Tags:
education
nursing
gamification
interprofessional collaboration gamification nursing educatio
pedagogy
Updated: 03/06/24
Games are an effective pedagogical approach that may be used to expose licensed professionals and students to interprofessional collaboration (IPC). A card game named Collaborate was designed for use with baccalaureate nursing and health science students to increase their self-reported IPC knowledge. The objective of this research was to determine if IPC knowledge, measured by the interprofessional competency in healthcare education survey, differed between an experimental and control group after the card game intervention. The mean aggregate survey score was 101.3 (n=78) for the experimental group, compared to 66.1 (n=68) for the control group (p
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: 03/07/24
Post-traumatic stress disorder (PTSD) has an overall estimated prevalence of 6.1% in the general population and between 4 -17% in service members. This clinical practice guideline (CPG) intends to promote evidence-based management of PTSD, thereby improving patient’s clinical outcomes. The CPG is designed to assist primary care and mental health clinicians and specialists in the diagnosis of PTSD, using a patient-centric approach in determination of appropriate treatment and delivery of individualized interventions with a focus on mental health recovery. The Department of Veterans Affairs/Department of Defense (VA/DoD) evidence-based practice work group convened a joint VA/DoD guideline development effort that included an interdisciplinary panel of practicing clinician experts. The clinician experts developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated published clinical literature through May 4, 2022. Recommendations are based on a systematic review of the scientific evidence, a weighing of the benefits and harms of interventions, consideration of what is known about patient values and preferences, and consideration of the applicability of the evidence across demographic groups and settings. Recommendations by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This CPG is intended to promote evidence-based management of PTSD and thereby improve patient’s clinical outcomes. Reducing mental health morbidity is important for the health and well-being of active-duty service members, veterans, and their families. This poster presentation summarizes key features of the CPGs: the appropriate diagnosis of PTSD, target treatment goals, algorithms, and nonpharmacologic and pharmacologic treatments.
Outcomes: Participants will be able to describe and emphasize the use of patient-centered care and shared decision making with persons who have PTSD. Participants will be able to describe algorithms for assessment, diagnosis, and management of PTSD. Participants will be able to describe guidelines for healthcare providers for adults with PTSD in all stages of PTSD to minimize preventable complications. Participants will be able to describe non-pharmacologic and pharmacologic treatments for the management of PTSD.
This CPG and algorithm are designed for adaptation by individual healthcare providers with respect to unique patient considerations and preferences, local needs, and resources. The algorithm serves as a tool to prompt providers to consider key decision points in the care for a patient with headache, encouraging to use a patient-centered, whole/holistic health approach. Service/agency this content is being presented from VA/DoD.
Outcomes: Participants will be able to describe and emphasize the use of patient-centered care and shared decision making with persons who have PTSD. Participants will be able to describe algorithms for assessment, diagnosis, and management of PTSD. Participants will be able to describe guidelines for healthcare providers for adults with PTSD in all stages of PTSD to minimize preventable complications. Participants will be able to describe non-pharmacologic and pharmacologic treatments for the management of PTSD.
This CPG and algorithm are designed for adaptation by individual healthcare providers with respect to unique patient considerations and preferences, local needs, and resources. The algorithm serves as a tool to prompt providers to consider key decision points in the care for a patient with headache, encouraging to use a patient-centered, whole/holistic health approach. Service/agency this content is being presented from VA/DoD.
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.
Sheryl Bartlett, BSN, RN, Nurse Manager, After-Hours Triage, UT Southwestern Medical Center
Updated: 03/07/24
Purpose: Create an early intervention process for acute medical conditions in oncology patients to efficiently move patients across levels of care to improve patient outcomes and decrease financial burdens. An after-hours triage program (AHTP) was established in October 2021. By February 2022, it was noted that the highest volume of patient phone calls were from oncology patients, which resulted in a large population being referred to the emergency room (ED). Telephone triage is essential in outpatient management of oncology patients to ensure they navigate to the appropriate level of care.
From February 2022 through June 2023, 778 oncology patient phone calls were managed by AHTP, with 35% (n=272) of patients referred to the ED. In June 2023, the after-hours triage program (AHTP) began a collaboration with the cancer center’s acute care clinic (ACC), an ambulatory care clinic that provides care for oncology patients with acute medical issues. Patients placing after-hours calls are triaged to determine the correct disposition of care with protocols embedded in the electronic medical record (EMR). ACC providers are paged for consults during their operational hours. For overnight calls, a high-priority EMR message is sent, and the ACC provider is paged the next morning. The outcomes of this collaboration have not previously been measured.
