• Implementation of a Perinatal Dental Screening Tool in an Obstetric Practice

      Spencer, Michelle; Idzik, Shannon (2019-05)
      Background Oral health is an important aspect of overall health and should be maintained during pregnancy. Due to complex physiological changes during pregnancy, the pregnant woman is at risk for developing periodontal disease and dental caries. This is associated with poor birth outcomes including pre-term births and low birth weight infants. Evidence-based guidelines developed by several professional organizations indicate that oral screening should be included in the first prenatal visit. Local Problem Pregnant women enrolled in Medicaid have dental coverage during pregnancy. Despite this, only 27% of these women utilized their dental benefits. The purpose of this quality improvement project was to implement a dental screening tool at an obstetrical practice. The screening tool was used to identify pregnant women with oral health needs and provide subsequent referral to a dentist. Interventions Implementation occurred over fourteen weeks. The screening tool included three maternal oral screening (MOS) questions. The first question was to determine if the patient had a dental cleaning in past twelve months and the other two questions were about dental concerns, pain and bleeding gums. The purpose of the screening was to identify oral health needs and refer to dental provider as appropriate. Patients from all practice locations were screened and received a referral to an existing dental home or one covered by their insurance. Results A total of 826 pregnant women were screened. Of all the pregnant women screened 36.3% (n= 300) had not had their teeth cleaned in the past twelve months. Greater than 30% of pregnant women (n=316) reported some type of dental problem, 244 (29.5%) were screened during the first prenatal visit, and 36.7% (n=303) were enrolled in Medicaid. At the completion of the implementation, the number of dental referrals issued was 616 (74.6%). Conclusion Conducting oral health screenings during the prenatal visit is important for identifying pregnant women at risk for oral health problems and improving birth outcomes. Performing the screening at the first prenatal visit allows the woman time to visit the dentist prior to delivery. Integration of an oral health screening and referral process can be successfully implemented to meet the needs of the pregnant population.
    • Implementation of a Ventilator Associated Pneumonia Prevention Bundle in the Emergency Department

      Schulz, Cory; Idzik, Shannon (2019-05)
      Background Despite the ability to save lives, mechanical ventilation places patients at an increased risk for adverse events; specifically, ventilator associated pneumonia (VAP). VAP is associated with increased duration of mechanical ventilation, hospital and intensive care unit (ICU) length of stay, hospital costs, and mortality risk. Implementing guideline directed VAP prevention bundles has been shown to reduce hospital VAP rates. Local Problem One specific population at risk for VAP are mechanically ventilated patients in the Emergency Department (ED). Since the risk for VAP begins at the time of intubation, and patients can spend many hours in the ED waiting for bed availability, there is utility in implementing a VAP prevention bundle in this setting. Interventions The purpose of this quality improvement project was to develop, integrate, and evaluate a VAP prevention bundle in the ED at a suburban community hospital system. The long-term goal was to decrease VAP rates in mechanically ventilated patients admitted from the ED. The short-term goal was to have a 100% compliance rate with the bundle during the sixweek implementation period. The bundle was developed based on the recommendations from the Institute for Healthcare Improvement. Then, with help from a multidisciplinary team, it was incorporated into an order-set that was available in the clinical information system. The ED staff was educated during weeks one to four. The order-set was then made available at the beginning of week four and monitoring of compliance occurred from week four to week ten. Results For education, 133 out of 142 ED nurses completed the assigned online learning module (82.1%) and 45 nurses attended the in-services hosted by the project leaders (31.2%). Eleven of the 23 ED physicians attended a formal presentation by the project leader at their departmental meeting (47.8%). During the six weeks following the order-set integration, 16 patients were recorded as being intubated, of which five were excluded because they were terminally extubated in the ED. A total of 11 patient encounters were analyzed for compliance. Sixty-four percent of the patients received all three components of the VAP prevention bundle, 90% for HOB, 64% for CHG mouth care, and 80% for oral care every two hours. There were multiple contextual barriers and limitations to implementation that could have affected the results. These included a high patient census and acuity during project implementation, a cyber-security breach, an accrediting body hospital survey, the annual hospital-wide nursing competency evaluations, a documentation related malfunction, and the process for nurses to obtain the CHG oral solution. Conclusions This quality improvement project demonstrates the feasibility of implementing a ventilator bundle in the ED. The limitations and barriers encountered during this project are a reflection of the challenges associated with translating evidence into practice. There is a need for similar projects in the future and research regarding implementation science in general.
    • Implementation of an Oral Health Program in a Prenatal Practice Setting

