Nursing Leaders, Finance Professionals Should Improve Collaboration, Understanding

Nurses and finance professionals can align to improve finances at hospitals and health systems through a better understanding of their respective roles, a key nursing leader told attendees at the Healthcare Financial Management Association annual 2014 conference.

Pamela Thompson, CEO of the American Organization of Nurse Executives (AONE), suggested that understanding the importance of patient safety, and the changing science behind it, is one of the key steps in achieving alignment, Healthcare Finance News reports.

Nurses and other frontline providers deliver value to hospitals, but finance professionals often do not have a complete understanding of what they do, Thompson said in her remarks, noting that “the value of nursing is beyond the individual task performed … [it is] in the health outcomes achieved per dollar of cost spent.”

Patient safety is one area in particular that offers an opportunity to improve finances, particularly as the science surrounding patient care is becoming increasingly sophisticated. However, creating a safety culture takes time and resources and it can mean facing up to fears that reporting errors will lead to repercussions and retaliation, Thompson said.

“We have to convey the message that every time we reduce harm, we reduce costs,” Thompson said. “But we still need to work together to better determine the cost of allowing harm to occur. How do we measure the total patient harm rate per discharge?”

Ultimately financing and nursing professionals need to work collaboratively on questions such as these for the benefit of hospitals and patients, Thompson said. “Our commitments are very similar, we just articulate them differently. We have to align our goals, understand the interfaces and realize where coordination is essential.”

AONE houses the national program office of the RWJF Academic Progression in Nursing program.

Research Brief: Tailored Plan to Prevent Patient Falls

This week, we present the work of a team led by Patti Dykes and Blackford Middleton which has 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 team constructed the Fall Prevention Toolkit (FPTK), and conducted a randomized controlled trial to examine whether the FPTK led to a decrease in the incidence of patient falls and a decrease in the incidence of patient falls with injury. The use of their toolkit did significantly lower the incidence of falls in the intervention units and several units wished to continue using the tool after the conclusion of the study. By establishing links between nursing fall risk assessment, risk communication and tailored interventions to prevent falls, Dykes and Middleton hope to raise awareness of fall risks for patients, nurses and other providers and to lower mortality and morbidity for potential fall victims.

Access the research brief.

Example of a Fall TIPS Bed Poster
Example of a Fall TIPS Plan of Care
Example of Fall TIPS Patient Instructions

This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Nurse Burn-Out and Infections

A new study, published in the American Journal of Infection Control, presents the work of researchers at the University of Pennsylvania, who analyzed nurses' attitudes related to their work.  The team compared a hospital's percentage of "burned-out" nurses to its rates of surgical site infections and catheter associated urinary tract infections.  They found that every 10% increase in the number of high-burnout nurses correlated with two additional surgical site infections and one additional catheter associated urinary tract infection per 1,000 patients annually.

The INQRI program has also generated evidence that depression among nurses could have an impact on patient safety.  INQRI researchers Sue Letvak, Chris Ruhm, and their team evaluated the influence of presenteeism (decreased productivity due to health problems) on hospital registered nurses' quality of patient care.  The team found that pain and depression were significantly associated with presenteeism and that presenteeism was significantly associated with patient falls, medication errors and the perceived quality of care.

Of course, INQRI research has also shown that nurses can have a strong impact on keeping patients safe from infections.  Led by David Thompson and Jill Marsteller, a team at Johns Hopkins conducted the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. This study, conducted in ICUs in 12 states, has shown that substantial reductions in infections can be widely achieved and this project did so with nurses leading the infection control efforts.

An INQRI team led by Eileen Lake and Jeannette Rogowski has demonstrated the importance of nurse staffing and the professional practice environment in preventing infection among tiny babies in neonatal intensive care units (NICUs). Their findings show that babies in units where nurses have less support and limited professional practice are at higher risk of developing infections. Higher levels of NICU experience are associated with better infant outcomes.

PCORI and NIA Announce New Partnership on Fall Prevention

The Patient-Centered Outcomes Research Institute (PCORI) recently announced an agreement with the National Institute on Aging (NIA) to form a new partnership that will fund a major intervention study aimed at preventing injuries from falls in older adults. This agreement is the first step in the formation of the "Falls Injuries Prevention Partnership," which is the basis for developing an NIA-PCORI funding announcement for a large-scale, multi-year clinical trial on preventing injurious falls in non-institutionalized older individuals. PCORI plans to commit up to $30 million to this effort, though the final amount is yet to be determined. The NIA is in the process of developing a Funding Opportunity Announcement that is expected to be finalized in late July; further details will be available at that time. NIA has issued a Request for Information to gather insights from individual stakeholders and organizations involved in the care and well-being of older individuals.

