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.

CLASBIs Rates Improved When Hospitals Implement Airline Industry Approach

Hospitals around the country are reducing central line associated bacterial infections (CLASBIs) by taking a “plane crash” instead of a “car crash” approach in their efforts, according to a VOX special report.

The theory is that car companies see accidents as unavoidable, no matter how much work goes into prevention. The aviation industry, however, treats each crash as potentially preventable and investigates how it could have been prevented. A similar divide exists among hospitals when it comes to treating CLASBIs central line infections, Vox reports.

While some hospitals view the infections as bad but inevitable, other hospitals “see each central line infection as a failure that requires investigation and better preventive techniques in the future.” And many of these “plane crash” hospitals are reducing infections, in part by empowering nurses and giving them the tools to prevent infections.

Peter Pronovost, a critical care physician at Johns Hopkins University in Baltimore, created a simple five-item checklist that centers on cleanliness when inserting central lines, and changing the dressing, and implementing changes such as centralized stock carts. But one of the most significant changes the hospital implemented was to instruct nurses to “call out” doctors who were not following checklists. Within three months, CLASBIs decreased by 50 percent, and they decreased by 70 percent after six months.

Hospitals in Michigan and California Follow Suit

After hearing of the success at Johns Hopkins, the Michigan Hospital Association implemented a similar the protocol at about 60 hospitals in the state, and realized a 70 percent decrease within three months. Similarly, Roseville Medical Center in California implemented its own version of Pronovost’s checklist and also gave an 18-nurse vascular access team exclusive responsibility for inserting and monitoring central lines. For seven years after the new program was instituted, Roseville did not have a single central line infection.

When the hospital’s seven year streak broke in 2014, Roseville decided to investigate. The investigation revealed that subcontracted nurses who treated dialysis patients, but who were not part of the central line team, were responsible for the infections. As a result of the findings the hospital now requires annual competency checks for contract nurses who manage central lines.

“The Roseville response mirrors what airlines do at a moment of crisis: analyze the situation and implement new policies that could prevent the same type of problem in the future.”

Reducing CLASBIs 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 full VOX article is available here.

Intervention Efforts Leads to Reduced Risk for Liver Patients

A nurse-led intervention improved rates of vaccination for Hepatitis A and Hepatitis B for patients awaiting liver transplantation, ultimately reducing the risk of disease and other post-transplant complications, according to an article in Medscape Medical News.
 
During the American Association of Nurse Practitioners 2015 National Conference Shari Perez of the Mayo Clinic in Scottsdale, Arizona told attendees that patients were nearly 9.5 times more likely to complete the vaccination series after a nurse intervention system was implemented at the clinic.

The new protocol incorporated a vaccine tracking system using the department database, and improvements to order entry for required vaccines and vaccine-scheduling practices.  The protocol also involved patient mail-in vaccination cards and an electronic medical record patient-flagging system for providers.

The full article is available here. (Free registration required.)

Magnet Aspirations Can Give Hospitals a Path to Excellence

Ann Kutney-Lee, PhD, RN, FAAN and Linda H. Aiken, PhD, RN, FAAN

More than 400 hospitals nationwide have been recognized as Magnet hospitals by the American Nurses Credentialing Center for demonstrating excellence in nursing. The link between Magnet status and better patient outcomes and better working environments for nurses when compared with hospitals that have not achieved Magnet status is well-established.(1) What is less clear is whether hospitals that have attained this status were already excellent or whether they achieved excellence through the rigorous process of working toward Magnet certification.

We conducted and recently published one of the first longitudinal studies to address that question, and the answer is that the work that must be done during the extensive application and review process to attain Magnet status substantially improves nurse work environments and better outcomes for patients and for nurses result.(2)

We analyzed 1999 to 2006 data for 136 Pennsylvania hospitals (11 hospitals that went through the Magnet review process and 125 that did not). And overall, those hospitals that pursued and obtained Magnet status made significant and lasting change at the patient, nurse and organizational levels.

The study, “Changes in Patient and Nurse Outcomes Associated With Magnet Hospital Recognition,” recently published in Medical Care, found that in 1999, hospitals pursuing Magnet status performed at the same level as or worse than non-Magnet hospitals on a range of measures, including risk-adjusted rates of mortality 30 days after surgery, and failure-to-rescue. By 2006, emerging Magnets had progressed significantly ahead of their non-Magnet counterparts, demonstrating markedly greater improvements including 2.4 fewer deaths per 1,000 patients for 30-day surgical mortality, 6.1 fewer deaths per 1,000 patients for failure-to-rescue, and lower adjusted rates of nurse burnout, job dissatisfaction, and intent to quit.