      Gorschboth, Susan; Idzik, Shannon (2019-05)
      Background Untreated periodontal disease during pregnancy can contribute to adverse health outcomes involving both oral health and pregnancy. Medicaid has offered full dental benefits in its coverage to pregnant women, but there has been a steady decrease in usage with only 26.8% of women enrolled utilizing this benefit. An oral health program that includes screening and referrals, and partnering with a Medicaid accepting dental provider addresses the barriers that pregnant women with Medicaid benefits encounter. Local Problem Prenatal practices have expressed difficulty addressing the oral health care needs of their Medicaid patients. The purpose of this quality improvement project was to implement a dental screening and referral program that would link Medicaid recipients within a prenatal practice to a clinic for oral health care. Interventions The structure of the program was based on the Oral Health Delivery Framework, and implementation occurred over fourteen weeks. The screenings consisted of a three-question selfassessment of dental concerns and one question determining if the patient had seen a dentist within the past twelve months. The purpose of the screenings was to assess the acuity of the dental needs and the level of urgency needed for the referral. All patients screened were then referred for dental care to a local Medicaid dental clinic. A pre-printed dental referral form was used to specify safe medical and dental treatments during pregnancy. Results All patients screened were referred to the clinic resulting in a 100% referral rate. The goals of having a patient’s first appointments scheduled within three weeks of the date of referral (mean time was 3.2 weeks) and subsequently, having treatment plans established within three weeks were not met. Only 7.5% of the women screened had seen a dentist within the past twelve months. The disease burden was found to be high when 70% of those screened had at least one dental concern, and 88.9% of the patients required more than just oral prophylaxis at their dental visit as a treatment plan needed to be established. Conclusion Prenatal practices are an optimal location for assisting women with Medicaid benefits to access dental care early in pregnancy. Prior identification of a Medicaid dental clinic was a critical component to the program’s success. The screenings provided the opportunity to determine the urgency of the referral. Using a dental referral form was beneficial to communicate safe treatments to the dental provider. Establishing the first scheduled appointment within three weeks of being referred to the dental clinic was the most significant barrier encountered. Expanding this program to include additional providers would potentially address this barrier and assist with increasing access to dental care for this population.
    • An Interprofessional Collaboration To Implement Diabetes Screening In A University Dental Hygiene Clinic

      Idzik, Shannon; Hack, Gary, D.D.S.; Bode, Claire; Manski, Marion; Cartee, Deborah (2016)
      The purpose of this project was to implement diabetes screening for patients with diabetes risk factors during their hygiene appointments at the dental school clinic. Diabetes is an epidemic in the U.S. 18 Million are currently effected and it is expected to rise over the next few years. One third of those with diabetes are asymptomatic and undiagnosed. There is literature to support screening for diabetes in non-primary care settings. There is a bidirectional relationship between diabetes and periodontal disease. Many patients with diabetes have at least one diabetes risk factor. A significant number of people see the dentist at least once a year.
    • Medical Emergency Training For Psychiatric Healthcare Staff

      Iyanobor, Angela I.; Idzik, Shannon (2019-05)
      Background: Physical comorbidities are highly prevalent among the mental health population. The associated risk between the two are said to be two- to fourfold. Inadequate emergency response training among mental health personnel has been identified as a common issue during medical emergencies, with personnel reporting feeling unprepared and unskilled. The use of clinical simulations has demonstrated improvements in clinical skills, communication, and confidence for healthcare personnel. Local Problem: The behavioral health ward of a suburban area hospital is planning to move to a stand-alone facility. When surveyed, its personnel felt the least confident with the medical management of acute strokes. The goals of this project were to have at least 85% of the inpatient behavioral health staff achieve the pre-determined minimal level of clinical competency for the management of acute stroke and 100% of the staff demonstrate improved confidence and critical thinking skills/knowledge in the management of acute stroke. Interventions: The purpose of this project was to develop and implement a simulation and additional resources for inpatient psychiatric staff, resulting in demonstrated clinical proficiency, as well as increased knowledge and competence in recognizing and responding to the signs and symptoms of an acute stroke. A sample of 20 personnel for Part 1 and 10 personnel for Part 2 participated in an educational training and evaluation of acute stroke. The training was divided into two phases: the delivery of didactic education and a series of clinical simulations. Results: Overall, participants felt more confident managing acute strokes post-simulation compared to pre-simulation. While there were no noticeable changes in clinical knowledge between the two phases, participants were able to demonstrate the pre-determined level of clinical proficiency during the simulation. Conclusions: This quality improvement project achieved the goals of demonstrated clinical proficiency and increased competence when recognizing and responding to the signs and symptoms of acute stroke for behavioral health personnel with the implementation of an educational resource and clinical simulation. While the goal of increased knowledge was not achieved, the usefulness of training behavioral health personnel to manage medical emergencies was validated. Additional educational resources and future research directed toward this population should be a priority for healthcare institutions nationwide.