Impact of Remote Patient Monitoring Program on Perceived Levels of Diabetes Knowledge
Identification: P44
This study assesses the impact of a remote patient monitoring (RPM) program on diabetic patients’ perception of their diabetes knowledge. This study also examines if there is a difference in perceived levels of diabetes knowledge between patients younger than 65 years and patients who are 65 and older. The growing diabetic epidemic in the United States has created additional chronic health problems and increased health care costs. To manage a complex disease such as diabetes, knowledge of disease processes and confidence to perform the recommended health care management tasks are vital for patients. Inadequate perception of knowledge often leads to the inability to complete tasks, process new information, or make proper judgments (Ziegler & Montplaisir, 2017). The learning for this presentation includes the effect of the 90-day RPM program on all participants’ perceived levels of diabetes knowledge and the effect of the 90-day RPM program on participants who are 65 and older versus those under 65 regarding their perceived levels of diabetes knowledge. Patients who participated in a 90-day RPM program conducted between June 2019 and August 2020 completed perceived diabetes knowledge questions before and after their RPM program experience. This study is a retrospective secondary analysis of perceived diabetes knowledge responses to a subset of the Robert Wood Johnson Foundation Diabetes Knowledge Assessment Questionnaire. Descriptive statistics were used to analyze continuous variables. Total and percentages were used for categorical variables. The paired t-test was used to analyze within-group differences between pre-program and post-program perceived levels of diabetes knowledge. The Mann Whitney U test was used to analyze the differences in perceived levels of diabetes knowledge between the two age populations participating in the RPM program. 37 diabetic patients (male 43.2 %, female 56.8%; 32.4% white, 67.6% African-American; 86.5%
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Electronic Health Record (EHR) in Ambulatory Care: A Virtual Training Toolkit
Identification: P45
Purpose: This project was supported by the CARES Act supplemental funding for NEPQR awardees, enhanced telehealth training opportunities for bachelor of science in nursing (BSN) students to prevent, prepare, and respond to COVID-19 in a large academic university.
Background/significance: This project evaluated how exposure to an e-learning module and virtual simulation course on the electronic health record (EHR) inbox management in the ambulatory care setting supports preparation to address the needs arising from COVID-19. This course was implemented in pre-licensure nursing curricula during a nursing clinical course in fall 2020 quarter.
Methods: A mixed methods qualitative and quantitative survey was used to evaluate the effectiveness of an educational intervention on a sample of 80 BSN nursing students. This project focused on educating students on EHR inbox prioritization, telephone triage, and team communication in a two-part simulation format. Students took a self-paced interactive virtual inbox simulation (part 1) online and continued the course in a scheduled virtual class via the Zoom platform to complete (part 2) of the simulation content. Information was collected using an anonymous voluntary Google forms survey at the end of the course. Students were asked multiple choice questions related to the learning objectives and rated the system usability using a modified system usability scale (SUS) to measure generic product usability along with a free text qualitative question.
Results: Among those who entered the study (N=83), 41.2%, (N=35) participants completed all of the survey measures. Response was double the goal of 20% participation. Preliminary data suggests that learning objectives were overwhelmingly met. The majority of students strongly agreed (N=, 88.5%) that they are able to “describe the role of the nurse in managing and responding to patient messages received through electronic communication.” (N=85.71%) strongly agree that they are better able to “prioritize messages using the nursing process an emphasizing patient safety.” (N=77.14%) report “I better understand how ambulatory care nurses use the inbox” and (N=80%) report “I feel my knowledge and skills with the EHR have improved.” When students were asked if the simulation helped them understand how to “engage the health care team as needed to delegate tasks (to medical assistants or LPNs) or seek provider input as appropriate.” (N=57%) strongly agreed and (N=34%) somewhat agreed, indicating a need for further education in this area. Students reported usability data with (N=77%) stating “I feel the module was easy to navigate,” and (N=82.85%) indicated “I found the various functions in the module were well integrated.” The free-text question “How do you imagine you will use the concepts learned in this simulation in your work as a nurse?” received a (N= 68.57%) response and indicated that the SOAP documentation technique and SBAR exercises during the virtual simulation were valuable to the majority of respondents.
