American Academy of Ambulatory Care Nursing
Login
Cart
Support
Search
Store
Certification Review Course
Conferences
Publication Contact Hours
FAQ
Quick Tips
Rotating banner image
Event Summary
Sessions
Engagement
More

The View Archive button will launch a recorded poster presentation.

Congratulations to the selected Spotlight posters! These featured posters are the top 10 scored posters.


  • Displaying 30 - 40 of 102
  • First
  • «
  • 2
  • 3
  • 4
  • 5
  • 6
  • »
  • Last
P022 - A Quality Improvement Project to Increase Continuous Glucose Monitor Utilization In Primary Care Practices
Heather Myrick, DNP, APRN-BC
Tags: technology education diabetes quality

Updated: 03/01/23

Updated: 03/01/23
Diabetes is a disease that affects millions internationally. Incidence of the disease is growing at a staggering rate. Complications include nephropathy, neuropathy, retinopathy, and macrovascular complications such as myocardial infarction and stroke. Complications will decrease in frequency with improved glycemic control. ADA has recommended an A1c of < 7% for all non-pregnant adults. However, decreasing A1c by even 1% is difficult for most patients with diabetes.
Continuous glucose monitoring (CGM) is an efficacious technology to significantly reduce A1C levels. CGM technologies have shown to significantly reduce A1C levels by 0.5 to 1.3% points. There is a reduction of time outside target glucose, suggesting an improvement of glucose variability. Currently CGM initiation is done mainly in endocrine practices. Unfortunately, there is a shortage of endocrine providers, and the average wait time to see a provider to start therapy is> 30 days.
The purpose of this study is to increase the utilization of CGM technology in primary care practices. Albert Bandura social cognitive theory provides the theoretical framework for this project. The model for improvement framework from the IHI was the model for this QI project. We established interventions to provide support and training to our primary care providers and staff.
The first PDSA cycle included the creation of a patient education process. There was a patient information sheet developed. We created an ordering flowchart to assist the providers with how to order the CGM products if they should proceed with starting therapy. Training included two information sessions, first with the providers and nurses to review the details of CGM therapy. The education session was 1-hour long and included a review of the new patient education sheet and the ordering flowchart. We educated the providers on which patients would benefit, how the CGM works, how to initiate therapy, and how to interpret the results. The second information session was with the nurses and medical assistants reviewing the new workflow.
The new workflow included the MA reviewing the chart before clinic and identifying patients who have a scheduled diabetes visit. The MAs placed the ordering flowsheet and patient education sheet attached to the patient intake card. Patients were provided with the education sheet on CGM therapy after the intake process was done. Patients were provided time to review this sheet while they were waiting for the provider. When the provider entered the room, they saw the ordering flowsheet attached to the patient vitals card. This was a reminder that this patient may be considered. Then together with patient, they decided if they were to proceed with treatment. If so, provider utilized the ordering flowsheet. The primary aim was to increase CGM utilization use in patients of the internal medicine practice by 20% over baseline with a 3-month intervention period. The secondary aim was for providers to report confidence in initiating CGM therapy in patients with diabetes. Data collection has concluded, and data analysis is underway with a completion date of October 30th.

Learning Objective:

  • 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.

P023 - Ambulatory Care Perspective: A Multidisciplinary Approach to Preventing Surgical Site Infections
Kathryn Farrell, MSN, RN, CPN, CNOR    |     Melissa Fox-Peters, BSN, RN
Tags: education prevention surgical site infection hospital-associated infection preoperative

