tag:blogger.com,1999:blog-65168389847817666652024-03-14T05:17:31.770-04:00INQRI BlogThe Blog of the Interdisciplinary Nursing Quality Research InitiativeINQRI Programhttp://www.blogger.com/profile/05672756518369446049noreply@blogger.comBlogger1244125tag:blogger.com,1999:blog-6516838984781766665.post-48767229810948733092015-12-09T16:21:00.000-05:002015-12-09T16:21:17.378-05:00Nurses 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 <a href="http://ccn.aacnjournals.org/" target="_blank">December issue of <i>Critical Care Nurse</i></a>.<br />
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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.<br />
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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, <i><a href="http://nursing.advanceweb.com/News/National-News/Nurses-Help-Tracheostomy-Patients-Regain-Speech.aspx" target="_blank">Advance Healthcare Network for Nurses</a></i> reports.<br />
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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.<br />
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The <i>Advanced Healthcare Network for Nurses</i> article is <a href="http://nursing.advanceweb.com/News/National-News/Nurses-Help-Tracheostomy-Patients-Regain-Speech.aspx" target="_blank">available here</a>.<br />
The <i>Critical Care Nurse</i> abstract is <a href="http://ccn.aacnjournals.org/" target="_blank">available here</a>.<br />
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INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-85361822483635555982015-11-20T15:14:00.000-05:002015-11-20T15:14:20.173-05:00Delirium Effects Linger for Critical Care Patients; Nurses Key to TreatmentICU patients often experience similar lingering emotional and psychological effects of delirium, according to a new study published in the November issue of the <a href="http://ajcc.aacnjournals.org/" target="_blank"><i>American Journal of Critical Care</i></a>.<br />
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The research team <a href="http://ajcc.aacnjournals.org/content/24/6/474.full" target="_blank">interviewed 10 adult patients</a> who had been diagnosed with delirium while in the ICU after they were no longer delirious. The overarching themes in patients’ reports were:<br />
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<li>Lack of recall about their experience, often accompanied by feelings of guilt and shame about their behavior while delirious; </li>
<li>Feeling disconnected while delirious and unable to communicate or move, leading to frustration and fear;</li>
<li>Vivid hallucinations, disorganized thinking and periods of disorientation; and</li>
<li>Believing they or their family were in danger while they were delirious. </li>
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The study also looks at the importance of <a href="http://www.aacn.org/wd/publishing/content/pressroom/pressreleases/2015/nov/ajcc-nov-delirium.content?menu=AboutUs" target="_blank">critical care nurses in early recognition and treatment</a> 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.<br />
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This work mirrors that of INQRI grantees <a href="http://www.inqri.org/grantee/dr-michele-balas" target="_blank">Michele Balas</a> and <a href="http://www.inqri.org/grantee/dr-william-burke" target="_blank">William Burke</a> 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. <br />
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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.<br />
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<a href="http://www.inqri.org/research-project/implementation-and-dissemination-interdisciplinary-nurse-led-plan-manage-delirium-c" target="_blank">Click here</a> to learn more about the Balas-Burke project "Implementation and Dissemination of an Interdisciplinary Nurse-Led Plan to Manage Delirium in Critically Ill Adults."<br />
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INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-20223627898482822152015-11-12T16:42:00.000-05:002015-11-12T16:44:12.489-05:00How Nurses Affect Medicare's Hospital Incentive Payments<i>By Janet Weiner, MPH</i><br />
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In our last <a href="http://ldi.upenn.edu/increasing-value-health-care-role-nurses" target="_blank">LDI/INQRI Brief</a>, 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 <a href="http://ldi.upenn.edu/file/12771/download?token=QzRaPK3q" target="_blank">brief</a>, we analyze the three Medicare programs designed to align hospital incentives with value, and how nursing-sensitive quality indicators relate to those programs.<br />
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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.<br />
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We've done the math, so you don't have to. Our brief includes detailed appendices with calculations for each program. Go<a href="http://ldi.upenn.edu/file/12771/download?token=QzRaPK3q" target="_blank"> read</a>.<br />
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<i>Janet Weiner is associate director for health policy at the Leonard Davis Institute of Health Economics at the University of Pennsylvania.</i>INQRI Programhttp://www.blogger.com/profile/05672756518369446049noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-26677686841971433042015-11-06T11:33:00.000-05:002015-11-06T11:33:54.109-05:00New GW Lab Named After Former INQRI GranteeGeorge Washington University’s <a href="http://nursing.gwu.edu/" target="_blank">School of Nursing</a> recently opened a new skills and simulation laboratory at the school’s <a href="http://virginia.gwu.edu/" target="_blank">Virginia Science and Technology Campus</a>. The “Johnson Lab” is named after the School of Nursing founder, and former INQRI Grantee, <a href="http://www.inqri.org/grantee/dr-jean-johnson" target="_blank">Jean Johnson</a>.<br />
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The new facility will serve as a virtual hospital and includes beds for 10 mannequins that simulate patients from infants to the elderly.<br />
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RWJF Executive Nurse Fellows program alumna <a href="http://www.executivenursefellows.org/fellow-detail.php?DirectoryId=2350" target="_blank">Pamela Jeffries</a> serves as the current dean of the School of Nursing and was instrumental in the launch of the lab. <span class="Apple-tab-span" style="white-space: pre;"> </span><br />
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“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 <a href="http://gwtoday.gwu.edu/school-nursing-cuts-ribbon-new-simulation-lab" target="_blank"><i>GW Today</i></a>. “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.”<br />
