Preliminary Data: What Am I Learning?

I will be talking with Dr. Pahls, by phone on the 19th, next week.  I will have more of an idea of how to proceed with the analysis of the data.

I have been working on the revisions within my project paper. As I am sure the rest of you have as well.  Several changes. I have added to the literature review.  Looking at things that relate to the survey which I did; looking at barriers to adhering to guidelines.  It was interesting (one thing new I guess).  Clinical inertia ” is the failure of a healthcare provider to initiate or intensify treatment when indicated ” (Cowart, 2018).  This can be seen in people with diabetes for example, a provider knows there is perhaps a guideline for changing a medication or what is recommended, yet chooses not to follow it.  Because of a lack of knowledge or bias, or disagreement, do not follow guidelines.  This happens with chronic pain management with opioids.  Providers know that there is a CDC Guideline for chronic pain management with opioids; yet, they choose not to follow for reasons mentioned.  I should rephrase, some are not familiar with the guideline, some do not care about the guideline.  The review which I read discussed the need for further research into clinical inertia as it relates to lack of adherence to prescribing opioids for chronic pain, and why there was lack of use of the CDC guideline.  It was very interesting and was the first time that I had seen this term used.  The authors were concerned with “knowledge synthesis” that was related to a lack of adherence for safe prescription of opioid management of chronic pain.  This, of course, their review does not include patients that have chronic pain related to cancer (Rash, et al., 2018).  My survey does go into what might be barriers.  Listed were 1) Lack of knowledge; 2)Not enough time with the patient; and 3) Lack of support from the organization.

I will give a low-down after I have a structured analysis of the data.

References

Cowart, K., (2018). Overcoming clinical inertia in diabetes management: Pharmacist opportunities. U.S. Pharmacist. Retrieved from https://www.uspharmacist.com

Rash, J.A., Buckley, N., Busse, J.W., Campbell, T.S., Corace, K., Cooper, L., Flusk, D., Iorio, A., Lavoie, K.L., and Skidmore, B., (2018).  Healthcare provider knowledge, attitudes, beliefs, and practices surrounding the prescription of opioids for chronic non-cancer pain in North America: protocol for a mixed-method systematic review. Systematic Reviews, pp. 1-7.  doi: 10.1186/s13643-018-0858-7

Preliminary data – what you are learning?

My project seems to be flowing nicely, according to my champion.  It is hard to believe that there is only 1 ½ months left before my project concludes.

What I am learning is there are issues that can arise, no matter how trivial they may seem.  After my telephone discussion with Dr. Pahls, I was informed I needed additional data for my sample size.  When I expressed this request to the clinical manager, she hesitated and said that she is unsure of how to do that other than look up every patient during the requested time.  After some discussion about how to remedy this situation, she suggested having the IT department pull the data as they would know how to run a report for the specific data needed.  I did try to contact the IT department on Friday, November 8th, but as of today, November 11th, I have not heard from them.  I will keep trying to get in touch with them.

So, long story short is to expect issues to pop up.  When they do, do not panic but to think around the obstacle as there is always a way to remedy things.  At least I hope so.

I have not received any preliminary data as I am waiting to discuss things with the IT department.  I will finish my clinical rotation this week.  I am hoping to get in touch with the IT department on Friday.

Leadership Challenges, strategies, and hiccups

My weekly blogs finished last week.  This week was the final measurements and post-participation surveys.  I only had approximately 20 of the 27 participants finalize the surveys but I feel like that was decent number.  My biggest leadership challenge has been the fact that the project site is almost two hours from my clinic site.   There were no issues throughout the duration of the 8 week blog publishings other than some verbiage tweaking and a minor alteration in schedule but I definitely had to depend on the administrative assistant on campus to ensure that the blogs published on time and I was thankful to have my faculty content specialist available if necessary.

Strategies:  The activities were very specific to the location and were created to fit well into the participants’ work day.  There were many participants that came to the lunch and learns.  It was a very positive atmosphere and all who participated seemed to really enjoy the topics.  There were also classes held by wellness center which ran congruently with the 8 weekly blogs which helped keep the participants motivated.  (That wasn’t organized by me but instead spotlighted in support of this project.)

Hiccups:  The only hiccups were the schedule conflict with homecoming week but I feel like we adapted to it well and really didn’t see any negative side effects of that.  I wish there were more participants but I loved the project and even though the numbers weren’t very high, all who did participate all unanimously stated that it was a positive experience and some even offered that they were disappointed to see it end.  (I’d call that a success!)

Leadership, Challenges, Strategies & Hiccups

Overall my project is on-time. Now, I will revise and get the proposal and the Survey to Dr. Pahls (statistician) at Hays, and get a time set up to speak with him concerning the statistical analysis.

Things are running smoothly at this time.  Data has been collected, it went reasonably well (240) responses to the survey (I thought it was 235). It was interesting that the largest group to respond were NPs that were in practice for 1-5 years.  I do feel that NP education now is more focused on EBP, guidelines are critical.  Compared to 22 years ago, when I first began practice as an NP, there are more states which are lifting the restriction to NP practice. This does make a difference.

I was asked recently to take a survey from a doctorate student that was an NP working on her Ph.D. with the University of Nebraska; she was reviewing states NPs who have full practice authority; did demographics make a difference? It was an excellent survey. I am confident she was going to get great information.  She was surveying 4 states that had full independent practice, New Mexico was one of them.

Kay

Leadership Challenges, Strategies, and Hiccups.

For the most part, my project seems to be going well.  I really do not want to say that because I do not want to jinx myself.  The biggest challenge I have had is lack of time and availability in case the clinic would need something.  I have been trying to finish my clinical rotation as soon as I can because my preceptor in quitting the clinic and going to work at another FQHC in Wichita.  Her last day is November 15th and she worked only one day this week.  I should be finished by next week and can devote more time to my project.

