Archive for Quality Improvement

First Week at the Atlanta VA!

Hello from the Atlanta VA Group! We have had a great start to our two week immersion experience with our Veterans! There are so many experiences to be had here at the VA, so we have been jumping in where ever we can. We started last Friday by attending an M, M and I meeting (Morbidity, Mortality, and Improvement). During this monthly meeting, a topic is chosen and a case within that topic is discussed. This month’s topic was Delirium vs. Dementia. It was so interesting to hear the experts discuss their views on something we have been discussing in class recently!

This week we started off by doing a scavenger hunt to orient ourselves with all the VA has to offer! We were able to introduce ourselves to many of the employees and volunteers that serve here. We were so impressed by the warm welcome we have received by everyone (patients, employees, volunteers, etc.). We can tell that the VA really takes pride in the amazing work that they do every day.

We have also been helping out with some research by transcribing interviews for part of a project called “Choosing Wisely” which focuses on starting a dialogue on how providers and patients can avoid unnecessary tests, treatments and procedures. As future providers, it is essential to be conscious of how we are utilizing resources while providing quality care for our patients.

Coming up next, we are excited to participate in Internal Medicine rounds and participate in another quality improvement project involving Value Stream Mapping.

D.R. Wrap-Up

Our final two days in San Francisco de Marcoris included Q.I. presentations about both programs we observed. The five of us who worked at the Hospital San Vicente de Paul, invited hospital administration, staff, and students to our presentation on the Kangaroo Care/Programa Caguro. Everyone did a wonderful job and the hospital team was very receptive to, and happy with, our observations over the two weeks. Later the same day, the second group presented to the Manhattan community and were also well received. No doubt we all learned a lot about a vastly different healthcare system than our own, and are so very grateful for our time in the D.R. Many of the people we met during our journey there will be faces remembered for the rest of our lives.

On the day before we flew back to the U.S., Dr. D gave a wonderful presentation on her research on Health and Spirituality, at the hospital. It was a big turn out! After grabbing our bags, we packed in to a minibus with fewer seats than people, and began a loooooooong, hot, squished journey to the capital, Santo Domingo. Many acres of rice fields, mountains, small towns, and farms later we arrived at the University, where we had a meeting with the new administrators about the purpose of our trip/projects.

Then piled back into the bus and drove around until we found our hostel for the night. Hostel Nomadas is a little slice of heaven in a beautiful city. We got out to do a bit of sightseeing, which included setting foot in the oldest cathedral in the New World. Amazing. Then the night ended with a lovely dinner on the rooftop of the hostel.

We all learned so much on this trip. And though it’s nice to be home, the experiences and people in the D.R. will be missed.

 

Vámonos al la playa

This weekend we had a wonderful getaway adventure. Our trusty driver, and our hostess, drove took us through the city of Nagua. Where we visited the Nagua campus of University de Santo Domingo. It was very impressive! The center is open air and feels as big as a futbol pitch.

We kept going on to Playa Grande. It was everything we’d hope it would and more: white beaches, clear water, sun, and great company. A few sunburns later, we were all ready to head to the hotel Bahia Blanca. It was a hidden gem in Río San Juan. Owned by a lovely Canadian woman, it is tucked away amongst a few small beaches. We ate dinner at an Italian restaurant in town called La Casita. With stuffed bellies, we returned to the hotel and continued the adventure on Sunday. We explored beaches and enjoyed wandering

Early morning swim

Early morning swim

around town. Then we returned to San Francisco de Macoris by bus (with air conditioning!).

This morning we all squeezed into our little red mini bus and headed out to the community of Manhattan for a health fair for the pregnant women who lived in the area. We talked about preeclampsia, baby development, and prenatal nutrition.

This afternoon a few of us went out to the countryside to enjoy an afternoon at El Rancho de Don Lulu. The bravest of us all headed up the mountain for a hike. The hiking group had some hiccups along the way, but returned safely after a few hours thanks to their trusty guide…who happens to be the pet dog of the man who usually guides people to the mountain top. He was off today but his sweet pooch made sure everyone was accounted for. Back at the ranch, the hikers cooled off in the natural spring pool there.

Tonight, we are finalizing presentations for tomorrow morning!

It’s Friday in the D.R.!

