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Congratulations to the selected Spotlight posters! These featured posters are the top 10 scored posters.
Updated: 03/23/23
Purpose: American Nurses Association Standards of Professional Practice: Education, Quality of Practice, and Resource Utilization all support the use of structured and organized resources to enhance the quality and delivery of nursing care (ANA 2015). These resources encompass staff education, standardized patient education, institutional workflows, policies, contact information, forms, and templates. Ambulatory care nurses at a large academic outpatient institution with multiple campuses identified a gap in the organization and accessibility of clinical resources integral to the clinical teams’ delivery of care. Resources were stored in multiple online locations and were not standardized across sites. Many resources had been developed by individual staff members and lacked appropriate validation and mechanisms for regular review.
Description: Two unit-based nurse experts began with a synthesis of national quality standards and analysis of institutional practices. They reviewed and organized online job aids and resources, along with policies and procedures for standardization and consolidation. The team created an Excel spreadsheet to organize the content and identify categories of information. Documents and resources were then validated by subject matter experts to ensure accuracy. The team then partnered with an IT analyst to develop an electronic repository (using InfoPoint, a Microsoft product) to centrally locate validated resources on topics needed by clinical staff. This repository was named General Oncology Finding Information and Documents Online (GO FIDO). Information on the site was organized into the following categories: general resources, EMR, surgery clinics and in-clinic procedures, medications, and helpful links. Within each of these categories, the team created "articles” or individual sites where the validated information was posted. The articles also include key contacts and links to related sites, staff education, patient education, and associated policies/procedures.
The GO FIDO site provides easy navigation including a home page with large category icons, a search feature, a document library, and a mechanism for staff to provide feedback if an article is incorrect or a link is broken. Content is maintained with automatic review dates which turn red when review is due and sends emails to the site owners to alert of an upcoming review date.
Evaluation/outcomes: The GO FIDO site was successfully implemented using the following strategies: communication through staff meetings, newsletters, links sent via team chats, and training to the resource during new hire orientation. “GO FIDO Updates” are posted in the clinic’s weekly newsletter. This resource has been well utilized by all clinical staff, especially leadership, new staff, and float personnel. GO FIDO was implemented July 2020 and has since had 40,000+ site visits and over 700 unique viewers (as of November 1, 2022). Integrating ANA standards, ambulatory care nursing expertise, and IT systems has optimized quality, safety, and efficiency for clinical practice which positively impacts patient outcomes.
References
American Nurses Association. (2015). Nursing: scope and standards of practice (3rd ed.). Silver Spring, MD.:Nursesbooks.org,
American Academy Ambulatory of Nursing Care Nursing https://www.aaacn.org/practice...
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.
Updated: 03/22/23
Updated: 03/22/23
Purpose: The purpose of this work was to implement a standard process for pediatric suicide risk screening and assessment in the ambulatory care specialty and primary care clinics to appropriate resources across the organization.
Background/significance: A health care regulatory agency requires and a national suicide prevention organization recommends that all medical patients in all medical settings be screened for suicide risk. Suicide ranks as the second leading cause of death among young people ages 10-24 and is the leading cause of death among youth in Washington state. Few ambulatory care pediatric specialty organizations have implemented an organizational wide suicide risk screening tool.
Description: Suicide risk screening was initially implemented in the organization’s emergency department and inpatient units in 2019. For the implementation into ambulatory care specialty clinics and primary care clinic, a multidisciplinary team was formed with members from psychiatry, social work, medical and nursing leadership, operations, project management, informatics, analytics, and nursing education. The patient population eligible for suicide risk screening included patients aged 10 years and older who are developmentally able to answer a validated suicide risk screening tool. As a result of this team, a standardized screening pathway, electronic health record updates, training tools for staff and providers, and education to patients and families on this initiative were developed and communicated to stakeholders. Suicide risk screening began in a phased approach for in-person visits in 2021, adding new clinics every other week to a total of 27 specialty clinics, a primary care clinic, and 11 regional locations in Washington state. Screening occurred verbally to the patient during the rooming process of a clinic visit and has since transitioned to an electronic tablet for screening, with the responses loading directly into the patient’s medical record for review by the healthcare team.
Evaluation and outcomes: As of November 2022, over 70,000 suicide risk screenings have been completed on patients aged 10 and older who are developmentally able to answer the screening tool questions. An average of 10.3% of patients screen positive to the suicide risk screening tool. Of those patients screened from October 2021 to November 2022, 362 pediatric patients had a plan for self-harm and received intervention. In response to support the positive screenings, a dedicated team of social workers specific to follow up on positive suicide risk screening was added to conduct risk assessments and connect patients and families to appropriate resources across the organization. Also, with the transition to electronic screening from verbal screening, an increase in declination for suicide screening by patients/families has occurred. Evaluation of collecting patient responses via an electronic tablet versus verbal screening is occurring.