Updated: 03/22/23

Updated: 03/22/23
Surgical site infections are hospital-associated infections (HAIs), defined as an infection occurring at the incision, organ, or space in which surgery took place. National guidelines exist for the prevention of surgical site infections (SSI); however, SSIs still account for 20% of all HAIs (NHSN, 2022) and ranked as the 4th largest contributor to harm caused in the national pediatric hospital quality network (SPS, 2021). Moreover, SSIs are the costliest HAIs, averaging approximately $10,000-25,000 per infection, which drastically can increase to > $90,000 for implant surgeries (JAMA, 2017).
Like other HAIs, prevention and education is key. Often, there is a large focus on the inpatient setting to prevent HAIs due to numerous risk factors present at the time of hospitalization and surgery; yet many surgical patients start in the ambulatory care setting (Prin et al., 2017). There is an opportunity to target preoperative interventions in the outpatient setting. These silos within the system may be a contributing factor to prevention optimization.
At our pediatric health system, we identified an opportunity for improvement to target the ambulatory care setting and enhance existing processes. A hospital-based surgical site infection task force was previously established and focused on learned opportunities from swarming or reviewing cases after the patient developed an infection at the surgical site. Ambulatory care did not have a seat at the “table.” Most patients came through the ambulatory care setting preoperatively, and an opportunity to provide education could have existed. Furthermore, without collaboration within the health system, identified action items may or may not have resulted in loop closure for improvement in the outpatient setting.
SSI task force membership was evaluated, and the orthopaedic clinical nurse manager was added to the multidisciplinary team including infection prevention, infectious disease, surgical quality, inpatient leaders, and front-line staff. This specific membership addition opened communication on a weekly basis for surgical patients flowing between the ambulatory and acute care settings. Not only were potential contributing factors to SSIs identified during case review, additional opportunities for improvement to increase prevention strategies emerged.
Tools were created for ambulatory care surgical divisions by pulling pertinent ambulatory care SSI prevention bundle information from our evidence-based policy utilizing CDC and SPS guidelines. These resources, partnered with targeted staff education and rounding from the perioperative quality specialist, increased awareness of preoperative SSI prevention education for patients and families. The ambulatory care team recognized the need to revise an existing preoperative SSI prevention educational flyer provided to surgical patients and families during ambulatory care visits. The document was sent to the task force for revisions, resulting in an enhancement through the prevision of a QR code with video instruction to match the written instructions.
The evolution and inclusiveness of the SSI task force targeted SSI prevention from all aspects of care. In addition to the ambulatory care interventions, hospital- and surgical-based interventions were implemented in plan-do-study-act fashion. Through collaboration of the multidisciplinary team, the pediatric SPS, or solution for patient safety, SSI rate (per 100 procedures) decreased from 2.57 (2020 centerline) to 1.75 (2021 centerline), resulting in a 32% reduction.

Learning Objective:

  • 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.

P024 - Elevating and Investing in Clinic Nurses: Having Impact on High-Risk Pregnancy Outcomes through Diabetic Education
Penny Peter, BSN, RN, CDCES    |     Melissa Straley, MSN, RN, CPN
Tags: education outcomes diabetes elevating

Updated: 03/22/23

Updated: 03/22/23
Healthcare has seen a paradigm shift from inpatient care to a greater focus on ambulatory care in recent years. This shift impacted the way nursing within the ambulatory care setting is utilized, due in part to the increased number of complex patients requiring a higher level of care. Ambulatory care nurses now play a pivotal role in the ongoing relationship with complex patients to elicit a positive impact on outcomes and minimize gaps in care through engagement of the health care team. As this paradigm shift has occurred, the maternal fetal medicine clinic at an urban academic health center saw an increase in the diabetic population and demands over the last couple of fiscal years without increasing staff. In order to adapt to the changing health care landscape, our operational and department-wide culture was analyzed; we invested in a nurse that had interest in the diabetic population. Elevating a clinic nurse to become a certified diabetic educator ensured that we are providing the highest level of care backed by education. We know that many health implications can arise when a patient does not understand the impact in having tight control over this disease on their body and baby; however, most of our patients in this urban community do not. To list a few, poor blood glucose control, diet control, and medication adherence have been known to cause increase in fetal weight, higher rates of needing a cesarean birth, and preeclampsia, which in and of itself can cause harm to mom and baby.
Our top priority was to develop a robust education class which also included dietary support, education on impacts of carbohydrates, community resource materials, and identification of goals that each patient felt comfortable with. Early results reflected an increase in our patient’s adoption of carbohydrate counting, appreciation of having in-person classes in both English and Spanish, and decrease in the ideal fetal weight. The data has shown 87% of patients in our program had an increase in carbohydrate counting after their first education class, and just prior to delivery majority of our patients had estimated fetal weights less than 95%.
We plan to follow our data over the next few quarters to see what other gaps we have and how to address them. With the success of the program, we are educating our other clinic nurses to be comfortable being an expert in educating this population. This is important in so many ways, but mostly to have continuity of care and ensuring that all nurses are using our evidence-based recommendations.

