Analyzing Apparent Causes of 30-Day Readmissions to Acute Care From Skilled Nursing Facilities.

This quality improvement project implemented a bidirectional apparent cause analysis of patients readmitted to 1 hospital from 8 skilled nursing facilities (SNFs). The purpose of the project was to receive input from both hospital and SNF nursing staff to critically examine the apparent causes of SNF readmissions from both settings and identify opportunities for improvement. Nurse-led measures to prevent readmissions can be found in 5 domains: improved collaboration, communication, coordination, clarification, and cause analysis.

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.

A Quality Improvement Project: Using the STOP-BANG Tool in a Military Population to Improve Equity in Preoperative Screening.

BACKGROUND: The lack of a preoperative screening tool to detect obstructive sleep apnea (OSA) may lead to an increase in postoperative complications. AIM: The aim of the study was to implement a prescreening tool to identify diagnosed or undiagnosed OSA before a surgical procedure. SETTING: The study was conducted in the surgical admission center and postanesthesia care unit at a military treatment facility in Hawaii. PARTICIPANTS: Participants of the study included military personnel, military family members, veterans, and veteran beneficiaries. METHODS: The STOP-BANG (snore/tired/obstruction/pressure-body mass index/age/neck/gender) tool was used between April and June 2013 to identify and stratify 1,625 patients into low-risk, intermediate-risk, high-risk, and known OSA categories. RESULTS: The STOP-BANG tool confirmed the diagnosed OSA rate to be 13.48%, and increased at-risk OSA detection by 24.69%. Hawaiians/Pacific Islanders were more frequently found to be at risk with known OSA, likely to have complications, and be transferred to PACU 23-hour extended stay compared to other races and intermediate-risk and high-risk categories. CONCLUSION: The STOP-BANG tool identified and stratified surgical patients at risk for OSA and standardized OSA assessments.

Postoperative Delirium Prevention in the Older Adult: An Evidence-Based Process Improvement Project.

Postoperative delirium is a major complication in hospitalized older adults. Implementation of a screening tool and evidence-based delirium-prevention protocol on a surgical unit increased nurses' knowledge regarding delirium, increased identification of delirium, and produced medical treatment alterations leading to positive patient outcomes.