Conclusions and implications: This research highlights the need further education on the electronic tools that facilitate patient assessment, team communication, and proper documentation in the electronic health record. This study may form as a guide for future education for ongoing nursing clinical courses.
Background/significance: This project evaluated how exposure to an e-learning module and virtual simulation course on the electronic health record (EHR) inbox management in the ambulatory care setting supports preparation to address the needs arising from COVID-19. This course was implemented in pre-licensure nursing curricula during a nursing clinical course in fall 2020 quarter.
Methods: A mixed methods qualitative and quantitative survey was used to evaluate the effectiveness of an educational intervention on a sample of 80 BSN nursing students. This project focused on educating students on EHR inbox prioritization, telephone triage, and team communication in a two-part simulation format. Students took a self-paced interactive virtual inbox simulation (part 1) online and continued the course in a scheduled virtual class via the Zoom platform to complete (part 2) of the simulation content. Information was collected using an anonymous voluntary Google forms survey at the end of the course. Students were asked multiple choice questions related to the learning objectives and rated the system usability using a modified system usability scale (SUS) to measure generic product usability along with a free text qualitative question.
Results: Among those who entered the study (N=83), 41.2%, (N=35) participants completed all of the survey measures. Response was double the goal of 20% participation. Preliminary data suggests that learning objectives were overwhelmingly met. The majority of students strongly agreed (N=, 88.5%) that they are able to “describe the role of the nurse in managing and responding to patient messages received through electronic communication.” (N=85.71%) strongly agree that they are better able to “prioritize messages using the nursing process an emphasizing patient safety.” (N=77.14%) report “I better understand how ambulatory care nurses use the inbox” and (N=80%) report “I feel my knowledge and skills with the EHR have improved.” When students were asked if the simulation helped them understand how to “engage the health care team as needed to delegate tasks (to medical assistants or LPNs) or seek provider input as appropriate.” (N=57%) strongly agreed and (N=34%) somewhat agreed, indicating a need for further education in this area. Students reported usability data with (N=77%) stating “I feel the module was easy to navigate,” and (N=82.85%) indicated “I found the various functions in the module were well integrated.” The free-text question “How do you imagine you will use the concepts learned in this simulation in your work as a nurse?” received a (N= 68.57%) response and indicated that the SOAP documentation technique and SBAR exercises during the virtual simulation were valuable to the majority of respondents.
Conclusions and implications: This research highlights the need further education on the electronic tools that facilitate patient assessment, team communication, and proper documentation in the electronic health record. This study may form as a guide for future education for ongoing nursing clinical courses.
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Undergraduate Nursing Students and Telehealth Competency in COVID-19 Triage: Learning from Actors in Virtual Simulation
Identification: P46
Objective: In this presentation, we describe the process of using standardized patients (SPs) during a virtual telehealth-enabled COVID-19 triage simulation in a pre-licensure nursing program, and the effectiveness of the simulation on the students’ confidence and competence.
Background: Simulation-based learning experiences (SBLEs) have long-been recognized as an effective educational tool in BSN education (Aebersold, 2018). The addition of standardized patients (SPs) who have training in providing the most realistic possible scenario adds additional benefit to the simulation experience. SPs have been used extensively in medical education and more recently in nursing education (Speeney, Kameg, Cline, Szpak, & Bagwell, 2018).
For this simulation, the university school of nursing collaborated with the school of medicine to obtain actors who had served as SPs in their program. These actors were provided with the script for the simulation well in advance, and provided a level of realism not possible when those roles were played by faculty or non-professional volunteers.
Funding for the use of SPs was provided to the school of nursing through a supplemental grant by the Health Resources and Services Administration to strengthen telehealth training to address COVID-19 care in primary care. Use of telehealth and COVID-19 triage protocol via virtual simulation is one way for nursing schools to prepare nurses to provide telehealth-enabled COVID-19 care to the community.