Learning Objective:

  • 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.

P025 - Feel Prepared: Not Scared! Domestic Violence and Human Trafficking Education in the Ambulatory Care Office
Kelly Koontz, MSN, RN-BC, AMB-BC    |     Terri Kowalski, BSN, MOL, AMB-BC
Tags: violence domestic abuse trafficking guideline

Updated: 03/22/23

Updated: 03/22/23
Healthcare workers are often the first to suspect or aid in helping men or women who are in trouble. Domestic violence (referred to as intimate partner violence) and human trafficking (known as “modern slavery”) are decisions by others to create control and inequity in a relationship. Domestic violence can be psychological, emotional, sexual, and financial abuse. One in five women experience a form of abuse, while one in seven men experience physical violence and one in 12 men experience sexual violence. In the United States, abuse victims lose a total of 8.0 million days of paid work each year. The cost over a lifetime related to abuse is $103,767 per woman and $23,414 per man according to a CDC study in 2021. One in 15 children are exposed to domestic violence, and 90 % of those children are eyewitnesses to that violence.
Human trafficking (forced labor, commercial sexual acts, and involuntary labor to pay debt) affects almost 21 million people worldwide according to statistics from 2017. One million children are trafficked for commercial sexual exploitation. Victims are double victimized when domestic violence and human trafficking are combined. Although certain communities experience inequities, domestic violence and human trafficking affects all races, economic, and educational levels.
Ambulatory care staff members are prepared to respond quickly to emergencies such as chest pain and breathing difficulty. However, staff are often unprepared to care for a victim of domestic violence or human trafficking when patients present in the office setting. Workflows, education, and resources are more available in the acute care setting but not in the ambulatory care setting. Lack of training in the ambulatory care setting prevents delay of care for possible violent situations.
A recent domestic abuse situation in our clinic involved a patient who was threatened with injury by her intimate partner. When the patient and partner arrived together, the patient privately stated that she required assistance. The team safely accompanied the patient out the back door into a waiting taxi. The partner was escorted out of the office by a public safety officer.
A successful outcome was evident; however, the situation was chaotic. Staff struggled to address the situation confidently. Multiple phone calls were made attempting to find the appropriate resources. The need for training and education was apparent. Understanding that the non-vulnerable adult must consent to report and choose his or her own safety choices may create legal and ethical conflicts in staff. The use of a quick reference guide with key points taken from the facility policies can boost the confidence of the staff encountering these situations.
This poster presentation displays the educational tool developed for ambulatory care staff. An extensive literature search regarding domestic violence and human trafficking revealed research related to definitions, signs of recognition, the cycle of the abuser, and safety plans. However, there was a lack of research on strategies to manage these situations. This tool demonstrates the collaboration of multidisciplinary staff members and leaders from agencies, emergency departments, legal counsel, and nursing colleagues to protect our patients.

Learning Objective:

  • 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.

P027 - Using Standardized Workflow and a “No Interruption Zone” to Reduce Nursing Medication Errors
Ryan Marler, MSN, MBA, RN-BC, Nurse Manager, UK Healthcare
Tags: interventions nursing medication errors

