Improvement Project Research Articles

Patient Readiness for Surgery: A Quality Improvement Initiative

ABSTRACTThe use of a surgical safety checklist can help prevent sentinel events; however, a lack of adherence to the checklist can result in inadequate preoperative patient readiness and negative outcomes. The purpose of this quality improvement project was to address preoperative concerns that prevent patient readiness in a military hospital. To change practice, the project involved the use of an evidence‐based practice model and Kurt Lewin's change theory. The primary investigator provided an educational initiative on the required checklist for perioperative personnel and collected data on key elements (ie, consent completion, laboratory test results, antibiotic availability, checklist completion) for 30 days after the initiative. Consent completion rates were 100% both before and after the intervention. Statistical analysis (chi‐square [χ2]) showed significant improvement for the remaining three elements. The results were the most significant for laboratory test results (χ21 = 33.496, P < .00001).

The introduction of a dedicated cardiology clinic including a clinical scientist led pathway for women with turner's syndrome

Abstract Background There are more than 15,000 women living with Turner’s Syndrome (TS) in the UK, over 700 of whom are cared for within our linked Endocrinology services. Mortality is predominantly related to cardiovascular disease therefore close cardiology review with a focus on aortopathy is essential (1). However appropriate surveillance is challenging with growing pressures on all aortopathy services across the United Kingdom. Purpose To audit our current practise according to current international guidelines (2) and seek methods to improve the pathway for our growing population of TS patients including the feasibility of a Clinical Scientist led clinic, aiming to improve capacity and efficiency of our service. Methods A quality improvement project was conducted over a three-year period, piloting a dedicated clinical scientist-led clinic under close Cardiology Consultant supervision. Patients selected were deemed lower risk for cardiovascular complications according to American Heart Association (AHA) recommendations (2) (figure 1). Follow-up intervals of patients under both consultant-led and clinical scientist led pathways were analysed. Results Among a total of 226 patients analysed, 103 (46%) fell into the lowest risk category and therefore deemed suitable for prospective Clinical Scientist led pathway (figure 2). Analysis of all patients demonstrated that 60% had appropriate follow-up intervals according to guidelines, while 37% were too short and 3% were too long. A five-year projection indicated a consequential 96 unnecessary additional appointments for patients that were being seen too frequently. Further analysis showed that the time frame for follow up was too short in 25% of patients seen in the clinical scientist led clinic compared to 41% in the Consultant-led clinic. There were no aortic dissections in patients under surveillance during this period. In the last 10 years 1 patient on the waiting list for surgery (having presented with a type B dissection but requiring workup for liver cirrhosis) had a retrograde type A dissection (indexed aortic root dimension 2.4cm/m²). No other adverse events were recorded. Conclusion Auditing our service revealed safe management and improved adherence to guidelines in the clinical scientist-led clinic, identifying opportunities to optimize follow-up and enable physicians to focus upon high-risk patients. This pilot demonstrates the feasibility of a clinical scientist-led clinic in managing low risk TS patients, suggesting scalability to other conditions involving aortopathy to address capacity issues and improve pathways.

Marker Assisted Selection in Advanced Backcross Population of Rice Variety, MTU1010 for Bacterial Blight and Blast Resistance

The present study was aimed for identification of the bacterial blight and blast resistant lines in the advanced back cross population of MTU-1010 using marker assisted foreground selection and also for evaluation of agro-morphological characters. The M-16-59 introgressed line (derived from an intercrossing of BC2F1 plants of MTU-1010 x GPP2 and MTU-1010 x NLR 145) is developed under ongoing DBTDBSRR subproject -IV possessing Xa21, xa13, Pi1 and Pi54 resistance genes having broad spectrum resistance to bacterial blight and blast is used as a donor parent and MTU-1010 was used as a recurrent parent for the back cross. Before attempting the backcross both the parents were verified for the target genes along with the original donors GPP2 and NLR 145 using gene specific/linked molecular markers viz., xa13-promo for xa13 gene, pTA248 for Xa21 gene, RM 224 for Pi1 and Pi54 MAS for Pi54. under the F1 generation (equivalent to BC3F1 because two backcrosses were completed earlier), 120 plants were screened, and 16 plants were confirmed for xa13, Xa21, Pi1, and Pi54 genes under heterozygous conditions. These confirmed plants were assessed for agro-morphological characteristics such as yield, grain features, and plant type. The results showed that the confirmed heterozygous plants were comparable to MTU-1010 and passed to the next round of selection and evaluation. The BC1F1-198th plant (96.8%) was selfed to produce BC1F2 population. Twenty five plants were advanced to BC1F3 generation based on BB resistance and above other phenotypic characters. The selected BC1F3 progenies were screened for blast and BB resistance. Four BC1F3 progenies with four target genes (xa13xa13Xa21Xa21Pi54Pi54Pi1Pi1) showed very high level of resistance to both the diseases. BC1F2-198-52nd line found similar to MTU1010 with respect to yield and yield related characters besides showing resistance to both BB and blast.Improved lines of MTU1010 can be advanced for multi-location testing under All India Coordinated Rice Improvement Project (AICRIP) for their evaluation and possible release for the benefit of rice farmers.

