Simulation to Support Standardization of Delivery Room Management of the Very Low Birth-Weight Infant.

BACKGROUND: The birth of a very low birth-weight (VLBW) infant occurs infrequently, especially in the community hospital setting. It is critical that the team managing care of the infant in its first minutes of life follow evidence-based resuscitation guidelines and practices to optimize outcomes for this population. PURPOSE: To implement a simulation program in a community hospital setting that supports standardized evidence-based delivery room practices of the premature infant born less than 30 weeks' gestation. METHODS: Two VLBW emergent delivery scenarios were developed utilizing the neonatal resuscitation program scenario template. Special care nursery interprofessional team members from a community hospital were invited to participate in the simulation program (n = 28). Participants were asked to complete a neonatal version of the Emergency Response Confidence Tool, then view a short presentation related to delivery room management of VLBW infants. Participants attended a simulation program and completed the confidence tool after simulation. The simulation facilitator and unit educator documented team actions during each simulation session. FINDINGS/RESULTS: Fifteen opportunities for improvement within 4 simulation sessions were identified and categorized. Fourteen paired pre- and postsurveys were analyzed. Reported confidence increased in 22 of 23 resuscitation-related items. IMPLICATIONS FOR PRACTICE: Education and simulation programs providing opportunities to experience high-risk, low-frequency VLBW delivery situations can assist in identifying areas for improvement and may improve team member confidence. IMPLICATIONS FOR RESEARCH: Additional research is needed to assess whether results would be similar if this program were provided at all levels of neonatal care throughout the healthcare system.

Closing the Loop on Electronic Referrals: A Quality Improvement Initiative Using the Care Coordination Model.

Primary care providers refer nearly one-third of their patients to specialty care services. Despite provider recommendations, approximately 1 in 4 referrals are never completed. Incomplete referral rates are higher among vulnerable and medically underserved individuals. Sixty-seven percent of federally qualified community health centers report difficulty obtaining specialty care appointments and incomplete referral rates as high as 73%. Effective electronic referral processes can improve health outcomes, reduce waste, and mitigate risks. Using the Care Coordination Model as its framework, this quality improvement initiative implemented evidence-based interventions aimed at improving patient support and organizational accountability for electronic referrals.

Empowered to Serve: Implementing Community Stroke Outreach Using Peer Educators to Improve Readiness to Act Among Local Community Members.

The purpose of this project was to develop a community-based volunteer group of peer educators to provide stroke education to local residents aimed at increasing stroke awareness and action readiness using the American Heart Association and American Stroke Association's "Empowered to Serve" evidence-based curriculum. The "Don't Miss a Stroke" module addresses the recognition of stroke warning signs, actions to take during a stroke, and stroke prevention. A total of 16 volunteers were recruited and subsequently trained. Six volunteers organized community events during the initial 3 months of the project, reaching more than 300 community members. Most participants (84.9%) identified as female, with a mean age of 63 years. Analysis of variance revealed significant improvements in knowledge regarding stroke immediately after the class, which was present 1 month later (F2,144 = 4.832, P = .009). This approach to raising community awareness about stroke emergencies was effective and did not require significant financial investment. Easy access to the curriculum and availability of free printed materials minimized the overall program costs and enhanced the quality of the educational content.

Educating Nurses to Screen and Intervene for Intimate Partner Violence During Pregnancy.

Intimate partner violence (IPV) is a problem affecting women and families across the nation, and it has been associated with adverse pregnancy and birth outcomes. Here we describe how our team implemented an evidence-based protocol for the screening of pregnant women for IPV and case management for those experiencing violence. This protocol was implemented on an antepartum triage unit where nurses were educated on IPV, methods for screening pregnant women, and a brief intervention. Education included an online module and a live session with role-playing exercises. Test scores indicated a significant increase in nurses' knowledge after completion of the module, and the overall educational program was rated as excellent by program participants. As part of the project, the Abuse Assessment Screen and the Danger Assessment-5-two instruments with predictive validity-were incorporated into the electronic health record.

NAP SACC: Implementation of an Obesity Prevention Intervention in an American Indian Head Start Program.

Low-income American Indian preschoolers are at greatest risk for overweight and obesity among children aged 2-5 years. The Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program is an evidence-based intervention that promotes healthy weight development for children enrolled in child care centers. The goal of this continuous quality improvement program is for the child care staff to establish environmental policies and practices that positively influence nutrition and physical activity-related behaviors. A community needs assessment of a Head Start program on an American Indian reservation identified obesity as a priority issue. This project implemented NAP SACC at 15 Head Start sites on the reservation.

Be wise: implementing a lifestyle intervention to reduce stroke risk in low-income midlife women.

Stroke is a leading cause of death for women, and midlife, low-income women are unlikely to appreciate their risk for stroke. The Well-Integrated Screening and Evaluation for Women Across the Nation program, administered by the Centers for Disease Control and Prevention Division for Heart Disease and Stroke Prevention, was developed for this population. The program offers screenings, referrals, and evidence-based lifestyle interventions targeting poor nutrition and physical inactivity. The goal of "Be Wise," the evidence-based lifestyle intervention developed for the Illinois Well-Integrated Screening and Evaluation for Women Across the Nation program, is for midlife women to develop healthier diet and physical-activity-related behaviors and, as a result, reduce their risk for heart disease and stroke. The goal of this project was to implement "Be Wise" at a federally funded community health center serving a primarily Hispanic population. The project's director, a stroke program coordinator and clinical nurse specialist, for the area's advanced primary stroke center collaborated with the community health center's medical staff and registered dietitian in delivering the program.

Meeting the needs of a community: teaching evidence-based youth violence prevention initiatives to members of strategic communities.

Youth violence is among the most serious health threats in the nation today. Violence disproportionately affects young people and people of color. Although the national rates of violent injury and homicide have shown a decline in most regions of the United States over the past 15 years, the rates of violence and related injuries among youth remain unacceptably high. The prevention of youth violence has been a priority of health departments nationwide, including the Cook County Department of Public Health. The goal of this project was to provide key community leaders, social service workers, and nurses within suburban Cook County with educational sessions on Blueprints for Violence Prevention, an initiative to promote evidence-based youth violence prevention programs.

Cuidate: implementation of a culturally based sexual risk reduction program for Hispanic adolescents.

Birth rates for adolescents have been declining in the United States since 1991 for all races. However, the rate for Hispanic teens still remains significantly higher than those for White teens. The Centers for Disease Control and Prevention (CDC) recommends that community-based organizations implement evidence-based programs to address the risky sexual behaviors of adolescents. Cuidate is an evidence-based sexual risk reduction program designed specifically for Hispanic adolescents ages 13-18 years. The program uses Hispanic cultural beliefs to influence the use of abstinence and condoms as culturally accepted practices. The purpose of this article is to describe the implementation of Cuidate at a federally funded community health center to reduce the sexual risk behaviors of the adolescent Hispanic population it serves.