If the U.S. Lacks Doctors, Can Nurses, Optometrists and Pharmacists Take Their Place?

Health Leaders Media, Cheryl Clark, 04/26/2010

The Association of American Medical Colleges' predicts that the nation's physician shortage will grow from 25,000 today to 150,000 in 15 years. Who will treat the millions more people who will have health coverage for the first time under health reform? Some of this care is almost certain to come from non-physician providers expanding their education and scope of practice.

Click here to read the story.

We've Said it Before... Nurse Interruptions Can Lead to Medication Errors

Interviewed about a new study just published in the Archives of Internal Medicine, INQRI researcher Linda Flynn is quoted as saying, "Patients and family members don't understand that it's dangerous to patient safety to interrupt nurses while they're working.  I have seen my own family members go out and interrupt the nurse when she's standing at a medication cart to ask for an extra towel or something [else] inappropriate."

The study found that nurses who are interrupted have an increased risk of making a medication error.  The research team observed nurses in two teaching hospitals in Sydney, Australia from September 2006 through March 2008.  The study included 98 nurses prepping and administering 4,271 medications to 720 patients.  Less than 20% of these interactions was completely error free.

You can download a copy of the study, "Association of Interruptions With an Increased Risk and Severity of Medication Administration Errors"  via the journal website.

 

More posts on this topic:

• How Do Distractions Impact Nurses?
• Reducing Distractions = Reducing Medication Errors
• Ten Years Later: Look to Nurses as Champions of Patient Safety

Discovery Channel Documentary on Medical Errors

If you missed the new Discovery Channel documentary, "Chasing Zero: Winning the War on Healthcare Harm," you can catch it when it airs again on Saturday, May 1, or you can watch it here. In the film, Dennis Quaid, whose newborn twins were accidentally given an overdose of Heparin, presents the stories of patients who have died due to medical errors. He also sings the praises of those who are working to reduce preventable deaths to zero.

Read more at TIME.

Quality Measures and Nursing

Despite the $2.3 trillion spent on U.S. health care, public and private payers still have a hard time measuring whether the kind of care they are paying for is of the highest value and produces the best outcomes. Nurses represent the largest group of health care professionals in the United States and have a direct affect on patient care, yet quality measures historically have focused on treatment of conditions or diseases, not on the care delivered by nurses. That changed in 2004, when the National Quality Forum (NQF) endorsed the first set of nationally standardized performance measures to assess the quality of care provided by nurses who work in hospitals.

By focusing on patient centered outcome measures such as prevalence of pressure ulcers and falls, as well as restraint use and frequency of catheter-associated infections, the NQF began to examine the link between what nurses do and the quality of care they provide. INQRI has played an important role in adding to the evidence about the utility of the NQF-endorsed Nursing Sensitive Measures by promoting the development and testing of new measures designed to both improve care and nursing performance, as well as reduce costs.
 
Click here to download a research synthesis on this topic.

INQRI Director: "Nurses play a central role in the prevention of hospital readmissions."

Hospital readmission and emergency department utilization within the first 30 days following hospital discharge represent adverse, potentially avoidable, and costly outcomes of hospitalization.

In a new article for Nurse Week, Cathryn Domrose writes about the success INQRI director, Mary Naylor, has had with her transitional care model to help reduce hospital readmissions. In fact, Naylor’s studies have shown an average per patient savings of $5,000 one year after hospitalization.

For more information on the transitional care model, please click here.

INQRI researchers Marianne Weiss and Olga Yakusheva have recently completed their project, "A Quality and Cost Analysis of Nurse Practice Predictors of Readiness for Hospital Discharge and Post-Discharge Outcomes." This interdisciplinary team broke new ground by linking the unit-level nurse practice environment and nursing care processes with patient outcomes at discharge and post-hospitalization. Specifically, the study examined direct and indirect causal relationships between the nursing practice environment, the discharge teaching process and readiness for hospital discharge with hospital readmission and emergency department utilization.

Are Hospital Rankings Popularity Contests or Measures of Quality?

In an article published yesterday, Janice Simmons wonders if hospital rankings are true measures of quality.