Method: 89 students in an ambulatory care course during the last semester of their pre-licensure bachelor of science in nursing degree program participated in a 2.25-hour virtual telehealth simulation. The course faculty modified a previous telephone triage in-person simulation to include a COVID-19 exposure scenario and added a team of actors who were experienced simulation educators to act as SPs. These SPs were provided with the script and background information for their role, and after each individual simulation they offered feedback to the participating students.
Using Zoom as a virtual learning platform, learners participated in a 45-minute pre-briefing, where they learned about the use of telehealth in nursing practice and about COVID-19 telephone triage and care protocol (CDC, 2020). They then participated in a 30-minute, one-on-one simulation with the SPs in a Zoom breakout room, including feedback from SPs and faculty, before joining a one-hour structured debriefing session. Change in the learners’ knowledge and confidence in providing telehealth-enabled COVID-19 care was measured with a 19-item pre- and post-survey.
Outcomes: The students completed a pre- and post-simulation survey assessment of their perceived confidence and competence in telehealth encounters related to COVID. These included question items such as confidence in assessment, triage, treatment and referral, patient education, and other factors. Analysis of the survey results indicates that the students perceived a significant increase in both confidence and competence in managing clients with possible COVID infection through a telehealth platform. Comments were generally positive about the experience.
Conclusion: The use of SPs provided a consistency in delivery of the telehealth simulation experience, and the structure and delivery of the simulation improved the students’ perceived confidence and competence in telehealth delivery of COVID care.
Background: Simulation-based learning experiences (SBLEs) have long-been recognized as an effective educational tool in BSN education (Aebersold, 2018). The addition of standardized patients (SPs) who have training in providing the most realistic possible scenario adds additional benefit to the simulation experience. SPs have been used extensively in medical education and more recently in nursing education (Speeney, Kameg, Cline, Szpak, & Bagwell, 2018).
For this simulation, the university school of nursing collaborated with the school of medicine to obtain actors who had served as SPs in their program. These actors were provided with the script for the simulation well in advance, and provided a level of realism not possible when those roles were played by faculty or non-professional volunteers.
Funding for the use of SPs was provided to the school of nursing through a supplemental grant by the Health Resources and Services Administration to strengthen telehealth training to address COVID-19 care in primary care. Use of telehealth and COVID-19 triage protocol via virtual simulation is one way for nursing schools to prepare nurses to provide telehealth-enabled COVID-19 care to the community.
Method: 89 students in an ambulatory care course during the last semester of their pre-licensure bachelor of science in nursing degree program participated in a 2.25-hour virtual telehealth simulation. The course faculty modified a previous telephone triage in-person simulation to include a COVID-19 exposure scenario and added a team of actors who were experienced simulation educators to act as SPs. These SPs were provided with the script and background information for their role, and after each individual simulation they offered feedback to the participating students.
Using Zoom as a virtual learning platform, learners participated in a 45-minute pre-briefing, where they learned about the use of telehealth in nursing practice and about COVID-19 telephone triage and care protocol (CDC, 2020). They then participated in a 30-minute, one-on-one simulation with the SPs in a Zoom breakout room, including feedback from SPs and faculty, before joining a one-hour structured debriefing session. Change in the learners’ knowledge and confidence in providing telehealth-enabled COVID-19 care was measured with a 19-item pre- and post-survey.
Outcomes: The students completed a pre- and post-simulation survey assessment of their perceived confidence and competence in telehealth encounters related to COVID. These included question items such as confidence in assessment, triage, treatment and referral, patient education, and other factors. Analysis of the survey results indicates that the students perceived a significant increase in both confidence and competence in managing clients with possible COVID infection through a telehealth platform. Comments were generally positive about the experience.
Conclusion: The use of SPs provided a consistency in delivery of the telehealth simulation experience, and the structure and delivery of the simulation improved the students’ perceived confidence and competence in telehealth delivery of COVID care.
