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.

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

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

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

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

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

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

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

Webinar Explores how Nurse Informaticists Improve Patient Outcomes

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

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

Further information and registration for the webinar is available here.

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

“Bundle” of Practices Reduces Risks of Delirium and Immobility, INQRI Study Shows

Patients in hospital intensive care units (ICUs) are often put on ventilators, sedated, and/or immobilized for part of their stays. Unfortunately, all of these procedures can also put them at risk for delirium, which can be debilitating and have long-term negative effects. A new study funded by INQRI and published in Critical Care Medicine, finds that implementing a set of practices to encourage patients’ mobility and reduce sedation effectively reduces delirium and the need for a ventilator, and increases patients’ mobility during hospitalization, which decreases weakness.

The study tested the effectiveness and safety of implementing a bundled set of evidence-based practices into everyday practice in the ICU. It is called the ABCDE bundle, for Awakening and Breathing Coordination, Delirium monitoring and management, and Early mobility.

The research team, led by Michele Balas and William Burke, examined the results of having a nurse-led interdisciplinary team use the bundle with roughly 150 patients in five adult ICUs, one step-down unit, and an oncology/special care unit in a medical center and compared their outcomes with those of a similar group of patients in the same setting prior to implementation of the bundle.

Patients in the study who were managed with the ABCDE bundle spent more days breathing without a ventilator (a median of 24 days compared with a median of 21 days). Fewer of those patients experienced delirium, compared with the other group (48.7% compared with 62.3%), and delirium duration was reduced by one day. Patients treated with the bundle had twice the odds of getting out of bed at least once during their hospital stays, and lower hospital mortality (11.3% compared with 19.9%).

ABCDE is a bundle of interventions tested in clinical trials that have been adapted for everyday use 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 oversedation and prolonged attachment to a ventilator that can lead to delirium and weakness.

New Study Offers Guidance on how to Offer Evidence-Based Care

Evidence-based care is a hallmark of good health care practice, but it can be difficult to ensure that evidence-based practice is the norm throughout health care systems. A new study conducted by nurse researchers offers guidance for health care providers on effective adoption of evidence-based practice in clinical settings. The guidance includes 24 evidence-based practice competencies for registered and advanced-practice nurses in real-world clinical settings.

The study, led by Bernadette Melnyk, dean of The Ohio State University College of Nursing and chief wellness officer for Ohio State, recommends that health care institutions build these skills into employment expectations, evaluations, and clinical ladder promotion systems to ensure ongoing implementation of evidence-based care.

To develop the list of competencies, the research team collected input from national leaders in evidence-based practice (EBP) and surveyed 80 nurses who are EBP mentors. Thirteen of the competencies apply to registered nurses and the other 11 are for advanced practice nurses.

The list of the 24 evidence-based practice competencies is available here: http://onlinelibrary.wiley.com/doi/10.1111/wvn.12021/full and the full study is published in the journal Worldviews on Evidence-Based Nursing. An Ohio State University statement on the study is available here.

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

Webinar: Dissemination and Implementation of Evidence-Based Methods to Measure and Improve Pain Outcomes

Did you miss yesterday's webinar?  If so, here's your chance to catch up...

Thank you to INQRI grantees Susan Beck and Nancy Dunton for their presentation on evidence-based methods to measure and improve pain outcomes and to INQRI National Advisory Committee member Shelley White-Means for facilitating our discussion.

NYT Notes Importance of Evidence-Based Solutions

Yesterday's New York Times featured an excellent piece by David Bornstein that demonstrates the need for widespread use of evidence-based solutions to address society's major issues. The piece highlights impact on improving care and reducing costs via the Transitional Care Model, which provides comprehensive in-hospital planning and home follow-up for chronically ill high-risk older adults hospitalized for common medical and surgical conditions.

Click here to read the piece.

INQRI Grantee on the Importance of Transforming the U.S. Health System

Continuing INQRI's contribution to RWJF's Human Capital blog carnival on "Health Care in 2013," INQRI grantee Robin Newhouse's post was featured today. Dr. Newhouse details her resolution for the U.S. in 2013: that the country "begin the transformation of health care systems to enhance high quality patient-centered care." Her post focuses on the importance of implementing evidence-based practices and the measurement and improvement of patient outcomes.

Click here to read Dr. Newhouse's piece.

Nurses as Effective Case Managers

A new Advance for Nurses article describes the impact nurses can have as effective case managers.  The task of ensuring seamless, high-quality, cost effective care across the care continuum is daunting one made easier, author Caitlin Nalley notes, by employing evidence-based practices and interdisciplinary collaboration.

Click here to read the article.

