TELEMEDICINE AS A TOOL TO MANAGE PATIENTS WITH POORLY CONTROLLED TYPE 2 DIABETES MELLITUS: A QUALITY IMPROVEMENT PROJECT
Creators: name: Calzada, Alicia
Publisher: name: Zenodo
Year: 2021

description: The aim of this quality improvement project was to facilitate the implementation of the Pediatric Early Warning System (PEWS) in a general pediatric unit. Background: Various illnesses can affect a child's health condition. When a child becomes ill, especially with a respiratory illness, they are at risk of deteriorating quickly. Children who are sick need to be monitored closely, so signs and symptoms of distress can be caught early before a child's condition deteriorates or even dies. Assessment skills are crucial in identifying deterioration and changes in a child’s health status. A child on the decline requires prompt intervention to prevent unexpected death. There are benefits to early referral and recognition of respiratory distress signs, the key to timely care. Consequently, the nurse needs a clear understanding of the difference between distress and normal physiology in the child, so that essential and appropriate care can be implemented, leading to positive outcomes. Methodology: Utilizing an appreciative inquiry framework, this improvement project entails three phases. In phase 1, a focus group was conducted to assess strengths, opportunities, barriers, and resources available for the use of the PEWS. In phase 2, findings of the focus group provided strategies for the systematic implementation of the PEWS. Phases 1 and 2 near completion. For phase 3, retrospective chart reviews to assess nurses’ utilization of the PEWS tool are ongoing. Results: First phase findings show that the focus group is highly motivated to use evidencebased tools in providing clinical care. Medical and administrative teams were in support of changes in practice. Using a Strength, Opportunities, Aspiration, Results (SOAR) analysis, the core values of the unit were identified and included supportive leadership, motivation to change, desire to use evidence-based practice and to increase commonality in communication. In phase 2, 36 nursing staff (3 male, 33 females) participated in the PEWS education. One third of nurses was under five years into their nursing careers and one third have over 20 years in the field. Furthermore, development of an online module has been proposed to the unit manager and is under consideration. In phase 3, an analysis of up to 60 random patients’ charts showed that utilization increased from 1.6 ± 0.2 (mean ± SEM) ‘yes’ responses from up to four patients charts per day audited over seven days before PEWS education to 3.6 ± 0.2 charts audited over eight days after PEWS education; p&lt;0.0001, unpaired T-test. This is an increase of ~ 125% and is an indication that the goal of utilizing the PEWS tool was achieved in the immediacy of postPEWS education. The process of monitoring ongoing patient assessment and providing additional support for the team will continue over the next five months. Conclusion: Patient assessment is a crucial part of care delivery. Nursing and medical staff commitment to change and best practices is crucial in designing, implementing, and evaluating quality improvement projects in patient care areas. Evidence-based devices such as the PEWS tool help to enhance clinician’s performance in the assessment and care of children. Keywords: children, pediatric early warning score, PEWS tool