Communication and teamwork are essential components of safe patient care. This evidence-based practice project evaluated the communication and teamwork the operating room staff engaged in during 30 surgical procedures (ophthalmology, plastics, or otorhinolaryngology). Findings provided insight into whether or not the communication and teamwork education that occurred in August, 2012 for registered nurses and surgical technologists was sustained and encultured. This descriptive project utilized a convenience sample consisting of approximately fifty staff members who work in the operating room of a teaching hospital, including surgeons, anesthesiologists, residents, certified registered nurse anesthetists (CRNAs), registered nurses, and surgical technicians. To evaluate the quality of communication the Communication and Teamwork Skills (CATS) Assessment Tool was used. From 2012 to 2014, improvement in CATS scores was marked: for example, the score for the communication category went from 91.60% to 99.5% and that for the coordination category from 93.50% to 97.6%.Study findings suggest that education and quality monitoring with teaching moments improve team-based outcomes and, ultimately, increase patient safety. All operative team members should not only be competent in their individual roles but should also work together in a structure exhibiting the expertise of team members functioning synergistically as team members. A nursing competency with a post-test component on communication and teamwork will be developed.
Polypharmacy is the concurrent use of multiple medications. Polypharmacy presents increased health risks and increased hospitalizations due to its synergistic effects particularly in the elderly population. In addition, there is a significant increase in health care spending. Polypharmacy is of special concern among elderly individuals because this practice can lead to other health risks, hospitalization and increased healthcare cost. The Centers for Medicare and Medicaid Services (CMS) estimates that polypharmacy costs the nation’s health plans more than $50 billion annually. Polypharmacy is linked to higher incidence of adverse drug reactions (ADRs), falls, hospitalization and behavioral incidents among the elderly especially if one or more of the medications is a psychotropic medication. The CMS has therefore established a guideline for the gradual dose reduction (GDR) of psychotropic medications. The aim is to reduce the negative effects of these medications on patients and thereby improve their general quality of life. This evidence based project examined the effects of the gradual dose reduction among residents between the ages of 65-75 living in a long-term care facility in the inner city of North-East Bronx. The project also evaluated the facility’s policy regarding GDR within this population and proposed ways to enhance the policy improve patient safety and reduce medication cost.
Child welfare staff are at risk for secondary traumatic stress due to daily exposure to vicarious trauma while working with children and families who are traumatized, often due to family violence. The stress of working with maltreated children is significant in that it contributes to negative client outcomes and high staff turnover rates and results in an inexperienced workforce of care providers. There is a need to address secondary traumatic stress among child welfare workers using a systematic, organizational approach to reduce staff turnover and improve the quality of care delivery to children. New Jersey child welfare services are delivered via Care Management Organizations that often struggle to meet the federally mandated goals of child safety, protection, permanency, and well-being. Child well-being is often not addressed, and knowledge regarding trauma-informed care is often lacking among child welfare workers. The purpose of this capstone project was to investigate whether implementation of trauma-informed care practices in a child welfare service delivery setting resulted in decreased turnover and secondary traumatic stress symptoms among workers. Using the evidenced-based National Child Traumatic Stress Network Child Welfare Trauma Training Toolkit, a Care Management Organization’s service delivery design was changed to become trauma-informed and the impact of the change evaluated using measures of turnover rates and workers’ compassion fatigue, secondary traumatic stress, and professional quality of work life.
The purpose of this evidence-based practice project was to evaluate the effectiveness of using the PHQ-9 tool to assess depression. Currently, no tool is being used to assess and diagnose patients with depression in an outpatient psychiatric practice. Instead, patients are diagnosed with depression based on a diagnostic interview with the healthcare practitioner (HCP). This study's objective was to improve the current clinical depression assessment and diagnosis practice by using the PHQ-9 screening tool to improve accuracy in diagnosing depression. The PHQ-9 is a reliable and valid tool for assessing patients in identifying factors predictive of depression, as well as a reliable measure of depression severity. These characteristics and its brevity make the PHQ-9 a valuable clinical and research tool in psychiatric outpatient practices. The data from this study supported the rationale for implementing this screening instrument in this outpatient psychiatric practice. Forty-nine new patients ages 18–54 years who were seeking treatment for depression at a psychiatric practice who had not been previously diagnosed with depression completed the PHQ-9 as well as the diagnostic interview with an HCP. The impact of the COVID-19 pandemic on patient depression was also explored. All participants were assessed using PHQ-9 and the diagnostic interview method. Data were analyzed using Stata 15 for descriptive and inferential statistics to examine the relationship between the two methods. Findings indicate that patients who expressed suicidal ideation during the clinical interview indicated the same on the PHQ-9. Results also show that PHQ-9 scores were significantly related to the severity of depressive symptoms. Finally, patients who indicated that COVID-19 had impacted them were significantly more likely to be assessed with major depressive disorder via the PHQ-9 instrument.