Nursing Management (springhouse)最新文献

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Building a safe unit culture with CUSP 用CUSP建立安全单位文化

Nursing Management (springhouse)

Pub Date : 2016-12-01 DOI: 10.1097/01.NUMA.0000508266.49722.7d

J. Slade, R. Hata

Improving care delivery quality and patient safety is a growing priority for many facilities in the modern healthcare landscape, and nurse managers play an important role in ensuring the success of new safety measures. Research has shown that the way nurse managers engage RNs in decision making and problem solving has a direct influence on improving care delivery quality and patient safety.1 In addition, frontline RN engagement positively impacts satisfaction rates.2 The Comprehensive Unit-Based Safety Program (CUSP) utilizes the clinical experience of frontline

在现代医疗保健领域，提高护理质量和患者安全是许多设施日益增长的优先事项，护士管理人员在确保新安全措施的成功方面发挥着重要作用。研究表明，护士管理者让注册护士参与决策和解决问题的方式对提高护理质量和患者安全有直接影响此外，前线注册护士的敬业度对满意度有积极影响综合单位安全计划(CUSP)利用一线的临床经验

引用次数: 0

Aim for high reliability 追求高可靠性

Nursing Management (springhouse)

Pub Date : 2016-12-01 DOI: 10.1097/01.NUMA.0000508264.64969.95

K. Drake

M ic h a e l Tr in s e y Standardizing processes within your organization will affect the quality of care on your unit because doing so meets the principles of high reliability: sensitivity to operations, reluctance to accept “simple” explanations for problems, preoccupation with failure, deference to expertise, and resiliency.1 These principles fall into two categories: anticipation and containment. First, let’s address the principles in the anticipation category. Sensitivity to operations means that operations are complex and dynamic. Consistent rounding on your unit gives you firsthand knowledge of challenges, opportunities, and best practices. Being transparent increases attention to patient care processes. For instance, you’re observing medication administration using a recently added bar code reader and you notice the nurse pulling the device’s cord due to its short length and dropping it as a result. You share the information with other leaders and it’s determined that this is a common issue; as a result, the bar code reader cords are replaced with longer ones. Reluctance to accept “simple” explanations for problems means to dig deep into answers by performing a root cause analysis. Continuing with our bar code reader example, you discover that a nurse makes a medication error. On your organization’s reporting tool, you document the “simple” explanation for the error: the unit was short staffed that shift. However, upon further review, the root cause was that the nurse overrode a process due to bar code reader failure, which contributed to the error. There was no record of the device being reported as defective or any attempt to obtain another bar code reader before administering the medication. Preoccupation with failure means that leaders are looking at how processes may break. Evaluating the good catches in your environment may lead to preventing future failures. Also, being thoughtful and observant of what’s working well assists in error prevention. Replicating what’s working well in other areas is essential for high-reliability organizations. Now, let’s review the principles in the containment category: deference to expertise and resiliency. A common misconception regarding deferring to an expert is that it’s based on seniority or positional hierarchy. In some cases, the process expert is the clinical nurse who performs the task daily. That’s why it’s important when changing products that we ask staff members to evaluate them. Another example is that employees who are new to your organization may communicate best practices from previous employers. As a leader, refrain from saying “I know” because this deters employees from sharing ideas that may lead to improvements. Resiliency is the ability to recover quickly in times of high stress, adapt well to change, keep focused, and learn from adversity. A clinical example of nursing resilience is during a code. Nurses stay focused in what may be a rapidly changing situation and rebound quick

