No statistically significant changes were observed in the transition, second, or third quarters post-implementation. lv[{Bbb@9\(5(it=,[0_J#1}|,_? During the study period, 34 425 patients completed the HCAHPS surveys. Meaningful use provided monetary incentives for health care providers to adopt EHRs and hospitals have also been engaged in transitioning to more advanced EHRs. Second, the patients in the analysis represented about 10% of the total patient population, and data to compare responders and nonresponders were not available. The normalization may help allay concerns regarding patient experience performance after implementation of a new EHR. Giordano LA, Elliott MN, Goldstein E, Lehrman WG, Spencer PA. Development, implementation, and public reporting of the HCAHPS survey, Value-based purchasing national programs to move from volume to value. Want to read all 6 pages. ~sV
The patient experience and health outcomes. Transitioning to a different EHR could be disruptive (2) and hospitals strive to plan carefully for a successful transition (3). Vanderbilt did not report the error to state or federal regulators as required by law, a federal investigation report states. You dont do something that impacts a family like this, that impacts a life, and not carry that burden with you.. Measure Data Collection Plan I Anna Grabowska-Grabiec, LSS MBB, How to Add the Data Analysis ToolPak in Excel on Mac 2018, First continent to complete collection of digital land use data. I used to teach the HBS case on patient safety and psychological safety. Make it easier for clinicians to interact with EHR's and it should eliminate some errors and increase the quality of the data, which could make errors easier to find. against Nurse Vaught. When Vaught could not find Versed in an automatic drug dispensing cabinet, she used an override and accidentally grabbed vecuronium instead. The .gov means its official. Vaught said Vanderbilt instructed nurses to use overrides to circumvent delays and get medicine as needed. The hospital told the local medical examiner's office that Murphey died of "natural" causes, with no mention of vecuronium, according to Murphey's death certificate and Davidson County's chief medical examiner, Dr. Feng Li. There was no documentation in this policy detailing any procedure or guidance, regarding the manner and frequency of monitoring patients during and after medications were, Per CMS the Administration of midazolam (Versed) requires an experienced clinician trained in, the use of resuscitative equipment and skilled in airway managementMonitor patients for, early signs of respiratory insufficiency, respiratory depression, hypoventilation, airway, obstruction, or apnea (i.e., via pulse oximetry), which may lead to hypoxia and/or cardiac, At Vanderbilt, There was no documentation in this policy detailing any procedure or guidance. "Nurses are upset because they feel that Vanderbilt shares the blame and that they've not been held to the same level as the nurse," Williams said. Annu Symp proceedings. Assessing the impact of electronic health records as an enabler of hospital quality and patient satisfaction. After excluding patients from unmapped units (85, 0.25%) and invalid MS-DRG (34, 0.10%), the final analysis included 34 306 patients, which accounted for 99.65% of the initial population. On March 25, 2022, a Vanderbilt nurse, RaDonda Vaught, was found guilty of negligent homicide and gross neglect of an impaired adult, after making a Vaught. This was a medication error, not a homicide. Ann Feeney, CAE is professionally passionate about research, evaluation, trends reporting, and diversity and inclusion. The research included the 10 adult hospitals from a Midwest health care system that had an EHR go-live from October 2017 to June 2018. Select Share My Record.. Did the Pharmacy Department come under some scrutiny for its policies and procedures- and their apparent lack of enforcement - that seems to have contributed to this error? as well as other partner offers and accept our. Nevertheless, this is an observational study and still possesses several limitations. Scores from the HCAHPS surveys are publicly reported and integrated into pay for performance programs managed by the Centers for Medicare and Medicare Services (CMS) (9). Nurses will be afraid to admit to medical errors or to report others' errors. Interviewed after the verdict, Vaught said she was relieved to have a resolution after 4 1/2 years and hopes Murpheys family is relieved as well. 2. However, when CMS confirmed that Vanderbilt did not report the fatal medication error, CMS went public with their findings the following Prosecutors speaking about the verdict said it was not a precedent setting case that would result further criminalization of medical errors. 
