Sound Panels Used to Reduce Noise in Michigan Hospital

The University of Michigan Health System in Ann Arbor is experimenting with acoustic panels to diffuse sound in patient hallways and address concerns that hospital noise from monitors and paging systems interrupts patients' sleep and affects their blood pressure and heart rates, FierceHealthcare reports.

The University recently published findings from its pilot study in BMJ Quality and Safety, which indicated that the sound-absorbing panels, which are similar to ones used in music rooms, reduced noise in patient areas by three to four sound decibels.

The hospital is also promoting a “culture of quiet” in patient areas by providing complimentary headphones to patients and families; setting quiet hours in all inpatient areas; setting pagers to vibrate when medically appropriate; coordinating care in order to reduce unnecessary entry into patient rooms during quiet hours; and reminding staff to use quiet voices and behaviors in the patient care setting and to close doors quietly.

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.

The University’s study abstract is available here.

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 Nurse.com 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 Nurse.com.

“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.

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.

Patient Sensor Improves Pressure-Ulcer Prevention Compliance

A three month study of a wearable ulcer prevention technology showed that it was effective in preventing the occurrence of pressure ulcers by increasing adherence to established protocols, according to Leaf Healthcare, Inc., the company that developed the device.

The Leaf system is a wearable sensor that electronically monitors a patient's position and movements and then wirelessly communicates the data collected to central monitoring stations or mobile devices so that nurses and other caregivers can check on patient position and movement. The Leaf sensor also will sound alerts when necessary to ensure that all patients are repositioned according to established turning schedules, to reduce the incidence of pressure ulcers.

Results of the clinical trial were presented this month at the American Nurses Credential Center National Magnet Conference in Dallas. The trial found that use of the monitoring device increased compliance with hospital turn protocols from a baseline of 64 percent at the start of the trial, to 98 percent after the system was implemented.

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.

Webinar to Help Nurses Manage Alarm Fatigue

Advance Healthcare Network for Nurses is hosting a webinar on the issue of nurses facing alarm fatigue. The webinar is scheduled for Thursday, October 16, 2014 from 3:00pm-4:00pm ET. The webinar will provide information about:

• Current literature on alarm fatigue.
• Systems and human issues that contribute to alarm fatigue.
• A system wide approach that can be developed to address alarm fatigue.

The webinar will also feature a question and answer session. Registration is available here. The webinar is sponsored by Covidien.

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.

Rates of Infections, Falls, Pressure Ulcers, Other Hospital Acquired Conditions Drop

Hospitals saw a nine percent decrease in harms experienced by patients from 2010 to 2012, according to a new report from the U.S. Health and Human Services Department (HHS). There were reductions in adverse drug events, falls, infections, pressure ulcers, and other areas, estimated to have prevented nearly 15,000 deaths and 560,000 cases of patients being harmed in hospitals.

The HHS report also shows that the incidences of hospital-acquired infections dropped from 145 per 1,000 discharges in 2010 to 132 per 1,000 discharges in 2012, resulting in 560,000 few incidents in two years, FierceHealthcare reports. Falls and trauma declined 14.7 percent and pressure ulcers fell 25.2 percent.

In addition to lives saved, the reduction in harm to patients saved $4.1 billion according to the report, which credits factors such as diverse public-private partnerships, active engagement by patients and families, and new tools provided by the Affordable Care Act (ACA), with the improvement. In 2011, under the ACA, HHS launched the Partnership for Patients, a nationwide public private initiative to keep patients from being harmed in hospitals and heal without complication. The Partnership shares best practices with more than 3,700 hospitals enrolled in the initiative.

INQRI grantees have conducted a number of studies into how nurses can lead efforts to reduce medical errors and patient harm, including:

• Reducing central line-associated bloodstream 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.
• 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.
•  INQRI grantee Patti Dykes worked with a team to develop the Falls: Tailoring Interventions for Patient Safety (Falls TIPS) online tool kit to educate patients and families about how they can work with nurses and other providers to prevent falls. The toolkit was developed based on the Fall TIP: Validation of Icons to Communicate Fall Risk Status and Tailored Interventions to Prevent Patient Falls study, which involved developing and validating a set of icons designed to communicate fall risk status, and developing tailored interventions to prevent patient falls in hospitals.

The full HHS report is available here.

Nurse Leads Development of Breastfeeding App and Outpatient Services for Moms of Babies Leaving NICU

When tasked with the duty of addressing a dramatic drop-off in breastfeeding rates after moms and babies were released from the NICU, Sara Rosenbaum saw an opportunity to build a community of breastfeeding support with outpatient services, including a breastfeeding app for smart phones.

Rosenbaum is Adventist Hinsdale Hospital’s regional obstetrical educator. Adventist has an 85 percent breastfeeding initiation rate at the time of NICU discharge, but the number drops to 21 percent after the mother and baby go home, Advance Healthcare Network for Nurses reports.

