Building Team-based Primary Care: Lessons From an Academic-Community Network Partnership.

BACKGROUND: Team-based care is fundamental to providing high-quality health care for patients. However, moving from a traditional, hierarchical way of providing care to team-based care is challenging and involves systematic and sustained process changes. OBJECTIVES: To describe the implementation and evaluation of a partnership between academics, clinic, and community to improve team-based care in primary care practices serving vulnerable populations utilizing a structured change package and implementation support. METHODS: The partners 1) created a six-strategy structured change package, 2) designed implementation support, and 3) evaluated implementation using an assessment scale at baseline and every 6 months. RESULTS: Practices improved in all care-team functions from May 2015 to August 2018, with the most improvement seen in population management, planned care and empanelment. CONCLUSIONS: Academic-community partnerships can use evidence-based practice supports to measurably improve team-based care in primary care practices serving vulnerable populations.

End of life care for patients with implanted heart devices.

Thank you for the excellent article on end of life care for patients with heart failure (Art & Science August 20). Many patients have implanted devices, including re-synchronisation pacemakers and defibrillators.

Has anyone received support for management strategies training?

In these cash-starved times, we nurses, particularly those like myself in specialist practice, should be able to demonstrate our worth.

Reflection on a patient's airway management during a ward-based resuscitation.

BACKGROUND: The bag-valve-mask (BVM) system is a common adjunct used during adult resuscitation to ventilate the lungs and deliver oxygen to patients in cardiopulmonary arrest. Gastric inflation, regurgitation and aspiration are well-documented complications of BVM ventilation, which can have serious consequences for patients. AIM: The aim of this paper is to review the cause of gastric inflation, regurgitation and aspiration during BVM ventilation and to consider techniques that have been suggested to reduce these problems. METHOD: Using a reflective model, the author revisits an actual cardiac arrest, and within a structured framework considers the event itself, the context of the event and looks at ways in which practice could be improved in future. RESULTS: It is clear from the evidence that a reduction in peak airway pressure can reduce the risk of gastric inflation, regurgitation and aspiration. A review of the available research strongly suggests that in expert hands, the most effective means of reducing peak airway pressure is by reducing tidal volume by using a smaller bag. CONCLUSION: Although the evidence, as presented, for a reduction in bag size is convincing, there appears to be a problem that less regular users do not appear to be able to produce effective tidal volumes when using a smaller bag. If a reduced bag size is standardized, further research using a diverse group of health care workers with the BVM is required before a clear policy can be achieved. It is likely that training and practice will be shown to be important for nursing staff expected to use the smaller BVM.