Now showing items 1-20 of 1183

    • SINI 2018: Cyber Security Summing Up! Simulation Exercise and Future Direction

      Nahm, Eun-Shim; Lacey, Darren; Martin, Susan, R.N., J.D., C.I.P.P./G., C.P.H.I.M.S.; Lardner, Michelle C. (2018-07)
    • SINI 2018: Malware? What are They and How to Prevent

      Martin, Susan, R.N., J.D., C.I.P.P./G., C.P.H.I.M.S.; Lacey, Darren (2018-07)
    • SINI: Effective and Efficient Anonymization of Health-Related Physical Activity Data

      Parameshwarappa, Pooja; Chen, Zhiyuan, Ph.D.; Koru, Gunes (2018-07)
    • SINI 2018: From Frontline to the Executive Office: Disaster Planning that Works

      Gosselin, Kate, D.N.P., R.N., C.E.N.; Medvec, Barbara R. (2018-07)
    • SINI 2018: The Security Informatics Nurse Specialist Role

      Sawyerr, Claribel; Stevens, Kim, M.S.N., R.N.; Martin, Susan, R.N., J.D., C.I.P.P./G., C.P.H.I.M.S. (2018-07)
    • Early Hearing Detection: Using Pre-Discharge Education and Standardized Referrals to Reduce Lost-To-Follow-Up Rates

      Riggs, Julie; Gourley, Bridgitte; Clark, Karen (2019-05)
      Background: There are lags in ensuring that infants who do not pass their hospital newborn hearing screens receive the follow-up testing they need by the recommended three-month benchmark. The purpose of this project is to address disparities in infants lost to follow-up (LTF) by implementing a program for pre-discharge education and referral plan to free follow-up care at a suburban hospital in a mid-Atlantic state. Intervention: A partnership between the state department of health and a local university audiology program provided education and free follow-up testing of infants who did not pass the newborn hearing screen. Audiology technicians provided a screening result card to families, which also included hearing developmental milestones. Families received brief verbal education about the test result and the urgent need for a retest for those who did not pass. Infants requiring follow-up received appointments with the partner audiology clinic for a free evaluation. Results: 216 infants were born at the site and 214 babies received the in-hospital hearing screens. All 214 babies passed the in-hospital screens and did not require referral. An additional three babies were referred to the university clinic from other sites. Conclusion: This project did not yield opportunities for evaluation of LTF due to low birth volume during the short data collection period. However, this project indicated future potential for positive change. Families responded well to the cards and engaged with the education. This partnership provided opportunities for follow-up of at-risk infants in the region and is likely a model worth continuing and expanding.
    • Implementing a Standardized Nursing Handoff between the Emergency Department and Inpatient Departments

      Foltz, Kimberly A.; Quattrini, Veronica (2019-05)
      Background It is estimated that 80% of serious medical errors have a component of miscommunication between caregivers when a patient is being transferred. Ineffective handoffs can lead to delays in, or inappropriate treatments, and increased length of stay. Approximately half of hospital staff indicate information related to the patient is lost during handoffs. For a handoff to be successful, the following is needed: (1) standardized content, forms, tools, and methods; (2) the opportunity to ask questions; (3) staff accountability and monitoring; and (4) education and coaching. Additionally, the electronic health record should be used to enhance handoffs between senders and receivers. Local Problem The purpose of this quality improvement project was to implement and evaluate evidence-based patient-centered handoff from the emergency department to inpatient medicine departments within an urban, academic medical facility based in Maryland. Prior to this project, there was not a handoff report which contained all of the critical elements, an easy way for the inpatient nurse to contact the emergency department nurse with questions, and/or the ability to document that handoff was complete. Interventions Lewin’s change theory was used as the framework. The interventions were: (1) create a new report in the electronic health record, which contained all elements noted to be critical content by The Joint Commission, and (2) add a field to the electronic health record which the inpatient nurse completed after the report has been reviewed. The inpatient nurse was able to document ‘Chart reviewed, no questions’, ‘Chart reviewed, questions answered’, or ‘Other’ with the ability to add a comment. Results There was a reduction of handoff related patient safety events from four preimplementation to two post-implementation. Though the theme of all of the events was communication, there was a difference in miscommunication versus lack of communication. The percentage of compliance with the new process was 48.6%. Not all of the responses to the preimplementation and post-implementation survey questions are statistically significant; however, there was a statistically significant difference in ‘I am satisfied with the process for emergency department to inpatient handoff’ on both the inpatient (pre-data (M=2.3, SD=1.1) and post-data (M=3.3, SD=1.3); t=-2.8, p=0.006) and emergency department (pre-data (M=3.3; SD=1) and post-data (M=4.4, SD=0.7); t=-3.9; p=0.0003) surveys. Nurse satisfaction with the handoff process has increased. Conclusions The project decreased patient safety events, and increased overall nurse satisfaction related to handoff from the emergency department to inpatient medicine units. As all transfers from the emergency department to non-intensive care inpatient areas followed the same process pre-implementation, expanding the use of the new process into those areas is recommended. The emergency department to intensive care unit process is currently a verbal handoff with no specific format. In the future, it will be guided by the new electronic health record report. There are opportunities to implement an improved handoff process in other areas of the medical center. Patients are transferred between units, procedural areas, and from one clinician to another frequently. The model used in this project could be the foundation for improvements in those handoffs.
    • Use of Cord Blood for Admission Lab Testing in High Risk Neonates

