Publications by authors named "B E Horner"

76 Publications

A comprehensive intervention to enhance inpatient colon preparation quality for colonoscopy.

Minerva Gastroenterol (Torino) 2021 Apr 1. Epub 2021 Apr 1.

University of Utah School of Medicine, Salt Lake City, UT, USA -

Background: Adequate colon preparation is a critical component of high quality colonoscopy especially for inpatients undergoing colonoscopy for acute indications. Inpatient colonoscopy has a high incidences of inadequate preparations. We report implementation of a multifaceted quality improvement intervention to improve inpatient colonoscopy preparations.

Methods: Bowel preparation quality from inpatient colonoscopies performed for the 12 months prior to the comprehensive intervention were compared to colonoscopies performed for 12 months following the intervention. The intervention had multiple components including: EMR-based colonoscopy preparation order set; Automated EMR alerts prompting nursing assessment of preparation progress; Standardized nursing charting processes for tracking preparation progress; Standardized education for nursing staff and ordering providers on adequate colon preparation, assessment of colon preparation quality, and use of the above processes; and print and video patient education materials.

Results: 238 inpatient colonoscopies were performed in the pre-intervention assessment period and 163 colonoscopies in the post-intervention period. Median pre-intervention Boston Bowel Preparation Score (BBPS) was 6 and 26% of patients had inadequate colon preparation. Median postintervention BBPS was 8 with 16% inadequate colon preparation (p=0.016). The postintervention group had less ASA class I patients and used a lower dose of fentanyl than the preintervention group. There were no other significant differences between the pre- and postintervention groups.

Conclusions: Implementation of a comprehensive colon preparation quality intervention resulted in significantly improved inpatient colon preparation quality and decreased frequency of inadequate preparations. The intervention consisting of an EMR-based order-set, nursing alerts and charting process, and patient education materials is continually being refined.
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April 2021

Development of a Toolkit to support sustainable culture change in residential aged care.

Australas J Ageing 2021 Mar 17;40(1):77-83. Epub 2020 Dec 17.

Western Australian Centre for Health and Ageing, University of Western Australia, Perth, WA, Australia.

Objective: This study aimed to develop and evaluate a Toolkit to support implementation of the Towards Organisational Culture Change (TOrCCh) intervention, with minimal external facilitation, in aged care facilities, to implement long-lasting organisational change.

Methods: Eight residential aged care facilities across two Australian states participated. A Toolkit was drafted iteratively, engaging staff from participating sites and a reference group. Participating facilities undertook two change projects utilising the Toolkit. Qualitative data were collected from site project sponsors, work teams and other care staff, and analysed thematically.

Results: The intervention was perceived to provide a generic approach that could be applied to solve agreed challenges in the workplace generating useful outcomes including staff development, increased communication, teamwork and leadership. The role of a project sponsor, and organisational support, was perceived as important for sustainability.

Conclusion: Aged care facility staff teams report they can work together effectively for sustainable improvements when provided with a Toolkit.
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March 2021

Development and evaluation of an organisational culture change intervention in residential aged care facilities.

Australas J Ageing 2020 Mar 9;39(1):56-63. Epub 2019 May 9.

Western Australian Centre for Health and Ageing, School of Medicine and Centre for Medical Research, Royal Perth Hospital, The University of Western Australia, Crawley, Western Australia, Australia.

Objective: To develop and evaluate an organisational culture change intervention for residential aged care settings.

Methods: This study was undertaken in five residential aged care facilities (RACFs). All staff working within participating RACFs were invited to take part. Participatory action research was used to develop a structured approach, supporting small workgroups of staff in each facility to undertake change cycles, focusing on improved leadership, teamwork and communication. Qualitative data were gathered from reflection and evaluation sessions with facility work team focus groups, interviews with managers and other staff who were not engaged in the work team, field journals and reflective discussion with research team members.

Results: Staff and management both positively evaluated the intervention and process, and there were perceived cultural shifts in communication, teamwork and staff empowerment.

Conclusion: An organisational culture change intervention that engages work teams through brief change cycles appears to be feasible for use in RACF.
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March 2020

The North Carolina State Health Plan for Teachers and State Employees: Strategies in Creating Financial Stability While Improving Member Health.

N C Med J 2018 Jan-Feb;79(1):56-61

director, Customer Experience and Communications, North Carolina State Health Plan, Raleigh, North Carolina.

The North Carolina State Health Plan provides health care coverage to more than 700,000 members, including teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents. The State Health Plan is a division of the North Carolina Department of State Treasurer, self-insured, and exempt from the Employee Retirement Income Security Act as a government-sponsored plan. With health care costs rising at rates greater than funding, the Plan must take measures to stem cost growth while ensuring access to quality health care. The Plan anticipates focusing on strategic initiatives that drive results and cost savings while improving member health to protect the Plan's financial future.
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June 2018