Nurses Important Part of Interdisciplinary Team for Tracheostomy Patients

Critical care nurses are essential in helping patients with tracheostomies regain their ability to speak, according to an article in the December issue of Critical Care Nurse.

The article, "Restoring Speech to Tracheostomy Patients," notes that critical care nurses are an important part of an interdisciplinary team that includes respiratory therapists, speech pathologists, advanced practice nurses and physicians.

There are several determining factors in patients being able to speak after a tracheostomy; including patients having an adequate supply of air reach the vocal cords and the type or size of the tracheostomy tube itself, Advance Healthcare Network for Nurses reports.

Nursing interventions for tracheostomy patients can also vary, depending on if the patient is spontaneously breathing, being treated with intermittent mechanical ventilation, or is fully ventilator dependent, and nurses need to be aware of all the options available, according to the researchers.

The Advanced Healthcare Network for Nurses article is available here.
The Critical Care Nurse abstract is available here.

Delirium Effects Linger for Critical Care Patients; Nurses Key to Treatment

ICU patients often experience similar lingering emotional and psychological effects of delirium, according to a new study published in the November issue of the American Journal of Critical Care.

The research team interviewed 10 adult patients who had been diagnosed with delirium while in the ICU after they were no longer delirious. The overarching themes in patients’ reports were:

• Lack of recall about their experience, often accompanied by feelings of guilt and shame about their behavior while delirious; 
• Feeling disconnected while delirious and unable to communicate or move, leading to frustration and fear;
• Vivid hallucinations, disorganized thinking and periods of disorientation; and
• Believing they or their family were in danger while they were delirious. 

The study also looks at the importance of critical care nurses in early recognition and treatment of patients with delirium, and how that can positively influence patient outcomes. Nurses also help patients and families deal with the aftermath of delirium in the ICU, particularly the psychological effects, according to the researchers.

This work mirrors that of INQRI grantees Michele Balas and William Burke who conducted research on patients on ventilators in ICUs, who are typically at high risk for delirium and weakness. Their research focused on preventing complications in ventilated patients through use of the "Awakening and Breathing Coordination, Delirium assessment and management and Early Exercise and progressive mobility (ABCDE)" bundle.

Balas and Burke led a team to implement, analyze and disseminate an evidence-based, nurse-led, inter-professional, multi-component program focused on improving the care and outcomes of critically ill adults.  Their "Implementing the ABCDE Bundle at the Bedside" was selected as the American Association of Critical-Care Nurses' first PEARL (Practice, Evidence, Application, Resources and Leadership) web-based tool.

Click here to learn more about the Balas-Burke project "Implementation and Dissemination of an Interdisciplinary Nurse-Led Plan to Manage Delirium in Critically Ill Adults."

How Nurses Affect Medicare's Hospital Incentive Payments

By Janet Weiner, MPH

In our last LDI/INQRI Brief, we looked at the evidence of nursing's role in increasing the value of health care, and we pointed out where "value" and "business case" may differ for hospitals. In our latest brief, we analyze the three Medicare programs designed to align hospital incentives with value, and how nursing-sensitive quality indicators relate to those programs.

We point out the overlap between nursing quality indicators and Medicare’s incentive structure, which includes the Value-Based Purchasing Program, the Hospital Acquired Condition Reduction Program, and the Hospital Readmissions Reduction Program. There's a lot of money at stake, and value to be added, by reducing central line infections, catheter-associated urinary tract infections, pressure ulcers, and ventilator-associated pneumonia.

We've done the math, so you don't have to. Our brief includes detailed appendices with calculations for each program. Go read.

Janet Weiner is associate director for health policy at the Leonard Davis Institute of Health Economics  at the University of Pennsylvania.

New GW Lab Named After Former INQRI Grantee

George Washington University’s School of Nursing recently opened a new skills and simulation laboratory at the school’s Virginia Science and Technology Campus. The “Johnson Lab” is named after the School of Nursing founder, and former INQRI Grantee, Jean Johnson.

The new facility will serve as a virtual hospital and includes beds for 10 mannequins that simulate patients from infants to the elderly.

RWJF Executive Nurse Fellows program alumna Pamela Jeffries serves as the current dean of the School of Nursing and was instrumental in the launch of the lab.

“When you look at traditional clinical training, if you don’t have sims, you are always a student nurse and always following your instructor,” Jeffries told GW Today. “And then you graduate, and you are an RN, and if you’ve never functioned as an RN before, that’s a problem. What we’re doing here is we are having you rehearse your roll.”

Johnson’s INQRI-supported work, in collaboration with Shoshanna Sofaer, helped to shed light on whether some of the National Quality Forum's nursing sensitive measures are perceived as meaningful by consumers. The team conducted focus groups with recently hospitalized patients to understand their perception of the measures. Consumers found several patient safety measures to be very compelling, and clearly believed that nurses had a significant role in hospital quality. However, consumers did not think nurses should be advising patients to quit smoking, stating that nurses have better things to do with their time. The team learned that overall the public, while valuing nurses highly, has an incomplete understanding of their job duties and to whom they are accountable.

Former INQRI Grantee Elected to National Academy of Medicine

Marita Titler, a professor and chair of the Department of Systems, Populations, and Leadership at the University of Michigan, School of Nursing, has been elected to the prestigious National Academy of Medicine.

Titler’s work focuses on improving care for older adults in areas such as pain management, cancer care, heart failure, and fall prevention. Her INQRI-funded research with Gary Rosenthal investigated links between level of professional nursing practice and adoption of evidence-base practices, fall prevalence, and injury from falls. The study was titled: “Impact of System-Centered Factors, and Processes of Nursing Care on Fall Prevalence and Injuries from Falls.”

Palliative Care Growing, but Not for All Patients

While palliative care is increasing in hospitals generally, access to programs is not consistent throughout the United States, according to a new study published in the Journal of Palliative Medicine.

Patients’ access to palliative care programs varies across geographic regions and also depends on factors such as hospital size and tax status, researchers write in "The Growth of Palliative Care in U.S. Hospitals: A Status Report."

While 90 percent of hospitals across the country with 300 beds or more have palliative care programs, only 56 percent of smaller hospitals offer these services. Additionally, for-profit hospitals are less likely than not-for-profit or public hospitals to have palliative care programs.

The study is available free of charge on the Journal of Palliative Medicine website until November 1, 2015.

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.

Military Nurse Showcases Evidence-based Innovation

A nurse from the San Antonio Military Medical Center (SAMMC) recently shared her research on reducing alarm fatigue during a joint military course in San Antonio, Texas.

Army Capt. Amanda Rodriguez provided details on her patient safety project, which sought to reduce false physiological alarms and improve patient safety.

“Many studies have demonstrated as many as 99 percent of alarm signals may be false and can result in patient harm or death when a clinically actionable alarm is missed due to alarm fatigue,” Rodriguez told participants at the TriService Nursing Research Program’s Research and Evidence-based Practice Dissemination course.

Nurses in Rodriguez’s project implemented the American Association of Critical-care Nurses Practice Alert for Alarm Management at SAMMC, which involves reviewing alarm setting and patient-specific tailoring of the physiological alarms during every shift. After a six-week trial, alarms were reduced by more than 900 fewer per day. The results were well received at SAMMC and show the value of implementing and sharing evidence-based research, Rodriguez said.