This morning we sent a few people to the hospital, while the rest of the group headed out to Manhattan’s La Casita de Salud, where a CPR training session took place. Community leaders were trained in CPR (RCP, in Spanish), and taking blood pressure readings. The road there was a bit bumpy (literally) thanks to road construction. Despite getting started a bit late due to the costruction and a non-functioning projector, it was a great program. A large, stuffed batman doll and an inflatable CPR doll, MiniAnn, served as the willing patients during the demonstration. Back at the hospital we intended to interview the hospital administrator about both programs in which we are involved. Unfortunately, he was not there. But as Dr. D says, “Flexibility is our motto.”

After lunch together, we all piled into a couple carritos (small taxis) and headed to La Sirena, which is basically a slightly smaller version of our super Walmart in the States. They have air conditioning and ice cream with marshmellow fluff topping. Needless-to-say, it’s a small piece of paradise here in beautiful, hot, sticky San Francisco de Marcoris. There we worked on our presentations while munching on snacks in the food court.

Tonight a few people are going out dancing in town, while the rest of us are staying home to write blogs and get ready for our one-and-only trip to the beach tomorrow. Happy Weekend to all!!

St. Thomas: Photo recap of our first week!

 

Greetings from beautiful St. Thomas! Where do I even begin? We have so much to share from the past 7 days, so we decided to do a photo blog so you could experience it with us!

As Holly mentioned in her previous post, the eight of us were split up for the first week (1/2 with Dr. Barzey, 1/2 at the FQHC). The lovely staff at the FQHC welcomed us with a sweet sign 🙂 Annie, Rachel, Eyelle, and Kelly have been working hard to distribute ambulatory care surveys, creating educational materials for patients, shadowing the providers, and making the health center more patient friendly.

Rachel, Eyelle, Annie  & Kelly at the FQHC

Rachel, Eyelle, Annie & Kelly at the FQHC

The other group worked with Dr. Barzey (the only endocrinologist on the island)  to create a comprehensive booklet on diabetes education that she can give to her patients. We also had the chance to go out into the community and survey the locals about their nutrition and exercise choices.

Mackenzie, Christina, Mary Macon, & Holly getting some cultural education from Dr. Barzey

Mackenzie, Christina, Mary Macon, & Holly getting some cultural education from Dr. Barzey

Speaking of food choices, the most popular fruit on the island are mangos! They are sold on almost every street corner, and are some of the most delicious mangos we have ever tasted!

A local fruit stand in downtown St. Thomas

A local fruit stand in downtown St. Thomas

If you don’t believe me, ask Eyelle!

Eyelle enjoying a mango!

Eyelle enjoying a mango!

Both groups worked dilligently all week to meet their goals and deadlines. We have learned so much about the culture here on the island. It is amazing how differently islanders live, and how much they appreciate the small things that we often take for granted.

The most frequent mode of transportation on the island: The "Safari" serves as a taxi to the locals. Usually less than $5 per ride!

The most frequent mode of transportation on the island: The “Safari” serves as a taxi to the locals. Usually less than $5 per ride, and can fit up to 18 people!

At the end of a long week, Dr. Wright invited us to have dinner at her and her husband’s beautiful ocean side home in St. Thomas.

The girls with Dr. Wright and her husband Chip.

The girls with Dr. Wright and her husband Chip.

Did we mention the view from Dr. Wright's front deck? (#nofilter)

Did we mention the view from Dr. Wright’s front deck? (#nofilter) p.s. that is St. John in the distance

Before we knew it, the weekend was here! We took a ferry (only $6, 10 mins) to the gorgeous island of St. John to enjoy our weekend off! Here are some pics of our trip:

St. John

Welcome to St. John!

The girls enjoying the view of Trunk Bay- one of the beautiful beaches in St. John

The girls enjoying the view of Trunk Bay- one of the beautiful beaches in St. John

A traditional dish of the island: curry chicken, yellow rice, boiled sweet potatoes, and veggies

A traditional dish of the island: curry chicken, yellow rice, boiled sweet potatoes, and veggies

The girls showing off their “Caribbean Hook Bracelets”

"Caribbean Hook Bracelets have been worn for centuries by islanders in the Caribbean, serves as "island time" to be a popular symbol of unity and love. The open end of the hook pointed up toward the heart means your love is take, the open end of the hook worn down away from the heart, means your love is free (unattached or single)"

“Caribbean Hook Bracelets have been worn for centuries by islanders in the Caribbean, serves as “island time” to be a popular symbol of unity and love. The open end of the hook pointed up toward the heart means your love is take, the open end of the hook worn down away from the heart, means your love is free (unattached or single)”

 

We had an amazing time in St. John and were sad to leave 🙁 But also excited to start another week, and this time, all eight of us were reunited at the FQHC!

