Paaskelind9975
The ICU diary is a cost-effective and efficient intervention to help patients and family members cope with the burden of critical illness.
The ICU diary is a cost-effective and efficient intervention to help patients and family members cope with the burden of critical illness.
Two evidence-based practice projects and an innovative model provided best evidence and a framework for the implementation and sustainment of a bedside shift report (BSR) quality improvement project.
Without a standardized BSR process, there was a lack of Veteran involvement in care planning decisions and nurse dissatisfaction related to missed communication of pertinent patient information.
Facilitators and barriers were identified and addressed during planning. Key elements of BSR were incorporated. After approval by shared governance, unit-based champions and leaders supported the change. Implementation began every 2 weeks on a different unit.
Implementation was completed in 4 months for 11 units. After 15 months, there was consistent BSR on 82% of the units and improved patient satisfaction with nurses taking time to listen.
Best evidence, unit-based champions, leadership support, project coordinators, and persistence are critical to implementing and sustaining practice change.
Best evidence, unit-based champions, leadership support, project coordinators, and persistence are critical to implementing and sustaining practice change.
A common complication of diabetes mellitus (DM) is diabetic retinopathy (DR).
An audit in a primary care office found that fewer than 50% of patients with DM received an annual ocular examination. The aim of this project was to increase timely annual ocular examinations among patients with type 2 DM to 85% within 90 days.
The model for improvement with 4 Plan-Do-Study-Act (PDSA) cycles was implemented in a rapid cycle format as well as changes in an electronic medical record (EMR) checklist and referral processes.
Interventions included team huddles and trainings, the Association of Diabetes Care and Education Specialists checklist with additional information about DR, an EMR checklist, and a logbook referral tracking process changes.
Of the patients referred during the project, 87% completed the ocular appointment, and the rate for patients with DM having annual ocular examinations increased from 48% to 86% meeting the current guideline of the American Diabetes Association.
Timely annual ocular examinations increased to 86% in 90 days, thus improving current DM treatment guidelines in primary care.
Timely annual ocular examinations increased to 86% in 90 days, thus improving current DM treatment guidelines in primary care.
Equivalent clinical outcomes, lower costs, and fewer invasive procedures have resulted in revised recommendations for the removal of peripheral intravenous catheters (PIVCs) from the traditional 72- to 96-hourly removal to removal based upon clinical indication.
Uptake of this evidence-based innovation to health systems is often delayed, in part due to the lack of a guiding framework for successful implementation strategies to guide systems to transition to and sustain clinically indicated PIVC removal.
We used the Consolidated Framework for Implementation Research (CFIR) to reflect on strategies likely important for the successful implementation of PIVC removal evidence into policy and practice.
We discuss and provide a critique of salient strategies for successful implementation of clinically indicated PIVC removal with regard to intervention characteristics, the outer and inner settings, characteristics of individuals, and implementation processes.
Successful implementation of clinically indicated PIVC removal can be achieved through planned and systematic processes within the CFIR framework.
Successful implementation of clinically indicated PIVC removal can be achieved through planned and systematic processes within the CFIR framework.
Peripheral intravenous catheter (PIVC) insertion is the most frequently used method for intravenous (IV) treatment in pediatric patients.
The aim of this study was to determine the effect of the Intravenous Infiltration Management Program on the success of PIVC insertion and infiltration in infants.
The study was carried out using a quasi-experimental design with pretest-posttest control groups and included 750 PIVC procedures for 218 infants between 28 days and 12 months of age.
The program decreased the number of PIVC insertions per patient, although it was not statistically significant (P = .076) and had an impact on the success of the PIVC attempt (P < .001), first PIVC attempt (P < .001), PIVC dwell time, and early detection of infiltration (P < .001).
The program is effective in the success of the PIVC insertion process and early detection of infiltration.
The program is effective in the success of the PIVC insertion process and early detection of infiltration.
Joseph is a 20-month-old boy who was thriving and developing well before a 4-day hospitalization for paralytic ileus at 11 months of age. Joseph is the first child born to parents who immigrated to the United States from Southeast Asia 3 years ago. check details Before the hospitalization, Joseph consumed 3 meals and 480 to 600 mL of milk daily. Oral feedings were restricted during the hospitalization with subsequent rejection of foods upon reintroduction of oral feeds. This resulted in 2 kg of weight loss by follow-up at 13 months. Joseph was referred to the multidisciplinary feeding and nutrition clinic at 16 months for failure to thrive, complicated by iron deficiency anemia and zinc deficiency. Joseph's feeding issues had negatively affected other aspects of his well-being; his development had stagnated, his sleep was fragmented (napping 5 times daily and frequent night waking attributed to hunger), and he had become withdrawn and irritable. By 16 months of age, Joseph was accepting only a couple of bites of solid foencies were corrected. Joseph made significant gains within 2 weeks of beginning to receive enteral nutrition. Initial improvement in weight gain (25 g daily over 2 wk, resulting in weight for age z score improving to -1.85) was rapid. Joseph regained ability to stand and began taking a few independent steps. He also acquired the ability to use one word spontaneously and appropriately. His sleep improved, his previously cheerful disposition returned, and he became much easier to engage. Unfortunately, at 20 months, Joseph's parents chose to have the NG tube removed, and his growth began to falter. What would be your next steps in Joseph's care?