Description: Two registered nurses with more than 30 years of experience conducted a review of the current process of AHTP and evaluated the following variables: patient encounters, the volume of patients referred, the number of arrivals and patients seen, treatments received, and disposition of patients from the ACC.
Evaluation: After implementation of the AHTP/ACC collaboration from July 2023 through October 2023, AHTP managed 624 oncology patient calls and referred 35% (n=221) patients to the ED. AHTP referred 4% (n=25) of patients to ACC during this time period. Of the 25 patients referred, 76% (n=19) arrived at ACC for their appointment. Treatments for these patients included: IV hydration, fever management, pain control, and evaluation of upper respiratory symptoms. Of the patients referred to ACC, 79% (n=15) were discharged home, 11% (n=2) were directly admitted to the hospital, and two patients (11%) were transferred to the ED. An additional 61 encounters were identified as potential ACC referrals when the encounter disposition would have allowed for a visit during ACC operational hours. Further review is needed to validate these potential referrals, to prevent manageable symptoms from being referred to the ED.
Outcome: Data demonstrates that 75% of the patients are open to the ACC referral process and keep their scheduled appointments with the ACC. The AHTP collaboration was successful across levels of care between AHTP and ACC improving workflow, early intervention, and eliminating unnecessary ED visits. Additional interventions should focus on expanding ACC weekend hours and measuring patient outcomes with the expansion.
From February 2022 through June 2023, 778 oncology patient phone calls were managed by AHTP, with 35% (n=272) of patients referred to the ED. In June 2023, the after-hours triage program (AHTP) began a collaboration with the cancer center’s acute care clinic (ACC), an ambulatory care clinic that provides care for oncology patients with acute medical issues. Patients placing after-hours calls are triaged to determine the correct disposition of care with protocols embedded in the electronic medical record (EMR). ACC providers are paged for consults during their operational hours. For overnight calls, a high-priority EMR message is sent, and the ACC provider is paged the next morning. The outcomes of this collaboration have not previously been measured.
Description: Two registered nurses with more than 30 years of experience conducted a review of the current process of AHTP and evaluated the following variables: patient encounters, the volume of patients referred, the number of arrivals and patients seen, treatments received, and disposition of patients from the ACC.
Evaluation: After implementation of the AHTP/ACC collaboration from July 2023 through October 2023, AHTP managed 624 oncology patient calls and referred 35% (n=221) patients to the ED. AHTP referred 4% (n=25) of patients to ACC during this time period. Of the 25 patients referred, 76% (n=19) arrived at ACC for their appointment. Treatments for these patients included: IV hydration, fever management, pain control, and evaluation of upper respiratory symptoms. Of the patients referred to ACC, 79% (n=15) were discharged home, 11% (n=2) were directly admitted to the hospital, and two patients (11%) were transferred to the ED. An additional 61 encounters were identified as potential ACC referrals when the encounter disposition would have allowed for a visit during ACC operational hours. Further review is needed to validate these potential referrals, to prevent manageable symptoms from being referred to the ED.
Outcome: Data demonstrates that 75% of the patients are open to the ACC referral process and keep their scheduled appointments with the ACC. The AHTP collaboration was successful across levels of care between AHTP and ACC improving workflow, early intervention, and eliminating unnecessary ED visits. Additional interventions should focus on expanding ACC weekend hours and measuring patient outcomes with the expansion.
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: 03/07/24
This project’s purpose was to improve patient access and decrease wait time for outpatient interventional radiology (IR) procedures. This was an opportunity for nursing to work more autonomously and allow advance practice providers (APP) to see more complex patients, thereby improving the timeliness in care, patient outcomes and retention of cancer patients. The registered nurse (RN)-led teaching program was developed to provide education and prepare patients for procedures leveraging APPs for clinical escalation as needed, with the goal to decrease wait time for procedures related to clinic provider availability.
Delays in cancer diagnosis can lead to devastating consequences. Patient access to cancer care can be a limiting factor, and time to diagnosis is critical in treatment planning. Many patients can miss a critical time window during which cancer treatment may have been most effective. At a National Cancer Institute (NCI)-designated cancer center, a multidisciplinary task force was convened to create and implement a new nurse led patient pre-procedure education program workflow with the goal to decrease wait time for procedures.
