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Recent Submissions

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    Increasing Suicide Screening in a Pediatric Primary Care Clinic: A Quality Improvement Project
    (Creighton University, 2024-05-09) Cooper, Elizabeth
    Purpose: The purpose of this quality improvement (QI) project was to implement the use of the ASQ Toolkit and clinical pathway to identify and make referrals for adolescents at risk for suicide in a pediatric primary care clinic setting. Background: Mental health in adolescents is a rising concern in the U.S., with 4.1 million adolescents reported having major depressive episodes, and only 41.6% seeking care. Suicide is the 2nd leading cause of death for 15–24-year-olds in the U.S. Half of adolescents that committed suicide were seen by a provider within four weeks of their death. Population: Two pediatric nurse practitioners, one physician assistant, and two medical assistants in a pediatric in primary care clinic. Methods: The Ask Suicide-Screening Questions (ASQ) toolkit was utilized by administering the PHQ-9 and ASQ for adolescents ages 12 and above at well child visits upon arrival to the exam room Upon review by the best next steps were determined with the assistance of the NIMH pathway. An updated referral and resource list was also created. Results: Over an 8-week period, 48 of 49 patients were screened with both the PHQ-9 and ASQ. 6 or 7 high scoring patients were given referrals or resources. 12 patients were given resources or referrals for mental health care. All of the patients were properly billed and coded in the EHR. Staff satisfaction was high amongst all providers as a way to streamline care and have supportive guidelines.
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    Data collection for the identified patients occurred only once with the pre- or post-intervention data collection. Secondary data collection would only occur if the patient were to undergo a code status change again with another procedure during the same hospital stay while admitted to the identified units.
    (Creighton University, 2024-05-09) Golden, Natalie C.
    Discordant CPR continues to occur in hospitals across the U.S leading to undesirable patient health outcomes, patient dissatisfaction, and related legal and malfeasance difficulties. In hospitals where discordant CPR occurs, a gap in code status order versus action was identified. Many hospitals choose to invoke a Full code status prior to patients undergoing procedure or surgery in contrast to the patient’s elected code status of MDNR or DNR. After procedure, the code status is not returned to the original order and discordant CPR can occur. An intervention was introduced using a smartphrase in the EMR. The intervention alerted providers to evaluate the code status order and return to the original order when appropriate. An increase in return to original code status order post- procedure was achieved. No discordant CPR events occurred for those patients whose code status order was not returned to the original.
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    Treatment of Anxiety and Depression in Primary Care: Reducing Barriers to Access
    (Creighton University, 2024-05) Kane, Mallory
    Purpose: The purpose of this quality improvement project was to develop and implement a standardized follow-up plan for all adult patients with anxiety and/or depression who were newly being referred to a counseling center by their primary care provider. Background: The majority of mental health disorders, specifically anxiety and depression, are treated by primary care providers. They identify patients who need referral to mental health specialists. Sample/Setting: The setting was within pod 5 of the family practice department of large semi-rural, multi-tenant medical center in Hudson, Wisconsin. The sample included 4 family practice physicians & two-family nurse practitioners, the medical assistants within pod 5, & Hudson Medical Center’s referral team. Methods: Key outcomes included the percentages of patients receiving handouts on local mental health services, 2-week follow up calls, and clinic notifications from counseling centers. A post-survey assessed the referral team's perception of sustainability. Results: 20 adult patients participated (65% men, 35% women). Ages ranged from 18 to 85 years. Diagnosis: 25% depression, 30% anxiety, 45% both. All patients received mental health service handouts. 40% had follow-up within 2 weeks; 60% after 2 weeks. 40% successfully scheduled outpatient mental health appointments. 37.5% of successful participants had notification letters sent to counseling center. Reasons for declining referrals: lack of time, interest, cost concerns, personal situations. Post-survey themes from referral team: lack of time, insurance issues, patient non-compliance, long wait times. Conclusion: This project sheds light on the challenges and successes of implementing a standardized follow-up plan for mental health referrals within a primary care setting, underscoring the importance of addressing barriers to optimize patient care.
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    Increasing Digital Outreach to Promote Early Initiation of Discharge Education for Families in the Cardiac PICU
    (Creighton University, 2024-05) St. John, Isabelle
    Background: Caregivers of patients with congenital heart disease (CHD) who have never been home before require extensive discharge education to promote positive outcomes. Discharge teaching should be started early, incorporate technology, and provide caregivers with unlimited access to educational materials. Currently, at a large Midwestern pediatric research hospital, discharge teaching for this population is being postponed until late in a patient’s admission, and caregivers cannot access discharge education materials unless they are at the bedside. The result is an overwhelming discharge education process for families. Purpose: The Digital Care Activity (DCA) is a new application within the electronic health record (EHR) at this hospital that provides caregivers with unlimited access to educational materials. The purpose of this project is to evaluate the effectiveness of the DCA as a tool to promote early initiation of discharge teaching for patients with CHD who have never been home before. Methods: This study was implemented over a 14-week period in the hospital’s 24-bed CICU. Bedside nurses were educated on how to assign caregivers the required Infant CPR and Safe Sleep discharge education via the DCA. The DCA sample (n=9) was comprised of patients who had never been home before who were admitted to the CICU during the implementation period. The pre-DCA sample (n=9) was comprised of patients from the same population who were admitted before the DCA was a part of the EHR. A retrospective chart review was completed to compare the average number of days from the date a patient was extubated to the date that discharge education was first documented. The averages were compared between the samples to state on average, how many days earlier discharge education was initiated for families who received education with the DCA versus families who did not. Results: In the pre-DCA sample, there was an average of 21 days from extubation to Infant CPR education initiation, and an average of 16 days from extubation to Safe Sleep education initiation. There was an average of 2.1 days from extubation to both Infant CPR and Safe Sleep education initiation in the DCA sample. Caregivers received Infant CPR education 90% earlier (p<0.05) and Safe Sleep education 86.9% earlier (p>0.05) in their child’s admission when nurses used the DCA to assign education. Conclusions: Using the DCA was successful in helping nurses initiate discharge teaching earlier in a patient’s admission, supporting a more evidence-based approach to discharge teaching on the unit. This study will act as a catalyst for future quality improvement studies to further refine the discharge education process in this hospital’s CICU.
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    The Revolution is Religious: Religion, Peace, and New Public Spheres in Colombia
    (Rabbi Myer and Dorothy Kripke Center, Creighton University, 2024) Bartel, Rebecca C.; Duque, Katerine Alejandra Duque
    This article considers the construction of new and alternative publics in Colombia following the 2016 Peace Accords. Through practices of reconciliation based on collective economic practices, and the moral imperatives that motivate them, this paper traces the discourses and practices of belief that sustain the possibility of peaceful publics in Colombia. Specifically, this essay considers the ways new publics and counter-subjectivities are being created, among others, by communities of victims and former guerrilla combatants in the southwestern region of Colombia. These initiatives to “create anew” emerge as strategies to generate innovative social, political and, above all, economic relations aimed at territorial restoration amid ongoing violence, and to further generate conditions of peacebuilding. Whereas civil wars annihilate the plural public sphere, peace requires multiple publics that are committed to reimagined social relations and economic structures that serve the public good, and guarantee that debate, conflict, disagreement, and negotiation can occur without the use of violence.