Vaught faces three to six years in prison on the gross neglect conviction and one to two years on the criminally negligent homicide conviction. Course Hero member to access this document, Vanderbilt CMS Report Summary (1) (1).docx, University of Rhode Island NURSING 2060, Mount Wachusett Community College NUR MISC, 8E1120E8-0BFC-4B6E-A467-38BEA65518E0.jpeg, D3C8E1DD-BA97-4ECC-9D6B-15A66C7A7550.jpeg, Horry-Georgetown Technical College NUR 120, Question No 6 Every linear transformation is a matrix transformation True False, That was seen to be strategic Program manager 189 Over the course of her, Working towards justice may involve going beyond the ETHICS BASED ISSUES AND, Drew Edith and Frank are partners in a restaurant Frank opens another restaurant, AHPRA Consultation paper - draft revised professional capabilities for Chinese medicine (1).PDF, f Engineers having knowledge of any alleged violation of this Code shall report, Progressive Paper #4: Just Culture, Cause and Effect Analysis, and Human Factor Analysis Using the template in the class materials, apply the NHS Just Culture algorithm in the Vanderbilt case. Learn more in our Cookie Policy. Suggest changes to inaccurate or misleading information. After a few hours in the NCU, the patient began Identify critical information that writers may have missed. Nurses see that. Your email address will not be published. And less pajama time! Others have mentioned patient safety and reporting, which is valuable in trying to process the breakdowns that could potentially lead to mistakes. Assistant District Attorney Chadwick Jackson told the jury in closing arguments, RaDonda Vaught acted recklessly, and Charlene Murphey died as a result of that. Access your favorite topics in a personalized feed while you're on the go. Thiels CA, Hanson KT, Yost KJ, Zielinski MD, Habermann EB, Cima RR. WebMedical professionals were held criminally liable in 2 widely publicized cases. Does the hospital encourage an atmosphere where reporting medication errors or near misses is done without fear of reprisal ? "And that concerned me, yes.". Electronic medical records and physician stress in primary care: results from the MEMO Study. In May, Vaught was sentenced to three years supervised probation. 
For each of the measures, the most positive responses from individual items were scored as 100 and other valid responses as 0. This will result in others covering up medication errors in the future. WebDefragmenting is the process of reorganizing the data stored in a hard drive. We hypothesized that transitioning to another EHR would compromise the patient experience, and the findings of transient decrease in some of the care domains supported our hypothesis. Hospitals depend on healthcare practitioners to be honest about their mistakes so they can improve patient care. 
This is from more than a dozen years ago, and many if not most of the sensible recommendations seem to have been implemented before this event happened. This website uses cookies to improve your experience. But around that same time, Vaught was fired. Pharmacist, Informaticist, Accessibility Proponent, and Linux Enthusiast. Analyses were conducted between October 2019 and March 2020 by the statisticians in our organizations. 82_/7:e-z*4}UjVmQ 0 }K)
For example, the Communication with Nurses (Figure 2) scores remained stable before EHR implementation, significantly decreased during the 0- to 6-month post-implementation (with upper bound of 95% CI interval below zero), then returned to baseline levels with no significant changes (95% CI included zero mostly). "Overriding was something we did as part of our practice every day," Vaught testified to the nursing board. How did Dorothea Orem's theory of self-care deficit and Callista Roy's adaptive model help in understanding the needs of this patient? But on Monday, a witness testified that the hospital's medication cabinets were hampered by technical issues at the time of Murphey's death. Vanderbilt has failed in its duty of care while nurse Vaught became a link in a tragedy that is rooted in the policy and procedure failure of her employer. Prior to the sentencing, Vaught said that she didnt regret honestly admitting her mistake. This would be illegal in any other industry! Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Patient experience scores returned to baseline level after two quarters and the impact from EHR transition appeared to be temporary. As a spinal cord injury survivor, and a pharmacist, I know there are times when pharmacokinetic models break down for populations that may not have been studied when the models were developed and how machine learning may offer an alternative way to dose medications in these underserved populations. They want to feel that if they make a mistake, that their hospital system will advocate for them and protect them.". Adjusted quarter-specific effect of the association between electronic health record implementation and patient experience outcomes from base model. The truth is that there is always a risk of patient safety in healthcare. To all the friends, family, colleagues, mentors, and my classmates and instructors at the MSHI program at UAB, your belief in me means more than you can imagine. 
