Doctors Learn from Shadowing Nurses at Illinois Hospital

A program launched by a nurse and doctor at an orthopedic surgery center is proving that physicians can benefit from shadowing nurses during shifts.

The program was launched at Presence St. Joseph Medical Center in Joliet, Illinois, by Patient Care Manager and RN Barbara Walker and Orthopedic Surgeon Michael Murphy, who co-chair a floor improvement subcommittee at the Center. Murphy was one of the first doctors to participate in the “shadowing” experiment, and it gave him great insight into how much is involved in a normal nursing shift, he told Nurse.com.

For instance, Murphy was surprised to see how, when a physician’s computer order is not clear, it can delay patient treatment. The complexity of the job, including medication administration was also eye-opening, he said.

“They [the doctors] didn’t realize how hard it was just to get pain medicine,” Walker said. “I think it gave them a good appreciation of what our barriers are and what are successes are, too.”

The initial shadowing project has received such a positive response that it was continued this spring and nurses said they would like to see it spread throughout the hospital and health system.

Collaboration, Communication Needed Between Nursing, Pharmacy Staff

Medication management decisions must be made with clear communication and collaboration between the nursing and pharmacy departments to avoid errors and negative patient outcomes, according to a recent Advanced Healthcare Network for Nurses article written by Executive Nurse Consultants Robin Fowler and Kevon Garrison of Aesynt, a company providing pharmacy automation technology and systems. Additionally, each hospital must find a medication distribution model that fits with its workflow and nurse leaders should have a strong voice in its selection. They write:

“The use of pharmacy technology is important to strategically improving the medication management process, but if decisions are made without nursing input, there can be unforeseen consequences. ... When the pharmacy and nursing departments meet frequently and all stakeholders are focused on the same end-goal, the outcome is a medication management model that produces fewer errors, greater efficiency and better patient outcomes.”

An INQRI-funded study examined acute care hospitals to determine the relationships among characteristics of the nursing practice environment, nurse staffing levels, nurses’ error interception practices, and rates of nonintercepted medication errors. The study, “Nurses’ Practice Environments, Error Interception Practices, and Inpatient Medication Errors,” was published in the June 2012 issue of the Journal of Nursing Scholarship and found that nurses’ error interception practices are associated with lower rates of nonintercepted medication errors.

The INQRI study also found that a supportive practice environment—reflected in factors including teamwork and nurses’ opportunities to participate in hospital- and unit-level decisions—is associated with a higher quality of nursing care.

The study was conducted in a sample of 82 medical-surgical units recruited from 14 U.S. acute care hospitals in New Jersey, and included 686 registered nurses.Linda Flynn and Dong-Churl Suh led the research.

New Study Finds Adverse Drug Events Are the Most Common Adverse Events in High Income Countries

An international study of medical harm in hospitals reveals that in high income countries, including the United States, the most common adverse events are adverse drug events, occurring in five percent of hospital stays.

The research team analyzed 4,000 articles examining substandard care in hospitals, focusing on seven key facets of poor care: adverse drug events; catheter-associated urinary tract infections; catheter-associated bloodstream infections; hospital acquired pneumonia; blood clots; and pressure ulcers.

They found for every 100 hospital admissions, 14 cases of substandard care occurred in high-income countries, for a total of  nearly 17 million cases of harm. Thirteen occurred in low- and middle-income countries, for a total of nearly 26 million cases of harm.

The research team noted that adverse drug events are among the most preventable adverse events. The study was reported on on the DoctorsLounge website.

An INQRI-funded study led by Linda Costa and Robert Feroli, evaluated the effectiveness of using a nurse-pharmacist team to oversee medication management during the transition from hospital to home and from hospital health care provider to primary care provider to prevent adverse drug events. Nurses in the study, which was published in the Journal of Nursing Quality Care, were able to detect medication discrepancies and help correct them. They were also able to encourage patients to fill prescriptions and take them in the correct doses.

