Transforming Healthcare - Exploring the Current Challenges and Possibilities in Nursing Poster Presentations February 15, 2018 These Presenters have provided outstanding research and projects Be sure to visit each of the participants and their presentations
Poster Presentations Poster #1 Narumi Fujinc RN MSN Email: fujionon@cc.saga-u.ac.jp Challenges in providing outreach support by community activity support centers Research Qualitative Purpose: To clarify the challenges in providing outreach support by community activity support centers in cooperation with institutions. Method: Qualitative descriptive research was conducted by analyzing the contents of semistructured interviews with 10 professionals providing outreach support for persons with mental disorders at community activity support centers. Results: The following challenges in providing outreach support by community activity support centers in cooperation with institutions were extracted: 1. Necessity to maintain the strength of cooperation with medical institutions 2. Strengthen the process of evaluating various outreach support. Discussion: The outcome of outreach support is the decrease in re-hospitalization of persons with mental disorders and the enhancement of their settlement in the community. It is expected that outreach support can enable medical institutions to reduce the number of beds occupied by providing methods of continuation of independent life on their own for persons with mental disorders in the community. In the future, it is important to provide comprehensive multi-disciplinary out-reach support that takes into consideration a person s individuality. Track: Mental Health Nursing
Poster Presentation #2 Stacy Glocke RN BSN MN Email: sglocke@smcgov.org Phone 651-485-2449 Research Qualitative Enhancing Nursing Education for Pediatric Emergencies Enhancing Nursing Education for Pediatric Emergencies Pediatric acute care places great strain on and presents many challenges for nursing. In our level III emergency department at San Mateo Medical Center (SMMC), acute care for the pediatric population is considered to be a low frequency/high risk situation. Purpose: Providing realistic educational pediatric education was a priority for the staff. Simulation education allows participants to learn in an environment that is as close as possible to real clinical situations. Simulation provides hands on education and testing of knowledge, skills and critical thinking. In May of 2016, we developed a Pediatric Simulation program with guidance from Stanford s medical education center. Method: Our team consisting of: 1 physician, 1 clinical nurse and the emergency department clinical nurse educator, we spent 1 day at the Stanford Simulation lab learning how to create a successful Simulation program. We created content based on our pediatric population and pre-developed learning objectives for each scenario. Debriefing of each scenario allows for positive feedback, discussion about observed teamwork and performance assessment. Quantitative and qualitative data is collected from each scenario. Each scenario is scored based on timeliness of meeting set objectives. Comparison data is maintained and narrative feedback is compiled. Results: While our program is still young, we have already witnessed improved confidence, critical thinking, communication and teamwork when dealing with pressured filled critical pediatric situations. Simulation allows us the opportunity to learn and practice critical care skills in a controlled and safe environment and provides a bridge between theory and practice. Keywords: Pediatric, simulation, education, emergency department. Track 4: Nursing Education
Poster Presentation #3 Bobbi Whitworth, PhD, MSN RNC bobbie.whitworth@mail.waldenu.edu Patti Urso PhD patti.urso@waldenu.edu Robin E. Squellati, PhD, APRN-C Robin.Squellati@gmail.com Transforming the Practicum Experience for an Online MSN Program Research Qualitative The online MSN practicum experience is a supervised, structured experience, taking place in both the online didactic setting and the onsite practicum setting. Purpose: The practicum experience is designed to assist students in developing analytical and critical thinking skills, and integrating professional knowledge, while providing a quality student experience in the practicum setting based on course and program objectives. These experiences, while essential for the MSN students to assimilate and apply knowledge learned, can be laden with challenges. Some of the challenges include 1. Partnering with appropriate practicum settings and preceptors for online students who may live in remote areas and in distant countries. Even students in heavily populated urban areas can have difficulty finding appropriate preceptors, validating the American Association of Colleges of Nursing s (AACN) statement that there is a shortage of preceptors available for MSN students. 2. Another challenge is competition between nursing programs to partner with appropriate practicum settings. 3. Evaluation of the students by their preceptors can also present a challenge, especially when different academic programs utilize different evaluation tools. 4. Obtaining approval for the affiliation agreement can be difficult and time consuming; many practicum settings choose to use their own legal jargon, which may conflict with that of the nursing program s affiliation agreement. In this presentation, the practicum steps for the Walden MSN students will be outlined. The AACN Master s Essentials will be mapped to the practicum experience. Challenges will be described and new models for transforming the practicum experience to meet the needs of the 21st century will be presented. Track 5: Innovations in Nursing Education