Each year since 1990, U.S. News & World Report has ranked more than 5,000 hospitals in a variety of categories.  They present a "Top 50" in each one, with the goal of helping consumers select the hospital that is right for them.  However, a study recently published in the Annals of Internal Medicine claims that the standings do not really reflect objective measures of quality.

Tell us what you think - are rankings true quality measures?

Center to Champion Nursing in America Releases Latest E-Newsletter

This week, the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation, released the second edition of its Champion Nursing Quarterly News Digest.  This latest edition addresses the role of nurses in health care reform, including meeting the increased demand as more patients enter the health care system.


Read the April issue of the newsletter.

Better Nurse-to-Patient Ratios Can Save Lives

INQRI NAC member Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, has just published a study in Health Services Research examining California's 2004 nurse staffing ratio mandate.  Aiken found that if the same ratio had been used in Pennsylvania and New Jersey hospitals in 2006, the states would have seen a reduction in deaths among general surgical patients by 10.6% and 13.09% respectively. 

"All hospitalized patients are likely to benefit from improved nurse staffing, not just general surgery patients," Aiken says, adding that "the potential number of lives that could be saved by improving nurse staffing in hospitals is likely to be many thousands a year."

This work comes at a very important time - 18 states (including Massachusetts, Minnesota and Illinois) are considering lowering their ratios.

To learn more about this study, please click here.

To read an interview with Dr. Aiken regarding nursing's role in health reform, please click here.

Implementation Science and QUERI

Special thanks to Brian Mittman for today's webinar presentation on the VA Quality Enhancement Research Initiative (QUERI).  If you missed the session, you can download the slides or view the presentation via the INQRI website:

PowerPoint Presentation

Webinar Recording

The Translation Series has been co-sponsored by the INQRI program and the Donague Foundation.  For more information on this collaboration, please visit the Funders Forum blog.

Commonwealth Webinar on Eliminating CLABSIs

An archive of The Commonwealth Fund's April 14 webinar, "Getting to Zero: Strategies to Eliminate Central Line-Associated Bloodstream Infections," is now available for download. The event was moderated by Anne-Marie J. Audet, M.D., M.Sc., Commonwealth Fund vice president for the Program on Health Care Quality and Efficiency and featured:

• Lucian L. Leape, M.D., adjunct professor, Department of Health Policy and Management, Harvard School of Public Health
• Peter J. Pronovost, M.D., Ph.D., director, Johns Hopkins University Quality and Safety Research Group
• Brian S. Koll, M.D., medical director and chief, infection prevention, Beth Israel Medical Center.

An INQRI team at Johns Hopkins is engaged in this work, as well.  Click here to read about their project.

 

Last Translation Webinar TOMORROW

Thank you to everyone who has made our translation webinar series a success! Unfortunately, all good things must come to an end... the last session will be held tomorrow:

Implementation Science and QUERI
Speaker: Brian Mittman, Ph.D., VA Quality Enhancement Research Initiative (QUERI)
Date: April 20, 2010: 2:00 p.m. - 3:00 p.m. EST
Click here to register.

The Translation Series has been co-sponsored by the INQRI program and the Donaghue Foundation, continuing the partnership formed with last year's Funders Forum.

If you missed the earlier sessions in this series, please click here.

Please contact Heather Kelley with any questions.

The Health and Human Services Department Cites a Need for Improvement on HAIs

According to a report released last week, U.S. hospitals have offered "very little progress" in eliminating hospital-acquired infections (HAIs). The Health and Human Services department's 2009 quality report encourages "urgent attention" be paid to keeping patients safer.

Click here to learn more.

Recent blog entries on this topic:

• How Teamwork Can Reduce the Risk of Infection
• Safe Patients, Smart Hospitals
• What's Enough in Error Reporting?
• "There's Absolutely Nothing as Painful as a Pressure Ulcer"

Beacon, the Bay Area Patient Safety Collaborative

Special thanks to Bruce Spurlock from Convergence Health for Wednesday's webinar on Beacon, the Bay Area Patient Safety Collaborative.

Please click here to watch the presentation on your desktop.

In addition to leading a very interesting discussion, we must also thank Dr. Spurlock for turning us on to the hit song "Turn the Patient" - the key for keeping those HAPU rates down.



This webinar was part of the Medication Management webinar series, co-sponsored by the Gordon and Betty Moore Foundation.

Tax Day...

