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Background of the problem: Transitions can greatly impact hospital readmission risk when there is a gap in communication. An absence of a standard process to facilitate communication between the skilled nursing facility (SNF) and patient care team leads to gaps in information related to patient’s plan of care, medication management and continuity of care.
Literature review: Communication tools, care coordination, and collaboration between SNFs and patient care team support patient continuity of care and reduces patient risk for 30-day readmission. Care coordination of patient transitions reduces readmissions. Health information technology tools facilitate communication and reduce patient risk.
Objective/purpose: Establishing a standardized process of communication between SNF and primary care providers fosters partnerships and reduces fragmentation of patient care with SNF transitions. Utilizing a health information technology (HIT) web- based tool, CarePort, facilitates communication of patient information and supports care coordination of patient care that occurs with SNF transitions.
Methods: Established partnerships and implemented standardized process of communication with SNFs to support communication of SNF patient transition information. Standardized communication of SNF patient transitions using templates and technology tools. Standardized communication tools, with use of templates, to support patient SNF transition care between the SNF setting and primary care practice team members, population health medical assistant (PHMAs), HIT team, and primary care coordinators. Implemented standardized process of communication with SNF and primary care team, with the use of CarePort portal, for monitoring SNF patient transitions and outcomes. Establish and increase collaborative partnerships with SNF care team to support communication of transition patient information, using standardized documentation, technology, and CarePort portal. Utilize technology to collect, store, monitor, track, and communicate patient information and data related to patient SNF transition status. Utilize CarePort technology portal tool to support communication of SNF patient transitions.
Outcomes: Improvement of communication between SNF and primary care team members in 6-month time period. Increase # of SNF telephone contacts from primary care team. Increase # of SNF partnerships formed through CarePort portal. Reduced 30-day hospital readmissions of SNF discharged patients with implementation of standardized communication tools. Standardization of communication tools and collaborative partnerships supports communication of SNF patient transition information and bridges transitions from SNF setting and primary care. Communication tools and collaborative relationships facilitate and support care coordination of patient transition care with SNF and primary care settings.
Conclusion/implications for nursing practice: Developing standard processes of communication between SNF and primary care team members supports patient transition care and decreases readmissions. Establishing collaborative relationships and utilizing technology supports continuity of patient care across the continuum. Standardized communication tools support communication of patient information between SNF and primary care practices and foster team collaboration.
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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.
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