Pilot Quality Improvement Project Research Articles

Virtual reality to aid in competency-based online nurse practitioner curriculum (VR-NP)

Virtual reality (VR) simulation use in graduate nursing education is a growing innovative trend that can help with competency-based education. The Virtual Reality Simulation to aid in competency-based online nurse practitioner curriculum (VR-NP) pilot innovation and quality improvement project sought to deliver VR simulation as an educational strategy in an online graduate nursing program advanced health assessment course that enrolled sixty-six students. Twenty-nine of the students were provided loaner VR equipment to complete simulated advanced health assessments from their home while the remainder of students completed the same simulations using screen-based technology. For all students, weekly simulations were paired with follow-up debriefing led by faculty using synchronous web conferencing. Students using VR completed a mid-implementation and post-implementation survey, consisting of the System Usability Scale (SUS), Simulation Effectiveness Tool-Modified (SET-M), and open ended questions. Students using screen-based technology, completed similar surveys with only the SET-M and open-ended questions. Necessary adjustments were made to the implementation process based on data received mid-implementation. Overall students were satisfied with the use of VR simulation from a distance and minimal implementation challenges were encountered. Recommendations for integration of VR into other graduate nursing programs are shared.

Impact of pharmacist-led transitions of care model on length of hospital stay and 30-day readmission rates at a quaternary care hospital: A pilot study

BackgroundData about the impact of pharmacist-led transitions of care (TOC) approach are not well established. ObjectivesThe objective of this pilot study was to evaluate the impact of pharmacist-led TOC enhanced workflow on the length of hospital stay (LOS) and the 30-day hospital readmission rates (HRRs). MethodsThis is a quality improvement pilot project conducted at a quaternary care hospital in the United Arab Emirates over 6 weeks on a medical floor and 4 weeks on a cardiac floor. TOC was defined as admission medication reconciliation (AMR) and discharge medication reconciliation (DMR). ResultsThe median LOS was statistically significantly lower in patients who received AMR on the medical floor (4 days [3-8]) than those who did not (7 days [4-20]) (P < 0.001). The median LOS on the cardiac floor was not statistically significantly affected—3 (1.75-8) versus 3 (1-8) (P = 0.736). However, the multivariate linear regression model, adjusting for the number of interventions, indicated that LOS was statistically significantly lower on both floors; AMR was an independent risk factor for reducing the LOS on the medical floor (B = −8.37 [95 CI −11.37 to −5.36], P = .001) and on the cardiac floor (B = −2.76 [95% CI −5.23 to −0.28], P = 0.029). The 30-day HRR was not different on the medical floor but was numerically lower on the cardiac floor in patients who received DMR alone (12.9%) than in those who did not (17.2%) (P = 0.476). However, the multivariate logistic regression analysis, adjusting for number of interventions, indicated that the pharmacist-led AMR and DMR combined were numerically associated with lower rates of 30-day HRR with respective odds ratios of 0.64 (95% CI 0.3–1.38) and 0.83 (95% CI 0.4–1.9) (P = 0.83) on the medical floor and of 0.96 (95% CI 0.3–2.6) and 0.7 (95% CI 0.3–1.8) (P = 0.28) on the cardiac floor. In addition, the impact of the described pharmacist-led TOC approach on health care costs at the hospital was quantifiable and reflected a median medications utilization cost of $1142.95 (639.69-2444.88) when TOC is performed versus $1371.54 (402.92-4277.39) without TOC (P < 0.001) on the medical floor and of $4728.98 (2436.66-6846.34) versus $5252.79 (3907.63-7784.57) (P < 0.001) on the cardiac floor throughout the study time period. ConclusionPharmacist-led TOC interventions, specifically AMR, significantly reduced the LOS on the medical and the cardiac floors, whereas both AMR and DMR represented promising predictors of decreased 30-day HRR on the studied floors. Furthermore, the TOC interventions were generally associated with a statistically significant financial impact on both studied floors.

