Strategies for developing faculty confidence and competencies to mentor quality improvement DNP projects.

DNP faculty who mentor students in quality improvement (QI) DNP projects often lack essential knowledge of QI principles. The purpose of this article is to guide DNP programs in developing confident and competent faculty mentors for QI DNP projects, facilitating DNP student success. At a multi-campus practice- and research-intensive university, strategies employed to teach College of Nursing faculty essential knowledge of QI principles comprise structural and process components. Structural supports standardize faculty workload, promote potential for collaborative scholarship, and provide instructional and resource support for faculty mentors. Organizational processes facilitate identification of practice sites and meaningful projects. A College of Nursing and university Institutional Review Board collaboration established policy to guide human subjects protection regarding DNP project activity, streamlining and standardizing the process. Library support mechanisms, access to ongoing faculty QI training and resources, and faculty feedback processes to improve QI faculty development are ongoing and sustained. Peer coaching provides continued support for faculty development. Initial process outcomes indicate that implemented strategies are well-received by faculty. The transition to competency-based education provides opportunities to create tools to measure multiple student quality and safety competencies highlighted in Domain 5 of The Essentials: Core Competencies for Professional Nursing Education and inform future directions for faculty development essential to support student success.

Collaborative Care: Integrating Behavioral Health Into the Primary Care Setting.

INTRODUCTION: Integrated behavioral health is a model of health care that aims to meet the complex health care needs of patients in primary care settings. Collaborative Care (CC) is an evidence-based model incorporating an interdisciplinary team to improve outcomes for behavioral health disorders commonly seen by primary care providers. AIM: CC was implemented in a nurse-managed health center in a medically underserved community of Chicago with a team of family nurse practitioners, psychiatric mental health nurse practitioners, and a licensed clinical social worker. METHODS: Integration of the CC model required restructuring of the patient visit, the care team, and financial operations. Weekly team meetings were held for interdisciplinary case consultation and training for the primary care team by the psychiatric nurse practitioner. The model includes suggested goals of reducing patient scores of validated depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) screening tools to a score less than 5 points or to less than 50% of original score. RESULTS: During the initial year of implementation, 166 patients received care under the CC model, with 64 patients currently receiving active care. In this cohort, 22% reached suggested goals for depression and 47% for anxiety. CONCLUSIONS: CC has benefits for both patients and providers. Patients receive holistic treatment of both mental and physical health needs and access to psychiatric services for medication initiation and behavioral health modalities when necessary. We observed that the CC model improved collaboration with behavioral health specialists and the competence and confidence of family nurse practitioners.

A Correctional Facility Academic-Practice Partnership: Implementation of a Nurse-Led COVID-19 Initiative.

In 2020, the COVID-19 pandemic resulted in one in five individuals incarcerated in U.S. correctional institutions contracting COVID-19 and 1,700 deaths. Correctional adult transition centers house incarcerated individuals who typically do not have on-site health care access. A COVID-19 outbreak could devastate this population, who live in high-density conditions and have been documented as high risk for poor health outcomes. Owing to a robust practice partnership between a college of nursing and two adult transition centers, a nurse-led COVID-19 initiative was implemented to minimize transmission in the facilities and ensure appropriate health care referral for residents who tested positive for COVID-19. The initiative identified six residents with positive results, who were transferred to a state prison infirmary for management and to minimize risk for other residents.

Leveraging an Academic Practice Partnership to Support a COVID-19 Mass Vaccination Clinic.

BACKGROUND: When the first coronavirus disease 2019 (COVID-19) vaccines received emergency use authorization by the U.S. Food and Drug Administration in December 2020, distribution of the vaccine began within 24 hours. METHOD: Nursing faculty leveraged a long-standing practice partnership with the academic health center (AHC) to lead an innovative effort mobilizing nursing and interprofessional student volunteers to support the COVID-19 mass vaccination program for AHC frontline health care staff, patients, and community members. RESULTS: Student vaccinators administered 98,000 vaccinations and contributed a significant service to the university health system by supporting the swift rollout of the vaccine program. The total number of volunteer vaccinator hours (11,820) resulted in an approximate cost savings of $768,300 to the AHC. CONCLUSION: During a global health crisis, nursing students and faculty demonstrated a strong commitment to the academic-practice partnership and improved access to COVID-19 vaccinations for residents of the health system's underserved communities. [J Nurs Educ. 2022;61(6):308-313.].

Closing the gap: Collaborative care addresses social determinants of health.