While becoming a Magnet hospital is a significant undertaking – and can be a costly one – our findings, coupled with the body of research documenting that Magnet hospitals provide higher quality care, establish a strong business case for pursuing Magnet status. Even the process of working toward certification boosts patient safety and increases retention of nursing staff, which saves the cost of recruiting and training new hires. Further, our results are consistent with another recent study published in Medical Care that demonstrates the economic benefits associated with Magnet status.(3).

We undertook a longitudinal study because nearly all previous studies of Magnet hospitals have relied on a cross-sectional design, which limits the researchers’ understanding of the causal relationship between Magnet status and improved outcomes.  With this longitudinal evidence, our study can give hospital leaders a different perspective on the potential for improvement. And the take-away for them is that pursing Magnet status is an investment that’s well worth it.


1. McHugh MD McHugh MD, Kelly LA, Smith HL, Wu ES, Vanak J, Aiken, LH.  2013.  Lower mortality in Magnet hospitals.  Medical Care.  51:382-388. 
2. Kutney Lee A, Stimpfel A, Sloane DM, Cimiotti J, Quinn LW, Aiken LH.  2015.  Changes in patient and nurse outcomes associated with Magnet hospital designation.  Medical Care.  53(6):550-557.
3. Jayawardhana J, Welton JM, Lindroth RC. 2014. Is there a business case for Magnet hospitals? Estimates of the cost and revenue implications of becoming a Magnet. Medical Care.52:400-404.


Ann Kutney-Lee, PhD, RN, FAAN, is an assistant professor of nursing at the University of Pennsylvania School of Nursing and Linda H. Aiken, PhD, RN, FAAN, is a professor and the director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. Their study was funded by the Robert Wood Johnson Foundation Initiative on the Future of Nursing.

Palliative Study Identifies Best Measures of Quality Care

A recent study out of the University of Rochester seeks to identify the best available set of measures to evaluate whether facilities are delivering the highest quality service possible to palliative care and hospice patients, and their families, Epoch Times reports.

The study, “Measuring What Matters,” was led by Sally Norton, associate professor in nursing and palliative care at the University of Rochester. It narrows down 10 “Measures That Matter” from a list of 75 indicators, based on what’s most important to patients and families. They include:

• Comprehensive assessment, including physical, psychological, social, spiritual, and functional screening soon after admission;
• Screening for pain, shortness of breath, nausea, and constipation during admission;
• Documented discussion regarding emotional needs and spiritual concerns; 
• Documentation of their preferences for life-sustaining treatments; and
• Adherence to documented preferences to withhold or withdraw life-sustaining treatments.

Researchers for the study, which was published in the Journal of Pain and Symptom Management, chose scientifically rigorous measures that: were meaningful for patients and their families; are able to be implemented by providers; and that can significantly improve the level of care. Researchers hope that this study will eventually create health care benchmarks for the industry.

Norton and her colleagues also recommend developing a method for identifying all patients who could benefit from palliative and hospice care, and developing a survey for patients or their families that is valid in all settings.

The INQRI-funded “Nursing's Specific Contributions to Quality Palliative Care within the Context of Interdisciplinary Intensive Care Practice” explored the relationships between quality palliative nursing care delivered in intensive care units (ICUs) and patient and family outcomes. It also explored how to measure and to improve these outcomes. The purpose of this investigator-initiated study was to examine nursing's specific contributions to quality palliative care provided to patients and their families in the ICU. This interdisciplinary team was led by Lissi Hansen and Richard Mularski.

Mobile Apps Empower Nurses to Use Evidence-Based Guidelines, Identify Health Problems

A new nurse-led study concludes that custom mobile health applications can help nurse practitioners use evidence-based guidelines, which would improve their ability to diagnose health issues during exams, MHealthNews reports.

Mobile apps that include clinical decision support tools helped clinicians diagnose chronic health issues, according to the study led by Suzanne Bakken, alumni professor of nursing at Columbia University School of Nursing.

