Implementation of eLearning solutions for patients with chronic pain conditions.

Background: Digital and mobile (mHealth) solutions are online or application-based services intended to support individuals with health needs. Despite evidence supporting the use of mHealth for patients with chronic pain, and the increasing desire of these types of solutions by both patients and providers, adoption of mHealth solutions remains limited. Implementation mapping can serve as a practical method to facilitate implementation and adoption of mHealth solutions within healthcare settings. Methods: Implementation mapping was used to develop implementation strategies based on contextual determinants organized within the Consolidated Framework for Implementation Research (CFIR) for mHealth eLearning solutions across an integrated, multi-site healthcare system. We describe our experience identifying stakeholders, delineating implementation facilitators and barriers, defining implementation outcomes using RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, outlining initial implementation strategies, and iterating on implementation strategies. Results: A total of 30 implementation strategies were identified and implemented. Over the first year, primary and specialty care providers across all the clinical sites (n = 70) placed 2559 orders for the mHealth solution. Most patients reported receiving the mHealth eLearning module (74%), and most patients felt that the tool improved their knowledge regarding their condition (82%) and their ability to provide self-care related to the condition (73%). Conclusion: Practical applications of implementation science methods can help enable change within healthcare settings. Implementation mapping is an exercise that can engage stakeholders to facilitate the incorporation of new methods of care delivery, including mHealth solutions.

Continuous Physiological Monitoring Improves Patient Outcomes.

BACKGROUND: General patient acuity is increasing in the United States, with more patients having multiple comorbidities and acute-on-chronic conditions. Hospitalizations may also be complicated by serious adverse events, often unrelated to the admitting medical diagnosis. In our facility, the late detection of patient deterioration on general medical units often resulted in increased length of stay (LOS) in the ICU and poor patient outcomes. PURPOSE: The purpose of this project was to improve patient surveillance and better identify early signs of patient deterioration through the use of continuous vital sign monitoring technology. METHODS: To improve detection of patient deterioration, a nurse-led monitoring and response system was developed using a wearable, wireless device for continuous vital sign surveillance. The patient data the device provided was used with early warning scores and sepsis screening protocols for timely goal-directed interventions. RESULTS: Ninety-seven percent of patient deterioration events were recognized and treated as a result of this continuous monitoring and response system. Rapid response team activations decreased by 53% between baseline and the intervention period. LOS among patients transferred to the ICU decreased from 2.82 to 2.19 days. Nurse satisfaction with use of the continuous monitoring device was positive, with 74% of nurses surveyed reporting that information provided by the device enhanced decision-making. CONCLUSIONS: New technology for patient surveillance, in this case a nurse-led monitoring and response system, can be successfully integrated into general care practice. Use of the nurse-led response system helped nurses recognize early signs of deterioration and continue meaningful patient interactions.

Minimizing human error in radiopharmaceutical preparation and administration via a bar code-enhanced nuclear pharmacy management system.

UNLABELLED: The objective of this project was to ensure correct radiopharmaceutical administration through the use of a bar code system that links patient and drug profiles with on-site information management systems. This new combined system would minimize the amount of manual human manipulation, which has proven to be a primary source of error. The most common reason for dosing errors is improper patient identification when a dose is obtained from the nuclear pharmacy or when a dose is administered. A standardized electronic transfer of information from radiopharmaceutical preparation to injection will further reduce the risk of misadministration. METHODS: Value stream maps showing the flow of the patient dose information, as well as potential points of human error, were developed. Next, a future-state map was created that included proposed corrections for the most common critical sites of error. Transitioning the current process to the future state will require solutions that address these sites. To optimize the future-state process, a bar code system that links the on-site radiology management system with the nuclear pharmacy management system was proposed. A bar-coded wristband connects the patient directly to the electronic information systems. RESULTS: The bar code-enhanced process linking the patient dose with the electronic information reduces the number of crucial points for human error and provides a framework to ensure that the prepared dose reaches the correct patient. Although the proposed flowchart is designed for a site with an in-house central nuclear pharmacy, much of the framework could be applied by nuclear medicine facilities using unit doses. CONCLUSION: An electronic connection between information management systems to allow the tracking of a radiopharmaceutical from preparation to administration can be a useful tool in preventing the mistakes that are an unfortunate reality for any facility.