It's tax day and the excitement abounds. People rushing to get that April 15 postmark, fighting with Turbo Tax and standing in line at Starbucks and other chains determined to make the day go smoother with a few freebies.

David Harlow's HealthBlawg offers another treat today... a tax day-themed version of the Health Wonk Review. And while we never imagined that the founding of McDonalds and one of our grantee projects would be featured in the same paragraph... well, what can we say? Anything can happen on tax day.

Enjoy!

Nurses Key to Understanding the "Off-peak Effect"

Drs. Patti Hamilton, Gretchen Gemeinhardt, Sondip Mathur and their team recently had their article, "Expanding What We Know About Off-peak Mortality in Hospitals" published in the Journal of Nursing Administration.

Dr. Hamilton: For more than thirty years, weekend and/or night time hospitalizations have been associated with negative patient outcomes. Descriptive studies have verified the presence of this “off-peak” effect in twenty-five patient diagnostic groups but have done little to explain the cause of this effect. We believe nurses can help us to understand what happens on off-peak shifts that may lead to negative patient outcomes. The purpose of our INQRI-funded study is to describe challenges nurses encounter and deal with on off-peak shifts, and to explain how those challenges arose in institutions designed to avoid any such outcomes. Our research to date suggests a number of steps that nurse administrators might take to enhance their knowledge for handling off-peak challenges in their hospitals. Visit our study website at http://www.nursingopen247.com/ for more information about the study and for useful resources.

Click here to access the article on the Journal of Nursing Administration's website.

"Trust Your Caregiver... Not the Handoffs"

On MSNBC's Morning Joe yesterday, actor and patient safety advocate Dennis Quaid and Dr. Charles Denham (co-chair of the National Quality Forum Safe Practices program) reminded viewers that "we don't have bad people [in health care], we have bad systems" as they talked about the engagement of patients and family members in the fight against medical errors.

Visit msnbc.com for breaking news, world news, and news about the economy

For more information on INQRI's webinar series focused on medication management, please visit our website. This series is co-sponsored by the Gordon and Betty Moore Foundation.

Leapfrog CEO on CPOE

Last week, Leah Binder, the CEO of the Leapfrog Group, was a guest blogger for the Health Affairs blog.  She wrote about her recent experience touring a hospital that had adopted computerized physician order entry (CPOE).  Since Leapfrog had included the adoption of CPOE as one of the first standards on their hospital survey, Binder was thrilled to hear that the hospital's recently adopted CPOE system had already reduced errors, saved time and more importantly, saved lives.

In her post, Binder discusses the "pain" of adopting CPOE and suggests next steps.  Read her post here.

***

INQRI is very interested in the work of The Leapfrog Group.  Our grantee team at the Medical University of South Carolina studied and assessed a hospital patient safety reporting initiative implemented by Leapfrog as part of their project, "Linking Processes of Nursing Care and Patient Safety Outcomes: An Analysis of the Cause and Effect of Safe Practice."  Click here to watch a video series of Dr. Lindrooth presenting their study findings.

Effective Nurse Communication Integral to Patient Safety

A new study in the American Journal of Nursing reaffirms that a link exists between effective nurse communication and patient safety.  In "Nursing Handoffs: A Systematic Review of the Literature," authors Lee Ann Riesenberg, Jessica Leisch and Janet Cunningham highlight the barriers to and strategies for effective handoffs.  They found that despite the negative consequences of inadequate handoffs, little research has been done to identify best practices.

“Nursing handoffs occur when shifts change two or three times daily, seven days a week, yet despite the frequency of these events, there are few evidence-based standardized procedures to ensure that communication is managed effectively,” according to Dr. Riesenberg. “Errors in communication give rise to substantial clinical morbidity and mortality and, therefore, must be addressed.”

Read more.

Interested in Learning About the Bay Area Patient Safety Collaborative? Register Now!

Please join us next Wednesday for the next session in our Medication Management Webinar Series:

Beacon, The Bay Area Patient Safety Collaborative
Bruce Spurlock, Convergence Health
April 14, 2010: 3:00 p.m. - 4:00 p.m. ET
Click here to register.

In 2007, INQRI worked with the Gordon and Betty Moore Foundation (GBMF) to plan a day-long convening which brought researchers together with stakeholders to discuss the impact of medication errors. We are continuing this partnership with a series of webinars that began last October.
 