Conclusion: Suicide risk screening in medical settings is required by a healthcare regulatory agency and recommended by a national suicide prevention organization. In response to this need, a standardized approach for pediatric suicide risk screening and assessment was implemented across multiple ambulatory care clinic sites and specialties in a pediatric organization in Washington state. This is an important safety initiative for organizations to consider and identify patients at risk for suicide.
Background/significance: A health care regulatory agency requires and a national suicide prevention organization recommends that all medical patients in all medical settings be screened for suicide risk. Suicide ranks as the second leading cause of death among young people ages 10-24 and is the leading cause of death among youth in Washington state. Few ambulatory care pediatric specialty organizations have implemented an organizational wide suicide risk screening tool.
Description: Suicide risk screening was initially implemented in the organization’s emergency department and inpatient units in 2019. For the implementation into ambulatory care specialty clinics and primary care clinic, a multidisciplinary team was formed with members from psychiatry, social work, medical and nursing leadership, operations, project management, informatics, analytics, and nursing education. The patient population eligible for suicide risk screening included patients aged 10 years and older who are developmentally able to answer a validated suicide risk screening tool. As a result of this team, a standardized screening pathway, electronic health record updates, training tools for staff and providers, and education to patients and families on this initiative were developed and communicated to stakeholders. Suicide risk screening began in a phased approach for in-person visits in 2021, adding new clinics every other week to a total of 27 specialty clinics, a primary care clinic, and 11 regional locations in Washington state. Screening occurred verbally to the patient during the rooming process of a clinic visit and has since transitioned to an electronic tablet for screening, with the responses loading directly into the patient’s medical record for review by the healthcare team.
Evaluation and outcomes: As of November 2022, over 70,000 suicide risk screenings have been completed on patients aged 10 and older who are developmentally able to answer the screening tool questions. An average of 10.3% of patients screen positive to the suicide risk screening tool. Of those patients screened from October 2021 to November 2022, 362 pediatric patients had a plan for self-harm and received intervention. In response to support the positive screenings, a dedicated team of social workers specific to follow up on positive suicide risk screening was added to conduct risk assessments and connect patients and families to appropriate resources across the organization. Also, with the transition to electronic screening from verbal screening, an increase in declination for suicide screening by patients/families has occurred. Evaluation of collecting patient responses via an electronic tablet versus verbal screening is occurring.
Conclusion: Suicide risk screening in medical settings is required by a healthcare regulatory agency and recommended by a national suicide prevention organization. In response to this need, a standardized approach for pediatric suicide risk screening and assessment was implemented across multiple ambulatory care clinic sites and specialties in a pediatric organization in Washington state. This is an important safety initiative for organizations to consider and identify patients at risk for suicide.
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.
Updated: 03/22/23
Updated: 03/22/23
Upon completion of a literature review by nurses in ambulatory care services (ACS), it was determined that a knowledge gap exists among the patient population regarding fragility fractures and osteoporosis. Patients who visit our orthopedic clinic (general orthopedics, fracture, and spine) are at increased risk of fractures due to age, gender, prior fragility fracture, family history, chronic diseases, poor nutrition, inactivity, smoking, alcohol consumption, and certain medications.
Methodology: The Iowa Model was applied to facilitate the implementation of evidenced-based practice.
Purpose: To assure that ACS patients at high risk for fractures were identified, educated, and appropriately referred for osteoporosis screening.
Following a review of the literature, a multidisciplinary team created a fracture risk assessment questionnaire, using the US Bone and Joint Initiative as a resource. Pre-implementation data was collected in 3rd and 4th quarters of 2019 via chart audits of patient visits using the newly developed fracture risk assessment questionnaire. The inclusion criteria applied were age 50 and over who were seen by a nurse during the clinic visit. Of the 83 patients that were screened for fracture risk, 42.17% were positive for at least one or more risk factors. Pre-implementation data collection for 4th quarter 2019 indicated 40.52% of 116 patients screened for fracture risk were positive for at least one or more risk factor. To address those at risk, the workflow for ACS nurses was redesigned to include provision of patient education, and if needed, a physician referral for a DEXA scan and/or treatment letters that indicated increased fracture risk were sent to patients who were screened and their primary care providers. After roll out in January 2020, feedback was elicited from ACS nurses to ensure that the new redesigned workflow was feasible. Some changes were made; for instance, the implementation of the redesigned workflow was divided into two separate phases, phase I and phase II. ACS nurses also conducted peer-to-peer chart audits to ensure standardization of the new redesigned workflow.
