Diffusion of New Ideas - What Works?

Looking for tips on how to successfully translate research into practice? Then join us one week from today for the next webinar in our Translation Series:

Diffusion of New Ideas - What Works?

Elizabeth Bradley, Ph.D., Yale University

April 7, 2010: 12:00 p.m. - 1:00 p.m. EST

Click here to register.

The Translation Series is co-sponsored by the Donaghue Foundation. For more information on INQRI's collaboration with Donaghue, please visit the Funders Forum blog.

Can Reducing Noise Reduce Errors?

Some health consultants say the answer is yes. 

Last week, The Tennessan published a new article discussing ways that hospitals in Tennessee have taken action to reduce noise, which can lead to stress for both patients and caregivers.

"If you can reduce noise, you can reduce distractions, and that will help to reduce medical errors," said David J. Stewart, a principal in the health-care group at Gresham, Smith and Partners, a Nashville-based design and consulting firm.

Several hospitals have replaced overhead paging systems with individual pagers, some have redesigned their buildings to move noisy areas away from patient rooms, others have created sound barriers. 

Click here to read the story.

Nursing and Palliative Care - Communication Challenges

The American Journal of Nursing has recently published a column by Carrie Bennett, MS, CNS-BC on her experience with her mother-in-law's palliative care. She shares about the family's failure to understand the differences between "survival" and "recovery." Bennett writes about how often she has seen families caught up in the language that health providers use and how difficult it is to bring in a palliative care consultant when the family is not yet ready. As a clinical nurse specialist in geriatrics and palliative care, she was able to use her professional experience as a way to open the conversation with her husband's family.

Indeed, palliative care is a very sensitive and very challenging area to research. Very little is known about the relationships between quality palliative nursing care delivered in intensive care units (ICUs) and patient and family outcomes and on how to measure and to improve these outcomes. In their INQRI project, "Nursing's Specific Contributions to Quality Palliative Care within the Context of Interdisciplinary Intensive Care Practice," Drs. Lissi Hansen and Richard Mularski are examining nursing's specific contributions to quality palliative care provided to patients and their families in the ICU. The team began their work last October and plans to present their findings in September 2011.

Click here to read Carrie Bennett's column.

RWJF President and CEO Talks About New Health Care Law that Will Help the Millions of Uninsured

As President Obama signed the health care bill into law this week, the Robert Wood Johnson Foundation's President and CEO, Risa Lavizzo-Mourey, M.D., M.B.A., looks to the philanthrophic road that the Foundation has traveled over the past 40 years and continues to advocate for the improvment to the health and health care of all Americans.

Read Risa's remarks.

National Priorities Partnership Conference Next Monday

The National Priorities Partnership (NPP) is holding a virtual meeting open to the public next Monday, March 29 from 11:00 a.m. - 1:00 p.m.EST. Participants will learn how to get involved in achieving the National Priorities and Goals, and hear about current and upcoming work. Partners and other key stakeholders will provide updates on progress since the last NPP meeting, including activities surrounding the population health priority, coordination with the nursing community, and child health.

Click here to register.
Click here to view the agenda.

About the National Priorities Partnership

The National Priorities Partnership is the right people coming together at the right time, committed to real action that will transform the nation’s healthcare system. The 32 Partner organizations have significant influence over healthcare, uniquely positioning them to improve America’s health and healthcare system. The Partnership has a vision for world-class, affordable healthcare and is transforming healthcare from the inside out.

Where Patient Safety Really Counts – at the Bedside: A Conversation with Pam A. Thompson

By Pat Muccigrosso, contributor for Nursing News on NurseZone.com

Patient safety is not a new topic. It has been making headlines and driving practice reviews and changes for nurses for years. It has also been the object of intense research and study by organizations like the Agency for Healthcare Research and Quality (AHRQ).

Every year since 2003, AHRQ has released a report on health care quality which tracks several measures, including patient safety. Although progress has been made overall, findings released in their most recent report revealed that, "...reporting of hospital quality is leading improvement but patient safety is lagging."

Other organizations like the National Patient Safety Foundation (NPSF) have mounted a concerted effort to raise awareness of safety initiatives and provide resources for hospitals and health care providers to use, such as Patient Safety Awareness Week, March 7-13, 2010. But for Pam A. Thompson, the focus of a lot of these efforts is on nurses -- the women and men doing battle on the front lines at hospitals across the country.

Thompson, MS, RN CENL, FAAN, is chief executive officer of the American Organization of Nurse Executives (AONE), a national professional organization which has been providing leadership, advocacy and research to advance nursing practice and patient care since 1967. She believes patient safety starts with nurses.