Members of this multidisciplinary task force included nursing leadership, physicians, APP leadership, nurses, administrators, and radiology assistants. Weekly meetings were held to identify gaps, streamline processes, and create algorithms and workflows for the respective team members. A centralized scheduling template was created to promote flexibility and collaboration between IR clinic nurses. The role of the RN was to evaluate eligibility criteria, review patients’ comorbidities and medications, educate patients on procedures, review risk/benefits, and coordinate required outpatient visits. A pilot program was conducted in one area to evaluate its effectiveness and feasibility. After the pilot, improvements were identified and implemented. Once finalized, nursing-led teaching program was expanded to all IR clinic nurses across the cancer center.
Metrics identified included wait time to procedure, clinical escalation needs, procedure type, successful teaching completed, and reasons for unsuccessful teachings. Data showed from May 2023 prior to going live the average wait time to biopsy was 45 days. Post-implementation to October 2023 wait time was reduced to nine days. During the first three months, 386 RN teachings were scheduled and 87% were completed successfully. Data is continuing to be collected and evaluated.
The program achieved the goal of reducing wait times to procedure, biopsy, and diagnosis. It showed the ability to create efficient workflows in the outpatient scheduling system and demonstrated the impact of nursing collaboration towards patients gaining access to cancer care timely and safely. The workflow required collaboration among the multidisciplinary team and stakeholders which employs an evidence-based approach to optimize coordination of care. Future programs or similar approaches could be utilized at other institutions to maximize access for patients and diagnosis of cancer.
Delays in cancer diagnosis can lead to devastating consequences. Patient access to cancer care can be a limiting factor, and time to diagnosis is critical in treatment planning. Many patients can miss a critical time window during which cancer treatment may have been most effective. At a National Cancer Institute (NCI)-designated cancer center, a multidisciplinary task force was convened to create and implement a new nurse led patient pre-procedure education program workflow with the goal to decrease wait time for procedures.
Members of this multidisciplinary task force included nursing leadership, physicians, APP leadership, nurses, administrators, and radiology assistants. Weekly meetings were held to identify gaps, streamline processes, and create algorithms and workflows for the respective team members. A centralized scheduling template was created to promote flexibility and collaboration between IR clinic nurses. The role of the RN was to evaluate eligibility criteria, review patients’ comorbidities and medications, educate patients on procedures, review risk/benefits, and coordinate required outpatient visits. A pilot program was conducted in one area to evaluate its effectiveness and feasibility. After the pilot, improvements were identified and implemented. Once finalized, nursing-led teaching program was expanded to all IR clinic nurses across the cancer center.
Metrics identified included wait time to procedure, clinical escalation needs, procedure type, successful teaching completed, and reasons for unsuccessful teachings. Data showed from May 2023 prior to going live the average wait time to biopsy was 45 days. Post-implementation to October 2023 wait time was reduced to nine days. During the first three months, 386 RN teachings were scheduled and 87% were completed successfully. Data is continuing to be collected and evaluated.
The program achieved the goal of reducing wait times to procedure, biopsy, and diagnosis. It showed the ability to create efficient workflows in the outpatient scheduling system and demonstrated the impact of nursing collaboration towards patients gaining access to cancer care timely and safely. The workflow required collaboration among the multidisciplinary team and stakeholders which employs an evidence-based approach to optimize coordination of care. Future programs or similar approaches could be utilized at other institutions to maximize access for patients and diagnosis of cancer.
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: 03/07/24
Learning outcome: We augmented an automated post-discharge calls program with tailored outreach strategies to improve rates and close an equity gap in post-discharge communication. This approach has the potential to improve post-hospital recovery among at-risk populations.
Post-discharge calls are recommended as part of comprehensive care transitions programs, because they reduce patient anxiety and improve clinical outcomes. However, calls are time and resource intensive and may be limited in reaching at-risk individuals. Studies have shown that adding a text message option to post-discharge programs can increase post-discharge follow-up in surgical and established primary care patients, but this approach has not been tested in other at-risk populations.
In 2013, we implemented a hospital-wide automated, multilingual post-discharge phone call program as part of the care transitions outreach program (CTOP). Patient-reported post-discharge concerns are first identified via automated telephonic outreach. For certain "at-risk" patients who fail to answer the automated call—age >85 years, discharged home with services, or limited English proficiency—a nurse reviews the chart and calls the patient if they have not already been contacted by another clinician. For all patients who answer the automated or nurse call and identify a concern, a nurse speaks with the patient to provide symptom triage, teaching, care coordination, and referrals to social work, pharmacy, and/or patient relations, as indicated.