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Redesigning Primary Care in a Virtual World
Identification: P47
Purpose: The purpose of this quality improvement (QI) scholarly project is to describe primary care nurses’ (PCNs) utilization of telehealth in the primary care setting by evaluating a training program for PCNs that supports best practices and promotes efficient care delivery. The sudden onset of the COVID-19 pandemic led to the rapid implementation of telehealth technology in primary care settings, leaving clinicians to quickly adapt essential functions of care delivery with minimal education and training. Telehealth technology provides a cost-effective, efficient alternative for patients to access care from a distance, promoting delivery of the right care, to the right patient, at the right time. Given that telehealth has become a key component of care delivery, understanding PCNs’ perception of telehealth, as well as providing appropriate training, may influence utilization practices in the future. The Learning Objectives are to 1) describe telehealth for primary care delivery, focusing on PCNs and 2) explore PCNs utilization of telehealth to address patient education and integration of telehealth skills and knowledge into practice.
Description: This QI project utilizes a plan-do-study-act framework and will be performed at a non-profit, primary care organization, recognized as a leader in the field of primary care. The project consists of two phases. First, a comparison analysis of PCNs’ telehealth utilization rates, both pre- and post-educational training, will be completed through electronic medical record review to establish baseline and post-implementation criteria. Second, a web-based survey will explore the telehealth practices and program satisfaction among PCNs working in internal medicine for at least one year who participated in a telehealth training program. The survey will be developed and evaluated by a group of expert nurses for content validity, with refinements based on feedback. The final survey will be disseminated through Qualtrics, a web-based program. Descriptive statistics will be used to describe survey results, and free text data will be consolidated into themes regarding suggested recommendations for improving telehealth services.
Evaluation/outcome: This project is currently in progress with expected completion by January 2021. Results will be compiled into an executive summary and professional presentation to be shared among stakeholders consisting of nurses, physicians, and administrative leadership. Results will outline the educational experience and gaps influencing telehealth utilization practices and provide recommendations for future educational and training programs. Through appropriate education and training, PCNs may successfully integrate telehealth practices to positively impact access to care and overall patient outcomes as telehealth care delivery becomes universally available to patients. Better understanding telehealth utilization may serve as a template for other disciplines and care team members across the organization, increasing the value of care to patients.
Description: This QI project utilizes a plan-do-study-act framework and will be performed at a non-profit, primary care organization, recognized as a leader in the field of primary care. The project consists of two phases. First, a comparison analysis of PCNs’ telehealth utilization rates, both pre- and post-educational training, will be completed through electronic medical record review to establish baseline and post-implementation criteria. Second, a web-based survey will explore the telehealth practices and program satisfaction among PCNs working in internal medicine for at least one year who participated in a telehealth training program. The survey will be developed and evaluated by a group of expert nurses for content validity, with refinements based on feedback. The final survey will be disseminated through Qualtrics, a web-based program. Descriptive statistics will be used to describe survey results, and free text data will be consolidated into themes regarding suggested recommendations for improving telehealth services.
Evaluation/outcome: This project is currently in progress with expected completion by January 2021. Results will be compiled into an executive summary and professional presentation to be shared among stakeholders consisting of nurses, physicians, and administrative leadership. Results will outline the educational experience and gaps influencing telehealth utilization practices and provide recommendations for future educational and training programs. Through appropriate education and training, PCNs may successfully integrate telehealth practices to positively impact access to care and overall patient outcomes as telehealth care delivery becomes universally available to patients. Better understanding telehealth utilization may serve as a template for other disciplines and care team members across the organization, increasing the value of care to patients.
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
The Impact of an Education Bundle on Patient Utilization of the Online Portal System and Associated Smartphone Application
Identification: P48
Purpose: The purpose of this project is to evaluate the effectiveness of an education bundle on increasing patient knowledge and utilization of the portal system by patients seeking care in federally qualified health centers (FQHCs).
