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“Things That Are Round”
By Marsha Balian, NP
(more)
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Managing High-Risk Obstetric Cases and Analyzing Neonatal Outcome: The KP Northern California Regional Perinatal Service Center.
By Yvonne Crites, MD; Jenny Ching, RN, BSN; Connie Lessner, RN; Deborah Ray, MD
Santa Clara is the site of this regional center, that, having identified a causal connection between preterm birth and perinatal mortality and morbidity, created an award-winning preterm birth prevention programs which has been transferred to several KP regions. article>>
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“Jessie”
By Marsha Balian, NP
(more)
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“Canine Cake Walk”
By Marsha Balian, NP
(more)
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The Emergency Contraception Online Learning Module.
By Debbie Postlethwaite, RNP, MPH
Kaiser Permanente Northern California Regional Women’s Health developed this online module to improve utilization of a highly effective method for women at risk of unintended pregnancy. article>>
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“Egg Whites”
By Julie Nunes, RN, MS, CPHRM
(more)
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Normal Birth.
By Ione Brunt, CNM
Despite considerable debate and research over many years, the concept of “normality in labour and delivery is not standardized or universal.” This commentary advocates for attention to health maintenance for low-risk mothers. article>>
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“Bolinas Ridge”
By Julie Nunes, RN, MS, CPHRM
(more)
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2005 Vohs Award Honorable Mention
The Kaiser Permanente Northwest Cardiovascular Risk Factor Management Program: A Model for All.
By Jodi S Joyce, BS, BSN, MBA; Martina M Fetter, RN; Dean H Klopfenstein, RPh, CDE; Michael K Nash, BS
This 2005 Vohs Honorable Mention is a centralized, multidisciplinary, proactive clinical management intervention using computer-stored data to identify eligible members with multiple interrelated cardiovascular risk traits. article>>
2004 Lawrence New Project Award Winner
Perinatal Patient Safety Project.
By Julie Nunes, RN, MS, CPHRM; Sharon McFerran, RN, PhD, CPHQ
The 2004 Lawrence Patient Safety New Project Award-winning project, presented here, drew upon a multitude of theories, disciplines, and industries to create high-reliability perinatal units. article>>
Malnutrition in the Elderly: A Multifactorial Failure to Thrive
By Carol Evans, RNP, MS, MA
This presentation emphasizes the importance of taking a multidisciplinary approach that treats pathology and uses social and dietary forms of intervention when addressing malnutrition in the elderly. article>>
Spiritual Moments.
By Naomi Newhouse, MS, CNM
A true story of a nurse midwife who, by creating a sacred and safe space for a birth, engaged an entire family of 12 in the delivery room to experience the transformation of the mother. article>>
Bariatric Surgery in the KP Northwest Region: Optimizing Outcomes by Using a Multidisciplinary Program.
By Keith H Bachman, MD; Brenda Buck, RD; Julie Hanna, LCSW; Tamara J Mucha, PT; Mary Lou Greenwood, RN, BSN; David Moiel, MD
Although bariatric surgery can be an appropriate treatment option for extremely obese patients, uncertainty exists as to how to optimize treatment outcomes. This article describes a coordinated multidisciplinary program designed to educate and to behaviorally prepare patients for bariatric surgery and to support long-term behavioral change. article>>
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“Tea in the Garden”
By Barbara Poole, RN
(more)
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Treating Chronic Pain: New Knowledge, More Choices.
By Christine E Whitten, MD; Marilee Donovan, RN, PhD; Kristene Cristobal, MS
This third in a continuing series on pain management offers practical treatment advice based on the newest science. article>>
Fail Often To Succeed Sooner: Adventures in Innovation.
By Christi Dining Zuber, RN, MHA; Victor Alterescu, RN, MBA, MPH; Marilyn P Chow, RN
How will health care delivery for mothers and babies look in 2015? This article describes the innovation methodology used by the international design firm, IDEO, in collaboration with KP staff to design new hospitals and staff-patient processes, using the techniques of storytelling, brainstorming, and prototyping. article>>
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Harpooning the Vein.
By Shawna L Swetech, RN
A poem depicting the complexity of intergrating a technical task with compassion for the person who will feel pain. article>>
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“Zan”
By Sevada Younesian, RN
(more)
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A Successful Partnership to Help Reduce Health Disparities at Kaiser Permanente: The Institute for Culturally Competent Care and the Kaiser Permanente School of Anesthesia.
By Nilda Chong, MD, MPH, DrPH; Sassoon M Elisha, CRNA, MS, EdD, Maria Maglalang, RN, MN, NP; Karen Koh, MPH, DrPHi
This article describes the genesis, evolution, and potential impact of an ongoing partnership between the Kaiser Permanente School of Anesthesia and the California State University system in incorporating a formal cultural competence program. article>>
Life Lesson.
By Shawna L Swetech, RN
In an encounter with a paraplegic patient, a nurse, imagining his awful quality of life, experiences this man as not just a patient, but, today as her teacher. article>>
Miracle.