在你的组织中标准化过程将影响你单位的护理质量，因为这样做符合高可靠性的原则:对操作的敏感性，不愿意接受对问题的“简单”解释，对失败的关注，对专业知识的尊重，以及弹性这些原则可分为两类:预期和遏制。首先，让我们谈谈预期类别中的原则。对操作的敏感性意味着操作是复杂的和动态的。在你的单位里持续的四舍五入会给你带来挑战、机遇和最佳实践的第一手知识。透明增加了对患者护理过程的关注。例如，您正在使用最近添加的条形码阅读器观察药物管理，并且您注意到护士因其长度短而拉设备的脐带并因此将其丢弃。你与其他领导人分享信息，确定这是一个共同的问题;结果，条形码读取线被更长的线所取代。不愿意接受对问题的“简单”解释意味着要通过执行根本原因分析来深入挖掘答案。继续我们的条形码阅读器示例，您将发现一名护士犯了用药错误。在组织的报告工具上，您记录了错误的“简单”解释:该单位在该班次缺少人员。然而，经过进一步审查，根本原因是由于条形码阅读器故障，护士重写了一个过程，这导致了错误。没有记录表明该设备有缺陷，也没有任何在用药前试图获得另一个条形码阅读器的记录。对失败的关注意味着领导者正在关注流程可能如何中断。在您的环境中评估好的捕获可能导致防止未来的失败。此外，对工作良好的地方进行深思熟虑和观察有助于预防错误。对于高可靠性组织来说，复制其他领域的成功经验至关重要。现在，让我们回顾一下遏制类别中的原则:尊重专业知识和弹性。关于听从专家的一个常见误解是，这是基于资历或职位等级。在某些情况下，流程专家是每天执行任务的临床护士。这就是为什么在更换产品时，我们要求员工对产品进行评估是很重要的。另一个例子是，新到公司的员工可能会与以前的雇主交流最佳做法。作为领导者，不要说“我知道”，因为这会阻止员工分享可能导致改进的想法。弹性是指在高压力下迅速恢复的能力，适应变化的能力，保持专注的能力，以及从逆境中学习的能力。护理弹性的一个临床例子是在代码期间。护士在可能迅速变化的情况下保持专注，并在之后迅速恢复过来照顾下一个病人。代码完成后，团队聚集在一起进行汇报，讨论哪些进展顺利，哪些不顺利。团队从这种情况中学习，并将新知识应用到未来的事件中。我们可以将这次事件的经验教训与他人交流，以便在实践中做出改变。弹性还表明您的组织可以找到快速修复以防止错误。支持快速周期变化有助于提高可靠性。作为领导者，应将流程标准化视为确保患者和员工安全的积极步骤。您的组织已经观察到失败或错误，这增加了对流程的关注(操作的敏感性)。在开发标准化过程中，您的组织已经着眼于数据和未来预防的根本原因(不愿意接受对问题的“简单”解释)。因此，它已经找到了最佳实践(对专业知识的尊重)，并检查了实现更改的良好捕获，以减少未来错误的机会(专注于失败)。学习与标准化相关的技能将使您的员工成长并提供一致的护理(弹性)。纳米

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引用次数: 0

Bridging gaps in rapid response systems 弥合快速反应系统的差距

Nursing Management (springhouse)

Pub Date : 2016-12-01 DOI: 10.1097/01.NUMA.0000508260.11605.47

M. Douglas, M. Devita, R. Gilder, P. Lauer

lthough death is a part of everyday life for healthcare providers, avoidable death of hospitalized patients shouldn’t be. To reduce unnecessary mortality each year, hospital leaders across the nation focus on achieving the Institute for Healthcare Improvement’s (IHI) “Triple Aim.” This initiative aims to improve the patient care experience, including quality and satisfaction, and population health while reducing healthcare’s per capita cost.1-4 Rescuing a deteriorating patient before he or she progresses to a respiratory or cardiac arrest aligns with this focus. Failure to rescue a deteriorating patient in a hospital setting is now a nursing-sensitive measure reviewed by the Centers for Medicare and Medicaid Services.5 Studies show that early recognition of deterioration signs and implementation of prompt intervention can reduce permanent disability in stroke events and mortality associated with respiratory and cardiac arrests in hospitalized patients residing outside of the ICU.2,3,6,7 Historical background In 2004, the IHI recommended the implementation of rapid response teams (RRTs) to minimize unnecessary disabilities and deaths.6 As a result of this initiative, over 1,400 American hospitals implemented RRT programs by 2005.7 Before the June 2005 International Conference on Medical Emergency Teams, RRTs were commonly known as medical emergency teams or critical care outreach.8 Rapid response systems are designed to initiate RRT activation for stat assessment and treatment of patients whose clinical condition is deteriorating.8 In 2008, RRTs became a patient safety goal and a required component of hospital accreditation by The Joint Commission.7 Today, the Institute for Clinical Systems Improvement (ICSI) has created a healthcare protocol for RRTs to ensure quality. The protocol, based on evidence-based research, outlines key clinical strategies and recommendations for effective RRT implementation. According to the ICSI, eight areas need to be considered when implementing an RRT.3 (See Table 1.) Bridging gaps in rapid response systems