The INQRI program has long been interested in this topic and has funded two recent studies designed to take a personal approach to fall prevention.  Led by Patti Dykes, one INQRI team has developed and tested a fall prevention tool kit using health information technology that successfully reduced the number of in-hospital falls among older patients. The tool kit includes a fall risk assessment, a patient-specific prevention plan, a handout for patients and their families and a poster to hang over a patient’s bed. INQRI also funded a team headed by Marita Titler to test fall prevention interventions tailored to patients’ risks for falls. This study involves three Michigan community hospitals which will implement processes to address multiple patient-specific factors that can contribute to and put patients at risk for falls, creating a “targeted risk factor fall prevention bundle” for each patient.

Click here to check out INQRI resources related to falls.
Click here to learn more about the PCORI-NIA partnership.

AACN Webinar on Managing Alarm Fatigue

On Thursday, June 20 at 10am, the American Association of Critical Care Nurses (AACN) will present a free webinar: "Managing Alarm Fatigue: New Approaches and Best Practices."

The patient safety organization, ECRI Institute, has identified alarm hazards as its Top Health Technology Hazard for 2013 and The Joint Commission issued an April 2013 Sentinel Event Alert on alarm fatigue. AACN’s free, live webinar will discuss the scope of this growing problem, management of environmental alarms for improved patient safety and strategies for creating a more effective (and quieter) workplace.

Panel presenters:
• Marjorie Funk, RN, MSN, PhD, FAAN, FAHA
• Maria Cvach, RN, MSN, CCRN
• Sue Sendelbach, RN, PhD, CCNS, FAHA

Register here.

Nurses Are Concerned that Patient Safety Programs Aren't Up to Par

An online survey commissioned by by the American Nurses Association finds only two in five hospital nurses in the United States, United Kingdom and China describe their hospitals as "safe."  While more than nine in ten nurses report their hospitals have safety programs, more than two in five don't believe the programs are effective. This is particularly dismaying in light of numerous efforts to improve hospital safety.

The survey is covered on the Human Capital Blog.

Also from Human Capital is a story on INQRI's contributions to interdisciplinary research into nursing as documented in Medical Care's special supplement, in the current issue of Sharing Nursing's Knowledge, out today. The story also highlights a study published in JAMA Pediatrics by Eileen Lake and Jeannette Rogowski on the impact of nurse staffing levels in neonatal intensive care units on patient outcomes.

AARP and Leapfrog Group Identify Some of the Best Safety Innovations in Hospitals

INQRI researchers have developed and tested numerous interventions to improve patient safety and several of those interventions are being implemented today in various health care settings. Patient safety is an ongoing concern and one that receives much-deserved attention. This month's AARP Magazine identifies some of the most innovative programs being implemented in hospitals to prevent errors and improve patient safety. The Leapfrog Group scored the hospitals and created an online tool individuals can use to locate the best scoring  hospitals in their communities.

These are just a few of the practices identified by AARP and Leapfrog:

•  a program through which each day, a nurse assess patients for their fall risks and gives high-risk patient yellow slippers which identify them as being at a high risk for falling;
• bar codes on medications and patients' wristbands to ensure patients receive the right medications;
• a "time out towel" placed on the instrument stand in the operating room to remind staff to follow standardized procedures; and
• a "red zone" prohibiting staff from interrupting nurses who are dispensing medication.

The Human Face of Hospital Readmissions

Health Affairs blogger Risa Lavizzo-Mourey explores the human face of hospital readmissions, sharing the perspectives of two individuals representative of the one in five elderly patients returning to the hospital within 30 days of leaving.

Readmissions is a growing concern, and several initiatives seek to address this costly health care issue.  Aligning Forces for Quality, one of the initiatives attempting to determine factors associated with readmissions, encourages health care providers to tailor their approach to discover methods that work best for their patients’ individual circumstances. 

Another report was commissioned by The Robert Wood Johnson Foundation to examine the issue of readmissions through the eyes of those grappling with the problem.  The report is part of the Care About Your Care initiative, devoted to improving the transition from hospital to home.

Upcoming Opportunity: Interprofessional Faculty Development Institute for Quality Improvement and Patient Safety

The Interprofessional Education Collaborative (IPEC) is pleased to offer an opportunity for faculty teams to attend the Interprofessional Faculty Development Institute for Quality Improvement and Patient Safety on May 20-22, 2013 at the Dulles Hyatt in Herndon, VA. The overall goal of the institute is to create faculty champions who can enhance interprofessional curricula, learning experiences, and assessment of learners in quality improvement and patient safety at the point of care.

