2020
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Item Improving self-efficacy of heart failure patients with low health literacy by providing nutritional infographics(2020) Reddy, SarahHeart failure (HF) is considered one of the costliest health epidemics in the U.S. Research has shown that there is a direct correlation between health literacy, HF knowledge and overall health outcomes. Approximately one in three Medicare patients have low health literacy. The population chosen for this project were enrolled in a program called, PACE (program of all-inclusive care of the elderly). The program supports frail Medicare and Medicaid patients living independently in the community. The objective of this project was to evaluate the effectiveness of providing individuals with low health literacy infographics to help improve their self-efficacy and management of their HF. Instruments used included the Self-Efficacy for Managing Chronic Disease (SEMCD) 6-item Scale and UR What U Eat. The latter tool is a color-coded infographic depicting sodium content in food using green for ‘go’, or little to no sodium content, yellow for ‘slow’, or low to medium sodium content and red for ‘whoa, which indicates that the food is very high in sodium. This pilot project used an experimental design which involved a pre and post self-efficacy evaluation survey, weekly weight tracking and weekly coaching. Data were analyzed using a paired sample t-test. Results suggest that providing nutritional infographics to participants and weekly weight monitoring led to a significant improvement in their self-efficacy and ability to manage their heart failure. Increasing self-efficacy can lead to improved health outcomes, patient satisfaction and a reduction in hospital admissions.Item Move to Improve; a Pilot Project to Evaluate Restorative Mobility Interventions in Older Adult Veterans(2020) Saindon, KellyBackground: Physical function deterioration can occur rapidly for older adults who are discharged from intensive therapy. This problem has serious implications due to the amount and the high cost of medical care and potential health risks associated with decreased mobility. Move to Improve was a pilot quality improvement project that evaluated how effective an integrated restorative nursing intervention was at attaining or maintaining the highest physical, mental, and psychosocial well-being of older adult Veterans who have transitioned from intense therapy to long term care. Methods: A sample of ten geriatric Veterans were engaged in biweekly mobility group activities as well as issued activity trackers to increase engagement and collect mobility data. Pre-post test assessment using two subcomponents of the Barthel Index were used to measure mobility and transfer. Results: Eight out of nine (89%) Veterans who completed the 6-week restorative intervention maintained or increased functional status. Conclusion: The Move to Improve program effectively maintained functional status. The Veteran participants reported having no prior experience with wearable technology but use of the activity trackers engaged them in tracking their progress. The outcome of this quality improvement pilot project provides a foundation for future research.Item Evidence-Based Practices to Improve Monitoring for Surgical Patients with Obstructive Sleep Apnea(2020) Fotino, Karen L.Introduction: Patients who have obstructive sleep apnea (OSA) are at higher risk for opioid-induced respiratory depression postoperatively. Many patients who have OSA are not diagnosed before having surgery and may not be monitored appropriately postoperatively. Purpose: The purpose of this quality improvement project was to increase the number of preoperative patients screened for OSA and improve their postoperative monitoring through a novel OSA Protocol order set. Methods: Screening for OSA risk is performed preoperatively using the STOP-Bang instrument. High-risk patients, as well as patients with existing OSA, are monitored postoperatively using a bundle of evidence-based practices to identify early respiratory compromise. If respiratory events occur, a treatment intervention will be triggered. Outcome: Post-intervention chart reviews demonstrated 100% of the qualifying patients had OSA screening completed prior to surgery. The OSA Protocol was ordered for 28 patients. Patient harm may have been avoided through the use of continuous positive airway pressure (CPAP) triggered by actual respiratory events. Conclusion: It is important to identify patients before surgery through preoperative screening. Identified patients should be monitored closely postoperatively for the detection of early respiratory compromise. A standing order for CPAP for patients with respiratory events can provide treatment rapidly to optimize patient outcomes. The process for monitoring high-risk patients on this postoperative unit could be considered for replication on surgical units in other hospitals.Item Passive Monitoring of Physical Activity Using a Fitbit Charge 3 in Individuals at Risk for Depression(2020) Santomas, KellyPurpose: The purpose of this study was to measure the effectiveness of using an activity tracker, Fitbit Charge 3, on depression scores and physical activity scores in individuals at risk for depression. Design: This was a pilot project that passively monitored step count activity using a Fitbit Charge 3 over an 8-week intervention period in individuals who were at risk for depression. Individuals were screened for depressions risk using the patient health questionnaire-2 (PHQ-2). Methods: Individuals were recruited from a convenient sample. Selection criteria was limited to adults ages 18-69 with a score >1 on the patient health questionnaire-2 (PHQ-2) indicating risk for depression and who owned or had access to a smartphone. Upon enrollment, individuals completed the patient health questionnaire-9 (PHQ-9), the international physical activity questionnaire (IPAQ) and were issued a Fitbit Charge 3. Individuals were asked to wear their Fitbit Charge 3 for 8 weeks. Step count data was automatically uploaded into the individual’s electronic health record (EHR) every 24hrs via Bluetooth integration with the Fitbit Charge 3. At the end of the 8 weeks, individuals completed the PHQ-9 and IPAQ. Step count data was downloaded from the EHR at the end of the intervention. Results: Individuals with lower PHQ-9 scores had higher IPAQ scores and higher step counts. These individuals indicated they would continue to use the Fitbit post study. In most individuals, PHQ-9 scores decreased from baseline while IPAQ scores increased. Overall step count peaked at week 5, then decreased but stayed above baseline. Conclusions: Physical activity is an important component for mental and physical wellbeing. Using commercially available devices can provide clinicians an important tool in encouraging patients to engage with improving their overall health.