Virtual practice facilitation as an implementation strategy for launching opioid safety committees for quality improvement in primary care: feasibility, acceptability, and intervention fidelity

BackgroundPractice facilitation (PF) is an evidence-based multicomponent in-person implementation strategy. COVID-19-related lockdowns caused many implementation initiatives to rapidly shift to virtual settings, but there is limited evidence on PF deployed exclusively using virtual meeting platforms. Our objective was to assess the feasibility and acceptability of virtual PF used in a primary care setting to implement interdisciplinary opioid safety committees (OSCs) to improve care for patients using opioid medicines for persistent pain and reduce high-dose opioid prescribing. We also describe alignment of virtual PF with the core functions of PF and fidelity of participating clinics to the OSC intervention.MethodsWe applied qualitative and quantitative methods to evaluate virtual PF used to implement a quality improvement project at Kaiser Permanente Washington, an integrated health system in Washington State. We established interdisciplinary OSCs in primary care clinics using virtual PF. OSCs were tasked with promoting opioid safety and high-quality pain care through population management and chart reviews. We used administrative data to calculate feasibility measures including attendance and retention. Acceptability data came from interviews with OSC members conducted by evaluators. Measures of fidelity to the OSC intervention were abstracted from meeting notes and administrative data. We used qualitative methods to assess the adherence of virtual PF to the core functions of PF.ResultsFacilitators carried out a comprehensive PF approach virtually and demonstrated adherence to the core functions of PF. We established OSCs in eight clinics and conducted an average of 17.5 virtual PF meetings over eight months of PF for each clinic. Average attendance was 75% and we had 84% retention. OSC members were highly satisfied with virtual PF. Facilitators effectively supported teams through implementation and technical challenges and OSC members gained skills through virtual PF. We implemented OSCs with high fidelity, suggesting virtual PF is an effective implementation strategy.ConclusionsWe found virtual PF is a feasible and acceptable implementation strategy for this intervention and identified strategies to support care teams through challenges. Our findings can help inform future implementation efforts, especially those hoping to engage geographically dispersed clinics or remote clinical staff.Trial registrationNot applicable.

Updating Relatives of Patients Lacking Capacity in General Medicine: A Quality Improvement Project in a District Hospital in the United Kingdom

Updating Relatives of Patients Lacking Capacity in General Medicine: A Quality Improvement Project in a District Hospital in the United Kingdom

Improving Family-Centered Rounds With a Nursing Checklist in the Electronic Health Care Record.

Family-centered rounds (FCR) is the standard for pediatric communication, but community pediatric hospital medicine services may face barriers in implementation, including offering FCR to families with a language preference other than English (LOE) versus those with an English preference (EP). The goal of our quality improvement project was to increase FCR from 33% to 80% over 1 year. Interventions included an FCR checklist integrated into the electronic healthcare record (EHR-FCR checklist), staff education, visual prompts, and interpreters. Our primary outcome measure was weekly % FCR. Our main process measure was weekly % nursing documentation. To address language inclusion, we compared FCR encounters for families with LOE versus EP. The use of the checklist without interventions was assessed during the sustain period. Control charts were used to analyze measures. Fisher's exact test was used to compare FCR for families with LOE versus EP. FCR increased to 81% during the intervention period and then decreased to 73% during the sustain period. Nursing documentation increased to 93% with the EHR-FCR checklist implemented as a flowsheet. There was no statistical difference in the proportion of families with LOE versus EP who participated in FCR (84% versus 81%, P = .38) during the intervention period; a statistically higher proportion of families with LOE participated in FCR during the sustain period (87% vs 72%, P <.01). We increased documented FCR on our community pediatric hospital medicine service, including FCR for families with LOE, by implementing a nursing-completed EHR-FCR checklist supported by staff education, visual prompts, and interpreters.

