Implementing screening for social determinants of health using the Core 5 screening tool.

Social determinants of health (SDOH) have been documented to underpin 80% of overall health and are being increasingly recognised as key factors in addressing tertiary health outcomes. Yet, despite the widespread acceptance of the association of SDOH with health outcomes, more than two-thirds of hospitals do not screen for social risk factors that indicate individual-level adverse SDOH. Such screening for social risk factors represents the first step in connecting patients with resources and documents the prevalence of social needs. The aim of this project was to implement the Core 5 social risk screening tool and evaluate its efficacy and usability in identifying social risk factors in a presurgical spine population. Prior to this implementation, screening for social risk had not been performed. The Model for Improvement provided a framework for implementing and evaluating the Core 5 social risk screening tool. Methods included implementation of a patient self-report social risk screening tool, referral workflow to connect patients with needed resources and evaluation of staff feasibility in using the Core 5 tool. The results indicated that the screening tool identified patients with social risk factors and staff reported perceptions of efficacy and usability in clinical workflow. Overall, 52 of 88 (59%) of subjects in the presurgical spine population were effectively screened. Of these, five patients (10%) had identified social needs that needed to be addressed prior to surgery. The staff usability survey for the Core 5 tool demonstrated high acceptance and usability, with an average score of 4.4 (out of 5). Future work should evaluate the efficacy of the screening tool in other ambulatory and tertiary settings.

Implementation of a Perinatal Depression Care Bundle in a Nurse-Managed Midwifery Practice.

OBJECTIVE: To implement a perinatal depression care bundle at a midwifery practice to help certified nurse-midwives (CNMs) educate women about perinatal depression and direct those affected to mental health services. DESIGN: Quality improvement project to implement a perinatal depression care bundle for care of pregnant women between 24 and 29 weeks gestation. SETTING/LOCAL PROBLEM: CNMs practicing in a nurse-managed midwifery practice systematically screen all women for perinatal depression during pregnancy and the postpartum period but do not have a consistent method of providing anticipatory guidance about perinatal depression. PARTICIPANTS: All CNMs in the midwifery practice providing prenatal care (n = 16) participated in implementation. INTERVENTION/MEASUREMENTS: The perinatal depression care bundle included three elements: (a) an educational handout; (b) a brief, provider-initiated discussion about perinatal depression; and (c) lists of local and online mental health resources. Four weeks after the care bundle was implemented, we conducted a retrospective chart review to assess CNMs' adherence to the new bundle. RESULTS: Over 4 weeks, 51 prenatal visits met eligibility criteria for participation. CNMs implemented the perinatal depression care bundle for 22 (43.1%) eligible visits. CNM feedback indicated that the care bundle was brief, easy to incorporate into routine care, and well received by women. CONCLUSION: This project incorporated the use of a perinatal depression care bundle for women seen during routine prenatal care. Using a systematic approach to deliver perinatal depression education and resources reduces process variability and may destigmatize the illness, allowing women to feel empowered to seek help before depression symptoms become severe.

Translation of Evidence-Based Practice: Quality Improvement and Patient Safety.

Using knowledge gained from the disciplines of nursing, medicine, health care management, and medical and health services research, the quality improvement movement attempts to mobilize people within the health care system to work together in a systematic way using evidence based strategies and tactics to improve the care they provide. In this valuable work, discipline-specific knowledge is combined with experiential learning and discovery to make improvements. Quality improvement provides a knowledge-based framework and methods for the change agent to work toward a more predictable, effective, efficient, reliable, equitable, patient-centered care health care system.

Reducing Pressure Injuries in the Pediatric Intensive Care Unit.

This quality improvement project used the Model for Improvement including the Plan-Do-Study-Act cycle of change framework to educate pediatric intensive care unit (PICU) nurses on risk factors for pediatric pressure injuries and prevention strategies, improve turning compliance for PICU patients, and implement an electronic trigger to order nutrition consultations on all patients with a Braden Q score less than 16. The quality improvement project decreased preventable patient harm to PICU patients by decreasing the pressure injury incidence rate from 8% to 3% in the 6-week time period.

Barriers to the Implementation of Pediatric Overweight and Obesity Guidelines in a School-Based Health Center.

This project applied a quality improvement design to assess perceived barriers to pediatric overweight and obesity guideline implementation in school-based health centers. An electronic survey was administered to nurse practitioners and licensed practical nurses working in school-based health centers in New York. The most commonly cited primary care-based barriers were lack of patient compliance, family lifestyle, and the poor dietary practices and sedentary behaviors common in America. The most commonly cited school-based barriers were that children have little control over the groceries purchased and foods cooked at home and the lack of parent presence during appointments.

Chart It to Stop It: Failure Modes and Effect Analysis for the Reporting of Workplace Aggression.

The purpose of this quality improvement study was to describe the process for workplace aggression (WPA) reporting and the potential failures for this process in a pediatric emergency department. Interviews were conducted with 10 interdisciplinary employees. Findings yielded 7 tasks following WPA: contact security, contact police, contact clinical manager, notify emergency department director, call safety hotline, complete electronic safety form, and complete paper safety form. Focusing actions to prevent failure modes and causes for (1) notification of the emergency department director and (2) completion of an electronic safety form can garner the greatest improvement in overall risk for WPA reporting.

The Application of the Toyota Production System LEAN 5S Methodology in the Operating Room Setting.

The purpose of the Toyota Production System (TPS) Lean 5S methodology project is to improve the efficiency and effectiveness in a process by eliminating identified process waste of (1) defects (errors), (2) overproduction, (3) waiting, (4) confusion, (5) motion/travel, (6) excess inventory, (7) overprocessing, and (8) human potential. The specific aim of this quality improvement project was to evaluate the impact of the TPS 5S tool process, a problem-solving, space-organizing tool, on distractions and interruptions in the neurosurgery operating room (OR) workflow with a goal to decrease neurosurgery craniotomy infection rates in a neurosurgery OR suite within a 3-month period.

Implementation of a Nurse-Driven CAUTI Prevention Algorithm.

The cardiovascular thoracic step-down unit of an urban academic medical center had 4 catheter-associated urinary tract infections (CAUTIs) in 2 months compared with 5 in the previous year. The nursing literature showed that the implementation of nurse-driven algorithms for early removal of indwelling urinary catheters (IUCs) decreased the catheter days and risk of CAUTIs. Using the Model for Improvement, the nurse leader performed daily IUC rounds to enforce the removal algorithm and visual management tools to identify IUC removal barriers. The quality improvement project resulted in fewer catheter days, the implementation of evidence-based practice, and no new CAUTIs.

Evaluation of Telemetry Utilization on Medical-Surgical Units.

Alarm fatigue is the most common contributing factor in alarm-related sentinel events. Researchers have demonstrated a 35% overuse of telemetry, a key factor in alarm fatigue. This project evaluates practice patterns for the ordering and discontinuation of telemetry on medical-surgical units. Practice patterns were reviewed to determine if they aligned with the American Heart Association evidence-based practice guidelines for telemetry monitoring and whether the order indication was congruent with the patient's clinical status. Nurse's attitudes and practices related to alarm safety were evaluated.

Chart It to Stop It: A Quality Improvement Study to Increase the Reporting of Workplace Aggression.

A multicomponent intervention was attempted in a pediatric emergency department to increase reporting of workplace aggression committed by patients and visitors. Overall reporting decreased from 53% to 47% (P = .06). Reasons for reporting were severity of incident and being asked to report. Reasons for not reporting were incidents being too minor and no action would be taken. Future change efforts need to consider multiple modes of communication to promote adoption of reporting and inclusion of administrators in efforts to improve reporting.