Background/significance: Patient utilization of portal systems continues to be low despite widespread availability (Zhao et al., 2017). In 2017, patient self-reported use of portal systems was only 28% in the United States (Grossman et al., 2019). Lack of knowledge, computer skills, and internet access, along with privacy concerns, patient demographics, and lack of provider buy-in, are potential barriers to utilization of portal systems (Zhao et al., 2017). Underserved populations, such as individuals of low socioeconomic status, racial/ethnic minorities, those with chronic illnesses and/or disabilities, and the elderly, often have decreased levels of health literacy and are less likely to use patient portal systems (Grossman et al., 2019). Use of the portal system may lead to increased health literacy and help to overcome some of the barriers to achieving health equity in these populations (Grossman et al., 2019). Prior research on this topic is limited and excludes Spanish-speaking patients. Effective strategies to increase utilization of portal systems in underserved populations are needed and can potentially be addressed with implementation of bundled education interventions.
Methods: To increase patients’ knowledge and use of the portal system, researchers created and implemented an education bundle at two rural FQHCs providing care to underserved populations, in which approximately 16% of the population is best served in a language other than English. The bundle consists of staff/provider in-services, training of a portal resource staff person at each site, instructional videos on the clinics’ website, informational and instructional brochures, and informational flyers posted in patient rooms and at registration. All patient educational materials are in English and Spanish.
To assess effectiveness of the education bundle on increasing use of the portal system, researchers will compare the number of medication refill requests 4 months prior to and 4 months after implementation of the education bundle. Additionally, researchers will review results of an anonymous portal system patient satisfaction survey collected by the clinics during the spring of 2020 and conduct a voluntary follow-up patient satisfaction survey 4 months after implementation of the education bundle. The survey will be available in both English and Spanish.
Results: Data collection and analysis for this project are ongoing and will be completed in January 2021 and included on the poster presentation if invited to participate. Descriptive statistics and independent group tests will be used. Based on the level of measurement for the data analyzed, Chi-square test will be used. General comparisons of the aggregate data percentages will be used to evaluate clinical significance.
Conclusions/implications: This study aims to determine the effectiveness of an education bundle on increasing patient knowledge and use of the portal system. The results can potentially be used to support the continued use of an education bundle to inform patients of portal systems and their functions and increase access for English- and Spanish-speaking patients.
Background/significance: Patient utilization of portal systems continues to be low despite widespread availability (Zhao et al., 2017). In 2017, patient self-reported use of portal systems was only 28% in the United States (Grossman et al., 2019). Lack of knowledge, computer skills, and internet access, along with privacy concerns, patient demographics, and lack of provider buy-in, are potential barriers to utilization of portal systems (Zhao et al., 2017). Underserved populations, such as individuals of low socioeconomic status, racial/ethnic minorities, those with chronic illnesses and/or disabilities, and the elderly, often have decreased levels of health literacy and are less likely to use patient portal systems (Grossman et al., 2019). Use of the portal system may lead to increased health literacy and help to overcome some of the barriers to achieving health equity in these populations (Grossman et al., 2019). Prior research on this topic is limited and excludes Spanish-speaking patients. Effective strategies to increase utilization of portal systems in underserved populations are needed and can potentially be addressed with implementation of bundled education interventions.
Methods: To increase patients’ knowledge and use of the portal system, researchers created and implemented an education bundle at two rural FQHCs providing care to underserved populations, in which approximately 16% of the population is best served in a language other than English. The bundle consists of staff/provider in-services, training of a portal resource staff person at each site, instructional videos on the clinics’ website, informational and instructional brochures, and informational flyers posted in patient rooms and at registration. All patient educational materials are in English and Spanish.
To assess effectiveness of the education bundle on increasing use of the portal system, researchers will compare the number of medication refill requests 4 months prior to and 4 months after implementation of the education bundle. Additionally, researchers will review results of an anonymous portal system patient satisfaction survey collected by the clinics during the spring of 2020 and conduct a voluntary follow-up patient satisfaction survey 4 months after implementation of the education bundle. The survey will be available in both English and Spanish.
Results: Data collection and analysis for this project are ongoing and will be completed in January 2021 and included on the poster presentation if invited to participate. Descriptive statistics and independent group tests will be used. Based on the level of measurement for the data analyzed, Chi-square test will be used. General comparisons of the aggregate data percentages will be used to evaluate clinical significance.