Program evaluation and healthcare process improvement focused on complex wheelchair procurement

ABSTRACT The operations of a specialty wheelchair (WC) seating center can influence the evaluation to delivery timeframe in days for a complex rehab technology (CRT) WC. Operations at one facility improved due to departmental process improvement (PI) project with evaluation of the delivery workflow and implementation of changes. A retrospective chart audit gathered baseline data on the evaluation to delivery timeframe in days of a CRT WC for 50 individuals prior to PI changes. Standard departmental workflow collected 745 individuals’ post-PI changes. The interventions took place from March 25, 2017, to April 5, 2018, and included defining and educating stakeholders on their roles and expectations, revisions of the electronic medical record, weekly and quarterly meetings with supplier leadership, paperwork completion goals, and follow-up paperwork centralization. Mean pre- and post-intervention evaluation to delivery timeframes in days was significantly different (162.2 versus 127.4 days, p < 0.0001). Overall, a reduction in the mean evaluation to delivery timeframe in days of CRT WC by 21.5% or 34.8 days occurred. Systematic change takes time as well as the commitment of all key players. PI changes resulted in evaluation to delivery timeframe reduction for patients to receive their CRT WCs.

Increasing Follow-up for Adolescents With Depressive Symptoms.

Prompt follow-up for positive depression screen results is important in providing high-quality care for adolescents. We sought to improve follow-up within 30 days for adolescents (≥12 years) with Patient Health Questionnaire-9 scores ≥10, or those with a positive question 9, from 25% to 40%. We conducted a quality improvement project at 6 primary care locations serving ∼33,300 patients (70% Black, 7.3% Hispanic, 80% Medicaid-enrolled). Our team identified key drivers and iteratively tested interventions, including contacting patients after antidepressant medication initiation, scheduling patients for follow-up during index visits, collaborating with integrated psychologists to expedite therapy for higher-risk patients, and reaching out to patients without scheduled follow-ups. Pre-intervention, 13.3% (589 of 4427) of adolescent encounters met the criteria for follow-up within 30 days, and 25.8% had a documented follow-up within 30 days. During the intervention period, 12.3% (764 of 6224) of adolescent encounters met the criteria for follow-up within 30 days, and the mean follow-up rate increased to 43.1%. By monitoring process measures, we scheduled follow-up visits for 18.9% of patients during the index encounter. Outreach to the remainder led to 32.6% of these patients completing follow-up. Our balancing measure of monitoring integrated psychology visit volumes remained stable. The application of quality improvement methods in primary care practices increased the frequency of follow-up care for high-risk adolescents after a positive depression screen.

Identifying Barriers to Implementing Complementary and Integrative Health Therapies in Rhode Island Health Care Systems: A Qualitative Approach.

Introduction: Complementary and integrative health (CIH) therapies are widely used and make up billions of dollars in out-of-pocket expenditures. This quality improvement project aimed to identify stakeholders' perceptions of implementing CIH therapies in health care systems to examine the barriers and facilitators to CIH implementation in Rhode Island (RI). Methods: A qualitative approach guided by the Consolidated Framework for Implementation Research (CFIR) was used to conduct interviews with key stakeholder groups: health care administrators, health insurance administrators, physicians, and CIH practitioners. Interviews were analyzed by directed content analysis of transcripts with CFIR as the a priori coding framework. Results: Eleven subconstructs within four major domains were most prominent in interviews across all stakeholder groups. Key barriers in the "innovation" domain include a perceived lack of evidence and credibility of CIH therapies, logistical and administrative complexity of implementation, high costs to patients, and little financial incentive for hospitals and insurance companies. The "outer setting" domain highlights the utility of market pressure in decision making to implement CIH and the role of health policy. The "inner setting" domain demonstrates the varied personal beliefs about CIH, credentialing challenges, and the dissonance between medical system priorities and patient needs. Positive facilitation of implementation is marked by personal exposure to CIH and provider satisfaction in the "implementation process" domain. Conclusion: CIH therapies offer the medical system low risk and effective interventions that meet patient needs not currently met by Western medicine. However, implementation is difficult due to poor perception of evidence and lack of financial gain for the medical system. Acupuncture and massage may be modalities better situated for implementation in the RI medical system. Further education, awareness, and advocacy for CIH therapies would help meet patients' needs for CIH availability.

