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Now showing 1 - 5 of 17

Recent Submissions

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    CAR-T Cell Therapy Educational Toolkit: A Quality Improvement Project to Increase Patient Understanding and Decrease Staff Stress
    (Creighton University, 2024-05-09) Wakefield, Samantha
    Purpose: The purpose of the project was to decrease staff stress and time spent in patient rooms, as well as increase patient understanding of the education, through the use of a CAR-T cell therapy toolkit. Background: Chimeric Antigen Receptor (CAR) T-Cell Therapy is where T cells attack cancer cells in one’s body after being genetically modified in a laboratory. CAR-T cell therapy is an extensive process where patients receive increased amounts of education. Staff spend much of their time educating patients, which has been shown to increase staff stress, time spent in patient rooms, and decrease patient understanding. Sample/Setting: The sample included providers/nurses employed within a Midwestern hospital-based outpatient clinical setting who are trained in outpatient practice and CAR-T cell therapy. The sample also included patients being cared for within this facility. Methods: Staff stress levels were assessed pre/post-implementation with the use of the Workplace Stress Scale (WSS). There were four additional questions added to the staff post-survey to ask questions that were tool-kit specific. Time logs assessed time (in minutes) that staff spent in patient rooms educating pre/post-implementation. Patients received a 17-question tool called the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) post-implementation. The tool interpreted patient’s understandability and actionability of the new material. Results: Time Log- The implementation of the videos reduced the time spent in patient rooms. Prior to implementation, staff spent significantly more time in patient rooms on day -5 compared to days -1 and 0. After implementation, there was no significant difference in time spent in patient rooms when comparing days -5, -1, and 0. Staff Survey- Implementation of the videos reduced perceived staff stress compared to the pre-implementation study phase. Responses to questions 9-12 were largely positive. Patient Survey- Patients, overall, perceived the videos as positive. Conclusion: The toolkit impacted both staff and patients positively. Levels of stress for staff members and time spent in patient rooms decreased, and patients reported their overall satisfaction levels with the toolkit as positive.
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    Improving Door-to-EKG Time in the Emergency Department: A Quality Improvement Project
    (Creighton University, 2024-04) Meissen, Kirsten
    Abstract Introduction: The American Heart Association recommends that patients who present to the emergency department with symptoms of acute coronary syndrome (ACS) should receive an electrocardiogram (EKG) within 10-minutes of their arrival. The purpose of this quality improvement (QI) project was to improve compliance of door-to-EKG (DTE) times in 10-minutes or less for patients who present to the emergency department with complaints associated with ACS symptoms. Design: Educating triage and first look nurses of ACS symptoms, reviewing the early EKG screening criteria, in addition to completing EKGs prior to the triage process, rather than after the triage process, was the change proposed in the effort of reaching this goal. This project followed the quality improvement method, which collected quantitative data from two eight week phases preceding and eight weeks following the implementation of the intervention. Outcomes: Findings revealed statistically significant improvement in DTE times. DTE times decreased over the course of the three phases of the project (F(2,816) = 41.84, p < .001, partial η2 = .09). DTE times were lower in the QI phase (Fall 2023) compared to both pre-QI phases. Discussion: The success of this quality improvement project demonstrated the significant impact these projects can have on improving DTE times.
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    Noninvasive Respiratory Support Strategies for Extremely Premature Neonates
    (Creighton University, 2024-05-09) Uram, Jamie
    Purpose: To implement a noninvasive respiratory support protocol, standards of practice, and an alternative, effective noninvasive respiratory support system for extremely premature neonates after birth and extubation to improve noninvasive respiratory support success. Background: Noninvasive respiratory support failure causes increased incidences of intubation, prolonged durations of invasive mechanical ventilation (IMV) usage, and poor outcomes. Improving provisions of noninvasive respiratory support decreases morbidities and mortality in this population. Sample/Setting: Extremely premature neonates born at less than 29 0/7 weeks gestational age managed in a Midwest level III NICU from May 2023 through January 2024. Methods: The implemented noninvasive respiratory support system offered the ability to follow a protocol which prioritized utilizing an occlusive mask and the Nasal Intermittent Positive Pressure Ventilation (NIPPV) noninvasive mode. The changes were implemented in the included neonates (n=14) after birth and after any extubation and outcomes were followed for 10 days after. Five neonates did not exclusively utilize the implemented noninvasive respiratory support system so a separate cohort of neonates (n=9) which did were stratified. Results: Significantly more neonates only required intubation for surfactant administration and IMV use less than 24 hours when exclusive utilization of the new noninvasive respiratory support occurred (t(8)=2.53, p<0.05). The number of intubations were significantly lower (t(13)=1.88, p<0.05; t(8)=2.45, p<0.05) even though rates of unplanned extubations were similar. Rates of noninvasive success after birth and after initial extubation attempts were significantly higher post-implementation (t(13)=2.48, p<0.05; t(8)=2.29, p<0.05) with lower cumulative durations of IMV usage post-implementation. Conclusion: The outcomes of neonates utilizing the implemented changes to noninvasive respiratory support provisions were shown to be effective in improving noninvasive success and providers moved to full adoption of the system. This project could serve as model to improve noninvasive success in extremely premature neonates and decrease associated morbidities.
