the preintervention period and 31,303 fluoroquinolone e-scripts from the postintervention period, accounting for 520,388 cumulative fluoroquinolone DOT. Mean durations before and after the intervention were 7.8 (SD, 4.3) and 7.7 (SD, 4.5), a nonsignificant change. E-scripts with a 10-day duration decreased prior to and after the default removal. The inpatient setting showed a significant 8% drop in 10-day e-scripts after default removal and a reduced median duration by 1 day; 10-day scripts declined nonsignificantly in ED and ambulatory settings. In the ambulatory settings, both 7- and 14-day e-script durations increased after default removal. Removal of default 10-day antibiotic durations did not affect overall mean duration but did shift patterns in prescribing, depending on practice setting. Stewardship interventions must be studied in the context of practice setting. Ambulatory stewardship efforts separate from inpatient programs are needed because interventions cannot be assumed to have similar effects.

(182) Transurethral Laser Incision of Ejaculatory Duct for Complete Ejaculatory Duct Obstruction

Abstract Introduction It is estimated that approximately 5% of men presenting with infertility suffer from ejaculatory duct obstruction (EDO). Patients suspected to have EDO typically have a palpable vas deferens and normal testicular exam. On semen analysis, low volume and acidic pH should increase suspicion, and transrectal ultrasound is most commonly the first diagnostic modality utilized to confirm the diagnosis when suspecting EDO. Objective The objective of this surgical video is to describe the use of holmium laser for the management of ejaculatory duct obstruction (EDO) in the setting of obstructive azoospermia. Methods This was a 35 year old male with no significant past medical history who presented with obstructive azoospermia. His partner was a 32 year old female with no significant past medical history, with regular menstrual cycles, and a normal female reproductive evaluation. Semen analysis was significant for low volume (0.5 mL) azoospermia with an acidic pH (6.8). Abdominal and pelvic computerized tomography (CT) scan from 2017 when the patient presented for appendicitis noted an incidental finding of a 9.9 cm prostatic cyst. Thus, a transrectal ultrasound (TRUS) guided aspiration was performed in the ambulatory clinic which demonstrated a large prostatic cyst, with non-motile sperm in the aspirate. The patient was consented for Cystoscopy with transurethral laser incision of ejaculatory ducts. A 22 French (F) cystoscope was used, first for pan-cystourethroscopy, and then to cannulate the right ejaculatory duct with 5F pollack catheter and guide wire. Guide wire and catheter positioning within the cyst was confirmed with fluoroscopy. A 24F resectoscope with a laser bridge working element and 550 micron holmium laser fiber at settings of 1 Joule of energy and 10 hertz frequency to incise the right ejaculatory duct, circumferentially around the wire. The ejaculatory duct was incised and cyst was drained until the ejaculatory duct and thus prostatic cyst could be cannulated and examined with the cystoscope. On examination of the cyst, no vasal openings were identified. Left seminal vesiculography was attempted but unsuccessful due to significant contrast extravasation into the urethra. Results The case went well and was uncomplicated. There were no immediate or delayed complications or adverse effects reported by the patient. Post-operative instructions included rest for 1 week, followed by ejaculation every other day for 3 months. Semen analysis and transrectal ultrasound will be performed at 3 months post-operative. Conclusions Transurethral laser incision of ejaculatory duct is a safe surgical intervention for management of complete ejaculatory duct obstruction, and is demonstrated successfully in this step-by-step surgical video. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.

Use of point-of-care ultrasound in rural British Columbia: Scale, training, and barriers.

To determine the scale and scope of use of point-of-care ultrasound (POCUS) in rural British Columbia (BC). Online survey. Rural BC. Physicians practising in rural BC communities. Practitioner demographic and practice characteristics, locations and frequency of POCUS use, POCUS education and training, and practitioner attitudes about and barriers to POCUS use. Two hundred twenty-seven surveys were completed in fall 2021, corresponding to a response rate of 11.9% of all rural practitioners in BC. A total of 52.1% of respondents worked in communities with less than 10,000 people, while 24.9% had practices with relatively large proportions of Indigenous patients (more than 20% of the practice population). Respondents reported ease of access to local POCUS devices, with use highest in emergency departments (87.2%) followed by ambulatory care clinic (54.7%) and inpatient (50.3%) settings. Use of POCUS influenced clinical decision making in half the occasions in which it was employed, including a range of diagnostic and procedural applications. Barriers to use included lack of training, limited time to perform POCUS scans, and absence of image review or consultative support. Needed support for POCUS identified by respondents included real-time image acquisition advice and funding for both device acquisition and training. Recommendations for including POCUS training in undergraduate and residency education were strongly supported. Use of POCUS in BC is expanding in frequency, scope, and scale in practices serving rural areas and in rural communities with large Indigenous populations, with practitioners reporting important improvements in clinical care as a result. Future research could help improve systemic support for POCUS use, guide needed curriculum changes in medical school and postgraduate training, and be used to inform continuing professional development needs.

