Background: The cost of health care for end-stage kidney disease patients has exponentially increased over the years, costing 91,000 annually per patient. Peritoneal dialysis has proven to be a cost-effective renal replacement therapy compared to in-center hemodialysis. Quality evidence from a systematic literature review indicates that peritonitis is one of the leading causes of patients' ability to maintain peritoneal dialysis. Evidence suggests that enhanced patient education on infection control practices beyond standard education effectively reduces peritonitis incidents. Methods: Enhanced education on infection control practices was delivered to 18 peritoneal dialysis patients in Southern Arizona through the application of determinants of the Health Belief Model utilizing the principles of the ADKAR framework. Data analysis will be available through facility-specific quality metrics of decreased peritonitis and modality loss episodes. Each of these measures is to have data compared to pre/post-intervention. Results: All participants in the study were able to sustain peritoneal dialysis as their renal replacement therapy. Of the 18 participants, one patient episode of peritonitis occurred three months before the intervention, and zero episodes were reported during the first three months of monthly infection control education. Facility-specific peritonitis and modality loss measures are not available until after project publication. Conclusion: To decrease peritonitis rates and modality loss, the intervention will continue for eight to 12 months to determine success. More time is needed to determine if patients adhere to monthly infection control practices taught during enhanced education.

Problem Statement: The onset of the COVID-19 pandemic led to intense challenges for health care providers. Outpatient primary care practices rapidly moved from in-person practice to video-conferencing telehealth appointments. This shift requires study, particularly how this has impacted the lived experience of providers. Purpose: This project aims to explore primary care provider satisfaction with telehealth in the wake of the COVID-19 pandemic. Methods: A point-in-time survey was administered to primary care providers at a large university health system. Participants were recruited at a monthly provider meeting and invited to complete an anonymous online survey. Satisfaction with video-conferencing patient visits was explored via Likert scale and write-in responses. Providers highlighted specific complaints, problems, and successes that impacted their practice and patients. Aggregate health data from this organization was also obtained for comparison. Statistical analysis was performed and recommendations made for future practice. Findings: The provider experience of telehealth was overwhelmingly positive. 85% (n=11) of providers agreed or strongly agreed that telehealth allows them to manage their patients effectively. Lack of physical exam findings was the most commonly cited concern (n=9). 100% (n=13) of providers would like to continue seeing patients via telehealth in the future. Conclusion: Videoconferencing appointments in university health primary care promote high provider satisfaction. Future policies and innovations should support the use of a telehealth platform.

Breast or formula feeding is a personal and challenging decision for any new parent. Breastfeeding goes beyond the mother-baby dyad, having profound implications across different societal contexts, including financially and medically. Although a natural form of feeding, breastfeeding can be difficult and isolating if it does not come easily. A mother's first contact for help is usually at her newborn's first primary care appointment. However, these appointments are insufficient in allowing the healthcare provider to answer breastfeeding concerns or questions. A quality improvement project was conducted at a pediatric primary care clinic in the southeast valley of Arizona after approval was granted by an Institutional Review Board. Eight participants were recruited, and four completed the project. This project focused on extending the newborn appointment by 15 minutes to provide an educational resource binder and address breastfeeding questions. The Bristol Breastfeeding Assessment Tool (BBAT) was utilized to determine the mother's self-efficacy towards breastfeeding since the Theory of Self-Efficacy was the foundation for this project. Weekly follow-up telephone calls were conducted to address the mother's questions. The project concluded at the one-month appointment, where BBAT was performed again. The BBAT scores demonstrated an increase in breastfeeding self-efficacy. The participants were also evaluated if the project aided their breastfeeding journey. Every participant was breastfeeding by the one-month appointment except one who was not exclusively breastfeeding. In addition, all preferred the extended-length newborn appointments, educational binder, and weekly phone calls. Qualitative theming supported the use and continuation of the project for future mothers.

Loneliness and depression in older adults are under-recognized public health concerns that increase risks for all-cause mortality, medical morbidity, and rising healthcare costs. This quality improvement project assessed whether smartphone Mindfulness software mitigated self-reported feelings of loneliness and depression among community-dwelling older adults. Nine participants aged 65 and older, living at home, experiencing loneliness or depression, and owning a smartphone were recruited using newsletters and fliers. A short demographics questionnaire and two valid and reliable instruments, namely the University of California Los Angeles Loneliness Scale (UCLA V3) and Geriatric Depression Scale (GDS), were used in pre-intervention and four weeks post-intervention. Participants downloaded the UCLA Mindful app on their smartphones after attending a 20-minute Mindfulness education at a local church banquet room. Participants used the UCLA Mindful software twice weekly for ten minutes for four weeks. Of the nine participants, three completed the study. A two-tailed paired sample t-test and descriptive analysis were used to evaluate the efficacy of the UCLA Mindful smartphone software. The results of the two-tailed paired sample t-test were not statistically significant for the UCLA V3 Loneliness scale (p=.220) and GDS (p=.208) due to the small sample size. Although the results were negligible, participants nevertheless reported favorable impacts. Future research with a larger sample size is encouraged.

