Improvement Pilot Program Research Articles

Improving Dual Antiplatelet Therapy Adherence Via Implementation of a Pocket Card: A Quality Improvement Pilot Program.

Improving Dual Antiplatelet Therapy Adherence Via Implementation of a Pocket Card: A Quality Improvement Pilot Program.

An Asynchronous Evidence-Based Mindfulness Intervention for Professional Nurses.

Purpose: To evaluate the impact of an abbreviated (4-week) and asynchronous, mindfulness-based intervention (MBI) on nurses' perceived stress and mindful attention and awareness. Design: An evidence-based quality improvement pilot program. Methods: The participants (n = 15 nurses) attended a 4-week, asynchronous MBI. The participants attended a 90-minute webinar on mindfulness as a prerequisite, followed by 4 weeks of guided meditation and informal mindfulness practice materials. The MBI was offered remotely with self-modulated practice. Participants also provided the number of days per week they participated in formal meditation practice. Project participants completed pre- and post-intervention questionnaires. Project instruments included the Mindful Attention Awareness Scale (MAAS) and the 10-item Perceived Stress Scale (PSS). Findings: 12 complete pre-and post-intervention surveys were analyzed. Significant improvements were noted in participant mean MAAS scores post-intervention (p = .004). Cumulative PSS scores also decreased post-intervention (p = .009). Conclusion: The 4-week MBI demonstrated a statistically significant impact on nurses' perceived stress and mindful attention and awareness. Additionally, this Doctor of Nursing Practice (DNP) student led program was offered in an asynchronous and remote format, which was received well by program participants and may be a practical option for future MBIs.

Reduced Opioid Use and Prescribing in a Same Day Discharge Pilot Enhanced Recovery Program for Elective Minimally Invasive Colorectal Surgical Procedures During the COVID-19 Pandemic.

PurposeEnhanced recovery pathways (ERPs) are associated with reduced complications and length of stay. The validation of the I-FEED scoring system, advances in perioperative anesthesia, multimodal analgesia, and telehealth remote monitoring have resulted in further evolution of ERPs setting the stage for same day discharge (SDD). Pioneers and early adopters have demonstrated the safety and feasibility of SDD programs. The aim of this study is to evaluate the impact of a pilot SDD ERP on patient self-reported pain scoring and narcotic usage.MethodsA quality improvement pilot program was conducted to assess the impact of a SDD ERP on post-operative pain score reporting and opioid use in healthy patients undergoing elective colorectal surgery as an alternative to post-operative hospitalization during the COVID-19 pandemic (May 2020-December 2021). Patients were monitored remotely with daily telephone visits on POD 1-7 assessing the following variables: I-FEED score, pain score, pain management, bowel function, dietary advancement, any complications, and/or re-admissions.ResultsThirty-seven patients met the highly selective eligibility criteria for “healthy patient, healthy anastomosis.” SDD occurred in 70%. The remaining 30% were discharged on POD 1. Mean total narcotic usage was 5.2 tablets of 5 mg oxycodone despite relatively high reported pain scores.ConclusionsIn our initial experience, SDD is associated with significantly lower patient narcotic utilization for postoperative pain management than hypothesized. This pilot SDD program resulted in a change in clinical practice with reduction of prescribed discharge oxycodone 5 mg quantity from #40 to #10 tablets.

A Comprehensive Clinician Well-Being Assessment and Improvement Pilot Program: A Journey from Fatigue to Peak Performance

A Comprehensive Clinician Well-Being Assessment and Improvement Pilot Program: A Journey from Fatigue to Peak Performance

1260-P: A Clinical Care Improvement Pilot Program: Individualized Health Coaching and Use of Incentives for Youth with Type 1 Diabetes and Their Caregivers

