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Congratulations to the selected Spotlight posters! These featured posters are the top 10 scored posters.
Updated: 03/22/23
Updated: 03/22/23
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 discussion is to describe how nurse-led primary care interventions in ambulatory care are measured and examine the implications for the nursing workforce.
Background: Value-based payment models are a revenue generating form of compensation for the delivery of quality health care in primary care. To date, primary care has not capitalized on registered nurses’ ability to contribute to quality and payment. Although there is evidence of nurse-led interventions in the primary care setting, no synthesis of these interventions and their effect on patient and organizational outcomes has been conducted.
Methods: A literature review with searches done in PubMed, CINAHL, Google Scholar, and a university database for peer-reviewed articles. Inclusionary criteria included being published within the last 5 years, written in the English language and article abstract/title included keywords "payment for RNs," "unique nurse identifier," "primary care," "nursing," "payment model," "alternative payment models," "value-based payment," "nurses," "healthcare," "nurse-led," "ambulatory care," "chronic care model," "patient teaching," and "outcomes." International research articles and non-English language articles were excluded. Results presented in narrative form.
Results: We identified six studies, enrolling 3,284 participants, that met the inclusionary criteria measuring nursing care/interventions in the primary care setting in the United States. Five studies evaluated nurse-led interventions for different chronic disease and a sixth study focused on advanced care planning. Results were mixed with four studies finding improved outcomes and two studies finding no difference from standard care. Two themes were identified in this review. First, adequate training and organization support for nurse-led primary care interventions can improve the quality of patient outcomes and decrease the cost of care. Second, appropriate selection and utilization of measurement tools to evaluate nurse-led interventions supports assessment and valuation of nurses’ role in primary care delivery. Limitations of these studies were absence of assessment of nurse-led interventions using nurse-sensitive outcomes and lack of diverse patient populations, majority of the study participants were white males.
Conclusion: Registered nurses provide high-quality, cost-effective primary care given appropriate training and the opportunity to lead interventions in chronic disease management. However, future research is needed on the role of nurse-led interventions in diverse populations. Greater utilization of nurse-sensitive outcomes to examine nurse-led interventions is needed as a mechanism to standardize the assessment of primary care nursing. Payors can drive integration of nurse-sensitive indicators in primary care settings through reimbursement policies. When quality nursing care is recognized and valued, licensed nurses will be seen as a financial viability of practices contributing to the expansion of registered nurses in primary care.
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: 03/01/23
Updated: 03/01/23
Ambulatory care nursing is a unique and dynamic domain of specialty nursing practice that focuses on wellness, health promotion, and disease prevention (AAACN, 2010). Ambulatory care is advancing in a fast pace. Nurses have to keep up with the knowledge and clinical skills to ensure that the care delivered to the patients meet the highest standards. As such, an option to meet this requirement is the attainment of ambulatory care nursing specialty certification. The purpose of this performance improvement project was to identify the most common barrier in obtaining specialty certification and identify strategies to support the ambulatory nurses as they meet this professional goal. In September 2020, a survey was disseminated to the ambulatory nurses via email. The purpose of the survey was to gauge interest in obtaining certification in the ambulatory nursing specialty. More than 40 nurses were interested in obtaining ambulatory care certification but had expressed the lack of review course to prepare for the ambulatory care certification. The repository of specialty review courses (Nurse Builders) available for nurses in the organization was evaluated. There was a limited availability of preparatory course for ambulatory care certification. A plan was proposed to our nursing leadership to support about 20 ambulatory care nurses to receive a prepaid preparatory course for ambulatory care nursing certification. A set of criteria was developed to select the 20 nurses. Partnership with the American Academy of Ambulatory Care Nursing (AAACN) was developed and an online review course through ANCC was offered to the nurses. Provision of sample review questions were developed. The nurses were encouraged to answer and discuss the questions among their peers. An electronic chat box was created so the nurses can ask and answer questions about topics in the preparatory course. A monthly check-in with the nurses was performed to clarify issues and determine the progress of the certification preparatory process. As a result, about 60% of the nurses obtained certification in ambulatory care nursing. About 10% of the nurses failed the exam but were planning to retake through the Success Pays. 30% continue to prepare for the exam. In conclusion, a preparatory course is a great tool to cover the topics in the certification exam faster. It helps shorten study time and make the achievement of the specialty certification more realistic and attractive to a busy nurse.
