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Ohri U, Paul J, Vijayalakshmi P, Govindan R, Manjunatha N, Kumar CN, Math SB. The rationale and guiding principles to design a psychiatric curriculum for primary care nurses of India. J Family Med Prim Care 2023; 12:2114-2119. [PMID: 38024873 PMCID: PMC10657090 DOI: 10.4103/jfmpc.jfmpc_775_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 12/01/2023] Open
Abstract
Background The National Mental Health Survey reports a huge treatment gap for all mental disorders. There is an acute shortage of mental health professionals in India. Hence, there is a dire need to support task-shift interventions by nurses in providing non-pharmacological interventions for persons suffering from mental health issues. The traditional psychiatric nursing curriculum emphasizes nurses' knowledge and skills rather than their competency in providing mental health care. We designed an innovative, digitally driven, modular-based primary care psychiatry program for nurses (PCPP-N) to incorporate mental health with physical health and emphasize redesigning nursing practice. In this paper, we discuss the rationale and guiding principles behind designing the curriculum of PCPP-N. Discussion The PCPP-N program is based on nine guiding principles to provide skill-based, pragmatic, and feasible modules of a higher collaborative care quotient (CCQ) and translational quotient (TQ) that are essential for upskilling primary care nurses. In this program, nurses are trained through telemedicine-based 'on-consultation training' augmented with collaborative video consultations. A tele-psychiatrist/tele-psychiatric nurse will demonstrate how to screen, identify, and plan treatment for patients with psychiatric disorders from patients coming for general medical care using the manual Clinical Schedules of Primary care psychiatry Nursing (CSP-N). The CSP-N manual includes a screener, simplified diagnosing guidelines relevant for nurses and primary care settings, nursing management, pharmacological management, and related side effects, counseling, and follow-up guidelines. This program helps the nurses in identifying the most commonly prevalent adult psychiatric disorders presenting to primary care. Conclusion This PCPN curriculum contains pragmatic modules with higher CCQ and TQ. This curriculum is dynamic as the learning is interactive. Upskilling primary care nurses in integrating mental health with physical health may reduce the mental health burden. Further, the policymakers and administrators plan to integrate mental health along with physical health in national health programs.
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Affiliation(s)
- Uma Ohri
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - James Paul
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Poreddi Vijayalakshmi
- College of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Radhakrishnan Govindan
- Department of Nursing, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (Institute of National Importance), Bengaluru, Karnataka, India
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A Sleep Hygiene Intervention to Improve Sleep Quality for Hospitalized Patients. Jt Comm J Qual Patient Saf 2021; 47:343-346. [PMID: 33744173 DOI: 10.1016/j.jcjq.2021.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Poor sleep is a pervasive problem for hospitalized patients and can contribute to adverse health outcomes. METHODS We aimed to improve self-reported sleep for patients on a general medicine ward as measured by the Richards-Campbell Sleep Questionnaire (RCSQ) as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) question addressing quietness at night. We utilized a non-pharmacologic sleep hygiene bundle composed of a short script with sleep hygiene prompts, such as whether patients would like the shades closed or the lights turned off, as well as a sleep package including an eye mask, earplugs, lavender scent pad, and non-caffeinated tea. Relaxing music was played at bedtime and signs promoting the importance of quietness at night were placed around the unit. Front-line champions were identified to aid with implementation. RESULTS A total of 931 patients received the intervention. In a sample of surveyed patients, we observed an increase in the RCSQ global score from 6.0 (IQR 3.0-7.0) to 6.2 (IQR 4.0-7.8) from the pre- to post- intervention periods (p = 0.041), as well as increases in three of the five individual survey components. Additionally, HCAHPS "quietness at night" score increased on the unit from 34.1% pre-intervention to 42.5% post-intervention. CONCLUSION A nonpharmacologic sleep hygiene protocol paired with provider education and use of champions was associated with modest improvements in patients' perceived sleep and unit HCAHPS scores.
