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.

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.