CSP2023: 477 - Improving paediatric activity and exercise behaviours for musculoskeletal rehabilitation through outpatient exercise classes: a pilot quality improvement project

CSP2023: 477 - Improving paediatric activity and exercise behaviours for musculoskeletal rehabilitation through outpatient exercise classes: a pilot quality improvement project

Improving Vaccination Documentation Rates Among Patients With Breast Cancer Through Patient Outreach.

Patients with cancer are at high risk for infection-related morbidity and mortality; vaccinations reduce this burden. In 2021, vaccination documentation rates were low at an academic medical center breast clinic. The purpose of this pilot quality improvement project was to evaluate an education intervention to increase vaccination documentation among patients with breast cancer. During a 16-week period, the 4 Pillars™ Practice Transformation Program was implemented. The oncology nurse navigator assessed and documented vaccination history, discussed recommendations with the provider, and recommended concurrent vaccinations. Within a two-week period, the oncology nurse navigator completed and documented vaccination follow-up via telephone. Vaccination follow-up and documentation for influenza, shingles, and pneumococcal vaccines increased substantially. Findings indicate that an education and outreach program can increase vaccination documentation rates among patients with breast cancer.

Improving pediatric atopic dermatitis care in the emergency department and primary care setting: a collaborative quality improvement pilot project.

Emergency department visits and healthcare expenditures for pediatric atopic dermatitis have been increasing over the last two decades. There is a paucity of replicable quality improvement initiatives addressed at educating primary care and emergency medicine clinicians on this condition. The goal of this initiative was to improve clinician knowledge and comfort in the diagnosis and management of pediatric atopic dermatitis and superinfection. Clinicians were recruited via email from academic and community settings in Travis County, Texas, in 2020. They were sent a pre-intervention survey, a series of three quizzes, and a post-intervention survey. After each quiz, participants received performance feedback and various forms of multimodal education. Differences between the first and final quiz scores and clinician confidence levels were analyzed for statistical significance. Fifty-six clinicians completed the intervention. The average overall and treatment-specific scores increased significantly by 10% and 37%, respectively. Further, confidence levels improved significantly in the majority of clinicians. Clinician qualitative feedback revealed high satisfaction. Results from this educational quality improvement project have demonstrated that this is an effective and replicable resource for educating clinicians who manage pediatric atopic dermatitis in the emergency department and outpatient setting.

Improving Nurse-Physician Bedside Communication Using a Patient Experience Quality Improvement Pilot Project at an Academic Medical Center.

Introduction Patient experience is a crucial aspect of healthcare delivery, and it encompasses various elements that contribute to a patient's perception of the care they receive. Patient satisfaction and patient experience are related but distinct concepts. Patient experience focuses on whether specific aspects of care occurred, while patient satisfaction gauges whether patient expectations were met. It goes beyond mere satisfaction and delves into the broader aspects of how patients interact with the healthcare system and the quality of those interactions, with health plans, doctors, nurses, and staff in various healthcare facilities. Other aspects highly valued by patients include elements such as timely access to care and information, good communication with the healthcare team, and friendly staff. Patient experience can influence both the healthcare and financial outcomes of healthcare facilities. It is well understood that positive patient experiences may lead to better care adherence, improved clinical outcomes, enhanced patient safety, and better care coordination. Payers, both public and private, have recognized the importance of patient experience. Improving patient experience benefits healthcare facilities financially by strengthening customer loyalty, building a positive reputation, increasing referrals, and reducing medical malpractice risk and staff turnover. Methodology A multidisciplinary retrospective quality improvement initiative was initiated to effectively improve nurse-physician communication and organizational outcomes in several hospital units. Results Using an innovative staff-developed and driven acronym, IMOMW (I'm on my way), the study demonstrated significant positive outcomes such as increased Epic documentation (Epic Systems Corporation, Verona, Wisconsin, United States) of physician and nursing rounding by 13%, a 10.5% rise in recommend facility net promoter score (NPS) patient experience survey scores, 13.4% increase in physician and nurse team communication, 5.4% increase in nursing communication, and a 5.3% increase in physician communication. Moreover, pilot units outperformed the control group consisting of medical-surgical units located in newer portions of the hospital. Conclusion This quality improvement study demonstrates improved interdisciplinary nurse-physician communication, Epic documentation, and patient experience scores. Further investigation is necessary to better understand the specific factors and/or processes that influence the sustainability of interventions that improve nurse-physician communication and patient experience.

