Above All, Do No Harm

Special thanks to Dr. Christopher Landrigan for the presentation he gave on this week's webinar. It was a fantastic discussion focused on his team's study, "Temporal Trends in Rates of Patient Harm Resulting from Medical Care," in the New England Journal of Medicine. Dr. Landrigan and his colleagues examined the rates of harm in ten North Carolina hospitals from January 2002 to December 2007, to determine whether there were any widespread improvements in preventable harms and overall rate of harms. This webinar served as a discussion platform to identify the resources and practices that are needed to translate effective safety interventions into routine practice and to monitor health care safety over time. INQRI grantee Linda Flynn provided a reaction to the study based on her INQRI work.

If you missed the session, don't worry!  You can view the presentation on your desktop or download the slides.

Click here to view the presentation on your desktop.
Click here to download Christopher Landrigan's slides.
Click here to download Linda Flynn's slides.

Enrollment Increase in Doctoral Nursing Programs

According to new data released recently by the American Association of Colleges of Nursing (AACN), enrollment in doctoral nursing programs increased significantly in 2010. The AACN believes that this shows a strong interest in both research-focused and practice-focused doctorates.

This comes at an exciting time, as the Initiative on the Future of Nursing committee has recommended strongly that nurses pursue advanced degrees. In fact, three of the eight recommendations focused on education for nurses:

• Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.
• Recommendation 5: Double the number of nurses with a doctorate by 2020.
• Recommendation 6: Ensure that nurses engage in lifelong learning.

Click here to read the recommendations.

Click here to read about the AACN data.

It's Crunch Time for Nurses in Massachusetts

Policy talks of controlling health care costs runs smack into the real world at the hospital nursing station. Hospital administrators are reorganizing work to become more efficient while maintaining the quality of care. However, many nurses and their unions say the practical result of efficiency plans equals a thin staff placing patients at great risk. This is true across the country, but especially in Massachusetts.

Click here to read the Boston Globe article, "Nursing a Conundrum."

It's Not Too Late! Register for Tomorrow's Webinar

Above All, Do No Harm

Tuesday, March 29, 2011
12pm - 1pm ET
Click here to register.

The webinar will be led by Christopher Landrigan, M.D.M, M.P.H., whose team recently published a study, "Temporal Trends in Rates of Patient Harm Resulting from Medical Care," in the New England Journal of Medicine. Dr. Landrigan and his colleagues examined the rates of harm in ten North Carolina hospitals from January 2002 to December 2007, to determine whether there were any widespread improvements in preventable harms and overall rate of harms. This webinar will serve as a discussion platform to identify the resources and practices that are needed to translate effective safety interventions into routine practice and to monitor health care safety over time.

Preventing Falls in Acute Care Hospitals

INQRI grantee Patti Dykes was recently interviewed for a piece in the American Journal of Nursing regarding her team's FallTIPs toolkit.  This INQRI project addressed gaps in knowledge by establishing linkages between nursing fall risk assessment, risk communication and tailored interventions to prevent falls. The goal of this study was to prevent patient falls by translating an individual patient's fall risk assessment into a decision support intervention. This innovative intervention communicates fall risk status and creates a tailored evidence-based plan of care that is accessible to interdisciplinary team members, paraprofessionals, patients and family members.

Click here to read the interview in the American Journal of Nursing.

New Study Shows Higher Nurse Staffing Levels in Hospitals Can Reduce Rates of Infection, Improve Outcomes for Patients

Numerous studies have established the overall impact of nurse staffing levels on patient outcomes, but those studies have rarely focused on specific hospital units. Little is known about whether higher staffing levels in Intensive Care Units (ICUs) or in non-intensive care units can improve care. It is also unclear whether the impact of nurse staffing is the same in safety net hospitals, which provide care to long-income, uninsured and vulnerable populations and tend to have poorer patient outcomes overall. A new study, published in the current issue of Medical Care, finds that higher staffing levels in both intensive care units and in non-intensive care units improve patient outcomes but not to the same extent in safety net hospitals.