In pediatric type 1 diabetes (T1D) care, collaboration among youth, caregivers, and medical providers is important for optimal glycemic control; however, many youth are still unable to achieve A1c goals (A1c < 7.5%). This study examined the effect of a 10-week clinical care pilot program on A1c in youth with suboptimal diabetes control. The program consisted of two primary components: 1) weekly individualized health coaching and insulin dose adjustments and 2) incentives for program completion and decreases in A1c. The program was offered to 179 youth with T1D receiving routine diabetes care (A1c 8.6%-10%). Twenty-five caregivers/youth (youth ages 4-18; Mage=11.6 years, Mean A1c=9.4%) completed the 10-week coaching sessions and follow-up A1c measure. Coaching, conducted at no cost via phone call and email (with caregiver and/or youth), was individualized based on family needs and conducted by diabetes team members. Each youth/family who participated and returned for an A1c measure received a gift card to a local grocery store to further dietary goals. Youth were entered into a drawing to win an iPad upon completion of A1c measure and for reductions in A1c. Of the 25 participants, 20 (80%) exhibited a decrease in A1c level at the end of the 10 weeks (mean decreased A1c of 0.5% across 25). Seventeen youth (68%) had a decrease in A1c greater than 0.5% and 7 youth (28%) had a decrease greater than 1.0%. Results from qualitative interview with health coaches suggest increased engagement and empathy from diabetes team members. Communication via phone/email coupled with outcome based incentives was an effective strategy for decreasing A1c in the short-term. This data suggests that moving from an office centric model of care to a sustained health coaching model delivered via phone/email may be a more effective strategy to improve diabetes outcomes. Patient satisfaction and sustained effect of the intervention will be monitored over time. Disclosure L. Clary: None. A. Dauber: Consultant; Self; Novo Nordisk Inc. Research Support; Self; Novo Nordisk Inc. S. Arboine: None. M.S. Dillon: None. B. Eshete: None. S. Hatchell: None. S. Jones: None. P. Vaidyanathan: None. F.R. Cogen: None.

Psychological impact of traumatic events in rural nursing practice: An Integrative review

Purpose: The purpose of this article is to present findings from a pilot quality improvement evidence-based new nurse transition program that facilitates clinical leadership skills in novice nurses at the point of patient care at a rural critical access hospital. Descriptive data from pre- and post-intervention scores are reported, and the percent change was evaluated. Sample: Due to the solitary nature of rural nursing, new graduate nurses in rural areas need support in transitioning to their new role as registered nurses. The author designed, and pilot tested a quality improvement evidence-based new nurse transition program in a rural critical access hospital utilizing complexity science as a framework. Method: A quality improvement pilot program designed for new graduate nurses was provided at a critical access hospital in a rural Midwestern State. Data was collected using pre- and post- intervention scores on the Leadership Characteristics and Skills Assessment and TeamSTEPPS Teamwork Attitudes Questionnaire. Descriptive data was evaluated. Findings: Participant post- test percent change scores increased in perceptions of ability to lead but decreased in attitudes about teamwork. Observations of participant interactions in the quality improvement project suggested that the new nurses were developing new ideas, patterns and structures regarding their roles as a team member in the healthcare setting. Conclusion: In a rural midwestern critical access hospital a quality improvement leadership program that used a complexity science framework was provided to novice nurses in transition. After the program participant total mean post scores increased in perception of what makes a good leader and in the participant’s perception of their ability to lead. An overall mean score decrease in attitudes about teamwork was noted among the small group of rural novice nurses. Keywords: rural, frontier, new registered nurse graduate, transition program, complexity science, leadership

Reducing Compassion Fatigue in Inpatient Pediatric Oncology Nurses.

To develop an evidence-based compassion fatigue program and evaluate its impact on nurse-reported burnout, secondary traumatic stress, and compassion satisfaction, as well as correlated factors of resilience and coping behaviors. The quality improvement pilot program was conducted with 59 nurses on a 20-bed subspecialty pediatric oncology unit at the St. Jude Children's Research Hospital in Memphis, Tennessee. Validated measures of compassion fatigue and satisfaction (Professional Quality of Life Scale V [ProQOLV]), coping (Brief COPE), and resilience (Connor-Davidson Resilience Scale-2) were evaluated preprogram and at two, four, and six months postprogram, with resilience and coping style measured at baseline and at six months postprogram. Secondary traumatic stress scores significantly improved from baseline to four months. Select coping characteristics were significantly correlated with ProQOLV subscale scores. Ongoing organizational support and intervention can reduce compassion fatigue and foster compassion satisfaction among pediatric oncology nurses.

Early Removal of Foley Catheter after Sigmoid Colectomy for Diverticular Colovesical Fistula without Intraoperative Bladder Repair or Postoperative Cystography: Feasibility of a Quality Improvement Pilot Program

Early Removal of Foley Catheter after Sigmoid Colectomy for Diverticular Colovesical Fistula without Intraoperative Bladder Repair or Postoperative Cystography: Feasibility of a Quality Improvement Pilot Program

A hypertension control quality improvement pilot program: Experiences and blood pressure outcomes from physician practices