Results: Implementation of a risk assessment will provide identification of patients who are at risk for a fracture via a nursing assessment utilizing a standardized fracture risk assessment tool. Providing patients with educational interventions via an individualized tailored educational plan for patients identified as high risk. Patients will be provided a referral to the osteoporosis clinic for a DEXA scan or a referral to their primary physician for possible DEXA scan and initiation of bone-strengthening treatment if warranted. Implementation of phase I began in January 2020 and phase II began in February 2020. For 1Q20, of the 60 patients that were screened for fracture risk, 45% were positive for at least one or more risk factors. In addition, patients with a history of fragility fracture were referred to the osteoporosis clinic as well as referral for a DEXA Scan.
Conclusions/implications: In conclusion, osteoporosis is underdiagnosed and undertreated among the aging population. More attention is needed to improving osteoporosis screening. ACS has proved to be a beneficial location for conduction of fracture risk screenings.
Methodology: The Iowa Model was applied to facilitate the implementation of evidenced-based practice.
Purpose: To assure that ACS patients at high risk for fractures were identified, educated, and appropriately referred for osteoporosis screening.
Following a review of the literature, a multidisciplinary team created a fracture risk assessment questionnaire, using the US Bone and Joint Initiative as a resource. Pre-implementation data was collected in 3rd and 4th quarters of 2019 via chart audits of patient visits using the newly developed fracture risk assessment questionnaire. The inclusion criteria applied were age 50 and over who were seen by a nurse during the clinic visit. Of the 83 patients that were screened for fracture risk, 42.17% were positive for at least one or more risk factors. Pre-implementation data collection for 4th quarter 2019 indicated 40.52% of 116 patients screened for fracture risk were positive for at least one or more risk factor. To address those at risk, the workflow for ACS nurses was redesigned to include provision of patient education, and if needed, a physician referral for a DEXA scan and/or treatment letters that indicated increased fracture risk were sent to patients who were screened and their primary care providers. After roll out in January 2020, feedback was elicited from ACS nurses to ensure that the new redesigned workflow was feasible. Some changes were made; for instance, the implementation of the redesigned workflow was divided into two separate phases, phase I and phase II. ACS nurses also conducted peer-to-peer chart audits to ensure standardization of the new redesigned workflow.
Results: Implementation of a risk assessment will provide identification of patients who are at risk for a fracture via a nursing assessment utilizing a standardized fracture risk assessment tool. Providing patients with educational interventions via an individualized tailored educational plan for patients identified as high risk. Patients will be provided a referral to the osteoporosis clinic for a DEXA scan or a referral to their primary physician for possible DEXA scan and initiation of bone-strengthening treatment if warranted. Implementation of phase I began in January 2020 and phase II began in February 2020. For 1Q20, of the 60 patients that were screened for fracture risk, 45% were positive for at least one or more risk factors. In addition, patients with a history of fragility fracture were referred to the osteoporosis clinic as well as referral for a DEXA Scan.
Conclusions/implications: In conclusion, osteoporosis is underdiagnosed and undertreated among the aging population. More attention is needed to improving osteoporosis screening. ACS has proved to be a beneficial location for conduction of fracture risk screenings.
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.
Updated: 03/24/23
Updated: 03/24/23
Purpose: The primary care setting is a care area that requires a unique skillset. While the AAACN has long supported teaching primary care concepts in undergraduate nursing school curricula and many schools of nursing have incorporated primary care settings into undergraduate clinical rotations, there are still barriers to having nursing students in such a specialized setting (Wojnar, & Whelan, 2017). Students and faculty may view placements in primary care as “less than” or not beneficial to their overall learning, RNs may view students as a burden, and faculty can find supervision of students in this setting challenging (Bos, Silén, & Kaila, 2015; Wojnar, & Whelan, 2017). The purpose of this poster presentation is to highlight the benefit of having students in primary care settings, not only for the students, but for primary care staff and patients, to support the inclusion of clinical placements in the primary care setting during undergraduate nursing programs.