CTOP now calls 27,000 patients annually (nearly all hospital discharges), with a 77% reach rate with the notable exception of black and/or African-American (B/AA) patients, who had a markedly lower 65% reach rate. To improve our overall reach rates and to address the identified inequity, we developed a tailored outreach escalation approach to enhance reach rates. First, patients who failed to answer the automated call received a follow-up text message with the same information as the automated call and translated into the same languages. Then, a CTOP nurse reviewed the chart for B/AA patients who did not respond to the automated call nor the text, and placed a personal call if no other clinician contact documented.
Adding text messages increased the overall reach rate from 77% to 84%. For B/AA patients, adding text messages increased the reach rate from 65% to 71%; adding a personal call (to 79 patients) further increased the reach from 71% to 77%. Because the text option increased the overall reach rate, it reduced the number of patients requiring a personal call. This helped improve efficiency, as nurses were able to complete calls to this limited number of patients within the scope of their existing roles and without requiring additional hours or CTOP personnel.
Post-discharge calls are recommended as part of comprehensive care transitions programs, because they reduce patient anxiety and improve clinical outcomes. However, calls are time and resource intensive and may be limited in reaching at-risk individuals. Studies have shown that adding a text message option to post-discharge programs can increase post-discharge follow-up in surgical and established primary care patients, but this approach has not been tested in other at-risk populations.
In 2013, we implemented a hospital-wide automated, multilingual post-discharge phone call program as part of the care transitions outreach program (CTOP). Patient-reported post-discharge concerns are first identified via automated telephonic outreach. For certain "at-risk" patients who fail to answer the automated call—age >85 years, discharged home with services, or limited English proficiency—a nurse reviews the chart and calls the patient if they have not already been contacted by another clinician. For all patients who answer the automated or nurse call and identify a concern, a nurse speaks with the patient to provide symptom triage, teaching, care coordination, and referrals to social work, pharmacy, and/or patient relations, as indicated.
CTOP now calls 27,000 patients annually (nearly all hospital discharges), with a 77% reach rate with the notable exception of black and/or African-American (B/AA) patients, who had a markedly lower 65% reach rate. To improve our overall reach rates and to address the identified inequity, we developed a tailored outreach escalation approach to enhance reach rates. First, patients who failed to answer the automated call received a follow-up text message with the same information as the automated call and translated into the same languages. Then, a CTOP nurse reviewed the chart for B/AA patients who did not respond to the automated call nor the text, and placed a personal call if no other clinician contact documented.
Adding text messages increased the overall reach rate from 77% to 84%. For B/AA patients, adding text messages increased the reach rate from 65% to 71%; adding a personal call (to 79 patients) further increased the reach from 71% to 77%. Because the text option increased the overall reach rate, it reduced the number of patients requiring a personal call. This helped improve efficiency, as nurses were able to complete calls to this limited number of patients within the scope of their existing roles and without requiring additional hours or CTOP personnel.
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.
Brittney Hahn, MSN, RN, RN-BC | Denise Rismeyer, DNP, RN, NPD-BC | Heidi Shedenhelm, DNP, RN, NE-BC | Kristine Zeitler, MSN, RN, NI-BC
Tags:
efficiency
nurse satisfaction
transformation of healthcare delivery
EHR enhancement
EHR usability
Updated: 03/07/24
Ambulatory care staff nurses caring for patients in person, via telephone, or patient portal frequently access patient’s history and contributing information in the electronic health record (EHR) to perform their work. Collecting and documenting relevant details requires navigating multiple sections of the EHR and can delay interactions with patients and/or team members. Concurrently, ambulatory nurse manager (ANM) work requires pulling of EHR data as it relates to workload and/or patient outcomes to drive practice improvement. Nurses have noted finding needed information within the EHR to be time consuming and cumbersome, and it is often expressed as a cause of administrative and cognitive burden. EHR usability issues are noted to negatively impact patient outcomes. In the complexity of today’s healthcare environment, with a growing nursing shortage, nurse workload demands continue to increase. Nurse leaders are being challenged to transform healthcare delivery through innovation and top-of-licensure work with the goal to maximize resources while ensuring optimal patient outcomes. This presentation will highlight the impact nurse-specific EHR views can have on nurse efficiency and satisfaction while promoting optimal patient outcomes.