The study, published in the Journal for Nurse Practitioners, examined the diagnosis rates of nearly 400 nurses during more than 34,000 patient exams and found significant diagnostic rate increases:

• Seven times more obese and overweight (33.9% vs. 4.8%)
• Five times more tobacco use (11.9% versus 2.3%)
• 44 times more adult depression (8.8% versus 0.2%)
• Four times more pediatric depression (4.6% versus 1.1%)

“What clinicians need is decision support tools that fit into their workflow and remind them of evidence-based practices,” Bakken said in a statement. "Our app focused specifically on the work that nurse practitioners do to identify health problems, counsel patients and coordinate care plans, resulting in higher diagnosis rates and more opportunities for intervention."

The goal of an INQRI-funded project “Dissemination and Implementation of Evidence-Based Methods to Measure and Improve Pain Outcomes” was to disseminate and implement evidence-based approaches to measure and improve pain care and outcomes in a sample of 100 hospitals across the United States. Two webinars are available detailing the results of the project: Webinar I and Webinar II. The interdisciplinary team was led by Susan Beck and Nancy Dunton.

INQRI Advisor to Lead Study on Nurses’ Impact

A new survey of more than 250,000 registered nurses (RNs) will help to generate evidence about how nurses impact the outcomes of their patients, according to a Nurse.com article. INQRI Research Manager and National Advisory Committee Member Linda Aiken will lead the survey of RNs and Nurse Practitioners holding active licenses in California, Florida, New Jersey, and Pennsylvania.
 
Aiken is the director of the University of Pennsylvania, School of Nursing’s Center for Health Outcomes and Policy Research (CHOPR). The National Institute of Nursing Research provided a $2.9 million grant to CHOPR for the survey, which is titled Panel Study of Effects of Changes in Nursing on Patient Outcomes. RWJF, the National Council of State Boards of Nursing, the Hillman Foundation, and the Boettner Center also provided funding.

“Our study will examine organizational-level changes over time in nurse inputs in education, staffing, skill mix, and work environment between 1999, 2006 and 2015,” Aiken said in a statement on CHOPR’s website. “The great strength of this project is that in creating a panel of organizational observations, we can see where change has occurred and why.”

INQRI Funded Study: More than Half of Ventilated ICU Patients Have Ability to Communicate

Assistive communication tools could benefit more than half of patients in intensive care units (ICU) who are using ventilators to help them breathe, according to a new study co-funded by the INQRI program.

“Our findings challenge the commonly held assumption of many clinicians and researchers that these patients are unable to communicate or participate in their care,” INQRI grantee and study co-author Mary Beth Happ said in a statement. Happ is a professor of nursing at The Ohio State University.

The study found that 53.9 percent of the patients screened met basic communication criteria and could possibly benefit from the use of assistive communication tools and speech language consultation, including such simple tools as notepads and pens.

“Establishing lines of communication is the first step in a patient being able to make his or her needs known and have accurate symptom assessment and management, and contributes to an overall better patient experience. We know from interviews with patients who remember their critical care experience that the inability to communicate is anxiety producing and, in some cases, terrifying,” said Happ.

The study, which involved screening nearly 3,000 mechanically ventilated patients over a two year period, appears in the January/February 2015 issue of the journal Heart & Lung and is co-authored with Happ’s colleagues from the University of Pittsburgh. The study is co-funded by the National Institutes of Health.


Happ’s previous INQRI work includes the study “SPEACS2: Improving Patient Communication and Quality Outcomes in the ICU,” which examined the value of a nurse-generated and nurse-led innovation by testing the impact of a computer-based nurse communication training and materials program (SPEACS-2) on intensive care unit patient care outcomes. The interdisciplinary research team included Amber Barnato, who also co-authors Happ’s current research.

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 Satisfaction, Outcomes Could Improve with Use of Nursing Quality Analytics Data

Having access to a quality analytics database that measures clinical data specific to the role of nurses as well as data about the nursing environment, could help improve patient satisfaction and outcomes nationwide, according to Christina Dempsey, chief nursing officer at Press Ganey.

Press Ganey, an organization that works to help hospitals and other medical facilities improve patient experiences, recently acquired the National Database of Nursing Quality Indicators (NDNQI) from the American Nursing Association (ANA). NDNQI includes clinical quality measures and corresponding information on nurse engagement and the nursing environment. Press Ganey is distilling the data into four areas that affect the patient experience. They believe this approach will ultimately help their clients decide where to invest in improvements.

“Nurse-sensitive indicators reflect the structure, the process and the outcomes of nursing care,” Dempsey told HealthITAnalytics. “The structure of nursing care is indicated by the supply of the nursing staff, the skill level of the nursing staff, and the education of the nursing staff.  Process indicators measure things like assessments, intervention, and job satisfaction.  And then outcomes are those things that improve if there’s a greater quantity or quality of nursing care, such as pressure ulcers and falls.”

