Trauma Center Transition From Paper to Electronic Quality Improvement: Enhancing Trauma Performance Efficiency.

BACKGROUND: The American College of Surgeons requires continuous process improvement review to maintain trauma center verification. Paper-based systems to monitor and track performance improvement are commonly used but can be inadequate to monitor concurrent ongoing improvement effectively. OBJECTIVE: To describe the implementation of an electronic process to capture and monitor performance improvement in near real time. METHODS: In 2020, a Midwestern U.S. Level I adult trauma center and a Level II pediatric trauma center's trauma programs transitioned from a paper to an electronic file-sharing system for performance improvement. We converted our primary, secondary, and tertiary review documentation into a single electronic performance improvement file stored on the institution's virtual hard drive, accessible to designated staff, allowing continuous real-time updates. RESULTS: The electronic file-sharing and monitoring process reinvigorated the team and enhanced performance improvement efforts, leading to increased efficiency through documentation and effective loop closure. Real-time monitoring allowed the trauma program to identify opportunities for improvement and enact timely action plans, including targeted performance improvement projects, department education, and ongoing training. CONCLUSION: We found that implementing an electronic file-sharing system enhanced the trauma team's ability to monitor and trend performance improvement in real time.

Nurses' Ability to Recognize and Prevent Opioid-Induced Respiratory Depression: An Evidenced-Based Practice Project.

Opioids are the primary therapy for acute postoperative pain, despite being associated with opioid-induced respiratory depression (OIRD). The purpose of this study was to improve nurses' knowledge, confidence, and ability to recognize, prevent, and treat OIRD in postoperative inpatients and evaluate the feasibility of using the Pasero Opioid-Induced Sedation Scale (POSS). Registered nurses completed three tools: (1) an Opioid Knowledge Self-Assessment, which was administered pre- and post-education; (2) a Confidence Scale, which was administered pre- and post-education; and (3) a POSS Perceptions and Usability Scale that was administered post-education. Nurses were educated on the POSS and then immediately following the training practiced by undertaking a patient assessment using the instrument. They then completed the POSS Perceptions and Usability Scale to rate their perception of the feasibility of using the POSS. Between preeducation and posteducation, participant knowledge increased in the following areas: recognizing opioid-induced side effects, dose selection, risk factors for oversedation, and information to make clinical decisions. However, there was a drop in scores when asked about knowledge of who is at risk for opioid-related side effects. These findings support our conclusion that OIRD education improves nursing confidence and knowledge. There was significant agreement between the nurse and subject matter experts POSS scores, indicating that this tool is easy to use.