Increasing rates of screening and treatment of iron deficiency in ambulatory patients with heart failure with reduced ejection fraction: a quality improvement cohort study

IntroductionIron deficiency anaemia (IDA) is common in patients with heart failure (HF) and is associated with advanced HF and increased mortality. Intravenous iron supplementation increases exercise tolerance, improves quality of...

Effectiveness of Standardized Medication Reconciliation Education on Provider's Compliance and Medication Discrepancies in an Ambulatory Clinic Caring for Post-Allo HSCT Patients. a Quality Improvement Project.

Effectiveness of Standardized Medication Reconciliation Education on Provider's Compliance and Medication Discrepancies in an Ambulatory Clinic Caring for Post-Allo HSCT Patients. a Quality Improvement Project.

Ketogenic diet in pharmacoresistant epilepsies: a clinical nutritional assessment.

Epilepsies are among the most prevalent chronic neurological diseases, usually beginning in childhood. About 30% of children with epilepsies develop seizures that are difficult to control with medication. Recurrent epileptic seizures hinder diet intake, impairing the nutritional status. Although non-pharmacological interventions (e.g., ketogenic diet therapy) can improve epileptic seizure frequency, few studies analyzed their impact on the nutritional status of children and adolescents with epilepsies. The aim was to evaluate the effects of a ketogenic diet on the nutritional status and clinical course of patients with pharmacoresistant epilepsies. This cross-sectional study included patients under 18 years of age followed up at the Ketogenic Diet Ambulatory Clinic of the Instituto de Medicina Integral Prof. Fernando Figueira between December 2015 and December 2021. Socioeconomic, clinical, nutritional, and laboratory data were collected from medical records at different time points during the ketogenic diet. The sample comprised 49 patients aged between 5 months and 17 years (median = 4.4 years), mostly male (62.1%), and from Recife and the metropolitan region (51%). Underweight patients (BMI-for-age) improved their nutritional status in six months. However, patients who were normal weight and overweight maintained their nutritional status. Dyslipidemia was a common and short-term adverse effect. Moreover, the treatment decreased epileptic seizure frequency and antiseizure medication intake. The ketogenic diet prevented malnutrition from worsening and reduced epileptic seizures and antiseizure medication intake.

Integrating Social Needs Screening and Resource Referral Into Standard Ambulatory Oncology Care: A Quality Improvement Project.

We previously implemented paper-based screening for health-related social resource needs (HRSN) in our gynecologic oncology clinic and found that 36% of patients who completed the screening reported HRSN. We identified two primary deficiencies with our process. First, only 52% of patients completed the screening. Second, 37% of patients with needs failed to indicate if they desired resource referral or not. Therefore, we conducted a quality improvement project to integrate screening and referral processes into the electronic medical record (EMR) and routine clinic workflow to achieve at least 90% screening compliance and 90% elicited referral preference. A multidisciplinary team consisting of physicians, a health outcomes researcher, a computer programmer, project assistants, and the staff of a partner community organization designed and implemented an intervention that screened for HRSN online via the EMR patient platform or in person during visits. The primary outcome was the percentage of eligible patients who completed the HRSN screening (ie, reach). Outcomes were reviewed weekly, and feedback was provided to stakeholders monthly. Iterative changes were incorporated into five successive Plan-Do-Study-Act (PDSA) cycles completed from January 2021 to March 2023. Screening compliance increased from the baseline of 52% (paper-based) to 97% in PDSA 4. Completion via the online patient portal increased from 17% in prelaunch to 49% in PDSA 4. Of patients who reported needs, 100% had a documented referral preference. Compared with paper-based screening, an EMR-integrated HRSN screening and referral system significantly improved reach to patients at a gynecologic oncology clinic. Implementation efforts to expand to other ambulatory clinic settings are in process.