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Johnson’s <a href="http://www.inqri.org/research-project/developing-and-testing-nursing-quality-measures-consumers-and-patients" target="_blank">INQRI-supported work</a>, in collaboration with <a href="http://www.inqri.org/grantee/dr-shoshanna-sofaer" target="_blank">Shoshanna Sofaer</a>, 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.INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-30051037750358358252015-10-30T11:31:00.001-04:002015-10-30T11:33:30.932-04:00Former INQRI Grantee Elected to National Academy of Medicine<a href="http://www.inqri.org/grantee/dr-marita-titler" target="_blank">Marita Titler</a>, a professor and chair of the Department of Systems, Populations, and Leadership at the <a href="http://ns.umich.edu/new/" target="_blank">University of Michigan</a>, School of Nursing, has <a href="http://ns.umich.edu/new/releases/23220-four-u-m-faculty-elected-to-prestigious-national-academy-of-medicine" target="_blank">been elected</a> to the prestigious <a href="http://nam.edu/" target="_blank">National Academy of Medicine</a>.<br />
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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 <a href="http://www.inqri.org/grantee/dr-gary-rosenthal" target="_blank">Gary Rosenthal</a> investigated links between level of professional nursing practice and adoption of evidence-base practices, fall prevalence, and injury from falls. The study was titled: “<a href="http://www.inqri.org/research-project/impact-system-centered-factors-and-processes-nursing-care-fall-prevalence-and-injur" target="_blank">Impact of System-Centered Factors, and Processes of Nursing Care on Fall Prevalence and Injuries from Falls.</a>”<br />
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INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-11164561092003420252015-10-09T10:58:00.001-04:002015-10-09T10:58:53.766-04:00Palliative Care Growing, but Not for All PatientsWhile 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 <i>Journal of Palliative Medicine</i>. <br />
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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 "<a href="http://online.liebertpub.com/doi/full/10.1089/jpm.2015.0351" target="_blank">The Growth of Palliative Care in U.S. Hospitals: A Status Report.</a>" <br />
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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.<br />
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The study is available free of charge on the <i>Journal of Palliative Medicine</i> website until November 1, 2015.<br />
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An INQRI study, "<a href="http://www.inqri.org/research-project/nursings-specific-contributions-quality-palliative-care-within-context-interdiscipl" target="_blank">Nursing's Specific Contributions to Quality Palliative Care within the Context of Interdisciplinary Intensive Care Practice</a>," 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 <a href="http://inqri.org/grantee/dr-lissi-hansen" target="_blank">Lissi Hansen</a> and <a href="http://inqri.org/grantee/dr-richard-mularski" target="_blank">Richard Mularski</a>.<br />
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INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-10260602413131067972015-09-25T13:48:00.000-04:002015-09-25T13:48:36.761-04:00Military Nurse Showcases Evidence-based Innovation A nurse from the San Antonio Military Medical Center (SAMMC) recently <a href="https://www.dvidshub.net/news/176896/nurses-showcase-innovations-triservice-course#.VgVQyEbG-ap" target="_blank">shared her research on reducing alarm fatigue</a> during a joint military course in San Antonio, Texas.<br />
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Army Capt. Amanda Rodriguez provided details on her patient safety project, which sought to reduce false physiological alarms and improve patient safety.<br />
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“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.<br />
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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.<br />
<br />INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-43283126531468658802015-09-11T10:27:00.000-04:002015-09-11T10:29:17.710-04:00INQRI Director Receives Award for Leadership in Gerontological Field The <a href="https://www.geron.org/" target="_blank">Gerontological Society of America</a> (GSA) chose INQRI Director <a href="http://www.nursing.upenn.edu/faculty/profile.asp?pid=71" target="_blank">Mary Naylor</a> as the 2015 recipient of the <a href="http://www.eurekalert.org/pub_releases/2015-08/tgso-neg082815.php" target="_blank">Doris Schwartz Gerontological Nursing Research Award</a>.<br />
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This honor, presented by GSA's Health Sciences Section, is given to a member of the Society in recognition of outstanding and sustained contribution to gerontological nursing research. Naylor will receive the award at <a href="http://www.geron.org/2015" target="_blank">GSA's 68th Annual Scientific Meeting in November</a>.<br />
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Among her accomplishments, Naylor developed the <a href="http://inqri.blogspot.com/2014/07/nurses-lead-innovations-in-geriatrics.html" target="_blank">Transitional Care Model</a>, which utilizes nurses to reduce hospital readmissions among elderly patients after they have been discharged. As many as one-third of re-hospitalizations are considered preventable, so reducing readmissions not only improves patients’ quality of life, but reduces health care costs.<br />
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In addition to her <a href="http://www.inqri.org/about-inqri/our-leadership-team" target="_blank">work with INQRI</a>, Naylor is the Marian S. Ware Professor in Gerontology and director of the <a href="http://www.nursing.upenn.edu/ncth/Pages/default.aspx" target="_blank">NewCourtland Center for Transitions and Health</a> at the <a href="http://www.nursing.upenn.edu/Pages/default.aspx" target="_blank">University of Pennsylvania School of Nursing</a>. Naylor leads an interdisciplinary program of research designed to improve the quality of care, decrease unnecessary hospitalizations, and reduce health care costs for vulnerable community-based elders.<br />
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Naylor was also the 2012 recipient of GSA's Maxwell A. Pollack Award for Productive Aging.<br />
