Thursday, January 29, 2015

INQRI Funded Study: More than Half of Ventilated ICU Patients Have Ability to Communicate

Assistive communication tools could benefit more than half of patients in intensive care units (ICU) who are using ventilators to help them breathe, according to a new study co-funded by the INQRI program.

“Our findings challenge the commonly held assumption of many clinicians and researchers that these patients are unable to communicate or participate in their care,” INQRI grantee and study co-author Mary Beth Happ said in a statement. Happ is a professor of nursing at The Ohio State University.

The study found that 53.9 percent of the patients screened met basic communication criteria and could possibly benefit from the use of assistive communication tools and speech language consultation, including such simple tools as notepads and pens.

“Establishing lines of communication is the first step in a patient being able to make his or her needs known and have accurate symptom assessment and management, and contributes to an overall better patient experience. We know from interviews with patients who remember their critical care experience that the inability to communicate is anxiety producing and, in some cases, terrifying,” said Happ.

The study, which involved screening nearly 3,000 mechanically ventilated patients over a two year period, appears in the January/February 2015 issue of the journal Heart & Lung and is co-authored with Happ’s colleagues from the University of Pittsburgh. The study is co-funded by the National Institutes of Health.

Happ’s previous INQRI work includes the study “SPEACS2: Improving Patient Communication and Quality Outcomes in the ICU,” which examined the value of a nurse-generated and nurse-led innovation by testing the impact of a computer-based nurse communication training and materials program (SPEACS-2) on intensive care unit patient care outcomes. The interdisciplinary research team included Amber Barnato, who also co-authors Happ’s current research.

Friday, January 16, 2015

Washington Post Tackles Nurse Staffing Minimums, Quotes INQRI Experts

A recent Washington Post article analyzing the impact of nurse staffing minimums provides insight from two INQRI advisors.

 “There’s plenty of evidence that there’s a shortage of nursing care, and it’s not solved by anything to do with the hospital supply,”  Linda Aiken, INQRI research manager and National Advisory Committee member, tells the Washington Post. “All the shortage of care at the bedside has to do with how much hospitals want to pay nurses, and whether they want to use their resources on something else.”

Aiken’s recent research, published in the Lancet in February 2014, found that patients are more likely to die after common surgical procedures when they are cared for in hospitals with heavier nurse workloads and fewer nurses with bachelor's degrees. The study found that every extra patient increased the chance of surgical patients dying within 30 days of admission by 7 percent.

A California law requiring mandatory minimum nurse staffing has shown benefit for nurses, with studies showing that patient loads and rates of occupational injury decreased in the state, while job satisfaction among nurses increased. The Post reports, however, that there is conflicting evidence as to whether legislating mandatory minimum staffing improves patient outcomes. Lori Melichar, a labor economist for RWJF and program officer for INQRI, tells the Post that the question is complicated. “And when you layer on ‘Is this policy going to be effective,’ as a researcher and an economist, I can’t make that determination,” she says.

An INQRI-funded study on the impact of nursing staffing on hospital performance revealed that increasing the number of registered nurse (RN) hours per patient day increased the quality of patient care. The study looked in particular at patients who were being treated for acute myocardial infarction, pneumonia or heart failure.) For all three conditions, increasing the number of RN hours increased the quality of care. This did not hold true for increasing the number of licensed practical nurse or nursing assistant hours.

The study's authors—Gestur Davidson, Ira Moscovice, and Kathy Belk—posited that RNs are involved in and directly affect procedures, practices and processes that directly influence patient outcomes. This was the first study into how nurse staffing affects hospital performance on quality metrics used in the Premier Hospital Quality Demonstration project. It is reviewed in a 2013 research brief on the RWJF website.

Friday, January 9, 2015

Preventing Hospital Acquired Infections among Elderly ICU Patients Reduces Death Risk, Saves Money

Elderly patients who develop hospital-acquired infections (HAIs) while in intensive care units (ICU) are approximately 35 percent more likely to die within five years than other patients, according to a new study co-authored by INQRI grantee Patricia Stone.

The most common HAIs are bloodstream infections caused by central lines and pneumonia caused by ventilators, reports Advanced Healthcare Network for Nurses. Decreasing the incidents of these two HAIs alone could increase the odds that ICU patients survive, and reduce health care costs by more than $150,000, according to Stone’s study.

Stone and her colleagues examined outcomes for 17,537 Medicare patients over a five year period and found that while 57 percent of all the elderly ICU patients had died, nearly 80 percent of patients who developed HAIs during their ICU stays died.

"Any death from preventable infections is one too many," Stone tells Advanced. "We've known for decades what works to prevent infections and save lives. Now, our study shows just how much money can be saved by investing in prevention."

The paper, "A decade of investment in infection prevention: A cost-effectiveness analysis," was published in the January 2015 issue of the American Journal of Infection Control and was funded by the National Institute of Nursing Research.

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.

Patricia Stone’s INQRI-funded project: “The Impacts of Nurse Staffing, Skill Mix, and Experience on Quality and Costs in Long-Term Care” examined whether there is a causal relationship between nursing input and patient outcomes in long-term care (LTC) facilities.

The full Advanced article is available here.

Tuesday, December 23, 2014

INQRI Brief: Non-Physicians Can Address Primary Care Shortage

A pending primary care shortage may be best addressed by implementing promising strategies that fully utilize non-physician health care professionals in new systems of care, according to a new research brief co-authored by INQRI Co-Directors Mary Naylor and Mark Pauly with Janet Weiner.