Piloting an Opioid Risk Screening Tool in Clinical Practice.

Background: Despite much research and many interventions, the opioid epidemic continues to plague the United States. According to the Centers for Disease Control and Prevention (2021), 136 people die daily from both prescription and illicit opioids. Objective: The goal of this pilot quality improvement project is to examine how the implementation of the Opioid Risk Tool (ORT) in clinical practice might impact the beliefs and attitudes of nurse practitioners (NPs) toward prescribing opioid therapy. Methods: A pre-post design was utilized. A convenience sample recruited participants from a private NP Facebook group. The intervention included a prerecorded presentation on the ORT and the use of the ORT for 8 weeks. Results: While 46 NPs completed the presurvey, only 19 NPs completed the postsurvey. Statistical results did not yield significance, but there were several significant clinical trends discovered. Conclusion: Utilizing the ORT to screen for opioid misuse risks has been shown to improve providers' confidence in opioid prescribing. ORT guides providers in discerning patient risk for developing dependence on opioids. Implications for Nursing: Screening for opioid misuse risk is feasible. ORT adds to the clinical context in deciding a course of treatment in pain management.

Implementing a Respectful Maternity Care Guideline During Childbirth Experiences

ObjectiveTo measure the impact of an evidence-based guideline on respectful maternity care on nurses’ attitudes and beliefs about childbirth practices. DesignA quality improvement pilot project with a pretest/posttest design examining the attitudes and beliefs of intrapartum nurses about childbirth practices of respectful care. SettingHigh-risk intrapartum unit at a tertiary care center in the southeastern United States. ParticipantsA convenience sample of 130 registered nurses were invited to participate, and nine completed the pre- and posttests. Intervention/MeasurementsThe intervention included a recorded webinar, access to printed and electronic copies of the guideline, discussions in daily huddles, and a virtual journal club. Data were collected using the 42-item Nurse Attitudes and Beliefs Questionnaire–Revised. Lower scores are reflective of attitudes and beliefs that support a medical model of care, whereas higher scores are reflective of a physiologic model of care. Descriptive statistics and the Wilcoxon signed rank test were used to analyze changes in attitudes and beliefs based on the aggregate scores of the nurse participants. ResultsAlthough there was no change in nurse attitude and beliefs about childbirth practices after 3 months (p = .058), the aggregate scores on a scale of 42 to 168 increased by 5.6 points. Two subscales of the Nurse Attitudes and Beliefs Questionnaire–Revised—Medical Model of Conflict and Women’s Autonomy—had the greatest increase in aggregate scores. ConclusionUnderstanding nurses’ attitudes and beliefs can assist in identifying barriers to the provision of respectful care, particularly during labor and birth, when patients are most vulnerable. Measurement of nurse attitudes and beliefs regarding respectful maternity care may require a longer immersion in a respectful maternity care program to allow for changes over time.

Screening to understand pregnancy preferences and offer referrals and treatment (SUPPORT): Results of a pilot quality improvement initiative.

