Friday, March 27, 2015

Interprofessional Teamwork Helps to Prevent Patient Falls

Nineteen hospitals in Nebraska are collaborating on an interprofessional, evidence-based approach to decreasing fall risk, reports FierceHealthcare, and they are seeing results.

"We had no process, no structures in place to decrease our fall risk," said Carol Kampschneider in a video posted on Hospitals & Health Networks (H&HN) Daily. Kampschneider is a registered nurse and vice president of clinical and regulatory services at St. Francis Memorial Hospital in West Point, Nebraska.  Prior to joining the collaboration, only falls that resulted in broken bones or head injuries were identified as serious at her hospital and no fall risk assessment was completed during patient admissions.

Through an Agency for Healthcare Research and Quality grant, the 19 hospitals became involved in the Collaboration and Proactive Teamwork Used to Reduce Falls (CAPTURE Falls) program, and began to see improvements. For example, the fall rate at St. Francis dropped from 7.31 per 1,000 patient days to 1.41 per 1,000 patient days, Kampschneider said.

As part of the program interprofessional teams collaborate and use tools to understand risks associated with inpatient falls. If a fall does occur, the teams will conduct a "post-fall huddle" to determine how they can prevent the patient from falling in the future.

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.

 The H&HN Daily video is available here.

Thursday, March 19, 2015

Nurse Team Reduces CAUTI Infections Through EHR Tool

A nurse-led initiative at a Missouri hospital used Electronic Health Records (EHRs) to reduce the number of catheter-associated urinary tract infections (CAUTIs) by 25 percent in its facilities, Becker’s Health IT & CIO Review reports.

Eileen Phillips, an RN at the University of Missouri Health System, led a team of nurses in reviewing literature on infections. The team then developed a list of appropriate, evidence-based indications for catheter use, and included a step in their EHRs that required nurses to document the reasons for use of a catheter. This led to a decrease in use of catheters and contributed to the subsequent 25 percent drop in infections.

The nursing team also began an educational and communications campaign called “CAUTIon: Zero Infections Ahead” that used web-based modules, posters, rewards systems, weekly quizzes, and staff meetings to highlight best practices for catheter use.

"This could not have occurred without first reducing our utilization, which is why the EHR task has helped so much," Phillips said in a blog post Q&A on Cerner’s website. "In 2013, our catheter utilization was 33 percent, and in 2014, utilization decreased to 25 percent, which is a 24 percent overall decrease. I am really happy with the progress we have made so far."

Reducing central line infections 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.

Thursday, March 12, 2015

Palliative Study Identifies Best Measures of Quality Care

A recent study out of the University of Rochester seeks to identify the best available set of measures to evaluate whether facilities are delivering the highest quality service possible to palliative care and hospice patients, and their families, Epoch Times reports.

The study, “Measuring What Matters,” was led by Sally Norton, associate professor in nursing and palliative care at the University of Rochester. It narrows down 10 “Measures That Matter” from a list of 75 indicators, based on what’s most important to patients and families. They include:

  • Comprehensive assessment, including physical, psychological, social, spiritual, and functional screening soon after admission;
  • Screening for pain, shortness of breath, nausea, and constipation during admission;
  • Documented discussion regarding emotional needs and spiritual concerns; 
  • Documentation of their preferences for life-sustaining treatments; and
  • Adherence to documented preferences to withhold or withdraw life-sustaining treatments.

Researchers for the study, which was published in the Journal of Pain and Symptom Management, chose scientifically rigorous measures that: were meaningful for patients and their families; are able to be implemented by providers; and that can significantly improve the level of care. Researchers hope that this study will eventually create health care benchmarks for the industry.

Norton and her colleagues also recommend developing a method for identifying all patients who could benefit from palliative and hospice care, and developing a survey for patients or their families that is valid in all settings.

The INQRI-funded “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 (ICUs) and patient and family outcomes. It also explored how to measure and to improve these outcomes. The purpose of this investigator-initiated study was to examine nursing's specific contributions to quality palliative care provided to patients and their families in the ICU. This interdisciplinary team was led by Lissi Hansen and Richard Mularski.

Wednesday, March 4, 2015

Mobile Apps Empower Nurses to Use Evidence-Based Guidelines, Identify Health Problems

A new nurse-led study concludes that custom mobile health applications can help nurse practitioners use evidence-based guidelines, which would improve their ability to diagnose health issues during exams, MHealthNews reports.

Mobile apps that include clinical decision support tools helped clinicians diagnose chronic health issues, according to the study led by Suzanne Bakken, alumni professor of nursing at Columbia University School of Nursing.