Click here to read the interview.

INQRI Grantee Wins NIH Grant for Improvement Science

Kathleen Stevens, Ed.D, R.N., A.N.E.F., won a $3.1 million grant from the National Institutes of Health (NIH) to advance health care improvement projects. Stevens is a professor of nursing and director of the Academic Center for Evidence-Based Practice at the University of Texas in San Antonio and an INQRI grantee, with Robert Ferrer, M.D., as co-principal investigator.

The two-year grant will enable Stevens to create the first national research network for research teams to test improvement strategies in an inter-professional context. Nurse scientists and collaborating researchers and clinicians will use the network to evaluate improvement strategies across multiple sites, share resources and results, and move the most effective strategies quickly to bedside care.

"Improving the quality of health care and patient safety has been a major goal of the federal government, accrediting bodies, regulatory agencies and patient-advocacy groups for at least 10 years, but progress has been slow in actually moving research into improvements that benefit patients," Stevens said in a statement. "Nurses are in a strong position to transform the care given in hospitals. This network provides a national laboratory in which to rapidly test and implement improvements in health care."

Under the project, research teams will be supported through a coordinating center at the University of Texas Health Science Center and a unique web-based collaborative. An improvement science web site was launched earlier this month. The inaugural improvement science summit, supported by the NIH, will be held in July in San Antonio, Texas. Registration fees are supported by the NIH.

Did You Miss Yesterday's Webinar?

Not to worry, it's available on our website!

Special thanks to Michael Cohen and Susan Paparella for updating us on the work of the Institute for Safe Medication Practices.

Click here to download the slides.
Click here to watch the presentation on your desktop.

The next webinar in the Medication Management series will be held on April 14 from 3:00 p.m. - 4:00 p.m. EST.  We will welcome Bruce Spurlock from Convergence Health for an overview of "Beacon, The Bay Area Patient Safety Collaborative."  Click here to register.


The Medication Management webinar series is co-sponsored by the INQRI program and the Gordon and Betty Moore Foundation.

Around the Web Today...

Check out the latest edition of the Health Wonk Review, hosted by RWJF's Health Reform Galaxy Blog.  Writer Minna Jung offers up a full selection of all the health care happenings around the web with a March Madness theme.  Also posted today was this week's edition of Change of Shift, hosted by the Nursing Student Chronicles blog, a new participant in Change of Shift.  INQRI was happy to be featured in both carnivals this week with two of our recent posts.

INQRI Team Offers New Tools to Measure Pain Management

Susan Beck and her colleagues at the University of Utah have published the first phase of their INQRI-sponsored work to develop tools to measure the quality of care related to pain management.

Dr. Beck: The purpose of this phase of our research was to establish content validity of the items and to evaluate whether patients understood each item and were able to make a judgment based on the care provided to them by nurses and their interdisciplinary team. We interviewed 39 hospitalized patients with pain at the end of a nursing care shift. The process allowed the team to produce a 44-item version of the tool that could then be tested in the clinical setting.

Copies of the final version of the tools that resulted from this ongoing work are available upon request. The first tool, "Pain Care Quality (PainCQ) Nursing" includes 14 items that measure three factors: Being Treated Right, Comprehensive Nursing Pain Care, and Efficacy of Pain Management. The second tool, "PainCQ-Interdisciplinary" contains six items that measure Partnership with the Healthcare Team and Comprehensive Interdisciplinary Pain Care. Please contact me at susan.beck@nurs.utah.edu to obtain a copy and request permission to use the PainCQ tools.

You can read the article in the March/April issue of Nursing Research, now available online.

Webinar: An Update from the Institute for Safe Medication Practices

Please join us tomorrow...

INQRI and the Gordon and Betty Moore Foundation are pleased to welcome Mike Cohen and Susan Paparella to our webinar series on medication management.

An Update from the Institute for Safe Medication Practices
Speakers: Mike Cohen and Susan Paparella
Date: Thursday, March 18, 2010: 3:00 p.m. - 4:00 p.m. EST
Click here to register.

Please contact Heather Kelley with any questions.
To learn more about the ISMP, please visit their website.

How do Distractions Impact Nurses?

Distractions and interruptions can be dangerous.

In a new article for Health Leaders Media, "Nurses Say Distractions Cut Bedside Time by 25 Percent," John Commins reports that hospital nurses spend 1/4 of their shift away from the patients' bedside to complete regulatory requirements, redundant paperwork, and other non-direct care, according to a recent online survey of more than 1,600 nurses.

