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.

Monday, June 1, 2015

Magnet Aspirations Can Give Hospitals a Path to Excellence

Ann Kutney-Lee, PhD, RN, FAAN and Linda H. Aiken, PhD, RN, FAAN

More than 400 hospitals nationwide have been recognized as Magnet hospitals by the American Nurses Credentialing Center for demonstrating excellence in nursing. The link between Magnet status and better patient outcomes and better working environments for nurses when compared with hospitals that have not achieved Magnet status is well-established.(1) What is less clear is whether hospitals that have attained this status were already excellent or whether they achieved excellence through the rigorous process of working toward Magnet certification.

We conducted and recently published one of the first longitudinal studies to address that question, and the answer is that the work that must be done during the extensive application and review process to attain Magnet status substantially improves nurse work environments and better outcomes for patients and for nurses result.(2)

We analyzed 1999 to 2006 data for 136 Pennsylvania hospitals (11 hospitals that went through the Magnet review process and 125 that did not). And overall, those hospitals that pursued and obtained Magnet status made significant and lasting change at the patient, nurse and organizational levels.

The study, “Changes in Patient and Nurse Outcomes Associated With Magnet Hospital Recognition,” recently published in Medical Care, found that in 1999, hospitals pursuing Magnet status performed at the same level as or worse than non-Magnet hospitals on a range of measures, including risk-adjusted rates of mortality 30 days after surgery, and failure-to-rescue. By 2006, emerging Magnets had progressed significantly ahead of their non-Magnet counterparts, demonstrating markedly greater improvements including 2.4 fewer deaths per 1,000 patients for 30-day surgical mortality, 6.1 fewer deaths per 1,000 patients for failure-to-rescue, and lower adjusted rates of nurse burnout, job dissatisfaction, and intent to quit.

While becoming a Magnet hospital is a significant undertaking – and can be a costly one – our findings, coupled with the body of research documenting that Magnet hospitals provide higher quality care, establish a strong business case for pursuing Magnet status. Even the process of working toward certification boosts patient safety and increases retention of nursing staff, which saves the cost of recruiting and training new hires. Further, our results are consistent with another recent study published in Medical Care that demonstrates the economic benefits associated with Magnet status.(3).

We undertook a longitudinal study because nearly all previous studies of Magnet hospitals have relied on a cross-sectional design, which limits the researchers’ understanding of the causal relationship between Magnet status and improved outcomes.  With this longitudinal evidence, our study can give hospital leaders a different perspective on the potential for improvement. And the take-away for them is that pursing Magnet status is an investment that’s well worth it.

1. McHugh MD McHugh MD, Kelly LA, Smith HL, Wu ES, Vanak J, Aiken, LH.  2013.  Lower mortality in Magnet hospitals.  Medical Care.  51:382-388. 
2. Kutney Lee A, Stimpfel A, Sloane DM, Cimiotti J, Quinn LW, Aiken LH.  2015.  Changes in patient and nurse outcomes associated with Magnet hospital designation.  Medical Care.  53(6):550-557.
3. Jayawardhana J, Welton JM, Lindroth RC. 2014. Is there a business case for Magnet hospitals? Estimates of the cost and revenue implications of becoming a Magnet. Medical Care.52:400-404.

Ann Kutney-Lee, PhD, RN, FAAN, is an assistant professor of nursing at the University of Pennsylvania School of Nursing and Linda H. Aiken, PhD, RN, FAAN, is a professor and the director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. Their study was funded by the Robert Wood Johnson Foundation Initiative on the Future of Nursing.

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

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.