Effectiveness of the Intrauterine Balloon Tamponade Compared With an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device for Postpartum Hemorrhage

OBJECTIVE: To compare intrauterine balloon tamponade and vacuum-induced hemorrhage-control devices in a multicenter hospital system using a standardized three-stage postpartum hemorrhage response algorithm. METHODS: As part of a quality improvement project, data were prospectively collected through ongoing detailed hemorrhage case audits from 65 facilities from August 2022 to February 2024. Postpartum hemorrhage-control devices are recommended for stage 2 or 3 of the postpartum hemorrhage algorithm. The primary outcomes were 1) quantitative blood loss after device placement, 2) rate of packed red blood cell (RBC) transfusion, 3) use of 3 units of packed RBCs or more, and 4) device failure. RESULTS: During the 17-month observation period, there were 123,292 deliveries, and postpartum hemorrhage occurred in 5,931 (4.8%). Postpartum hemorrhage-control devices were used in 11.2% of cases (666 total, intrauterine balloon tamponade n=300, and vacuum-induced hemorrhage control n=366). For intrauterine balloon tamponade and vacuum-induced hemorrhage-control devices, quantitative blood loss (median and interquartile range) after device placement was similar at 194 (67–440) mL and 240 (113–528) mL (P=.40), respectively, as was the rate of any packed RBC transfusion (59.7% vs 50.0%, P=.08), transfusion of 3 packed RBC units or more (27.0% vs 24.9%, P=.53), and device failure (7.7% vs 8.5%, P=.70). Placement of either device at a quantitative blood loss between 1,000 and 1,499 mL compared with 1,500 mL or more resulted in significantly lower rates of packed RBC transfusion (39.1% vs 70.3%, P&lt;.001), transfusion of 3 or more packed RBC units (13.7 vs 38.1%, P&lt;.001), and device failure (3.4% vs 12.9%, P&lt;.001). CONCLUSION: Transfusion and blood loss after device placement were similar with both hemorrhage-control devices. Earlier hemorrhage-control device placement reduced device failure and the need for transfusion.

Improving the efficiency and person-centredness of occupational therapy input into care-plans in a forensic mental health and rehabilitation service

Care-planning is vital to the delivery of timely, person-centred, safe and effective care. Despite the understanding of the benefits of person-centred care-plan in both services, occupational therapists (OTs) within our...

Improving Access to Community-Based Services for Sexual Assault Survivors

ABSTRACT Background Emergency department (ED) encounters are often the only healthcare provider encounter for patients seeking care after a reported sexual assault (SA), making the encounter a crucial opportunity to connect patients to support services in the community. An opportunity existed at an urban Level II trauma center to standardize SA discharge planning. Aims This quality improvement project aimed to improve access to SA support services. Methods The Model for Improvement guided two plan–do–study–act (PDSA) cycles. Implementation included (a) creation of a QR-code-accessible SA resource website, (b) ED standardized patient print and electronic medical record after-visit summaries with follow-up guidelines and the QR code, (c) ED staff education, and (d) a community stakeholder survey to assess facilitators and barriers to support services. Results During the first PDSA cycle, 19 reported SA survivors were seen in the ED (18 adult, one pediatric) and 14 SA resource website visits. During the second PDSA cycle, 13 reported SA survivors (10 adult, three pediatric) were seen in the ED and 29 website visits. Stakeholder survey data revealed barriers to support services were transportation, overloaded support services, and survivor knowledge of existing services. Conclusion The QR code intervention model is a discrete method of improving access to resources and is applicable to other vulnerable populations. The multiagency SA response team will utilize partner survey data to improve access to community resources such as housing and transportation.