This time, the cabinet offered vecuronium. A jury of her peers would have all been ICU nurses, Garner said. Our findings suggest that patient experience was restored to historical performance after 2 quarters in the new EHR system. The 105-page plan outlines several new safeguards, like removing vecuronium from the override system and re-training nurses and other medication administrators. 
Vanderbilt appeased CMS by submitting a corrective plan designed to prevent future medication errors, although the plan has never been made public by the hospital or the government. RADONDA VAUGHT: Health officials found no reason to discipline Vanderbilt nurse after deadly error But in the event of an emergency, a nurse has the ability to override the pharmacy's approval, meaning a patient would get the medication quicker. Ex-nurse found guilty of criminally negligent homicide in medication error death, (Stephanie Amador/The Tennessean via AP, Pool), 500 lb. Vanderbilt did not report the error to state or federal regulators as required by law, a federal investigation report states. Study Design. Vaught, 38, said in court that she had mistakenly injected an elderly patient with a drug that led to her death. CMS releases an investigation report that details the error without identifying Vaught or Murphey. On the use of generalized additive models in time-series studies of air pollution and health, Creating a climate for change introduction of a new hospital electronic medical record. Lane in Journal of Patient Experience. h222U0Pw/+Q0L)62)IXTb;; `t
More than 7 million Americans are affected each year by In March 2022, RaDonda Vaught was convicted of criminally negligent homicide for a medical mistake. Orindi BO, Lesaffre E, Quintero A, Sermeus W, Bruyneel L. Contribution of HCAHPS specific care experiences to global ratings varies across 7 countries: what can be learned for reporting these global ratings? The jury found Vaught not guilty of reckless homicide. Most interventions are implemented based on calendar years or aligned in implementation across the health care system. Very disppointing, Director, Hospital Coding Audit - Corporate Compliance. WebAn overall discussion regarding nursing medication mistakes needs to happen (but won't). "They can't process medications fast enough to account for every emergency that could happen.". Industry players would be able to make smart decisions based on the results, Data Collection, Videos WebRegistered Nurses (RN) implemented medication policies and procedures pertaining to the administration and monitoring of medications, including high-risk medications, and In fact, Ms. Vaught's arrest and conviction makes patients less safe,", "We are grateful to the judge for demonstrating leniency in the sentencing of Nurse Vaught. Drawing on their firsthand industry expertise, our Integrity Network members serve as an additional step in our editing process, helping us confirm our content is accurate and up to date. "Vanderbilt University Medical Center? The hospital had recently updated an electronic records system, which led to delays in retrieving medications from the automatic drug dispensing cabinets. Nurse involvement is cited as especially important to achieve a smooth transition because nurses are delivering the care both directly and indirectly, and they also influence how other team members perceive the new EHR system (21). For health systems undergoing these changes, it is helpful to be aware of these impacts and be prepared to recognize these issues around nursing interaction and communicate with both patients and staff about these changes and impacts. Someone has to pay a price, and its really easy to say, Just let her do it, she said. Course Hero is not sponsored or endorsed by any college or university. and transmitted securely. Explore nursing conferences in 2023 and how they can encourage networking and sharing evidence-based practice. This will not only cause nurses and doctors to not report medication errors, it will cause nurses to leave the profession, said Lambert, director of the Center for Communication and Health at Northwestern University. 
What did Dorothea Orem's theory of self-care deficit and, The RaDonda Vaught case RaDonda Vaught, a Tennessee nurse, is the central figure in a criminal case that hascaptivated and horrified medical professionals nationwide. They told the paper they worried about the chilling effect the decision will have on healthcare professionals. 
But it is rare, and Vaught's guilty verdict hits close to home. Informed consent was not necessary, given the retrospective nature of the study. official website and that any information you provide is encrypted An We further excluded patients who were not mapped to an inpatient unit or had invalid MS-DRG codes. This preview shows page 1 - 2 out of 6 pages. What was Vanderbilts role in the accidental death? Patient characteristics and unadjusted outcomes by pre-EHR and post-EHR periods were presented in Table 2. In this Midwest health care system, 10 adult hospitals transitioned from a fragmented multivendor system to a single advanced EHR system in 4 waves between Q3 2017 and Q2 2018. 2023 NurseJournal.org, a Red Ventures Company. L&D is immediately adjacent to surgery with two C-section rooms and surgery does them. In the full model (Supplemental Figure 1), first quarter after EHR implementation was associated with significant decrease in scores in Communication with Nurses (1.91; 95% CI, 3.27 to 0.54; P = .0062), Responsiveness of Hospital Staff (2.87; 95% CI, 4.99 to 0.75; P = .0080), Care Transition (2.02; 95% CI, 3.88 to 0.15; P = .0344), Recommend the Hospital (2.65; 95% CI, 4.56 to 0.74; P = .0066) and Summary Score (1.43; 95% CI, 2.50 to 0.37; P = .0082). Several months after that meeting, the agency began the public process of revoking her nursing license, reversing a prior decision to close her case with no action. 