To assess the feasibility of integrating a pregnancy intention assessment screening algorithm into the electronic medical record (EMR) at a multispecialty clinic focused on the health of women and people assigned female at birth (AFAB). This pilot quality improvement project implemented a series of clinician reminders, new data fields in the patient record, and templated clinical notes to prompt care providers across specialties to ask AFAB reproductive age individuals about their desire for future pregnancies. Investigators created a novel screening question based on prior literature and expert input. Prospective observational study of one year of during-intervention EMR data on screening uptake and documentation, contraceptive use, and referrals to obstetrics and gynecology (OBGYN) for preconception care, contraceptive care, and related services. SUPPORT launched in February 2020 and was paused for 6 months due to the COVID-19 pandemic. During the intervention period through July 2021, 18% of patients for whom the automated screening reminder was activated had a documented pregnancy intention. Patients were screened in OBGYN, internal medicine, and eight subspecialty medical clinics. Among those screened, individuals who reported they did not desire pregnancy in the next year were more likely to use contraception (aOR 1.8, 95% CI 1.1, 3.1). Individuals that did desire pregnancy in the next year were more likely to be subsequently referred to OBGYN (aOR 2.7, 95% CI 1.2, 6.0). Despite the competing demands of the COVID-19 pandemic, the SUPPORT intervention was utilized at higher rates than prior similar interventions and across multiple disease specialties. Results from the SUPPORT pilot suggest that pregnancy intention screening of reproductive age AFAB individuals with an EMR-based screening prompt is feasible at scale.

Structured, nurse-led ward rounds to improve interprofessional communication and optimize care of vascular surgery patients: a best practice implementation project.

Ward rounds are crucial inpatient activities during which patients' conditions are discussed. Team-based models such as nurse-led ward rounds (NLWRs) have been conceptualized and trialled, with positive results. An evidence-based quality improvement pilot project to introduce NLWRs was implemented at a cardiovascular medical-surgical unit in a Singapore tertiary hospital. The JBI Evidence Implementation Framework was used to guide the project. The evidence-based NLWR format incorporated stakeholder feedback on NLWR frequency, preparation, coordination, and content. Baseline and 6-month post-implementation audits were carried out. The 4 audit criteria improved from baseline, reaching 100% compliance for criteria 1, 2, and 3 associated with interprofessional communication and collaboration. An improvement from baseline (30% to 46.7%) was also observed for criterion 4 on patient involvement during medical ward rounds. Moreover, there were improvements in clinical outcome data such as patient hospitalization length, "best medical therapy" rates, and inpatient complications. A statistically significant improvement in nurses' confidence to lead discussions during medical rounds was also observed ( p = 0.026). This project promoted greater compliance with NLWR criteria through audit and feedback cycles and the contextualization of implementation strategies. A well-supported program that prepares nurses for interprofessional communication also improves nurses' confidence in team communication, bolstering their ability to provide high-quality patient care.

1416. Walk a Mile in Someone Else’s Shoes: Navigating the Complexity of Daily Environmental Cleaning – A Quality Improvement Pilot Project

Abstract Background A major tenet of environmental cleaning is to focus on high-touch surfaces (HTS). HTS in the patient’s proximity have high rates of contamination, yet cleaning compliance of HTS remains low particularly when the patient is present. This quality improvement (QI) project aimed to use stakeholder input to modify a HTS cleaning checklist. Methods This pilot project used a Plan-Do-Check-Act cycle to modify and evaluate a daily cleaning checklist across acute and long-term care settings at one Midwestern VA Hospital (Figure 1). PDCA Results Two pre-intervention focus groups (patients, N=8 and EMS, N=5) were conducted to understand stakeholder perspectives and barriers to daily cleaning to inform modifications to the cleaning checklist. Participants viewed the graphic and discussed patients’ and EMS’s possible notions upon EMS entering the patient room. The groups were then asked how these insights could be addressed during the cleaning process. Recurrent themes of stakeholder’s perceived barriers to cleaning are depicted in Figure 2. Integrating the stakeholder suggestions to overcome barriers, and the literature suggesting higher touch and contamination of surfaces within proximity to the patient, the QI team and EMS designed a paradigm shift for the checklist including modifying mental models for: a. cleaning patterns from clean-to-dirty to dirty-to-clean (Figure 3) and b. extent of surface cleaning (Figure 4). Pre- and post-intervention observations of daily cleaning compliance of 10 HTS showed a significant improvement of 38% (pre, N=7) to 72% (post, N=10) (p = 0.011). Two EMS interviews were conducted post-intervention to evaluate checklist usability. Emergent themes were discomfort with cleaning any surface near the patient while the patient was in the bed and with the use of the modified cleaning pattern due to discordance with previous training and practices Graphic Exercise Cleaning Pattern Mental Model Modified Checklist Modified Checklist Conclusion Current checklists do not address contextual factors of navigating the environment surrounding patients in bed. HTS cleaning rates may be improved by modifying checklists based on input from local stakeholders. Future research is needed to evaluate modified cleaning processes to facilitate daily cleaning of occupied patient rooms. Disclosures All Authors: No reported disclosures