At a large Midwest academic medical center, an ambulatory care practice solutions workgroup was charged with identifying and implementing initiatives aimed at improving the care of patients with less intensity of caregivers. This collaborative workgroup, comprised of front-line staff, informatics nurse specialists, and nurse leaders held focus groups and identified opportunities to explore and implement EHR solutions that promote practice efficiencies for both front-line staff and ANMs. Four themes emerged: documentation burden, difficulty locating patient information, knowledge deficit in EHR report functionality, and time constraints. Team members acknowledged the value a synthesized ANM dashboard with embedded links to frequently run reports could provide. Team members also noted a specific EHR view that synthesizes patients' key medical information, while commonly used by providers, has not been widely implemented in nursing, would be of value. Using the DMAIC model, an ANM dashboard, and the creation of a nurse-specific synthesized EHR view were selected, with the aim to improve nurse efficiency and satisfaction navigating the EHR by 20% by December 31, 2023. Workgroup members met with key stakeholders to develop the two EHR synthesized views. Evidence-based tools were utilized to collect baseline and post-pilot data measuring cognitive demand, work efficiency, performance, and behavior change. Subject matter experts (SMEs) were identified within each pilot unit to serve as embedded change agents. Education was provided one-week prior to go-live, with SMEs available throughout the pilot period to assist with real-time trouble shooting and to convey feedback to the workgroup. The two views were piloted in four diverse practices subspecialties for one month. Preliminary outcome data is positive, with participant feedback identifying additional enhancements to further improve nurse efficiency and satisfaction. Outcome data will be showcased along with key lessons learned and feasibility of replication.
At a large Midwest academic medical center, an ambulatory care practice solutions workgroup was charged with identifying and implementing initiatives aimed at improving the care of patients with less intensity of caregivers. This collaborative workgroup, comprised of front-line staff, informatics nurse specialists, and nurse leaders held focus groups and identified opportunities to explore and implement EHR solutions that promote practice efficiencies for both front-line staff and ANMs. Four themes emerged: documentation burden, difficulty locating patient information, knowledge deficit in EHR report functionality, and time constraints. Team members acknowledged the value a synthesized ANM dashboard with embedded links to frequently run reports could provide. Team members also noted a specific EHR view that synthesizes patients' key medical information, while commonly used by providers, has not been widely implemented in nursing, would be of value. Using the DMAIC model, an ANM dashboard, and the creation of a nurse-specific synthesized EHR view were selected, with the aim to improve nurse efficiency and satisfaction navigating the EHR by 20% by December 31, 2023. Workgroup members met with key stakeholders to develop the two EHR synthesized views. Evidence-based tools were utilized to collect baseline and post-pilot data measuring cognitive demand, work efficiency, performance, and behavior change. Subject matter experts (SMEs) were identified within each pilot unit to serve as embedded change agents. Education was provided one-week prior to go-live, with SMEs available throughout the pilot period to assist with real-time trouble shooting and to convey feedback to the workgroup. The two views were piloted in four diverse practices subspecialties for one month. Preliminary outcome data is positive, with participant feedback identifying additional enhancements to further improve nurse efficiency and satisfaction. Outcome data will be showcased along with key lessons learned and feasibility of replication.
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.
Tags:
clinical practice
incivility
Updated: 03/07/24
Purpose: The purpose of this study was to explore RN-BSN students’ experiences with incivility in the workplace in an effort to better understand their perceived challenges with incivility. The outcome of this research project was to tailor nursing curricula to include the necessary skills for registered nurses to identify incivility in the workplace and manage it effectively. Nursing students do not receive adequate training and education about incivility and how to handle in the clinical setting. In bridging this academic gap, nursing faculty can help students be better prepared for practice.
Background/significance: Incivility in health care has detrimental effects on patient care such as an increased risk in errors and a decrease in the quality of care provided. In addition, incivility can cause harmful effects on nurses such as experiencing post-traumatic stress disorder, lacking the motivation to work, and burnout.
Methods: This project consisted of an exploration of RN-BSN students’ experiences with incivility in the workplace. The setting consisted of a 4-year institution in Central California. A purposeful sample of 11 novice registered nurses enrolled in an online RN-BSN program was utilized. The participants were asked to share their experiences with incivility and its consequences on themselves, the team, and the patients they were caring for. The participants were asked to share their experiences in an online discussion board. Open and axial coding was utilized to analyze the obtained qualitative data.