The Utilization of Empathy and Self-awareness Models to Deescalate Violence in the Ambulatory Clinic Setting.

Our objective was to understand how empathy and self-awareness content, alongside traditional deescalation training, might impact ambulatory clinic staff responses to patient and family escalation events. Verbal and physical workplace violence is escalating across healthcare organizations, including ambulatory clinics. Deescalation content is often developed with acute care, psychiatric, or emergency care in mind. There is a need for relevant and empathic deescalation training for ambulatory clinic staff to address their specific needs. We developed empathic and self-reflective deescalation training which was interactive and relevant to ambulatory clinic staff. Staff were trained using both in-person and virtual modalities. Participant self-reflection pre- and postintervention questionnaires indicated increases in understanding and application of deescalation methodologies. Multiple ambulatory clinics where staff participated saw a decrease in patient complaints and grievances. Participating ambulatory clinics also saw an improvement in the likelihood to recommend practice. However, participating ambulatory clinics did not see a reduction in reported patient-involved workplace violence events. Ensuring both empathy and self-awareness content in deescalation training, along with relevant ambulatory clinic scenarios, support ambulatory staff to respond effectively and appropriately to escalation events, helps reduce patient complaints, and improves patient satisfaction.

Remaining Relevant in a Changing Healthcare Organization

Registered dietitian nutritionists working in ambulatory clinics should not be waiting for an administrator to invite them to the planning group for the transition from fee for service to value-based care payment models. Registered dietitian nutritionists should be identifying and promoting the services they can provide to ensure quality healthcare for patients. In this article, we describe value-based care as it is presented in dietetics literature. We also describe how registered dietitian nutritionists in our family medicine practice demonstrate their value as a member of the expanded interprofessional ambulatory care team providing quality care, reducing costs, and providing an exceptional experience for the patient. We call on educators of dietetics students, interns, and professionals to teach the necessary interprofessional skills to be successful in value-based care models of care.

Looking For the Unseen: Application of Wood’s Lamp in the Ambulatory Clinic

Looking For the Unseen: Application of Wood’s Lamp in the Ambulatory Clinic

Safety outcomes of suspected cardiac pathology assessed in an ambulatory rapid-access cardiology clinic

Safety outcomes of suspected cardiac pathology assessed in an ambulatory rapid-access cardiology clinic

Pilot Study: Moving Towards a Scalable Intervention for Postgraduate Communication Skills Training.

Communication skills are foundational to the practice of medicine and training to build them is recommended. Serious illness communication skills (SICSs) teaching is inconsistently and sparsely taught in postgraduate training and residents report feeling inadequately trained to have difficult conversations. The authors developed an e-module demonstrating high-yield communication skills from a known evidence-based training program to standardize core SICS teaching and questioned how using it before skills practice impacted comfort and preparedness for residents to complete advance care planning (ACP). Family medicine residents at an academic hospital in Toronto, Canada, completed a novel e-module that replaced a typical didactic-lecture introducing core SICS relevant to ACP conversations. Residents then discussed the skills, followed by practicing them deliberately in a structured role-play simulation with feedback by trained facilitators. Residents completed pre- and post-intervention attitudinal surveys. Residents preferred a combination of learning modalities and welcomed online and virtual teaching methods for learning SICS. Residents reported higher levels of preparedness for engaging in ACP, delivering serious news, and discussing goals of care post-intervention. Residents showed more interest in discussing ACP post-intervention but questioned feasibility for doing so in busy ambulatory clinics. Scalable time-efficient teaching strategies are needed to fill a known education gap. This study demonstrated benefits of incorporating brief e-module learning into residents' preparation for SICS training using deliberate practice simulation training. The online, interactive virtual training improved resident readiness and comfort for ACP, an area often overlooked in medical education. Moreover, it provides an evidence-informed standardized tool for clinician teachers to seamlessly incorporate into their teaching practices.

Improving outcomes in frail older adults with complex care needs in an ambulatory setting through timely, integrated person-centered care. A case for rapid access frailty clinics in Singapore.