Nonadherence to psychiatric medications was identified as an issue worldwide and in a non-profit organization for women recovering from substance use disorders (SUD) in the southwestern United States. Non-adherence is associated with increased hospitalizations and relapse. A literature review indicated that motivational interviewing (MI) was an evidence-based intervention for increasing psychiatric medication adherence in women recovering from SUD. This project aimed to assess if training the organization staff on MI, would impact their beliefs, knowledge, and comfort of using MI on their clients with non-adherence. The Theory of Planned Behavior is the underlying principle of the project. A recruitment flyer was sent to the organization via email, and interested staff attended the training on the basics of MI via a PowerPoint presentation through video conferencing. Pre-, post-, and one-month follow-up questionnaires were provided to assess participants' knowledge, familiarity, and comfort with MI. The questionnaires consisted of the reliable/validated Beliefs About Medication questionnaire (BMQ) and questions about MI. Participants were deidentified for data collection. A Friedman's test and descriptive statistics were used for analysis. 17 staff participated; five one-month follow-ups were completed. Participants believed medication was more beneficial than harmful and necessary for improvement-nonsignificant: Friedman test p = .179. Upon follow-up, 40% reported being comfortable using MI while 60% reported they had not used MI yet. MI training may improve staff comfort and ability to address medication nonadherence. A larger sample may lead to significant and generalizable results.

Background: Obesity is a known comorbidity for chronic disease and is responsible for 47% of related medical costs. Recognizing the complex etiology of obesity, the need for an effective and comprehensive screening tool will assist primary care providers in assessing their patient's needs and facilitating success in managing their weight and health. Primary care providers (PCP) have limited knowledge of current evidence in obesity treatment. The project guides the form of tools to help identify the patients' self-efficacy, change readiness, and insurance reimbursement. Methods: Expedited IRB approval was obtained, allowing for data analysis from completed de-identified screenings, surveys, and medical records gathered between September 2022 and April 2023. Screenings including Weight Efficacy, Lifestyle long-form (WEL-LF), and Stages Of Change Readiness And Treatment Eagerness Scale In Overweight And Obesity (SOCRATES-OO) were used to assess the effectiveness of the treatment plan. Russwurm and Larrabee's model for evidence-based practice change was chosen for the project's framework. The provider was given a guide for obesity management with tips for billing insurance. A convenience sample of eight patients met with the providers over three months as part of their obesity management treatment plan. Results: The pre and post-screenings collected from the remaining participants (n=8) showed no statistical differences. However, the satisfaction and feedback survey from patients (n=8), provider (n=1), and office staff (n=4) showed improved quality of care and greater confidence in the provider's part in initiating and managing their patient's chronic obesity. Conclusion: Improving PCPs' knowledge of Obesity treatment improves patient care. Expanding this project to a larger scale and disseminating the information can impact patients' lives positively. Keywords: Obesity; self-efficacy; readiness for change; stages of change; primary care, Weight Efficacy Lifestyle questionnaires

Background: Workplace violence (WV) is a significant problem in healthcare that affects the nurses' physical and mental health and impacts patient care. This is costing healthcare organizations millions of dollars for damage control as there is a lack of prevention. Hence, this evidence-based practice project uses the theory of planned behavior and nursing process discipline theory to explore the effectiveness of screening patients for violence. Method: After an aggregate IRB approval, a violence screening tool with high sensitivity and specificity, Broset Violence Checklist (BVC), was implemented twice daily and as needed for 15 days with 275 adult patients in a neurology/telemetry unit to help identify patients at high-risk for violence. All interventions and procedures were based on established policies, not the BVC score. Results: A generalized estimating approach with a logit link and linear regression was used for data analysis. Of the 1504 BVC screenings completed, 43 violent incidents were reported, with interventions recorded in 106 (7.1%) screenings. Patients with a BVC score of <2 required an intervention 16 times (1.2%), and BVC score of >2 required an intervention 90 times (54.2%), OR= 17.95 (95% CI: 3.55 to 90.84), p< 0.001. Discussions: Total BVC score, male gender, and older age were highly predictive of violence. Also, as the BVC score increased above 1, additional interventions were utilized. Conclusion: The BVC has value, indicating that patients who score above 1 can pose enough threat to require an intervention. Thus, uncovering risks and identifying the potential for violence is essential to diminishing harm and WV.