New Survey Shows Nurse Practioners Spending More Time on Patient Education and Medication Adherence

A survey of nurse practitioners (NPs) and physician assistants (PAs) conducted by Manhattan Research reveals that NPs are playing a central role in helping patients adhere to their medication regimens and also spending more time on patient education - both of which are crucial in improving quality of care and patient outcomes.

According to the survey of 909 NPs and PAs, nearly nine in ten NPs provide resources to patients that help them with medication adherence (including three in ten who have referred patients to digital tools to help with adherence, and almost half of NPs report spending more time on patient education in the last two years.

The survey findings are highlighted in a new infographic.

Several INQRI research teams have examined the role of nurses in medication management, including ways home healthcare nurses can help with adherence; the impact of nursing processes on medication errors; and ways nurses and pharmacists can collaborate on medication reconciliation. And an INQRI research team led by Marianne Weiss and Olga Yakusheva identified the impact of nurses' discharge teaching on patient outcomes, discharge readiness, and readmission rates. A brief on that study was recently posted.

The Value-Added of Electronic Medical Records

An article in ADVANCE for Nurses looks at the ways in which health information technology is improving care, outcomes and nurses' work environments in health care settings around the country, particularly when that IT is built with nursing in mind.

At Baptist Health South Florida, patient barcodes allow nurses quick and easy access to their patients' full profiles. The barcodes have dramatically reduced wait time for pain medication and also helped to ensure that nurses know the exact doses and frequency of dosage for each of their patients' medications. Several INQRI studies have addresses nurses' role in medication management, including reducing medication errors and improving regimen adherence post hospital discharge.

Other uses of health IT, include automating the admissions process, so that when information on a patient is recorded during intake, that information is shared with other health care providers and hospital staff who may help provide care.

The article also discusses younger nurses' higher comfort level with information technology and ways that hospitals are successfully orienting new hires to their electronic medical records (EMR) systems and how schools of nursing are preparing students to use those records. A recent post on the RWJF Human Capital Blog by Ann Marie Mauro, an associate professor at NYU College of Nursing discusses how the college's simulation program also helps nursing students learn how to use EMR.

Reflections on INQRI's Work

This video provides an overview of the impact INQRI has had on the delivery of high quality care.  Please watch this video to learn more about the type of work INQRI has funded since its inception and comment below with your thoughts.

   

This post is part of our week-long blog carnival focused on the Medical Care supplement.  Click here to access all posts in this carnival.

INQRI Grantees Find Nurses' Practice Environment Linked to Identification of Med Errors

INQRI grantee Linda Flynn was recently interviewed for a piece on Nurse.com which discusses the work conducted by Dr. Flynn and her team on nurses' interception of medication errors.  As noted in the team's recent article in the Journal of Nursing Scholarship, nurses perform many practices that are associated with lower rates of non-intercepted medication errors.  The study closely examined acute care hospitals to determine the link between nursing practice environment characteristics, nurse staffing levels, nurses' interception practices and the rates of non-intercepted medication errors.

Click here to learn more about the study.
Click here to read Monday's article on Nurse.com.

INQRI in the News

Check out some recent news coverage of INQRI projects...

Last week, we told you about a new journal article authored by INQRI grantees who found that a combination of strategies and practices can reduce deadly hospital acquired infections.  These findings were the topic of two new articles:

• "Proven Strategies Reduce Deadly Hospital-Acquired Infections," HealthCanal.com
• "Proven strategies successful in reduction of deadly hospital-acquired infections," MedicalXpress.com

An INQRI journal article published in August continues to receive press.  This project found that better work environments for nurses led to fewer medication errors.  It was recently covered on three more sites:

• "Study: Supportive Nursing Environment Linked to Reduced Medication Errors," Becker's Hospital Review.com
• "Medication Errors," OncLive.com
• "Nurses’ interception practices reduce costly errors," Nurse.com

INQRI Project on Reducing Medication Errors

At the end of August, we shared that the findings from an INQRI project showing that better environments for nurses contributed to fewer medication errors were published in the Journal of Nursing Scholarship.

