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Publication The Individualized Multidisciplinary Immediate Fall Response Program(2021-07-20) Awotundun, Adenike YAbstract Falls are frequent in older residents in the United States. 800,000 falls occur yearly, one in three residents will fall again within a year (Agency for Healthcare Research and Quality [AHRQ], 2017). In Frey Village, about 25 falls occur monthly with annual fall-injuries of 1.9%. This project focused on the Individualized Multidisciplinary Immediate Fall Response Program (IMIFRP). PICOT Question: In the older adults in a long-term facility (P), does an implementation of the individualized multidisciplinary immediate fall response program (I), improve fall care processes, and reduce fall rate (O) within 2-months post-intervention (T), compared to 2-months pre-intervention (C)? Conceptual and Theoretical Model: The IHI Plan-Do-Study-Act cycle was the conceptual framework that directed IMIFRP. The Theory of Bureaucratic Caring reinforced the impacts of providing quality, ethical, legal, and compassionate care. Methods: This pre/post-design quality improvement project included residents in long-term units, ³ 65 years. The IMIFRP was initiated with each fall. Project outcomes: usage of the IMIFRP form ([TRIPS]— Tracking Record for Improving Patient Safety) for falls data documentation, number of falls and repeated falls. Data were analyzed, using descriptive statistics, and run chart. Result: Fall rate reduced from 41 falls pre-intervention to 30 falls during the intervention. 27% reduced fall rate, 90% compliance rate in utilization of the TRIPS form and creation of a fall management team. Conclusion: The IMIFRP was well supported by the stakeholders and the IMIFRP led to development of a multidisciplinary fall committee.Publication Pressure Injury Prevention in Cardiac Surgery Using Risk Factor Assessment and Standardization(2021-08-05) Madeira, Timothy HCardiac surgical patients are more susceptible to pressure injury (PI) than other surgical specialties, and little is known about PI prevention (PIP) in this population. How do PIP strategies, compared to standard care, affect the incidence of PI during the post-operative recovery among adult cardiac surgery patients? The aim was to reduce the incidence of UAPI in an adult CVSICU by 5% in six weeks. The conceptual framework chosen was The Iowa Model Revised, and the theoretical framework employed was the Theoretical Model for Lesion Development. Quality improvement, single-group pretest-posttest design. Sample consisted of 69 cardiac surgery, LVAD, ECMO patients at Johns Hopkins CVSICU. The intervention was a standardized PIP bundle provided to “highest risk” patients screened before surgery. Outcome measures were UAPI count and incidence rates. Process measures were percentage of patients screened, prophylactic sacral dressing, rental bed cost. Balancing measures were PI severity, anatomic location, and time between wounds. Baseline data consisted of historic data and intervention data consisted of weekly survey observations. Implementation consisted of staff education, daily preoperative screening, weekly wound rounds. 33% of patients screened as “highest risk” and received the PIP bundle. PI count decreased from 25 to 13 during implementation and wound stages improved. Chi Square test of 2-proportions showed a reduced PI incidence of 8.56% (Z=1.66, p= .048) and 2-sample Poisson rate showed significance in count (Z=1.95, p=.036). Location changed to nose, buttocks, and occipital locations. There was an overall cost savings of $78,660. Reducing PI lead to reduced morbidity and cost.Publication World Health Organizations Surgical Safety Checklist Project(2018-12-02) Lyons, AmberMedical error, especially in the operating room, claims the lives of patients and contributes to complications. A project was conducted to investigate the effectiveness of the World Health Organizations Surgical Safety Checklist. Communication, teamwork, and the readiness of use by the operating room team was measured. The project design was descriptive utilizing the Surgical Safety Checklist and a modified version of the Safety Attitudes Questionnaire Operating Room. Post-implementation responses to the Safety Attitudes Questionnaire Operating Room survey revealed a significant improvement in the surgical teams’ perception of teamwork and communication. Results show the World Health Organizations Surgical Safety Checklist improves teamwork and communication, and improves awareness of patient safety factors when consistently implemented before each operation.Publication Implementing and Evaluating a Sepsis Algorithm to Mitigate Acute Care Readmissions in an Inpatient Rehabilitation Facility(2020-12-28) Lockett, Michelle LBACKGROUND: Readmissions from post-acute care to acute care hospitals is well documented in the literature. Inadequate management of infection is a top readmission diagnosis and is often preventable. Nurse driven, protocolized treatment is the gold standard for treating sepsis patients in post and acute care settings. A quality improvement (QI) project was implemented in a 58-bed inpatient rehabilitation facility (IRF) to determine if a nurse-driven sepsis algorithm would decrease readmission rates to acute care hospitals, increase nursing staff sepsis