Improving Health Outcomes: Blood Pressure (IHO: BP) was a Quality Improvement (QI) pilot program developed by the American Medical Association (AMA) and Johns Hopkins Medicine aimed at helping physicians and their care teams better manage patients with uncontrolled hypertension. The pilot study was conducted at 10 ambulatory practice sites between October 2013 and November 2014 in which the initiative was to devise a framework and intervention strategies for improving hypertension control. The program included evidence-based tools and materials to support the Measure Accurately, Act Rapidly, and Partner with Patients (M.A.P.) framework, interactive components with coaching support and peer-to-peer learning opportunities, and a measurement system supported by health technology, all intended to aid blood pressure management. This paper captures the learnings from the engagement, experiences, and satisfaction of care teams from the IHO: BP pilot that were used to adjust, reassess, and refine components of the QI program. Overall, participation in the IHO: BP pilot was associated with an increase in BP control rates from a mean of 69% to 75% (p < .05) for 3 of the 10 practices. Mean systolic and diastolic blood pressure was reduced in 8 of 10 practices by a mean of 12.5 mmHg/6.5 mmHg (p < .05). Furthermore, evaluation of participant experiences indicated that 75% of the respondents were satisfied or very satisfied with the initiative. The results from this study include components of the pilot that participants indicated were most helpful and were used to generate useful information for hypertension QI efforts that were later scaled and spread to subsequent initiatives.

Quality improvement pilot program selection based on dynamic hybrid MCDM approach

PurposeDriven by motivation of quality enhancement and brand reputation promotion, automotive industries try to improve product quality and customer satisfaction by performing quality pilot programs continuously. The purpose of this paper is to develop a dynamic model to select the improvement quality pilot program from competitive candidates based on dynamic customers’ feedback.Design/methodology/approachAn extended dynamic multi-criteria decision-making method is developed by embedding dynamic triangular fuzzy weighting average operators into fuzzy VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR) method, and the novel evaluation indicator “ζ” is introduced to reflect prioritization performance.FindingsThe two evaluation indicators (Q and “ζ” ) assist quality managers to identify the best program with respect to multiple conflicting criteria and the best choice based on these two indexes shows high conformity. Besides, ranking sequences obtained by “ζ” can avoid the dilemma that there are several candidates with top priority calculated by comprehensive group utility value Q.Practical implicationsThe dynamic MCDM method has been applied into the quality improvement procedure in Chinese domestic auto factories and contributes to highly efficient promotion.Originality/valueFew dynamic models on pilot program selection for quality improvement based on dynamic customers’ feedback, this study deals with the dynamic promotion by an extended fuzzy VIKOR method and presents a case application.

Medical Scribes in an Academic Dermatology Practice

This study examines the implementation of a multipractice quality improvement pilot program evaluating medical scribe impact on dermatologist documentation time and physician satisfaction.

Improving the knowledge and adherence of nursing staff to infection control ecommendations: a quality improvement pilot program

Since 2003, all nursing staff at HUG follow a mandatory course in infection control in the context of an institutional program. As part of a quality improvement pilot program we implemented a knowledge assessment tool in 2 units of a 300-bed geriatric hospital.

Improvement of Blood Glucose Control on the Bone Marrow Transplant (BMT) Unit: A Retrospective Review of Our Quality Improvement Pilot Program

Improvement of Blood Glucose Control on the Bone Marrow Transplant (BMT) Unit: A Retrospective Review of Our Quality Improvement Pilot Program

Quality Improvement Pilot Program for Vulnerable Elderly Surgical Patients

The elderly are a growing surgical population with more comorbidities and less physiological reserve compared with nonelderly patients. The objective of our study was to implement a quality improvement pilot program targeting the specific needs of the elderly. We prospectively enrolled consecutive patients aged 65 years or older undergoing inpatient general or vascular surgery operations. Patients completed a preoperative assessment including the Vulnerable Elder Survey (VES) to determine baseline functional status and incidence of polypharmacy (five or more medications). They were interviewed postdischarge Day 2 and Day 30 for changes in functional status. An intervention was implemented consisting of an elderly-specific postoperative order set and preoperative risk reports sent to the surgical team with instructions to order physical therapy consults and home health nursing on discharge for VES 3 or greater and geriatrics consults for patients with polypharmacy. The elderly-specific order set was used for 71 per cent of the postintervention group. There were no differences in the percentage of participants receiving physical therapy, geriatric, or home health nursing consults between the two groups. The postintervention group had significantly better functional status on postdischarge Day 30 (P < 0.01). Our preliminary data suggest that individualizing care for elderly patients is feasible and may improve postoperative outcomes.

Quality improvement pilot program for elderly surgical patients may improve postoperative functional status

Quality improvement pilot program for elderly surgical patients may improve postoperative functional status