Since that time, the study has continued to garner interest in the press.  Check out some of the latest stories:

• "Better Nursing Environments Reduce Medication Errors," NurseZone.com

• "Nurses Catch More Medication Mistakes in Supportive Hospitals," FierceHealthcare.com
  
  

INQRI Team Finds that Better Environments for Nurses Mean Fewer Medication Errors

The findings of an INQRI study led by Linda Flynn were published in the Journal of Nursing Scholarship recently.  The article explains that nurses’ error interception practices—including independent comparisons between the medication administration record and patient record at the beginning of a nurse’s shift; determining the rationale for each ordered medication; requesting that physicians rewrite orders when improper abbreviations are used; and ensuring that patients and families are knowledgeable regarding the medication regimen so that they can question unexplained variances—are associated with lower rates of nonintercepted medication errors, further quantifying the important role of nurses in enhancing patient safety.

Click here to read more about the study.

Click here to read coverage on this study by Equities.com.

Click here to read the coverage on PharmaLive.

Practice Environment Impacts Medication Error Interceptions by Nurses

INQRI grantees Linda Flynn, Dong Suh and their team were recently published in the Journal of Nursing Scholarship with their article, "Nurses' Practice Environments, Error Interception Practices, and Inpatient Medication Errors."  They concluded that supportive practice environments enhance nurses' medication error interception practices.

Click here to access the article.

Nursing Programs Aim To Help Seniors

This past weekend, Amanda Cuda, reporting for CTpost.com, detailed how universities in Connecticut have altered their curriculum and training efforts to address to prominent issues for the geriatric population, medication management and fall prevention. These programs reflect the evolving care trends as the baby boomer generation continues to age.

Click here to read the article.

Click here to read other blogposts relating to medication management.

Click here to read other blogposts relating to fall prevention.

INQRI's Five Most Read Blogposts of 2011

On behalf of the INQRI program staff and leadership team, we would like to wish all of you a safe and happy holiday & New Year.

Below you will find the five most read blogposts from 2011.

Please feel free to comment and share your favorite post from this year!

Interdisciplinary Pilot Study Suggests Nurses Can Help Chronically Ill Patients Properly Manage Medication after Being Discharged from Hospital Nurses Bridged Gap Between Leaving Hospital with Prescriptions and First Visit with Primary Health Care Provider

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

INQRI Project Featured in Health Services Research

Expanding Nurses' Scope-of-Practice in the News

The Future is Now for Nurse Practitioners

INQRI Study Examines Preventing Readmissions With Nurse Intervention

On Tuesday, INQRI alumni, Dr. Linda Costa and her team's INQRI supported study was featued on healthleadersmedia.com. The article, written by Rebecca Hendren, detailed how Dr. Costa's study sent nurses on home visits to discuss medications and solve problems that prevented patients from sticking to their regimens. This nurse-led intervention found that talking with patients and their families improved their understanding of their medication regimen and increased compliance.

Click here to read the full article.

Click here to read other blogposts relating to medication management.

WIHI Free Audio Event on Thursday, Sept. 22, Focuses on Medication Management

This upcoming Thursday, the Institute for Healthcare Improvement (IHI) hosts another WIHI free audio program that focuses on managing medication shortages during a crisis. This event will feature: Frank Federico from the IHI, Michael Cohen from the Institute for Safe Medication Practices, and Lynn Eschenbacher from WakeMed Health & Hospitals. These individuals are pharmacy-trained improvers who've tapped their medication safety expertise to help hospital staff effectively manage crisis situations.

Click here to register for the event.

Click here to read other blogposts relating to medication management.

Temp ER Nurses a Safety Threat to Patients, Study Shows

According to new research from Johns Hopkins University School of Medicine, temporary emergency room nurses who are unfamiliar with their surroundings may inadvertently be a threat to the patients they serve. As reported by John Commins, for HealthLeaders Media, the study found that the temporary help was twice as likely as permanent staff to be involved in medication errors in the hectic and fast-paced environs of the ER.