2669. Improving Trichomoniasis Screening Among Cis- and Transgender Women with HIV

Abstract Background In 2020, the Primary Care Guidance for Persons with HIV added the recommendation for annual trichomoniasis screening. We identified a low trichomoniasis annual screening rate among cis- and transgender female patients living with HIV at the Institute for Advanced Medicine – Morningside Clinic, a New York State Designated AIDS Center with over 1200 patients with HIV in the Mount Sinai Health System in Manhattan. The primary aim of this prospective quality improvement pilot project was to increase the clinic’s annual trichomoniasis screening rate to 25% over the six-month intervention period. Methods A gap analysis identified lack of efficient workflow as the major reason for low trichomoniasis screening. We developed and implemented an intervention as outlined in Figure 1. The intervention began on October 15, 2022. The data was reviewed on April 19, 2023 after the intervention period ended. Results At baseline, there were 423 cis- and transgender women with HIV engaged in care at the Morningside Clinic eligible for annual sexually transmitted infection screening, including trichomoniasis. Pre-intervention screening for trichomoniasis was low at 13.7% (n=58). During the six-month intervention period, there were 280 cis- and transgender women with HIV who required annual trichomoniasis screening and seen at least once for a clinic visit with a primary care provider. Of these 280 eligible patients, 178 were tested for trichomoniasis, a significantly increased screening rate of 63.6%. Conclusion The intervention successfully increased the clinic’s annual trichomoniasis screening rate from 13.7% to 63.6% among women with HIV. The observed increase within six months was above our goal and demonstrates the effectiveness of a low-intensity and highly sustainable intervention to improve annual trichomoniasis screening rates among women with HIV. Despite the intervention, there are still a number of patients who remain unscreened for trichomoniasis as well as other sexually transmitted infections such as gonorrhea, chlamydia and syphilis. We will continue this intervention longitudinally and further identify and address barriers to sexually transmitted infection screening among people living with HIV. Disclosures All Authors: No reported disclosures

Growing Novice Nurses to Perianesthesia Care: Formation of a Post-Anesthesia Care Unit (PACU) Fellowship

PurposeTo provide a proof of concept of a structured, replicable perianesthesia fellowship program for nurses with less than 2 years of experience and new graduate nurses. DesignAn immersive learning experience was implemented as a pilot quality improvement project using the Plan-Do-Study-Act method. MethodsThis 24-week fellowship program used blended learning approaches and the Tiered Skill Acquisition Model (TSAM) to develop foundational Post Anesthesia Care Unit (PACU) skills. Nurse Fellows (4) acquired knowledge in stages, with each week in the program reinforcing and building upon the prior week's learnings. Settings included an initial 10 weeks in the ambulatory PACU, then the acute care PACU (weeks 11-20), and the final 4 weeks were spent in the primary unit where the Fellow would transition into a PACU Staff RN. Through each phase, the Professional Practice Department’s Clinical Mentor Nurse promoted preceptor development, facilitated learning experiences and provided bimonthly evaluations of the Nurse Fellow’s progress via our institution's clinical rounding tool. We used the Nursing Anxiety and Self-Confidence Associated with Clinical Decision Making (NASC-CDM) scale to assess novice nurses’ anxiety and self-confidence associated with making clinical decisions at designated intervals. FindingsAll Nurse Fellows completed the program and remained in PACU positions 2 years post-fellowship. They reported discomfort and increased stress transitioning to different PACUs; however, they later indicated reduced anxiety and greater confidence in clinical decision-making, as noted in subsequent evaluations of the NASC-CDM scale. ConclusionsPerianesthesia fellowship programs incorporating blended learning, skill reinforcement, and formal mentoring on a primary PACU unit build confidence and competence in the novice nurse, making this once-excluded population of nurses a viable option for recruitment directly into the PACU environment.