虽然死亡是医护人员日常生活的一部分，但住院患者可避免的死亡不应该是日常生活的一部分。为了减少每年不必要的死亡率，全国各地的医院领导都致力于实现医疗保健改善研究所(IHI)的“三重目标”。这一举措旨在改善患者护理体验，包括质量和满意度，以及人口健康，同时降低医疗保健的人均成本。1-4在病情恶化的患者发展为呼吸或心脏骤停之前进行抢救符合这一重点。目前，医疗保险和医疗补助服务中心(Centers for Medicare and Medicaid services)审查了在医院环境中抢救恶化患者失败的护理敏感措施。研究表明，早期识别恶化迹象并及时实施干预，可以减少在重症监护病房外住院患者卒中事件中的永久性残疾，以及与呼吸和心脏骤停相关的死亡率。国际健康倡议建议设立快速反应小组，以尽量减少不必要的残疾和死亡作为这项倡议的结果，到2005年，超过1400家美国医院实施了RRT项目5.7在2005年6月国际医疗急救小组会议之前，RRT通常被称为医疗急救小组或重症护理外展快速反应系统旨在启动RRT激活，以评估和治疗临床状况恶化的患者2008年，RRTs成为了患者安全目标和联合委员会医院认证的必要组成部分。今天，临床系统改进研究所(ICSI)为RRTs创建了一个医疗保健协议，以确保质量。该方案以循证研究为基础，概述了有效实施RRT的关键临床策略和建议。根据ICSI，在实施rr3时需要考虑八个方面(见表1)。弥合快速反应系统的差距

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引用次数: 0

Vascular access devices: Setting your organization up for success 血管接入设备:让您的组织走向成功

Nursing Management (springhouse)

Pub Date : 2016-12-01 DOI: 10.1097/01.NUMA.0000508272.73964.EB

Lorelle Wuerz

引用次数: 3

Make the most of health IT 充分利用医疗信息技术

Nursing Management (springhouse)

Pub Date : 2016-12-01 DOI: 10.1097/01.NUMA.0000508263.57346.E8

J. Sensmeier

引用次数: 1

Screen and intervene: Depression's effect on CHF readmission 筛选和干预:抑郁症对心力衰竭再入院的影响

Nursing Management (springhouse)

Pub Date : 2016-12-01 DOI: 10.1097/01.NUMA.0000508257.88733.0c

S. Linder, S. Lizer, A. Doughty

ndividuals with congestive heart failure (CHF) have a high incidence of depression among patients with chronic diseases. The New York Heart Association (NYHA) functional class is closely related to co-morbid depression.1 Depression often leads to deterioration in physical well-being, resulting in an increased usage of healthcare resources.2 Fortunately, the identification and treatment of depression can reduce the risk of consequences associated with diagnosis, including decreased quality of life, loss of relationships, loss of self, reduction in satisfaction of life, and reduction in physical activity.3 For this reason, researchers conducted a study using depression screenings at a moderately sized tertiary medical center in the Rockford, Ill., metropolitan area to determine the influence of depression on hospital readmission rates in patients with CHF. The study resulted in recommendations for how nurse managers should educate their staff members on the proper administration of depression screenings and for policy makers on the amount of patient access to depression screenings. I Mental health Safety solutions

在慢性疾病患者中，充血性心力衰竭(CHF)患者的抑郁症发病率很高。纽约心脏协会(NYHA)功能分级与共病性抑郁症密切相关抑郁症通常会导致身体健康状况的恶化，从而导致医疗保健资源的使用增加幸运的是，抑郁症的识别和治疗可以减少与诊断相关的后果的风险，包括生活质量下降、人际关系丧失、自我丧失、生活满意度降低和体育活动减少出于这个原因，研究人员在伊利诺伊州罗克福德的一家中等规模的三级医疗中心进行了一项使用抑郁症筛查的研究。以确定抑郁症对CHF患者再入院率的影响。这项研究的结果是，对护士管理者应该如何教育他们的工作人员正确管理抑郁症筛查，以及为政策制定者提供有关患者接受抑郁症筛查的数量的建议。一、心理健康安全解决方案

引用次数: 2

Reimplementing bedside shift report at a community hospital 某社区医院床边值班报告的重新实施

Nursing Management (springhouse)