With grant money from CREATION Health, Rosenbaum worked with a mobile developer to create a smart phone app in both English and Spanish for new moms whose babies have been in NICU. The app will be able to be used in conjunction with a breastfeeding clinic and boutique on the grounds of Adventist Hinsdale.

Rosenbaum’s app will include reminder timers, a pumping schedule, and the ability to record the amount of milk the baby receives. “Moms can switch from NICU mode to a regular breastfeeding mode where they can track the number of wet diapers, which breast the baby fed from last, etc,” she told Advance Healthcare Network for Nurses.

A question and answer section will also be available on the app, with an appointment feature to book follow-up visits at the breastfeeding clinic and boutique. The boutique will have pumps, rentals, and other breastfeeding supplies available.

INQRI has funded several research teams that have created innovations to improve patient outcomes. Among them is a study led by Tracey Yap that involved developing a protocol to reduce pressure ulcers among long-term care residents. The “Interdisciplinary Mobility Team Approach to Reduction of Facility-Acquired Pressure Ulcers” included using music played at regular intervals to remind long-term care staff to encourage residents to move, or more those who could not move of their own accord, to avoid pressure ulcers.

Changes to Alarms Helps Reduce Noise Fatigue, Protect Patients

A new study aims to address reports of alarm fatigue, which have plagued nursing staff and contributed to negative health outcomes for patients, by determining variables that would safely reduce noncritical alarms on a general medical-surgical unit.

For the study, published in the Journal of Cardiovascular Nursing, Boston Medical Center reduced its weekly audible cardiac alarm rate by 89 percent, which increased the satisfaction rates of nurses and other staff, and their patients. Deborah A. Whalen led the study, which involved changing alarms for bradycardia, tachycardia, and heart rate limits to "crisis," FierceHealthcare reports.

Nursing staff who participated in the study had to view and act on the alarm each time it sounded, and self-resetting alarms were eliminated. The research team found that by eliminating alarms with self-reset capabilities, hospitals can significantly reduce the volume of calls without compromising patient safety.

The Joint Commission praised the Boston Medical Center study in a news release. The Commission previously issued a Sentinel Event Alert about alarm-related deaths and identified alarm safety as a 2014 National Patient Safety Goal. The Commission's two-phase National Patient Safety Goal aims to combat alarm fatigue, FierceHealthcare previously reported. The first phase, which began January 1, 2014 heightens awareness of the potential risks associated with clinical alarms and the second phase, which will begin January 1, 2016, will introduce requirements to mitigate those risks.

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. Dr. Yap blogged about the study and some unexpected results on the RWJF Human Capital blog.

Preventing Pressure Ulcers is the New Priority

Preventing pressure ulcers, rather than dealing with them as a “normal complication” for sick patients, is now common practice in many health facilities, according to an article in HealthLeaders.

One such facility, Crouse Hospital in Syracuse, N.Y., took action against pressure ulcers after it ranked higher than all but 105 other acute care hospitals reporting data on pressure ulcers in 2011, according to the article. Crouse launched numerous initiatives to reduce all of its preventable hospital-acquired conditions (HACs), including a control chart that tracks pressure ulcers at all severity stages by quarter. Teams with both nurse and physician educate frontline staff to be on the lookout for the earliest signs of skin redness and work with a team of wound ostomy nurses to evaluate patients who might be at higher risk.

In addition to the control chart, patient skin assessments are taken on a daily basis at Crouse and new beds designed to prevent pressure ulcers were purchased for the entire hospital. With these pre-emptive initiatives in place, Crouse's rates of severe decubitus ulcers are dropping, hospital officials told HealthLeaders.

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.

Music Eases Anxiety and Need for Sedation, Pain Medication for Patients on Ventilators

A study published online in the Journal of the American Medical Association reveals that listening to music can help soothe critically ill patients who are on ventilators, reducing their anxiety, need for pain medication and sedation. Reearchers conducted the trial with 373 ventilator patients in the ICU and found that those who listened to music for 80 minutes a day reduced their anxiety by nearly 20 points compared with those who did not.

The patients were divided into three groups: those who listened to white noise, those who chose music to listen to and those who received usual care, with neither intervention.  Being able to select the music they listened to also had an impact. Patients who chose their music and listened to it when they wanted to and for as long as they wanted required sedation less often that patients in the control or white noise group.

Most patients in the study had been intubated for respiratory failure or distress and all were alert and able to follow commands.

An INQRI-funded study led by Tracey Yap and Jay Kim found another use for music: reducing 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 couldn't move on their own. Dr. Yap blogged about the study and some unexpected results on the RWJF Human Capital blog for National Nurses Week.

Another INQRI-funded study, led by Michele Balas and William Burke, focused on helping critically ill patients on ventilators stay alert, calm and delirium-free. The researchers tested an intervention that used a nurse-led interprofessional team to implement a bundle of evidence-based practices related to communication, standardized care, and reducing sedation and the amount of time patients spent on a ventilator.