ABSTRACT: Social determinants of health have a significant impact on individual and community health outcomes. Using an integrated behavioral health model at a primary care clinic-a Federally Qualified Health Center-NPs led an interdisciplinary team to address outcome measures that are influenced by social determinants of health.

Transition of Nurse Practitioner Faculty Practice and Student Clinicals to Telehealth: Response to the COVID-19 Pandemic.

The COVID-19 pandemic forced the US health care system to evaluate alternative care delivery strategies to reduce the risk of coronavirus transmission to patients and health care providers. Telehealth modalities are a safe and effective alternative to face-to-face visits for primary and psychiatric care. Federal policy makers approved changes to telehealth reimbursement coverage and allowed flexibility of location for patients and providers. This article describes the transition of patient visits to telehealth by nurse practitioner faculty at an academic medical center to maintain continuity of care of underserved patient populations. This pivot facilitated resumption of clinical learning experiences for nurse practitioner students.

An Innovative Virtual Poster Session for Doctor of Nursing Practice Student Project Presentations.

BACKGROUND: The COVID-19 pandemic closed university campuses across the country. Nurse educators were challenged to develop innovative solutions for students to complete course requirements. The on-campus poster session used by a college of nursing as a scholarly forum for dissemination of all Doctor of Nursing Practice (DNP) student final projects was cancelled due to the pandemic. METHOD: Nurse educators developed and implemented an interactive, synchronous virtual session using the Zoom Video Communications platform. RESULTS: Twelve virtual sessions were held, and 73 students presented DNP project posters. More than 150 students and faculty attended the virtual poster sessions. Students and faculty had positive feedback regarding the virtual format. Student presentations were academically rigorous, and audiences engaged in robust discussion with DNP students. CONCLUSION: The virtual platform was successfully used for an interactive presentation by DNP student and nursing faculty participants. This format may be especially valuable for use of scholarship dissemination by distance learning programs. [J Nurs Educ. 2020;59(12):697-700.].

A Performance Improvement Initiative for Implementing an Evidence-Based Discharge Bundle for Lung Transplant Recipients.

BACKGROUND: Lung transplant recipients have high hospital readmission rates. Readmissions are costly to institutions and associated with higher mortality among patients within the first year of transplant. Strong evidence indicates that in hospitalized patients, the use of discharge bundles results in lower 30-day hospital readmission rates. LOCAL PROBLEM: A lung transplant team at a Midwest academic medical center performs 40 to 50 lung transplants annually and provides comprehensive, ongoing care for approximately 300 lung transplant recipients. The objective of this quality improvement project was development and implementation of an evidence-based discharge bundle (standardized patient discharge process) to reduce 30-day hospital readmission rates for this patient population. METHODS: A gap analysis was performed using focus groups to identify strategies to reduce readmissions. Using that data, a standardized discharge bundle was developed in collaboration with the transplant team. INTERVENTIONS: The discharge bundle included improvements in discharge planning, scripted communication methods between team members, a standardized medication template for patient education, standardized follow-up appointment process, and increased telephone calls to the patient after discharge. RESULTS: The primary outcome measured was the monthly 30-day hospital readmission rate of facility lung transplant recipients from June through August of 2019 as compared to the same time period in 2018. The readmission rate did not change during the evaluation period. Team members reported improved communication, efficiency, and improved standardization of follow-up care using the discharge bundle. CONCLUSIONS: Implementing a discharge bundle for lung transplant recipients resulted in improved staff satisfaction with the discharge process.

Need and Rationale for Geriatric Fracture Programs.

Fragility fractures among the older adult population are common, costly, and one of the top acute care facility diagnoses for this age group. Approximately 150,000 older adults in the United States are admitted to a hospital for treatment of a fragility hip fracture annually, with an estimated cost of more than $10 billion to the healthcare system. On admission to the hospital, patient treatment may be delayed, fragmented, or inadequate, adversely impacting length of stay and short- and long-term patient outcomes. Development of a geriatric fracture program implementing standardized, evidence-based guidelines can streamline clinical pathways and care processes and has been demonstrated to be a cost-effective method to improve patient outcomes.

Geriatric Fracture Programs: Implementation of a Geriatric Fracture Program.

The successful implementation of a geriatric fracture program is dependent on engaging a multidisciplinary team. The goal of these programs is to address the unique needs of patients with geriatric fracture by providing the support necessary for return to their prefracture level of activities of daily living. Identifying the key stakeholders and clarifying their role in pre- and postoperative patient support are vital to the development of such an initiative. The purpose of this article is to discuss the steps to plan and implement a geriatric fracture program in a hospital and lessons learned from our experience initiating such a program.