In her INQRI study, "Examining the Impact of Nursing Structures and Processes on Medication Errors," Linda Flynn has also noted the incredible affect that distractions can have on nurses and on the patients in their care. During a hospital visit, she saw a nurse who was unable to find a quiet place to work simply sit in the middle of a chaotic unit hallway to reconcile medications. She further observed that the nurse was interrupted every 45 seconds for tasks that could have easily been done by others on staff or could have waited until she finished. Click here to view Dr. Flynn's study findings on YouTube.

Comment below to share your thoughts on the impact distractions can have on patient care.

The Patient's Contribution to Quality

In a new article in the New England Journal of Medicine, "The Missing Voice of Patients in Drug-Safety Reporting," Dr. Ethan Basche writes about the importance of including patients' experiences with drugs in the drug-labeling process for reporting adverse effects.  The current model assumes that physicians' reports alone adequately describe the experiences of patients.

INQRI agrees that the inclusion of patients' voices during the quality discussion is incredibly important.  In fact, two of our studies were specifically designed with that goal in mind.

In their project, "Quality of Pediatric Nursing Care from the Children's Perspective," Drs. Nancy Ryan-Wenger and William Gardner and their team identified hospitalized children's perceptions of the linkages between the quality of nursing care and outcomes. This study identified the nursing care processes and outcomes that matter most to children during their hospitalization, and estimated the extent to which disparities exist in the quality of their care and outcomes. Researchers found that parents and children reported different perceptions regarding the care the children received.  Click here to watch the YouTube videos of the team's presentation of findings.

Drs. Shoshanna Sofaer and Jean Johnson and their team developed nursing-sensitive quality measures that patients find important and useful.  In their project, "Developing and Testing Nursing Quality Measures with Consumers and Patients," they studied how recent patients responded to existing nursing quality measures and worked on new measures in care coordination.  Click here to download a presentation of the team's findings.

They All Agree...

...from Pronovost, to Gawande, to INQRI's own grantee team at Johns Hopkins, they all agree - handwashing is vitally important to fighting hospital-acquired infections.

Click here to learn how Abington Memorial Hospital in Pennsylvania addressed the problem head on, increasing their handwashing compliance from 31% in December, 2007 to 88% in September, 2009.

Upcoming Event: International Forum on Quality and Safety in Health Care

Improving Quality, Reducing Costs

April 20-23, 2010

Nice, France

The 2010 International Forum on Quality and Safety in Health Care, which takes place in Nice, France, will address increasing challenges and opportunities in health care arising from current global financial pressures.

Keynote Speakers:

• Jim Easton, Director for Improvement and Efficiency for the Department of Health at NHS England
• Sir Michael Rawlins, Chairman, National Institute for Health and Clinical Excellence in England
• Laurent Degos MD, PhD and Chairman, French National Authority for Health

Please click here to learn more about the conference program or to enroll.

National Patient Safety Awareness Week

Patient Safety Awareness Week (March 7 - 13, 2010) is a national education and awareness-building campaign for improving patient safety at the local level. Hospitals and healthcare organizations across the country are encouraged to plan events to promote patient safety within their own organizations. Educational activities are centered on educating patients on how to become involved in their own health care, as well as working with hospitals to build partnerships with their patient community.

For information, check out this article about the week's activities or visit the National Patient Safety Foundation's website.

Also, in honor of this year's theme, "Let's Talk: Healthy Conversations for Safer Healthcare," check out a new conversation with Peter Pronovost in the New York Times.

Finally, nominations are open for the National Association of Public Hospitals and Health Systems' Safety Net Awards. Nominations are due Friday. Click here for more information.

Interested in Weighing in on a New NQF Committee?

The National Quality Forum is seeking to identify and endorse additional measures of outpatient care addressing emergency department and/or urgent care for public reporting and quality improvement. The Additional Outpatient Measures 2010 14-day review of the proposed roster for submitted nominees is now open through Monday, March 22, at 6:00 pm ET. Members and the public can provide comments on the proposed roster and potential vacancies in expertise.

INQRI is very interested in the work of the National Quality Forum (NQF).  Our first call for proposals (CFP) focused on measurement, with a specific interest in testing the effects of implementing the nursing sensitive performance measures endorsed by NQF. Click here to learn about the nine teams funded via our first CFP.

Safe Patients, Smart Hospitals

In Peter Pronovost's new book, Safe Patients, Smart Hospitals, he discusses a "toxic" hospital culture, in which nurses and patients don't feel that they can confront supposedly infallible doctors when they think something is going wrong.

