Thursday, May 21, 2015

Rehab Nurses Lead Multidisciplinary Efforts in Fall Prevention

At hospitals around the country rehab nurses are playing an essential role in reducing fall risk by educating their colleagues, in addition to their patients, according to an Advanced Healthcare Network for Nurses article.

At the Chicago-based Schwab Rehabilitation Hospital, nurses provide fall risk education to patients who also undergo a fall risk assessment at the time of admission. Schwab also uses stoplight model signs to identify the level of fall risk (green for low; yellow for moderate; and red for high) attached to patients’ beds and wheelchairs.

Additionally, rehab nurses at Schwab meet with hospital staff in other departments, including therapy, dietary, and environmental services, to educate them on the importance of notifying a nurse when a patient is at risk of falling. As a result of these efforts, Schwab has reduced their fall rate from 7.86 to 3.9 per 1,000 patient days over the course of a year.

INQRI grantees Patti Dykes and Blackford Middleton created a tool designed to prevent patient falls by translating an individual patient's fall risk assessment into a decision support intervention that communicates fall risk status, and creates a tailored plan that is accessible to care team members (including patients and family members).

The team constructed the Fall Prevention Toolkit (FPTK), and conducted a randomized controlled trial to examine whether the FPTK led to a decrease in the incidence of patient falls and a decrease in the incidence of patient falls with injury. The use of their toolkit did significantly lower the incidence of falls in the intervention units and several units wished to continue using the tool after the conclusion of the study. By establishing links between nursing fall risk assessment, risk communication and tailored interventions to prevent falls, Dykes and Middleton hope to raise awareness of fall risks for patients, nurses and other providers and to lower mortality and morbidity for potential fall victims.

Tuesday, May 12, 2015

Doctors Learn from Shadowing Nurses at Illinois Hospital

A program launched by a nurse and doctor at an orthopedic surgery center is proving that physicians can benefit from shadowing nurses during shifts.

The program was launched at Presence St. Joseph Medical Center in Joliet, Illinois, by Patient Care Manager and RN Barbara Walker and Orthopedic Surgeon Michael Murphy, who co-chair a floor improvement subcommittee at the Center. Murphy was one of the first doctors to participate in the “shadowing” experiment, and it gave him great insight into how much is involved in a normal nursing shift, he told Nurse.com.

For instance, Murphy was surprised to see how, when a physician’s computer order is not clear, it can delay patient treatment. The complexity of the job, including medication administration was also eye-opening, he said.

“They [the doctors] didn’t realize how hard it was just to get pain medicine,” Walker said. “I think it gave them a good appreciation of what our barriers are and what are successes are, too.”

The initial shadowing project has received such a positive response that it was continued this spring and nurses said they would like to see it spread throughout the hospital and health system.

Friday, May 1, 2015

Nurses Succeeding in Bone Marrow Biopsy Program

A nurse-led bone marrow aspiration/biopsy program is providing evidence that the use of procedurists is good for patient outcomes and good for clinical practice, according to a presentation at the Oncology Nursing Society’s 40th Annual Congress in Orlando, Florida. The presentation was titled Multidisciplinary Development of a Bone Marrow Aspirate and Core Biopsy Performed by Registered Nurses.

This use of nurse procedurists in bone marrow biopsies “demonstrates an innovative partnership for clinical practice, as recommended by the Institute of Medicine (IOM),” said Daravan Kao of the Seattle Cancer Care Alliance. The IOM’s landmark 2010 report, The Future of Nursing: Leading Change, Advancing Health, states that nurses “should practice to the full extent of their education and should be full partners in the redesigning of health care delivery,” Kao continued.

Registered nurses who participated in the bone marrow program maintained a 98 percent score, as rated by pathologists, for the quality of the samples they collected. Furthermore, there were no reported incidences of post procedure complications, Oncology Nurse Advisor reports.

A multidisciplinary team developed and implemented the biopsy program, which included didactic training, technical skills acquisition, and ongoing quality assurance.

Friday, April 24, 2015

Study Finds Patients Admitted to Hospitals on Weekends are at Greater Risk for “Never Events”

Falls and infections are more common among patients admitted to hospitals on weekends, according to a new study conducted by researchers at the University of Southern California and published in the British Medical Journal. The research team analyzed data from more than 350 million hospital admissions from 2002 to 2010. Even though the vast majority (81 percent) of the admissions were on weekdays, there were more complications in patients admitted on weekends (5.7 percent of complications compared with 3.7 percent for patients admitted on week days). The most common kinds of hospital-acquired infections among patients admitted on weekends were pressure ulcers and catheter-associated urinary tract infections.

The research team could not determine whether the higher proportion of complications were due to lower staffing rates on weekends or patients with more urgent treatment needs being admitted during those times.

These findings are consistent with a body of research showing that patients admitted during off-peak hours (like evenings and weekends) experienced more health problems, and were less likely to survive in-hospital cardiac arrest, and that newborns born on weekends were more likely to die than babies born during the week.

An INQRI-funded study led by Patti Hamilton and Gretchen Gemeinhardt found that nurses’ “off-peak” work environments play a significant role in the increased patient mortality during these time periods.  In particular, the researchers found that nurses who participate in hospital plans that allow them to work only weekend shifts for full pay and benefits are less familiar with their institutions’ initiatives and priorities that govern policies, procedures, principles and regulations for providing care, because those initiatives and priorities are stressed more during peak periods.