“… Being able to bring some of that data together will allow managers, clinicians, and nurses at the bedside better understand what they need to do for which population of patients to get the highest and best return,” Dempsey said.

Incorporating Patient-Reported Outcomes in Care Plans Beneficial

Improving two-way communication between patients and caregivers can improve outcomes for cancer patients in palliative care, particularly in the area of patient-reporting, according to an oncology nurse specialist and nurse scientist Jeannine M. Brant of the Billings Clinic in Montana.

During the American Society of Clinical Oncology’s inaugural Palliative Care Symposium Brant told participants “we really have a propensity to underestimate symptoms – not only the incidence, but also the severity of the symptom, and also what type of distress that symptom is causing for that individual patient. We need to incorporate patient-reported outcomes [PROs] into our clinical practice,” according to an article in The Oncology Report.

There are numerous reasons for a breakdown in communication between a care provider and patient, including patients’ embarrassment to disclose certain symptoms, the article notes. Physicians and nurses may not ask about specific symptoms due to gaps in their knowledge or time constraints.

Brant presented findings from a pilot study with the semi-automated care planning system On Q that uses both patient-reported and clinical data to generate a customized draft patient care plan. More than 90% of patients in the pilot reported being satisfied with the system and said they would recommend it to others, with one participant commenting that it provided a reminder to bring up issues they were dealing with.

An INQRI study, Nursing's Specific Contributions to Quality Palliative Care within the Context of Interdisciplinary Intensive Care Practice, explored the relationships between quality palliative nursing care delivered in intensive care units and patient and family outcomes. The study also explored how to measure and to improve these outcomes. This interdisciplinary team was led by Lissi Hansen and Richard Mularski.

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.

Finding Solutions for Stressed Out, Exhausted Nurses, and Potentially Depressed RNs

A new survey of more than 3,300 registered nurses (RNs) shows that a majority were extremely stressed out due to lack of sleep, long hours, and numerous other workplace issues.

These high levels of stress and fatigue could lead to medical errors, and negative patient outcomes, as well as an increase in nurse burnout, further aggravating the current nursing shortage, according to the study by the Vickie Milazzo Institute, a legal nurse consulting training institute.

Among the findings, 64 percent of respondents indicated that they rarely get seven to eight hours of sleep and 33 percent said they hardly ever get that amount. Twelve-hour shifts and on-call shifts after regular shifts and overnight shifts contribute to the fatigue problem, according to the study. Fatigue and irregular sleep patterns can also lead to health problems for nurses, including increased risk of depression and anxiety disorders.

An INQRI-funded study, published in the May/June 2012 issue of the journal Clinical Nurse Specialist, looked at how depression and musculoskeletal pain among nurses impacts workplace productivity and quality of patient care. Researchers found that nurses experience depressive symptoms at a rate twice as high—18 percent—as the general public. The team found that pain and depression were significantly associated with presenteeism, which was significantly associated with patient falls, medication errors, and the perceived quality of care. Additionally, depressed workers often exhibit low mood, have difficulty concentrating, and are accident-prone.

The researchers analyzed surveys from 1,171 hospital nurses in North Carolina and found that the productivity loss due to pain and/or depression was $14,339 per nurse and $876.9 million for the state of North Carolina. If these numbers were extrapolated to the nation, the productivity loss would be $22.7 billion.

Addressing the Problems

According to the Milazzo study, other factors contributing to high levels of stress for RNs are an unhealthy work/life balance, lack of authority, recognition, and fair pay in the workplace, and lack of effective management. To address these issues, the study recommends that hospitals:

• Make work hours for RNs realistic and sane;
• Provide access to nutritious food;
• Allow experienced RNs to have the authority to do their jobs and provide RNs with management opportunities; and
• Improve management style to recognize RN’s unique contributions and provide fair pay, adequate paid time off, and a positive work environment.

As the INQRI study points out, it is also imperative to devote more attention to depression screening and early treatment for nurses. Advanced practice nurses can educate staff RNs about the high prevalence of depression in nurses, who, like the general population, may be reluctant to get screening and treatment, due to the social stigma attached to mental illness. The study identified Web-based screening as a confidential and cost-effective means of reaching the nursing population.

