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.

Tuesday, July 14, 2015

CLASBIs Rates Improved When Hospitals Implement Airline Industry Approach

Hospitals around the country are reducing central line associated bacterial infections (CLASBIs) by taking a “plane crash” instead of a “car crash” approach in their efforts, according to a VOX special report.

The theory is that car companies see accidents as unavoidable, no matter how much work goes into prevention. The aviation industry, however, treats each crash as potentially preventable and investigates how it could have been prevented. A similar divide exists among hospitals when it comes to treating CLASBIs central line infections, Vox reports.

While some hospitals view the infections as bad but inevitable, other hospitals “see each central line infection as a failure that requires investigation and better preventive techniques in the future.” And many of these “plane crash” hospitals are reducing infections, in part by empowering nurses and giving them the tools to prevent infections.

Peter Pronovost, a critical care physician at Johns Hopkins University in Baltimore, created a simple five-item checklist that centers on cleanliness when inserting central lines, and changing the dressing, and implementing changes such as centralized stock carts. But one of the most significant changes the hospital implemented was to instruct nurses to “call out” doctors who were not following checklists. Within three months, CLASBIs decreased by 50 percent, and they decreased by 70 percent after six months.

Hospitals in Michigan and California Follow Suit

After hearing of the success at Johns Hopkins, the Michigan Hospital Association implemented a similar the protocol at about 60 hospitals in the state, and realized a 70 percent decrease within three months. Similarly, Roseville Medical Center in California implemented its own version of Pronovost’s checklist and also gave an 18-nurse vascular access team exclusive responsibility for inserting and monitoring central lines. For seven years after the new program was instituted, Roseville did not have a single central line infection.

When the hospital’s seven year streak broke in 2014, Roseville decided to investigate. The investigation revealed that subcontracted nurses who treated dialysis patients, but who were not part of the central line team, were responsible for the infections. As a result of the findings the hospital now requires annual competency checks for contract nurses who manage central lines.

“The Roseville response mirrors what airlines do at a moment of crisis: analyze the situation and implement new policies that could prevent the same type of problem in the future.”

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 full VOX article is available here.

Thursday, July 2, 2015

Intervention Efforts Leads to Reduced Risk for Liver Patients

A nurse-led intervention improved rates of vaccination for Hepatitis A and Hepatitis B for patients awaiting liver transplantation, ultimately reducing the risk of disease and other post-transplant complications, according to an article in Medscape Medical News.
During the American Association of Nurse Practitioners 2015 National Conference Shari Perez of the Mayo Clinic in Scottsdale, Arizona told attendees that patients were nearly 9.5 times more likely to complete the vaccination series after a nurse intervention system was implemented at the clinic.

The new protocol incorporated a vaccine tracking system using the department database, and improvements to order entry for required vaccines and vaccine-scheduling practices.  The protocol also involved patient mail-in vaccination cards and an electronic medical record patient-flagging system for providers.

The full article is available here. (Free registration required.)

Thursday, June 11, 2015

Expanding Opportunities for Rural Communities to Get Quality Care

by Susan Hassmiller, PhD, RN, FAAN, Senior Adviser for Nursing, Robert Wood Johnson Foundation 

The full version of this post is on the Robert Wood Johnson Foundation’s Culture of Health blog.

I read recently in The New York Times about Murlene Osburn, a cattle rancher and psychiatric nurse, who will finally be able to start seeing patients now that Nebraska has passed legislation enabling advanced practice nurses to practice without a doctor’s oversight.

Osburn earned her graduate degree to become a psychiatric nurse after becoming convinced of the need in her rural community, but she found it impossible to practice. That’s because a state law requiring advanced practice nurses to have a doctor’s approval before they performed tasks—tasks they were certified to do. The closest psychiatrist was seven hours away by car (thus the need for a psychiatric nurse), and he wanted to charge her $500 a month. She got discouraged and set aside her dream of helping her community.

I lived in Nebraska for seven years, and I know firsthand that many rural communities lack adequate health services. As a public health nurse supervisor responsible for the entire state, I regularly traveled to small, isolated communities. Some of these communities did not have a physician or dentist, let alone a psychiatric nurse. People are forced to drive long distances to attain care, and they often delay necessary medical treatment as a result—putting them at risk of becoming even sicker, with more complex medical conditions.

Read the rest of Hassmiller's post on the Culture of Health blog.