By Victoria Van Dyke, CNM
In this true story of the difficult birth of an anencephalic fetus, the miracle that emerges is the love of a mother and family. article>>
2006 Vohs Award Winner
Controlling High Blood Pressure.
By Patricia E Casey, RN, MSN; Amy Compton-Phillips, MD; Stacey Shapiro, MPH, RD; Phong Nguyen, MD
One of the two 2006 Vohs Award-winning projects describes the Mid-Atlantic Region’s quality improvement program to improve control of high blood pressure. article>>
2005 Lawrence Transfer Award Winner
The Southern California Perinatal Patient Safety Project.
By Jean Sandoval, RN, MSN; Janice McDonald, RN, MBA; Suzanne Graham, RN, PhD
The 2005 Lawrence Patient Safety Transfer Award-winning project was implemented by the Southern California Region. The implementation challenges and successes are presented here. article>>
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“View from the Water”
By Natalya Nicoloff, NP
(more)
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Team Disputes at End-of-Life: Toward an Ethic of Collaboration.
By Debra Gerardi, RN, MPH, JD
Difficulties in end-of-life care arise around issues such as: variability in practice, poor communication among providers, lack of consensus regarding plan of care, incomplete documentation, and differences of opinion regarding the definition of futility. Tools to create an ethic of collaboration are dialogue, coaching and mentoring, and appreciative inquiry into stories of success. article>>
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“Sunrise and Ship”
By Adrian Kalil, CRNA
(more)
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Quality Translations: A Matter of Patient Safety, Service Quality, and Cost-Effectiveness.
By Gayle Tang, MSN, RN; Oscar Lanza; Fátima M Rodríguez, MPH; Annie Chang
This article describes the importance of using high-quality translations in the health care setting, explains the accomplishments to date, and offers suggestions for future actions. article>>
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“Chaco Canyon, New Mexico”
By Patty Stelz, RN
(more)
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Heart Failure Etiology Is Usually Pluricausal Whether or Not There is Associated Coronary Disease.
By Arthur L Klatsky, MD; Sharon Gronningen, RN; Natalia Udaltsova, PhD; Douglas Chartier, MD; Somjot S Brar, MD; James Schipper, MD; Robert J Lundstrom, MD
An attempt to classify underlying etiology of heart failure for an epidemiologic study yielded surprises, including that no preponderant cause was identifiable in a large proportion and that most had multiple etiologic factors. article>>
Perioperative Tight Glycemic Control: The Challenge of Bariatric Surgery Patients and the Fear of Hypoglycemic Events.
By Bellal Joseph, MD; Jeff Genaw, MD; Arthur Carlin, MD; Jack Jordan, MS; Jean Talley, RN, BSN, MSN, APRN; Ilan Rubinfeld, MD, MBA
Although tight glycemic control has resulted in improved outcomes, fear of hypoglycemia has been an important barrier to implementation. This triple arm prospective trial demonstrates improved hyperglycemic control in bariatric surgery patients with no increase in hypoglycemia. article>>
Church-Based Heart Health Project: Health Status of Urban African Americans.
By Lisaann S Gittner, MSc; Salwa E Hassanein, PhD, RN; Pamala J Murphy, MD
In 2004, a community project was implemented to address the cardiovascular health disparity in the African-American population of greater Cleveland, OH. article>>
2006 David M Lawrence, MD, Chairman’s Patient Safety Award
Promoting Patient Safety: The Rapid Medical Response Team.
By Dawn Gould, RN, MSN, CNS
With teams of an ICU charge nurse and a respiratory therapist and directed primarily at nonICU medical and surgical patients, this program reduced adverse events, deaths, and unneeded ICU transfers. Readiness to initiate the process and education of the staff were major elements. article>>
2007 James A Vohs Award for Quality -- First-Place Selection
A Multidisciplinary Approach to Transition Care: A Patient Safety Innovation Study.
By Jeryl McGaw, MS, RN, ND; Douglas A Conner, PhD; Thomas M Delate, PhD, MS; Elizabeth A Chester, PharmD; Carol Ann Barnes, MS, PT, GCS
This article describes a systematic and comprehensive program for dealing with the problems inherent in a complex health system necessitating frequent transfers of responsibility among providers. There is concentration on avoidance of medication errors and coordination of outpatient care. article>>
Fetal Heart Rate Pattern Notification Guidelines and Suggested Management Algorithm for Intrapartum Electronic Fetal Heart Rate Monitoring.
By Thomas Downs, MD; Evelyn Zlomke, RN, MPH
Variability in the use of FHR guidelines may account for past trials showing lack of efficacy. The proof of effectiveness of a practice guideline is day-to-day use through a management algorithm. article>>
Whole Person Health for the Whole Population: One-Year Evaluation of Health Coaching.
By Melodi Licht, RN, MSN; Jeffrey M Davis, MD, MPH; Allison Scripps, MS, RD, CDE; Juanita Cone, MD, MPH
This article reports on the positive impact of personal health coaching on quality outcomes—improved glycemic control—and overall patient satisfaction. article>>
Which Chronic Obstructive Pulmonary Disease Patients Will Be Likely to Attend Consistently a Pulmonary Rehabilitation Program?