Results: The following five themes emerged from the data analysis: feelings of inadequacy, feeling intimidated, inability to seek assistance, delay in patient care, and decreased desire to return to the workplace.
Conclusions/implications: It was evident that new graduate RN-BSN students did not have the necessary tools to manage incivility in the workplace. The addition of incivility management to the RN-BSN nursing curriculum will benefit the new graduate students in managing incivility and promoting a healthy work environment.
Background/significance: Incivility in health care has detrimental effects on patient care such as an increased risk in errors and a decrease in the quality of care provided. In addition, incivility can cause harmful effects on nurses such as experiencing post-traumatic stress disorder, lacking the motivation to work, and burnout.
Methods: This project consisted of an exploration of RN-BSN students’ experiences with incivility in the workplace. The setting consisted of a 4-year institution in Central California. A purposeful sample of 11 novice registered nurses enrolled in an online RN-BSN program was utilized. The participants were asked to share their experiences with incivility and its consequences on themselves, the team, and the patients they were caring for. The participants were asked to share their experiences in an online discussion board. Open and axial coding was utilized to analyze the obtained qualitative data.
Results: The following five themes emerged from the data analysis: feelings of inadequacy, feeling intimidated, inability to seek assistance, delay in patient care, and decreased desire to return to the workplace.
Conclusions/implications: It was evident that new graduate RN-BSN students did not have the necessary tools to manage incivility in the workplace. The addition of incivility management to the RN-BSN nursing curriculum will benefit the new graduate students in managing incivility and promoting a healthy work environment.
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: 03/07/24
Purpose: It is well-documented that delivering high-quality and efficient patient care has mitigated significant bottlenecks, preventing delays in urgent cancer care for patients and enhancing the overall efficiency of all patient care processes. These improvements contribute to timely access to care and foster a more positive patient experience. The abstract is intended to delineate the reorganization of workflow, establishing a unified interface that improves communication and streamlines processes for the timely and efficient delivery of patient care.
Description: In October 2019, the nurse navigator project lead and subject matter expert identified several gaps in the new patient referral process in the urological surgical oncology department. After prioritizing these gaps through the lens of patient experience, quality, and efficiency, she set out to develop and implement the project focused on two primary workflow inefficiencies. Firstly, a centralized location in the workqueue was established to serve as a quick reference for the nurse navigator and new patient coordinator, consolidating communication and providing a snapshot of each referral's status. This involved implementing a "misc. flag" column with specific messaging options, alongside rearranging workqueue columns for better visibility. Secondly, the process for assigning a provider to non-direct referrals was redesigned. A reference sheet based on provider preferences was created to empower practice coordinators (PCs) to schedule patients with the next available provider, eliminating delays caused by provider unavailability.
Evaluation/outcomes: Collaborating with various stakeholders, including practice nurses, cancer center nurse navigators, nurse managers, and APeX, the project significantly improved the scheduling process. Before implementation, the volume of new uro/surg cancer patients waiting to be scheduled was as high as 400, with delays averaging weeks to two months. Post-implementation, the patient backlog decreased to less than 20, and patients were scheduled within an average of 1-4 days. The success of the project was shared at the True North Board and the cancer center-wide new patient council, inspiring other teams. This innovation continually enhances work performance and deliver optimal patient and organization care.
Description: In October 2019, the nurse navigator project lead and subject matter expert identified several gaps in the new patient referral process in the urological surgical oncology department. After prioritizing these gaps through the lens of patient experience, quality, and efficiency, she set out to develop and implement the project focused on two primary workflow inefficiencies. Firstly, a centralized location in the workqueue was established to serve as a quick reference for the nurse navigator and new patient coordinator, consolidating communication and providing a snapshot of each referral's status. This involved implementing a "misc. flag" column with specific messaging options, alongside rearranging workqueue columns for better visibility. Secondly, the process for assigning a provider to non-direct referrals was redesigned. A reference sheet based on provider preferences was created to empower practice coordinators (PCs) to schedule patients with the next available provider, eliminating delays caused by provider unavailability.