Mary Blegen, Ph.D., R.N., F.A.A.N., professor in Community Health Systems and director of the Center for Patient Safety at the University of California San Francisco School of Nursing is one of the lead investigators of the study, which was funded by the INQRI program. She led an interdisciplinary team with nurse administrators, health service researchers, and health economists that reviewed data from the University HealthSystem Consortium (UHC), which included details on 1.1 million adult patients cared for in 872 units (285 of them ICUs) in 54 hospitals, and the hours of care that nurses provided to those patients.

Researchers found that while the staffing levels were similar in safety net and non-safety net hospitals, patient outcomes were worse in safety-net hospitals. In non-safety net hospitals, higher nurse staffing rates and a larger number of registered nurses (RNs) were associated with fewer deaths due to congestive health failure; fewer incidents in which nurses did not note or initiate treatment in life-threatening situations (failure to rescue); and lower rates of infection, including infection after operations (postoperative sepsis); and fewer patients who were required to stay in the hospital for longer than expected.

“Higher levels of nursing skill and more nurses providing more hours of care, overall, are correlated with better care –shorter hospital stays, fewer infections and lower rates of failure to rescue,” said Blegen. “We suspect that the increase in mortality rates due to congestive heart failure in safety net hospitals are a function of patients’ overall health, rather than staffing rates, but more research needs to be done. We also need to know more about how non-RNs affect patient care.”

Click here to read the article in Medical Care.

REGISTER NOW for Tuesday's Webinar

Above All, Do No Harm
Tuesday, March 29, 2011
12pm - 1pm ET
Click here to register.

The webinar will be led by Christopher Landrigan, M.D.M, M.P.H., whose team recently published a study, "Temporal Trends in Rates of Patient Harm Resulting from Medical Care," in the New England Journal of Medicine. Dr. Landrigan and his colleagues examined the rates of harm in ten North Carolina hospitals from January 2002 to December 2007, to determine whether there were any widespread improvements in preventable harms and overall rate of harms. This webinar will serve as a discussion platform to identify the resources and practices that are needed to translate effective safety interventions into routine practice and to monitor health care safety over time.

Inpatient Mortality Linked to Nurse Understaffing

A recent article by Cheryl Clark for HealthLeaders Media details a newly published study, "Nurse Staffing and Inpatient Hospital Mortality," in the New England Journal of Medicine.

Hospital inpatient mortality increases by 2 percent for each below 8-hour shift and 4 percent for each high turnover, suggests a report by Jack Needleman, professor of health services at UCLA School of Public Health. The report encourages hospitals to measure and adjust nurse staffing to patient needs.

IHI Triple Aim Seminar

The Institute for Healthcare Improvement (IHI) invites you to learn how to be an effective partner in your own community by enrolling in the IHI Triple Aim seminar on April 14-15, 2011, in Boston, MA. During this seminar, you will learn a road map for achieving the IHI Triple Aim — better care for individuals, better health for populations, and lower per capita costs — at your organization.

This seminar is ideal for change agents working in the following types of organizations:

• Integrated delivery systems
• Government agencies and state initiatives
• Health plans
• Social service organizations
• Employer-based health systems
• Business groups on health
• Safety net health care organizations
• Other organizations with the will and capability to fulfill the IHI Triple Aim

Click here to enroll and to learn about the IHI Triple Aim work in which various types of organizations are already involved.

National Patient Safety Foundation's 2011 Patient Safety Congress

How will your organization cultivate patient safety this year?

At the 13th Annual National Patient Safety Foundation's Patient Safety Congress, you will learn from and exchange ideas with patient safety experts and practitioners from around the globe at the only conference with a singular focus on patient safety.

The Congress Preliminary Program is now available.

Click here to register... save $100 if you register by March 25.

Scope of Practice for Nurse Practitioners Discussed in the Senate

As mentioned in the Future of Nursing report, “Leading Change, Advancing Health,” the topic of scope of practice limitations for nurse is one being widely discussed at all levels of care. In fact, Senators Susan Collins and Kent Conrad have recently introduced S 227, The Home Health Care Planning Improvement Act of 2011, which would recognize and authorize nurse practitioners as eligible health care professionals who can order home health services under Medicare. Currently, nurse practitioners are unable to authorize orders for home health care services even though they are authorized Medicare providers.

Click here to read more about the bill.

Click here to learn about the Future of Nursing report.