By Salwa E Hassanein, PhD, RN; Georgia L Narsavage, PhD, APRN, FAAN; Sherrie Dixon Williams, MD, MHS; Mary K Anthony, PhD, RN; Lisaann S Gittner, MSc
With a view of optimizing use of limited resources, this study examines a variety of traits potentially predictive of good attendance at specialized pulmonary rehabilitation classes. Several are identified. Continued smoking is the greatest predictor of low attendance. article>>
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“Dif-fruit Points of View”
By Sharon Lacasad, RN
(more)
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“Haleakala
The House of the Sun”
By Charlene Hughes, RN
(more)
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Improving Chronic Care: The “Guided Care” Model.
By Chad Boult, MD, MPH, MBA; Lya Karm, MD; Carol Groves, RN, MPA
In a new model now being tested by Kaiser Permanente in the Baltimore-Washington, DC area, a registered nurse works in a practice with several primary care physicians conducting eight clinical processes for 50-60 multimorbid patients. article>>
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“Twenty-five years
and two days”
By Marilyn Mitchell, RN
(more)
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Implementation of a High-Alert Medication Program.
By Suzanne Graham, RN, PhD; Molly P Clopp, RN, MS, MBA; Nicholas E Kostek, RPh, MS; Barbara Crawford, RN, MS
High-alert medications—500,000 doses annually through Kaiser Permanente Northern California—carry a high risk of alarm, with potential clinical outcomes from administration errors. With program introduction, a statistically significant drop in errors occurred for 23 consecutive months. As of November 30, 2007, 232 days had passed without a negative event. The multidisciplinary group standardized handling, enhanced education, and developed monitoring functions. article>>
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“St Emilion”
By Elizabeth E Willer, RN, MSN, CPNP
(more)
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Corridor Consult
Do Patients Understand?
By Suzanne Graham, RN, PhD; John Brookey, MD
Limited literacy skills are one of the strongest predictors of poor health outcomes for patients; however, patients do not need to have limited literacy skills to have low health literacy. article>>
2008 James A Vohs Award for Quality
Collaborative Cardiac Care Service: A Multidisciplinary Approach to Caring for Patients with Coronary Artery Disease.
By Brian G Sandhoff, PharmD; Susan Kuca, RN; Jon Rasmussen, PharmD; John A Merenich, MD
Through lifestyle modification, medication initiation and adjustment, patient education, laboratory monitoring, and management of adverse events a Collaborative Care Service has improved cholesterol screening, reduced low-density lipoprotein cholesterol level, all-cause mortality associated with CAD. This service has also and improved patient and physician satisfaction. article>>
A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time?
By Ann Hendrich, RN, MSN, FAAN; Marilyn P Chow, DNSc, RN, FAAN; Boguslaw A Skierczynski, PhD; Zhenqiang Lu, PhD
In the first hospital environmental study to quantify how nurses spend their time, 767 nurses were randomized to two protocols at 36 hospital medical-surgical units within 17 health care systems and 15 states. Documentation consumed most nursing practice time (35.3%), followed by medication administration (17.2%), and care coordination (20.6%). Patient care activities only accounted for 19.3%. article>>
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“Mexican Marionette”
By Evelyn Zlomke, RN, MPH
(more)
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Early Discharge Study for Premature Infants: Singapore General Hospital.
By Yeo Cheo Lian, MD; Selina Ho Kah Ying, MD; Cheong Chiu Peng, RN; Tay Yih Yann, RN
At Singapore General Hospital, premature infants had a median birth weight of 1210 g. Discharge traditionally occurred when infants were medically fit and weighed 2000 g. The length of hospital stay was reduced 59.8%, primarily by improved discharge planning, revised guidelines (mean discharge at 1915 g), and nurses’ active preparation of parents psychologically and mentally for care of their babies at home. article>>
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“Household Saints
of Dubious Virtue”
By Marsha Balian, NP
(more)
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“As Time Goes By”
By Marsha Balian, NP
(more)
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The B-SMART Appropriate Medication-Use Process: A Guide for Clinicians to Help Patients—Part 1: Barriers, Solutions, and Motivation.
By Elizabeth Oyekan, PharmD, FCSHP; Ananda Nimalasuriya, MD; John Martin, MD; Ron Scott, MD; R James Dudl, MD; Kelley Green, RN, PhD
This multifaceted approach used before, during, and after any patient-clinician interaction creates a consistent method to help patients more effectively use their medications. Elements include: involving patients in the decision-making, simplifying dosage regimens, education about the medication, self-management training, ongoing reinforcement and motivation, and positive relationships. Concrete solutions are provided to nine common practice challenges, including: forgetfulness, literacy, denial, financial, depression, and lack of knowledge. article>>
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“Child is the Father
of the Man”
By Marsha Balian, NP
(more)
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