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INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-35229115584532240222015-08-28T16:25:00.001-04:002015-08-28T16:27:37.070-04:00Nurse Input and Leadership Needed in Health Care Design A new book explores the importance of nurse-led innovations in the <a href="http://www.healthcaredesignmagazine.com/article/bat-nurses-step-design-plate" target="_blank">process of designing health care environments</a>, <i>Healthcare Design</i> reports.<br />
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<i>Nurses as Leaders in Healthcare Design: A Resource for Nurses and Interprofessional Partners</i>, will be published this fall by <a href="http://www.nursingihd.com/" target="_blank">Nursing Institute for Healthcare Design</a> (NIHD) and <a href="http://www.hermanmiller.com/solutions/healthcare.html" target="_blank">Herman Miller Healthcare</a>. Its goal is to inform and guide nurses through the design process with practical information and case studies.<br />
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NIHD President Nurses Stichler and Kathy Okland, a senior health care consultant at Herman Miller Healthcare are the executive editors of the book. In an interview with Healthcare Design they discussed the pitfalls of not including nurses’ perspectives in the design process.<br />
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“When the nurses’ point of view is absent from the design table, serious mistakes have been made,” Stichler said. “For example, there was a trend to eliminate the centralized communication hub when designing decentralized nursing stations. Unfortunately that was a huge mistake because both centralized and decentralized work stations are needed.”<br />
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The centralized station is where nurses and other health care providers meet to discuss unit activities and patients’ status, and interacting with family members, Stichler said. When the design eliminated that centralized space, staff had to develop workarounds, including setting up a folding table so that the interprofessional team could meet. “So you can see how important it is to have a nursing voice that can speak up and say, wait, I don’t think you understand what goes on in that space, let me describe it to you.”<br />
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Okland and Stichler will lead an interactive discussion “Planning and Design for Healthcare Design: A Nurse’s Perspective” at the Healthcare Design Expo & Conference, November 14-17 in the Washington, DC area, for more information, visit <a href="http://www.healthcaredesignmagazine.com/conference/healthcare-design-conference" target="_blank">HCDmagazine.com/conference</a>.<br />
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The full interview is available here: <a href="http://www.healthcaredesignmagazine.com/article/bat-nurses-step-design-plate" target="_blank">http://www.healthcaredesignmagazine.com/article/bat-nurses-step-design-plate </a><br />
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INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-37676197688367005622015-08-21T15:30:00.000-04:002015-08-21T15:30:35.883-04:00Sound Panels Used to Reduce Noise in Michigan HospitalThe <a href="http://www.uofmhealth.org/news/archive/201508/quiet-design-hospital-experiments-sound-panels-reduce-noise" target="_blank">University of Michigan Health System</a> 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, <a href="http://www.fiercehealthcare.com/story/turning-down-volume-hospital-experiments-sound-panels-reduce-noise/2015-08-20" target="_blank"><i>FierceHealthcare </i>reports</a>.<br />
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The University recently published findings from its <a href="http://qualitysafety.bmj.com/content/early/2015/07/24/bmjqs-2015-004205.extract" target="_blank">pilot study</a> in <i>BMJ Quality and Safety</i>, 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.<br />
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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.<br />
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An <a href="http://www.inqri.org/research-project/interdisciplinary-mobility-team-approach-reduction-facility-acquired-pressure-ulcer" target="_blank">INQRI-funded study</a> found a unique way to use different sounds to reduce alarm fatigue and help keep patients safe. Led by <a href="http://www.inqri.org/grantee/dr-tracey-yap" target="_blank">Tracey Yap</a> and <a href="http://www.inqri.org/grantee/dr-jay-kim" target="_blank">Jay Kim</a> 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.<br />
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The University’s study abstract is <a href="http://qualitysafety.bmj.com/content/early/2015/07/24/bmjqs-2015-004205.extract" target="_blank">available here</a>.<br />
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INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-80530140002184250212015-08-14T12:00:00.000-04:002015-08-14T12:06:04.689-04:00NY Nurses Help Hospitals Realize Better Outcomes, Lower Health Care Costs Through AACN CSI ProgramSmall teams of nurses at seven New York hospitals have improved patient care and saved their hospitals millions of dollars by participating in a training program conducted by the <a href="http://www.aacn.org/" target="_blank">American Association of Critical-Care Nurses</a> (AACN).<br />
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The New York hospitals were the sixth cohort in the program. So far <a href="http://www.aacn.org/wd/publishing/content/pressroom/pressreleases/2015/apr/csi-academy-overview.content?menu=AboutUs" target="_blank">42 hospitals nationwide</a> have participated in the <a href="http://www.aacn.org/wd/csi/content/csi-landing.pcms?sidebar=none&menu=csi" target="_blank">AACN Clinical Scene Investigator (CSI) Academy</a>, a 16-month nursing leadership and innovation training project that has improved patient outcomes and saved hospitals more than $28 million annually.<br />
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In the New York cohort, groups of four nurses from each hospital chose a treatment area they wanted to address, such as preventing hospital-acquired infections and falls or standardizing protocols to assessing delirium or mobilizing ventilated patients, <a href="https://news.nurse.com/2015/08/03/ny-nurses-achieve-big-patient-care-successes-through-csi-academy/" target="_blank">reports <i>Nurse.com</i></a>. <br />
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At <a href="https://www.northshorelij.com/find-care/locations/north-shore-university-hospital" target="_blank">North Shore University Hospital</a>, nurses focused on reducing catheter-associated urinary tract infections (CAUTIs) in the intensive care unit (ICU), because their unit had the highest rate in the state’s health system. Interventions included education efforts for patients, staff, and families on the importance of earlier removal of the catheter, and a focus on hygiene practices. After implementing the changes, the hospital achieved more than six months without a CAUTI, a significant improvement from not having a single CAUTI-free month before the academy. The reduction in infections saved $112,000 for the hospital.<br />