knowledge, clinical confidence and communication. METHODS: This QI project was performed during a 3-month period in 2020. Readmission findings were compared before and after the study intervention implementation. Changes overtime in sepsis frequency were assessed through run charts. Pre- and post- survey data of sepsis knowledge, clinical confidence caring for a sepsis patient and care provider and clinician communication was assessed using a Wilcoxon Signed Rank Test. INTERVENTION: By utilizing the Systemic Inflammatory Response (SIRs) criteria, the Situation, Background, Assessment and Recommendation (SBAR) tool and Surviving Sepsis Campaign guidelines, a nurse driven sepsis algorithm was created and implemented in the rehabilitation facility. Additionally, pre-and post-surveys were administered to assess nurses’ knowledge of sepsis, clinical confidence in caring for a patient with suspected sepsis and bedside clinician to provider communication. RESULTS: Results show a decrease in readmissions to acute care hospitals post intervention but no statistically significant change in pre-post survey of sepsis knowledge, confidence or communication. CONCLUSIONS: An additional PDSA cycle of this QI project is needed to determine a true sepsis decrease overtime using the sepsis algorithm. A sepsis pre and post-test, and role play simulations may be key to a change in sepsis knowledge, confidence and communication. Keywords: inpatient rehabilitation facility, IRF, readmissions, sepsis, infection, surviving sepsis campaign, algorithmPublication Fall Prevention and Injury Reduction Utilizing Virtual Sitters in Hospitalized Patients(2020-12-08) Quigley, BethFalls and fall-related injuries occur far too often in hospitals every year. The goal of the quality improvement (QI) project reported here was to reduce the number of falls and fall injuries in hospitalized patients using virtual sitters and continuous video monitoring (CVM) cost effectively. Run charts portray data trends for fall rates and fall related injury rates at the inpatient care facility in two-week increments over a six-month period. Descriptive statistics were collected to characterize the sample and setting, and differentiate components of the falls, falls with injuries and related costs. The literature review noted positive outcomes regarding both cost savings and reduction in fall rates with the launch of virtual sitters. The QI project with the implementation of CVM with virtual sitters depicted a 14% decline in fall rates and a 6% decrease in fall-related injury rates with a cost savings to the hospital. Plans for expansion of the program were underway with integration into the electronic health record. As modalities such as CVM with virtual sitters are adopted by more institutions, additional at-risk patients will be monitored for fall prevention and additional uses continue to prevail. Fall prevention and injury reduction remain at the forefront of quality care, keeping patients safe.Publication Association of Clinical Timing with Self-Efficacy Among Student Registered Nurse Anesthetists(2021-05-01) Le Dang, Diana; Vacca, Kevin; Carrillo, EmilyObjectives: To uncover new findings on how best to implement education and training among students in nurse anesthesia programs. Design and Methods: The target participants are nurse anesthesia students currently enrolled in an accredited Doctor of Nursing Practice (DNP) program that met inclusion criteria. An online survey was distributed to measure self-efficacy using the 10-item Likert-style Schwarzer & Jerusalem General Self-Efficacy Scale. Participants were recruited from a convenience sample of 72 Council of Accreditation (COA) accredited nurse anesthesia programs. Contact was made with program leadership to obtain permission and facilitate the dissemination of the surveys. Inclusion criteria: enrolled in accredited DNP program, integrative or non-integrative curriculum as defined by the study and expected graduation date within 12 months. Sample size, n=847 senior nurse anesthesia students. Independent variable: curriculum structure (integrative or non-integrative). Dependent variable: composite score on General Self-Efficacy Scale, ranging from 10-40. Primary Results: Mean composite scores on the GSE survey were (33.37 ± 3.23) and (33.91 ± 3.52) for integrative and non-integrative programs, respectively. The mean composite score for participants in a non-integrative curriculum was 0.54 (95% CI, -1.69 to 0.60) higher than mean composite score for participants in an integrative curriculum. The independent samples t-test concludes that there was not a statistically significant difference in the mean composite scores between participants in an integrative and non-integrative curriculum t (138) = -0.940, p = 0.35, d= 3.40. Principle Conclusions: There is no statistically significant difference between the reported self-efficacy scores among students in both integrative and non-integrative curriculum.Publication An Electronic Alert to Reduce Postoperative Delirium in the Older Adult(2019-12-23) Warner, Vanessa; Fontanilla, Linda; Prendergast, CassieOlder adults frequently experience delirium after surgery, contributing to a decline in quality of life, increasing morbidity and mortality rates, and adding significant costs to the healthcare system. The Beers