Background: Frailty is a significant risk factor for recurrent hospital admissions and emergency department presentations. Frail older adults are especially vulnerable to hospital related adverse outcomes recognisably functional decline, delirium, institutionalisation and mortality. Fragmentation of care resulting in poorly defined care responsibilities, together with the limitation of community resources to manage acute issues in this group of patients, increase the likelihood of them presenting to an acute care setting.&#x0D; Methods: A retrospective study evaluated frail older adults seen in an ambulatory Geriatric clinic in a government funded public hospital from 2021 to 2022. The aim of the study was to determine if timely evaluation of acute issues in an ambulatory setting could avoid a hospital admission or an emergency department presentation. &#x0D; Results: Preliminary data in this study showed that (1) timely review of acute issues (&lt;1 week from presentation) led to avoidance of hospital admission, emergency department presentation as well as admission in the next 30 days; (2) the common presentations successfully managed include worsening behavioral and psychological symptoms of dementia (BPSD), delirium, infections and falls; (3) majority of the patients seen were moderately to severely frail based on their clinical frailty score (CFS). Additionally, there was high level of patient and caregiver satisfaction reported.&#x0D; Conclusion: This study shows that hospital admissions and emergency department presentations can potentially be avoided in frail older adults whose acute medical issues are recognised and managed early. Important contributing factors to the effective management of these patients include: easy accessibility to the primary geriatrician involved, same day investigations, timely follow ups, good social/family support as well as the engagement of community services. Rapid access frailty clinics, a service model built upon the similar recognition that acute issues in frail older adults needed to be addressed promptly, has been described and shown to have benefit elsewhere. In Singapore, innovations in care delivery both within the hospital and in the community has become ever more crucial with an increasingly frail population and in already overwhelmed healthcare institutions. Rapid access frailty clinics can be a useful hospital-based service delivery model to improve care of our frail older adults.

High prevalence of diffuse idiopathic skeletal hyperostosis (DISH) among obese young patients – A retrospective observational study

ObjectiveDiffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification of ligaments and entheses, and most commonly affects the spinal column. The prevalence of DISH is increasing with age and is considered uncommon before the age of 50 years, with an estimated prevalence of less than 5 %. DISH is known to be highly associated with metabolic syndrome and obesity. We aim to assess the prevalence of DISH among young (≤50 yr.) patients suffering from severe obesity (BMI of 35 kg/m2 or higher). MethodsA retrospective analysis assessing chest and spine radiographs (including Computed Tomography, CT) of patients with BMI≥35 visiting the bariatric ambulatory clinic in an academic medical center from 2013 to 2022. Patients included in the analysis were 31–50 years old. Diagnosis of DISH was made according to the Resnick criteria. The prevalence of DISH was calculated. Demographic, clinical and laboratory data were collected and compared between the DISH and non-DISH groups. Results183 young (mean age: 40.4; 118 females, 64.2 %) obese (BMI median: 40.6; range 35–73) patients were included in the radiographic review. DISH was diagnosed in 33 patients (18.0 %; 95 % CI: 13.1–24.2 %) which was significantly higher than the expected 10 % (Z = 3.62, p<.001); another 8 patients (4.4 %; 95 % CI: 2.2–8.4 %) were considered as “near DISH” (not fulfilling yet the Resnick criteria) as it represents a pre-disease state. Patients diagnosed with DISH were significantly older than patients without DISH (t = 4.54, p<.001), as the prevalence of DISH increased by age (linear association=14.95, p<.001). There was a statistically significantly higher prevalence of hypertension (χ2 = 8.30, p<.004), smoking (χ2 = 4.69, p<.03) and OSA (χ2 = 6.16, p<.013) in the DISH group as compared to their non-DISH counterparts. ConclusionThe prevalence of DISH among obese young patients was 18 %, which is much higher than in the general population. Early-onset DISH should be regarded as a musculoskeletal obesity-related complication.