Updated: 03/22/23

Updated: 03/22/23
Purpose: This quality improvement project will examine the effect of a standardized workflow and a “no interruption zone” to reduce nursing medication errors in an ambulatory care clinic.
Background and significance: Medication errors are a world-wide health issue because they may have serious negative effects on patients’ lives and cost the healthcare system billions of dollars annually. It is estimated that medication-related deaths range between 40,000 and 98,000 a year in the United States (Khalil, Shahid, & Roughead, 2017). Medication administration errors also occur in ambulatory care clinics and have involved antibiotics, vaccines, chemotherapeutic agents and intravenous infusions, and sample medications. In a report from US Pharmacopeia’s MEDMARXSM program, which was based on 1,837 records from both hospitals and clinics that were submitted between August 1998 and December 2002, the administering phase (49.5%) was the point of care where vaccine-associated errors occurred the most often, followed by the documenting/transcribing phase (20.2%), the dispensing phase (14.8%), the prescribing phase (7%), and the monitoring phase (0.4%); the remaining 8.1% of the reported errors were potential errors (Kuo, 2006). The MEDMARXSM reporting program is voluntary; therefore, these data may under-represent the actual prevalence of medication errors. Ambulatory care nurses are at-risk of medication verification and administration errors, particularly related to interruptions. A variety of interventions to reduce medication errors have been proposed including prohibition of non-essential conversation, phone calls and pages, use of "do not disturb" vests and signage, use of a medication administration checklist, and use of a clearly demarcated "no interruption zone" or physical barrier in medication preparation areas (Prakash, et al., 2014).
Quality improvement interventions: A standardized workflow was developed for the internal medicine clinic (IMC), which consists of scanning every medication given. Once the order is placed the clinical staff administering the medication will pull the medication to be given. They will verify medication with EHR. Once in the room with the patient, the clinical staff will confirm patient name and date of birth with EHR and again verify the medication. The medication is then scanned and administered. If, for some reason a medication won't scan, nurses will complete a verbal 2-person verification. In addition, the area around the PYXIS was identified with signage and brightly colored tape as a “no interruption zone.” Response to non-essential conversation, phone calls, and pages is prohibited within the “no interruption zone.” We will collect data based on medication error-related incident reports June 20, 202, through November 20, 2022, related to associated with distractions/interruption at any point in the process. Results will be based on the comparison of pre-intervention and post-intervention differences over the 6-month period.
Results: Nine medication errors were reported In the IMC between October 14 - June 14, 2022. All were associated with distractions or lack of a consistent process. Post-intervention results will be determined in December 2022.

Learning Objective:

  • 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.

P028 - Moving the Needle: Shifting Practice to the Ventrogluteal Site for Intramuscular Injection
Kelley Sears, MSN, RN, CPN, NPD-BC, Director of Clinical Education, Thundermist Health Center
Tags: education ventrogluteal dorsogluteal intramuscular injections education intramuscular injections

Updated: 03/22/23

Updated: 03/22/23
Purpose: The struggle over shifting nursing practice to choosing the ventrogluteal (VG) site over the dorsogluteal (DG) site for intramuscular (IM) injections is well documented. There is a vast amount of evidence that points nursing practice towards using the VG site as the safer choice (Blanchard & Payette, 2011; Walsh & Brophy, 2016; Zimmerman, 2010). Unlike the DG site, the VG site is free from major nerves and blood vessels, has a thinner layer of subcutaneous tissue, and may be less painful for patients (Isseven & Midilli, 2020). Despite the evidence, many nurses continue to choose the DG site for large volume, deep IM injections. Our community health center services over 55,000 patients and delivers a large number of IM medications. Most nurses in our organization choose the DG site for injection. A quality improvement project was initiated to promote the VG site as the safest choice for deep IM injections.
Description: Prior to the start of the project, nurses across the organization were surveyed regarding their injection practices. The survey had a 70% response rate and showed the DG site being the preferred site for IM injection. 67% of nurses stated they used the DG site every time they performed a deep IM injection. Just as concerning, 86% of nurses claimed they had never used the VG site. The top two responses for not using the VG site were lack of knowledge and lack of training. A long-term goal and timeline were established prior to starting the project and shared with the nursing staff. In 12 months, at least 50% of nurses would be using the VG site at least 75% of the time. Nurses would be surveyed again at 6 months into the project and lastly at 12 months. The project consisted of in-person didactic and skill-based education, infographics, just-in-time training with nurses during patient appointments, a video on proper landmarking and injection, and a patient education handout. The project expanded to include a VG injection site class for all onboarding nurses. Seven months into the project, “injection site drop-ins” were held for review on all injection sites. Nine months into the project, nursing annual competencies will incorporate safe injection practices including injection site choice and proper landmarking.
Evaluation/outcome: Survey data collected at six months showed a drop in the survey response rate to 50%. However, data from the survey revealed a positive trend, with only 6% of nurses responding they are continuing to use the DG site every time, and only 12% claiming they had never used the VG site. The repetitive reason given for not using the VG site was patient refusal. Data indicated approximately 34% of nurses are using the VG site at least 75% of the time. Results of each survey along with educational initiatives are shared with the nursing staff via conversations, email, and on the organization’s intranet. Project interventions will continue as planned. Twelve-month data will be collected and analyzed prior to the conference date.

