These state- and jurisdictional-level profiles complement the report on Maryland SNAP Households in 2023. Each jurisdiction has a one-page profile that examines all households in a jurisdiction that received SNAP during SFY 2023. It includes characteristics of households as well as demographics and employment information for adult recipients.

Problem and Purpose: Nationwide, nursing turnover is 23%. Chronic fatigue, low meaning and joy at work are high contributors. On a 30 bed Medical Surgical (MSU) the turnover rate was 30%. The purpose of this quality improvement (QI) project was to assist nurses to identify and eliminate barriers to achieving meaning and joy at work with a goal of reducing turnover. Methods: Project launched with the Meaning and Joy at Work Questionnaire (MJWQ) presurvey (two supplemental questions about Intent to Leave), followed by focus groups, action plans and a post intervention MJWQ. Turnover was measured monthly. Results: Of the 45 eligible nurses on MSU, 38% completed the pre-survey. The highest percentage of nurses completing the survey indicated no intent to leave their position, 47.1% or the profession in the next year, 94.1%. Many of the MJW questions scored positively, with most staff reporting they agree or strongly agree. Resulting interventions included staff recognition, coordination with departments to ensure supply delivery, and launching a Disruptive Behavior Policy. Post-Survey: Of the 45 eligible nurses, 17.8% completed the post-survey. Scores decreased in areas of feeling respected and meaning for the work, all other questions improved. The Intent to Leave data showed a 28% increase in staff indicating they did not intend to leave, a total of 75.1%. A slight increase in staff reporting they would leave the profession within the next year, from 5.9% pre to 12.5% post intervention. Turnover decreased over several months to 26.94%, and then 23.35%. Conclusions: Reasons nurses find meaning and joy at work are a sense of purpose and being present for patients. Teamwork, support and adequate staffing drive a sense of purpose. Facilitated focus groups provide nurses with an opportunity to explore perceptions of meaning, joy at work and to identify barriers. Barriers include staffing, resources, communication recognition, and disruptive behavior by patients and families. Staff and leadership interventions that address barriers are an effective tool to improve meaning, joy and reduce turnover.

"I cry and no one cares" INTRODUCTION It is important for healthcare organizations to prioritize suicide prevention and provide support for their staff to address this critical issue. However, even when that support exists, medical professionals are in a unique position to not seek out or accept mental health help. Stigma for seeking help is real, and getting confidential care is a valid concern.

Purpose: To measure the intercondylar distance (ICD) from cone-beam computed tomography (CBCT) scans of a large population of subjects to determine the average ICD in male and female subject and to correlate ICD measurement obtained with sex and ethnicity of the subjects. Materials and Methods: This cross-sectional study analyzed consecutive patients who had received maxillofacial field of view CBCT radiographic examinations at the University of Maryland School of Dentistry (UMSOD) between January 20th, 2016, and July 5th, 2023. Inclusion criteria comprised individuals over 18 years old who had maxillofacial CBCT scans on file in the UMSOD INFINITT (INFINITT NA, Phillipsburg, NJ) PACS system. Exclusion criteria included patients with prosthetic condyles, bone growth-affecting diseases, incomplete scans, poor image quality, or missing sex and age information. Of the initially included 459 patients, 25 were excluded. Data collected from patient charts included age, sex, presence of bone growth-affecting diseases, and measurements of left and right condyles, as well as ICD. The primary investigator reviewed scans, conducted chart reviews, and made measurements on the 434 included files. Results: Four hundred and thirty-four images of subjects were analyzed. The sample consisted of an even number of male and female subjects (217). The median ICD value was 102.9 mm (min 86.2 mm – max 118.2 mm) for male subjects and 98.4 mm (min 81.5 – max 117.2) mm for female subjects. The mean ICD value of male and female subjects combined (total 434 subjects) was 100.92 mm (min 81.5 mm – max 118.2 mm) and the median value was 100.5 mm. There was statistically significant difference between ICD values of male and female subjects (P<0.0001), but not between Caucasian and African American subjects (P=0.69). There was no significant difference in the interaction between sex and ethnicity (P=0.84). Conclusions: The ICD influences the radius of movement and the arcs traveled by the cusps during lateral mandibular movements in the horizontal plane. Although canine disocclusion can mitigate inaccuracies arising from an average ICD, it may not fully compensate for individual variations in all patients. For patients restored with group function occlusion, ICD setting may be more critical. Articulators with an adjustable ICD would provide a more anatomically correct tooth form for the treatment of full mouth rehabilitation cases.