Criteria was developed by the American Geriatrics Society and lists medications correlated with a decline in cognition among older adults. These medications are commonly administered in the perioperative period by anesthesia practitioners. At a large university hospital, an educational video was distributed, followed by the launch of an electronic health record alert advising over 300 anesthesia practitioners to reduce dosing or omit Beers Criteria medications in patients aged 70 or older. The total administration and total mean dosage of Beers Criteria medications administered were measured across four study periods: pre-educational video/pre-alert, post-education/pre-alert, and at two post-education/post-alert time points in select surgeries. This quality improvement project demonstrated significant reduction in Beers Criteria medications administered to patients 70 years or older to reduce rates of cognitive decline.Publication The Advancment & Uptake of an Enhanced Recovery After Cardiac Surgery Protocol(2020-12-30) Eno-Jones, Allison Maclay; Gao, Vivian Yang; Reyes, YvetteLiberal opioid administration during surgery leads to increased intubation time, intensive care unit and hospital length of stay, opioid-related adverse events, and health care costs. Patients undergoing cardiac surgery with and without preoperative opioid exposure are at an increased risk for opioid use disorder postoperatively. An enhanced recovery after cardiac surgery protocol with opioid minimization strategies was implemented since 2015 at a Philadelphia teaching hospital, but the effect on patient outcomes has never been analyzed. This quality improvement project conducted a retrospective chart review to evaluate the uptake and advancement of the enhanced recovery after cardiac surgery protocol. Primary outcomes of interest included total opioid administration, time to extubation (TTE), and length of stay (LOS). Pain scores, postoperative complications and 30-day readmissions were investigated as secondary outcomes. The statistically significant results comparing outcomes from 2016 to 2019 with an ERACS protocol are consistent with results of current evidence demonstrating improvements in total opioid consumption (pPublication Decreasing Continuous 1:1 Observation of Patients Experiencing Delirium by Improving Nursing Knowledge(2020-12-15) Frankel, Sunne EAbstract BACKGROUND: Nursing leadership identified that Certified Nursing Assistants (CNAs) and Registered Nurses (RNs) on the Acute Care for Elders (ACE) unit lacked delirium knowledge. Patients were being placed on continuous 1:1 observation without proper delirium assessment which the CNO identified as an opportunity to improve resource utilization. METHODS: A quality improvement project was conducted on the ACE unit at Penn Presbyterian Medical Center (PPMC). The CNAs and RNs completed a delirium knowledge survey prior to and after viewing an evidence-based dynamic education module based on the Hospital Elder Life Program (HELP) protocols. Pre- and post-survey mean scores were compared. Continuous 1:1 observation utilization was analyzed two months prior to and two months post-implementation to determine if the education impacted continuous 1:1 observation utilization. RESULTS: 17 CNAs and 34 RNs completed the pre-survey. Mean pre-survey scores were: 11.76 (sd 1.92, range 7-15) for the CNAs and 13.5 (sd 2.11, range 9-17) for the RNs. Ten CNAs and 20 RNs completed the post-survey. The post-survey mean scores were: 13.5 (sd 2.68, range 9-16) for the CNAs and 14.7 (sd 1.76, range 11-18) for the RNs. Bi-weekly continuous 1:1 utilization decreased from 5.0 to 3.4 after implementation of the evidence-based dynamic education module. CONCLUSION: Evidence based education on delirium prevention, identification, and interventions using the HELP protocols can improve CNA and RN knowledge and help reduce the financial strain on the health system by decreasing continuous 1:1 observation utilization.Publication Airway Fire Prevention in the Operating Room(2020-12-07) Patel, Dipika; Smith, Kendall; Woodmansee, ScottAirway fires during surgical procedures are preventable events that result in devastating outcomes for patients, healthcare providers, and healthcare facilities. Minimization of the risk of fires is a subsection of Standard 6 of the American Association of Nurse Anesthetists’ Standards for Nurse Anesthesia Practice. A central priority of operating room fire mitigation is the minimized use of oxidizing agents. Oxygen is one component of the fire triad responsible for increasing the likelihood of these events, which is controlled by anesthesia providers in the operating room. The primary aim of this quality improvement project was to increase anesthesia provider knowledge pertaining to airway fire risk mitigation strategies through the implementation of an evidenced-based educational intervention. The secondary aim of this quality improvement project was to demonstrate a quantitative reduction of airway fire risk through a comparison of pre-intervention and post-intervention supplemental oxygen administration levels during surgical procedures. The overall goal of this project was to highlight the value of optimized provider knowledge regarding airway fire risk mitigation techniques, especially among high-risk airway fire procedures.