Learning Objective:

  • 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.

P029 - Early Detection Can Reduce Suicide Risk in Ambulatory Care
Sarah Bass, BSN, RN, CNML
Tags: suicide ASQ PHQ-9 PHQ-2

Updated: 03/22/23

Updated: 03/22/23
Purpose: To create a standardized process for screening, assessment, reassessment, and safety planning for patients who present to an ambulatory care clinic with behavioral health concerns or identify as potentially having suicidal ideation while being cared for within primary care and specialty care clinics.
Background: Suicide is the 9th leading cause of death in individuals ages 10-64 (CDC, 2022). Most people who die by suicide visit a healthcare provider within months before their death (NIMH, n.d.). In 2019, The Joint Commission updated the National Patient Safety Goals to include suicide screening. In April 2022, the hospital system successfully implemented a standard evidence-based approach to suicide screening on all non-behavioral health units, pre-procedural areas, and the emergency department. Since April 2022, the suicide prevention steering committee (SPSC) continued collaboration to expand suicide screening in ambulatory care that is scalable organization wide.
Methods: The SPSC developed an algorithm to screen for suicidal ideation for patients who present with a behavioral health concern in the ambulatory care setting. The algorithm utilizes four evidence-based tools based on patient age and current clinic workflow including the PHQ-2, PHQ-9, PHQ-A, and ASQ to assess for suicide ideation and risk. Standardized assessment and management of patients at risk for suicide was established using the SAFE-T protocol with CSSRS. Two clinics were identified to trial this new process, including one primary care office and one specialty care office. Onsite suicide screening education was provided to nurses, medical assistants, and social workers. All providers were required to view 2 training modules focused on suicide assessment. An optional Q&A session was made available for all providers to attend. For the pilot, both offices were provided with an iPad for integrated behavioral health (IBH) that allows team members to request an urgent virtual behavioral health referral for further assessment and safety planning.
Results: Over the course of two weeks, primary care completed a total of 750 PHQ-2 screens and 41 PHQ-9 screens. Of this, 33 patients scored negative for suicide ideation while 8 patients scored positive for suicide ideation. A total of 7 patients were further assessed using the ASQ and screened non-acute positive for suicide risk. No patient screened imminent risk. Two IBH referrals were made, and safety plan developed. All but one of the remaining non-acute positive patients had no active safety plan documented. Specialty care had one patient present to clinic with a behavioral health concern and scored non-acute positive for suicide risk. The patient was referred to IBH. Data collection will be ongoing and three additional pilot sites will be included for analysis.
Conclusion: The mental health crisis has escalated since the COVID-19 pandemic. Since mental health providers are at capacity, it is essential that non-behavioral health staff are appropriately trained to detect early warning signs of suicide. These pilots have demonstrated that implementation of suicide screening in patients who present to ambulatory care can be achieved with positive outcomes.

Learning Objective:

  • 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.