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: 03/14/23
Updated: 03/14/23
In late 2021, ambulatory care services within a large academic health center in the Midwest United States developed an NPR committee and in 2022 the committee began their first peer review process. The NPR committee included the administrative director of multi-specialty services, the clinical educator for ambulatory care services, the ambulatory care clinical program manager for quality and safety, and eight direct care RNs. The NPR committee retrospectively reviewed all patient falls from 2020 and 2021 for their first event review. This exercise supported the council to formalize the NPR process, including gathering data from the medical record, facilitation of peer discussion, identification of deviations in generally accepted practice standards (GAPS), and generation of actionable items based on identified deviations.
In the first quarter of 2022, 45 incident reports were filed, of which 19 met criteria for NPR. The included reports were broken down as lab/diagnostic events (7), patient relation events (2), care delivery events (3), falls (2), surgery/procedure event (1), good catch/near miss (1), and safety event (1). The framework used to guide committee discussion was the Taxonomy of Failure Modes, which facilitated the team to identify system and individual failures and identification of associated follow-up actions. For example, review of fall events identified that the ambulatory care fall assessment was not a mandatory field in the electronic medical record as a part of the rooming process. Additionally, the review found the current fall risk assessment was not evidence-based, prompting a literature search that identified more comprehensive assessments, with evidence of validity and decreased harm events after implementation in the ambulatory care setting.
Overall, the NPR committee provided a collaborative and safe space to identify specific gaps that the team could act on immediately. NPR team members expressed satisfaction with the process and continued to be highly engaged through sustainment of the committee. When delivered in a psychologically safe environment, NPR can foster transparency and an in-depth approach to event review. Leaders in ambulatory care settings should consider integrating NPR to understand system and individual failures to more effectively align with strategic action plans that address and prevent further patient harm.
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.
Purpose: Humans have an innate drive to connect with other living things. There is a long-standing history of turning to animals for improving health and well-being. Modern research indicates that the human-animal interaction can decrease stress, lower blood pressure, and increase social connection (Fine, 2019). Horses and dogs are incredibly perceptive when sensing human emotions and observing or participating in interactions. They can provide immediate, honest, and non-threatening feedback, which can help guide and enhance treatment. Animal-assisted therapy (AAT) is directed by a licensed psychologist or mental health provider with specialized experience. Interactions with horses or dogs can provide patients opportunities to face fears and build confidence, learn and practice healthier ways of relating to others, and feel more comfortable working with their healthcare team.
Description: The ADAPT (assisted dog and pony therapy) program is a first-of-its kind model to incorporate animals into therapeutic treatment planning for patients at Nemours Children’s Health – Jacksonville, an outpatient free-standing multidisciplinary ambulatory care center. This program addresses a variety of children's mental and emotional health needs, including anxiety, anger issues, grief and loss, behavioral and family relationship concerns, communication difficulties, depression, and emotional adjustment to medical issues.
The ADAPT program was established as a three-year implementation science research project in partnership between Nemours Children’s Health and the University of North Florida to create ADAPT serves as a living laboratory for research in evidence-based practices incorporating animal-assisted therapy into a traditional medical healthcare setting. The World Health Organization promotes the use of implementation science methodology in research for new and innovative programing in systems that are often experienced as highly resistant to change, e.g., in educational institutions and healthcare organizations (WHO, 2019).
Evaluation/outcome: This poster presentation will provide learners with a foundation in the principles of implementation science research practices in animal-assisted therapy; strategies for building collaborations among healthcare organizations, university systems, and the Professional Association of Therapeutic Horsemanship (PATH) International, and equine-assisted services (EAS) programs. Strategies specific to provider education, organization policy/procedure development, and program approval will be reviewed. Funding-specific strategies will also be presented, as this program is 100% donor-funded. Finally, several ADAPT program research projects will be briefly outlined: determining organizational readiness for animal-assisted therapy implementation (2021) and the ADAPT pre-pilot procedure testing (2021). The layered approach to research and the future research agenda for the ADAPT program will also be revealed.