From KevinMD: Using Different ERs Can Lead to Errors

A recent post on KevinMD.com, "Danger of multiple emergency room visits to different hospitals," warns that making multiple trips to different emergency rooms (ERs) could cause many problems - both to patients' health and to their checkbooks.

"Patients who visited multiple ERs were exposed to the risk of medical errors, adverse events, delays in their treatment while waiting for more information and duplication of testing which added costs. Patients who visited more than two different sites racked up nearly twice the bill ($12,050 on average) compared with patients who went to the same sites ($7,465)."

The post by Jeffrey I. Kreisberg, PhD, discusses the implications of a study recently published in Annals of Internal Medicine, "Patients Treated at Multiple Acute Health Care Facilities: Quantifying Information Fragmentation," by Fabienne C. Bourgeois, MD, MPH; Karen L. Olson, PhD; Kenneth D. Mandl, MD, MPH.

There are multiple reasons why a patient might choose to visit different ERs... and in theory, doing so shouldn't cause errors or jumps in cost.  However, as Dr. Kreisberg observes, many providers have not yet become truly invested in using electronical medical records (EMRs) which could reduce errors. 

The Josie King Foundation provides a free app so that patients can manage their own electronic records.  Click here to learn more.

Batter Up...

How is baseball like healthcare?

Find out over at the Pizaazz blog, where Glenn Laffel has posted the latest edition of the Health Wonk Review.

Now Available: "Patient Safety and Quality: An Evidence-Based Handbook for Nurses"

To assist nurses in understanding what proven techniques and interventions they can use to improve patient outcomes, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared a comprehensive, 1,400-page, handbook for nurses on patient safety and quality.

"Patient Safety and Quality: An Evidence-Based Handbook for Nurses" features the work of many well-regarded scholars, including INQRI grantees: Marita Titler, Sean Clarke, Nancy Donaldson, Mary Wakefield and Joanne Disch.

This volume is now available for download and is organized by the following sections:

• Patient Safety and Quality
• Evidence-based Practice
• Patient-centered Care
• Working Conditions—Work Environment
• Critical Opportunities for Patient Safety and Quality
• Tools

Click here to download the entire volume as a PDF file (10 MB).
Click here to individual chapters.

INQRI Team Recognized for Work on "Aging in Place"

Congratulations to our team at the University of Maryland, led by Barbara Resnick and Sheryl Zimmerman.  Their project on Function-Focused Care recently won a Dorland Health Silver Crown Award in the Aging in Place category.

Dorland Health, a division of Access Intelligence, created the awards program to honor excellence and dedication among industry-leading organizations who provide exceptional services, products, and information to the over 55 community, and also recognizes individual healthcare professionals who achieve great success working with the senior population.

The Resnick-Zimmerman team conducted a randomized controlled trial to test Function Focused Care – Assisted Living (FFC-AL), an intervention designed to maintain and improve function, physical activity, muscle strength, psychosocial outcomes (efficacy expectations and life satisfaction) and decrease adverse events (pain, falls and hospitalizations) among assisted living residents. A total of 171 residents and 96 direct care workers (DCW) were followed for 12 months. Based on observations of care interactions, DCWs in treatment sites provided more function focused care by 12 months than those in the control sites. Residents in treatment sites demonstrated fewer declines in function and spent more time in moderate level physical activity at 4 months and more overall counts of activity at 12 months when compared to residents in control sites. There were fewer transfers to the hospital among those in the treatment sites. There was evidence of dissemination and implementation of FFC-AL within the sites that endured beyond the study period, showing that the team's work led to institutional policy and environmental changes. The study findings suggest that using a FFC-AL approach may help to prevent some of the persistent functional decline commonly noted in these communities, increase time spent in physical activity, and decrease the need for acute care transfers.

Click here to learn more about the Dorland Health Silver Crown Awards.

New States "Campaigning for Action"

The Future of Nursing: Campaign for Action, a Robert Wood Johnson Foundation initiative designed "to ensure that the health care workforce can deliver high quality, patient-centered care to every American," announced the selection of 10 Regional Action Coalitions (RACs). Ten new states will join New Jersey, New York, Michigan, Mississippi and California RACs, which initiated their activities last fall.

Click here to learn more.