P030 - Hypertension Medication Management for Registered Nurse (Ambulatory Primary Care)
Edna Green, MSN, RN-BC
Tags: patient experience nurse hypertension medication management protocol for registered nurse nurse-led visit nurses working to top of license

Updated: 03/01/23

Updated: 03/01/23

One study found that nurse-led care has the potential to provide efficient, effective, and impactful care delivery (Mai et al., 2019, p. 1). Additionally, registered nurses (RNs) endeavor to work at the top of their license, education, and expertise and do so through patient engagement, care coordination, enhanced teamwork, resource reduction, improved access, and quality outcome improvement (Paschke et al., 2017, p. 2). Targeting quality of care enhancement with nurse-led initiatives can be achieved through stringent implementation of the treat-to-target concept, which may lead to a higher percentage of patients reaching their treatment targets, thereby improving patient related outcomes, such as quality of life, functional capacity, and participation. (Mai et al., 2019, p. 1)
Our healthcare organization launched an innovative protocol titled “hypertension medication management protocol for registered nurses.” This strategically designed protocol allows trained RNs to optimize antihypertensive therapy in selected population under the supervision of their providers. The protocol allows the nurse in collaboration with the provider to initiate patient/family education utilizing teach-back method, care coordination, and follow-up and medication titration by ambulatory care registered nurse. Adequate knowledge of hypertension, consequences of uncontrolled hypertension, and treatment regime is essential to achieve blood pressure (BP) control (Himmelfarb, Commodore-Mensah, & Hill, 2016, p. 247).
Since the hypertension medication management protocol for registered nurses launched, in 2019, the nursing leadership team has held nine classes and trained 38 RNs and 65 primary care providers. Nurses have enrolled 265 patients in this innovative nursing-led protocol with a total of 71% achieving maximum benefit. In addition, nursing contribution in ambulatory Ccre is normally viewed as qualitative versus quantitative; this is an example on how nursing has shown a tremendous quantitative impact on outcomes by utilization of the hypertension medication management protocol for registered nurses.
Health care is continuously evolving, and people are living longer with multiple co-morbidities. Patients are being discharged from the hospital sooner requiring ongoing primary care and appropriate follow-up care. The hypertension medication management protocol for registered nurses provides a structured plan of care to help the patients meet their blood pressure goal and maintain optimal level of health. The patients appreciate the visit with the nurse, and this provides a positive patient experience to participate in their care, ultimately directly improving RNs job satisfaction. Opportunities from lessons learned included, but are not limited to, increasing overall engagement in ongoing education, meeting staffing challenges and fluctuating onboarding by adding protocol training into standard new-hire nursing orientation, continuing to increase collaboration between nurses and providers for patients who met eligibility criteria, and improving on streamlining analytics to better capture hypertension protocol nurse visits.

Learning Objective:

  • 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.

P032 - Mitigate Reoccurring Patient Safety Events that Have the Potential to Delay Care and/or Cause Serious Harm
Joni Anderson, MSN, RN    |     Michele Lower, MSN, RN    |     Shaunelle Page, MSN, RN    |     Shannon Peterson, MSN, RN
Tags: teamwork quality safety patient experience

Updated: 03/22/23

Updated: 03/22/23
Purpose: Reduce reoccurring patient safety events that have the potential to delay care and/or cause serious harm.
Background: The most common reoccurring errors in ambulatory care clinics include administering the wrong medication, mislabeling or failing to label a lab specimen, and misidentifying patients. These errors lead to decreased patient satisfaction, decreased quality of care (including delays in care), increased potential harm, and increased cost. These events were named “never events,” meaning that they should never occur by an employee following the correct standard work process.
Methods: We created process that includes K-cards observations and safety pauses to systematically reduce or eliminate reoccurring errors. The K-card is a self- and peer-audit tool that helps to ensure each of the workflow steps are followed correctly. A safety pause is implemented when an employee experiences a “never event.” A safety pause takes place wherever a workflow or task error leads to an actual safety event that involves a patient or a caregiver. The pause allows the team (including the employee that caused the error) to investigate the causes, barriers and action items that can be learned from the event. Electronic tracking of K-cards allows clinic leaders to review results of the observation results. An electronic tracking was created to reflect how many departments are performing K-card audits and to evaluate the results of the process (e.g., how many K-card audits were a pass or fail).
Results: The K-card audit has reduced the number of events related to the workflow. We found that K-card self-audits are a good way of checking our internal processes but found increased benefit in peer audits. Peer audits allow another caregiver to determine if a peer is following all the designated steps involved with the task, thereby increasing the knowledge of two people rather than one. The safety pause provides a time for the employee and the team to reflect on what occurred and why. The entire team shares are part to ensure this type of event does not occur again.
Conclusion: Use of K-card audits and the safety pause process has helped reduce Intermountain’s ambulatory care never events. Common errors in ambulatory care can have serious safety consequences for patients and caregivers (employees/staff). Reducing or eliminating these errors has the potential to improve patient experience by following best practices and leads to safer outcomes.