With approximately 30 million people expected to gain coverage through the Affordable Care Act (ACA), demands on primary care services will no doubt grow. The brief, Primary Care Shortages: It’s More Than Just a Head Count, examines how the ACA will affect the delivery of primary care, and reviews recent research on the primary care shortage and possible strategies to address it.

The brief outlines several strategies that show promise for addressing these demands. Among them is ACA’s investments in health professional education and training to increase the number of primary care providers, including nurse practitioners and physician assistants. Other models, like retail clinics could ensure that more people can access primary care services, particularly in rural areas.

Ultimately, allowing health care providers to practice to the full extent of their education and training is central to increasing access to primary care, the authors write.

An article on the brief from RWJF’s December 2014 Sharing Nursing’s Knowledge is available here.

Friday, December 19, 2014

Nurses Working in Wound Care Produce Innovative Research, Best Practices

Nurses working in wound care often become innovators, devising new research, treatments, and best practices for the field, in their ongoing daily efforts to provide the best care for their patients, according to a article.

The article cites the work of Janice Beitz, director of the new Wound, Ostomy, and Continence Nurses Society program at Rutgers School of Nursing, who along with her colleagues has been creating algorithms for nursing care, including the prevention of pressure ulcers. They developed a one-page, 26-step visual algorithm to help nurses understand and prevent pressure ulcer formation.

Development of such best practice documents is not uncommon in the fields of wound and ostomy care, since best practices learned while treating patients regularly overlap with ongoing research, Beitz told

“The great strength of this is that it captures much research evidence on various patient risk factors that are routinely collected and modifiable, and places them in one succinct visual aid,” Beitz said.

The INQRI funded project “Interdisciplinary Mobility Team Approach to Reduction of Facility-Acquired Pressure Ulcers” developed a sustainable, system-wide program for pressure ulcer prevention that enhances mobility of long-term care (LTC) residents. The primary goal, under nursing's leadership, was to reduce LTC facility-acquired pressure ulcer incidence by 50 percent using a cost-effective innovative program to increase resident active or passive movement. The team, which developed and implemented a program that involved using musical cues to remind residents to move or staff to help residents move, was led by Tracey Yap, a nurse researcher, and  Jay Kim, an engineer.

Thursday, December 11, 2014

Nurse-led Study Provides First Ever Real-World Data on Hospital Alarm Noise

More than 2.5 million alarms were triggered on bedside monitors in a single month, according to the first study on hospital alarms conducted in a real-world setting. An article about the study in Medical Express notes that excessive alarm noise can lead to alarm fatigue among nurses and other clinicians and negative outcomes for patients.

The study was conducted by Jessica Zègre-Hemsey, assistant professor at the University of North Carolina - Chapel Hill School of Nursing and a cardiac monitoring expert, and University of California, San Francisco (UCSF) School of Nursing Professor Barbara Drew, along with her UCSF colleagues. The study also found that 88.8 percent of the alarms for abnormal cardiac conditions were false.

"Current technologies have been instrumental in saving lives but they can be improved," Zègre-Hemsey tells Medical Xpress. "For example, current monitoring systems do not take into account differences among patients. If alarm settings were tailored more specifically to individuals that could go a long way in reducing the number of alarms health care providers respond to."

Zègre-Hemsey and her colleagues recommend that clinicians, engineers, and administrators collaborate to develop monitors that can be configured to individual patients and create a "gold standard" database of annotated alarms to reduce false alarms.

"Alarm fatigue is a large and complex problem," she said. "Yet the implications are far-reaching since sentinel events like patient death have been reported. This is a current patient safety crisis."

The full study is available on PLOS ONE.

In a related story, the Columbus Dispatch (Columbus, Ohio) looks at what local hospitals are doing to reduce alarm fatigue. For example, the Ohio State University’s Wexner Medical Center recently moved to a system in which some patient alarms go directly to a nurse’s phone, thereby decreasing alarm noise by approximately 20 percent.

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.

Wednesday, November 26, 2014

Patient Satisfaction, Outcomes Could Improve with Use of Nursing Quality Analytics Data

Having access to a quality analytics database that measures clinical data specific to the role of nurses as well as data about the nursing environment, could help improve patient satisfaction and outcomes nationwide, according to Christina Dempsey, chief nursing officer at Press Ganey.

Press Ganey, an organization that works to help hospitals and other medical facilities improve patient experiences, recently acquired the National Database of Nursing Quality Indicators (NDNQI) from the American Nursing Association (ANA). NDNQI includes clinical quality measures and corresponding information on nurse engagement and the nursing environment. Press Ganey is distilling the data into four areas that affect the patient experience. They believe this approach will ultimately help their clients decide where to invest in improvements.

“Nurse-sensitive indicators reflect the structure, the process and the outcomes of nursing care,” Dempsey told HealthITAnalytics. “The structure of nursing care is indicated by the supply of the nursing staff, the skill level of the nursing staff, and the education of the nursing staff.  Process indicators measure things like assessments, intervention, and job satisfaction.  And then outcomes are those things that improve if there’s a greater quantity or quality of nursing care, such as pressure ulcers and falls.”

“… Being able to bring some of that data together will allow managers, clinicians, and nurses at the bedside better understand what they need to do for which population of patients to get the highest and best return,” Dempsey said.