Description: Faculty in a VA nursing academic partnership (VANAP) worked with students and primary clinic staff to support students during clinical rotations at primary care clinics. In addition to understanding patient care delivery in these settings, students worked on population health projects to improve health outcomes for the veteran population. These projects engage students and RNs in thinking about the unique care needs of this population and how nurses can play an active role in improving care delivery. Over the last several years, students have worked on a variety of projects including updating diabetic patient education, assessing patient barriers to cervical cancer screening, providing patient reminders for colorectal cancer screenings, and providing patient information for self-referrals to mental health services.
Outcome: Students have learned the specialized skills needed to care for veterans in the primary care and the unique care needs of this population. They have gained an appreciation for the complexity of the work and role of the RN in this setting and have learned skills such as communication, interdisciplinary collaboration, and care coordination that they can apply to any setting. Students also have high levels of satisfaction in contributing to meaningful and sustainable projects that improve patient outcomes for the veteran population. RN and clinic managers have found student involvement in these settings to also be beneficial. Students are seen as a resource in participating in ongoing quality improvement initiatives and RNs have high satisfaction in working with undergraduate nursing students. From participation in these clinical rotations, some students have decided to purpose further opportunities in primary care.
Conclusions: By placing students in primary care settings and including them in meaningful ways on population health projects, students can learn key primary care concepts while contributing to improving patient outcomes. RNs can also see the tangible benefit of having students in clinics because of the contributions they make on these projects. This model can help the continued training of undergraduate nursing students in the primary care setting by addressing perceived barriers.
Description: Faculty in a VA nursing academic partnership (VANAP) worked with students and primary clinic staff to support students during clinical rotations at primary care clinics. In addition to understanding patient care delivery in these settings, students worked on population health projects to improve health outcomes for the veteran population. These projects engage students and RNs in thinking about the unique care needs of this population and how nurses can play an active role in improving care delivery. Over the last several years, students have worked on a variety of projects including updating diabetic patient education, assessing patient barriers to cervical cancer screening, providing patient reminders for colorectal cancer screenings, and providing patient information for self-referrals to mental health services.
Outcome: Students have learned the specialized skills needed to care for veterans in the primary care and the unique care needs of this population. They have gained an appreciation for the complexity of the work and role of the RN in this setting and have learned skills such as communication, interdisciplinary collaboration, and care coordination that they can apply to any setting. Students also have high levels of satisfaction in contributing to meaningful and sustainable projects that improve patient outcomes for the veteran population. RN and clinic managers have found student involvement in these settings to also be beneficial. Students are seen as a resource in participating in ongoing quality improvement initiatives and RNs have high satisfaction in working with undergraduate nursing students. From participation in these clinical rotations, some students have decided to purpose further opportunities in primary care.
Conclusions: By placing students in primary care settings and including them in meaningful ways on population health projects, students can learn key primary care concepts while contributing to improving patient outcomes. RNs can also see the tangible benefit of having students in clinics because of the contributions they make on these projects. This model can help the continued training of undergraduate nursing students in the primary care setting by addressing perceived barriers.
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.
Updated: 03/22/23
Updated: 03/22/23
Background: Discussion with newly hired and experienced nurses in the ambulatory care setting identified a gap when triaging phone calls. Telephone triage is a skill that the ambulatory care registered nurse utilizes daily. Escape rooms are known to be an effective learning strategy to add engagement and aide in delivering content to staff on various topics. The nursing professional development specialists created a portable escape box allowing for mobilization in clinics across the organization. The box focuses on triaging patients with multiple medical conditions with games and puzzles as they work through the scenarios.
Purpose: The purpose of the telephone triage escape box was to sharpen critical thinking, allowing for more confidence in triaging phone calls and directing to the appropriate level of care. This unique strategy has made a significant impact on how the ambulatory care nurses have integrated nursing concepts and resources while increasing productivity.
Methods: The nursing professional development specialists used the theoretical framework of Lewin’s change theory to assist the nurses with overcoming resistance to variation. The telephone triage escape box was developed with four different types of locks to open each different scenario. These scenarios focus on triaging an urgent phone call, writing in SBAR format, choosing the correct protocol, and using telephone triage nuggets of knowledge. The nurse has one hour to escape the box and solve the puzzles.
Conclusion: More than 75 staff members participated in the telephone triage escape box since implementing this new educational tool during their orientation. Utilizing this distinct methodology to restructure validation practices produced favorable evaluations. The staff stated that this modality of education will help to improve their triaging skills and job performance, as well as impact their productivity. The most valuable measure was utilizing triage resources and learning new ways to communicate with patients during phone triage.
Purpose: The purpose of the telephone triage escape box was to sharpen critical thinking, allowing for more confidence in triaging phone calls and directing to the appropriate level of care. This unique strategy has made a significant impact on how the ambulatory care nurses have integrated nursing concepts and resources while increasing productivity.