Intensive Case Management to Reduce Hospital Readmissions: A Pilot Quality Improvement Project.

Hospital readmissions burden the U.S. health care system, and they have negative effects on patients and their families. The primary aim of this study was to pilot an intensive case management (ICM) intervention to reduce 30-day hospital readmissions. A secondary aim was to obtain patient- and caregiver-reported reasons for readmission. The setting was a vertically integrated health care system located in Northern California. This pilot quality improvement project occurred over a 4-month period. The intervention was delivered by master's degree students in nurse case management through an academic-clinical partnership. Patients hospitalized with a 30-day readmission were offered the ICM intervention. A total of 36 patients were identified and 20 accepted. Patient and/or caregiver was interviewed to identify reasons for their readmission. Data were collected about pre-/post-health care utilization including subsequent 30-day readmission. Mixed methods were used to analyze the findings. Thirteen of 20 enrolled patients received the weekly ICM intervention for at least 30 days. Seven declined further contact before 30 days. Patient-reported reasons for readmission included being discharged too soon, poor communication among providers and with patients/families, lack of understanding about disease management and/or treatment options, and inadequate support. Several patients believed that their readmission was unavoidable due to the complexity of their illnesses. We compared 30-day readmissions for those who participated in and those who declined the ICM intervention, finding that those who received the ICM intervention had a lower readmission rate than those who did not receive the intervention (35% vs. 37.5%).

Intensive Case Management to Reduce Hospital Readmissions: A Pilot Quality Improvement Project.

Intensive Case Management to Reduce Hospital Readmissions: A Pilot Quality Improvement Project.

Increasing Nurse-Physician Family-Centered Rounds Communication: A Quality Improvement Pilot Project.

Increasing Nurse-Physician Family-Centered Rounds Communication: A Quality Improvement Pilot Project.

Impact of an Interprofessional HIV Quality Improvement Team on Patient Care and Resident Learning Opportunities.

Although human immunodeficiency virus (HIV) care is a recommended competency for family medicine training, many programs report a lack of HIV expertise among faculty. After the departure of faculty with HIV care experience, an interprofessional HIV quality improvement team (HIV-QIT) of physicians and pharmacists aimed to maintain on-site HIV care and retain learning opportunities for residents, using process improvement and panel reviews with a remote HIV specialist faculty member. This study reports on a multicycle quality improvement pilot project with pre- and postintervention chart reviews between December 2019 and May 2021. All patients received primary care and HIV-QIT chart reviews on-site. We compared patients with integrated HIV care on-site to those receiving external HIV specialty care. Primary outcomes included virologic suppression, CD4 count ≥200 cells/mm3, and adherence to guideline-recommended HIV care. In cycle 1 (January-June 2020), the HIV-QIT reviewed patient charts and sent guideline-based recommendations to physicians. In cycle 2 (July 2020-May 2021), the HIV-QIT implemented several HIV-specific processes, including decision support updates, note templates, order sets, and reference materials. Sustained process improvements included HIV panel chart audits every 3 to 6 months and subsequent provider education. Of 29 patients, more than half (55%, n=16) received integrated HIV care at the primary care site. We found no significant difference in care quality measures between primary and specialty care. Barriers to care completion included missed or canceled follow-up visits, on-site phlebotomy service closures, and declined HIV services. The HIV-QIT maintained on-site HIV treatment and retained experiential learning opportunities through process improvement and specialist-supported care recommendations to primary care physicians.