Problem: The United States Preventive Services Task Force (USPSTF) recommends annual lung cancer screening with low dose computed tomography (LDCT) for eligible patients. A detailed smoking history informs clinical decision making regarding the recommendation to pursue LDCT. In March 2023, a random chart audit in a rural primary care center revealed a detailed smoking history was missing on 82% of all patients and an evidence-based decision regarding LDCT was missing for 100% of patients. Purpose: This quality improvement (QI) project aims to optimize smoking history documentation, increasing referral for LDCT in order to screen for lung cancer and refer for management. Methods: Prior to project implementation, an interdisciplinary team of stakeholders at the practice site including a physician and six office staff members was mobilized and educated on the proposed practice change including integration of a smoking history data collection tool (SHDCT), establishment of a referral process for appropriate patients, and creation of a follow up procedure for specialist referral. Office staff provides each patient with the SHDCT to complete privately in the waiting room; an estimated 500 patients will complete the SHDCT during the 15-week implementation. The provider then reviews the SHDCT with the patient, determines screening eligibility, and orders LDCT if indicated. Following the encounter, office staff scans SHDCT into the electronic health record and schedules LDCT for suitable patients. After LDCT is obtained, provider reviews the results and refers screening-positive patients to a specialist. Results: Of the 438 patients seen during implementation, 87.7% of patients now have completed SHDCTs documented in the EHR. Of the 54 patients qualified for LDCT, 72.2% have LDCT ordered. Of the ordered LDCTs, 45% are complete by the end of the 15-week implementation. No patients required specialist referral based on LDCT findings. Conclusions: Results reveal the intervention has promoted best Problem: The United States Preventive Services Task Force (USPSTF) recommends annual lung cancer screening with low dose computed tomography (LDCT) for eligible patients. A detailed smoking history informs clinical decision making regarding the recommendation to pursue LDCT. In March 2023, a random chart audit in a rural primary care center revealed a detailed smoking history was missing on 82% of all patients and an evidence-based decision regarding LDCT was missing for 100% of patients. Purpose: This quality improvement (QI) project aims to optimize smoking history documentation, increasing referral for LDCT in order to screen for lung cancer and refer for management. Methods: Prior to project implementation, an interdisciplinary team of stakeholders at the practice site including a physician and six office staff members was mobilized and educated on the proposed practice change including integration of a smoking history data collection tool (SHDCT), establishment of a referral process for appropriate patients, and creation of a follow up procedure for specialist referral. Office staff provides each patient with the SHDCT to complete privately in the waiting room; an estimated 500 patients will complete the SHDCT during the 15-week implementation. The provider then reviews the SHDCT with the patient, determines screening eligibility, and orders LDCT if indicated. Following the encounter, office staff scans SHDCT into the electronic health record and schedules LDCT for suitable patients. After LDCT is obtained, provider reviews the results and refers screening-positive patients to a specialist. Results: Of the 438 patients seen during implementation, 87.7% of patients now have completed SHDCTs documented in the EHR. Of the 54 patients qualified for LDCT, 72.2% have LDCT ordered. Of the ordered LDCTs, 45% are complete by the end of the 15-week implementation. No patients required specialist referral based on LDCT findings. Conclusions: Results reveal the intervention has promoted best

Problem & Purpose: Spinal-induced hypotension is a common side effect of spinal anesthesia that compromises uterine blood flow and fetal circulation, subsequently leading to fetal hypoxia, bradycardia, and acidosis. The general practice in the labor and delivery operating room at a community hospital in Maryland was to administer ondansetron after spinal anesthesia. This has contributed to a 20% incidence of spinal induced hypotension in the obstetric population. The purpose of this quality improvement project was to implement and evaluate the compliance of the use of four milligrams of intravenous ondansetron five minutes prior to spinal anesthesia to reduce the incidence of spinal-induced hypotension. Methods: Key stakeholders and change champions were mobilized to aid in the successful implementation of this project. Two educational sessions were held in person for 24 anesthesia providers including six anesthesia technicians on the current evidence of spinal-induced hypotension, project goals, and workflow changes. Eligible participants included parturients undergoing elective cesarean sections with no contraindications to spinal anesthesia or ondansetron. The anesthesia providers administered and documented four milligrams of ondansetron five minutes prior to spinal anesthesia and documented if parturients experienced spinal-induced hypotension. Data was collected weekly via chart audits to assess project goals. Results: Over 15 weeks, 38 cesarean sections were performed. A total of 32 parturients received four milligrams of ondansetron prior to spinal anesthesia, achieving an overall compliance rate of 84.2%. Of these 32 parturients, 54.3% did not experience spinal-induced hypotension. Conclusion: Findings suggest that implementation of a spinal-induced hypotension evidence-based protocol was feasible at the project site. It was a cost-effective intervention that reduced the incidence of spinal-induced hypotension and improved patient outcomes with minimal workflow changes.