Other strategies for assisting nurses with depression include increasing staff nurses and managers’ awareness of and sensitivity to depression, advocating policies that support good mental health and treatment for those with problems, and promoting supportive work environments, according to the study.

The Effects of Nurse Presenteeism on Quality of Care and Patient Safety was led by INQRI grantees Susan Letvak and Christopher J. Ruhm.

The Vickie Milazzo Institute survey results are available here.

National Nurse Leadership Training Program Yields Results in Boston

A nursing team from Boston that took part in a national leadership training program has shown measurably improved patient outcomes and a combined $8 million in anticipated annual savings for their hospitals. The Boston initiative is part of a broader training program conducted by the American Association of Critical-Care Nurses (AACN).

AACN directs and funds the AACN Clinical Scene Investigator (CSI) Academy, a 16-month, hospital-based nurse leadership and innovation training program. The program empowers bedside nurses as clinician leaders whose initiatives generate quantifiable improvements in patient care and cost savings, according to an AACN media statement. Teams of staff nurses from participating hospitals take part in the training.

The Massachusetts AACN CSI Academy teams recently presented the results of their projects at an Innovation Conference in Boston, reporting successes such as:

• Decreased the average length of stay in the intensive care unit (ICU) for ventilated patients by nearly eight days using an early mobility program;
• Reduced incidence of pressure ulcers acquired while in the ICU by 50 percent;
• Improved communication between units, leading to a 100 percent decrease in patient handoff incident reports;
• Decreased the average number of mechanical ventilation days for ICU patients; and
• Improved assessment of ICU-related delirium in critical care patients, leading to improved cognitive scores and decreased benzodiazepine use in patients with documented delirium.

The Massachusetts team is the third group to complete the Academy, after Indiana and North Carolina. Hospitals in New York, Pennsylvania, and Texas are currently participating and nursing teams from 42 hospitals will have completed the program by the end of 2014, according to AACN.

AACN’s searchable Innovation Database provides access to a compilation of CSI team results and documentation, including real-world project plans, clinical interventions, data collection tools, outcomes and references.

Webinar Highlights Benefits of Nurse Informaticists as Team Leaders

A recent webinar highlights the success of White Plains Hospital, in White Plains, NY, in implementing a evidence-based interdisciplinary plan of care (IPOC) led by nurse informaticists to improve patient outcomes. Zynx Health, which acted as White Plains’ evidence-based care coordination technology partner, hosted the webinar in conjunction with Health IT Outcomes.

During the webinar, experts explained that much of IPOC’s success was due not just to technology, but also to a strong organizational culture shift within the organization toward a team-based approach. Prior to the implementation of IPOC, only nurses owned care plans. Afterward, it became clear that care plans needed to involve multidisciplinary teams, Health IT Outcomes reports.

White Plains Hospital was able to develop and implement the plans quickly. The team customized 55 IPOCs in less than three days and deployed them in under eight months. They reported a significant increase in interdisciplinary collaboration, and more meaningful documentation about patient goals.

The new IPOC also helped White Plains Hospital decrease its average Length of Stay from 4.81 days to 4.75 days. The initiative has also helped the hospital reduce both development and documentation time.

Slides from the webinar are available to view here.

When It Comes to Cost and Quality of Hospital Care, Nurse Tenure and Teamwork Count

This post originally appeared on the Robert Wood Johnson Foundation Human Capital Blog.

The largest study to examine the relationship between nurse staffing and patient care reveals that patients get the best care when they are treated in hospital units staffed by teams of nurses who have extensive experience in their current jobs. The study, conducted by an interdisciplinary team including Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy at the Columbia University School of Nursing and Ciaran Phibbs, PhD, research economist at the Health Economics Resource Center at the Palo Alto Veterans Administration Health Care System, was funded by the Interdisciplinary Nursing Quality Research Initiative (INQRI).

The research team reviewed more than 900,000 patient admissions over four years (from 2003 through 2006) at hospitals in the Veterans Administration Health Care System. They analyzed nurses’ payroll records and patients’ medical records to see how nurse staffing affected patients’ length of stay. Longer hospital stays tend to be associated with delays and errors in care delivery, so shorter stays indicate better care. Shorter stays also reduce the cost of care.

Researchers found that a one-year increase in the average tenure of registered nurses (RNs) on a hospital unit was associated with a 1.3 percent decrease in the average length of stay.

The study also found that patients’ length of stay was longer when a member of a team of experienced RNs was missing or a new member was added to the team. Stone, one of the principal investigators, notes that “when the same team of nurses works together over the years, the nurses develop a rhythm and routine that lead to more efficient care.”