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Tsega S, Hernandez-Meza G, DiRisio AC, D'Andrea MR, Cho HJ. A Multifaceted, Student-Led Approach to Improving the Opioid Prescribing Practices of Hospital Medicine Clinicians. Jt Comm J Qual Patient Saf 2020; 46:153-157. [PMID: 31899157 DOI: 10.1016/j.jcjq.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/05/2019] [Accepted: 11/19/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The development of guidelines for opioid prescribing, including those from the Society of Hospital Medicine and the Centers for Disease Control and Prevention, has been associated with changes in prescription patterns. However, many providers remain unaware of best practices surrounding appropriate opioid prescribing. METHODS The research team implemented a multimodal quality improvement intervention, led by first-year medical students, designed to increase clinician adherence to current prescribing guidelines for patients discharged on opioids. This intervention included an awareness campaign, educational sessions for providers, and weekly performance feedback. RESULTS A total of 4,993 discharges were identified in the baseline period and 4,811 discharges in the intervention period. During the baseline period, 12.3% of all patients discharged were discharged with opioid prescriptions vs. 11.4% during the intervention period (p = 0.165). Of these, approximately 60% were new opioid prescriptions during both periods (p = 0.991). The study's efforts were associated with a decrease in the percentage of patients discharged with opioid prescriptions longer than seven days (45.2% preintervention to 39.5% postintervention, p < 0.042); an increase in the percentage of patients with follow-up appointments within seven days of discharge (38.6% to 65.9%, p = 0.001); and an increase in documentation of prescription history obtained from the state Prescription Monitoring Program registry (32.5% to 39.7%, p = 0.042). CONCLUSION This intervention provided a successful framework to engage learners in improving opioid prescribing practices. The results are promising, but the experiences highlight the significant effort and resources needed to change prescriber practices, potentially limiting sustainability.
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Feinberg J, Shaw S, Kashyap N, Illuzzi J, Campbell K, Hsiao AL, Pettker CM. Evaluating the Impact of a New Smartphone Texting Tool on Patient Care in Obstetrics, an Emergent Healthcare Setting. Appl Clin Inform 2019; 10:879-887. [PMID: 31747710 DOI: 10.1055/s-0039-1700868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Hospitals across the country are investing millions of dollars to adopt new Health Insurance Portability and Accountability Act (HIPAA)-compliant secure text messaging systems. However, in nearly all cases, these implementations are occurring without evaluation of their impact on patient care. OBJECTIVE To evaluate perceived impact on patient care and workflow of new text messaging system implemented in obstetrics at Yale-New Haven Hospital and to inform guidelines for future implementations in emergent settings. METHODS A new HIPAA-compliant texting system was implemented in obstetrics in 2016. Before implementation of the new system, residents and nurses were surveyed on perceived effect of communication system (pagers with text receiving, service mobile phones, personal cell phones) on clinical workflow and patient care using 5-point Likert scale and open-ended questions. Following roll-out (1 and 6 months), both teams were surveyed with same questions. Results were compared using Wilcoxon-Mann-Whitney test (0-1 months and then 0-6 months). Open-ended question results were qualitatively compared for recurrent unifying themes. RESULTS In both nursing and resident domains, 1 month after implementation, the new communication system was perceived to significantly improve efficiency and patient care across all metrics. After 6 months, this effect decayed in nearly all categories (including efficiency, real-time communication, and knowledge of covering provider). The exception was nurse's knowledge of which resident to contact and resident's timely evaluation of patient, for which we observed sustained improvements. System shortcomings identified included interrupted connection (i.e., dropped calls), dysfunctional and inaccurate alert system, and unclear identification of the covering provider. CONCLUSION A new text-messaging-based communication system may improve efficiency and patient care in emergent settings, but system shortcomings can substantially erode potential benefits over time. We recommend implementers evaluate new systems for a set of specific functional requirements to increase probability of sustained improvement and decrease risk of poor patient outcomes.