Learning Objective:

  • 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.

P033 - Improving the Process of Trialing Pediatric Patients with Chronic Respiratory Failure Off Ventilatory Support In A Pediatric Pulmonology Clinic Setting
Jennifer Pfieffer, MSN, APRN, PCNS-BC, ESMHL    |     Abby Zaleski, RN
Tags: pediatric ambulatory care complex care outpatient tracheostomy ventilator clinical pathway

Updated: 04/12/23

Updated: 04/12/23
Background: There is a paucity of studies or protocols specifically designed for the initial wean off ventilatory support in pediatric patients with chronic respiratory failure during an outpatient follow-up visit. Most of the published protocols are in the inpatient setting. This quality improvement (QI) project will evaluate the preparedness and safety of pediatric patients with chronic respiratory failure during pulmonology appointments, streamline the trial off ventilatory support in the clinic, and ensure safe and adequate attempts.
The QI project will focus on the population of pediatric patients dependent on ventilatory support. The intervention is a newly developed clinical pathway for the initial wean off ventilatory support at the outpatient clinic setting. We will collect baseline data related to the safety and preparedness of the visits before the implementation. As an extra layer of safety precaution, our clinical team will also assess the tracheostomy go-bags that families are instructed to carry. Our team will evaluate all their safety equipment with them as part of their clinic appointment. We developed an appointment checklist to ensure access to the necessary items.
Before the visit: The clinical team would notify the durable medical equipment (DME) company that the patient will come in for an initial wean off ventilatory support and ask if their respiratory therapist (RRT) will be present at the appointment and bring the necessary equipment. Next, the nurse (RN) would round with the medical team at the beginning of the week to review if any patients would be doing a ventilator wean during any upcoming appointments. Then, the RN would call the families the day before the scheduled appointment. They will review the equipment checklist over the phone to ensure the tracheostomy go-bag and other necessary equipment were safely stocked.
During the visit: The pulmonologist, RN, and RRT would be present during the initial wean off ventilatory support. The RN/RRT would review and compare the equipment checklist before starting the appointment. Safety parameters would be discussed and followed throughout the wean, including frequency of vital sign monitoring, oxygen saturations, end-tidal CO2s, amount of oxygen supplementation to be used, and specific signs of respiratory distress to monitor. The team will discuss the parameters to abort the trial. These include low pulse oximetry, end-tidal CO2 elevation, or any other evidence of respiratory distress.
Conclusion of the visit: At the end of the study, the patient should be placed back on the ventilator in the original setting.
Outcome: The expected outcome is to improve the number of successful initial weans off ventilatory support and their safety. We anticipate that the intervention will benefit children on ventilatory support by decreasing the number of clinic appointments required to wean ventilation. We will provide re-education for our families on the importance of always having their tracheostomy go-bags. We aim to improve their familiarity with all the equipment and have the necessary knowledge to use it effectively during an emergency. We will achieve this by re-educating our families on the safety checks to improve outcomes for their patients with chronic respiratory failure.

Learning Objective:

  • 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.

  • Displaying 30 - 40 of 102
  • First
  • «
  • 2
  • 3
  • 4
  • 5
  • 6
  • »
  • Last
Library Home |AAACN Website
Privacy Center

Copyright © 2025 American Academy of Ambulatory Care Nursing
Powered by Conexiant DXP
Privacy Policy Update: We value your privacy and want you to understand how your information is being used. To make sure you have current and accurate information about this sites privacy practices please visit the privacy center by clicking here.