The study, published in the Journal for Nurse Practitioners, examined the diagnosis rates of nearly 400 nurses during more than 34,000 patient exams and found significant diagnostic rate increases:

  • Seven times more obese and overweight (33.9% vs. 4.8%)
  • Five times more tobacco use (11.9% versus 2.3%)
  • 44 times more adult depression (8.8% versus 0.2%)
  • Four times more pediatric depression (4.6% versus 1.1%)

“What clinicians need is decision support tools that fit into their workflow and remind them of evidence-based practices,” Bakken said in a statement. "Our app focused specifically on the work that nurse practitioners do to identify health problems, counsel patients and coordinate care plans, resulting in higher diagnosis rates and more opportunities for intervention."

The goal of an INQRI-funded project “Dissemination and Implementation of Evidence-Based Methods to Measure and Improve Pain Outcomes” was to disseminate and implement evidence-based approaches to measure and improve pain care and outcomes in a sample of 100 hospitals across the United States. Two webinars are available detailing the results of the project: Webinar I and Webinar II. The interdisciplinary team was led by Susan Beck and Nancy Dunton.

Tuesday, February 24, 2015

Nurse-led Intervention Successful in Increasing Older Patients' Activity Levels

Nurse-led primary care interventions can lead to sustained increases in physical activity (PA) among older adults, according to a recent article published in PLOS Medicine by lead author Tess Harris of St George's University of London. Additionally, the participating patients indicated that they felt positively about the intervention, reports Medical Xpress.

Researchers enrolled nearly 300 people ages 60-75 in the trial, and randomly separated them by household, to receive either standard care or the nurse-led intervention. Primary care nurses delivered PA consultations over a three month-period to the intervention group, providing individualized activity plans and feedback on data recorded from pedometers and accelerometers worn by the patients.

At the three month mark, the intervention group reported that they took 1,037 more steps than the control group. Additionally, the intervention group spent 63 more minutes per week in PA sessions of 10 minutes or more. There was a sustained gap at the 12-month mark, although it decreased to 609 steps per day and 40 minutes per week.

The trial, funded by the National Institute for Health Research, suggests that this type of nurse-led intervention may be an effective way to increase PA in older adults, resulting in better health. However, the researchers said that additional trials are needed to discover what aspects of the intervention were most effective and how it would work in larger and more socio-economically diverse populations.

INQRI grantees Barbara Resnick and Sheryl Zimmerman also found success with an intervention designed to deliver Function Focused Care to residents in assisted living facilities. Their intervention was designed to maintain and improve function, PA, 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.

Thursday, February 12, 2015

INQRI Advisor to Lead Study on Nurses’ Impact

A new survey of more than 250,000 registered nurses (RNs) will help to generate evidence about how nurses impact the outcomes of their patients, according to a article. INQRI Research Manager and National Advisory Committee Member Linda Aiken will lead the survey of RNs and Nurse Practitioners holding active licenses in California, Florida, New Jersey, and Pennsylvania.
Aiken is the director of the University of Pennsylvania, School of Nursing’s Center for Health Outcomes and Policy Research (CHOPR). The National Institute of Nursing Research provided a $2.9 million grant to CHOPR for the survey, which is titled Panel Study of Effects of Changes in Nursing on Patient Outcomes. RWJF, the National Council of State Boards of Nursing, the Hillman Foundation, and the Boettner Center also provided funding.

“Our study will examine organizational-level changes over time in nurse inputs in education, staffing, skill mix, and work environment between 1999, 2006 and 2015,” Aiken said in a statement on CHOPR’s website. “The great strength of this project is that in creating a panel of organizational observations, we can see where change has occurred and why.”

Tuesday, February 10, 2015

States Benefit from Increased Autonomy for Nurses

States that allow Advanced Practice Registered Nurses (APRNs) to practice independently saw an improvement in health outcomes for patients and decreases in costs to Medicare and Medicaid, according to a study by researchers at the Missouri University Sinclair School of Nursing, reports.

The study, “Impact of Nurse Practitioners on Health Outcomes of Medicare and Medicaid Patients,” was published in the November-December issue of Nursing Outlook. Researchers analyzed previous studies with data on Medicare and Medicaid patients and found that states with full practice of nurse practitioners have lower hospitalization rates in all of the groups examined.

An INQRI-funded study, "Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That Can Be Achieved In Retail Clinics,” found similar cost savings at retail clinics in states where nurses had more independence. The study, co-led by Joanne Spetz and Stephen Parente, found that visits to nurse-managed retail clinics were associated with lower costs, and the costs were even lower when Nurse Practitioners (NPs) practiced independently. The researchers concluded that eliminating restrictions on NPs’ scope of practice could have a large impact on the cost savings that can be achieved by retail clinics.