Ring, Michael T

An ST-segment elevation myocardial infarction is a life-threatening condition within the spectrum of acute coronary syndrome, with well-recognized implications for short-term and long-term health outcomes. Retrospective review of our institutional electronic health records identified patterns of inaccurate acute coronary syndrome diagnostic assignment, including the presence of erroneous ST-segment elevation myocardial infarction diagnoses in discharge records. Such erroneous diagnoses in the durable health record may increase risk to patients through inadequate risk assessment and inappropriate follow-up care. Misapplication of a shortcut in our electronic health record system for rapidly ordering emergent cases was identified as a potential cause of the quality gap. To address this issue, a nurse-led quality improvement project was developed by using the define, measure, analyze, improve, and control framework. The project intervention decreased the percentage of patients with erroneous diagnoses from 24% to 7% and marginally improved nursing staff satisfaction. Our project successfully addressed an institutional quality concern. Our goal of reducing erroneous discharge diagnoses with minimal disruption to our existing practice was achieved, positively affecting our patients. Including both nurse leaders and frontline health care workers ensured the success of our project.

Introduction: Patients undergoing percutaneous coronary intervention (PCI) acquire or continue an average of five medications specific to their intervention during hospitalization, some of which are continued for life. It has been identified that poor communication between health care professionals and patients is a contributor to medication nonadherence. The aim of this quality improvement project was to determine if the implementation of individualized medication education forms and patient-centered medication training would improve nurse-patient medication communication. Methods: Project interventions were implemented on a post-PCI telemetry unit from December 2020 to February 2021. Patients with acute coronary syndrome requiring PCI during hospitalization were surveyed on five domains at the time of discharge from October 2020 to February 2021. The five domains included: 1) medication communication 2) confidence in medication name recall 3) ability to manage medications 4) understanding of medication purposes and 5) side effect management. Results: A total of 53 patients were included in this analysis, with 28 in the pre-intervention group and 25 in the post-intervention group. Comparatively, patients in the post-intervention group reported a subjective improvement in medication communication, confidence in recalling medication names, ability to manage medications, and understanding of medication purposes and side effects when compared to patients in the pre-intervention group. Conclusion: The use of multidimensional, standardized medication education forms and medication training positively impacted medication communication between nursing and post-PCI patients.

BackgroundPropofol is a drug of diversion because of its high-volume use, lack of prescribed control mechanisms, and accessibility. As a result, intensive care unit nurses and other health care professionals are placed at unnecessary risk. Decreasing the risk of drug diversion can save lives, licenses, and livelihoods.Local ProblemObjectives were to reduce the risk of drug diversion and diminish the environmental impact of medication discarded down the sink. Disposing of residual propofol into activated carbon pouches was successful and sustainable in operating rooms at the study institution. Literature findings supported this intervention because of propofol’s potential for abuse, ongoing diversion events, ease of access, poor control mechanisms, lack of standardization, excessive waste, and ecological impact.MethodsThe intensive care unit with the highest propofol use was selected to replicate the propofol disposal process used in the operating rooms. Activated carbon pouches and bottle cap removal tools were located in each intensive care unit room at the nurses’ workstation for ease of use. Audits of unsecured waste bins and staff surveys of institutional policy awareness, disposal processes, barriers, and concerns were completed before and after the intervention.ResultsSurvey results determined significant concern for drug diversion risk. The pilot project displayed success: 44.1% of propofol bottles in waste bins were full before the intervention and 0% were full afterward.ConclusionFollowing institutional approval, this propofol disposal process was replicated in all intensive care units and the emergency department in the study institution.