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Affiliation(s)
- Jacqueline Feinberg
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Sara Shaw
- Yale New Haven Hospital, New Haven, Connecticut, United States
| | - Nitu Kashyap
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Jessica Illuzzi
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Katherine Campbell
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Allen L Hsiao
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Christian M Pettker
- Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut, United States
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Born KB, Moriates C, Valencia V, Kerssens M, Wong BM. Learners as Leaders: A Global Groundswell of Students Leading Choosing Wisely Initiatives in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1699-1703. [PMID: 31299673 DOI: 10.1097/acm.0000000000002868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Resource stewardship and reducing low-value care have emerged as urgent priorities for health care delivery systems worldwide. However, few medical schools' curricula include adequate content to allow learners to master the knowledge, skills, and attitudes needed to contribute to this transformation toward value-based health care. This article describes a program to launch student-led curriculum enhancement initiatives in 7 countries. The program, called STARS (Students and Trainees Advocating for Resource Stewardship), was inspired by Choosing Wisely, a campaign by the American Board of Internal Medicine Foundation that seeks to promote conversations on avoiding unnecessary medical tests, treatments, and procedures.The initial STARS model, which originated in Canada in 2015, included a leadership summit, where students from multiple medical schools learned about Choosing Wisely principles, leadership, and advocacy. These students then led grassroots efforts at their local medical schools with faculty and other students to raise awareness and advocate for changes related to resource stewardship. Student-led efforts resulted in the integration of Choosing Wisely principles into case-based learning, the creation of student interest groups and electives, the launch of social media campaigns, and the organization of special presentations by local experts.The rapid spread of similar programs in 6 other countries (Italy, Japan, the Netherlands, New Zealand, Norway, and the United States) by 2018 suggests that STARS resonates across multiple settings and signals the potential for such a model to advance other important areas in medical education. This article documents results and lessons learned from the first 4 years of the program.
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Affiliation(s)
- Karen B Born
- K.B. Born is knowledge translation lead, Choosing Wisely Canada, and assistant professor, Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. C. Moriates is assistant dean for health care value, Department of Medical Education, and associate chair for quality, safety, and value and associate professor of internal medicine, Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas, and executive director, Costs of Care, Boston, Massachusetts. V. Valencia is assistant professor, Department of Medical Education, Dell Medical School, University of Texas at Austin, Austin, Texas. M. Kerssens is junior consultant at Adviestalent, part of Twynstra Gudde, Amersfoort, the Netherlands, and was recently a summer research intern with Choosing Wisely Canada, Toronto, Ontario, Canada. B.M. Wong is medical education lead, Choosing Wisely Canada, associate director, Centre for Quality Improvement and Patient Safety, University of Toronto, and associate professor, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Tsega S, Kalra A, Sevilla CT, Cho HJ. A Bottom-Up Approach to Encouraging Sustained User Adoption of a Secure Text Messaging Application. Appl Clin Inform 2019; 10:326-330. [PMID: 31091544 DOI: 10.1055/s-0039-1688554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Inpatient providers are increasingly utilizing alternative communication modalities outside what has traditionally been used, including short messaging service text messaging and application-based chat tools. Text messaging that meets the recommendations of the Joint Commission ("secure text messaging") allows for the communication of sensitive patient information through an encrypted platform. OBJECTIVE In this quality initiative utilizing the Plan-Do-Study-Act (PDSA) model, we attempted two rollout designs to maximize user adoption of a secure text messaging application. METHODS Our institution launched a secure text messaging application (Cureatr) using a top-down approach during the first PDSA cycle, defined as communication and outreach through department chairs and administrative leaders throughout the hospital. After inadequate user adoption, we transitioned to a bottom-up approach in the second PDSA cycle, defined as direct communication and engagement with end users. This campaign targeted the hospital medicine and inpatient social work department, and used discharge planning as a use case to encourage adoption. RESULTS Over a 6-month period, we observed an increase in active users in the hospital medicine department (7.5 unique users per month to 29 users during the first and second PDSA cycles, p < 0.01). Additionally, we saw an increase in messages sent and received by the medicine (687 messages on average per month and 7,367 messages per month in each respective PDSA cycle, p < 0.01) and social work departments (350 messages on average per month and 6,083 messages during the first and second PDSA cycle, p < 0.01). We did not observe a significant change in active users or messages sent in the surgery department, which did not participate in the second PDSA cycle. CONCLUSION We believe that a bottom-up approach is important to introducing mobile applications to the inpatient setting and can contribute to sustained user adoption.
