New Study Finds Benefits to Increasing Nurse-Physician Collaboration

Healthcare-associated infections (HAIs) decreased when collaboration between nurses and physicians working in critical care increased, according to a new study published in the April issue of Critical Care Nurse (CCN).

In critical care units in which nurses reported a more favorable perception of nurse-physician collaboration, researchers found lower rates of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI).

Researchers for the study, including Christine Boev, performed a secondary analysis of nurse surveys conducted in four specialized intensive care units (ICUs) over a five year period. The resulting article, “Nurse-Physician Collaboration and Hospital-Acquired Infections in Critical Care,” shows the association between nurses’ perception of their working relationships with physicians and the rates of VAPs and CLASBSIs.

“Our findings suggest that raising the quality of collaboration and communication among nurses and physicians has the potential to improve patient safety,” Boev said in a statement. “Efforts to prevent healthcare-associated infections must include interventions to improve nurse-physician collaboration.”

Boev, an assistant professor at the Wegmans School of Nursing, St. John Fisher College, suggested multidisciplinary daily patient rounds and shared simulation training to improve collaboration.

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 CCN article abstract and full-text PDF is available at: http://ccn.aacnjournals.org/.

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.

INQRI Project Provides New Online Communication Tools to Improve ICU Patient Care

ICU patients who can’t communicate because they are ventilated or using artificial airways can become anxious, frustrated and possibly even panic, putting them at risk for adverse events. Now, new evidence-based online training materials are available to help nurses and other health care providers communicate with these patients.

An interdisciplinary research team funded by INQRI developed and tested SPEACS-2 (Study of Patient-Nurse Effectiveness with Assisted Communication Strategies), a program that includes web-based communications training for nurses, resources to use with patients, and bedside teaching rounds provided by a speech pathologist. The program improves nurses’ knowledge of, comfort with, and satisfaction communicating with mechanically ventilated patients. It also helps patients avoid the frustration and stress of being unable to communicate.

Now the SPEACS-2 communications training program is available online. It consists of tools, resources, and six ten-minute interactive learning modules, which include:

• Introduction to the SPEACS-2 program and assessment to determine how best to use the communications strategies and tools;
• Techniques to help patients better understand questions and instructions, assessing patients’ ability to communicate and establishing communications with patients;
• Techniques to help patients who are cognitively impaired understand and communicate;
• Techniques to better support and understand patients’ “unaided” communications, such as gestures or mouthing words;
• Techniques and materials to assess and support patients’ written communications; and
• Demonstrations of communications strategies to use with patients with impaired movement or attention, and a presentation of the role of a speech language pathologist in assisting with communication.

The INQRI-funded research team that developed and tested SPEACS-2 was led by Mary Beth Happ and Amber Barnato. The study was conducted at the University of Pittsburgh.

Diagnosing and Adequately Treating Delirium Vital for Patient Recovery

As many as two out of every three patients in hospital settings with delirium may not be recognized as such by health care professionals. This is due in part to of a lack of validated tools for properly managing delirious patients and because some practitioners may not recognize the condition, according to an article in MedPage Today.

A major barrier to assessing delirium in emergency departments (ED) is the lack of a rapid assessment tool specifically designed for such a fast-paced environment. Relying on past experience and the patients’ behavior is not enough.  In fact, using clinical gestalt to diagnose delirium can result in providers missing up to 83 percent of cases, particularly in patients where the symptoms are more subtle.

The impact on the patient of a missed diagnosis can be dire. Generally, patients with delirium should receive adequate oxygenation, hydration, nutrients, pain treatment if necessary, and judicious drug intervention if needed. They should not be restrained, and should be kept awake and alert, according to experts quoted in the article.

Jin Han, MD, MSc, of the Vanderbilt University School of Medicine in Nashville, Tenn, and colleagues developed a two-step, validated diagnostic of delirium for ED patients age 65 and older: the Brief Confusion Assessment Method and Delirium Triage Screen. The screens have 82 percent sensitivity and 95.8 percent specificity when used together, Han wrote in an article published in the Annals of Emergency Medicine. Delirium assessment tools currently available often take as much as five minutes to complete, while Han’s Brief Confusion Assessment method takes only one minute, an important time difference in the ED.

However, Han noted that there is still much work to be done in screening methodology. "I don't think there is a one-size-fits-all approach to delirium screening," he said. "Different clinical environments will have different expertise, time constraints, and goals for the patients."

An INQRI-funded study led by Michele Balas and William Burke, explored the high risk for delirium and weakness for patients on ventilators in hospital intensive care units (ICU). The study found that a bundle of practices, employed by a nurse-led interprofessional team of health care providers, could help ICU patients avoid delirium and weakness. The study was published in Critical Care Nurse.

Researchers examined a “bundle” of evidence-based practices called the Awakening, and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility bundle (ABCDE bundle), which uses the best available evidence on delirium, immobility, sedation and analgesia, and ventilator management in the ICU. The bundle is founded on three primary principles: improving communication among members of the ICU team; standardizing care processes; and breaking the cycle of over-sedation and prolonged attachment to a ventilator that can lead to delirium and weakness.

American Association of Critical Care Nurses to Host Webinar on Assessing and Managing Delirium - Sept. 19

The next presentation in the American Association of Critical Care Nurses' (AACN) Critical Care Webinar Series will focus on delirium in acute and critical care settings.

The webinar, Delirium Challenge: Assessing and Managing in Acute/Critical Care, will be held at 10am Pacific Daylight Time on Thursday, September 19.  The presenter is Leanne Boehm, RN, MSN, ACNS-BC. She is a research nurse in Vanderbilt University's Intensive Care Unit Delirium and Cognitive Impairment Study Group. And was part of an  INQRI-funded research project addressing the problem of critically ill patients on ventilators developing led by Michele Balas and William Burke. The team tested a bundle of practices aimed at reducing delirium among patients in Intensive Care Units (ICUs). The study revealed that a nurse-led interprofessional team employing the bundle could help patients int eh ICU avoid delirium and weakness so that they healed sooner and were healthier after leaving the hospital.

 Registration for the webinar is free.  To register, click here.

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.