Browsing by Author "Thompson, Julie A"
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Item Open Access Implementing Venous Leg Ulcer Education and Clinical Decision Support: A Quality Improvement Project(Wound Management and Prevention, 2022-09-01) Beatty, Amelia; Jones, Penny S; Vail, Christopher; Thompson, Julie A; Reynolds, Staci SBACKGROUND: Venous leg ulcers (VLU) require early identification and treatment to prevent further harm. Health care providers often fail to initiate evidenced-based VLU treatment promptly because of a lack of knowledge of VLU guidelines. PURPOSE: To improve early treatment for patients with VLUs presenting to outpatient clinic settings. METHODS: Plan-DoStudy-Act cycles were used for this quality improvement project. Virtual education and a comprehensive clinical decision support (CDS) order set were implemented. Outcome metrics included the rate of ankle-brachial index (ABI) testing, mechanical compression therapy, and home health service referrals for patients with VLUs. The frequency with which the CDS order set was used was also measured. RESULTS: Forty health care providers attended the virtual education sessions among 3 outpatient clinics. There was an increase in ankle-brachial index testing from pre (n = 7; 15.9%) to post (n = 10; 18.2%) (P =.796), but there was a decline in mechanical compression therapy from pre (n = 15; 34.1%) to post (n = 4; 7.3%) (P =.002) and home health service referrals from pre (n = 11; 25%) to post (n = 9; 16.4%) (P =.322). The CDS order set was used 9 times over 13 weeks. CONCLUSION: Future Plan-Do-Study-Act cycles will include completing in-person education and reducing the VLU CDS order set length. Future projects should consider these approaches when implementing evidence-based VLU guidelines.Item Open Access Program Evaluation of an Early Nurse Intervention Team.(AACN advanced critical care, 2022-03) Heitman, Sarah; Allen, Deborah H; Massengill, Jennifer; Orto, Victoria; Thompson, Julie A; Reynolds, Staci SBackground
Many hospitals have implemented early rapid response teams to improve detection of patients at risk for decline. However, formal evaluation of these programs is rare.Objective
To evaluate the Early Nurse Intervention Team program at a large community hospital in the southeastern United States.Methods
A retrospective evaluation was performed of unplanned intensive care unit transfers, hospital length of stay, length of stay index, ventilator days, and mortality in 2 patient groups: those with and those without an Early Nurse Intervention Team nurse present.Results
There was a marked decline in unplanned intensive care unit transfers as the Early Nurse Intervention Team nurse staffing increased. There were no significant interaction or main effects for length of stay, length of stay index, ventilator days, or mortality between the 2 groups.Conclusions
This study showed a positive impact of implementation of an Early Nurse Intervention Team program, with significant savings given the cost of unplanned intensive care unit transfers.Item Open Access Retrospective Chart Review of the Triage Algorithm for Psychiatric Screening (TAPS) for Patients Who Present to Emergency Departments With Psychiatric Chief Complaints(Journal of Emergency Nursing, 2018-01) Schieferle Uhlenbrock, Jennifer; Hudson, John; Prewitt, Judy; Thompson, Julie A; Pereira, Katherine© 2017 Emergency Nurses Association. Introduction: There is a growing number of mental health illnesses (MHIs) in the nation and no standardization of the medical screening examination (MSE) in the emergency department. Many health care organizations are at the tipping point of discarding a battery of laboratory workups. A triage tool-specific to psychiatric chief complaints and cost effective-is needed for the emergency department. Methods: A nonexperimental, retrospective overlay of the Triage Algorithm for Psychiatric Screening (TAPS) onto previous psychiatric patients' records was performed to determine the sensitivity and specificity of the TAPS in ruling out acute medical illness. The laboratory test results, length of stay (LOS), and cost of treatment for all psychiatric patients were examined to determine if there was a correlation with their TAPS scores or if the use of the TAPS would have resulted in efficient care and cost savings. Results: This study shows the TAPS tool can be used reliably to rule out acute medical illness in patients with psychiatric chief complaints in a community hospital setting with an on-site inpatient psychiatric unit. The TAPS tool appropriately identified low-acuity patients without significant medical illness (TAPS of 0). As such, the TAPS tool could be used in selected settings to expedite psychiatric care and reduce unnecessary laboratory testing. Implications for Practice: The results of this project represent a valuable step forward in improving the triage of adult patients who present to the emergency department with psychiatric chief complaints. A reproducible study of the TAPS method was the next practice step in determining feasibility. Use of the TAPS tool can be a method to decease costs and ED crowding. For research and quality improvement projects in the future, addiction chief complaints should be treated as a separate category from psychiatric or medical complaints, as they meet the criteria of both.Image 1 Contribution to Emergency Nursing Practice •The TAPS tool can be used reliably to rule out acute medical illness in patients with psychiatric chief complaints in community hospital settings with on-site inpatient psychiatric units.•The TAPS tool appropriately identified low-acuity patients without significant medical illness (TAPS of 0).•Addiction chief complaints was a confounding variable because these patients often had mental health complaints in addition to medical complaints. The TAPS tool is a simple and cost-effective tool to use in the emergency department during triage.•The TAPS tool could be used in selected settings to expedite psychiatric care and reduce unnecessary laboratory testing.