Problem: Nurse anesthetists in the Endoscopy unit of a large quaternary academic medical center are exposed to radiation throughout their workday, but noncompliance with wearing their radiation dosAimetry badge has been as high as 89.5% - 98.7% of nurse anesthesia staff. Chronic fluoroscopy radiation exposure disproportionately increases the risk of cataracts, unilateral brain cancers, and chromosomal damage of healthcare workers. Dosimetry badge compliance is necessary for fluoroscopy radiation exposure to be properly measured and maintain a safe working environment for nurse anesthetists. Purpose: The purpose of this quality improvement project is to increase nurse anesthesia radiation dosimetry badge compliance with the use of a radiation safety timeout over a 15-week period in the Endoscopy unit. Methods: A project team consisting of a project leader, nurse anesthesia champion, and Endoscopy nurse champion instituted a radiation safety timeout practice change in the Endoscopy unit. Project strategies included electronic and unit-based education to 25 nurse anesthetists and 15 nurses (emails and in-services), collaboration (weekly site visits and project champions), and evaluation (data collection and analysis). Nurse anesthetists completed an anonymous QR code survey tool, evaluating the frequency of fluoroscopy cases in which the radiation safety timeout was performed, and dosimetry badges were correctly worn. Results: Fifteen weeks of data collection showed an average reported compliance of 83.8% with proper display of dosimetry badges and 73% with the radiation safety timeout. Survey response rate was 33.9%. Run charts show a nonrandom increase in dosimetry badge compliance, but the trend showing increased radiation timeout compliance may be due to reminders from nurse anesthesia staff, and not the intervention itself. Re-education through email and an in-person in-service led to increased compliance reporting during week 3. A change in leadership contributed to absence of data in weeks thirteen through fifteen. Conclusion: Dosimetry badge compliance did not reach 100%, but non-significant improvement exists since implementation of the radiation safety timeout and education. Knowledge gaps and opportunities for re-education to increase nurse anesthesia buyin and compliance will be assessed and ongoing.

Problem: Cervical cancer (CC) is one of the most common cancers affecting women. Incidence of CC is significantly reduced through regular and timely cervical cancer screening (CCS). In the US, rates of overdue CCS increased from 14% in 2005 to 26.1% in 2021. A nurse practitioner (NP)-owned primary care clinic in the Mid-Atlantic experienced inadequate tracking and timely uptake of CCS. Baseline data showed 17.6% of 21–29-year-olds and 22.1% of 30–65-year-olds were overdue for CCS with only 12.7% having a documented CCS in the electronic health record (EHR). This sub-optimal tracking and detection increases opportunities for patients to miss CCS. Purpose: The purpose of this quality improvement initiative was to increase CCS uptake among clinic patients through text message invitations to schedule an appointment or obtain a referral. Methods: A new policy standardizing identification, contact, and tracking of soon-due and overdue CCS patients was created. The new workflow sent two text message reminders to patients 21-65 years old who were soon-due or overdue for CCS. Participants were determined by EHR report to include age, sex, history of hysterectomy, and date of last pap smear. Results: 46 patients participated in the project. Of the text messages sent, 32.6% (n=15) responded. 33.3% (n=5) of respondents scheduled their CCS and of those, 60% (n=3) completed it during implementation. 33.3% (n=5) reported an up-to-date CCS. Post-intervention rates of overdue CCS were 13.7% for 21–29-year-olds and 14.5% for 30–65-year-olds, a 3% and 7% improvement. Overall, an 85.8% CCS compliance rate was seen post-intervention. Conclusions: Findings suggest the use of text messaging reminders is a low cost, low barrier way to increase uptake of CCS in this setting. Addressing barriers and organizational processes may help increase patient response to text messaging and increase timely uptake of CCS.

Problem: In a 15-bed cardiac medical intensive care unit, there has been decreased nurse presence and participation in multidisciplinary rounds. Purpose: The purpose of this quality improvement project was to implement a practice change that improves communication and provides a consistent rounding process while increasing nurse presence and participation in the cardiac intensive care unit during daily multidisciplinary rounds. Methods: Over 15 weeks during the Fall of 2023, the introduction of and utilization of the tool adapted from the Agency for Healthcare Research and Quality (AHRQ) daily goals checklist and served as a daily cue during rounds. The structure change was creating the evidence-based tool. At the start of rounds, nurses discussed overnight events and remained with the team to discuss the care plan for each system. Data was entered into an encrypted data collection system using a QR code embedded in the rounds sheet by the charge nurse. Weekly text reminders were sent to attending physicians to remind them of process changes. Daily huddle announcements were given to the nursing staff to remind them of the process change. Results: Results showed nurse attendance rates ranged from 10% to 100%, with an overall increased median rate of 70 % attendance during rounds. Complete utilization of the tool on all occupied beds ranged from 14% to 93.9%, with a median rate of 53.9%. Conclusions: Results indicate that nurse attendance during rounds has improved during implementation. Adherence to completing the rounding tool was challenged due to the changing rounding location and the location of the rounding tool on the unit. Adherence to process change was also challenged by varying high acuity days and mock surveys for accrediting bodies.