Annie pausing for a smile while preparing her ambulatory care surveys!

Annie pausing for a smile while preparing her ambulatory care surveys!

Mackenzie and Christina going over some important details for their clinical day

Mackenzie and Christina going over some important details for their clinical day

Rachel and Dr. Wright at the FQHC

Rachel and Dr. Wright at the FQHC

We’ve had an incredible week so far here in the Virgin Islands, and look forward to this week’s adventures!

Nursing love,

Christina

 

 

 

 

 

Dominican Republic Orientation

Before I begin writing about our experiences in Dominican Republic, I want to say that although I will try to capture the experiences of all of us in the group, what I write will inevitably be reflections of my own experience and my perceptions.
After a 3 hour plane ride and a 2 hour bus ride from Santo Domingo to San Francisco de Macoris, we arrived at the homes of our hosts Tuesday evening. Two students are staying at one home and the other 6 and the faculty leader is staying at another.

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The bus ride allowed us to see the country as we traveled from one of the two biggest cities in the country through mountainous rural areas into a different city. San Francisco de Macoris is the third largest city in the country. Motorcycles, taxis, “carditas”, and mopeds speed rapidly along the street and appear not to abide by any sort of traffic regulations. Traffic accidents, including those involving pedestrians, are common and a major reason for emergency admissions into the hospital. The city is noisy with dogs barking and the traffic and trash litters the street. We are able to walk to the hospital in about 25 minutes and receive far too many cat calls from the Dominican men.
Yesterday (Wednesday), all of us went to Hospital de San Vincente de Paul for an orientation. The hospital is at the end of a street off the main street. We met and spoke briefly with the hospital director as well as with the director of nursing. Much of what was said went over my head due to my inadequate Spanish and the Dominican accent. Those who are fluent in Spanish are having difficulty understanding at times due to the accent and different idioms. IMG_1163

 

We then went to see the Kangaroo Program that the hospital has. The Kangaroo Program was created to help premature babies with temperature regulation. Because babies, especially those born prematurely, are unable to regulate their temperature effectively, they can lose heat quickly. Thus, it is critical that babies are kept warm. In a lower resource area like Dominican Republic, isolettes are limited. Kangaroo care uses the heat of the mother’s body to warm the baby by keeping the baby skin to skin with the mother. In order for babies to be in the kangaroo program, they must be stable. In the United States, viability of a premature infant is about 23 weeks gestation. In the United States, viability is at 28 weeks. This reflects a great disparity in the technology and care between the United States and the Dominican Republic as the vast majority of the 28-weekers in the United States survive.

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After spending time seeing the Kangaroo Program, we went to the maternity floor. There are six different rooms that the women are in, with about 8 beds per room. There is no air conditioning in the rooms and the ceilings have water dripping from them.

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Once the women reach 4 cm in dilation, they are moved to Sala de Cinco, which is the room for active labor. Once they progress to 7cm, they are taken back to a delivery bed where they deliver.

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There is also a surgical room for caesarean sections. Something that struck me about maternal care was the fact that 50% of births in Hospital de San Vincente de Paul are elective C-sections and 90% of births in private hospitals are C-sections. Because C-sections carry more risks than a vaginal delivery, I am curious if maternal mortality would decrease if C-sections were performed more sparingly. The women receive no medication for labor pain and are often there for days or even weeks because they are admitted to the hospital under false diagnosis of “active labor.” I met a lady today who had been there for 2 weeks and still is yet to deliver. Approximately 1/3 of all births are to teenagers so there is a Sala de Adolescente (Adolescent Room). Once the babies are born, the mothers return to one of the 6 rooms on the floor and the babies stay in the room with the mom. They do not have beds for the babies so the babies are in the beds with the mom. There is a unit in which they put babies that need some extra care. In this unit, there are baby cribs and a few isolettes. It was incredibly simple compared to a NICU in the United States and personally reminded me more of the set up of the newborn equipment in a normal delivery room.
In addition to seeing the maternity floor, we were able to see a dialysis center that was completed donated by a famous Dominican baseball player whose name I do not know, and we walked through the pediatric floor and the ambulatory clinic (outpatient). The outpatient clinic has multiple specialties, but is not open all day every day like the OB/GYN and pediatrics floors are.

This tour allowed us to have a taste of what the healthcare system looks like in Dominican Republic as well as see the facilities and resources available before we begin our project.

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