Journal of nursing care quality最新文献

Background: Emerging evidence suggests that virtual patient observation (VPO) may help promote patient safety.

Purpose: The purpose of this study was to examine and describe the demographic and clinical characteristics of patients who incurred VPO.

Methods: A retrospective analysis was conducted. Differences in total VPO hours between groups were examined, followed by a hierarchical regression to investigate the effect of predictor variables on VPO utilization variance.

Results: A total of 286 patient charts were reviewed. Mean VPO hours were higher in patients with an intensive care unit admission history. Adjusted for gender and history of dementia/Alzheimer's/memory impairment, the prediction of total VPO hours increased with the patient's intensive care unit admission history and overall hospital length of stay.

Conclusions: Examining the prevalence and variability in the pattern of VPO utilization by specific patient characteristics is essential for identifying what patients could best benefit from this technology.

Background: Bedside shift report improves patient satisfaction, peer accountability, communication, and decreases safety events.

Local problem: Clinical practice of bedside report varied prior to the pandemic. Due to limited personal protective equipment and exposure risk, bedside report was halted during the pandemic.

Approach: The Iowa Model of Evidence-Based Practice was used to guide this project. To standardize communication during bedside report, safety data and literature were reviewed and grouped by themes. The acronym COAST was developed, consisting of code status, oxygen, access, safety, and tubes/drains. These elements were to be discussed at the bedside during handoff.

Results: Compliance with completing elements of COAST increased during the pilot, 9- and 12-month sustainment periods. Additional safety-related outcomes of cardiopulmonary resuscitation wristband application, falls, and good catches improved. Notably, overtime declined.

Conclusions: A bedside report with standardized communication focusing on safety elements can improve compliance with adoption and patient safety outcomes.

Background: Nursing care delivery models influence nursing workload.

Problem: Poorly designed nursing workforce models may lead to lack of satisfaction in practice, inability to recruit staff, and nursing turnover.

Approach: This paper describes a process that our team undertook to evaluate one nursing unit's nursing care delivery model and provides a recommendation for a nursing workforce model that ensures practice to top of scope while maintaining a balanced workload. Team brainstorming and affinity diagramming tools were used.

Outcomes: The team findings resulted in a recommendation for an innovative care-based nursing model pilot.

Conclusions: The use of brainstorming and affinity diagramming is an effective method for identifying opportunities to improve a nursing workforce model.

Background: Education and training may improve outcomes within an experienced vascular access team.

Purpose: The purpose of this study was to measure the impact of a standardized peripheral intravenous catheter insertion educational program (Operation STICK) on vascular access outcomes.

Methods: A quasi-experimental study design was used. Adult inpatients with difficult intravenous access (DIVA) requiring ultrasound-guided insertion by a vascular access specialty team were eligible. Data were collected before and 7 months after the educational training program.

Results: A total of 54 subjects were included (24 pre- and 30 post-implementation). Significant improvements were found for mean peripheral intravenous catheter dwell time (3.62 to 14.97 days, P < .001), completion of therapy (58.3% to 96.7%, P = .001), and first-stick success rate (79.2% to 100%, P = .013). Catheter-to-vein ratio significantly decreased (P = .007).

Conclusions: Standardized education/training in vascular access focusing on best practices yields favorable outcomes for DIVA patients within an established specialty team.

Background: The health and well-being of the nursing workforce has received recent attention due to nurse attrition and the critical nurse shortages projected across the country. A nurse's well-being may impact patient outcomes.

Purpose: The purpose of this scoping review was to assess the association between nurse well-being factors and specific patient outcomes.

Methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) PRISMA Scoping Review protocol and 2020 reporting guidelines were utilized in this review.

Results: Staffing, environment, physical health, and mental health of nurses were correlated to specific adverse patient outcomes among the 97 articles included in the final review. The majority of the articles reported significant findings.

Conclusions: Patient outcomes were reviewed as discrete events in the articles examined. With mixed results found on key patient outcomes, future research requires more in-depth investigation into the role nurse well-being has on patient outcomes.

Background: Hip fracture is a major health concern and the use of an indwelling urinary catheter (IUC) constitutes a significant burden on elderly patients undergoing hip fracture surgery.

Local problem: The institution had a high rate of urinary tract infection (UTI) and IUC reinsertion after hip fracture surgery.

Methods: A pre/post-implementation design was used for this quality improvement initiative.

Interventions: A nurse-driven process was developed and implemented to improve the successful removal of IUC among patients after hip fracture surgery.

Results: There was a significant reduction in post-operative urinary retention (P = .042), UTI rate (P = .047), and IUC reinsertion (P = .042) in the post-implementation group. IUC duration decreased by 1.1 days, however this was not significant (P = .206). Nurse compliance with following the new process was 93.3%.

Conclusion: The nurse-driven process designed for elderly patients following hip fracture surgery presents a promising approach to reducing IUC reinsertion rates and UTI.

Background: Optimal quality improvement in health care is based on research and other types of evidence. Critical appraisal of evidence is a fundamental component of evidence-based practice (EBP) and is also needed to evaluate the quality of quality improvement (QI) projects.

Problem: Currently available EBP or QI critical appraisal tools can be challenging for students learning the critical appraisal process and for practicing clinicians who desire access to a standardized EBPQI approach to inform health care decision-making. The currently available tools are incomplete, too brief, or too complicated for ease of use in education and practice.

Approach: This article introduces the first combined EBP and QI (EBPQI) critical appraisal tool, which is aligned with the new EBPQI mountain model.

Conclusion: This newly developed appraisal tool may be used in appraising evidence for an EBPQI initiative and to appraise the quality of disseminated EBPQI.

Background: Human trafficking affects nearly 1.1 million persons in the United States. Over 50% of victims will receive care in an emergency department (ED) during their exploitation.

Purpose: The purpose of this study was to assess the effectiveness of a human trafficking protocol and electronic medical record screening and assessment tool in identifying victims of human trafficking in the ED.

Methods: A 5-year, retrospective chart audit was conducted.

Results: Over 2 million ED visits occurred during the 5-year study period. Less than 1% (n = 525) of those patients screened positive as potential victims, while 45 (8.6%) were confirmed trafficking victims. The number of victims identified dropped following the pandemic.

Conclusions: Pandemic issues, staffing turnover, and lack of ongoing trafficking education impeded the identification of victims. Recommended changes to the protocol are presented.