CONDUCTING A NEEDS ASSESSMENT TO INFORM AGE-FRIENDLY HEALTH SYSTEMS INITIATIVE FOR UNIVERSITY OF UTAH HEALTH

Abstract Today, people live longer and more productive lives than ever. The number of adults aged 65 and older is projected to nearly double 98 million by 2060 to 24% of the U.S. population (Administration on Aging &amp; Administration for Community Living, 2018). Increased life expectancy, coupled with the exponential growth of the older adult population will create more demand for healthcare professionals to meet the care needs of older adults living with chronic conditions. Chronic conditions can lead to complex care and increase the usage of healthcare systems (Axon &amp; Kamel, 2021). The Age-Friendly Health Systems initiative provides specific evidenced-based best-practice interventions to all older adults in a health system setting (Fulmer et al., 2022). An Age-Friendly Health System is one in which every older adult’s care is guided by an essential set of evidence-based practices known as the 4Ms framework: What Matters, Medications, Mentation, and Mobility (Institute for Healthcare Improvement, 2022). This project developed and delivered a Needs Assessment to providers practicing in the U Health Ambulatory Care Clinics to identify baseline knowledge, gaps in knowledge, and current practices related to the AFHS 4Ms Framework. The Needs Assessment consists of using online surveys and semi-structured interviews. Significant findings were that: 1) U Health ambulatory care clinic providers have very little to no baseline knowledge of the AFHS 4Ms Framework, 2) U Health ambulatory care providers are already providing care that aligns with the 4Ms framework, 3) There are barriers and challenges to providing Age-Friendly care.

ASSOCIATIONS BETWEEN GAIT MEASURES AND QUADRICEPS MUSCLE THICKNESS AS MEASURED BY POINT-OF-CARE ULTRASOUND

Abstract Gait parameters and sarcopenia predict falls risk which is one of the major causes of both mortality and morbidity among older adults. Our objective was to evaluate whether anterior thigh muscle measured by point-of-care ultrasound is significantly associated with standard gait measures. All subjects were referred from ambulatory geriatric medicine clinics at an academic center. Quadriceps muscle thickness was measured by a portable ultrasound device. Gait variables were measured by the patient walking for 6 minutes. The primary response variables were gait variables, and the predictor variables were age, biological sex, body mass index, and MT. Univariate and multivariate regression analyses were performed. A total of 150 participants were recruited from geriatric medicine clinics. Muscle thickness was measured in 149 participants and the mean (SD) was 1.91 (0.52) (median 1.82 cm, 0.96 to 3.68 cm). Among all the gait variables, average swing time (P = 0.010) and average stance time (P = 0.010) were correlated significantly with muscle thickness. Muscle thickness also showed a negative association with step time variability percent (P = 0.005). Muscle thickness (P = 0.046), age (P = 0.025), and gender (P = 0.047) had a statistically significant association with present step time variability. PoCUS showed a significant association with average swing time, average stance time, and step time variability all of which are predictive of future falls risk. Although more work needs to be done, PoCUS is a reliable and feasible muscle measurement method, which could lead to faster clinical decision-making and falls risk assessment.

Knowledge and Perceptions of Final-Year Nursing Students Regarding Antimicrobials, Antimicrobial Resistance, and Antimicrobial Stewardship in South Africa: Findings and Implications to Reduce Resistance.

Antimicrobial resistance (AMR) is being increasingly seen as the next pandemic due to high morbidity and mortality rates, with Sub-Saharan Africa currently having the highest mortality rates driven by high rates of inappropriate prescribing in ambulatory care. In South Africa, nurses typically provide a range of services, including prescribing, in public ambulatory care clinics. However, little is currently known about the perception of final-year nursing students regarding antibiotic use, AMR, and antimicrobial stewardship (AMS). Consequently, we sought to address this important evidence gap. A quantitative descriptive study using a self-administered online questionnaire via Google Forms® was undertaken among six universities in South Africa offering a Baccalaureus of Nursing. Knowledge on the classes of antibiotics, organisms covered, and mechanism of action was lacking. The sample size to achieve a confidence interval of 95% with a 5% error margin was 174, increased to 200 to compensate for possible attrition. Only 15.3% of nurses knew that ceftazidime is not a fourth-generation cephalosporin, and only 16.1% knew that clavulanic acid does not decrease inflammation at the site of infection. In addition, only 58.9% and 67.7% agreed that the prescribing of broad-spectrum antibiotics and poor infection control, respectively, increase AMR. AMS was also not a well-known concept among final-year nurses. The lack of knowledge regarding antibiotics, AMR, and AMS among final-year nurses could have important repercussions in practice once these nurses are qualified. Consequently, this information gap needs to be urgently addressed going forward with updated curricula and post-qualification educational activities to reduce AMR in South Africa.