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At <a href="http://www.med.nyu.edu/" target="_blank">NYU Langone Medical Center</a> nurses wanted to establish a consistent approach to treating and assessing delirium in the medical ICU. They collaborated with the care team, including the IT department, which developed a way to incorporate delirium assessment into electronic health records. Innovations also included an assessment checklist for delirium printed on mousepads, which eliminated the need to search for the tool. The Center estimates it will save between $3.3 million and $5.5 million as a result of the changes.<br />
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Nationwide, the CSI Academy has trained 163 nurses to address clinical challenges such as hospital-associated infections, pressure ulcers, delirium, early mobility, falls, and patient handoffs. Project materials developed by each team, including plans, data collection tools, practice resources and references in a searchable online database, are available on the AACN website at <a href="http://www.aacn.org/csiprojects" target="_blank">www.aacn.org/csiprojects</a><span id="goog_1660831766"></span><span id="goog_1660831767"></span><a href="https://www.blogger.com/"></a>.<br />
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The <i>INQRI Blog</i> featured previously released data from the Academy from regional groups working in <a href="http://inqri.blogspot.com/2014/06/national-nurse-leadership-training.html" target="_blank">Massachusetts</a> and <a href="http://inqri.blogspot.com/2014/03/nurse-led-initiatives-benefit-patients.html" target="_blank">North Carolina</a> and <a href="http://inqri.blogspot.com/2015/04/aacn-academy-shows-value-of-investing.html" target="_blank">overall progress </a>in the program.<br />
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INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-28348488645700868212015-07-31T13:39:00.000-04:002015-07-31T13:39:41.268-04:00Resnick to Head Gerontological Society Congratulations to former INQRI Grantee <a href="http://www.inqri.org/grantee/dr-barbara-resnick" target="_blank">Barbara Resnick</a>, who was recently voted president-elect of the <a href="https://www.geron.org/" target="_blank">Gerontological Society of America</a> (GSA).<br />
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Resnick, who currently serves as professor and Sonia Ziporkin Gershowitz Chair in Gerontology at the <a href="https://www.nursing.umaryland.edu/" target="_blank">University of Maryland School of Nursing in Baltimore</a>, will begin as president-elect in 2015-2016, and then become president for the 2016-2017 term. GSA is devoted to research and education in all aspects of gerontology, including medical, biological, psychological and social.<br />
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“I am honored to serve in the role of GSA’s president-elect, and in the future, as its president,” Resnick said in a news release. “GSA has the opportunity to be a leader in interdisciplinary work in the areas of gerontology and geriatrics, including educational aspects, research, practice and policy.”<br />
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Resnick and fellow INQRI grantee <a href="http://www.inqri.org/grantee/dr-sheryl-zimmerman" target="_blank">Sheryl Zimmerman</a> developed a <a href="http://www.inqri.org/research-project/res-care-al-intervention-study" target="_blank">successful intervention</a> designed to deliver <a href="http://www.functionfocusedcare.org/home" target="_blank">Function Focused Care</a> to residents in assisted living facilities. Their intervention was designed to maintain and improve function, physical activity, muscle strength, psychosocial outcomes (efficacy expectations and life satisfaction) and decrease adverse events (pain, falls and hospitalizations) among assisted living residents. Residents in intervention treatment sites demonstrated fewer declines in function and spent more time in moderate level physical activity at 4 months and more overall counts of activity at 12 months when compared to residents in control sites. There were also fewer transfers to the hospital among those in the treatment sites.<br />
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INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-82010236830677662172015-07-14T10:40:00.000-04:002015-07-14T10:40:47.811-04:00CLASBIs Rates Improved When Hospitals Implement Airline Industry ApproachHospitals 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 <a href="http://www.vox.com/2015/7/9/8905959/medical-harm-infection-prevention" target="_blank"><i>VOX</i> special report</a>.<br />
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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, <i>Vox</i> reports. <br />
<br />
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.<br />
<br />
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.<br />
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<b>Hospitals in Michigan and California Follow Suit</b><br />
<br />
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.<br />
<br />
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.<br />
<br />
“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.”<br />
<br />
Reducing CLASBIs was the focus of an INQRI-funded <a href="http://www.inqri.org/multicenter-phased-cluster-randomized-controlled-trial-reduce-central-line-associated-bloodstream-in" target="_blank">study</a> led by <a href="http://www.inqri.org/grantee/dr-david-thompson" target="_blank">David Thompson</a> and <a href="http://www.inqri.org/grantee/dr-jill-marsteller" target="_blank">Jill Marsteller</a>. 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.<br />
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The full VOX article is <a href="http://www.vox.com/2015/7/9/8905959/medical-harm-infection-prevention" target="_blank">available here</a>.<br />
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INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-37197244179824570322015-07-02T10:24:00.000-04:002015-07-02T10:24:48.349-04:00Intervention Efforts Leads to Reduced Risk for Liver PatientsA nurse-led intervention improved rates of vaccination for Hepatitis A and Hepatitis B for <a href="http://www.medscape.com/viewarticle/846820" target="_blank">patients awaiting liver transplantation</a>, ultimately reducing the risk of disease and other post-transplant complications, according to an article in <i>Medscape Medical News</i>.<br />