Pub Date : 2016-12-01 DOI: 10.1097/01.NUMA.0000508265.42099.cc

Bonnie Boshart, Mary C Knowlton, Ramona Whichello

Bedside shift report aids in the development of employee teamwork, ownership, and accountability, and has been shown to increase nurse satisfaction.1 It allows for the rapid determination of a patient’s condition, surroundings, and treatment, which facilitates identification of medication errors, prevents patient falls, and provides the opportunity for nurses to recognize a change in a patient’s clinical status.2 Moving shift report to the bedside promotes effective communication between patients and caregivers through transparency and open dialogue. Promotion of patient involvement in their own care plan enforces selfefficacy and adherence to treatment. The goal of bedside shift report is to help improve the patient experience and ensure safe handoff of care between nurses by involving the patient and family.3 To improve the patient experience, we must change the way nurses practice and communicate with each other and their patients.4 One of the ways to change nursing culture is to introduce different techniques to communicate patient-specific care at shift change. By reporting at the bedside in the presence of the patient, a culture shift can occur. The purpose of this project was to use a quality improvement process to reintroduce bedside shift reporting at a 294-bed community hospital in eastern North Carolina. The hospital consists of two medical-surgical units, a telemetry unit, an ICU, an ED, women and children’s services, and a labor and delivery suite. It employs 1,100 staff members, 250 of who are RNs. Standard practice at this facility included nurse-to-nurse shift report at the nurses’ station or in a conference room away from the bedside. Although bedside shift report had been introduced 2 years prior, the implementation failed. To better understand the reasons for the failure, clinical nurses and staff development specialists involved with the initial implementation were informally interviewed. It became apparent that the cause of the failure was multifaceted: inadequate staff education, lack of buy-in by nursing staff and leadership, and lack of accountability and supervision from nursing leadership. Education about bedside shift reporting provided to clinical nurses was substandard; nurses reported a lack of understanding of the benefits and rationale. Because clinical nurses didn’t understand the reason for the change, there was resistance to adopt the new method of patient handoff. Follow-up hadn’t been carried out effectively and there was a lack of buy-in by not only clinical nurses, but also directors, unit managers, and supervisors who were responsible for ensuring the nurses’ participation. Without leadership holding clinical nurses accountable for implementation of bedside shift report, they slowly reverted to the previous behavior of giving report at the nurses’ station.

床边值班报告有助于员工团队合作、主人翁精神和责任感的发展，并已被证明可以提高护士的满意度它允许快速确定病人的状况、周围环境和治疗，从而促进药物错误的识别，防止病人跌倒，并为护士提供识别病人临床状态变化的机会将轮班报告移到床边，通过透明和公开的对话促进患者和护理人员之间的有效沟通。促进患者参与自己的护理计划，加强自我效能和坚持治疗。床边轮班报告的目标是通过患者和家属的参与，帮助改善患者的体验，确保护士之间的护理安全交接为了改善病人的体验，我们必须改变护士的工作方式，改变护士与病人之间的交流方式改变护理文化的方法之一是在换班时引入不同的技术来沟通患者的具体护理。通过在病人面前在床边报告，可以发生文化转变。该项目的目的是在北卡罗莱纳东部一家拥有294个床位的社区医院，采用质量改进流程重新引入床边轮班报告。该医院由两个内科外科单元、一个遥测单元、一个重症监护室、一个急诊科、妇女和儿童服务以及一个分娩和分娩套房组成。它拥有1100名员工，其中250名是注册护士。该设施的标准做法包括在护士站或远离床边的会议室进行护士对护士轮班报告。虽然早在2年前就引入了床边值班报告，但实施失败。为了更好地了解失败的原因，对参与最初实施的临床护士和员工发展专家进行了非正式访谈。很明显，失败的原因是多方面的:员工教育不足，护理人员和领导缺乏支持，护理领导缺乏问责制和监督。向临床护士提供的床边值班报告教育不合格;护士报告缺乏对其好处和理由的理解。由于临床护士不了解改变的原因，对采用病人交接的新方法存在阻力。随访没有得到有效实施，不仅临床护士缺乏支持，而且主管、单位经理和负责确保护士参与的主管也缺乏支持。没有领导要求临床护士对床边值班报告的执行负责，他们慢慢地恢复到以前在护士站报告的行为。

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引用次数: 7

Prioritize the patient experience. 优先考虑病人的体验。

Nursing Management (springhouse)

Pub Date : 2016-11-01 DOI: 10.1097/01.NUMA.0000502799.06930.17

Jeffrey N. Doucette

引用次数: 0

To know is to care...transformation through satisfaction 知道就是关心……满足转化

Nursing Management (springhouse)

Pub Date : 2016-11-01 DOI: 10.1097/01.NUMA.0000502800.84058.31

F. Collins

引用次数: 2

How do patients perceive hourly rounding? 病人如何看待每小时就诊?

Nursing Management (springhouse)

Pub Date : 2016-11-01 DOI: 10.1097/01.NUMA.0000502807.60295.c5

Linda Bragg, A. Bugajski, M. Marchese, R. Caldwell, Lisa Houle, R. Thompson, R. Chula, Corey Keith, A. Lengerich

A generally accepted strategy designed to improve patient care, hourly nurse rounding is defined as a consistent nurse-patient interaction involving an assessment of patient needs and the provision of effective responses to those needs.1 Considerable research has been conducted addressing the outcom

一种被普遍接受的旨在改善病人护理的策略，每小时护士查房被定义为一种持续的护士-病人互动，包括对病人需求的评估和对这些需求的有效回应针对这一结果进行了大量研究

引用次数: 7

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