59 Enhancing career development in paediatrics residency: A needs assessment

Abstract Background Mentorship is a cornerstone of professional growth within medical training, yet the role of formal mentorship in career advising for medical residents remains understudied. In 2020, our Paediatrics Residency program introduced the role of faculty advisors as part of the Competence by Design framework, with a mission to guide academic growth, professional development, and excellence in patient care. However, it is unclear to what extent career advising is occurring in this advisor-advisee relationship. Objectives The primary aim of this study was to complete a needs assessment for Paediatric residents to inform faculty advisor roles and responsibilities and effectively support paediatric residents in their career development. This included examination of the current state, identification of the ideal state, followed by a gap analysis and recommendations to create a comprehensive advising program. Design/Methods This study utilized a mixed methods approach, using quantitative and qualitative survey methodologies. The survey questions (n=20) were designed from background literature and pilot testing. An anonymous survey was administered through the Qualtrics platform to the Paediatrics residents (n=59). The protocol was submitted for REB review and was granted an exemption as a quality improvement project. Thematic analysis of the qualitative content was completed by two investigators, utilizing the Braun &amp; Clarke six-phase framework. Results The response rate for the survey reached 34% (n=20) with the final sample including 16% PGY1, 42% PGY2, 16% PGY3, and 26% PGY4 residents. Alarmingly, most residents (63%) did not have a well-defined plan for monitoring career goals. No residents claimed to have sufficient career mentorship at present (0%), with majority (84%) expressing their interest in regular career planning sessions. A significant proportion (79%) also underscored the importance of considering life context when setting career goals. Our thematic analysis revealed that career advising currently follows a non-formal, self-initiated process, with time constraints as the primary obstacle. Primary themes elicited emphasized career exploration (n=15), networking (n=7) including discussions around life context (n=6), mentorship (n=6), and advisor role clarity (n=6). Conclusion Our findings affirm a compelling need for enhanced career development within our Paediatrics Residency program. In response, we propose a multi-faceted approach advocating for structured formal career development. This entails scheduled information sessions, resident goal setting, and formal mentorship. We recommend creating opportunities for networking to enable personalized career development considerations. Exploring an adjunctive role to faculty advisors may be necessary to ensure the success of these recommendations in optimizing resident career education.

09 Penicillin allergy de-labeling: Adaptation of risk stratification tool for patients and families

Abstract Background Penicillin allergy is reported in 10% of the population, however, over 90% of patients are deemed non-allergic upon allergist assessment. A validated mobile penicillin allergy risk assessment tool was previously developed to help healthcare providers identify patients at low risk of penicillin allergy and de-label them. Objectives The goal of this quality improvement project is to validate a patient-driven version of the assessment tool. Design/Methods Patients 6 months to 18 years old and pregnant women referred to the institution’s allergy clinics for penicillin allergy assessment were invited to use the patient tool to complete a self-assessment prior to their appointment, resulting in the assignment of a risk category: allergic, high risk, low risk, or not allergic. At their appointment, the allergist conducted an assessment with the standardized validated tool. The risk categories determined using the patient tool were compared against the allergist assessment. Patients were provided satisfaction surveys. Results The allergist assessment and patient tool demonstrated agreement in 57/84 (67.9%, 95% CI [56.7%,77.4%]) assessments, intra-class correlation (ICC) = 0.618, p&amp;lt;0.001. Of these, 45/57 (78.9%) patients were stratified as low risk or not allergic. In 22/84 (26.2%) assessments, the patient tool determined a higher risk category than the allergist, primarily due to differences in patients’ perceived timing and description of symptoms. Only 5/84 (6.0%) patients were placed in a lower risk category using the patient tool compared to the validated tool. Of these, one patient responded to the self-assessment accounting for a mild reaction, whereas the allergist assessment accounted for a second, more severe reaction. The other 4/5 patients mistakenly answered that they had never taken penicillin so were stratified as not allergic on the patient tool; however, they had previously taken penicillin and were found at risk of possible allergy by the allergist. Of those who responded to the satisfaction survey, 53/62 (85.5%) agreed that the patient tool was easy to use. Conclusion The patient tool demonstrates good agreement in determining penicillin allergy risk, generally aligning with the validated tool and offering potential as a method of empowering patients to assess their risk and advocate for their care. For a small minority of patients, the patient tool determined a lower risk category than the allergist assessment. To improve safety, agreement, and accessibility, iterative cycles of assessment and changes to the patient tool structure will be applied. Potential competing interests Funding was obtained from Valeo, Polaris Health, CeraVe, ALK, Astra Zeneca, Medexus, Novartis, Sanofi, Pfizer