<br />
During the <a href="http://www.aanp.org/conferences" target="_blank">American Association of Nurse Practitioners 2015 National Conference</a> Shari Perez of the <a href="http://www.mayoclinic.org/patient-visitor-guide/arizona" target="_blank">Mayo Clinic in Scottsdale, Arizona</a> 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. <br />
<br />
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.<br />
<br />
The full article is <a href="http://www.medscape.com/viewarticle/846820" target="_blank">available here</a>. (Free registration required.)INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-54668120599866113332015-06-11T16:45:00.000-04:002015-06-11T16:50:09.289-04:00Expanding Opportunities for Rural Communities to Get Quality Care<i>by Susan Hassmiller, PhD, RN, FAAN, Senior Adviser for Nursing, Robert Wood Johnson Foundation</i><b><i> </i></b><br />
<br />
<b><i>The full version of this post is on the Robert Wood
Johnson Foundation’s <a href="http://www.rwjf.org/en/culture-of-health/2015/06/expanding_opportunit.html?cid=xpr_rwjf_AiL-post2015">Culture
of Health blog</a>.</i></b><br />
<br />
I read recently in <a href="http://www.nytimes.com/2015/05/26/health/rural-nebraska-offers-stark-view-of-nursing-autonomy-debate.html?smprod=nytcore-iphone&smid=nytcore-iphone-share">The <i>New York Times</i></a>
about Murlene Osburn, a cattle rancher and psychiatric nurse, who will
finally be able to start seeing patients now that Nebraska has passed
legislation enabling advanced practice nurses to <a href="https://www.blogger.com/blogger.g?blogID=6516838984781766665">practice</a> without a doctor’s oversight.<br />
<br />
Osburn earned her graduate degree to become a psychiatric nurse after
becoming convinced of the need in her rural community, but she found it
impossible to practice. That’s because a state law requiring advanced
practice nurses to have a doctor’s approval before they performed
tasks—tasks they were certified to do. The closest psychiatrist was
seven hours away by car (thus the need for a psychiatric nurse), and he
wanted to charge her $500 a month. She got discouraged and set aside her
dream of helping her community.<br />
<br />
I lived in Nebraska for seven years, and I know firsthand that many
rural communities lack adequate health services. As a public health
nurse supervisor responsible for the entire state, I regularly traveled
to small, isolated communities. Some of these communities did not have a
physician or dentist, let alone a psychiatric nurse. People are forced
to drive long distances to attain care, and they often delay necessary
medical treatment as a result—putting them at risk of becoming even
sicker, with more complex medical conditions.<br />
<br />
Read the rest of Hassmiller's post on the <a href="http://www.rwjf.org/en/culture-of-health/2015/06/expanding_opportunit.html?cid=xpr_rwjf_AiL-post201506" target="_blank">Culture of Health blog.</a><br />
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<br />INQRI Programhttp://www.blogger.com/profile/05672756518369446049noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-86429111968245788862015-06-01T11:50:00.000-04:002015-06-01T11:50:44.665-04:00Magnet Aspirations Can Give Hospitals a Path to Excellence<h4>
<i>Ann Kutney-Lee, PhD, RN, FAAN and Linda H. Aiken, PhD, RN, FAAN</i></h4>
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 <a href="http://journals.lww.com/lww-medicalcare/Abstract/2013/05000/Lower_Mortality_in_Magnet_Hospitals.2.aspx" target="_blank">well-established</a>.(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.<br />
<br />
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 <a href="http://journals.lww.com/lww-medicalcare/Abstract/2015/06000/Changes_in_Patient_and_Nurse_Outcomes_Associated.12.aspx" target="_blank">result</a>.(2)<br />
<br />
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.<br />
<br />
The study, “Changes in Patient and Nurse Outcomes Associated With Magnet Hospital Recognition,” recently published in <a href="http://journals.lww.com/lww-medicalcare/Abstract/publishahead/Changes_in_Patient_and_Nurse_Outcomes_Associated.99051.aspx" target="_blank"><i>Medical Care</i></a>, 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.<br />
<br />
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 <i>Medical Care</i> that demonstrates the <a href="http://journals.lww.com/lww-medicalcare/Abstract/2014/05000/Is_There_a_Business_Case_for_Magnet_Hospitals_.4.aspx" target="_blank">economic benefits</a> associated with Magnet status.(3).<br />
<br />
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.<br />
<br />
<br />
<span style="font-size: x-small;">1.<span class="Apple-tab-span" style="white-space: pre;"> </span>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. </span><br />
<span style="font-size: x-small;">2.<span class="Apple-tab-span" style="white-space: pre;"> </span>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.</span><br />
<span style="font-size: x-small;">3.<span class="Apple-tab-span" style="white-space: pre;"> </span>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.</span><br />
<br />
<br />
<i>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.</i><br />
<br />INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-88462787393954146552015-05-21T16:11:00.000-04:002015-05-21T16:11:27.586-04:00Rehab Nurses Lead Multidisciplinary Efforts in Fall Prevention At hospitals around the country rehab nurses are playing an essential role in reducing fall risk by educating their colleagues, in addition to their patients, according to an <a href="http://nursing.advanceweb.com/Features/Articles/Falls-Prevention.aspx" target="_blank"><i>Advanced Healthcare Network for Nurses</i></a> article.<br />
<br />
At the Chicago-based <a href="http://www.schwabrehab.org/" target="_blank">Schwab Rehabilitation Hospital</a>, nurses provide fall risk education to patients who also undergo a fall risk assessment at the time of admission. Schwab also uses stoplight model signs to identify the level of fall risk (green for low; yellow for moderate; and red for high) attached to patients’ beds and wheelchairs.<br />
<br />
Additionally, rehab nurses at Schwab meet with hospital staff in other departments, including therapy, dietary, and environmental services, to educate them on the importance of notifying a nurse when a patient is at risk of falling. As a result of these efforts, Schwab has reduced their fall rate from 7.86 to 3.9 per 1,000 patient days over the course of a year.<br />
<br />
INQRI grantees <a href="http://www.inqri.org/grantee/dr-patricia-dykes" target="_blank">Patti Dykes</a> and <a href="http://www.inqri.org/grantee/dr-blackford-middleton" target="_blank">Blackford Middleton</a> created a tool <a href="http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407343" target="_blank">designed to prevent patient falls</a> 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).<br />