Evaluation of compatibility and stability of filtered 99mTc-sulfur colloid when combined with fluorescent indocyanine green dye.

UNLABELLED: It is a common practice to administer dyes and radiopharmaceuticals separately for the localization of sentinel nodes in patients with biliary tract malignancies. The objective of this study was to evaluate the chemical properties and particle size of filtered (99m)Tc-sulfur colloid before and after it is combined with indocyanine green for injection. This study also evaluated the compatibility and stability of the two when combined, for the possibility of a single injection. METHODS: (99m)Tc-sulfur colloid was prepared according to the package insert, and the final preparation was passed through a sterile 0.2-µm filter. Green dye was also prepared as per the package insert. In a sterile syringe, 0.25 mL of 14.8-MBq (400-µCi) filtered (99m)Tc-sulfur colloid was mixed with 0.25 mL of 1.25-mg green dye in a 1:1 proportion for a total volume of 0.50 mL. The radiochemical purity and pH of filtered (99m)Tc-sulfur colloid were obtained immediately and at 1 and 2 h after preparation. Particle size was analyzed using an electron microscope immediately and at 2 h. RESULTS: The average radiochemical purity was 97.6% ± 2.0% (n = 51). The average pH was 5.56 ± 0.26 (n = 51). Evaluation of the particle size of filtered (99m)Tc-sulfur colloid with the green dye was determined by electron microscopy to be an average of 53 ± 30 nm (n = 365) at 0 h and 60 ± 35 nm (n = 303) at 2 h. This was compared with filtered (99m)Tc-sulfur colloid without the green dye, which averaged 71 ± 41 nm (n = 41). Measurements of unfiltered (99m)Tc-sulfur colloid were recorded at 253 ± 192 nm (n = 21) for additional comparisons. CONCLUSION: The chemical properties and particle size of filtered (99m)Tc-sulfur colloid were not affected by the addition of the green dye; thus, combination of filtered (99m)Tc-sulfur colloid and green dye in the same syringe for administration is suitable.

Stability evaluation of (18)F-FDG at high radioactive concentrations.

UNLABELLED: The objective of our study was to determine the concentration of ethanol, a known radiolytic stabilizer, needed to maintain stability for 12 h at an (18)F-FDG concentration of 19.7-22.6 GBq/mL (533-610 mCi/mL) at the end of synthesis (EOS). METHODS: (18)F(-) was formed by the (18)O(p, n)(18)F reaction using 16.5-MeV protons on a cyclotron. (18)F-FDG was synthesized using a synthesis platform. The final product was formulated in 15 mL of phosphate buffer. The synthesis took 22 min, delivering up to 336.7 GBq (9.1 Ci) of (18)F-FDG at the EOS. A series of 9 runs, 19.7-22.6 GBq/mL (533-610 mCi/mL), was completed. Three runs were doped with 0.1% ethanol, 3 with 0.2% ethanol, and 3 with no ethanol added. The radiochemical purity (RCP) was tested at about 1-h increments over a 12-h period. RCP was found by radio-thin-layer chromatography using aluminum-backed silica gel plates, acetonitrile, and water 90:10. An (18)F-FDG standard of 1 mg/mL was used to confirm radiochemical identity. The chromatography plates were analyzed on a radio-thin-layer chromatograph using a ß-detector. Residual solvents were also tested using gas chromatography with flame ionization detection and a capillary column. Other quality control measurements performed were pH and appearance. RESULTS: The 3 runs doped with 0.1% ethanol failed RCP after 5 h. The 3 runs using an ethanol concentration of 0.2% maintained stability through 12 h beyond the EOS. For these 3 runs, the radiolytic impurities were relatively constant at 6.1% ± 0.7% after 3 h. The runs using no ethanol failed RCP at 1 h. The pH varied between 5.3 and 6.1. Visual inspection was always clear and particulate-free. For the runs with 0.2% and 0.1% ethanol, the residual solvents were 0.21% ± 0.02% and 0.10% ± 0.02%, respectively. Regardless of ethanol concentration, chemical purity and identity passed quality control measurements. CONCLUSION: With the addition of 0.2% ethanol, (18)F-FDG (19.7-22.6 GBq/mL [533-610 mCi/mL]) kept stability through 12 h beyond the EOS. Each run passed stability parameters related to radiolysis-that is, radiochemical identity and RCP, chemical purity and identity, appearance, pH, and residual solvents.