54 Efficacy of a quality improvement project in paediatric procedural pain management during needle procedures

Abstract Background In paediatric hospital settings, needle procedures significantly contribute to children’s experiences of pain and distress. A structured approach integrating preparation, comfort positions, distraction, relaxation techniques, and topical anesthetics can enhance children’s ability to cope with procedural discomfort. We developed a quality improvement (QI) initiative aiming to alleviate procedural pain and distress through a staggered implementation approach over a 3-year period. Objectives This study aimed to evaluate the impact of the first 2 years of an institutional QI initiative on managing procedural pain and distress in children undergoing needle procedures. The primary objective was to evaluate the use of multimodal strategies to reduce needle-related procedural pain/distress following the QI initiative. The secondary objective was to compare pain scores for needle procedures before and after the QI initiative. Design/Methods This observational study was conducted in a tertiary care university-affiliated paediatric hospital with an ongoing hospital-wide QI initiative aiming to alleviate procedural pain and distress in children undergoing needle procedures. The QI initiative consisted of mandatory sector-by-sector training of healthcare providers (HCP) on procedural pain/distress strategies to increase the use of multimodal pain care. Pain scores were measured during needle procedures (i.e. Numerical Rating Scale (NRS), Faces Pain Scale-R (FPS-R) or the FLACC scales, according to patient age) pre and 3-6 months post implementation of the QI initiative. Scheduled audits were conducted using a standardized questionnaire by a deployment champion nurse during needle procedures to document pain scales and pain/distress strategies used by the HCP during needle procedures in each of the hospital services. Results Throughout the first two implementation years (June 2021-June 2023), 363 audits were conducted on needle procedures for 363 children (Median age 7 yo (0month-18yo□). At this stage, audits took place in 14 different hospital services. The most frequent procedures were IV-line insertions (34%), venous blood draws (27%), and capillary blood sampling (26%). Parental presence and the use of distraction techniques were frequently used (90% and 80% of procedures, respectively). Of the 363 audits, 221 were pre-implementation and 142 post-implementation. Post QI initiative, an increased number of procedures were realized using multimodal strategies (4 or more strategies) to reduce pain/distress (from 60% to 78%). Pain scores were recorded for 203/221 audits pre and 134/142 post with a reduction in severe pain scores (7 or more) from 25% pre to 5% post-implementation. Conclusion The institutional QI initiative demonstrated both an increase in the number of strategies used to prevent pain/distress and a reduction in severe pain scores associated with paediatric needle procedures. This project emphasizes the significance of employing a multifaceted approach to managing procedural pain/distress in children undergoing needle procedures.

07 Partnering with patients with living and lived experience of eating disorders to improve inpatient care on an acute paediatric medicine unit

Abstract Background Since the COVID-19 pandemic, hospitals nationally are seeing a growing number of adolescent patients with eating disorders requiring acute medical stabilization, which is often a time of crisis in the trajectory of this ego-syntonic disorder. The complexity of these admissions often lead to safety events for patients and moral distress for clinicians. Medical admissions can also be an opportunity to engage youth and families. Patient partners are a pillar in healthcare quality improvement, but historically we have not engaged adolescent patient partners in improving acute eating disorder treatment. We gathered the experience of patients and families with living and lived experience of eating disorder treatment to improve their quality of care in an acute paediatric medicine unit. Objectives We aimed to describe the experience of patients and families with living and lived experience of eating disorder treatment, specifically acute medical stabilization, through a quality improvement patient engagement project. Design/Methods We used a mixed-methods design of semi-structured interviews and a focus group with adolescents with eating disorders and their caregivers in an acute medical unit at a tertiary paediatric hospital in British Columbia. We employed opportunity sampling by distributing recruitment flyers through patient experience councils, outpatient clinics, other non-acute units, and to all patients admitted with a medically unstable eating disorder at our hospital during the study period. The interviews consisted of open-ended questions, yes/no questions, and Likert scales related to four categories: admission process, inpatient experience, team communication, and discharge process. Two reviewers analyzed the qualitative data using thematic analysis, and the quantitative data was analyzed descriptively. Quality improvement projects are exempt from Research Ethics Board approval. However, we utilized the "A Project Ethics Community Consensus Initiative" (ARECCI) Ethics Guideline and Screening Tool and presented our proposal at the hospital's quality improvement and research oversight committees. Results We completed 8 interviews with patients with current living experience admitted to our acute medical unit. We also completed 1 interview with a patient with past lived experience and 1 focus group with patients and caregivers. Primary themes identified included uncertainty about their overall treatment journey and stress due to the sudden new expectations on the inpatient unit, such as activity restriction, meal plans by the hospital, and bathroom access after meal times. Patients identified the importance of relational care, inclusion in treatment planning, acknowledgement of the demanding nature of eating disorders, and individualized care. Due to variability in training, resource allocation, and gaps in communication, these patient-identified priorities are not always met. While 100% of participants stated they understood the reasons and goals for admission, participants averaged 3.7 on a 1 (lowest) to 5 (highest) Likert scale when asked to rate their satisfaction with the information they received. Five out of eight adolescents felt that there was consistency in communication within the team. Conclusion We demonstrate the complex needs of patients with eating disorders who require acute medical stabilization. Targeted knowledge mobilization initiatives through admission orientation documents and family-centered rounds could better meet those needs. We are currently developing an admission pamphlet and journal for patients admitted with a new eating disorder to our medical unit. Patient partners exhibited a high willingness to participate in our study and readily acknowledged the importance their contributions could hold for other patients.