The Impact of Health Literacy on Readmission

A recent article in the Washington Post, "Improving Health Literacy Will Decrease Hospital Readmissions, Costs," details the effect that patients' knowledge of health information can have on hospital readmissions.  In fact, the article states that "under health reform, measures to improve patients' ability to obtain, understand and use health information are expected to decrease costly hospital readmissions and complications."

An INQRI team found that nurses are key to the educational efforts that happen at discharge and help prevent readmissions.  Researchers at Marquette University have been studying what hospital-based nurses do to influence outcomes that occur after discharge from a hospital. Specifically, they looked at identifying the contributions that nursing staff make to the quality of discharge teaching on patient outcomes, readiness and readmission rates of patients who are discharged home. They have found that when units had more RN hours per patient day, less overtime hours and fewer vacancies, the discharge teaching was of higher quality, patients reported greater readiness for hospital discharge, and post-discharge utilization of readmission and emergency room visits was lower.  The team published some of their study results in the May 2010 edition of Medical Care.

• Read the abstract on the Medical Care website.
• Read the recent article in the Washington Post.

Next Webinar: Above All, Do No Harm

Much of the current health care research is aimed at improving patient safety and quality of care. The need for these improvements was brought to light ten years ago by the Institute of Medicine's groundbreaking report, To Err Is Human.

Today that work is far from over.

The next webinar in INQRI's Spring 2011 Webinar Series: The Future of Nursing series will focus on the work still to be done to realize the promise of this report.

Above All, Do No Harm
Tuesday, March 29, 2011
12pm - 1pm ET
Click here to register.

The webinar will be led by Christopher Landrigan, M.D.M, M.P.H., whose team recently published a study, "Temporal Trends in Rates of Patient Harm Resulting from Medical Care," in the New England Journal of Medicine. Dr. Landrigan and his colleagues examined the rates of harm in ten North Carolina hospitals from January 2002 to December 2007, to determine whether there were any widespread improvements in preventable harms and overall rate of harms. This webinar will serve as a discussion platform to identify the resources and practices that are needed to translate effective safety interventions into routine practice and to monitor health care safety over time.

Nurse-Led Medical Homes: Increasing Access to Quality Care

The leadership role of advanced practice registered nurses (APRNs) in patient-centered medical homes is the topic of a Tuesday, April 5 day-long symposium at George Washington University in Washington, D.C., hosted by the Nursing Alliance for Quality Care and American Academy of Nurse Practitioners.
National experts, including leaders from NCQA and the Center for Medicare and Medicaid Innovation, will deliver talks and lead panels to bring clarity to accreditation requirements; discuss new opportunities under ACA; highlight nurse-led medical homes that are models for quality care delivery; and deliver new data about the quality of care related to their use.

With the Future of Nursing report recommending removing scope-of-practice barriers for APRNs, this symposium comes at a very important time.  Join the discussion by either attending or participating via webcast.

Learn more about the symposium.

Mentorship Key to Utilizing Best Practices

The Future of Nursing report highlighted the importance of continuing education and mentorship for nurses, so we were pleased to learn about a Transition to Practice study being coordinated through the National Council of State Board of Nursing. The study is aimed at identifying best practices for closing the gap for new nursing graduates as they transition from nursing school to providing care to patients in a complex technical environment.  Newly graduated nurses in the program will work with a mentor during their first six months of employment. The mentors and mentees will both complete training modules and report ongoing progress.

Click here to learn more.

INQRI FallTIPS Study Profiled by AHRQ

We're thrilled to announce that FallTIPS, an INQRI team's fall prevention tool kit, is being featured on AHRQ's Healthcare Innovations Exchange.  Led by Patricia Dykes and Blackford Middleton, the team 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 profile on the Innovations Exchange features a recap of the intervention, how it was designed and offers suggestions for ways other sites can adopt and sustain the innovation.

Click here to access the profile.

Collaborative Approaches to Care: Nurses on Multidisciplinary Teams

As the Future of Nursing committee has encouraged that nurses should be able to practice to the full scope of their education and training and that they be full partners with physicians and other leaders in redesigning health care, nurses' role on health care teams is a topic of much importance.

