Friday, October 9, 2015

Palliative Care Growing, but Not for All Patients

While palliative care is increasing in hospitals generally, access to programs is not consistent throughout the United States, according to a new study published in the Journal of Palliative Medicine.

Patients’ access to palliative care programs varies across geographic regions and also depends on factors such as hospital size and tax status, researchers write in "The Growth of Palliative Care in U.S. Hospitals: A Status Report."

While 90 percent of hospitals across the country with 300 beds or more have palliative care programs, only 56 percent of smaller hospitals offer these services. Additionally, for-profit hospitals are less likely than not-for-profit or public hospitals to have palliative care programs.

The study is available free of charge on the Journal of Palliative Medicine website until November 1, 2015.

An INQRI study, "Nursing's Specific Contributions to Quality Palliative Care within the Context of Interdisciplinary Intensive Care Practice," explored the relationships between quality palliative nursing care delivered in intensive care units and patient and family outcomes. The study also explored how to measure and to improve these outcomes. This interdisciplinary team was led by Lissi Hansen and Richard Mularski.

Friday, September 25, 2015

Military Nurse Showcases Evidence-based Innovation

A nurse from the San Antonio Military Medical Center (SAMMC) recently shared her research on reducing alarm fatigue during a joint military course in San Antonio, Texas.

Army Capt. Amanda Rodriguez provided details on her patient safety project, which sought to reduce false physiological alarms and improve patient safety.

“Many studies have demonstrated as many as 99 percent of alarm signals may be false and can result in patient harm or death when a clinically actionable alarm is missed due to alarm fatigue,” Rodriguez told participants at the TriService Nursing Research Program’s Research and Evidence-based Practice Dissemination course.

Nurses in Rodriguez’s project implemented the American Association of Critical-care Nurses Practice Alert for Alarm Management at SAMMC, which involves reviewing alarm setting and patient-specific tailoring of the physiological alarms during every shift. After a six-week trial, alarms were reduced by more than 900 fewer per day. The results were well received at SAMMC and show the value of implementing and sharing evidence-based research, Rodriguez said.

Friday, September 11, 2015

INQRI Director Receives Award for Leadership in Gerontological Field

The Gerontological Society of America (GSA) chose INQRI Director Mary Naylor as the 2015 recipient of the Doris Schwartz Gerontological Nursing Research Award.

This honor, presented by GSA's Health Sciences Section, is given to a member of the Society in recognition of outstanding and sustained contribution to gerontological nursing research. Naylor will receive the award at GSA's 68th Annual Scientific Meeting in November.

Among her accomplishments, Naylor developed the Transitional Care Model, which utilizes nurses to reduce hospital readmissions among elderly patients after they have been discharged. As many as one-third of re-hospitalizations are considered preventable, so reducing readmissions not only improves patients’ quality of life, but reduces health care costs.

In addition to her work with INQRI, Naylor is the Marian S. Ware Professor in Gerontology and director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing. Naylor leads an interdisciplinary program of research designed to improve the quality of care, decrease unnecessary hospitalizations, and reduce health care costs for vulnerable community-based elders.

Naylor was also the 2012 recipient of GSA's Maxwell A. Pollack Award for Productive Aging.

Friday, August 28, 2015

Nurse Input and Leadership Needed in Health Care Design

A new book explores the importance of nurse-led innovations in the process of designing health care environments, Healthcare Design reports.

Nurses as Leaders in Healthcare Design: A Resource for Nurses and Interprofessional Partners, will be published this fall by Nursing Institute for Healthcare Design (NIHD) and Herman Miller Healthcare. Its goal is to inform and guide nurses through the design process with practical information and case studies.

NIHD President Nurses Stichler and Kathy Okland, a senior health care consultant at Herman Miller Healthcare are the executive editors of the book. In an interview with Healthcare Design they discussed the pitfalls of not including nurses’ perspectives in the design process.

“When the nurses’ point of view is absent from the design table, serious mistakes have been made,” Stichler said. “For example, there was a trend to eliminate the centralized communication hub when designing decentralized nursing stations. Unfortunately that was a huge mistake because both centralized and decentralized work stations are needed.”

The centralized station is where nurses and other health care providers meet to discuss unit activities and patients’ status, and interacting with family members, Stichler said. When the design eliminated that centralized space, staff had to develop workarounds, including setting up a folding table so that the interprofessional team could meet.  “So you can see how important it is to have a nursing voice that can speak up and say, wait, I don’t think you understand what goes on in that space, let me describe it to you.”