Prevention and Control of Catheter-Associated Urinary Tract Infection (CAUTI): A Patient Safety and Quality Improvement Project

Prevention and Control of Catheter-Associated Urinary Tract Infection (CAUTI): A Patient Safety and Quality Improvement Project

Healing Hives: Exploring the Effects of Beekeeping on Veteran Mental Health and Quality of Life

Veterans experience higher risks of suicide and mental health disorders due to the traumas of military service, disabilities, and the difficulties of reassimilation into civilian life. Therapeutic interventions using human-animal interactions have shown promising results in reducing many risk factors affecting veterans’ quality of life. This quality improvement project sought to consider if veterans participating in a recreational therapy program focused on beekeeping and administered by the Department of Veteran Affairs would experience quality of life improvements using a standardized EQ-5D-5L assessment. Our results indicate significant changes in mobility, anxiety/depression, and overall health for veterans participating in beekeeping as a recreational therapy. Implications for practice and future research are presented.

Optimizing Emergency Department Length of Stay and Quality of Care: A Quality Improvement Project.

Background Patients' long length of stay (LOS) in the emergency department (ED) is a common measure of quality of care that could be a cause of increased morbidity and mortality. This quality improvement project (QIP) aimed to identify causes of long LOS and to improve common causes such as long consultation times. Methodology Over two months, three plan, do, study, and act (PDSA) cycles were conducted aiming to identify causes of long ED LOS and improve common causes that extended ED LOS beyond four hours. Additionally, the projectaimed to reduce the time taken from requesting a consultation from another specialty until it was completed and documented to an average of 60 minutes. Main interventions included raising awareness of staff and administration through video presentations, printed posters, direct contact, and optimizing the electronic health records system to audit performance. Results From PDSA cycle 1 through PDSA cycle 3, average consultation times decreased from 91 to 65 minutes. Common organization-related causes of long LOS included pending radiology or laboratory investigations, awaiting inpatient admission, and awaiting consultations from other specialties. Physician-related factors included delay in documentation likely resulting from heavy workload. Pending investigations and admissions were factors that could be amended with better administrative control. Conclusions A multifaceted approach that tackles physician-related and organization-related factors could be a necessity to improve LOS and the quality of care in the ED. Having staff and administration aware of targets and performance along with utilizing the electronic health records system to audit performance and increase efficiency are beneficial in improving the LOS in the ED.

Nurses as UN champions: Increasing nursing presence and influence at the United Nations.

Representing half of the global health workforce, nurses are critical to health promotion, disease prevention, and the economic and social needs of populations. However, nursing expertise is underutilized in the UN System, and nurses are underprepared for roles in policy to influence global health and sustainable development. Innovative education strategies are necessary to address the sidelining of nursing expertise in these spaces and build nursing literacy in shaping global policy. This quality improvement project aimed to develop and evaluate a model to build a USA-based school of nursing's literacy and engagement with the United Nations (UN) System. A Doctor of Nursing Practice (DNP) student developed an innovative educational model, the United Nations Essentials for Global Nursing Leadership, in partnership with a school of nursing (SON), to build faculty knowledge and skills on initiating and sustaining bidirectional engagement with the UN. In 2023, SON faculty piloted the model, and pre-/post-intervention survey data were utilized for improvement. Participants reported increased knowledge, awareness, and confidence related to the UN System and their ability to engage as policy influencers, health diplomats, and global citizens. In total, 100% of participants volunteered to hold the role of UN champion for the SON. This innovative model advances nursing knowledge and coherence in the UN System and key areas of policy, diplomacy, and global governance for meaningful UN engagement. CONCLUSION AND IMPLICATIONS FOR NURSING, HEALTH, AND SOCIAL POLICY: Models that invest in closing the global nursing leadership preparation gap can raise the profession's visible UN presence and strategic policy influence at a critical time for people and theplanet.