Research conducted by INQRI grantees have made multiple contributions to quality improvement and patient safety.

Click here to access the registration page

Click here to learn about the contribution INQRI has made in quality measures. 

TOMORROW: Register for Webinar Now

TOMORROW  

Webinar: Moving Beyond Fall Risk Scores: Implementing an Evidence-Based Targeted Risk Factor Fall Prevention Bundle 

Accidental falls are the most common reported patient safety incident in hospitals, and beneficial effects of fall reduction interventions increase when interventions are targeted to patient specific risk factors. Yet, few hospitals focus on implementing fall prevention interventions that mitigate patient specific risks for falls. To translate evidence to practice, an INQRI team led by Marita Titler and Paul Conlon conducted a study to implement fall prevention interventions that target patient specific risk factors and evaluate the impact on fall rates, and fall injuries. Please join the team tomorrow as they present their study results.

Mar. 12, 2013, 4:00--5:00 p.m. ET

Click here to register.

WIHI Event: No Excuses, No Slack! The Latest from the Front Lines on Hand Hygiene

The upcoming WIHI event,  "No Excuses, No Slack! The Latest from the Front Lines on Hand Hygiene" will be held March 7 from 2:00 – 3:00 PM ET and will focus on the importance of good hand hygiene in the prevention of infections.

As IHI points out in the promotion for this event, "among the biggest contributors to hospital-acquired infections are, inadvertently, health professionals themselves... and others who come in contact with patients."  During the live event, participants will have the opportunity to hear about increased awareness of this issue and compliance with strict hand hygiene requirements.

INQRI researchers David Thompson and Jill Marsteller appreciate the goals of this session. The goal of their INQRI-funded work was to implement a comprehensive safety program including an evidence based intervention to reduce central line-associated blood stream infections while examining the context of nursing care delivery on patient outcomes. The team conducted the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. This study, conducted in ICUs in 12 states, has shown that substantial reductions in infections can be widely achieved and this project did so with nurses leading the infection control efforts. Their study builds on the well-known work of Dr. Peter Pronovost, creator of the line insertion “checklist.” Hospitals that followed the components of their ICU safety program (which included a focus on hand washing), and adopted a safety improvement environment that fostered nurse involvement in quality improvement efforts, reduced, and in some cases completely eliminated, bloodstream infections for several months at a time. Their research is also showing that higher nurse turnover is related to higher infection rates.

Click here to enroll in the "No Excuses, No Slack" event.

Click here to learn more about the Thompson-Marsteller study and access publications from this work. 

Missed Last Week's Webinar?

Did you miss the session on the Creation of a Nurse Manager Development Program to Increase Patient Safety? Well, you can catch up right here! This presentation is the third in a series providing the study findings from INQRI's final cohort of grantees. Their work focused on translating research into practice. This video features Drs. Linda Flynn and Joel Cantor presenting study findings from the design and implementation of a nurse manager development program to positively effect patient safety.

 

To view past sessions in the translation series or register for upcoming events, please visit www.inqri.org.

Reporting Back from Care About Your Care

What a great event yesterday about preventing hospital readmissions.  If you missed out, don't worry - you can check out the Care About Your Care website for patient and provider resources and many, many videos.

The event also was trending in the "Twitterverse."  Take a look at the #yourcare posts on Twitter to read up on the conversation that occurred online during the webcast.

And don't forget - INQRI has a terrific online event planned for today - a webinar from a grantee team regarding the Creation of a Nurse Manager Development Program to Increase Patient Safety.  Join us from 3p-4pmET to learn about an  intervention to increase patient safety by enhancing the leadership and team building skills of nurse managers.

Click here to register. 

Two Days: Two Exciting Events

TODAY

Live Webcast: Care About Your Care

The Robert Wood Johnson Foundation and dozens of organizations will convene today for Care About Your Care, a national initiative that highlights what works to improve care transitions and reduce avoidable hospital readmissions.

Nancy Snyderman, MD, chief medical editor for NBC News, will lead experts and health care leaders from diverse communities in sharing how they bring together patients, care providers, and community services to foster better health care outcomes.

Feb. 13, 2013, 12:30–2:00 p.m. ET

Steps to join the event:

1. GO TO: http://www.visualwebcaster.com/event.asp?id=92212 
2. CLICK on the “Launch Webcast” button. (Note: You may need to disable pop-ups). IMPORTANT: You may access this link to perform a system check or troubleshoot in advance of the webcast.
3. PROBLEMS? If you experience problems accessing the webinar, email Joyce Kim at jkim@gymr.com or call (202) 745-5068.