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
To better manage the patient’s overall health needs effectively, our organization funded and formed a team for pre-visit planning. Pre-visit planning (PVP) increases the quality of visits by preparing patient information for the provider and addresses several important topics even before the visit. Completion of PVP by RN was linked to provider time saved. The calculation of saved provider time increases revenue became the source of funding for adding quality of patient care in our initial PVP pilot.
Patients are scheduled one to fourteen days before their in-person annual wellness visit (AWV) with their primary care provider (PCP) through a scheduling panel algorithm working behind-the-scenes of our electronic medical record. PVP is a 30-minute telephone visit where the RN completes medication reconciliation and health risk assessment (HRA) including fall risk assessment, depression screening, cognitive impairment screening, and education of resources, including topics on advance care planning and social determinants of health (SDOH) addressing health maintenance recommendations.
The PVP RN pilot has demonstrated that outpatient care is improved when utilizing RNs to complete pre-visit planning for AWVs. In our 2019 provider survey sampling, five providers showed 100% (5/5 responses, 5 surveys sent) felt a positive difference in their clinic workflow with the PVP completed. In our 2019 patient care survey, 66% (204/309 responses, 10745 surveys sent) felt that PVP was beneficial, and 59% (183/308 responses, 10745 surveys sent) felt their AWV with provider was improved from having PVP. In 2022, we surveyed a primary care provider new to PVP, and he responded positively, stating the work is impactful and makes a positive difference. When a patient presents in-person at the clinic, the telehealth performed nursing assessment of health risks and triage of patient concerns puts the provider in a better position to fully utilize their clinic time to meet the needs of the patient.
The scope of the RN permits assessment and education of patients which contributes to the patient’s ability to better understand and manage their health. This type of health care provides the highest level of quality and efficiency using the strength of all team members. Telephonic pre-visit planning in primary care by remote nurses can be summarized by: preparation – to enhance the time patients have with provider; presentation – of information collected from PVP RN to provider; partnership – with clinical teams and 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.
Updated: 03/22/23
Updated: 03/22/23
Methods: In late 2019, a multidisciplinary team was formed to implement pre-visit planning. Two primary care clinics were selected as pilot sites, which included leader input from the nursing, physician, and operational perspectives. However, the dissemination efforts to all practices were halted due to COVID-19 pandemic in April 2020. In April 2021, an analysis was conducted to determine which practices were utilizing pre-visit planning. In the summer of 2021, nursing, physician, quality improvement specialists, the primary care nurse educator, operational leaders, and clinical support staff created a standard workflow. Medical assistants and licensed practical nursing staff provided input on key tasks to shape the workflow for patient visits and rooming. They assisted with peer-to-peer training and collaboration with schedulers to include steps on obtaining medical records and the state’s immunization registry access. Tests of change included creating a standard pre-visit clinic workflow based on Gemba walks and a standard pre-visit planning document. In October 2022, the hospital system transitioned to a new electronic medical record platform allowing pre-visit planning and gap closure to be more readily operationalized.
Results/outcomes: By September 2021, seven practices began to roll out the process and evaluation of the processes occurred. In December 2021, nine additional practices were conducting pre-visit planning. As of February 2022, all 54 primary care practices have pre-visit planning as their standard workflow. The pre-visit planning process continues to be utilized even upon transition to a new EMR. A rooming checklist process was developed by the front-line staff with mentorship and guidance by the nurse leaders. The RN educator and nurse manager leaders continue to provide training updates for current and new staff members. Nurse leaders and front-line staff collaborated with physician partners and operational leaders during the EMR transition to ensure the incorporation of the pre-visit planning process.
Implications for practice: Pre-visit planning has implications for patient partnerships, chart review, rooming practices, and office staff communications to provide comprehensive, quality care.