He believes that "hospitals can't improve if they don't acknowledge their errors and try to learn from them."

Dr. Pronovost has commented on the inspiration he has drawn from working with Sorrel King and hearing the story of her 18-month old daughter, Josie, who died as a result of a hospital-acquired, central line infection.  Her story, he has said, inspired him to try to improve hospitals.  He developed a program to prevent central line infections which saved 1,500 lives and $75 million in Michigan over 18 months.  With support from the Agency for Healthcare Research and Quality, Dr. Pronovost and his team are now working with hospitals in each state to implement this program.

Members of Dr. Pronovost's team, David Thompson, Jill Marsteller and Bryan Sexton recently completed an INQRI grant, showing promising results from the first randomized controlled trial to reduce central-line-associated blood stream infections among ICU patients.  Click here to read more about their INQRI project.

Like Dr. Pronovost, INQRI leaders are also inspired by Sorrel and Josie King.  We were very honored when Sorrel presented a webinar for us last month.  Click here to download her slides or view the presentation from your desktop.

Are Error Rates Impacted by Socioeconomic Status?

A new article in the Hartford Courant, "Health Officials Say Adverse Report Data Might Not Tell The Whole Story" details efforts by Connecticut legislators to enact an error reporting law in the state. However, Wendy Furniss, chief of the health care systems branch for the Department of Public Health, explains that her department is in opposition to the bill because they believe that each hospital's size and population served impacts their individual error rates.

What do you think? Is error disclosure enough? Share your comments below.

Click here to read letters submitted to the paper in response to the article.

Translating Research into Practice: The Transitional Care Model

Special thanks to INQRI director Mary Naylor and INQRI national advisory committee member Randall Krakauer for presenting yesterday's webinar: "Translating Research into Practice: The Transitional Care Model."  Thank you, also, to all of our very engaged participants.  The event was well attended and we enjoyed a rich question and answer period. 

If you missed the webinar, you can view it on your desktop or download the slides.

***

This session was part of the "Translation Series," co-sponsored by the Donaghue Foundation.  Our next session will be held in April:

"Diffusion of New Ideas - What Works?"

Speaker: Elizabeth Bradley, Ph.D., Yale University

Date: April 7, 2010: 12:00 p.m. - 1:00 p.m. EST

Click here to register.

For more information on our collaboration with Donaghue, please click here.

INQRI on the Road...

We're pleased to announce that two of our grantee teams will be presenting on their INQRI-funded projects at events this month:

• Dr. Pat Noga will be presenting on her project, "Lessons Learned from State Roll-Out of the NQF Nursing Sensitive Measures" at the spring quarterly meeting of the Massachusetts Organization of Nurse Executives on March 12. Part of INQRI's first cohort, Dr. Noga's team evaluated two statewide implementations of the National Quality Forum's Nursing-Sensitive Measures created to provide hospitals and the public with comparative measures of nursing quality. The two statewide implementations represented a voluntary effort in Massachusetts hospitals and a government mandated effort in Maine hospitals.
  


• Drs. Patti Hamilton and Gretchen Gemeinhardt will be presenting their project, "The Effect of Off-Peak Hospital Environments on Nurses' Work: an Institutional Ethnography" during the American College of Healthcare Executives 2010 Congress, March 22-25. Members of INQRI's third cohort, this project uses Institutional Ethnography (IE) to situate nursing in the center of an interdisciplinary approach to learn how and why off-peak work environments are different, and how they affect nurses' work and patient care. This project will provide researchers with insight into how to account for temporal variations in nurses' work environment when specifying causal models linking nursing care to patient outcomes. The project also will provide stakeholders with materials that help them identify, evaluate and anticipate effects of initiatives to improve efficiency, effectiveness, quality and cost on nursing care provided during off-peak periods.
  

What's Enough in Error Reporting?

In 2005, Sam Mason entered the University of Iowa Hospital for two spinal operations. A hospital acquired infection cost him dearly - the bottom half of both legs and the tips of all ten fingers were amputated due to a severe staph infection.

In an editorial published last Wednesday, the Des Moines Register advocated that Iowa join twenty-seven other states which require hospitals to publicly report adverse events. Although the state currently encourages hospitals to report errors to a non-governmental organization, state Senator Jack Hatch (and the Register) believe that's not enough.

What do you think? What's enough in error reporting? Share your thoughts below.

Click here to read the editorial.
Click here to read more about Sam Mason.