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Affiliation(s)
- Surafel Tsega
- The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, United States
| | | | - Cesar T Sevilla
- Population Health and Payer Systems, Mount Sinai Health System, New York, New York, United States
| | - Hyung J Cho
- Department of Quality, New York City Health and Hospitals, New York, New York, United States
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Moriates C, Valencia V. Emerging principles for health system value improvement programmes. BMJ Qual Saf 2019; 28:434-437. [PMID: 30926744 DOI: 10.1136/bmjqs-2019-009427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Christopher Moriates
- Internal Medicine and Medical Education, Dell Medical School at The University of Texas at Austin, Austin, Texas, United States .,Costs of Care Inc, Boston, Massachusetts, United States
| | - Victoria Valencia
- Internal Medicine and Medical Education, Dell Medical School at The University of Texas at Austin, Austin, Texas, United States
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A Student-Led, Multifaceted Intervention to Decrease Unnecessary Folate Ordering in the Inpatient Setting. J Healthc Qual 2019; 41:e54-e60. [PMID: 30649001 DOI: 10.1097/jhq.0000000000000177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
To reduce unnecessary laboratory testing, a three-phase intervention was designed by students to decrease serum folate laboratory testing in the inpatient setting. These included an educational phase, a personalized feedback phase, and the uncoupling of orders in the electronic medical record. Average monthly serum folate ordering decreased by 87% over the course of the intervention, from 98.4 orders per month at baseline to 12.7 per month in the last phase of the intervention. In the segmented regression analysis, joint ordering of folate and vitamin B12 significantly decreased during the intervention ([INCREMENT]slope = -4.22 tests/month, p = .0089), whereas single ordering of vitamin B12 significantly increased ([INCREMENT]slope = +5.6 tests/month; p < .001). Our intervention was successful in modifying ordering patterns to decrease testing for a deficiency that is rare in the U.S. population.
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Cardone F, Cheung D, Han A, Born KB, Alexander L, Levinson W, Wong BM. Choosing Wisely Canada Students and Trainees Advocating for Resource Stewardship (STARS) campaign: a descriptive evaluation. CMAJ Open 2017; 5:E864-E871. [PMID: 29263153 PMCID: PMC5741424 DOI: 10.9778/cmajo.20170090] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Resource stewardship is being increasingly recognized as an essential competency for physicians, but medical schools are just beginning to integrate this into education. We describe the evaluation of Choosing Wisely Canada's Students and Trainees Advocating for Resource Stewardship (STARS) campaign, a student-led campaign to advance resource stewardship education in medical schools across Canada. METHODS We evaluated the campaign 6 months after its launch, in November 2015. STARS students were administered a telephone survey eliciting a description of the initiatives that they had implemented or planned to implement at their schools to promote resource stewardship, and exploring their perceptions of facilitators of and barriers to successful implementation of their initiatives. We used a mixed-methods approach to analyze and summarize the data. RESULTS Twenty-seven (82%) of the 33 eligible students representing all 17 medical schools responded. In 14 schools (82%), students led various local activities (e.g., interest groups, campaign weeks) to raise awareness about resource stewardship among medical students and faculty. Students contributed to curriculum change (both planned and implemented) at 10 schools (59%). Thematic analysis revealed key program characteristics that facilitated success (e.g., pan-Canadian student network, local faculty champion) as well as barriers to implementing change (e.g., complex processes to change curriculum, hierarchical nature of medical school). INTERPRETATION This student-led campaign, with support from local faculty and Choosing Wisely Canada staff, led to awareness-building activities and early curricula change at medical schools across Canada. Future plans will build on the initial momentum created by the STARS campaign to sustain and spread local initiatives.
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Affiliation(s)
- Franco Cardone
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
| | - Daphne Cheung
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
| | - Angela Han
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
| | - Karen B Born
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
| | - Lisa Alexander
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
| | - Wendy Levinson
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
| | - Brian M Wong
- Affiliations: Faculty of Medicine (Cardone, Cheung, Han, Alexander), University of Toronto; Choosing Wisely Canada (Born, Levinson, Wong), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Born); Department of Medicine (Levinson, Wong); Centre for Quality Improvement and Patient Safety (Wong), University of Toronto, Toronto, Ont
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