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/.

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.