Improving Patient Flow From the Emergency Department Utilizing a Standardized Electronic Nursing Handoff Process.

OBJECTIVE: The goal of this project was to decrease handoff delays from the emergency department (ED) as measured by ready to move (RTM)-to-occupied time. BACKGROUND: ED boarding compromises the quality, safety, and experience of patient care. Lack of standardized and transparent handoff communication contributes to boarding time. This process improvement initiative implemented a standardized electronic situation, background, assessment, and recommendation (eSBAR) format-based nursing handoff process from the ED to a medical unit. METHODS: Nursing staff were educated face-to-face regarding the initiative background, significance, and process. Outcomes were measured before and after eSBAR implementation. RESULTS: Before implementation, the house-wide average RTM-to-occupied time was 83.6 minutes. This decreased to 49 minutes (a 41.4% decrease) 3 weeks after implementation and improved further to 47 minutes at 10 months after implementation. No related patient safety or quality issues were identified. CONCLUSIONS: The use of an electronic, standardized handoff communication process resulted in decreased boarding time and increased bed flow efficiency.

CE: Managing Stable COPD: An Evidence-Based Approach.

: Chronic obstructive pulmonary disease (COPD) affects as many as 16 million Americans and is expected to be the third leading cause of death worldwide by 2020. To increase awareness of COPD, encourage related research, and improve care of patients with this chronic disease, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was launched in 1998 and published an evidence-based report on COPD prevention and management strategies in 2001 that has been revised regularly. The fourth major revision, which was published in 2017 and revised in 2018, includes significant changes related to COPD classification, as well as to pharmacologic, nonpharmacologic, and comorbidity management. The authors discuss the changes to the GOLD recommendations and, using a patient scenario, explain their application to clinical practice.

Evaluating Diabetes Care for Patients With Serious Mental Illness Using the Chronic Care Model: A Pilot Study.

People with serious mental illness (SMI) have a higher incidence of type 2 diabetes mellitus (T2DM) and shorter life span due to medical health problems. The chronic care model (CCM) has been used to improve care of patients with T2DM. One clinical organization that provided primary care to patients with SMI had excellent diabetes outcomes but did not have information on how they achieved those outcomes. Thus, we conducted a pilot study chart review for 30 patients with T2DM and SMI to determine how well the clinic's system aligned with the overall CCM components and which components correlated with diabetes control. We also evaluated use of the CCM using the Assessment of Chronic Illness Care provider survey. Results showed that the clinic had an overall basic implementation level of the CCM, which allows opportunity for improvement. Two elements of the CCM were correlated with hemoglobin A1C and both were in an unexpected direction: self-management support in the variable of percentage of visits that included patient-specific goal-setting (rs = .52; P = .004) and delivery system design in the variable of number of nurse practitioner visits per study period (rs = .43; P = .02). These findings suggest that the clinic may have made more concentrated efforts to manage diabetes for patients who were not in good diabetes control. Providers noted the influence of SMI and social service organization support on these patients' clinical outcomes. The findings will be reexamined after a fuller implementation of the CCM to further improve management in this population.

Promoting Hand Hygiene With a Lighting Prompt.

OBJECTIVES: The objective of this pilot study was to assess an automatic sink light design intervention as a prompt for clinician hand hygiene (as defined by World Health Organization [WHO]). BACKGROUND: Healthcare-associated infections (HAIs) are still leading causes of morbidity and mortality and contribute to burdens on our healthcare system. Hand hygiene has been related to reducing the rate of HAIs and positively impacting both patient and hospital outcomes. METHODS: This pilot study was a prospective, longitudinal observational study of a convenience sample of healthcare clinicians. In one inpatient room, clinicians were exposed to a hand hygiene reminder that consisted of a light turning on over the sink as they entered. A control room (the adjacent inpatient room) did not have the intervention. RESULTS: A total of 88 clinician encounters were monitored during the study. On the first observation day at the initial activation of the signal light system, the percentage of clinicians performing hand hygiene upon entering a room was only 7% in the control room and 23% in the intervention room. During the second observation (Day 14), those percentages were 16% in the control room and 30% in the intervention room. During the third observation (Day 21), those percentages were 23% in the control room and 23% in the intervention room. CONCLUSIONS: The healthcare system frequently relies on expensive technology to improve healthcare delivery, but implementation of low-cost, low-technology methods such as this light may be effective in prompting hand hygiene.