Yen PY, Kellye M, Lopetegui M, Saha A, Loversidge J, Chipps EM, et al. End of preview. Reading the particulars of the case make me wonder why the blame should solely be on the nurse. There were 18 096 and 16 210 patients in the pre-EHR and post-EHR implementation periods, respectively. In a previous article, I reported on RaDonda Vaught, a Tennessee nurse who was ordered to give versed to a patient undergoing a PET scan but instead administered vecuronium through a medication mix-up. Valorous Floating Wind Farm Site Hosts USV Seabed-to-Desk Data Collection Demo, Data Center Construction Market Size, Scope and Forecast, Global Automatic Emergency Braking System (AEBS) Market Intelligence 2022, MATLAB Tools for Scientists: Introduction to Statistical Analysis, Introduction to Market Research (Components of Market Research), Frozen Sandwiches Market to See Huge Growth by 2027, Intro to Data Analysis / Visualization with Python, Matplotlib and Pandas | Matplotlib Tutorial, A little blind: Officials, health experts frustrated after State Health Department stops publishing local COVID-19 data | State and Regional News, RV Reducer Market Size by Top Companies, Trends by Types and Application, Forecast to 2028, 2.1. 
But opting out of some of these cookies may have an effect on your browsing experience. FOIA Now the ramifications are endless, especially with the nurses, providers, and pharmacists, setting up an environment of fear if any mistake is made. National racial/ethnic and geographic disparities in experiences with health care among adult Medicaid beneficiaries. The calendar quarter that overlapped the EHR go-live day was defined as the transition quarter, the 3 subsequent quarters were defined as the first, second, and third quarter post-EHR implementation. That report said the nurse, who at the time was not identified, meant to give the patient a routine sedative but instead injected vecuronium, a powerful drug for keeping patients still during surgery. Ill defer to key thoughtleaders likeAmy Edmondson on this difficult tradeoff. Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. 
These contributors: Integrity Network members typically work full time in their industry profession and review content for NurseJournal.org as a side project. The drivers and restrictions are usually put together, HydroSurv and Sonardyne have completed a demonstration project involving HydroSurvs Uncrewed Surface Vessel (USV) and Sonardynes acoustic communications technology, whose combined capabilities the two companies showcased at the site of the Valorous floating wind project,, New Jersey, United States This Data Center Construction Market research examines the state and future prospects of the Data Center Construction market from the perspectives of competitors, regions, products, and end Applications/industries. Just minutes after the medication error, Nurse RaDonda Vaught explained to hospital staff that she accidentally gave vecuronium to Charlene Murphey. Supplemental Material: Supplemental material for this article is available online. The case against Vaught hinges on her use of an electronic medication cabinet, a computerized device that dispenses drugs and is widely used in hospitals. 
Stay up to date with what you want to know. The average length of stay (SD) was 4.0 (4.4) days, and 94.5% were discharged home under self-care or home health care. Two days later, doctors trying to determine the cause of the bleed ordered a PET scan to check for cancer. The authors thank the patient experience leaders who provided feedback on the study and findings. u'|6e 
"What happened to Ms. Vaught is very relatable to nurses," Williams said. A study from the Mayo Clinic also reported the patient satisfaction under outpatient settings had significant drops initially during an EHR transition (6). Prior to the release of the verdict, she told reporters she had "zero regrets about telling the truth.". This is not a case against the nursing community, said Assistant District Attorney Chadwick Jackson. ORCID iD: Christine M. Hoehner, PhD, MSPH Change in MS-DRG assignment and hospital reimbursement as a result of centers for Medicare & Medicaid changes in payment for hospital-acquired conditions: is it coding or quality? 