Okland and Stichler will lead an interactive discussion “Planning and Design for Healthcare Design: A Nurse’s Perspective” at the Healthcare Design Expo & Conference, November 14-17 in the Washington, DC area, for more information, visit

The full interview is available here: 

Friday, August 21, 2015

Sound Panels Used to Reduce Noise in Michigan Hospital

The University of Michigan Health System in Ann Arbor is experimenting with acoustic panels to diffuse sound in patient hallways and address concerns that hospital noise from monitors and paging systems interrupts patients' sleep and affects their blood pressure and heart rates, FierceHealthcare reports.

The University recently published findings from its pilot study in BMJ Quality and Safety, which indicated that the sound-absorbing panels, which are similar to ones used in music rooms, reduced noise in patient areas by three to four sound decibels.

The hospital is also promoting a “culture of quiet” in patient areas by providing complimentary headphones to patients and families; setting quiet hours in all inpatient areas; setting pagers to vibrate when medically appropriate; coordinating care in order to reduce unnecessary entry into patient rooms during quiet hours; and reminding staff to use quiet voices and behaviors in the patient care setting and to close doors quietly.

An INQRI-funded study found a unique way to use different sounds to reduce alarm fatigue and help keep patients safe. Led by Tracey Yap and Jay Kim the team used music to reduce the incidence of pressure ulcers. The study used music to cue patients in long-term care facilities to move in order to avoid getting pressure ulcers. The music also cued staff to help to move those patients who could not move on their own.

The University’s study abstract is available here.

Friday, August 14, 2015

NY Nurses Help Hospitals Realize Better Outcomes, Lower Health Care Costs Through AACN CSI Program

Small teams of nurses at seven New York hospitals have improved patient care and saved their hospitals millions of dollars by participating in a training program conducted by the American Association of Critical-Care Nurses (AACN).

The New York hospitals were the sixth cohort in the program. So far 42 hospitals nationwide have participated in the AACN Clinical Scene Investigator (CSI) Academy, a 16-month nursing leadership and innovation training project that has improved patient outcomes and saved hospitals more than $28 million annually.

In the New York cohort, groups of four nurses from each hospital chose a treatment area they wanted to address, such as preventing hospital-acquired infections and falls or standardizing protocols to assessing delirium or mobilizing ventilated patients, reports

At North Shore University Hospital, nurses focused on reducing catheter-associated urinary tract infections (CAUTIs) in the intensive care unit (ICU), because their unit had the highest rate in the state’s health system. Interventions included education efforts for patients, staff, and families on the importance of earlier removal of the catheter, and a focus on hygiene practices. After implementing the changes, the hospital achieved more than six months without a CAUTI, a significant improvement from not having a single CAUTI-free month before the academy. The reduction in infections saved $112,000 for the hospital.

At NYU Langone Medical Center nurses wanted to establish a consistent approach to treating and assessing delirium in the medical ICU. They collaborated with the care team, including the IT department, which developed a way to incorporate delirium assessment into electronic health records. Innovations also included an assessment checklist for delirium printed on mousepads, which eliminated the need to search for the tool. The Center estimates it will save between $3.3 million and $5.5 million as a result of the changes.

Nationwide, the CSI Academy has trained 163 nurses to address clinical challenges such as hospital-associated infections, pressure ulcers, delirium, early mobility, falls, and patient handoffs. Project materials developed by each team, including plans, data collection tools, practice resources and references in a searchable online database, are available on the AACN website at

The INQRI Blog featured previously released data from the Academy from regional groups working in Massachusetts and North Carolina and overall progress in the program.

Friday, July 31, 2015

Resnick to Head Gerontological Society

Congratulations to former INQRI Grantee Barbara Resnick, who was recently voted president-elect of the Gerontological Society of America (GSA).

Resnick, who currently serves as professor and Sonia Ziporkin Gershowitz Chair in Gerontology at the University of Maryland School of Nursing in Baltimore, will begin as president-elect in 2015-2016, and then become president for the 2016-2017 term.  GSA is devoted to research and education in all aspects of gerontology, including medical, biological, psychological and social.

“I am honored to serve in the role of GSA’s president-elect, and in the future, as its president,” Resnick said in a news release. “GSA has the opportunity to be a leader in interdisciplinary work in the areas of gerontology and geriatrics, including educational aspects, research, practice and policy.”

Resnick and fellow INQRI grantee Sheryl Zimmerman developed a successful intervention designed to deliver Function Focused Care to residents in assisted living facilities. Their intervention was designed to maintain and improve function, physical activity, muscle strength, psychosocial outcomes (efficacy expectations and life satisfaction) and decrease adverse events (pain, falls and hospitalizations) among assisted living residents. Residents in intervention treatment sites demonstrated fewer declines in function and spent more time in moderate level physical activity at 4 months and more overall counts of activity at 12 months when compared to residents in control sites. There were also fewer transfers to the hospital among those in the treatment sites.