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
Discussion will include six-month post-implementation return-on-investment metrics including scan rates, the leveraging of 340 B pricing, provider order entry accommodations, the linking of therapy to wound and healing process, nurse satisfaction, compliance, and increased reimbursement. Problems and barriers encountered will be shared to provide guidance on how to optimally design and transition to a new model of nursing informatics support. Improvements made and lessons learned will be explored.
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: 04/12/23
Updated: 04/12/23
Purpose: To facilitate the successful transition of RNs from the inpatient to the outpatient setting through evidence-based education that prepares the RN to practice competently and safely in ambulatory care services with improved job satisfaction.
Description: Insufficient orientation experiences often contribute to increased turnover rates for RNs transitioning to ambulatory care services from the inpatient setting, which can compromise the ability to deliver competent and safe patient care. The American Academy of Ambulatory Care Nursing (AAACN) identifies two major trends demonstrating the need for ambulatory care transition-to-practice (ATTP) programs: 1) leaving the job - experienced RNs new to ambulatory care environments return to previous work due to unrealistic expectations and lack of understanding of the interprofessional approach in ambulatory care and 2) complex health care needs - in the US, 1 in 4 adults have 2+ chronic conditions that are managed in an outpatient setting.
RNs in ambulatory care must demonstrate competencies in guiding and teaching patient self-care management and healthcare navigation, which can be facilitated through a structured evidence-based onboarding experience. A pre-assessment was conducted of organization results from the 2018 Press Ganey Workforce and Engagement Solutions survey. One question became the focal point for the ATTP program due to marginal results, “I get the tools and resources I need to provide the best care/service for our clients/patients” (Adequacy of Resource Staffing). As a result, an online stakeholder needs assessment survey (SNAS) was conducted of managers and front-line RNs in ambulatory care services across the system. The survey consisted of 15 questions that utilized the 2017 AAACN Transition to the Specialty of Ambulatory Care and Vizient curriculum guidelines. The survey compared the leadership perception of a new RN’s ability to practice competently and safely versus the front-line nurse’s perception of their own competence and safety practices. Once the data was sorted, a team of stakeholders collaborated to create a program tailored to organizational and learner needs.
Evaluation/outcomes: ATTP launched its first class in January 2019. As of August 2022, (46) groups (~545 RNs) have completed the program. We saw a 15% increase in response to the question, “I get the tools and resources I need to provide the best care/services for our clients/patients” (Adequacy of Staffing Resources). On a broader scale, 62% of managers and 85% of RNs reported ATTP specifically assisted the RN to care for patients more competently and safely. To further determine the validity and quality of ATTP, a repeat SNAS is disseminated to managers of new hires and RNs who complete the ATTP program. Results from this SNAS revealed 58% RNs and 74% managers reported ATTP increased job satisfaction. Additional results obtained through the SNAS will assist stakeholders in making adjustments to the curriculum to further achieve program goals.
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: 04/12/23
Updated: 04/12/23
Understanding ambulatory care nursing practice was essential to the redesign and adaption of TSAM concepts in a new setting. The team used job descriptions, professional practice standards, and nursing workflows (Brixey & Newman, 2018) along with TSAM® concepts to design a core orientation record, resource time activities, and continuous partnership strategies that supported telehealth and ambulatory care workflows. The orientation record was organized in a tiered structure with short self-study resource time activities that allowed learners to engage in reflection and critical thinking.
The TSAM® re-design produced one core orientation record, standardized resource time activities, and realistic continuous partnerships across 25 primary and specialty care clinics and has been successfully sustained post-implementation.
1) Brixey, L. & Newman, C. A. (Eds.). (2018). Ambulatory care nursing orientation and competency assessment guide (3rd ed.). Pitman, NJ: American Academy of Ambulatory Care Nursing.
2) Joswiak, M. E., (2018) Transforming orientation through a tiered skills acquisition model. The Journal for Nurses in Professional Development, 34 (3), 118-122.
3) Wojnar, D. M., & Whelan, E. M. (2017). Preparing nursing students for enhanced roles in primary care: The current state of pre-licensure and RN-BSN education. Nursing Outlook, 65(2), 222-232.
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.