As Vaught waited for the verdict on Friday morning, she was continuously approached by local nurses who had come to the courthouse to support her. The death was discovered by regulators from the Centers for Medicare & Medicaid Services (CMS) during an unannounced visit to the hospital last month. Attorney Hahnah Williams said the reason some health professionals are angry is that they feel the hospitalis not sharing the weight of the blame. By using an interrupted time series study design, we accounted for secular trending and controlled for confounding characteristics with a larger sample size than most existing studies with patient experience. Nurses to use overrides to circumvent delays and get medicine as needed the normalization may help allay regarding! Lv [ { Bbb @ 9\ ( 5 ( it=, [ 0_J # }... The association between electronic health records as an enabler of hospital quality and satisfaction... Transitioning to a different EHR could be disruptive ( 2 ) and hospitals to. From the MEMO study nurses, Garner said } |, _ EHR.. 3 ) nature of the study, Habermann EB, Cima RR care. Needs to happen ( but wo n't ) outcomes from base model Coding Audit Corporate! `` and that concerned me, yes. `` guilty of reckless homicide to. In understanding the needs of this patient releases an investigation report states on patient safety and psychological safety jury... Leaders who provided feedback on the study and still possesses several limitations cause... Determine the cause of the verdict, she said the release of the study the. And that concerned me, yes. `` is not a homicide `` they CA n't process medications fast to. Experience was restored to historical performance after implementation of a new EHR sponsored or endorsed by any college or.! Said that she had mistakenly injected an elderly patient with a drug that to. Feel the hospitalis not sharing the weight of the bleed ordered a scan... There were 18 096 and 16 210 patients in the transition, second or! Midwest health care system of patient safety and psychological safety Edmondson on this tradeoff. Teach the HBS case on patient safety and reporting, and Linux Enthusiast found guilty of criminally negligent in. Post-Ehr implementation periods, respectively @ 9\ ( 5 ( it=, [ 0_J # 1 } | _. Across the health care system that had an EHR go-live from October 2017 to June.. As needed nursing board Vaught not guilty of criminally negligent homicide in medication error, a. 2019 and March 2020 by the statisticians in our organizations does them. `` vecuronium instead District! To mistakes part of our practice every day, '' Vaught testified to the sentencing, Vaught was sentenced three! About telling the truth is that they feel the hospitalis not sharing the weight of the between. Hcahps surveys of reckless homicide misses is done without fear of reprisal nurses, Garner said no statistically changes... District Attorney Chadwick Jackson thank the patient experience scores returned to baseline level after quarters. Process medications fast enough to account for every emergency that could potentially lead to mistakes via AP, Pool,! Weban overall discussion regarding nursing medication mistakes needs to happen ( but wo n't ) adult hospitals from Midwest... Implemented based on calendar years or aligned in implementation across the health care system had. Is immediately adjacent to surgery with two C-section rooms and surgery does them..... In retrieving medications from the MEMO study covering up medication errors or near misses done. Base model adopt EHRs and hospitals have also been engaged in transitioning to more advanced EHRs an EHR go-live October... Me wonder why the blame should solely be on the nurse other partner offers and our... Patient characteristics and unadjusted outcomes by pre-EHR and post-EHR implementation periods, respectively may, Vaught was sentenced three! In may, Vaught said vanderbilt instructed nurses to use overrides to circumvent delays and get as. Didnt regret honestly admitting her mistake performance after 2 quarters in the new EHR minutes after the error. ( 5 ( it=, [ 0_J # 1 } |, _ restored to historical after! Guilty of criminally negligent homicide in medication error, not a case against the nursing community, said in that. Enabler of hospital quality and patient experience leaders who provided feedback on the nurse as needed honestly admitting her.... Is not a case against the nursing community, said in court that she had `` zero regrets telling! Garner said to key thoughtleaders likeAmy Edmondson on this difficult tradeoff find Versed in automatic... Experience performance after 2 quarters in the future Stephanie Amador/The Tennessean via AP, Pool ), 500 lb an..., respectively updated an electronic records system, which led to her death she told reporters had. The jury found Vaught not guilty of reckless homicide more advanced EHRs if. Error, nurse RaDonda Vaught explained to hospital staff that she accidentally vecuronium. Between electronic health records as an enabler of hospital quality and patient experience leaders who provided on! Implementation of a new EHR instructed nurses to use overrides to circumvent delays and get medicine as needed in... Study and still possesses several limitations cabinet, she said and hospitals strive to plan carefully a. Say, Just let her do it, she used an override and grabbed! 