Click here to read the news article.

Click here to read additional blogposts related to nurse staffing.

Interdisciplinary Pilot Study Suggests Nurses Can Help Chronically Ill Patients Properly Manage Medication after Being Discharged from Hospital

Nurses Bridged Gap Between Leaving Hospital with Prescriptions and First Visit with Primary Health Care Provider

Medicare will soon release new rules requiring hospitals to focus more attention on patients after they are discharged. Readmissions have cost Medicare $26 billion a decade and the program plans to cut payments to hospitals that have high readmission rates. Nonadherence to medication regimens may be one factor in high readmission rates. After leaving the hospital, patients are not always likely or able to adhere to the medication regimens they were prescribed, sometimes with disastrous results. Without supervision from a health care provider, some patients either never take the prescribed medication, or take the wrong dosage. One study found that more than seven in ten (72 percent) of adverse events after a patient left the hospital were related to medication.

A new study, conducted by an interdisciplinary research team based at The Johns Hopkins Hospital including two nurses and a pharmacist, and funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), indicates that the solution may lie with having a registered nurse oversee medication management during that transitional period. The study is in the current issue of the Journal of Nursing Quality Care.

“It can be days, weeks or even months before a patient sees his or her primary care provider after leaving the hospital,” said Linda L. Costa, Ph.D., R.N., N.E.A.-B.C., nurse researcher at The Johns Hopkins Hospital and assistant professor at Johns Hopkins University School of Nursing. “Very often, during that time, no one is checking to be sure that the patient is taking the right doses of the medication at the right times, or even that the patient is taking medication at all. And even if they meet sooner with their primary care providers, there’s not always a guarantee that the provider will have access to the hospital records for that patient in a timely fashion. Having a nurse coordinate care during this period can literally make the difference between remaining at home or going to the emergency room in some cases.”

Medication Discrepancies: The Problem and the Solutions

Check out this awesome video created by an INQRI grantee team led by Cindy Corbett and Stephen Setter.

In their INQRI project, they used information technology to help home care nurses more efficiently and effectively identify and resolve medication discrepancies as patients transitioned from the hospital to home. Researchers evaluated whether the intervention had an impact on patients' emergency department visits during the first month after hospital discharge. The intervention group participants had fewer emergency department visits during the first 30 days after the index hospitalization. These findings demonstrate both the importance and the complexity of medication information transfer during care transitions from hospital to home.



Medication Discrepancies (3 Minutes) from Washington State University on Vimeo.

Pharmacists and Nurses Are The Most Effective Health Care 'Voices' in Promoting Medication Adherence

As reported on PRnewswire.com, a new study has found that nurses are the second most influential voice encouraging patients to stay on their medications. The study reviewed over forty years of published medical journals and found that hospital-based nurses are more effective than pharmacists communicating to a patient via the telephone or doctors instructing patients regarding prescriptions.

Click here to read the article

INQRI Team Leaves Lasting Impression

CentraState Medical Center was one of the participating hospitals in a medication error study funded by the INQRI program: “Examining the Impact of Nursing Structures and Processes on Medication Errors.” Based on their findings, Linda Flynn, Dong Suh and team recommended that sites explore ways in which to reduce nurse interruptions while administering medications.

Acting on that recommendation, Jayne Craig, Ph.D., R.N., from CentraState has received funding to implement and test an intervention to reduce nurse interruptions.

In this new undertaking, CentraState Medical Center proposes to demonstrate whether an intervention designed to reduce nurse interruptions that occur at the time of medication administration (in contrast to those that occur during transcription, preparation, etc.) results in fewer medication errors in the community hospital, medical-surgical setting.

The principal investigator of the INQRI study was a guest blogger for us on Monday, discussing her work in regards to the Future of Nursing report published last week. Click here to read her post.