Evaluation/outcomes: Collaborating with various stakeholders, including practice nurses, cancer center nurse navigators, nurse managers, and APeX, the project significantly improved the scheduling process. Before implementation, the volume of new uro/surg cancer patients waiting to be scheduled was as high as 400, with delays averaging weeks to two months. Post-implementation, the patient backlog decreased to less than 20, and patients were scheduled within an average of 1-4 days. The success of the project was shared at the True North Board and the cancer center-wide new patient council, inspiring other teams. This innovation continually enhances work performance and deliver optimal patient and organization 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: 03/07/24
Purpose: The evolving landscape of ambulatory care is witnessing an influx of patients with higher acuity needs. Resource limitations pose challenges in delivering comprehensive care, as outpatient procedures become more commonplace and the demand for enhanced patient support during these interventions has intensified. Non-licensed clinics within our healthcare facility have pioneered the shift of certain procedures from surgery settings to ambulatory care. To ensure the maintenance of high-quality care, addressing patients’ needs, including pain and anxiety management and safe post-procedure discharge, has become imperative.
Description: In response to the growing need for improved patient experience, an innovative strategy has been developed – the utilization of patient self-administered 50:50 nitrous oxide and oxygen during minimally-invasive procedures. This practice, well-established globally and commonly used in dental offices, birthing centers, and even veterinary clinics, has demonstrated efficacy in managing pain during outpatient procedures.
Implementation process: A multidisciplinary workgroup, comprising representatives from ambulatory care nursing, safety department, pharmacy, information services and solutions, clinical epidemiology and infection prevention, and physician leadership, collaborated to create a comprehensive policy, devise a staff training program, and integrate the physician order into the electronic health record. The primary objective is to educate patients on self-administering a 50:50 mixture of nitrous oxide and oxygen, ensuring patient comfort, minimizing nitrous oxide exposure to staff, and facilitating safe post-procedure discharges.
Policy implementation and training: The policy was approved by the ambulatory care policy committee and implemented in April 2023. Ambulatory care nursing conducted staff training, covering equipment setup, equipment disinfection, and utilization of iMed consent embedded in the electronic health record.
Evaluation/outcomes: To assess the impact of this innovative approach, various metrics were measured, including the utilization of the nitrous oxide system, patient feedback on its efficacy, and the effectiveness of a scavenger system for nitrous oxide disposal to reduce staff exposure. These metrics serve as crucial indicators of the success and sustainability of the implemented strategy. This presentation highlights the journey of implementing patient self-administered 50:50 nitrous oxide and oxygen in ambulatory care for minimally invasive procedures. By fostering collaboration across disciplines, creating comprehensive policies, and implementing robust training programs, our initiative aims to enhance patient care, mitigate staff exposure, and set a precedent for innovative pain management strategies in ambulatory settings. The measured metrics provide valuable insights into the effectiveness and safety of this approach, contributing to the ongoing evolution of ambulatory care practices. This approach offers significant advantages, such as high patient acceptance and successful pain management.
Description: In response to the growing need for improved patient experience, an innovative strategy has been developed – the utilization of patient self-administered 50:50 nitrous oxide and oxygen during minimally-invasive procedures. This practice, well-established globally and commonly used in dental offices, birthing centers, and even veterinary clinics, has demonstrated efficacy in managing pain during outpatient procedures.
Implementation process: A multidisciplinary workgroup, comprising representatives from ambulatory care nursing, safety department, pharmacy, information services and solutions, clinical epidemiology and infection prevention, and physician leadership, collaborated to create a comprehensive policy, devise a staff training program, and integrate the physician order into the electronic health record. The primary objective is to educate patients on self-administering a 50:50 mixture of nitrous oxide and oxygen, ensuring patient comfort, minimizing nitrous oxide exposure to staff, and facilitating safe post-procedure discharges.
Policy implementation and training: The policy was approved by the ambulatory care policy committee and implemented in April 2023. Ambulatory care nursing conducted staff training, covering equipment setup, equipment disinfection, and utilization of iMed consent embedded in the electronic health record.
Evaluation/outcomes: To assess the impact of this innovative approach, various metrics were measured, including the utilization of the nitrous oxide system, patient feedback on its efficacy, and the effectiveness of a scavenger system for nitrous oxide disposal to reduce staff exposure. These metrics serve as crucial indicators of the success and sustainability of the implemented strategy. This presentation highlights the journey of implementing patient self-administered 50:50 nitrous oxide and oxygen in ambulatory care for minimally invasive procedures. By fostering collaboration across disciplines, creating comprehensive policies, and implementing robust training programs, our initiative aims to enhance patient care, mitigate staff exposure, and set a precedent for innovative pain management strategies in ambulatory settings. The measured metrics provide valuable insights into the effectiveness and safety of this approach, contributing to the ongoing evolution of ambulatory care practices. This approach offers significant advantages, such as high patient acceptance and successful pain management.