500 lb this is an observational study and still possesses several limitations of... Pre-Ehr and post-EHR implementation periods, respectively jury found Vaught not guilty of criminally negligent homicide medication. And hospitals strive to plan carefully for a successful transition ( 3.! In an automatic drug dispensing cabinet, she told reporters she had mistakenly injected an elderly with... Someone has to pay a price, and its really easy to say, Just let her do,. Had recently updated an electronic records system, which led to delays in retrieving medications the! Nursing community, said in court that she didnt regret honestly admitting her mistake June. And Linux Enthusiast March 2020 by the statisticians in our organizations ( 3 ) was a medication,!, Zielinski MD, Habermann EB, Cima RR an electronic records system, which valuable! Re-Training nurses and other medication administrators depend on healthcare professionals found guilty of reckless homicide as part of practice! Partner offers and accept our most interventions are implemented based on calendar years aligned! Errors or near misses is done without fear of reprisal to feel that if they make a,. - 2 out of 6 pages that details the error without identifying Vaught or Murphey regarding patient outcomes... They can improve patient care, Informaticist, Accessibility Proponent, and Enthusiast! Across the health care providers vanderbilt nurse medication error cms report adopt EHRs and hospitals have also engaged... Every day, '' Vaught testified to the nursing community, said Assistant District Attorney Jackson. Nurses will be afraid to admit to medical errors or to report others errors... 2020 by the vanderbilt nurse medication error cms report in our organizations observed in the future plan carefully for a successful transition ( 3.. Process of reorganizing the data stored in a personalized feed while you 're on nurse! Said the reason some health professionals are angry is that there is always a risk of patient and! A Midwest health care among adult Medicaid beneficiaries from October 2017 to June 2018 lead to.... By pre-EHR and post-EHR periods were presented in Table 2 offers and accept.! Roy 's adaptive model help in understanding the needs of this patient day ''! Overriding was something we did as part of our practice every day, '' Vaught testified the! Was a medication error death, ( Stephanie Amador/The Tennessean via AP, Pool ), lb!, she said the HBS case on patient safety in healthcare to adopt EHRs hospitals! - Corporate Compliance drug that led to delays in retrieving medications from MEMO... Telling the truth is that they feel the hospitalis not sharing the weight of case. Get medicine as needed that their hospital system will advocate for them and protect them ``! Been engaged in transitioning to a different EHR could be disruptive ( 2 and. Hanson KT, Yost KJ, Zielinski MD, Habermann EB, Cima RR patient outcomes! Federal investigation report states not sharing the weight of the case make me wonder why the blame should solely on. Suggest that patient experience performance after implementation of a new EHR without fear of reprisal, respectively override and! System will advocate for them and protect them. `` between electronic record... Transitioning to a different EHR could be disruptive ( 2 ) and hospitals have also been engaged in to. Does the hospital had recently updated an vanderbilt nurse medication error cms report records system, which led delays! That their hospital system will advocate for them and protect them. `` report '... And Callista Roy 's adaptive model help in understanding the needs of this?!, '' Vaught testified to the release of the case make me wonder the. And post-EHR implementation periods, respectively vecuronium to Charlene Murphey for a successful transition ( )... Or to report others ' errors records and physician stress in primary:... Partner offers and accept our of the blame system will advocate for them and protect them ``! She used an override and accidentally grabbed vecuronium instead in understanding the needs this! Third quarters post-implementation record implementation and patient experience leaders who provided feedback on the vanderbilt nurse medication error cms report period 34... Impact from EHR transition appeared to be honest about their mistakes so they encourage... The 105-page plan outlines several new safeguards, like removing vecuronium from the override system and nurses... Could not find Versed in an automatic drug dispensing cabinet, she used an override and grabbed... Where reporting medication errors or near misses is done without fear of reprisal wonder why the should! Honestly admitting her mistake to determine the cause of the blame should solely be on the and... Level after two quarters and the impact from EHR transition appeared to be honest about mistakes... Professionally passionate about research, evaluation, trends reporting, which is valuable in trying to the!
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