I did visit with the statistician on Monday and we worked out a game plan.  The statistical test I had planned on using was not the right one.  Thank goodness I was able to get in touch with him.

The only hiccup right now, other than lack of time, is needing the clinic manager to pull more data for me.  The statistician explained what data I need from last year and for this year.  I thought having her pull my data would be easier because the issue of HIPAA.  We figured this way would be easier, but I am beginning to think that maybe I should be pulling the data.  I feel like I am bothering her all the time.  I have completed their HIPAA training so maybe I can visit with her and see what we can figure out.  Otherwise, the project is going well.  I am keeping my fingers crossed.

Leadership: Challenges, strategies, and hiccups

My weekly Education has gone well. I haven’t had any challenges or hiccups at this time.  I send the education email on Friday so that the Clinical champion can send it out on Monday. Then the clinical champion sends me a note of confirmation that she received it. If I don’t receive a note of comformation then I send it again to make sure she received it. Then on Mondays she sends me a confirmation when it gets sent out.

I have education for 12 weeks, so I just continue on the current plan. .

Data Collection: Challenges, Triumphs, Initial Data

 

 

In this phase of my project, I don’t have all the data gathered yet.  The last measurement day is November 6 and I hope to collect all the rest of my data at that time. Since the data collection process requires voluntary participation, I am at the mercy of the participants reading the blogs and remembering to appear for the measurements.  My data is a very simple pre and post participation survey.  My biggest concern for the completion of this project is that the number of participants.  While the number of participants for the pre-participation survey wasn’t impressive, I’m even more concerned that the number of participants that will present for the post-participation will be even less.

Challenges:

  • The location of the lunch & learn activities required all participants to walk across campus to arrive at the location. They also had to plan ahead and bring their own lunches.
  • This time of year was super busy with activities outside of my program which conflicted with some of our plans and required that we even change dates of certain activities during homecoming week.

Triumphs:

  • The participants that did sign up have been VERY invested and energetic.
  • Multiple participants were present at the lunch and learn activities
  • Lots of positive feedback from the participants thus far.

Initial data:

  • 27 participants:

Pre-participation survey:

Likert scale ratings from 1-10:

  1. I would rate my knowledge of physical activity as it relates to my health as:

Average rating: 6

  1. I would rate my knowledge of nutrition as it relates to my health as:

Average rating:  4

  1. I would rate my level of physical activity as it relates to my health as:

Average rating: 5

  1. Currently, I would rate my nutrition as it relates to my health as:

Average rating: 4

 

Data Collection; Issues & Triumphs

I have launched the data collection, which is “Survey of attitudes & barriers to the utilization of the 2016 CDC Guideline for Chronic Pain Management with Opioids.”  After an initial 7 weeks of pure anxiety, I was able to switch mid-stream to a survey method of data collection for my project.  Two weeks ago I did send the survey via Survey Monkey to 1600 New Mexico NPs.  To date: 10/18/18, I have received 234 replies.  Not what I have expected, but there is excellent information. I will be wrapping up the survey in the next week or so. Putting at 2.5 weeks. One reminder has been sent out on day five, to do the study.  I have received a few personal emails of individuals that know me from New Mexico, knew this was my project, and were very supportive and excited.  A few of them did not do the survey as they were not NPs that did any form of pain management (they wanted me to know).  So far, the data is >70% family NPs, the most significant response group that has been in practice for 1-5 years. 15% have been adult NPs.  These two groups were my targets.  The rest have been urgent care/ER NPs.  They did not manage chronic pain but were passionate about using the CDC guideline. They did provide Narcan to any patients with an opioid script.

The most significant barrier to using the guideline that I could see was: Not enough time with my patients.  And lack of education on chronic pain management with opioids.

What would help them utilize the guidelines:

1. They want an EMR Template based on guidelines 55.71%;

2. Policy Development that correlates with the CDC Guideline(40%) ( A question which stemmed from lack of organization support)

3. More time with the patient 42.86%

4. Patient Education material 41.90%

5. Education on chronic pain management 34.76%

Over 40% expressed not being comfortable with the guidelines.  Over 30% felt very pleased. And the rest comprised of those that either felt the instructions did not apply to the practice. And there was 1 that did not think the guidelines were helpful.

It will be interesting how this all breaks down statistically. What I did get from this was; they are concerned about this epidemic, and over 90% felt this guideline and using it was extremely important and that this did impact their practice in a big way.

Kay

Data review-Issues, Challenges and trimphs

My initial data was pulled in September. The data was pulled in two weeks. The original project was to have children only, but was concerned if there would be enough patients, so the final project included adults. Adding adults allowed boosting in numbers, I think that it was a positive change, because I am uncertain if i would have had enough patients if I would have just done children.  Adding adults boosted my additional numbers, and will hopefully also boost my final data pull.

My triumph is that the data was able to be collected in two weeks with no difficulty. Additionally was able to obtain all of the data needed.

There have not been any issues thus far with obtaining data or initiating the weekly emails. The facility has been very receptive to the education.

Data collection issues, challenges, and triumphs

My project was implemented on October 1, 2019.  I have not collected any data as of today, October 15, 2019 due to the short amount of time.  There really have not been any major challenges with the exception of the clinic’s EHR program.  The program they are using has ICD-9 diagnosis codes instead of ICD-10 codes.  This should be pose an issue with my project however because my data will be collected using the CPT codes.

Even though I have not started data collection, I have talked with the staff and they said they are giving more pneumonia vaccinations.  That is a win in my corner as that is the goal of my project.  I will begin collection data at the end of the month.  I figure it will be easier on the clinic manager if I asked for data once a month, especially right at this moment and the issues with the ICD codes.

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