by Rebecca Ferrini, MD

The annual California Association of Long Term Care Medicine conference is a great opportunity to do something new and different—present a POSTER on something your facility has done to improve quality. The following gives you some ideas and some guidelines on submitting, developing. Laying out and presenting a poster at a meeting of your colleagues.

What to write about
In long term care we are operating with thin margins and constant, unrelenting work with frequent crises to liven things up. We are constantly improving, but many times, rather than celebrate an improvement, we just move to the next problem.  We are all facing similar problems and coming up with ideas, forms, policies and approaches that work. Making a poster is about reflecting on what you have done better, documenting what you did and why it made it better, and publicizing that to an audience of people who are also interested in making things better.

So what can you write about? What have you done new? Have you tried a new product? A New form? A new educational technique? Have you had a problem that you addressed and the solution worked? Implemented a new policy? Changed your practice? Have you changed mealtimes, medication distribution, added some new activities? Reduced deficiencies or improved a MDS quality indicator? Think--what is different in my facility now compared to six months ago?  Did you ever try something on one unit and something different on another and compared which one worked better?

You might look in long-term care journals—what are other people  doing. Have you ever looked at something published and said—“hey, we did that, too!” or thought that you had a better solution?  The difference between them and you is that they published what they did and got publicity and began to be looked at as experts—and you did something great that no-one knows about.

Looking at your facility, comparing it to others, looking at the literature are all places to get great ideas about what to do with a poster.

What about data
Data collection is one of the big struggles--it takes time to get it, to analyze it, and it is very easy to spend a lot of time collecting data that is not meaningful. Collecting data is usually not the problem, it is the thinking part---what should collect and how should I interpret it? Many times we work on a project to change or improve something without getting data--we just know it is a problem. One source of data we all have is the MDS--is you want to present something that has anything to do with something on the MDS, this can be a good place to start.  It's a good idea to get in the habit of collecting some data before you try something new and then after you do it to see if the new thing was any better. You can conduct a survey or an audit before and after or you can make observations. In general, a sample size of at least 30 is the best.  Let’s say you have a new form for diabetic orders. You might then look at 30 diabetic orders before the form is put in place and measure a few things - when you started the new form, did you have less hypoglycemia? Less frequent fingersticks? Fewer telephone orders or order clarifications? What percentage used sliding scale insulin? What was the average total insulin/day? How many fingersticks a month were ordered for each and what was the average? Then look at your diabetic monitoring--how many episodes of hypoglycemia (you have to define, how about below 60…) were identified in all those people in one month. How many measurements of blood sugar were taken total? How many blood sugar measurements were over 400? How many had HgBA1c measurements taken within the last quarter? What was the minimum, maximum and mean of HgBA1c. You might ask someone to fill out the form and see how long it takes and compare it to how long it used to take. How many minutes did it take to complete the form on average? How many minutes for each fingerstick? How many minutes to "manage" and episode of hypoglycemia? Then implement your form and do this same audit again--what changed? Notice this is a little different than saying--"the nurses liked the form." You would be surprised once you get the hang of it how easy it is to get the data and how the data tells the story of what really happened. If you are not a person with a lot of experience in data, find someone who has a strength in that area to help you. If you can’t find someone locally, email me and I can help!

Another thing to consider is not all important “data” may be reflected in numbers.  Some issues may be important areas of staff training like patient dignity, spirituality, risk-management or privacy issues that reflect ways to avoid deficiencies or liabilities where we actually don’t want numbers (i.e., 0 deficiencies or areas of heightened liability is good).  While these sort of things may be difficult to quantify and numbers may not be practical, sharing a good approach may be quite beneficial. In other words, if you don’t have a lot of numbers, it still may be a good poster.

Writing it up:
You have to be able to  succinctly express what you did and how it was effective (that is the abstract) and then have enough data to expand on more (for the poster). Most abstracts include one sentence in each of the following categories, then the poster expounds more. The categories may vary, but they are similar to these.

Title: Make it catchy, no colons, and have it summarize what you did.

Introduction: what the problem was and why you bothered to do something about it.

Materials/Methods/Interventions: What exactly did you do? How did you audit? What data did you extract, what steps were done to make this change--who was educated (how many people and how?). You may use a flow chart here.

Results: What did you find out? We had a 20 percent reduction in time for C.N.A. to place briefs, we used 30% fewer briefs, we reduced the incidence of dehydration from 1 a month to one in 6 months. Staff reported a 205 improvement in morale, we went from 5 fingersticks a week per patient to 3 on average and reduced hypoglycemia events from 4/month per 30 patients to 0 for three months.

Timeline: What happened where.

Barriers: What got in your way of success and how were these barriers overcome?

Conclusions: Remind the reader of what was said and how it is important.

Literature cited: Look for others who are studying the same thing and read what they did.

Acknowledgments: Thank individuals for specific contributions to project and if you have any potential conflicts of interest, mention it here.

Further information: Provide your e-mail address, your web site address, and perhaps a URL where they can download a PDF version of the poster.

Design
Once you are accepted to present, it is time to think about designing your poster. Many people find this the most daunting step because it is something many of us have never done before. First, relax--the poster was accepted and the information sharing is the most important thing. And the great thing is that there are templates which can guide you through the process. I like to use the templates in PowerPoint which already even have headings in them and have all the colors and margins and borders set up for you. Publisher also has templates to use. A humorous, but thorough article on making a poster is found at

http://www.swarthmore.edu/NatSci/cpurrin1/posteradvice.htm

which provides more detail than you need.   But here are some highlights: Remember the poster is meant to be read and digested quickly, people like to see if it relates to them and they like to skip to the main points. Each section can stand alone. the poster itself does not need an abstract (which saves you space). Lay it out so it is easy to read while standing up from 6 feet away. The templates often pre-set the font and column size which helps. Try to avoid shrinking the font to get more on the poster—less is more. Edit and have people look at it before you spend money to print it. The whole poster should have 800 words or less with maybe 11 words in a line/column and no more than 10 lines of text in a box. Embrace the white space and try to avoid crowding. Don’t use colors that are too dark. When you have photos or clip art, watch out--because these often look very grainy when blown up. Avoid all caps or capitalizing the first words in a title--this is actually harder to read. When you are done laying it out, you can put it on a thumb drive and take it to a printing shop (e.g. Kinko’s)--I find the poster costs $150-200 to print on nice paper.   Alternatively, if your budget is an issue, while not as “finished,” it is also possible to print your poster as a series of PowerPoint slides and paste or tack these to your display board.

Audience
Think of the audience for your poster. The audience is mainly long-term care professionals, but will this target the physician, the nurse, the administrative team or perhaps for the public, highlighting a great program. Knowing the audience will make a difference in the design, the text (for example, you often use more big words and diagnoses and such with a physician audience on a scientific paper than you would if the audience is the public where you would use less medical terminology or explain the words you do use).

Presenting
Hang it up on foam board with thumbtacks, bring blue tape. Stand with your poster.  Have business cards and a legal or letter size shrunken version of your poster or other handouts. Prepare a one to three sentence summary for those people who some up to the poster so you can say something quickly

What to do afterwards?
When you take your poster down, roll it up and put it back in the cardboard sheath, but when you get back to your facility, take it out again. Find a place to hang it. Many of these fit nicely on a hallway, where people who pass can read about the great things your facility is doing. If it happens to be a more controversial topic (say, for example, sex offenders in long term care), then the display site might be in a "staff-only" area.  Look for other opportunities to show the poster--local meetings, for example. Make sure the presentation is on your resume and that the administrator or other "higher-ups" in your facility know you presented at a scientific meeting.  Begin to think--what can I do next year?