It was our pleasure to discuss these issues during this week's webinar titled, "Collaborative Approaches to Care: Nurses on Multidisciplinary Teams."  Special thanks to INQRI grantee Robert Ferrer (University of Texas Health Science Center) who served as the moderator for our panel of grantees: Gerri Lamb (Arizona State University), Joanne Disch and Doug Wholey (University of Minnesota) and Cheryl Dennison (Johns Hopkins University).  Dr. Lamb presented on nurse care coordination, Drs. Disch and Wholey presented on nurse-physician co-leadership and Dr. Dennison presented on the participants in a rural hospital collaborative.

Click here to view the presentation on your desktop.
Click here to download Gerri Lamb's slides.
Click here to download Joanne Disch and Doug Wholey's slides.
Click here to download Cheryl Dennison's slides.

Time to Bring Infection Reduction Efforts to ALL Wards

Our blog has frequently posted on efforts to reduce bloodstream infection rates... especially nurse-led efforts like our project at Johns Hopkins (led by David Thompson and Jill Marsteller).  Efforts like these have paid off with a decrease in infection rates, but it looks like there is more work to do...

In a New York Times article from March 1, Denise Grady writes that government researchers have found that bloodstream infections have dropped significantly from 2001 to 2009 in intensive care patients.  However, the researchers found very high rates of these infections in other hospital wards and among patients receiving dialysis.

Click here to read the article.

Click here to read INQRI's previous posts on bloodstream infection rates.

Tennessee Is Short On Nurses, And Those To Teach Them

On Saturday, Tom Wilemon, of The Tennessean, reported how Tennessee is not only short on RNs, but Nurses with advanced degrees as well. Mr. Wilemon detailed how over 3,000 nursing school applications were rejected not on their merit but because there was not enough nursing faculty to teach all the aspiring nurses. The article also mentioned the recommendations made by the IOM's Initiative on the Future of Nursing committee's report: "The Future of Nursing: Leading Change, Advancing Health" as a foundation to change Tennessee nursing education policy.

Click here to read the news article.

Click here to find similar blogposts relating to the IOM's recommendations.

Nurse Practitioners Are Trusted Health Care Providers

For all of those who are regular readers of the blog, this press release is no surprise! On Tuesday, prnewswire.com shared a press release from the Council for Responsible Nutrition describing the effect that Nurse Practitioners have on patients' lives, whether they are aware of it or not. A study conducted by the American Academy of Nurse Practitioners showed that 60% of American adults had no clue as to what NPs actually do yet the same survey revealed that 81% of adults had or knew someone that had direct experience with a NP.

Click here to read the press release.

University Receives Grant For Online Doctor of Nursing Practice Program

Yesterday, Scott Manning of U.S News University Directory reported that Georgia Southern University recently announced they would be creating an online Doctorate of Nursing program after receiving a three-year grant worth $792,000 from the Health Resources and Service Administration (HRSA). This degree program will offer flexibility to current nurses who have rigorous work schedules and want to obtain a DNP part-time. The awarding and utilization of this grant coincide with recommendations made by the IOM's Initiative on the Future of Nursing committee's report: "The Future of Nursing: Leading Change, Advancing Health." It is very encouraging to see the Federal government and a private institution working together on an innovative approach to reduce the looming shortage of DNPs and nurse educators.

Click here to read the article.

Click here to access other blogposts relating to the IOM committee's recommendations.

Texas Senate Panel Advances Bill To Protect Nurses

Yesterday, Sommer Ingram reported in the Houston Chronicle how a bill filed by Senator Jane Nelson will protect nurses from being fired, punished or discriminated against if they were to report malpractice by doctors. This bill is in response to a case in 2009 in which two nurses reported malpractice by the physician they worked for and were subsequently fired after their identities were revealed. One of these nurses even faced criminal charges for "misuse of official information" but was later acquitted. This bill is to be presented to the full Senate in the near future.

Click here to read the news article.

Homes Can Be Classrooms For Nursing Students Too!

Last week, Cindy Stauffer, of lancasteronline.com, reported how an elderly community is assisting nurses in training become more comfortable with treating patients in their own home. This innovative approach to educating new nurses gives insight into how patients live and take care of themselves outside of a hospital. The Lancaster General College of Nursing & Health Sciences has created a course based upon a five week rotation in a community health setting. The students make home visits and perform many tasks a visiting nurse would conduct in order to familiarize themselves with treating patients outside of a typical health care facility.

Click here to read the news article.