250 Streamlining rehabilitation for hip fracture patients: a pilot quality improvement project

Abstract Background University Hospital Waterford (UHW) is a busy trauma unit, serving five counties in Ireland’s South East. UHW treats approximately 400 hip fracture patients annually, 27% of whom are referred for off-site rehabilitation either locally or regionally. The national average Length-of-Stay (LoS) for hip fracture patients is 12 days, whereas in UHW the average LoS is 17 days, higher in those awaiting off-site rehabilitation (19 days). Earlier access to rehabilitation results in reduced LoS, better patient outcomes, and enhanced patient flow through the hospital system. Methods We created a pilot six-bedded rehabilitation unit in Kilcreene Regional Orthopaedic Hospital (KROH, an orthopaedic hospital affiliated with UHW) for hip fracture patients. Hip fracture patients for rehabilitation in KROH are identified by the Orthogeriatric team. Weekly multidisciplinary team meetings and wards rounds are conducted by the UHW based Orthogeriatric Consultant and Advanced Nurse Practitioner (ANP). We measured duration of time waiting for rehabilitation in hip fracture patients since this unit’s commencement and compared to data from a previous audit conducted in 2020 in hip fracture patients awaiting rehabilitation. Results Since April 19th 2023, seventeen hip fracture patients have been transferred to KROH for rehabilitation, fifteen of whom were transferred on the same day or the day after they were identified as medically fit and rehabilitation ready. To date, the longest wait time for transfer was three days in two patients. Data from 2020 indicated that the median wait for off-site rehabilitation in centres across the south-east was six days. Conclusion Early results indicate that this pilot six-bedded rehabilitation unit reduces the wait time for rehabilitation in selected hip fracture patients, enhances continuity of care, and improves patient flow through the hospital system. Our future aims include expansion of the unit and collaborating with regional integrated care services to ensure continuity of care post-discharge.

Novel hand hygiene promotion method in a pediatric and maternity hospital: A quality improvement pilot project using auditory feedback.

A pilot quality improvement project was conducted to examine the effect of playing an applause sound effect at a busy hospital concourse for three consecutive days whenever hand hygiene behavior was observed. The immediate effect was documented. The project demonstrated observable interest among people passing by, and hand hygiene events triggered by the sound effect represented 10.1% of all hand hygiene events documented. This supports the possible utility of this intervention in generating public awareness and increasing hand hygiene behavior and demonstrates the feasibility of a longer trial utilizing audio devices.

A Quality Improvement Pilot Project for Noise Reduction in the NICU.

Increased noxious noise leads to adverse short-term and long-term effects on the growing neonate. The American Academy of Pediatrics recommends maintaining a noise level of less than 45 decibels (dBA). The average baseline noise level in an open-pod neonatal intensive care unit (NICU) was 62.6 dBA. The purpose of this pilot project was to reduce the average noise levels by 39% at the end of an 11-week period. The location of the project was in a large, high-acuity level IV open-pod layout NICU that consisted of 4 pods, one of which was cardiac-focused. The average baseline noise level in the cardiac pod was 62.6 dBA in a 24-hour period. Noise levels were not monitored before this pilot project. This project was implemented over an 11-week period. Several modes of education were used for parents and staff. Post-education, Quiet Times were implemented at set times twice daily. Noise levels were monitored for 4 weeks during Quiet Times, with weekly noise level updates for staff. General noise levels were collected a final time to evaluate the overall change in the average noise levels. At the end of the project, noise levels decreased from 62.6 dBA to 54 dBA, a 13.7% reduction. At the end of this pilot project it was noted that: Online modules were the best way to educate staff. Parents should be included in the implementation of quality improvement. Healthcare providers need to know and understand that they can make preventative changes to improve the outcomes of the population.