Journal of nursing care quality最新文献

Background: Sustaining evidence-based practice (EBP) in nursing faces systemic and workforce barriers. Implementation science (IS) offers structured approaches to support EBP integration. Under Saudi Arabia's Vision 2030, scalable nurse-led models are critical to bridging the research-to-practice gap.

Aim: To evaluate the Evidence-Based Quality Improvement Project (EQUIP), a nurse-led model grounded in IS, by assessing its implementation through frontline implementation lead (IL) nurses.

Methods: A mixed-methods formative evaluation was conducted across multiple healthcare facilities. Two IL nurse-led quality improvement (QI) projects were used as illustrative examples. Data sources included QI documentation, clinical metrics, and researcher field notes.

Results: EQUIP enabled IL nurses to apply EBP in routine care and proved adaptable across diverse settings. However, inconsistent engagement and competing workload demands were the most influential barriers, underscoring the need for structured support.

Conclusion: EQUIP presents a scalable IS-based initiative to embed EBP in nursing. Institutional support is essential for sustained implementation.

Background: Patient discharge lounges have been used to improve hospital throughput for more than 30 years; however, their implementation has been inconsistent due to varying levels of engagement from providers, staff, and patients.

Local problem: A project team sought to reduce wait times for patients admitted from the emergency department (ED) by reducing discharge delays.

Methods: This quality improvement initiative used a pre/post-implementation design.

Intervention: Key strategies included selecting appropriate staff, identifying eligible patients, ensuring timely delivery of discharge medications, and interprofessional education. The discharge lounge was uniquely staffed by unlicensed patient care technicians.

Results: Discharge lounge use increased by 12.5%. The time from written discharge order to the patient's departure from an inpatient unit decreased by 14 minutes, and ED wait time decreased by an average of 192 minutes.

Conclusion: These innovative strategies yielded positive returns and may help other organizations to improve patient throughput.

Background: Frequent hand hygiene is essential for infection control among health care workers (HCWs) but may cause adverse skin effects.

Purpose: To assess the relationships between frequent hand hygiene practices, skin symptoms, and microbiota alterations in HCWs.

Methods: A comprehensive search of 7 databases was conducted to identify articles published between January 2014 and July 2024 in English and Chinese.

Results: A total of 24 studies were included in the review. Frequent hand hygiene was associated with reduced microbial flora in 2 studies and high incidences of skin dryness, itching, peeling, erythema, fissures, burning, and pain in 18 studies. Fifteen studies linked frequent hand hygiene to eczema, dermatitis, acne, and folliculitis, while 1 study found higher Staphylococcus aureus detection in severe eczema cases.

Conclusions: Prolonged frequent hand hygiene alters hand microbiota and induces various skin symptoms, necessitating attention to chronic occupational exposure among HCWs.

Background: Individuals with heart failure (HF) and adverse social determinants of health (SDOH) experience significant health care disparities.

Local problem: We noted high rates of acute care utilization by patients with adverse SDOH and unmet social needs.

Methods: This pilot quality improvement project used a pre-post design.

Intervention: A nurse-led, trauma-informed, community-based HF program (CHFP) was developed, providing care at each patient's chosen location (eg, shelter, tent). Guideline-directed medical therapy was adjusted to achieve patient goals.

Results: Sixteen patients participated in the CHFP. Reductions were seen in the number of emergency department visits, mean number of hospitalizations, and days hospitalized. The number of patients with ≥1 hospitalization significantly decreased from 12 to 5 ( P = .07). Cardiology outpatient encounters significantly increased from 11.19 to 19.38 ( P = .02).

Conclusions: CHFP reduced acute care utilization and has the potential to improve patient outcomes.

Background: Early recognition and intervention of sepsis in the pediatric population have been shown to decrease hospital length of stay and mortality rates. Stakeholders within a pediatric intensive care unit (PICU) identified a need to improve sepsis recognition in compliance with the Improving Pediatric Sepsis Outcomes Collaborative recommendations.

Purpose: The purpose of this study was to identify appropriate screening variables in an electronic health record (EHR)-embedded sepsis screening tool to improve sepsis recognition in the PICU setting.