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: 03/07/24
Purpose: The purpose of this nursing students’ evidence-based project, as part of a population health clinical rotation, is to abridge discrepancies and misunderstandings that persist in medication management for low-English proficiency patients, both via in-person interaction and via telehealth environment.
Background: At a clinic serving mostly low-English proficiency population, the nursing students encountered patients taking multiple medications for their chronic illnesses which made adhering to their medication a struggle. Several patients also experienced transportation challenges, resulting in the clinic setting up telehealth encounters for them. This encounter led the students to curate an evidence-based individualized medication reconciliation approach for the patients, both with in-person clinic and via telemedicine environment.
Description: Evidence shows that involving the patient and their family members in medication prescription and education increases comprehension of medical conditions, health self-management, and satisfaction with health care, as postulated by the practices of patient- and family-centered care. The students’ intervention consisted of a group session on medication safety, followed by individual reviews of patients’ current medications and their medical records, under faculty supervision. The patients had family members present with them, as well as an interpreter. The students ensured that the patients and their family knew where to obtain refills, the purpose of each medication, and the frequency and time of day to take each. Students also participated in telehealth calls, working with nurse practitioner preceptor, conducting medication reconciliation with patients via interpreters. Families were also present with the patients during these visits.
Evaluation/outcome: As a result of the in-person medication reconciliation intervention, the patients became more aware of their medication regimen, where and how to obtain refills, and the importance of medication adherence. However, challenges such as transportation issues, limited available interpreters for an efficient 1:1 session resulted in a low number of patients served. In the telehealth setting, patients and family were more likely to have all their current medications with them. There is more flexibility to have an interpreter virtually, unlike the in-person environment. The increased accessibility of telehealth allowed patients who had transportation issues to be seen. However, not all patients have reliable internet access to allow high-quality calls. Many patients and families also struggled to confirm the medication names via telehealth.
Implication: Medication reconciliation activities should be considered for all nursing students as part of the clinical experience in ambulatory care settings as it is a valuable learning experience. When possible, engaging family members and interpreter if the patient has low-English proficiency in either the clinic setting or via telehealth may contribute to the patient’s better understanding of their medical management regimen.
Background: At a clinic serving mostly low-English proficiency population, the nursing students encountered patients taking multiple medications for their chronic illnesses which made adhering to their medication a struggle. Several patients also experienced transportation challenges, resulting in the clinic setting up telehealth encounters for them. This encounter led the students to curate an evidence-based individualized medication reconciliation approach for the patients, both with in-person clinic and via telemedicine environment.
Description: Evidence shows that involving the patient and their family members in medication prescription and education increases comprehension of medical conditions, health self-management, and satisfaction with health care, as postulated by the practices of patient- and family-centered care. The students’ intervention consisted of a group session on medication safety, followed by individual reviews of patients’ current medications and their medical records, under faculty supervision. The patients had family members present with them, as well as an interpreter. The students ensured that the patients and their family knew where to obtain refills, the purpose of each medication, and the frequency and time of day to take each. Students also participated in telehealth calls, working with nurse practitioner preceptor, conducting medication reconciliation with patients via interpreters. Families were also present with the patients during these visits.
Evaluation/outcome: As a result of the in-person medication reconciliation intervention, the patients became more aware of their medication regimen, where and how to obtain refills, and the importance of medication adherence. However, challenges such as transportation issues, limited available interpreters for an efficient 1:1 session resulted in a low number of patients served. In the telehealth setting, patients and family were more likely to have all their current medications with them. There is more flexibility to have an interpreter virtually, unlike the in-person environment. The increased accessibility of telehealth allowed patients who had transportation issues to be seen. However, not all patients have reliable internet access to allow high-quality calls. Many patients and families also struggled to confirm the medication names via telehealth.
Implication: Medication reconciliation activities should be considered for all nursing students as part of the clinical experience in ambulatory care settings as it is a valuable learning experience. When possible, engaging family members and interpreter if the patient has low-English proficiency in either the clinic setting or via telehealth may contribute to the patient’s better understanding of their medical management regimen.
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.