The researchers note that their findings suggest that hospital executives should consider policies that will help them retain experienced nurses and that encourage nurses to remain on their current units.

The paper, “Human Capital and Productivity in a Team Environment for the Healthcare Sector” was published in the April 2014 issue of American Economics Journal: Applied Economics.

The Robert Wood Johnson Foundation created INQRI to generate, disseminate, and translate research to understand how nurses contribute to and can improve patient care quality.

New Hospital Initiative Involves Nurses Conducting Universal Screening for Depression

Hospital patients who have undiagnosed depression often have a slower and more difficult recovery. Now, nurses at Cedars-Sinai hospital in Los Angeles, are leading efforts to screen all patients for possible depression, Nurse.com reports.

The new process is designed to help nurses detect symptoms of clinical depression characterized by a severely disheartened mood, lowered activity level, and persistent negative thoughts lasting longer than two weeks.

“We know, based on multiple medical studies over several years, that addressing depression improves all aspects of patient health,” Linda Burnes Bolton, Cedar-Sinai’s vice president for nursing, CNO, and director of nursing research, said in a news release. Burnes Bolton served as liaison to INQRI’s national advisory committee prior to joining RWJF’s Board of Trustees. “By routinely screening our patients for depression upon admission, we can ensure that they receive the appropriate treatment and protocol.”

For the new initiative, an RN will interview each patient within 24 hours of admission, asking questions about mood and energy level. If the answers indicate possible depression, the nurse will use a standard, detailed questionnaire to assess other depression symptoms, including any thoughts of suicide. If possible depression is found, Cedars-Sinai social workers and physicians will determine an appropriate intervention for the patient. For patients who are suicidal, the nursing department will notify the patient’s physician and protect the patient from self-harm.

Nurse-Led Interventions Reduced Shortness of Breath, Fatigue in Lung Cancer Patients

A nurse-led symptom management program conducted in Canada showed improvements for patients with lung cancer in the areas of dyspnea, or shortness of breath, and fatigue. Nurses provided patients with information and support, according to a study presented at the Oncology Nursing Society (ONS) 39th Annual Congress.

Researchers at the Grand River Regional Cancer Centre in Kitchener, Ontario, Canada, conducted the study in partnership with the Dyspnea Management Clinic. Oncology nurses used the results of an assessment of patients’ understanding of their symptoms to develop a protocol for patients with underlying lung cancer, Oncology Nurse Advisor reports. The protocol included:

• Assessment of breathlessness,
• Understanding the meaning of symptoms,
• Recognition of problems that require medical intervention,
• Offering breathing retraining,
• Use of relaxation technique, and
• Goal setting.

Each of the 43 patients participating received a one-hour consultation combined with follow-up visits. Their understanding of symptoms was measured by advanced nurse practitioners. The nurses could then implement a comprehensive approach to address dyspnea symptoms. Scores for dyspnea and tiredness were significantly improved in all patients when compared to a previous control group of 40 patients. The results demonstrate that oncology nurse-led interventions are effective methods for improving symptom management in patients with lung cancer, according to the researchers.

The role of nurses in providing care to cancer patients was explored by an INQRI team at the University of Utah. Led by Susan Beck, this interdisciplinary team designed a robust measure to assess adult patients’ opinions about how nurses manage cancer-related pain. Beck and her team developed an instrument using qualitative and quantitative data to elicit patients’ opinions about how their nurses and other members of their care team managed their pain and, ultimately, to help patients select hospitals based on this dimension of their care experience.

Webinar Explores how Nurse Informaticists Improve Patient Outcomes

An evidence-based care plan implemented by nurse informaticists improved patient outcomes in a White Plains, New York hospital. The plan, and factors in its success, will be analyzed in an upcoming webinar.

The webinar, scheduled for May 15, 2014 at 2:00 p.m. eastern, is hosted by Zynx Health in conjunction with Health IT Outcomes. It will explore an initiative at White Plains Hospital where nursing leadership implemented evidence-based care plans and saw care plan utilization increase from 58 percent to 95 percent. User satisfaction among clinicians increased as well. Factors in the success included nurse informaticists who brought a rich history of experience as staff nurses and informaticists that helped bridge the communication gap between clinicians and informaticists, according to Health IT Outcomes.

Further information and registration for the webinar is available here.

Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice, according to the Healthcare Information and Management Systems Society (HIMSS).