Click here to read an INQRI research synthesis focusing on medication errors.

Diffusion of New Ideas - What Works?

Special thanks to Dr. Elizabeth Bradley for today's webinar presentation, "Diffusion of New Ideas - What Works?" If you missed the session, please visit the INQRI website to either:

Download the slides as a PDF, or
View the presentation from your desktop.

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.

The next session in this series will be held on April 20 at 2:00 p.m. ET. "Implementation Science and QUERI" will be presented by Brian Mittman, Ph.D., VA Quality Enhancement Research Initiative (QUERI).
Click here to register.

Patient Safety Advocates: Health Reform Can Reduce Errors

Patient safety advocates believe that the new health reform bill will lead to a reduction in hospital errors by establishing financial incentives for safer care and requiring that some mistakes be made public.

"More reforms are needed to protect patients from preventable medical harm, but the new law creates a solid foundation that will help ensure that the health care we are paying for is safe," said Lisa McGiffert, director of the Consumers Union's Safe Patient project.

Click here to read the article in the Times Union.

The Issues Surrounding Medication Management

The Institute of Medicine noted that a hospital patient on average is subject to at least one medication error per day, making medication errors the most common cause of preventable adverse events.

Last week it was announced that the Medication Management Research Network at the University at Buffalo's New York State Center of Excellence in Bioinformatics and Life Sciences has a new role in preventing errors.  The organization is helping to improve patient safety in Western New York and was recently designated by the federal government as a Patient Safety Organization.  Click here to read more about this announcement.

The INQRI program is deeply committed to investigating the issues surrounding medication management.  We have funded three projects focused on different aspects of this work:

"Examining the Impact of Nursing Structures and Processes on Medication Errors"

Rutgers University
Dr. Linda Flynn and Dr. Dong Suh

This interdisciplinary study was designed to disentangle the effects of nursing structures and care processes on non-intercepted medication errors in acute care hospitals. The economic impact of non-intercepted medication errors was determined to explore the business case for evidence-based recommendations.

"Nursing-Pharmacy Collaboration on Medication Reconciliation: A Novel Approach to Information Management"

Johns Hopkins Hospital
Dr. Linda Costa and Dr. Robert Feroli

Deficits in communication across the continuum of care in regards to medication use can place patients at serious risk for harm. This interdisciplinary team examined how to economically support direct care providers in medication reconciliation in order to facilitate safe transition to and from hospital and community. The team evaluated the effectiveness of a nurse-pharmacist clinical information coordination team in improving drug information management on admission and discharge, quantified potential harm due to reconciliation failures, and determined cost-benefit related to averted harm.

"Empowering Home Care Nurses to Efficiently Resolve Medication Discrepancies"

Washington State University
Dr. Cynthia Corbett and Dr. Stephen Setter

To contribute to a better understanding of the potential for home care nurses to lead in the identification and resolution of medication discrepancies during transitions between hospital and home care providers, this team will conduct a clinical trial that investigates a new nurse-led, informatics-based intervention. They hypothesize that with this improvement in their environment, home care nurses already on staff can enhance patients' outcomes, reduce healthcare costs, and eliminate the need for duplicative services by external consultants or specialty providers.

Click here to read an INQRI research synthesis focusing on medication errors.

INQRI has also worked with the Gordon and Betty Moore Foundation (GBMF) to explore the issues surrounding medication management.  In 2007, INQRI and GBMF hosted a day-long convening which brought researchers together with stakeholders to discuss the impact of medication errors. We have continued this investment with a series of webinars that began last October.  The next webinar will feature a participant from the 2007 meeting.  On April 14, Bruce Spurlock from Convergence Health will give an update about Beacon: the Bay Area Patient Safety Collaborative.

Click here to view the webinars from Fall 2009.
Click here to view the webinars from 2010 and register for those yet to come.

INQRI Featured in RWJF's Nursing E-Newsletter

INQRI was pleased to be included in the most recent edition of RWJF's "Sharing Nursing's Knowledge."

Click here to read the story, which gives details on the selection of our final cohort of grantees and profiles two previous grantees, Linda Flynn and Nancy Ryan-Wenger.