According to The Joint Commission, most sentinel events in healthcare can be attributed to errors in communication. Thousands of medical students in the United States lack adequate communication training. Current literature illustrated that communication skills training programs increase confidence and communication skills of medical students and residents. These programs vary in techniques, with many including lectures and role play exercises. This project aimed to improve outcomes at a forensic facility in Arizona by utilizing a student role play intervention and lecture. Outcomes were measured utilizing developed pre- and post-intervention surveys. The surveys included a validated tool which measured four communication skill categories. A convenience sample consisted of pre-medical interns who participated in the project. The small sample size (four) led to descriptive statistics utilization to provide preliminary data. Prior to the intervention, communication skill average scores were as follows: listening (15), giving and getting feedback (12), sending clear messages (13.75), and handling emotional interactions (11.5). Post-intervention, the average scores for the communication skills were as follows: listening (18.25), giving and getting feedback (13), sending clear messages (16), and handling emotional interactions (12.75). Average scores for each category showed an increase after the implementation of the intervention. The survey was completed for four (100%) of participants, and 75 percent of participants stated they felt more confident with utilizing communication skills in their internship. A communication skills training program can enhance communication skills of medical trainees by providing structured support. Further research is needed on effective techniques to train medical trainees.

Objective A needs assessment identified a nursing knowledge gap of chemotherapy-induced neurotoxicity (CIN) symptoms as a significant factor in delayed recognition of patients' neurologic decline. The quality improvement (QI) project aimed to increase nursing comfort levels and knowledge related to screening for CIN in hospitalized pediatric hematology, oncology, and bone marrow transplant (Heme/Onc/BMT) patients. Methods Nursing CIN education and pre- and post-education assessment questions were created using best practice parameters to screen and monitor CIN in Heme/Onc/BMT pediatric patients. Pre- and post-surveys included a valid Likert-type scale to assess comfort levels using neurotoxicity screening tools (NST) followed by knowledge-based formative assessments. ASU IRB and hospital QI board standards were maintained. Results Heme/Onc/BMT nurses (n=37) participated. The most frequent pre-education comfort level was three or somewhat comfortable (n=13). Most frequent post-education comfort level is four or very comfortable (n=21). The two-tailed Wilcoxon signed rank test for pre- and post-education comfort levels was significant based on an alpha value of .05 and p < .001. Conclusion Nursing comfort and knowledge of screening for CIN increased. Early recognition of CIN will improve outcomes for high-risk hospitalized Heme/Onc/BMT pediatric patients.

Background: Diabetes (DM) is a costly disease that negatively impacts patients and the healthcare system that requires complex and structured management. Literature has shown a gap in effective, structured diabetic education and management for providers and patients. Objective: The purpose of this quality improvement project was to investigate the impact of how outreach, through a structured educational care plan, affects healthcare team experience, perception, and impact on their ability to communicate and comanage patients' chronic diabetes. Utilizing telemedicine as an alternative to the office visit healthcare model to address a gap in care by providing ongoing, structured diabetes education and management. Methods: A small-scale study initially included ten participants, with five that completed the study. This included the Population Outreach Team (POT), one provider, and four auxiliary support staff. They were introduced to and utilized a care plan tool (CPT) to assist providers and auxiliary health team communication and education delivery to patients with DM. The theoretical and implementation framework that guided the study was based on the nudge theory, focused on altering habits and behavior, and the Model for Improvement supporting future alterations and improvement as identified. A CPT was designed based on HEDIS diabetes measures and the American Diabetic Association (ADA). Improvement was measured through nine question pre- and post-surveys with an additional four questions specific to the CPT use based on a modified RAND Likert scale patient satisfaction survey. A post-qualitative interview with the provider was conducted to gain further insight into CPT use and perception. Results: A total of ten healthcare and auxiliary participants joined the study; of these, five completed it. The data, including the pre- and post-perception surveys, were collected over a 6-week study period with a post-implementation interview with one provider. Data analysis was captured through descriptive statistics. Pre-perception, M = 19.6 (SD. 4.04, 14 – 25). Post-perception, M = 7.60 (SD. 1.34, 6 – 9). CPT perception post, M = 14.4 (SD. 3.65, 10 – 18). A lower score indicated improvement. The interview identified the following barriers that impacted the CPT's success, including the patient-provider relationship, EHR "easability", patient readiness, and patient education barriers. Conclusion: This small study indicated the positive impact structured, ongoing education provides to improve communication and comanage patients' with DM through the POT improved perception with CPT use. Barriers identified will assist with future implementations and other areas for improvement, which may increase success in the objective of this study and the delivery of healthcare for patients with DM. Future utilization of this intervention may be easily translated to other primary care environments. The intention is that successful DM management may lead to decreased medical management, complications, and financial strain.