Click here to read about INQRI's view on the importance of interdisciplinary collaboration.

Facilitating The Use of Research Evidence

A new issue of the Milbank Quarterly has recently been made available free of charge that is focused on facilitating the use of research evidence. This issue, which includes articles from 2002 - 2011, discussed the importance of research translation and dissemination, as well as the application and use of comparative effectiveness research. INQRI grantee, Dr. Robin Newhouse, and her colleagues' work, which discussed a transdisciplinary model of evidence-based practice, are also featured in this issue.

Click here to access the full list of articles.

Click here to directly access the article that included the work of INQRI grantee, Dr. Robin Newhouse.

INQRI Grantee Awarded Episteme Laureate Award From Sigma Theta Tau International

It is with great honor to share with all of you that last week, Kathleen R. Stevens, EdD, RN, FAAN, received the Episteme Laureate award from the honor society of nursing, Sigma Theta Tau International. Dr. Stevens, who was a co-PI of a previously funded INQRI study, is nationally recognized for her involvement in improvement science and the dissemination of evidence-based practices. Dr. Stevens is also the founding director of the Academic Center for Evidence-Based Practice (ACE) at the University of San Antonio Health Science Center where the Star Model of Knowledge Transformation was created.

Click here to read the full recap of Dr. Steven's award presentation.

Click here or here to read more about Dr. Steven's INQRI work.

Click here to find out more information about the ACE.

Nurse Clinicians and Researchers Partner at the University of Louisville

Inspired by the IOM report, The Future of Nursing: Leading Change, Advancing Health, the University of Louisville School of Nursing faculty are teaming up with nurses and other health care team members from the University of Louisville Hospital and James Graham Brown Cancer Center to improve patient care and quality of life through clinical nursing research and evidence based practice projects.

M. Cynthia Logsdon, a professor in the School of Nursing and the associate chief of nursing for research at the hospital and cancer center, is facilitating partnerships between nurses in clinical practice and doctorally prepared nurse scholars.

Click here to learn more about their collaborations.

Now Available: "Patient Safety and Quality: An Evidence-Based Handbook for Nurses"

To assist nurses in understanding what proven techniques and interventions they can use to improve patient outcomes, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared a comprehensive, 1,400-page, handbook for nurses on patient safety and quality.

"Patient Safety and Quality: An Evidence-Based Handbook for Nurses" features the work of many well-regarded scholars, including INQRI grantees: Marita Titler, Sean Clarke, Nancy Donaldson, Mary Wakefield and Joanne Disch.

This volume is now available for download and is organized by the following sections:

• Patient Safety and Quality
• Evidence-based Practice
• Patient-centered Care
• Working Conditions—Work Environment
• Critical Opportunities for Patient Safety and Quality
• Tools

Click here to download the entire volume as a PDF file (10 MB).
Click here to individual chapters.

INQRI Team Recognized for Work on "Aging in Place"

Congratulations to our team at the University of Maryland, led by Barbara Resnick and Sheryl Zimmerman.  Their project on Function-Focused Care recently won a Dorland Health Silver Crown Award in the Aging in Place category.

Dorland Health, a division of Access Intelligence, created the awards program to honor excellence and dedication among industry-leading organizations who provide exceptional services, products, and information to the over 55 community, and also recognizes individual healthcare professionals who achieve great success working with the senior population.

The Resnick-Zimmerman team conducted a randomized controlled trial to test Function Focused Care – Assisted Living (FFC-AL), an intervention 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. A total of 171 residents and 96 direct care workers (DCW) were followed for 12 months. Based on observations of care interactions, DCWs in treatment sites provided more function focused care by 12 months than those in the control sites. Residents in 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 fewer transfers to the hospital among those in the treatment sites. There was evidence of dissemination and implementation of FFC-AL within the sites that endured beyond the study period, showing that the team's work led to institutional policy and environmental changes. The study findings suggest that using a FFC-AL approach may help to prevent some of the persistent functional decline commonly noted in these communities, increase time spent in physical activity, and decrease the need for acute care transfers.

Click here to learn more about the Dorland Health Silver Crown Awards.

Video: Standardizing and Collecting Nursing Data

Yesterday, blip.tv posted a fascinating interview with Peggy White, Program Manager of Canadian Health Outcomes for Better Information and Care, discussing the importance of collecting standardized nursing data for patient care. INQRI benefits from the utilization of improved nursing data which allows for greater scrutiny of nurse practices, and in turn, improved patient outcomes.

Click here to watch the video

Recent INQRI Grantee's Work Recognized By Local TV Station

Last week, an INQRI funded interdisciplinary team led by Michele Balas, Ph.D. and William Burke, M.D of the University of Nebraska was featured on local ABC affiliate station, KHGI, in Nebraska. The article, which is a reprint of an Associated Press piece, highlights the goals and importance of the teams' work.