Poster Presentation #4 Dr. Jennifer Armfield, RN MSN DNP Email: jennifer.armfield@nau.edu Phone 928-266-5548 Project Boost and Cardiovascular Disease Readmissions in Rural Acute Care Facility Research Quantitative Background: Hospital readmissions are a source of reduced payment as mandated by the Centers for Medicare and Medicaid Services as part of the Affordable Care Act (ACA). The number of dollars used for hospital readmissions has increased over $17 million for heart failure alone. The changes in the ACA reimbursement guidelines has put stress on many hospitals as they are facing reduced income, increased use of resources, and increased length of stay. Objective: The objective of this presentation is to describe risk factors for 30-day hospital readmission in patients with cardiovascular disease using the Project BOOST risk assessment tool and compare hospital readmission rates between pre- and post-intervention groups. This presentation will also address strategies of project boost that most greatly affected the reduction in readmission rates. Methods: A retrospective chart review was performed while descriptive and predictive statistics were used to analyze obtained data. Pre- (n = 114) and post-intervention (n = 93) groups were compared to evaluate the implementation of Project BOOST, its components, and their predictability for hospital readmission. Results: Patients with cardiovascular disease admitted to the study hospital have high risks for readmission, such as problem medications, polypharmacy, psychological issues, and principal diagnoses. Integrating elements from Project BOOST significantly decreased 30-day hospital readmissions. Discussion: Data from this study revealed a statistically significant reduction in 30-day hospital readmission rates from 22% in the pre-intervention period to just 4% in the post-intervention period. Patients who did not receive the risk assessment tool were 14 times more likely to be readmitted to the hospital within 30 days of the index hospitalization. Track Track 21: Transitional Care Nursing
Poster Presentation #5 Andrea Coyle Email:coylea@musc.edu Phone: 843-792-7769 Nursing Informatics in Shared Governance: Transforming Data into Wisdom! Research Qualitative Purpose: The goal was to dedicate a nurse informatics lead to support nursing shared governance at all levels. By leveraging clinical informatics and analytics, nurses are able to use data to drive clinical practice decisions and integrate informatics into care delivery and improve patient outcomes. Relevance/Significance: While collectively all aim to achieve positive clinical performance outcomes, historically informatics was not considered a core competency in meeting these collective goals. Analytics was perceived as a barrier to success and in many cases nurses felt intimidated by anything technology-related. Collaborating with informatics and analytics fosters a relationship that will fortify shared governance decision making that is rooted in evidence and data, which will enhance nursing credibility. Strategy and Implementation: Each shared governance council is organized around the domains of Magnet.to ensure empirical outcome success, development of tooling (dashboards, clinical decision support mechanisms), insights (predictive analytics), automation, and standardization has poised our new shared governance construct to truly lead change. As trends are identified using data, council members establish metrics of success based on goal setting which aligns with baseline data and post data points. Evaluation: Since embedding Nursing Informatics in each council, the percentage of clinical nurse involvement in decisions leading to optimization of EHR configuration and improvement in patient outcomes has increased. Blood Product Administration Module involved no clinical nurses. Now optimization is 100% clinical RN lead. Monitoring Early Warning Signs and Bedside Shift Report are also optimized by RN's. Implications for Practice: Leveraging technology to improve outcomes requires that unit-based and organizational-level councils, all of which are comprised of direct caregivers, understand that the EHR value paradigm has shifted from one that emphasizes technical issues to one that focuses on clinical excellence. Track 11: Nursing Informatics
Poster Presentation #7 D'Lane Alexander MSN, RN-BC Email: dlane.alexander@nicholls.edu Phone 225.303.3328 Use of Home Tele-monitoring Surveillance Services in Patients with Congestive Heart Failure Research Qualitative Background Congestive Heart Failure (CHF) is a serious, progressive disease that adversely affects approximately 5.7 Americans, and approximates to some 300,000 deaths in this country (Smith, 2013). CHF accounts for greater than 1 million hospitalizations, 2.8 million office, emergency room and outpatient visits, exceeding $32 billion annually (Black, Romano, Sadeghi, Aurrbach, Ganiats, Greenfield, Kaplan, & Ong, 2014). These alarming statistics have posed query that some hospital readmissions can be prevented, thereby reducing costs (Black et al., 2014). Subsequently, many healthcare organizations have implemented measures, such as the use of Tele-surveillance Monitoring to prevent hospital readmissions. Tele-monitoring surveillance is the use of electronic and communication technology to monitor and transmit objective healthcare data remotely (Institute of Medicine, 1996). This data reported includes electrocardiogram, blood pressure, daily weight, pulse oximetry, and respirations (Institute of Medicine, 1996). Tele-monitoring has been implemented in recent years by healthcare practitioners to monitor CHF patient s progress post discharge. This educational module will identify the results of extensive research on the use of Tele-surveillance monitoring of patients with CHF, along with economic and financial impacts. Method: The literature review will examine factors such as 1. Cost, 2. Ease of implementation, and 3. Stakeholders to be educated on utilization of equipment. Methods For this educational module, an extensive review of CINAHL, PubMed, and Academic Search Premier Databases were examined for the literature review from 2006 to 2017. Search terms included heart failure, congestive heart failure, CHF, tele-monitoring, and tele-surveillance monitoring. Recommendations for Future Practice The synthesis of findings from the literature review have proven to be encouraging for the use of tele-monitoring surveillance monitoring in patients with CHF to reduce healthcare costs, morbidity, and mortality. Track 20: Telemedicine and e-health