Methods: The nursing professional development specialists used the theoretical framework of Lewin’s change theory to assist the nurses with overcoming resistance to variation. The telephone triage escape box was developed with four different types of locks to open each different scenario. These scenarios focus on triaging an urgent phone call, writing in SBAR format, choosing the correct protocol, and using telephone triage nuggets of knowledge. The nurse has one hour to escape the box and solve the puzzles.
Conclusion: More than 75 staff members participated in the telephone triage escape box since implementing this new educational tool during their orientation. Utilizing this distinct methodology to restructure validation practices produced favorable evaluations. The staff stated that this modality of education will help to improve their triaging skills and job performance, as well as impact their productivity. The most valuable measure was utilizing triage resources and learning new ways to communicate with patients during phone triage.
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.
Updated: 03/22/23
Updated: 03/22/23
As the patient-centered medical home model stresses the importance of the team-based approach as a foundation to improving care, costs, and patient experience, the need for supporting medical assistants in the ambulatory care setting with a new innovative way was recognized. High-performing care teams and expanded roles have been shown to improve health outcomes for the chronically ill and improve team and patient satisfaction. Historically, primary care practices relied on clinicians to provide the totality of preventive, chronic, and acute care for patients. Recent literature has highlighted the logistical challenges associated with this model. Medical assistants (MAs) and other professionals are increasingly being called upon to perform key roles on the care team even as traditional educational programs may not equip them for this new way of working. Medical assistants play a crucial role on the ambulatory health care team and are one of the fastest growing health professions.
Challenges to expanding the medical assistant role include quality and safety assurance, confusion about scope of practice, and clinician comfort with expanded MA responsibilities. With the growing complexity of the MA role, we recognize the need to support newly hired team members with a foundation for success. To address this challenge, we developed an innovative internship program for medical assistants (MAs) within our large medical group with over 600 clinic locations throughout North Carolina and South Carolina. This internship supports the needs of team members with various knowledge and skill backgrounds, with the aim of building confidence and competence in foundational knowledge to ensure delivery of quality patient care utilizing evidence-based standards.
Our medical assistant internship program expands our standard orientation from one week to a focused six weeks consisting of a combination of instructor-led training and hands-on practice in both the classroom and clinic setting. The internship focuses on topics and skills required in their role including scope of practice, rooming process, medication administration, chronic disease management, and more. It allows our new MAs to work in tandem with ambulatory care clinical educators, medical group clinics, and their preceptors. For two weeks on Mondays and Tuesdays, they follow a hybrid didactic format concentrating on scope and skills. The MAs then spend Wednesday through Friday with their preceptor training in the clinic. The internship schedule concludes with the team members receiving continued support from their preceptor in the clinic for the next one to two weeks and adapting to specific team members’ needs. Preceptors are further supported with new team member onboarding with standardized guides, including orientation roadmaps and competency tools. With the growing complexity of the medical assistant role, this structured internship program provides a bridge that anchors and advances the knowledge and skill that leads to improved competency during their onboarding process.
Challenges to expanding the medical assistant role include quality and safety assurance, confusion about scope of practice, and clinician comfort with expanded MA responsibilities. With the growing complexity of the MA role, we recognize the need to support newly hired team members with a foundation for success. To address this challenge, we developed an innovative internship program for medical assistants (MAs) within our large medical group with over 600 clinic locations throughout North Carolina and South Carolina. This internship supports the needs of team members with various knowledge and skill backgrounds, with the aim of building confidence and competence in foundational knowledge to ensure delivery of quality patient care utilizing evidence-based standards.
Our medical assistant internship program expands our standard orientation from one week to a focused six weeks consisting of a combination of instructor-led training and hands-on practice in both the classroom and clinic setting. The internship focuses on topics and skills required in their role including scope of practice, rooming process, medication administration, chronic disease management, and more. It allows our new MAs to work in tandem with ambulatory care clinical educators, medical group clinics, and their preceptors. For two weeks on Mondays and Tuesdays, they follow a hybrid didactic format concentrating on scope and skills. The MAs then spend Wednesday through Friday with their preceptor training in the clinic. The internship schedule concludes with the team members receiving continued support from their preceptor in the clinic for the next one to two weeks and adapting to specific team members’ needs. Preceptors are further supported with new team member onboarding with standardized guides, including orientation roadmaps and competency tools. With the growing complexity of the medical assistant role, this structured internship program provides a bridge that anchors and advances the knowledge and skill that leads to improved competency during their onboarding process.