      George, Ronie; Bode, Claire (2019-05)
      Background: As part of their care in the neonatal intensive care unit (NICU) most neonates require routine admission labs, which could equal up to 10% of their total blood volume. This, and the subsequent lab draws while in the NICU can predispose them to anemia and hypovolemia with the possibility of needing blood transfusions. Local Problem: This QI project is being done in a twenty four bed level three NICU and in a twelve bed labor and delivery (L & D) unit in a major urban medical center in the Mid –Atlantic region. The current practice is to draw admission labs directly from the baby which is not only invasive but also traumatic and expensive considering the supplies used. Participants include registered nurses, neonatal nurse practitioners, neonatologists, laboratory personnel, and information technology staff. Aim: To implement the feasibility of drawing admission labs from the cord blood as an alternative to the current practice of neonatal phlebotomy. The data collected will be the number of staff who are trained to the number of staff working in the L&D and NICU and the number of samples collected from the cord blood to the number of NICU admissions during this timeframe. Interventions: The theoretical framework used here was the Plan Do Study Act. All nurses working in the labor and delivery and NICU and all high risk infants between 22 and 42 weeks who were admitted to the NICU were eligible to participate. An evidence based literature review guided improvement of current practice. Unit based practice guideline, power point presentation, competency checklist and data collection tools were prepared for education, training and data collection. Champions were selected and individual and group training sessions were done. Select cord samples were collected and sent to lab. Results: Education was completed by 80% L & D nurses, and 80% NICU nurses. Samples were collected on 64.47% neonates admitted to the NICU. Based on the posttest administered after the education, 98% agreed that using cord blood for admission labs is safe and reliable and helps prevent pain and other complications. Conclusion: The procedure has a high degree of usability and staff are continuing to collect samples from cord blood. In this present era where our focus is on quality improvement initiatives, making a wise use of available resources like umbilical cord blood will bring about a better outcome for the sick neonate and cost containment for the patients and their family as well as for the organization where it is implemented. In conclusion, cord sampling as an alternative to neonatal phlebotomy is an easily accessible procedure with the potential to improve the outcome of the sick neonates.
    • Improving Inhaler Technique Education in a Pediatric Emergency Department

      Bell, Lisa M.; Bundy, Elaine (2019-05)
      Background: Efficacy of inhaled medications for asthma is dependent upon proper administration technique. Rates of metered dose inhaler and spacer misuse are high among both patients and healthcare providers, and gaps in patient education practices are widespread. Practice guidelines recommend patient technique be demonstrated and assessed at every encounter using a checklist of critical steps with repetition until competency is achieved. Local problem: The purpose of this project was to improve metered dose inhaler and spacer technique education provided by registered nurses in a pediatric emergency department. Nurses in this setting do not receive training on metered dose inhaler technique, and patient technique demonstrations are not routinely assessed or documented utilizing checklists. Interventions: All nurses working in the pediatric emergency department (n=20) received education on metered dose inhaler and spacer technique at the initiation of the project. Training checklists were developed and incorporated into the electronic medical record based upon practice guidelines. Prior to discharge, patients with asthma were asked by a nurse to demonstrate their technique using a metered dose inhaler and spacer. The nurse used the checklist in the patient’s electronic medical record to assess and document competency in the critical steps of metered dose inhaler and spacer technique. Instruction was provided by the nurses to remedy any patient errors until competency was demonstrated. Results: In patient chart audits conducted over a 10-week period 138 charts met audit criteria; 95 of which had documented checklists. One-hundred percent of patients and/or caregivers with documented checklists were able to demonstrate competency in all critical steps prior to discharge, with 35% requiring additional education to correct errors in technique. Conclusions: This project demonstrated the benefit of maximizing a pediatric emergency department encounter to provide evidence-based asthma education on a critical component of asthma management. Similar projects are needed that focus on inhaler technique in other settings, as well as with other inhalation devices.