How Patients who needed CT scans on an ambulatory basis are scanned and reviewed in a major teaching hospital

Abstract Aim This study focuses on the status of service provision for Emergency General Surgical patients requiring Ambulatory CT scans at a major teaching hospital. Method CT scans that took place between May 2023 – July 2023 where patients who received scans were reviewed and categorized between Urology and EGS. Results During the 13-week study, we were able to scan 233 patients (17.92 scans per week) in total between both specialties where 82 scans were for EGS patients (35%). All of these patients were reviewed by a member of the EGS team before they were booked for ambulatory scans at an allotted time and date where patients were scanned at an average of 2.15 days after initial review. After the scan, the patients are reviewed in the Ambulatory Clinic with their results where decisions were made. 93% of the patients were seen on the same day after the scan. Most wait was 11 days due to delay of scanning. Of all the scans 75% of the scans are for common indication for scans in an Ambulatory setting. Indication for scanNumberDiverticular20Post-operative collections14Appendicitis11Non-specific abdominal pain10Hernias8 Conclusion After symptomatic management, scanning and reviewing patients on an ambulatory pathway is effective in both receiving scans in a timely manner as well as making timely appropriate decisions regarding their cause of presentation. It also helps reducing the number of patients going into the acute team.

Embedding a Novel Screening Programme for Sexually Transmitted Infections Within an Ambulatory Emergency Surgical Admissions Unit: An Observational Cohort Study

Abstract Aims To establish a sexually transmitted infection (STI) screening programme for females presenting to an Emergency Ambulatory Surgical Clinic (ASC), and to analyse incidence and prevalence of STIs as an underlying cause for their abdominal pain. Methods Observational cohort study in ASC of a tertiary hospital. Between December 2021 to December 2022, females aged 18-44 years presenting with abdominal pain were offered self-collected vulvovaginal swabs for chlamydia and gonorrhoea as part of a new standardised diagnostic pathway. Positive results were referred to local sexual health services for treatment and contact tracing. Main outcome measures included number of patients consenting to the screening programme and number of positive swab results. Results The cohort comprised 297 eligible patients; 259 with 20 patients declining testing and 18 samples rejected. A total of 5.4% of swabs were positive (2 gonorrhoea, 12 chlamydia) with mean age of 24.5. All positive patients presented with lower abdominal pain and of these, only 25% had a documented sexual history during assessment. 7 had further imaging with 4 results diagnosing pelvic inflammatory disease (PID). 4 patients were treated for PID empirically. Remaining patients were treated for non-specific pain or unrelated pathology. Conclusions Undiagnosed STIs are prevalent, and have known fertility and public health risks. Young females with lower abdominal pain provide an opportunistic and arguably necessary screening cohort in ASC with good uptake of self-testing. Results demonstrate high incidence of positive tests, suggesting that inclusion of sexual history during assessment is vital to identify those with highest STI risk.

Effectiveness of implementation strategies to improve nutrition education interventions in adults living in rural and/or low-income communities.

The objective of this project was to promote evidence-based practice and identify how to best implement nutrition education interventions for adults living in rural and/or low-income communities. Adults living in rural and/or low-income communities are at increased risk for poor nutrition and chronic health conditions. Patients are referred to the EversCare Clinic (ECC), an ambulatory clinic at an academic medical center in Mississippi, USA, to receive assistance with social needs. In addition to living in rural and/or low-income communities, over 90% of the patients seen at the ECC are food-insecure, yet nutrition education is inconsistently provided. The JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback tools were used. The ECC team conducted a baseline audit of 30 patient electronic health records, designed and implemented best-practice nutrition education strategies, and completed a follow-up audit of 30 patient electronic health records. Four evidence-based criteria for nutrition education in adults living in rural and/or low-income communities were audited, and various interventions were used to address multiple levels. The baseline audit revealed patients were not receiving recommended nutrition education interventions. Following the implementation, there was a 64.2% improvement in compliance with all four best practice criteria. Involving nursing students proved to be an effective method of improving compliance. Adherence to best practices regarding implementing nutrition education interventions was satisfactory, with 80% of patients receiving interventions at individual, interpersonal, community, and societal levels. Future audits are planned to ensure sustainability.