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.
Patricia Gray, MSN, RN, Assistant Patient Service Manager, Yale New Haven Hospital
Updated: 03/14/23
Updated: 03/14/23
There is a national mental health crisis that has been accelerated by the COVID-19 pandemic. According to the CDC, in 2020 suicide was the 2nd leading cause of death for ages 10-14. In 2018-2019, in adolescents aged 12-17 years old, 8.8% seriously considered attempting suicide, 15.7% made a suicide plan, 8.9% attempted suicide, and 2.5% made a suicide attempt requiring medical treatment. The pediatric specialty centers (PSC) have optimized the screening process and evaluation of at-risk youth in the ambulatory care setting, prompting early intervention and potentially preventing significant injury or death by suicide.
The PSC consists of six ambulatory care sites throughout Connecticut. Three years ago, the PSCs began screening children aged 12 and older for depression and suicidal ideation. Worsened by the pandemic, there has been a stark increase in the number of children identified as at-risk for suicide who have required further assessment by a medical professional. A complete suicide assessment is completed by a social worker to determine the need for further evaluation, treatment, or psychiatric admission to an accredited mental health facility. Currently, not all PSC sites have a social worker present onsite and clinical nurses at these locations have requested more support and resources. A collaborative team of nursing staff, leaders, educators, social workers, and IT specialists has worked to develop a streamlined screening process to identify and assess children at-risk.
The first step involved a process change and training of clinical nurses to administer the Columbia-Suicide Severity Rating Scale (CSSR-S) screening tool. From July to October 2022, nurses used the CSSR-S tool to identify 29 pediatric patients who were screened as either low, moderate, or high risk for suicide. Of the 29 patients, 14 patients (nearly 50%) screened as moderate or high risk for suicide; eight were assessed by an onsite social worker and discharged home with a safety plan in place. The remaining six patients were cared for at locations without an onsite social worker. For five of these patients, nurses contacted the on-call social worker to receive guidance by phone. The five patients were discharged home with instructions and a list of crisis resources in the event the patient’s situation were to change or warrant further intervention. One patient, however, was transported via ambulance to the emergency room, received a psychiatric evaluation, and was then discharged home. This reinforced the importance and need for access to a social worker at all PSC sites.
The dedicated interdisciplinary team worked collaboratively to implement an innovative new telehealth process for locations without onsite social workers. Through a video visit conducted on a tablet device, social workers now provide a live telehealth mental health assessment for patients screened as moderate or high suicide for suicide, providing the same level of care across all six PSC sites. Since the rollout of telehealth assessments on November 7, 2022, ambulatory care nurses now feel empowered to screen children, coordinate assessments, and manage the care of this most vulnerable pediatric patient population.
The PSC consists of six ambulatory care sites throughout Connecticut. Three years ago, the PSCs began screening children aged 12 and older for depression and suicidal ideation. Worsened by the pandemic, there has been a stark increase in the number of children identified as at-risk for suicide who have required further assessment by a medical professional. A complete suicide assessment is completed by a social worker to determine the need for further evaluation, treatment, or psychiatric admission to an accredited mental health facility. Currently, not all PSC sites have a social worker present onsite and clinical nurses at these locations have requested more support and resources. A collaborative team of nursing staff, leaders, educators, social workers, and IT specialists has worked to develop a streamlined screening process to identify and assess children at-risk.
The first step involved a process change and training of clinical nurses to administer the Columbia-Suicide Severity Rating Scale (CSSR-S) screening tool. From July to October 2022, nurses used the CSSR-S tool to identify 29 pediatric patients who were screened as either low, moderate, or high risk for suicide. Of the 29 patients, 14 patients (nearly 50%) screened as moderate or high risk for suicide; eight were assessed by an onsite social worker and discharged home with a safety plan in place. The remaining six patients were cared for at locations without an onsite social worker. For five of these patients, nurses contacted the on-call social worker to receive guidance by phone. The five patients were discharged home with instructions and a list of crisis resources in the event the patient’s situation were to change or warrant further intervention. One patient, however, was transported via ambulance to the emergency room, received a psychiatric evaluation, and was then discharged home. This reinforced the importance and need for access to a social worker at all PSC sites.
The dedicated interdisciplinary team worked collaboratively to implement an innovative new telehealth process for locations without onsite social workers. Through a video visit conducted on a tablet device, social workers now provide a live telehealth mental health assessment for patients screened as moderate or high suicide for suicide, providing the same level of care across all six PSC sites. Since the rollout of telehealth assessments on November 7, 2022, ambulatory care nurses now feel empowered to screen children, coordinate assessments, and manage the care of this most vulnerable pediatric patient population.