The main goal of this project is 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. The study will focus on applying a program of delirium screening, prevention, and treatment developed at Vanderbilt University.

Click here to read the article.

Click here to read more about this study and other recent INQRI grantees' work.

Joint Commission Annual Report Shows Big Improvements for Hospital Care

The Joint Commission released its annual report last week which showed great improvements in the quality of care being delivered to patients and significant progress in consistently using evidence-based treatments.

“It is very encouraging that this year’s report shows high rates of performance on these critical process measures and high levels of consistent excellence among hospitals on many measures,” said Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission. “Hospitals devote enormous resources and energy to using these performance measures to drive improvement in their clinical processes. This report demonstrates that these efforts are resulting in consistently improving patient care in America’s hospitals.”

Notable Improvements:

• In 2002, hospitals achieved 81.8 percent composite performance on 957,000 opportunities to perform care processes related to accountability measures. In 2009, hospitals achieved 95.4 percent composite performance on 12.5 million opportunities – an improvement of 13.6 percentage points. 
• Hospital performance on measures of quality relating to inpatient care for childhood asthma has increased dramatically in the two years since being introduced. The 2009 children’s asthma care result is 88.1 percent, up from 70.7 in 2007.
• The 2009 pneumonia care result is 92.9 percent, up from 72.4 percent in 2002 – an improvement of 20.5 percentage points.
• The surgical care result improved to 95.8 percent in 2009 from 77.4 percent in 2004.

Areas for Improvement:

• Only 55.2 percent of hospitals achieved 90 percent compliance or better in providing fibrinolytic therapy within 30 minutes of arrival to heart attack patients. 
• Only 67.5 percent of hospitals achieved 90 percent compliance or better in providing antibiotics to intensive care unit pneumonia patients within 24 hours of arrival.

Click here to download the report, Improving America’s Hospitals:  The Joint Commission’s Report on Quality and Safety 2010.

Click here to read the press release.

INQRI Grantee Wins NIH Grant for Improvement Science

Kathleen Stevens, Ed.D, R.N., A.N.E.F., won a $3.1 million grant from the National Institutes of Health (NIH) to advance health care improvement projects. Stevens is a professor of nursing and director of the Academic Center for Evidence-Based Practice at the University of Texas in San Antonio and an INQRI grantee, with Robert Ferrer, M.D., as co-principal investigator.

The two-year grant will enable Stevens to create the first national research network for research teams to test improvement strategies in an inter-professional context. Nurse scientists and collaborating researchers and clinicians will use the network to evaluate improvement strategies across multiple sites, share resources and results, and move the most effective strategies quickly to bedside care.

"Improving the quality of health care and patient safety has been a major goal of the federal government, accrediting bodies, regulatory agencies and patient-advocacy groups for at least 10 years, but progress has been slow in actually moving research into improvements that benefit patients," Stevens said in a statement. "Nurses are in a strong position to transform the care given in hospitals. This network provides a national laboratory in which to rapidly test and implement improvements in health care."

Under the project, research teams will be supported through a coordinating center at the University of Texas Health Science Center and a unique web-based collaborative. An improvement science web site was launched earlier this month. The inaugural improvement science summit, supported by the NIH, will be held in July in San Antonio, Texas. Registration fees are supported by the NIH.

Evidence-based treatments have improved care quality, Joint Commission says

This week, Victoria Forlini wrote a piece for FierceHealthcare, explaining the way that the Joint Commission says that evidence-based practices improve patient care.

Hospitals are striving for--and hitting--many outcome improvements, the Joint Commission reports. National improvement on 12 outcomes, reflecting best evidence-based treatments for heart attacks, heart failure and pneumonia, rose between 4.9 percent and 58.8 percent between 2002 to 2008, according to Improving America's Hospitals: The Joint Commission's Report on Quality and Safety 2009.

"In addition to saving lives and improving health, improved quality reduces healthcare costs by eliminating preventable complications," said Mark Chassin, the accreditor's president. Hospital improvements included:

• Overall heart failure care results improving so that evidence-based treatments were given 91.6 percent of the time, up from 59.7 percent in 2002.
• Evidence-based treatments being given 92.9 percent of the time in pneumonia cases in 2008, up from 72.3 percent in 2002.

The report presents scientific evidence of improvement and how it relates to common medical conditions and procedures. The Joint Commission measures 31 outcomes, including several for children's care. More than 3,000 Joint Commission-accredited hospitals contributed data.

For more information, check out this press release.