Using Practice Guidelines for Quality Improvement in the Treatment of Depressive Disorders in Managed Delivery Systems

Purpose The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance. The aim of this project was to reduce pain as evidenced by pain scores at the time of vaccination at the North Bay Nurse Practitioner-Led Clinic (NBNPLC). Design/methodology/approach The design for this study was quasi-experimental utilizing descriptive statistics and QI tools. The NBNPLC utilized the model for improvement to test change ideas. A validated observation tool to assess pain during vaccination with the pediatric population (revised Face Legs Activity Cry and Consolability) was used to test changes. The team deliberately planned improvements according to best practice guidelines to optimize use of strategies to mitigate pain during injections. QI tools and leadership skills were utilized to improve the pediatric experience of pain during vaccinations. Parents and clinicians provided qualitative and quantitative feedback to the project. Findings Nurses tested pain assessment tools and agreed to use a validated tool to assess pain during vaccinations. Parents agreed to use of topical anesthetic during vaccinations. Improved pain scores during vaccinations were demonstrated with the use of topical anesthetic. Parents agreed to use of standardized sucrose solution during vaccination. Reduced pain scores were observed with the use of standardized sucrose water. To sustain implementation of the guideline, a nursing documentation form was devised with nurses agreeing to ongoing use of the form. Research limitations/implications This is a QI project that examined the intricacies of moving clinical practice guidelines into clinical practice. The project validates guidelines for pain management during vaccinations. Leaders within clinics who want to improve pediatric pain during vaccinations will find this paper helpful as a guide. Practical implications Pain management in the pediatric population will be touched on in the context of parental expectations of pain. QI tools, lessons learned and suggestions for nurses will be outlined. Leadership plays an influential role in translating practice guidelines into practice. Originality/value This paper outlines how organizational supports were instrumental to give clinicians time to deliberately challenge practice to improve quality of care of children during vaccinations.

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Quality improvement, practice guidelines and patient education

Patient Education and Counseling ◽

10.1016/0738-3991(91)90072-d ◽

1991 ◽

Vol 18 (1) ◽

pp. 1-2 ◽

Cited By ~ 1

Author(s):

Edward E. Bartlett

Keyword(s):

Quality Improvement ◽

Patient Education ◽

Practice Guidelines

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Clinical Practice Guidelines: A Manual for Developing Evidence-Based Guidelines to Facilitate Performance Measurement and Quality Improvement

Otolaryngology ◽

10.1016/j.otohns.2006.06.1277 ◽

2006 ◽

Vol 135 (4_suppl) ◽

pp. S1-S28 ◽

Cited By ~ 35

Author(s):

Richard M. Rosenfeld ◽

Richard N. Shiffman

Keyword(s):

Quality Improvement ◽

Clinical Practice ◽

Performance Measurement ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Evidence Based ◽

Evidence Based Guidelines

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Aligning Documentation With Congenital Muscular Torticollis Clinical Practice Guidelines: Administrative Case Report

Physical Therapy ◽

10.2522/ptj.20150012 ◽

2016 ◽

Vol 96 (1) ◽

pp. 111-120 ◽

Cited By ~ 4

Author(s):

Dennis Gutierrez ◽

Sandra L. Kaplan

Keyword(s):

Quality Improvement ◽

Case Report ◽

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Medical Center ◽

Successful Implementation ◽

Full Time ◽

Congenital Muscular Torticollis ◽

Muscular Torticollis

Background and Purpose A hospital-based pediatric outpatient center, wanting to weave evidence into practice, initiated an update of knowledge, skills, and documentation patterns with its staff physical therapists and occupational therapists who treat people with congenital muscular torticollis (CMT). This case report describes 2 cycles of implementation: (1) the facilitators and barriers to implementation and (2) selected quality improvement outcomes aligned with published clinical practice guidelines (CPGs). Case Description The Pediatric Therapy Services of St Joseph's Regional Medical Center in New Jersey has 4 full-time, 1 part-time, and 3 per diem staff. Chart audits in 2012 revealed variations in measurement, interventions, and documentation that led to quality improvement initiatives. An iterative process, loosely following the knowledge-to-action cycle, included a series of in-service training sessions to review the basic anatomy, pathokinesiology, and treatment strategies for CMT; reading assignments of the available CPGs; journal review; documentation revisions; and training on the recommended measurements to implement 2 published CPGs and measure outcomes. Outcomes A previous 1-page generic narrative became a 3-page CMT-specific form aligned with the American Physical Therapy Association Section on Pediatrics CMT CPG recommendations. Staff training on the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, classification of severity, type of CMT, prognostication, measures of cervical range of motion, and developmental progression improved documentation consistency from 0% to 81.9% to 100%. Clinicians responded positively to using the longer initial evaluation form. Discussion Successful implementation of both clinical and documentation practices were facilitated by a multifaceted approach to knowledge translation that included a culture supportive of evidence-based practice, administrative support for training and documentation redesign, commitment by clinicians to embrace changes aimed at improved care, and clinical guidelines that provide implementable recommendations.

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