<br />
The team constructed the <a href="http://www.inqri.org/tool/falls-tips-website" target="_blank">Fall Prevention Toolkit</a> (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.INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-55010535101398882032015-05-12T12:02:00.000-04:002015-05-12T12:02:39.187-04:00Doctors Learn from Shadowing Nurses at Illinois Hospital A program launched by a <a href="http://news.todayinpt.com/article/20150505/IL02/150504003#.VU0spi52Cao" target="_blank">nurse and doctor at an orthopedic surgery center</a> is proving that physicians can benefit from shadowing nurses during shifts.<br />
<br />
The program was launched at <a href="http://www.presencehealth.org/locations/hospitals/presence-saint-joseph-medical-center" target="_blank">Presence St. Joseph Medical Center</a> in Joliet, Illinois, by Patient Care Manager and RN Barbara Walker and Orthopedic Surgeon <a href="http://findadoctor.presencehealth.org/docs/Murphy_Michael_1224772" target="_blank">Michael Murphy</a>, 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 <i>Nurse.com</i>.<br />
<br />
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.<br />
<br />
“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.”<br />
<br />
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.<br />
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INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-54940835209476430402015-05-01T15:56:00.000-04:002015-05-01T15:57:46.647-04:00Nurses Succeeding in Bone Marrow Biopsy Program A nurse-led bone marrow aspiration/biopsy program is providing evidence that the use of procedurists is good for patient outcomes and good for clinical practice, <a href="http://www.oncologynurseadvisor.com/bone-marrow-program-nursing-aspiration-biopsy-training/article/411166/" target="_blank">according to a presentation</a> at the <a href="https://www.ons.org/" target="_blank">Oncology Nursing Society’s</a> 40th Annual Congress in Orlando, Florida. The presentation was titled <i>Multidisciplinary Development of a Bone Marrow Aspirate and Core Biopsy Performed by Registered Nurses.</i><br />
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This use of nurse procedurists in bone marrow biopsies “demonstrates an innovative partnership for clinical practice, as recommended by the Institute of Medicine (IOM),” said <a href="http://congress2015.sched.org/speaker/daravankaornbsnocnr#.VUPZly52Cap" target="_blank">Daravan Kao</a> of the <a href="http://www.seattlecca.org/" target="_blank">Seattle Cancer Care Alliance</a>. The IOM’s landmark <a href="http://campaignforaction.org/directory-of-resources/iom-report" target="_blank">2010 report</a>, <i>The Future of Nursing: Leading Change, Advancing Health</i>, states that nurses “should practice to the full extent of their education and should be full partners in the redesigning of health care delivery,” Kao continued.<br />
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Registered nurses who participated in the bone marrow program maintained a 98 percent score, as rated by pathologists, for the quality of the samples they collected. Furthermore, there were no reported incidences of post procedure complications, <i>Oncology Nurse Advisor</i> reports.<br />
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A multidisciplinary team developed and implemented the biopsy program, which included didactic training, technical skills acquisition, and ongoing quality assurance.<br />
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INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-15946076758318510272015-04-24T10:25:00.000-04:002015-04-24T10:25:06.468-04:00Study Finds Patients Admitted to Hospitals on Weekends are at Greater Risk for “Never Events”Falls and infections are more common among patients admitted to hospitals on weekends, according to a new study conducted by researchers at the University of Southern California and published in the <a href="http://www.bmj.com/content/350/bmj.h1460" target="_blank"><i>British Medical Journal</i></a>. The research team analyzed data from more than 350 million hospital admissions from 2002 to 2010. Even though the vast majority (81 percent) of the admissions were on weekdays, there were more complications in patients admitted on weekends (5.7 percent of complications compared with 3.7 percent for patients admitted on week days). The most common kinds of hospital-acquired infections among patients admitted on weekends were pressure ulcers and catheter-associated urinary tract infections.<br />
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The research team could not determine whether the higher proportion of complications were due to lower staffing rates on weekends or patients with more urgent treatment needs being admitted during those times.<br />
<br />
These findings are consistent with a body of research showing that patients admitted during off-peak hours (like evenings and weekends) experienced more health problems, and were less likely to survive in-hospital cardiac arrest, and that newborns born on weekends were more likely to die than babies born during the week. <br />
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An <a href="http://www.inqri.org/research-project/effect-peak-hospital-environments-nurses-work-institutional-ethnography" target="_blank">INQRI-funded study</a> led by <a href="http://www.inqri.org/grantee/dr-patti-hamilton" target="_blank">Patti Hamilton</a> and <a href="http://www.inqri.org/grantee/dr-gretchen-gemeinhardt" target="_blank">Gretchen Gemeinhardt</a> found that nurses’ “off-peak” work environments play a significant role in the increased patient mortality during these time periods. In particular, the researchers found that nurses who participate in hospital plans that allow them to work only weekend shifts for full pay and benefits are less familiar with their institutions’ initiatives and priorities that govern policies, procedures, principles and regulations for providing care, because those initiatives and priorities are stressed more during peak periods.INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-69383325986786916622015-04-17T15:21:00.000-04:002015-04-17T15:23:37.877-04:00AACN Academy Shows Value of Investing in Nurse Leadership Development After participating in a 16-month leadership and innovation training program, nurses at <a href="http://www.aacn.org/wd/publishing/content/pressroom/pressreleases/2015/apr/csi-academy-overview.content?menu=AboutUs" target="_blank">42 hospitals nationwide</a> went on to direct quality initiatives that improved patient outcomes and saved more than $28 million annually.<br />
