Evidence-based interventions cause multifold increase of influenza immunization rates in a free clinic.

BACKGROUND: Every year in the United States, influenza-related infection causes thousands of deaths, the complications of which require millions of dollars in hospital-related care. The influenza vaccine is proven to effectively reduce incidence of infection and complications from influenza viruses. LOCAL PROBLEM: A clinic in southeast Florida for the uninsured offered influenza immunization at no cost to its patients, yet the immunization rate was still low. METHODS: A quality improvement project was conducted to determine whether the use of evidenced-based bundled interventions would increase the rate of the influenza vaccination at the clinic. INTERVENTIONS: The bundled interventions included mass communication, leadership, improved work flow, and improved access. RESULTS: Evidence-based interventions led to a 597% increase in the influenza uptake rate. Trends were analyzed by using data gathered from the electronic medical record regarding patient demographics, influenza immunization uptake rate, type of visit for the immunizations, and reason for declining. Overcoming the access barrier led to great improvements in this clinic. Initially more vaccines were given in nurse visits; as the season progressed, more vaccines were given by providers in the clinic. Common reasons for patient refusal of the vaccine were fear of side effects and fear of contracting the influenza virus. Streamlined documentation could promote continued staff compliance over time. CONCLUSIONS: To reduce influenza-related costs and improve health outcomes, it is imperative that nurse practitioners use evidence-based interventions in the practice setting to increase influenza uptake rates in the adult uninsured population.

Decreasing Incontinence-Associated Dermatitis in the Surgical Intensive Care Unit: A Quality Improvement Project.

PURPOSE: The purpose of this quality improvement (QI) project was to determine if use of an algorithm focusing on skin care in patients with fecal and urinary incontinence reduces the rate of hospital-acquired incontinence-associated dermatitis (IAD) over a period of 4 months. PARTICIPANTS AND SETTING: The QI setting was an 18-bed surgical intensive care unit (SICU) in an acute care urban hospital located in the southeastern United States. Two hundred eleven patients participated in this pre/postintervention QI project. APPROACH: The algorithm for skin care used evidence-based bundled interventions for patients with fecal and urinary incontinence. The project comprised education of the SICU nursing staff in January 2018 and implementation of the algorithm from February 5, 2018, to June 5, 2018. Weekly chart reviews were conducted to determine algorithm compliance, documentation of fecal and urinary incontinence, and accuracy of IAD documentation. Descriptive statistics were used to determine the rate of hospital-acquired IAD, algorithm compliance, and average length of time from admission to the onset of hospital-acquired IAD. OUTCOMES: Seventy-nine individuals with incontinence were included in the 3-month preintervention period and 132 individuals with incontinence in the 3-month postintervention period. We observed a 24% reduction in the rate of hospital-acquired IAD following implementation of the algorithm (29% vs 5%). The average length of time from admission to the onset of hospital-acquired IAD increased from 15 days in February 2018 to 25 days in May 2018. IMPLICATIONS FOR PRACTICE: Our experience with this QI project suggest that IAD can be identified and managed at the bedside by first clinical nursing staff without expertise in skin assessment and wound care.

Increasing Follow-Up Rates at a Free Clinic.

This project aimed to increase the follow-up visit rates at a free medical clinic and evaluate the effects of SMS messaging on follow-up adherence, regardless of whether patients scheduled their follow-up appointments prior to leaving the clinic or if they received paper reminder cards. The use of the SMS application increased overall follow-up rate by 7%. This project supports that patients who received reminder messages via the SMS application kept their follow-up appointments consistently.

Increase Adherence to Psychotropic Medication Through Motivational Adherence Therapy: A Quality Improvement Project.

BACKGROUND: Non-adherence to psychiatric mediations is a nationwide problem for people diagnosed with severe mental illness (SMI). National non-adherence rates for psychotropic medications are estimated to range from 50% to as high as 75%. The project site data is reflective of the national data. AIMS: The aim of this manuscript is to report the impact of Motivational Interviewing Style Adherence Therapy (MISAT) on adherence to psychotropic medication in veterans living with SMI. METHOD: Implementation of evidence-based MISAT through a quality improvement project in a Veterans Affairs Mental Health Clinic. RESULTS: MISAT was found to be clinically significant in improving adherence to psychotropic medication. Average refill history for participants increased from 82% to 85%. MISAT also unified how non-adherence to psychotropic is addressed by mental health providers. DISCUSSION: MISAT should be considered in other settings where patients diagnosed with SMI are faced with non-adherence to psychotropic medication, but the sessions' format should be structured to fit the patients' needs.

Primary care management of ulcerative colitis.