Poster Presentaton #8 Halli Carr, RN -MSN ACNP-BC Email: halli.carr@gmail.com Phone 214-277-3448 Evaluation of a Nurse Practitioner-driven pre-donor management clinical practice guideline Research Quantitative Upload Background: Transplantation has become the standard treatment for many patients with end-stage organ failure; however, lack of viable organs for transplantation in the U.S. results in an increased number of deaths among patients each year while waiting on the organ transplant list. Evidence suggests that the use of standardized pre-donor management guidelines increases the number of organs available for transplantation. Methods: All patients referred for potential organ donation at Baylor University Medical Center, an urban hospital, during a 3-year period (2014-2017). 1. Retrospective data was collected and the 22-month period prior to implementation of a nurse practitioner-driven clinical practice guideline was compared to the 22-month period following implementation of the guideline. 2. Comparisons were analyzed with descriptive statistics and nonparametric statistics. Results: 66 patients were evaluated during the 3-year period. 32 patients were included in the preimplementation group and 34 in the post-implementation group. 3. The average number of organs transplanted per donor increased from 3.125 to 3.94 after implementation. Time between referral and organ donation decreased by 1.1 days during the period following implementation. Conclusion: There is a significant increase in number of organs transplanted per donor and significant decrease in length of stay with the use of a nurse practitioner-driven pre-donor management clinical practice guideline. Track 8: Nurse Practitioner
Poster Presentation #9 Renate Hunter Email: rehunter@mednet.ucla.edu Phone 818-693-3638 Streamlining Workflow and Enhancing Patient Safety in the NICU Using 5S Methodology Research Qualitative Background: 1. Workplace clutter and lack of an organized supply system pose a problem in NICU settings, especially when critical supplies are needed during emergencies. 2. Dissatisfaction with the workplace environment is a major contributor to nurse stress and burnout. Nurses, respiratory therapists and physicians in our NICU were experiencing frustration with excess waste in the unit that was contributing to decreased productivity and delayed patient care. 3. Additionally, space needed to store high-risk low-volume items was limited due to the overabundance of items in the supply room. Method: The NICU staff recognized that process improvement was needed to streamline workflow, improve culture of safety and examine the financial impact of waste reduction. Using the lean principles of 5S Methodology, we tasked an interdepartmental team comprised of staff nurses, central supply and NICU management with downsizing non-essential inventory to create an efficient Visual Workplace. The 5S principles of Sort, Set in Order, Shine, Standardize and Sustain guided the intervention to improve profitability, efficiency, service and safety. The team navigated the process from assessment to inventory to intervention to standardization of practice with the ultimate goals of eliminating waste and enhancing productivity. Results: Work flow and efficiency, staff satisfaction and staff perception of culture of safety increased following implementation of the 5S project. 1. Staff verbalized their ease with locating critical supplies using a picture-based color-coded system. 2. The Staff floating to the NICU from other units were more comfortable with the environment and confident in their ability to locate needed equipment and supplies. 3. A cost analysis revealed that low usage items were actually 75% above par. Conclusion: 5S Methodology is an effective tool to prevent waste, streamline productivity and enhance patient safety in the clinical setting. Utilizing an interdepartmental team approach throughout the process leads to engagement in best practices and an investment in sustainability. Track 5: Innovations in Nursing Education
Poster Presentation #10 Heather Nolette Email:hnolette@cvph.org Phone: 1 (518) 314-3872 Does a "Track & Trigger" System Promote Timely Intervention? Research: Qualitative Purpose: To determine whether or not implementing a Track and Trigger System serves as a realtime predictive warning tool for decision support at the bedside. Rationale and Significance: Patients exhibit subtle physiological changes eight to twelve hours prior to a serious life-threatening event. Evidence shows that these subtle changes go undetected or not acted on in a timely manner. Care teams are failing to recognize, interpret, and respond to these changes. These are major causes for increased admissions to higher levels of care, increased length of stay, cardiac/respiratory arrest, or death. Methodology: An extensive literature review was conducted to survey timely interventions that Track and Trigger Systems initiate. The John Hopkins Model Research Evidence Appraisal Tool was utilized for systematically appraising, ranking, and synthesizing evidence. A pre and post go-live comparison of 2016 and 2017 data was collected. The number of code blues and transfers to higher level of care were examined. Findings: Three timely interventions were extracted; 1. Frequent vital sign monitoring, 2. Interdisciplinary communication, and 3. Activation of rapid response and/or physician consult. Four sustainability and three barrier themes also emerged from the literature. This led to the creation of the Sustainability Practice Model. Conclusions: Evidence supports implementing an automated Track and Trigger system because it serves as a predictive warning tool when appropriate guidelines are in place. Positive patient outcomes are correlated when barriers are addressed, effective interventions are acted upon, and a sustainably practice model is utilized during the lifecycle of the system. Recommendations for Future Study: These systems mandate continuous interdisciplinary engagement for proper management. A sustainability practice model is recommended throughout the life-cycle of the application. This model warrants further research due to the sustainability factor of the system. Track 11: Nursing Informatics