Friday, April 17, 2015

AACN Academy Shows Value of Investing in Nurse Leadership Development

After participating in a 16-month leadership and innovation training program, nurses at 42 hospitals nationwide went on to direct quality initiatives that improved patient outcomes and saved more than $28 million annually.

The AACN Clinical Scene Investigator (CSI) Academy is a 16-month leadership and innovation training program for staff nurses delivered by the American Association of Critical-Care Nurses (AACN) that seeks to empower nurses as clinician leaders and catalysts for change.

The CSI Academy trained 163 nurses to address clinical challenges such as health care associated infections, pressure ulcers, delirium, early mobility, falls, and patient handoffs. The nursing teams saw great success, according to AACN, significantly reducing many common hospital errors.

Regional groups working in Indiana, Massachusetts, New York, North Carolina, Pennsylvania and Texas showed progress in decreasing:
  • Intensive care unit (ICU) and progressive care unit lengths of stay by one day; 
  • Days on mechanical ventilation by 14 percent or approximately one day;
  • Health care-acquired infections and ICU complications by 50 percent;
  • Patient falls by 50 percent;
  • Pressure ulcers by 40 percent;
  • Catheter-associated urinary tract infections by 70 percent; and
  • Confusion Assessment Method for the ICU (CAM-ICU) positive scores by 14 percent
“These outcomes solidly reaffirm the value of investing in bedside nurses’ leadership development,” AACN CEO Dana Woods said in a statement. “Our program evaluations confirm that dedicated time for nurses to apply their skills in leading organizational and behavioral change was vital to achieving the program’s impressive results.”

AACN provides project materials from each team, including plans, data collection tools, practice resources and references in a searchable online database, which can be accessed at www.aacn.org/csiprojects.

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

Friday, April 10, 2015

Special Flooring Could Reduce Fall Injuries Among Patients

Impact-absorbing flooring reduced fall injuries by nearly 60 percent in a new study of women in Swedish nursing homes, reports Reuters Health.

Researchers for the study, which is published in the journal Injury Prevention, collected fall and injury data from a nursing home in Sweden with 60 apartments. Six of the apartments were fitted with 12-millimeter flexible impact absorbing tiles.

During the three-year research period, 57 female nursing home residents participated in the study, with 39 falling at least once. Injuries resulted 30 percent of the time on regular flooring, but only 17 percent of the time with the special flooring. Although falls seemed to occur more often on the special flooring, researchers told Reuters Health that nursing home staff may have moved patients at greater risk for falling into the softer flooring areas. The study did not include bathrooms, where patients frequently fall.

INQRI grantees Patti Dykes and Blackford Middleton created a tool designed to prevent patient falls by translating an individual patient's fall risk assessment into a decision support intervention that communicates fall risk status, and creates a tailored plan that is accessible to care team members (including patients and family members).

The team constructed the Fall Prevention Toolkit (FPTK), and conducted a randomized controlled trial to examine whether the FPTK led to a decrease in the incidence of patient falls and a decrease in the incidence of patient falls with injury. The use of their toolkit did significantly lower the incidence of falls in the intervention units and several units wished to continue using the tool after the conclusion of the study. By establishing links between nursing fall risk assessment, risk communication and tailored interventions to prevent falls, Dykes and Middleton hope to raise awareness of fall risks for patients, nurses and other providers and to lower mortality and morbidity for potential fall victims.

Thursday, April 2, 2015

New Study Finds Benefits to Increasing Nurse-Physician Collaboration

Healthcare-associated infections (HAIs) decreased when collaboration between nurses and physicians working in critical care increased, according to a new study published in the April issue of Critical Care Nurse (CCN).

In critical care units in which nurses reported a more favorable perception of nurse-physician collaboration, researchers found lower rates of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI).

Researchers for the study, including Christine Boev, performed a secondary analysis of nurse surveys conducted in four specialized intensive care units (ICUs) over a five year period. The resulting article, “Nurse-Physician Collaboration and Hospital-Acquired Infections in Critical Care,” shows the association between nurses’ perception of their working relationships with physicians and the rates of VAPs and CLASBSIs.

“Our findings suggest that raising the quality of collaboration and communication among nurses and physicians has the potential to improve patient safety,” Boev said in a statement. “Efforts to prevent healthcare-associated infections must include interventions to improve nurse-physician collaboration.”

Boev, an assistant professor at the Wegmans School of Nursing, St. John Fisher College, suggested multidisciplinary daily patient rounds and shared simulation training to improve collaboration.

Reducing CLASBIs was the focus of an INQRI-funded study led by David Thompson and Jill Marsteller. Their study, involving 45 intensive care units in 35 hospitals in 12 states, tested a nurse-led intervention that used a bundle of evidence-based practices to reduce infections. The intervention was successful in significantly reducing infections and also highlighted the importance of promoting a culture of safety and communication. It also established that nurses should play a central role in quality improvement interventions.

The CCN article abstract and full-text PDF is available at: http://ccn.aacnjournals.org/.