Ulcerative colitis (UC) is an inflammatory bowel disease marked by mucosal inflammation. UC has an impact on quality of life and places a financial burden on the healthcare system. This article focuses on the impact, presentation, diagnosis and classification, systemic manifestations, complications, management, and treatment associated with UC.

Home Therapy to Reduce Office Visits for Patients with Chronic Kidney Disease and Anemia.

Anemia is a common complication of chronic kidney disease (CKD) and a predictor of increased mortality. This project integrated erythropoietin-stimulating agent (ESA) with CKD care under one practice setting, co-managing anemia with CKD while reducing frequency of office visits in a rural setting. Patients self-administered their weekly dosage of erythropoietin with monthly follow-ups. As a result, office visits decreased by 56% for patients with CKD Stage 4 and by 54% for patients with CKD Stage 5.

Identification and Management of Obese Patients in a Pediatric Orthopaedic Clinic.

BACKGROUND: Childhood obesity is a complex healthcare problem that affects all aspects of a child's health. The American Academy of Pediatrics and the Expert Committee recommends that all children be evaluated for current medical conditions including the risk for obesity by identifying elevated body mass index (BMI), physical activity habits, and diet. Childhood obesity is defined as a BMI of 95th percentile or greater on standardized age-based growth charts. Abdominal and visceral fat mass has a negative effect on bone formation during childhood and adolescence. Effective interventions are aimed at prevention and treatment and include collection and assessment of obesity, eating habits, physical activity, and family history. At a local outpatient pediatric orthopaedic practice, few patients had a diagnosis of childhood obesity and weight management varied by providers. PURPOSE: The purpose of this quality improvement project was to improve identification of obese children and increase referrals to a weight management program. METHODS: Setting: A hospital-affiliated pediatric orthopaedic clinic staffed with 3 orthopaedic surgeons and 2 nurse practitioners. POPULATION: 6- to 18-year-olds with a BMI of greater than 95th percentile (N = 239). DATA COLLECTION: Electronic medical record chart review for documented obesity and referral to weight management program: Intervention: Provider educational in-service reviewing management guidelines and referral process. RESULTS: Average percentages of documented obesity diagnosis increased from 11% to 53%. The number of referrals to Heart Healthy weight management program increased by 400%. CONCLUSION: An educational-based intervention in a pediatric orthopaedic clinic was effective in increasing the number of patients with a diagnosis of obesity and referred to a weight management program.

Integrating a Question Prompt List on an Inpatient Oncology Unit to Increase Prognostic Awareness.

BACKGROUND: Many patients with incurable cancer do not accurately understand their prognosis, which can lead to aggressive and, often, futile treatment. Improved prognostic awareness can help patients to appropriately de-escalate aggressive treatment sooner in an illness trajectory. OBJECTIVES: The purpose of this article is to introduce a patient-initiated discussion aid (question prompt list) on an oncology unit to increase prognostic awareness by promoting patient-provider dialogue, which could lead to limitation of life-sustaining treatments at the end of life and increased do-not-resuscitate (DNR) orders and hospice referrals. METHODS: Medical records of consecutively admitted patients with a solid malignancy who were urgently admitted to the inpatient setting were reviewed for three months to determine the percentage of DNR orders and referrals to hospice care. After inclusion of the communication aid in admission packets, records of consecutively admitted patients to the inpatient setting were reviewed for three months to reassess the percentage of DNR orders and referrals to hospice care. FINDINGS: An increase was seen in the percentage of patients with active DNR orders and in hospice referrals after a discussion aid was included in admission packets.

Improving Follow-Up for Failed Newborn Hearing Screening in Emirati Infants.

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

Implementing a Pediatric Fall Prevention Policy and Program.

Preventing patient falls begins with an accurate assessment of a patient's risk of falling followed by the initiation and continued evaluation of a fall prevention program based on patient-specific identified risks. Children have a normal tendency to fall based on developmental growth, and each child is different in physical and cognitive abilities. Falls may occur both in and out of the hospital setting. Prevention programs that have revealed the most favorable restuls include the use of a validated fall risk assessment tool. The Humpty Dumpty fall Scale is a screening tool specifically developed for pediatric patients to assess risk for fall. This project developed a pediatric fall prevention policy and implemented an inpatient pediatric fall prevention program. Pediatric staff contributed to the development of this policy and program by providing feedback, support, and cooperation, which was instrumental in the success of this program resulting in no falls after implementation.

Primary care management of celiac disease.

: Celiac disease is an autoimmune disorder with genetic predisposition that affects as many as 1 in 100 individuals. Treatment is a lifelong, strict adherence to a gluten-free diet. Management by a primary care provider may lead to increased adherence and can minimize effects of nonadherence to the diet.