Methods: A retrospective data analysis was conducted to test 3 versions of an EHR sepsis screen including triggers based on vital signs and/or laboratory results.

Results: Of the 3 tested versions, the sepsis screen version that triggered based on both vital signs and laboratory findings showed the most promising results with a sensitivity of 83.3% and a specificity of 76%.

Conclusions: EHR-embedded sepsis screens that monitor documented variables can identify potential sepsis while avoiding over-triggers.

Background: Maternal morbidity and mortality in the U.S. remain a significant concern, particularly in obstetric emergency settings where inefficient triage delays care and contributes to adverse outcomes.

Local problem: The obstetric emergency department (OBED) faced challenges in aligning triage processes with acuity-based care, leading to delays in provider response times.

Methods: A quality improvement initiative was conducted. Pre/post-implementation data were collected to evaluate the alignment of maternal-fetal triage index (MFTI) scores with provider-at-bedside (PAB) times.

Interventions: The MFTI system was implemented to prioritize patients based on acuity, aligning provider response times with MFTI-advised targets.

Results: Alignment between MFTI scores and PAB times improved from 40% to 90%. Documentation of MFTI scores and PAB times increased, while total visit times remained stable. Overall, survey data suggested providers were satisfied with the MFTI system.

Conclusions: The MFTI system enhanced triage efficiency and care quality in the OBED without extending total visit times, supporting acuity-based triage in obstetric emergencies.

Background: Medication errors are a significant problem in ambulatory care, occurring at any stage, from prescribing to administration.

Local problem: Medication error rates due to interruptions were high on an ambulatory medical unit.

Methods: A quality improvement design was used for the project.

Interventions: A Safe Zone protocol was developed by nurses, certified nursing assistants, and unit secretaries. Implementation included clear medication preparation areas, administration checklists, and staff and patient education.

Results: The number of distractions decreased by 20% over a 90-day period. Medication errors decreased from a rate of 0.97 events per 1000 doses administered to a rate of 0.20 after implementing the Safe Zone protocol.

Conclusions: Due to its flexibility and adaptability, the Safe Zone protocol offers a template that can be replicated in environments needing to address similar issues.

Background: Evaluating patient safety culture is vital for improving health care quality. The safety attitudes questionnaire (SAQ) is a well-established tool to measure attitudes toward safety in health care personnel, but its psychometric properties have not been extensively studied in the acute care nursing population.

Purpose: This study examines the psychometric properties of the SAQ specifically within an acute care nursing sample.

Methods: Reliability and validity of the SAQ were evaluated using correlation and confirmatory factor analysis (CFA) with a sample of nurses from acute care settings in California.

Results: Cronbach's alpha was 0.78, with subscales ranging from 0.70 to 0.90, indicating moderate reliability. CFA revealed a 2-factor model demonstrating excellent fit.

Conclusion: The SAQ subscales reliably measure their constructs. Strong factor loadings validate the 2-factor structure, affirming the tool's effectiveness in assessing patient safety attitudes in acute care nursing.

Background: Surgical site infections (SSIs) are preventable complications. The Joint Commission (TJC) National Patient Safety Goal® (NPSG) 7 focuses on decreasing health care-associated infections (HAIs), such as SSIs.

Local problem: The neurosurgery service line encountered 4 SSIs from craniotomy procedures over a 27-month period with 2 occurring in 1 month requiring immediate attention.

Methods: A pre- (January 2018 to March 2020)/post-implementation (April 2020 to July 2022) design, using rapid Plan-Do-Study-Act cycles, guided this evidenced-based practice quality improvement project.

Interventions: The Crani Bundle, a nurse-led SSI prevention initiative focusing on patient hand hygiene and postoperative chlorhexidine gluconate bathing, was developed and implemented to reduce SSI after craniotomy (SSI-CRAN).

Results: Implementation of the Crani Bundle decreased SSI-CRAN from 3.38% ( n = 4/118) to 0.0% ( n = 0/87).

Conclusions: The Crani Bundle was effective in reducing SSI-CRAN, meeting TJC NPSG® of preventing HAIs and improving patient safety.