An initiative to improve documentation to meet the Centers for Disease Control and Prevention (CDC) recommendations for assessment of students who may be infected with STDs (sexually transmitted diseases); and a program to avoid abrupt fluctuations in blood sugar in patients with diabetes undergoing endoscopy procedures are winners of the 2011 Bernard A. Kershner Innovations in Quality Improvement Awards. The awards – one for surgical/procedural care and one for primary care – are given annually by the AAAHC Institute for Quality Improvement (AAAHC Institute), a not-for-profit subsidiary of the Accreditation Association for Ambulatory Health Care.
Honorable mention in the surgical/procedural category went to a program to enhance the process of informed consent and, in the primary care category, to an initiative to improve the evaluation and treatment of pharyngitis/tonsillitis.
The winners will present their studies and receive their awards at the AAAHC Institute’s 10th Annual National Educational Forum for Ambulatory Health Care, Dec. 3 – 4, 2011, at the Bellagio Hotel Resort and Casino in Las Vegas.
Improving STD Assessment in Health
The Award winner in the primary care category is the University Health Service, University of Michigan, Ann Arbor, for a QI initiative to improve the documentation of risk factors, discussion of HIV testing and prevention counseling in students requesting STD assessment, as recommended by the CDC.
In 2008, peer review of charts of patients seeking an STD assessment found high risk behaviors were not documented, condom use was recommended in 20 percent of cases and HIV testing was recommended in 50 percent of cases. Initial performance goals were set at 60 percent for each measure
The QI program was conducted in six cycles of corrective action and re-measurement from May 2010 through May 2011. Corrective actions included the introduction of a template for assessing sexually transmitted infections, staff placement of the template in charts when STD assessments were requested, education to reinforce the importance of provider completion of the template, and provider self review to make sure the template was completed. Review of the data at the end of the six cycles found that assessment of risk factors and recommendation of condom use were documented in all cases, and HIV testing was discussed in 90 percent, according to Margaret Jacobs, MSN, RNC, ANP, quality improvement chairperson.
Controlling Blood Sugar Fluctuations in Patients with Diabetes
Do sedated endoscopy procedures cause significant fluctuations in blood sugar in diabetic patients and does the type of intravenous solution used affect fluctuations? These were the questions asked by staff at Elgin Gastroenterology Endoscopy Center in Elgin, IL in a quality improvement study that won the AAAHC Institute Award in the surgical/procedural category. Patients were divided into two groups: those that received intravenous solutions with dextrose (D5/0.9NS) and those that received solutions without dextrose (0.9NS). Blood sugar levels were measured before and after the procedures. The average change in blood sugar was 114.58 mg/dl in the dextrose group and -3.75 mg/dl in the no-dextrose group.
As a result of the findings, the IV solution for all diabetic patients was changed to 0.9NS. After the change, the average blood sugar level was -1.4, according to Susan Theobold, RN, nurse manager, EGEC.
Runner-up in the primary care category was the University Health Services of the University of Texas at Austin for a program to improve the evaluation and treatment of pharyngitis/tonsillitis and avoid the overuse of antibiotics in patients with these diagnoses. Patient charts were reviewed in 2008. Following the review, evidence-based guidelines derived from the Centor Criteria and endorsed by the CDC in their “Principles of Appropriate Antibiotic Use” were implemented, electronic health record (EHR) processes were streamlined to improve documentation, and rapid strep testing was initiated. A subsequent review of patient data showed that antibiotic prescriptions at the initial patient visit decreased from 76 percent in 2008 to 46 percent in 2010.
The runner-up for the surgical/procedural category was a QI activity to improve performance in obtaining informed consents and documenting that a “time out” was performed prior to surgical procedures. Staff at Pinehurst Surgical Clinic, Pinehurst, NC, noticed variations in completing informed consents and documenting time outs among the 44 providers and seven specialties at the clinic. Performance in these areas was studied from September 2009 through December 2010. Policies and procedures were reviewed and revised and shared with staff, resulting in a significant improvement in performance at the end of the study period.