Join the Twitterverse: With the hashtag #yourcare


TOMORROW

Webinar: Creation of a Nurse Manager Development Program to Increase Patient Safety 

Evidence indicates leadership skills of frontline nurse managers are key to creating magnetic work environments that promote positive outcomes. Yet, weaknesses in nurse managers' skills often result in environments that threaten patient safety. To translate evidence to practice, an INQRI team led by Linda Flynn and Joel Cantor has built upon their prior INQRI study to design an intervention to increase patient safety by enhancing the leadership and team building skills of nurse managers. They have partnered with award-winning journalist and patient safety advocate Suzanne Gordon and other interdisciplinary experts including a certified Crew Resource Management trainer to design and implement a nurse manager development program. Please join the team on Valentine's Day as they present their study results.

Feb. 14, 2013, 3:00--4:00 p.m. ET

Click here to register. 

Webinar: Creation of a Nurse Manager Development Program to Increase Patient Safety

Evidence indicates leadership skills of frontline nurse managers are key to creating magnetic work environments that promote positive outcomes. Yet, weaknesses in nurse managers' skills often result in environments that threaten patient safety. To translate evidence to practice, an INQRI team led by Linda Flynn and Joel Cantor has built upon their prior INQRI study to design an intervention to increase patient safety by enhancing the leadership and team building skills of nurse managers. They have partnered with award-winning journalist and patient safety advocate Suzanne Gordon and other interdisciplinary experts including a certified Crew Resource Management trainer to design and implement a nurse manager development program.

On February 14, the team will lead a webinar to present their study results.  Please join us from 3pm - 4pmET to learn all about this amazing project.

Click here to register.

New Article Shows Checklists Can Assist in the Operating Room

A new Reuters article details the ways that step-by-step checklists can help doctors and nurses manage emergencies in the operating room.

"People have called (checklists) ‘dumbing down' medicine, but what we showed is that even in this incredibly stressful, high-complexity situation, the teams that worked from a kind of pre-planned set of steps had three quarters lower likelihood of missing critical lifesaving steps," noted Dr. Atul Gawande, from Brigham and Women's Hospital.


Click here to read the article.

ANF: Rest Important for Nurses

A new Health Leaders Media article details an important message from the American Nurses Foundation (ANF) to nurses who may struggling with shift work disorders: "Get some sleep." Kate Judge, the ANF's executive director, is quoted in the article and she cites the growing body of research which shows the impact that rest has on cognitive function and decision making. The ANF is concerned that shift work disorders can have negative effects on nurses and patient safety.

Click here to read this article.

For more information about the impact of nurses working when they are unwell, check out the INQRI project led by Susan Letvak and Christopher Ruhm. Their project outlines some of the negative outcomes associated with nurse presenteeism (attending work when sick).

Click here to learn about the Letvak-Ruhm project.

Op-Ed In The Huffington Post Highlights the Significance of Nurses

Earlier this morning Brian Secemsky, M.D., a resident physician in internal medicine at UCSF Medical Center, emphasized the importance of recognizing nurses' integral role in the delivery of team-based care. Dr. Secemsky highlighted just a few of the roles that nurses play in the delivery of care, and how these roles improve the patient and provider experience.

To read Dr. Secemsky's full Op-Ed, click here.

Massachusetts' Governor Signs Bill Banning Mandatory Overtime

Earlier this week, Governor Deval Patrick's signed new health care cost containment legislation that included a ban on mandatory overtime at acute care hospitals. Since the Institute of Medicine's focus on preventable deaths related to mandatory overtime on patient care in their 2004 report: "Keeping Patients Safe: Transforming the Work Environment of Nurses", many states have enacted similar legislation to ban the practice of mandatory overtime.

To read more about the passage of this integral piece of patient safety legislation, click here.

How to Better Motivate Nurses and Cut Costs

Yesterday, Karen Minich-Pourshadi, Senior Editor for HealthLeaders Media, published a fascinating piece that discussed innovative ways for hospital systems to cut costs while motivating their nursing workforce. Ms. Minich-Pourshadi recommends that hospitals take a cue from airline companies and utilize a point system, similar to 'travel miles', that rewards nurses for covering their colleagues shifts or providing exemplary care. The case study presented by Ms. Minich-Pourshadi demonstrates how hospitals are looking at other industries to solve some of their workforce issues that previously was viewed as unfeasible.

To read more about this innovative program, click here.