Conclusions/implications: This study aims to determine the effectiveness of an education bundle on increasing patient knowledge and use of the portal system. The results can potentially be used to support the continued use of an education bundle to inform patients of portal systems and their functions and increase access for English- and Spanish-speaking patients.
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Patients Negotiating Their Emergency Room Disposition in Primary Care
Identification: P49
Purpose: Recent US data (2017) has the hospitalization rate from the emergency room (ER) at 10.4%, continuing attention on the overuse of the ER for symptoms that could be managed cost-efficiently in primary care. The purpose of this evidence-based practice (EBP) quality improvement project was to strengthen the effectiveness of telephone triage nurses’ use of protocols in advising the ER disposition to primary care patients with emergent symptoms.
Description: A centralized team of 17-20 telephone triage nurses receive an average of 250 daily calls from patients seen at seven family practice and internal medicine offices. Patients call triage nurses, who use a symptom-appropriate, evidence-based pediatric (Schmitt) or adult (Thompson) protocol, embedded in EPIC, to generate a disposition, one of which is advising to go to the ER.
Triage administration responded to an internal leadership question about triage nurses appropriately sending patients to ER, resulting in the identified need for a EBP project to address how nurses use the protocols to generate an ER disposition and how the patients respond to the ER advice. A review of telephone triage research found variable results, for example, appropriateness of a triage decision ranged 44-98% and patients’ response ranged 56-98%.
The project planned to first ascertain how the triage nurses used the protocols to advise ER to patients and how the patients responded (time 1), to give an educational update on protocol use at a monthly staff meeting and then one month later to evaluate the nurses’ performances and patients’ responses (time 2). Five items measured steps in protocol use; these are consistent with instructions from the Schmitt and Thompson references. The hospital’s institutional review board approved this project.
Evaluation/outcome: EPIC queries for patients with an ER disposition were done for a 15-day period in in October 2019 (time 1) and in February 2020 (time 2); from each, a random sample was drawn. Trained nurses conducted charts audits on 114 patients for both times. Patients were predominately English-speaking, female, mean age 55, 51, with private insurance, and were 54%, 52% white, 26%, 31% Hispanic, 10%, 11% black (time 1, time 2).
At time 1, triage nurses scored 74%-91% across the five protocol use items; at time 2, after the educational update, improved to 89%-98%. For time 1, 70% of nurses advised the ER to patients; at time 2 89% did. Provider agreement with the protocol-generated ER disposition was 55% at both times; this reflects a negotiation between patients and providers, through triage nurses, after patients told nurses they did not want to go to ER. This negotiation ended with 59% of patients agreeing with either the protocol-generated ER disposition or with the negotiated provider’s disposition at time 1; 73% at Time 2. At time 1, 49 patients (43%) went to the ER, compared to 53 patients (46%) at Time 2. For time 1, the 28.6% hospitalization rate from ER (14 patients) is higher the hospital’s 2018-2019 rate of 15.2% and the US 2017 rate of 10.4%; time 2 rate was 16.9% (9 patients).
Description: A centralized team of 17-20 telephone triage nurses receive an average of 250 daily calls from patients seen at seven family practice and internal medicine offices. Patients call triage nurses, who use a symptom-appropriate, evidence-based pediatric (Schmitt) or adult (Thompson) protocol, embedded in EPIC, to generate a disposition, one of which is advising to go to the ER.
Triage administration responded to an internal leadership question about triage nurses appropriately sending patients to ER, resulting in the identified need for a EBP project to address how nurses use the protocols to generate an ER disposition and how the patients respond to the ER advice. A review of telephone triage research found variable results, for example, appropriateness of a triage decision ranged 44-98% and patients’ response ranged 56-98%.
The project planned to first ascertain how the triage nurses used the protocols to advise ER to patients and how the patients responded (time 1), to give an educational update on protocol use at a monthly staff meeting and then one month later to evaluate the nurses’ performances and patients’ responses (time 2). Five items measured steps in protocol use; these are consistent with instructions from the Schmitt and Thompson references. The hospital’s institutional review board approved this project.