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The <a href="http://www.aacn.org/wd/csi/content/csi-landing.pcms?sidebar=none&menu=csi" target="_blank">AACN Clinical Scene Investigator (CSI) Academy</a> is a 16-month leadership and innovation training program for staff nurses delivered by the <a href="http://www.aacn.org/" target="_blank">American Association of Critical-Care Nurses </a>(AACN) that seeks to empower nurses as clinician leaders and catalysts for change.<br />
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The CSI Academy trained 163 nurses to address clinical challenges such as health care associated infections, pressure ulcers, delirium, early mobility, falls, and patient handoffs. The nursing teams saw great success, according to AACN, significantly reducing many common hospital errors.<br />
<br />
Regional groups working in <a href="http://www.aacn.org/wd/publishing/content/pressroom/pressreleases/2013/dec-aacn-csi-patient-outcomes-cost-savings.pcms?menu=publications" target="_blank">Indiana</a>, <a href="http://www.aacn.org/wd/publishing/content/pressroom/pressreleases/2014/june/csi-academy-boston-nurse-led-initiatives.pcms?menu=publications" target="_blank">Massachusetts</a>, <a href="http://www.aacn.org/wd/publishing/content/pressroom/pressreleases/2014/dec/aacn-csi-academy-spurs-results.pcms?menu=publications" target="_blank">New York</a>, <a href="http://www.aacn.org/wd/publishing/content/pressroom/pressreleases/2014/feb/csi-north-carolina-hospitals.pcms?menu=publications" target="_blank">North Carolina</a>, <a href="http://www.aacn.org/wd/publishing/content/pressroom/pressreleases/2014/oct/latest-csi-improved-patient-outcomes.pcms?menu=publications" target="_blank">Pennsylvania</a> and <a href="http://www.aacn.org/wd/publishing/content/pressroom/pressreleases/2014/aug/csi-aacn-academy-impacts-future-of-nursing.pcms?menu=publications" target="_blank">Texas</a> showed progress in decreasing:<br />
<ul>
<li>Intensive care unit (ICU) and progressive care unit lengths of stay by one day; </li>
<li>Days on mechanical ventilation by 14 percent or approximately one day;</li>
<li>Health care-acquired infections and ICU complications by 50 percent;</li>
<li>Patient falls by 50 percent;</li>
<li>Pressure ulcers by 40 percent;</li>
<li>Catheter-associated urinary tract infections by 70 percent; and</li>
<li>Confusion Assessment Method for the ICU (CAM-ICU) positive scores by 14 percent</li>
</ul>
“These outcomes solidly reaffirm the value of investing in bedside nurses’ leadership development,” AACN CEO Dana Woods said in a statement. “Our program evaluations confirm that dedicated time for nurses to apply their skills in leading organizational and behavioral change was vital to achieving the program’s impressive results.”<br />
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AACN provides project materials from each team, including plans, data collection tools, practice resources and references in a searchable online database, which can be accessed at <a href="http://www.aacn.org/csiprojects" target="_blank">www.aacn.org/csiprojects</a>.<br />
<br />
<i>INQRI Blog</i> featured previously released data from the Academy from regional groups working in <a href="http://inqri.blogspot.com/2014/06/national-nurse-leadership-training.html" target="_blank">Massachusetts</a> and <a href="http://inqri.blogspot.com/2014/03/nurse-led-initiatives-benefit-patients.html" target="_blank">North Carolina</a>.<br />
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INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-7558660338874891932015-04-10T12:01:00.000-04:002015-04-10T12:03:53.663-04:00Special Flooring Could Reduce Fall Injuries Among Patients Impact-absorbing flooring reduced fall injuries by nearly 60 percent in a <a href="http://www.reuters.com/article/2015/04/09/us-health-elderly-soft-floors-idUSKBN0N01TP20150409?feedType=RSS&feedName=healthNews" target="_blank">new study of women in Swedish nursing homes</a>, reports <i>Reuters Health</i>.<br />
<br />
Researchers for the study, which is published in the journal <a href="http://injuryprevention.bmj.com/content/early/2015/04/01/injuryprev-2014-041468.short?g=w_injuryprevention_ahead_tab" target="_blank"><i>Injury Prevention</i></a>, collected fall and injury data from a nursing home in Sweden with 60 apartments. Six of the apartments were fitted with 12-millimeter flexible impact absorbing tiles.<br />
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During the three-year research period, 57 female nursing home residents participated in the study, with 39 falling at least once. Injuries resulted 30 percent of the time on regular flooring, but only 17 percent of the time with the special flooring. Although falls seemed to occur more often on the special flooring, researchers told <i>Reuters Health</i> that nursing home staff may have moved patients at greater risk for falling into the softer flooring areas. The study did not include bathrooms, where patients frequently fall.<br />
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INQRI grantees <a href="http://www.inqri.org/grantee/dr-patricia-dykes" target="_blank">Patti Dykes</a> and <a href="http://www.inqri.org/grantee/dr-blackford-middleton" target="_blank">Blackford Middleton</a> created a tool <a href="http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407343" target="_blank">designed to prevent patient falls </a>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).<br />
<br />
The team constructed the <a href="http://www.inqri.org/tool/falls-tips-website" target="_blank">Fall Prevention Toolkit</a> (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.INQRI Programhttp://www.blogger.com/profile/00039932399410649691noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-78546918124439616072015-04-02T15:32:00.000-04:002015-04-02T15:35:23.004-04:00New 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 <a href="http://ccn.aacnjournals.org/" target="_blank"><i>Critical Care Nurse</i></a> (CCN). <br />
<br />
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).<br />
<br />
Researchers for the study, including <a href="http://www.sjfc.edu/academics/nursing/faculty-staff/fac-staff-detail.dot?id=79bb6573-c3b4-4447-91d7-738bfaf708d7" target="_blank">Christine Boev</a>, performed a secondary analysis of nurse surveys conducted in four specialized intensive care units (ICUs) over a five year period. The resulting article, “<a href="http://ccn.aacnjournals.org/content/35/2/66.full" target="_blank">Nurse-Physician Collaboration and Hospital-Acquired Infections in Critical Care</a>,” shows the association between nurses’ perception of their working relationships with physicians and the rates of VAPs and CLASBSIs.<br />
<br />