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.
Updated: 03/23/23
Updated: 03/23/23
The number of pediatric youth identifying as transgender, gender non-conforming, or gender-diverse treated in the ambulatory care setting has steadily increased in recent years. The literature recommends promoting gender-affirming clinical care environments so that transgender youth can access gender-affirming inclusive and safe clinical care. Providing gender-affirming treatment to youth decreases depression and suicidal ideation lifetime odds in patients (Call, 2021). In alignment with Rivera’s gender-affirming nursing care model (GANC) and the Pediatric Endocrine Society’s (PENS) Transgender health Position Statement, an intervention to utilize a protocol to advance gender-affirming care was established. This quality improvement project focused on implementing gender-affirming care practices among pediatric ambulatory care nurses. The project enables them access to add/edit the patient’s preferred name and gender identity, and chosen pronouns were added to the electronic medical record demographics sheet storyboard. The results showed a significant increase in participants’ scores before (M = 8.29) and after (M = 12.14) the intervention was implemented. Pediatric nurses have an ever-expanding role and opportunity to improve organizational gender-affirming care practices through education and complete SOGI data documentation in the EMR.
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.
Caroline V. Coburn, DNP, APRN, ANP-BC, Associate Clinical Professor, Emory University | Gina Papa, DNP, MSN, BSN, FNP-BC, APRN, RN
Updated: 03/24/23
Updated: 03/24/23
Purpose: An ongoing challenge in ambulatory care education is to provide clinical experiences that allow students to fully use their clinical and critical-thinking competencies. It is a vital part of ambulatory care that RNs be able to work at the highest level of competency (Flinter, et al., 2017), and learners need role models who can demonstrate the potential in this arena. Creating this optimal learning environment can be a challenge in any setting but is even more so when the clients being served are low-income patients from a variety of global origins. In an RN pre-licensure population management course, an innovative approach used in this setting allows the student to practice a high-level RN role and implement the principles of cultural humility. This clinical experience is structured to allow the student to implement team-based primary care coordination for patients with social, economic, and cultural barriers.
Description: In this setting, students integrate their knowledge of pharmacology, pathophysiology, psychology, population/public health, and chronic disease management to provide patient care through telehealth/virtual means as well as in-person. Whether virtual or in-person, the clinical day begins with the student preparing for the assigned patients by reviewing the reason for the visit, administering pertinent physical assessment, and providing medication reconciliation. The student then gives a report to the provider using the SBAR (situation, background, assessment, recommendation) format, and participates in the visit if possible. This participation may take the form of acting as scribe for the provider, which further reinforces the student’s familiarity with medical terminology. At the visit conclusion, the student then provides follow-up education, health navigation, and care coordination.
The clinic through which students rotate serves community members who are uninsured and cannot afford episodic care at retail clinics. Because the clinic serves clients from many countries, students learn how to provide linguistically appropriate and culturally informed care. They are immersed in the refugee, migrant, immigrant, asylum seeker, and undocumented patient experience in the context of social and structural determinants of health, provisioning of care, care coordination, and patient navigation.
Evaluation: This clinical experience is part of an academic course in which students evaluate their overall clinical experience. In written and verbal comments, students provide overwhelmingly positive feedback regarding improvement in their understanding and skills in working with culturally diverse patients. In this instance, the academic-clinical collaboration is facilitated by the faculty member’s dual role as clinic administrator and course co-coordinator. This allows for a full understanding and implementation of the clinical goals and objectives. Specifically, the faculty member is able to seamlessly incorporate topics addressed in the classroom such as telehealth competencies and principles of social determinants of health. In the absence of this built-in connection, these topics would need to be specifically reinforced with the clinical partner, and specific interventions to facilitate that process will be shared.
Description: In this setting, students integrate their knowledge of pharmacology, pathophysiology, psychology, population/public health, and chronic disease management to provide patient care through telehealth/virtual means as well as in-person. Whether virtual or in-person, the clinical day begins with the student preparing for the assigned patients by reviewing the reason for the visit, administering pertinent physical assessment, and providing medication reconciliation. The student then gives a report to the provider using the SBAR (situation, background, assessment, recommendation) format, and participates in the visit if possible. This participation may take the form of acting as scribe for the provider, which further reinforces the student’s familiarity with medical terminology. At the visit conclusion, the student then provides follow-up education, health navigation, and care coordination.