Evaluation/outcome: EPIC queries for patients with an ER disposition were done for a 15-day period in in October 2019 (time 1) and in February 2020 (time 2); from each, a random sample was drawn. Trained nurses conducted charts audits on 114 patients for both times. Patients were predominately English-speaking, female, mean age 55, 51, with private insurance, and were 54%, 52% white, 26%, 31% Hispanic, 10%, 11% black (time 1, time 2).
At time 1, triage nurses scored 74%-91% across the five protocol use items; at time 2, after the educational update, improved to 89%-98%. For time 1, 70% of nurses advised the ER to patients; at time 2 89% did. Provider agreement with the protocol-generated ER disposition was 55% at both times; this reflects a negotiation between patients and providers, through triage nurses, after patients told nurses they did not want to go to ER. This negotiation ended with 59% of patients agreeing with either the protocol-generated ER disposition or with the negotiated provider’s disposition at time 1; 73% at Time 2. At time 1, 49 patients (43%) went to the ER, compared to 53 patients (46%) at Time 2. For time 1, the 28.6% hospitalization rate from ER (14 patients) is higher the hospital’s 2018-2019 rate of 15.2% and the US 2017 rate of 10.4%; time 2 rate was 16.9% (9 patients).
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
The Use of Web-Based Health Education among Safety-Net Ambulatory Care Clinic Adult Diabetic Patients
Identification: P50
Background: A large public safety-net hospital system implemented a web-based video education program to improve chronic disease management outcomes. Using animation and a calm engaging voice, the program explains complex medical information and directs patients on making healthy lifestyle choices and decisions regarding their care. Patients receive notification that web-based education has been ordered for them either verbally by a care team member, on an after-visit summary, or through the organization’s patient portal. The video is then accessed via smartphone, tablet, laptop, or desktop computer. If the video is not accessed by the patient or caregiver within 6-8 weeks, the order expires and is no longer available. Initial evaluations of the initiative found that patients who completed the web-based education reported the program: “helped them manage their health”, “answered questions they would have called their doctor to discuss,” and “motivated them to change their lifestyles.” However, the video programs were viewed by a very small number of patients and little was known about the profile or demographic make-up of the patients who were most likely to complete the videos. Without this information, determining how to reach the most complex patients is a difficult task.
Purpose: To identify factors associated with the use of an online, web-based health education program among diabetic patients at five ambulatory care clinics of a large public safety-net hospital system.
Methodology: A retrospective chart review of the electronic health record was conducted. Diabetic patients who had active orders for the web-based programs were identified on patient registries.
Analysis: Mean, frequencies, and percentages were calculated to the describe sample. Chi square, t-tests, ANOVA, and multiple regression were used to answer the research questions.
Results: N=300. Only 5.3% (16) patients completed the diabetes type 2 education video, and 9.3% (28) completed the diabetic eye exam education video. Patients who completed a web-based video more likely to be younger, caucasian, living outside of inner-city core, and users of the organization’s patient portal; they were also more likely to complete their annual diabetic eye exam. No association between the completion a web-based video and gender, number of clinic visits, number or type of co-morbid conditions, or medical insurance. Use of patient portal was the most predictive variable for completing at least one web-based video, completion of diabetic eye exams, and improving hemoglobin A1c.
Conclusion: The use of eHealth technology has great potential to empower patients to take a more active role in managing their health conditions and ultimately achieving improved health outcomes as seen with the results related to diabetes management in this study. To maximize the positive impact of eHealth and web-based disease management support tools, health care organizations must consider barriers to the use of these tools. Future research will focus on strategies to address issues of access to digital devices, eHealth literacy deficits, and varying comfort levels with the use of the evolving technology.
Learning outcome: Describe factors influencing use of technology for patient education at a large public safety-net hospital system.
Purpose: To identify factors associated with the use of an online, web-based health education program among diabetic patients at five ambulatory care clinics of a large public safety-net hospital system.
