Poster Day 2023: Abstracts: Quality Improvement

Hannah Mixon, Sandra Fanous, Margaret Deyton, Vanesa Figueredo, M.S., Camille Chancellor, James Nolin, FNP-C

Background:

Emergency departments in the U.S. and Canada lack readiness to care for pediatric patients based on the WPRS (Weighted Pediatric Readiness Score). The NPRP (National Pediatric Readiness) Assessment was implemented in 2013 based on a joint policy statement. Studies found some of the factors affecting pediatric readiness include distance from an ED, availability of pediatric emergency care coordinators (PECCs), and lack of awareness of national guidelines.

Design:

Researchers searched PubMed, Embase, Google Scholar, and EBSCO using the keywords “pediatric readiness,” “emergency medicine,” and “WPRS.” 86 articles were evaluated. Selection criteria included data from peer-reviewed journals in the U.S. and Canada that were published between 2013-2023 with a target demographic of children 0-18 years.

Results:

We selected 25 articles for inclusion in our review, 23 articles from PubMed and 2 articles from Embase. 22 of the included articles were from the United States, 2 were from Canada, and 1 article included results from both the United States and Canada. The results consistently demonstrated that higher WPRS scores are associated with lower patient mortality.

Conclusion:

The articles included indicated that higher WPRS scores are associated with lower patient mortality. All the research articles were based on the 2013 WPRS assessment. A 2021 WPRS survey was conducted, but there have been no assessments of this data and changes in mortality based on the updated scores. The 2013 outcomes demonstrated that additional research is needed to further improve pediatric survival in critical care settings.

Taylor F. Faust, OMS-III., Garrett Cail, OMS-III., Hannah Yates, OMS-II.

Management of postoperative pain following craniotomy can be dealt with in several forms. Treatment options range from conventional protocols involving opioid narcotics, NSAIDS, non-opioid pain management, and non-pharmacological management. Due to the massively publicized opioid crisis in the United States and in other countries there is a call for alternative methods for pain management. Of the alternative pain management techniques, gabapentin is one of the options that has been used in acute postoperative settings due to its anticonvulsant properties and pain management capabilities. This drug has been extensively used in the adult population, but its use in the pediatric population is uncommon. The purpose of this article is to discuss why gabapentin has not been utilized as either an opioid alternative or in combination with non-opioid analgesics for postoperative pain management in pediatric populations. This text will discuss the postoperative use of gabapentin, specifically following craniotomy in children, and will evaluate the extent of under-documentation in the literature in relation to this approach in the pediatric population. This scoping review will emphasize the need to further explore the use of gabapentin in this setting. It will also accentuate gabapentin’s potential benefit as an alternative medication for pain management.

Meaghan Barros, OMS-II; Priya Pohani, OMS-II, Dr. Veronica Hill, DNP, CRNP

Patient adherence to preventative care is low and rural residents are suspected to have even lower rates, as compared to urban patients. Clinical audits have shown minimal compliance to preventative screenings locally and nationally, highlighting the need to close the healthcare maintenance gaps for patients in rural America. In 2019, the Alabama College of Osteopathic Medicine opened a student run rural clinic in Ashford, AL to serve the needs of the community. Patients there had not received access to primary care in decades, creating large gaps in preventative healthcare. Recognizing the need to close these gaps and the unique availability of multiple medical students rotating through the clinic monthly, a quality improvement project was designed.

Using the Plan Do Study Act (PDSA) framework, three PDSA cycles were implemented measuring care gap closures in three-month intervals by a team consisting of a nurse practitioner, medical students, physicians, and the nursing staff. Interventions targeted multiple preventative care screenings and were refined to find the best way to utilize resources to close the gaps. The final cycle utilized medical students to place the needed preventative screenings into the electronic medical record prior to clinicians seeing the patients.

This resulted in a range of 9%-19% increases in care gap closures and multiple diseases caught in their early stages.

Multidisciplinary teams have been successful in helping close healthcare gaps in rural communities and should be looked at as potential means to close these gaps in other academic or student involved clinics.

Donna L. Yost, DNP-ENA, MSN-CNL, RN, OCN, CNE and Devesh Dahale, MS, MBA, CPHQ

Falls are not only the leading cause of injury for adults age 65 and older; furthermore, they are the most common cause, are costly, and generally are preventable (CDC, 2023).  Additionally, one (1) out of five (5) falls result in broken bones or a head injury (CDC, 2023).

Moreland, Kakara, and Henry (2020) state approximately 32,000 deaths result from falls yearly with overall costs of falls exceeding $50 billion annually.

In healthcare organizations, falls are noted as ‘never events’ –defined as preventable events with adverse outcomes when providers-multidisciplinary, not just nursing of care adhere to safety guidelines (AHRQ, 2019).

The SE Health Falls Team built on the successful implementation of the 2021-22 FY fall-risk assessment initiative. The focus for the 2022-23 FY year centered on identified risk factors and applied interventions. 

Using SPC (Statistical Process Control) chart, we were able to demonstrate a statistically significant reduction in # of falls per month from a baseline of average 30 falls per month to an average of 24 falls per month (20% relative reduction).

Data entry was subjective as unit staff completed the post-fall huddle sheet, nurse managers reviewed the sheets, and data then interpreted and entered by the falls team lead.  A process revision is in place for 2023-24 FY data collection.