Letter to the Editor: A Quality Improvement Initiative for Pediatric Resident Education in Venous Thromboembolism Risk Assessment in Pediatric Patients

Azul, Melissa; Hsu, Lewis L.; Krepel, Andrew; Sales, Jocelyn M.; Porto, Isabel Cristina Celerino de Moraes; Hammamieh, Muhannad

doi:10.1177/1062860619879981

Cited by 2 publications

(1 citation statement)

References 5 publications

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“…Per institutional protocol, each patient was classified as low, moderate or high risk for DVT according to a pediatric risk assessment tool. 34,35 Moderate-risk adolescent patients were ordered to have IPCD, with provision that IPCD would not be applied to a leg with SCD vaso-occlusive pain or surgical pain. Low-risk adolescent patients had no IPCD ordered, only early mobilization to get out of bed.…”

Section: Methodsmentioning

confidence: 99%

Improving VTE prophylaxis adherence among hospitalized adolescents using Human-Centered Design

Kim

Klugman

Norell

et al. 2021

Journal of Patient Safety and Risk Management

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Background/problem statement Venous thromboembolism (VTE) is the leading cause of preventable hospital mortality in the United States; however, compliance with VTE prophylaxis is poor. Most materials for education about VTE prophylaxis are oriented toward adults rather than adolescents, for whom VTE risks are lower and prophylaxis indications differ. We hypothesized that educational materials for adolescents could improve compliance with VTE prophylaxis, reduce nurse burden for initiating and maintaining VTE prevention practices, and reduce practice variation by standardizing the conversation between clinicians and patients. Methods A multidisciplinary team including physicians, nurses, quality experts, communication designers, service designers, and medical students applied a human-centered design (HCD) process to define, iteratively prototype, and test education tools for nurses assigned to adolescents. We piloted a suite of six educational tools for adolescent VTE prophylaxis to fit into the existing hospital workflow. Results An in-room poster was selected after 85% of nurses responded favorably to this intervention. Adolescent adherence with Intermittent Pneumatic Compression Device increased from 69% to 79%, attaining the benchmark goal of 78%. Staff reported greater confidence in educating adolescent patients after the intervention: 62% of nurses and 72% of residents. Conclusion An HCD process helped nurses improve VTE prophylaxis for adolescents with an in-room poster and messaging strategy. Engaging staff in the design increased receptivity and adoption. The piloted materials also helped to create an environment of shared priority among the clinicians.

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Section: Methodsmentioning

confidence: 99%

Improving VTE prophylaxis adherence among hospitalized adolescents using Human-Centered Design

Kim

Klugman

Norell

et al. 2021

Journal of Patient Safety and Risk Management

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Using Theories, Models, and Frameworks to Inform Implementation Cycles of Computerized Clinical Decision Support Systems in Tertiary Health Care Settings: Scoping Review

Fernando,

Abell,

Tyack

et al. 2023

J Med Internet Res

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Background Computerized clinical decision support systems (CDSSs) are essential components of modern health system service delivery, particularly within acute care settings such as hospitals. Theories, models, and frameworks may assist in facilitating the implementation processes associated with CDSS innovation and its use within these care settings. These processes include context assessments to identify key determinants, implementation plans for adoption, promoting ongoing uptake, adherence, and long-term evaluation. However, there has been no prior review synthesizing the literature regarding the theories, models, and frameworks that have informed the implementation and adoption of CDSSs within hospitals. Objective This scoping review aims to identify the theory, model, and framework approaches that have been used to facilitate the implementation and adoption of CDSSs in tertiary health care settings, including hospitals. The rationales reported for selecting these approaches, including the limitations and strengths, are described. Methods A total of 5 electronic databases were searched (CINAHL via EBSCOhost, PubMed, Scopus, PsycINFO, and Embase) to identify studies that implemented or adopted a CDSS in a tertiary health care setting using an implementation theory, model, or framework. No date or language limits were applied. A narrative synthesis was conducted using full-text publications and abstracts. Implementation phases were classified according to the “Active Implementation Framework stages”: exploration (feasibility and organizational readiness), installation (organizational preparation), initial implementation (initiating implementation, ie, training), full implementation (sustainment), and nontranslational effectiveness studies. Results A total of 81 records (42 full text and 39 abstracts) were included. Full-text studies and abstracts are reported separately. For full-text studies, models (18/42, 43%), followed by determinants frameworks (14/42,33%), were most frequently used to guide adoption and evaluation strategies. Most studies (36/42, 86%) did not list the limitations associated with applying a specific theory, model, or framework. Conclusions Models and related quality improvement methods were most frequently used to inform CDSS adoption. Models were not typically combined with each other or with theory to inform full-cycle implementation strategies. The findings highlight a gap in the application of implementation methods including theories, models, and frameworks to facilitate full-cycle implementation strategies for hospital CDSSs.

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Letter to the Editor: A Quality Improvement Initiative for Pediatric Resident Education in Venous Thromboembolism Risk Assessment in Pediatric Patients

Cited by 2 publications

References 5 publications

Improving VTE prophylaxis adherence among hospitalized adolescents using Human-Centered Design

Improving VTE prophylaxis adherence among hospitalized adolescents using Human-Centered Design

Using Theories, Models, and Frameworks to Inform Implementation Cycles of Computerized Clinical Decision Support Systems in Tertiary Health Care Settings: Scoping Review

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