Methodology: A retrospective chart review of the electronic health record was conducted. Diabetic patients who had active orders for the web-based programs were identified on patient registries.
Analysis: Mean, frequencies, and percentages were calculated to the describe sample. Chi square, t-tests, ANOVA, and multiple regression were used to answer the research questions.
Results: N=300. Only 5.3% (16) patients completed the diabetes type 2 education video, and 9.3% (28) completed the diabetic eye exam education video. Patients who completed a web-based video more likely to be younger, caucasian, living outside of inner-city core, and users of the organization’s patient portal; they were also more likely to complete their annual diabetic eye exam. No association between the completion a web-based video and gender, number of clinic visits, number or type of co-morbid conditions, or medical insurance. Use of patient portal was the most predictive variable for completing at least one web-based video, completion of diabetic eye exams, and improving hemoglobin A1c.
Conclusion: The use of eHealth technology has great potential to empower patients to take a more active role in managing their health conditions and ultimately achieving improved health outcomes as seen with the results related to diabetes management in this study. To maximize the positive impact of eHealth and web-based disease management support tools, health care organizations must consider barriers to the use of these tools. Future research will focus on strategies to address issues of access to digital devices, eHealth literacy deficits, and varying comfort levels with the use of the evolving technology.
Learning outcome: Describe factors influencing use of technology for patient education at a large public safety-net hospital system.
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Injection Site Selection – Changing Practice
Identification: P17
Aim: STOP the use of the dorsogluteal site for intramuscular injections by the ambulatory nurses. The nurses reported they were using the unapproved dorsogluteal intramuscular site (Lippincott, 2019). The nurses' rationale for the site selection was due to patient requests and the nurses’ discomfort using the ventrogluteal and vastus lateralis injection sites. The literature reported similar findings. Of reporting nurses, 35.9% were uncomfortable using the ventrogluteal site (Sari, Sahin, Yasar, Taskiran, & Telli, 2017). The targeted group for the change of practice were nurses who administered testosterone and ceftriaxone injections. Testosterone was given by over 190 nurses in 15 nurse-run clinics. Ceftriaxone was given by over 220 nurses in the 22 back offices for primary care, urgent care, and specialty care.
Methods: The quality improvement project used the knowledge-to-action framework (Graham et al., 2006), which focused on leadership support of the goal, use of audits, feedback, and content expertise. The audits were released monthly to the managers with the names of those staff who did not select the correct injection site. The managers used the audits to provide feedback to the individual nurse to guide change of practice. Those nurses who reported they were uncomfortable with their current skills were supported with training and practice sessions for ventrogluteal and vastus lateralis injections.
Results: The results were a successful change of practice and sustainability. The testosterone group interventions began in March 2019. This group demonstrated a reduction of incorrect site selection from the baseline of 10.6% to less than 1% from December 2019 through December 2020. The ceftriaxone group interventions began in May 2019. This group demonstrated a reduction of incorrect site selection from the baseline of 20% to less than 1% from December 2019 through December 2020.
Conclusions: The results demonstrated sustainability of the desired practice change for the correct site selection for intramuscular injections by the ambulatory nurses. Patient safety was improved with the reduction of the selection of the dorsogluteal site. The knowledge-to-action framework can be used with other identified clinical practice gaps where implementation and adherence are critical to success.
References
- Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: Time for a map? Journal of Continuing Education in the Health Professions, 26(1), 13-24. doi:10.1002/chp.47
- Lippincott Procedures. (2019, June 14). Intramuscular injection, ambulatory care. Retrieved from https://procedures.lww.com/lnp...,injection,site,injections,sites,injecting&a=false&ad=false
- Sari, D., Şahin, M., Yaşar, E., Taşkiran, N., & Telli, S. (2017). Investigation of Turkish nurses’ frequency and knowledge of administration of intramuscular injections to the ventrogluteal site: Results from questionnaires. Nurse Education Today, 56, 47-51. doi:10.1016/j.nedt.2017.06.005
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.