“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 <a href="http://www.aacn.org/wd/publishing/content/pressroom/pressreleases/2015/mar/ccn-hai-study.content?menu=AboutUs" target="_blank">statement</a>. “Efforts to prevent healthcare-associated infections must include interventions to improve nurse-physician collaboration.” <br />
<br />
Boev, an assistant professor at the <a href="http://www.sjfc.edu/academics/nursing/about/index.dot" target="_blank">Wegmans School of Nursing</a>, <a href="http://www.sjfc.edu/home/index.dot" target="_blank">St. John Fisher College</a>, suggested multidisciplinary daily patient rounds and shared simulation training to improve collaboration.<br />
<br />
Reducing CLASBIs was the focus of an INQRI-funded <a href="http://www.inqri.org/multicenter-phased-cluster-randomized-controlled-trial-reduce-central-line-associated-bloodstream-in" target="_blank">study</a> led by <a href="http://www.inqri.org/grantee/dr-david-thompson" target="_blank">David Thompson</a> and <a href="http://www.inqri.org/grantee/dr-jill-marsteller" target="_blank">Jill Marsteller</a>. 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.<br />
<br />
The CCN article abstract and full-text PDF is available at: <a href="http://ccn.aacnjournals.org/" target="_blank">http://ccn.aacnjournals.org</a>/.INQRI Programhttp://www.blogger.com/profile/05672756518369446049noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-61602880600323994072015-03-27T14:30:00.000-04:002015-03-27T14:30:22.326-04:00Interprofessional Teamwork Helps to Prevent Patient FallsNineteen hospitals in Nebraska are collaborating on an interprofessional, evidence-based approach to <a href="http://www.fiercehealthcare.com/story/how-teamwork-can-prevent-patient-falls/2015-03-24?utm_medium=rss&utm_source=feedly&utm_campaign=rss" target="_blank">decreasing fall risk</a>, reports <i>FierceHealthcare</i>, and they are seeing results.<br />
<br />
"We had no process, no structures in place to decrease our fall risk," said Carol Kampschneider in a <a href="http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Daily/2015/March/Patient-falls-prevention-video-hoppszallern" target="_blank">video posted</a> on <i>Hospitals & Health Networks (H&HN) Daily</i>. Kampschneider is a registered nurse and vice president of clinical and regulatory services at <a href="http://www.saintfrancismemorial.org/index.htm" target="_blank">St. Francis Memorial Hospital</a> in West Point, Nebraska. Prior to joining the collaboration, only falls that resulted in broken bones or head injuries were identified as serious at her hospital and no fall risk assessment was completed during patient admissions.<br />
<br />
Through an <a href="http://www.ahrq.gov/" target="_blank">Agency for Healthcare Research and Quality</a> grant, the 19 hospitals became involved in the Collaboration and Proactive Teamwork Used to Reduce Falls (<a href="http://www.unmc.edu/patient-safety/capturefalls/" target="_blank">CAPTURE Falls</a>) program, and began to see improvements. For example, the fall rate at St. Francis dropped from 7.31 per 1,000 patient days to 1.41 per 1,000 patient days, Kampschneider said.<br />
<br />
As part of the program interprofessional teams collaborate and use tools to understand risks associated with inpatient falls. If a fall does occur, the teams will conduct a "post-fall huddle" to determine how they can prevent the patient from falling in the future.<br />
<br />
INQRI grantees <a href="http://www.inqri.org/grantee/dr-patricia-dykes" target="_blank">Patti Dykes</a> and <a href="http://www.inqri.org/grantee/dr-blackford-middleton" target="_blank">Blackford Middleton</a> created a tool <a href="http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407343" target="_blank">designed to prevent patient falls</a> 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).<br />
<br />
The team constructed the <a href="http://www.inqri.org/tool/falls-tips-website" target="_blank">Fall Prevention Toolkit</a> (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.<br />
<br />
The <i>H&HN Daily</i> video is <a href="http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Daily/2015/March/Patient-falls-prevention-video-hoppszallern" target="_blank">available here</a>.<br />
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INQRI Programhttp://www.blogger.com/profile/05672756518369446049noreply@blogger.com0tag:blogger.com,1999:blog-6516838984781766665.post-42813847551900006302015-03-19T16:48:00.000-04:002015-03-19T16:48:29.746-04:00Nurse Team Reduces CAUTI Infections Through EHR Tool A nurse-led initiative at a Missouri hospital used Electronic Health Records (EHRs) to <a href="http://www.beckershospitalreview.com/healthcare-information-technology/university-of-missouri-health-care-uses-ehrs-to-reduce-cautis.html" target="_blank">reduce the number of catheter-associated urinary tract infections</a> (CAUTIs) by 25 percent in its facilities, Becker’s Health IT & CIO Review reports.<br />
<br />
Eileen Phillips, an RN at the <a href="http://www.muhealth.org/" target="_blank">University of Missouri Health System</a>, led a team of nurses in reviewing literature on infections. The team then developed a list of appropriate, evidence-based indications for catheter use, and included a step in their EHRs that required nurses to document the reasons for use of a catheter. This led to a decrease in use of catheters and contributed to the subsequent 25 percent drop in infections.<br />
<br />
The nursing team also began an educational and communications campaign called “CAUTIon: Zero Infections Ahead” that used web-based modules, posters, rewards systems, weekly quizzes, and staff meetings to highlight best practices for catheter use.<br />
<br />
"This could not have occurred without first reducing our utilization, which is why the EHR task has helped so much," Phillips said in a <a href="http://www.cerner.com/blog/Improving_Our_CAUTI_rate_within_the_EHR/?langtype=1033" target="_blank">blog post</a> Q&A on <a href="http://www.cerner.com/" target="_blank">Cerner’s website</a>. "In 2013, our catheter utilization was 33 percent, and in 2014, utilization decreased to 25 percent, which is a 24 percent overall decrease. I am really happy with the progress we have made so far."<br />
<br />
Reducing central line infections was the focus of an INQRI-funded <a href="http://www.inqri.org/multicenter-phased-cluster-randomized-controlled-trial-reduce-central-line-associated-bloodstream-in" target="_blank">study</a> led by <a href="http://www.inqri.org/grantee/dr-david-thompson" target="_blank">David Thompson</a> and <a href="http://www.inqri.org/grantee/dr-jill-marsteller" target="_blank">Jill Marsteller</a>. 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.<br />
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INQRI Programhttp://www.blogger.com/profile/05672756518369446049noreply@blogger.com0