An increase was seen in the percentage of patients with active DNR orders and in hospice referrals after a discussion aid was included in admission packets.
An educational-based intervention in a pediatric orthopaedic clinic was effective in increasing the number of patients with a diagnosis of obesity and referred to a weight management program.
PURPOSE:
The purpose of this quality improvement (QI) project was to determine if use of an algorithm focusing on skin care in patients with fecal and urinary incontinence reduces the rate of hospital-acquired incontinence-associated dermatitis (IAD) over a period of 4 months.
PARTICIPANTS AND SETTING:
The QI setting was an 18-bed surgical intensive care unit (SICU) in an acute care urban hospital located in the southeastern United States. Two hundred eleven patients participated in this pre/postintervention QI project.
APPROACH:
The algorithm for skin care used evidence-based bundled interventions for patients with fecal and urinary incontinence. The project comprised education of the SICU nursing staff in January 2018 and implementation of the algorithm from February 5, 2018, to June 5, 2018. Weekly chart reviews were conducted to determine algorithm compliance, documentation of fecal and urinary incontinence, and accuracy of IAD documentation. Descriptive statistics were used to determine the rate of hospital-acquired IAD, algorithm compliance, and average length of time from admission to the onset of hospital-acquired IAD.
OUTCOMES:
Seventy-nine individuals with incontinence were included in the 3-month preintervention period and 132 individuals with incontinence in the 3-month postintervention period. We observed a 24% reduction in the rate of hospital-acquired IAD following implementation of the algorithm (29% vs 5%). The average length of time from admission to the onset of hospital-acquired IAD increased from 15 days in February 2018 to 25 days in May 2018.
IMPLICATIONS FOR PRACTICE:
Our experience with this QI project suggest that IAD can be identified and managed at the bedside by first clinical nursing staff without expertise in skin assessment and wound care.
Ulcerative colitis (UC) is an inflammatory bowel disease marked by mucosal inflammation. UC has an impact on quality of life and places a financial burden on the healthcare system. This article focuses on the impact, presentation, diagnosis and classification, systemic manifestations, complications, management, and treatment associated with UC.
MISAT should be considered in other settings where patients diagnosed with SMI are faced with non-adherence to psychotropic medication, but the sessions' format should be structured to fit the patients' needs.
Background:
Every year in the United States, influenza-related infection causes thousands of deaths, the complications of which require millions of dollars in hospital-related care. The influenza vaccine is proven to effectively reduce incidence of infection and complications from influenza viruses.
Local problem:
A clinic in southeast Florida for the uninsured offered influenza immunization at no cost to its patients, yet the immunization rate was still low.
Methods:
A quality improvement project was conducted to determine whether the use of evidenced-based bundled interventions would increase the rate of the influenza vaccination at the clinic.
Interventions:
The bundled interventions included mass communication, leadership, improved work flow, and improved access.
Results:
Evidence-based interventions led to a 597% increase in the influenza uptake rate. Trends were analyzed by using data gathered from the electronic medical record regarding patient demographics, influenza immunization uptake rate, type of visit for the immunizations, and reason for declining. Overcoming the access barrier led to great improvements in this clinic. Initially more vaccines were given in nurse visits; as the season progressed, more vaccines were given by providers in the clinic. Common reasons for patient refusal of the vaccine were fear of side effects and fear of contracting the influenza virus. Streamlined documentation could promote continued staff compliance over time.
Conclusions:
To reduce influenza-related costs and improve health outcomes, it is imperative that nurse practitioners use evidence-based interventions in the practice setting to increase influenza uptake rates in the adult uninsured population.
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