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    Pneumococcal Disease in Patients with Diabetes– Increasing Vaccination Rates
    (Creighton University, 2024-05-09) Norman, Katelyn
    Background: Patients between the ages of 19-64 with diabetes are at an increased risk of contracting pneumococcal infections and experiencing associated complications. However, vaccination rates for this patient population remain below optimal levels. Purpose: This quality improvement project focused on increasing pneumococcal vaccination rates among patients aged 19 – 64 with diabetes, emphasizing the significance of vaccination as a preventive measure. It highlights the heightened risk of pneumococcal pneumonia in diabetic patients and the underutilization of vaccines in this group. The project aimed to boost vaccination rates through a 13-week quality improvement project at the Community Health Center of Yavapai County in Cottonwood, Arizona. Methods: A multi-faceted intervention was designed, which included (1) provider education sessions on the significance of pneumococcal vaccination for special population diabetic patients, (2) patient educational materials emphasizing the importance and safety of the vaccine, (3) decision tree algorithm for clinical staff to determine who qualifies for vaccination, and (4) a tracking form to track vaccination assessments and barriers. Results: The results demonstrate an increase in vaccination assessment, discussions, and administration within the target population. During the implementation period, there was a noticeable increase in the percentage of eligible patients being assessed for and offered the pneumococcal vaccine. The provider and patient education components of the intervention have been well-received. This project underscores the importance of targeted public health initiatives and customized interventions to enhance vaccine uptake in high-risk populations.
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    Utilizing Rolling Refresher Simulation to Enhance Skills for the Prevention of Respiratory Failure in the Pediatric Cardiac Intensive Care Unit
    (Creighton University, 2024-05-09) Norwood, Bethany
    Purpose: This quality improvement project (QI) evaluated the impact of repeated exposure to in-situ, simulation-based training on cardiac intensive care unit (CICU) staff’s time to appropriate intervention and performance of technical skills when responding to a simulated patient’s respiratory decompensation. Background: Respiratory failure is the most common cause of pediatric in-hospital cardiac arrest (IHCA). In 2022, the CICU at Children’s Hospital Colorado had a 47% increase in cardiac arrests compared to the prior year, with 55% occurring due to respiratory failure. Pediatric IHCA survival rate to discharge is 41%. Respiratory decompensation is often seen prior to a cardiac arrest. Retention of pediatric advanced life support (PALS) resuscitation skills and knowledge declines post-training with subsequent deviation from the American Heart Association’s (AHA) recommended guidelines during resuscitation events. Deviation from these guidelines results in poor patient outcomes. Setting: Children’s Hospital Colorado 22-bed CICU. Sample: 68 CICU RNs. Methods: Monthly rolling refresher in-situ simulations focusing on pediatric respiratory decompensation. RN performance was scored by time in seconds to initiate bagging and completion of critical interventions (calling for help, bagging at the recommended rate with appropriate technique). The simulation experiences were unannounced and occurred in an unoccupied CICU room during the RNs’ scheduled shift over a 3-month period. Results: RN participation declined from 58.8% (n=40) to 29.4% (n=20) during project implementation. Call for help had clinical significance with a completion increase of 15%. Time in seconds for participants to recognize and begin bagging the mannequin significantly improved (p<0.001) and the average time went from 63.1 seconds in the first month to 20.1 seconds by the last month. Conclusion: Exposure to rolling refreshers in-situ simulation training for CICU nurses appeared to improve adherence to the AHA-recommended pediatric resuscitation interventions and improved time in seconds to recognize and rapidly intervene in respiratory decompensation scenarios.