• Clinical Decision Support for Fall Risk Assessment and Plan of Care

      Lytle, Kay (2015-07)
      Objectives: • Discuss variations in process outcomes for falls documentation of a quality improvement project using clinical decision support. • Compare the clinical outcomes for falls-­related quality improvement project using clinical decision support. • Discuss lessons learned in implementation and evaluation of clinical decision support tools
    • Implementation of Dextrose gel for Asymptomatic Hypoglycemia in Newborns

      Solaiman, Anjana; Wise, Barbara V. (2020-05)
      Problem & Purpose: Neonatal asymptomatic hypoglycemia is a common problem that may contribute to poor health outcomes. Firstline treatment includes formula feeding, and/or transfer to the Neonatal Intensive Care Unit (NICU) for intravenous glucose. Both of these treatment options are sub-optimal because breastfeeding/bonding are disrupted, and costs may be increased due to NICU care. The purpose of this quality improvement (QI) project was to implement 40% buccal dextrose gel as the first line treatment of asymptomatic hypoglycemia in newborns at an academic medical center in the mid-Atlantic region to improve glycemic outcomes. Methods: This QI project was implemented during a 12-week period in the Fall of 2019. The target population included infants admitted to the newborn nursery who were less than 24 hours of life (HOL) with an identified risk factor for hypoglycemia (birthweight >3800 grams or <2500 grams, gestational age <37 weeks, LGA or SGA, or is an infant of diabetic mother), with asymptomatic hypoglycemia (blood glucose levels between 20- 40mg/dl). The QI project involved modifying the hospitals current neonatal hypoglycemia clinical practice guideline (CPG), to implement 40% dextrose gel as initial therapy in conjunction with feeding, developing an order set, creating documentation in the electronic health record, training personnel and collaborating with pharmacy to stock the gel. Results and Conclusions: During the implementation 16 newborns received glucose gel (N=16). Treatment success, defined as blood glucose levels >40mg/dL following the first and/or second administration of gel, was achieved in 87.5% of newborns. Newborns who did not respond favorably to glucose gel had an initial blood glucose level of <20mg/dL, a deviation from the modified CPG. Fifty five percent of newborns who were exclusively breastfeeding (N=9) received medically indicated formula supplementation. Five patients were transferred (N=5) to the NICU, 2 patients had achieved treatment success, but were unable to maintain adequate glycemic levels. Future QI cycles should include exploration of treatment failure with modifications to improve CPG adherence, consideration for increasing doses for responsive newborns as well widening the gestational age criteria. Overall the outcomes of this QI project demonstrated that glucose gel as the initial treatment for infants with asymptomatic hypoglycemia is effective.
    • Universal Suicide Screening in a Pediatric Gastroenterology Outpatient Clinic

      Stankiewicz, Morgan H.; Wise, Barbara V. (2020-05)
      Problem and Purpose: Suicide is the second leading cause of death in young people ages 10-24 in the United States. The Joint Commission issued a sentinel event recommending healthcare providers screen all patients for suicide. Universal screening is a key strategy to prevent suicide in the pediatric population. This quality improvement (QI) project implemented an evidence-based suicide screening tool for patients ages 10-21 who presented to a multidisciplinary pediatric gastroenterology (GI) outpatient clinic affiliated with a large urban academic medical center and referred at risk patients for further evaluation and treatment. Methods: The Ask Suicide-Screening Questions (ASQ) screening tool was chosen for its robust reliability and validity among pediatric medical patients. The GI clinicians were trained to use the ASQ tool and to further assess at risk patients with a brief suicide safety assessment (BSSA). The clinic social worker screened all patients meeting inclusion criteria, and results were entered into the electronic health record (EHR). Patients were excluded from screening if they were less than age 10, the guardian refused, or the patient could not answer the questions due to a developmental delay. Patients at risk for suicide received a safety plan and follow up resources. Results: The clinicians self-reported 100% competency prior to implementation. During the implementation phase, sixteen patients met inclusion criteria, and one guardian refused screening. Ten patients had screening results recorded in the EHR (66%), and two patients (20%) were found to be at risk for suicide. Both patients screened positively due to previous suicide attempt(s) which is a strong predictive factor for future suicidal behaviors. Conclusions: With proper training, the GI clinicians were confident to implement suicide screening using the ASQ tool. Twenty percent of patients screened at risk for suicide and received mental health resources. This QI project validates the feasibility and value of suicide screening in a pediatric subspecialty clinic and suggests screening could be implemented in other subspecialty clinics within the hospital system.