The clinic through which students rotate serves community members who are uninsured and cannot afford episodic care at retail clinics. Because the clinic serves clients from many countries, students learn how to provide linguistically appropriate and culturally informed care. They are immersed in the refugee, migrant, immigrant, asylum seeker, and undocumented patient experience in the context of social and structural determinants of health, provisioning of care, care coordination, and patient navigation.
Evaluation: This clinical experience is part of an academic course in which students evaluate their overall clinical experience. In written and verbal comments, students provide overwhelmingly positive feedback regarding improvement in their understanding and skills in working with culturally diverse patients. In this instance, the academic-clinical collaboration is facilitated by the faculty member’s dual role as clinic administrator and course co-coordinator. This allows for a full understanding and implementation of the clinical goals and objectives. Specifically, the faculty member is able to seamlessly incorporate topics addressed in the classroom such as telehealth competencies and principles of social determinants of health. In the absence of this built-in connection, these topics would need to be specifically reinforced with the clinical partner, and specific interventions to facilitate that process will be shared.
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.
Marie Ferrucci, MSN, ML, RN | Catima Potter, MPH, Senior Analyst, Press Ganey Associates LLC
Updated: 03/22/23
Updated: 03/22/23
Learning objective: Participants will learn depression screening rage in primary care setting along with characteristics of individuals who screened positive for depression.
Background/significance: Anxiety and depression are one of the most common reasons for primary care visits. Depression is one of the leading causes of disability among people 15 years and older. Several studies have noted a relationship between depression and patient outcomes. The U.S Prevention Services Task Force (USPST) recommends screening all adults, ages 18 years and older, for depression. A positive screening for depression should be followed by a more extensive evaluation of the patient. Nurses can play a vital role in screening patients and assistance with connecting patients with follow-up care.
Methods: Using data from a national nursing quality database, we examined the rate of patients who were screened for depression and subsequent follow-up care for those who screened positive. The sample consisted of 70 primary and specialty care units in nine US facilities who submitted a one-day depression screening point prevalence study in 2022. Descriptive statistics were used to determine the screening rate and positive screened patient characteristics.
Results: Total screening rate ranged from 0% to 100% with mean rate of 60% of eligible patients screened. Over 6% of the study’s sample screened positive for depression. Positive screen patients included female (67.38%), aged 50 years and older (59.87%), while mean follow-up care plan consisted of one item with the most frequent intervention being addition evaluation. However, 23% of positive screen patients had no follow-up care documented.
Conclusions/implications: Monitoring depression screening and associated follow-up care plan implementation can provide facilities with additional information for quality improvement efforts related to behavioral health issues. While continued promotion of depression screening should be maintained in healthcare practices, it is equally important to ensure that timely follow-up and intervention is pursued for patients with positive screenings. Primary and specialty care practices can utilize quality improvement strategies to monitor rates of depression screening with documented follow-up for positive screenings to ensure an accountable correlation and engage nurses to help improve early intervention and coordination for positive depression screenings.
Background/significance: Anxiety and depression are one of the most common reasons for primary care visits. Depression is one of the leading causes of disability among people 15 years and older. Several studies have noted a relationship between depression and patient outcomes. The U.S Prevention Services Task Force (USPST) recommends screening all adults, ages 18 years and older, for depression. A positive screening for depression should be followed by a more extensive evaluation of the patient. Nurses can play a vital role in screening patients and assistance with connecting patients with follow-up care.
Methods: Using data from a national nursing quality database, we examined the rate of patients who were screened for depression and subsequent follow-up care for those who screened positive. The sample consisted of 70 primary and specialty care units in nine US facilities who submitted a one-day depression screening point prevalence study in 2022. Descriptive statistics were used to determine the screening rate and positive screened patient characteristics.
Results: Total screening rate ranged from 0% to 100% with mean rate of 60% of eligible patients screened. Over 6% of the study’s sample screened positive for depression. Positive screen patients included female (67.38%), aged 50 years and older (59.87%), while mean follow-up care plan consisted of one item with the most frequent intervention being addition evaluation. However, 23% of positive screen patients had no follow-up care documented.
Conclusions/implications: Monitoring depression screening and associated follow-up care plan implementation can provide facilities with additional information for quality improvement efforts related to behavioral health issues. While continued promotion of depression screening should be maintained in healthcare practices, it is equally important to ensure that timely follow-up and intervention is pursued for patients with positive screenings. Primary and specialty care practices can utilize quality improvement strategies to monitor rates of depression screening with documented follow-up for positive screenings to ensure an accountable correlation and engage nurses to help improve early intervention and coordination for positive depression screenings.
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.
