HCA healthcare journal of medicine最新文献

Background: Our single-center, quality improvement project evaluated the impact of a fall reduction plan while using a Just Culture Algorithm that included weekly fall reviews involving front line staff using a non-punitive structure. The project has shown successful results.

Methods: Prior to starting the program, data at this institution indicated falls were higher than the national fall rate of 3-5 per 1000 patient days. To achieve the goal of reducing the fall rate to below 3.1, an interdisciplinary fall committee was formed, consisting of nurses, nursing leaders, patient care technicians, pharmacists, and physical therapists. The committee operated in a non-punitive format and included all staff members directly involved in fall-related incidents. Protocols for implementing an evidence-based prevention program were developed to (1) address environmental concerns, (2) educate clinical workers and patients' families, (3) enforce interventions, (4) conduct weekly non-punitive, round table discussions, and (5) provide leadership support. Measures were implemented to proactively prevent falls. Data was collected and reported to all departments monthly.

Results: Following implementation of the program, results showed a statistically significant decrease in average fall rates per 1000 patient days from pre-intervention (4.05) to post-intervention (2.54) (P = .0001). Results showed improvement below the national average (3-5 falls per 1000 patient days), resulting in cost savings for the institution due to fewer falls. Inpatient medical-surgical and progressive care units had a noteworthy decline in the total number of falls, with notable estimated cost savings.

Conclusion: Preventative interventions have shown effective results with compassionate, non-punitive leadership, an interdisciplinary team, and continuous follow-up education. Heeding to the Just Culture Algorithm as the foundation of weekly reviews, staff were empowered to engage in fall reduction strategies. A comprehensive weekly fall review program with ongoing staff education and transparent data reporting yielded a significant, sustained reduction in patient falls, with a substantial cost savings in excess of $1.6 million dollars over the life of the program.

Description This evocative artwork is inspired by the inner workings of the human body, specifically the complexities of blood flow and vascular systems. The deep reds and dynamic patterns represent the movement of blood through arteries and veins, while the interplay of lighter hues evokes the diffusion of oxygen and nutrients. This abstract interpretation aims to capture the vibrancy and essential functions of circulatory processes, celebrating the unseen yet vital life force that sustains us. The piece invites viewers to appreciate the intricate beauty and power of the human body's most fundamental systems.

Description Working as a nurse is stressful. Two things that help me decompress are the beach and fused glasswork. Both of those items are represented in this piece. I hand-cut glass to represent a wave and then fused it together in a kiln at high temperatures. Waves wash away my stress. Many people find calm in the ocean, and I am one of such people. The glass mirrors the water.

Background: Despite efforts to prevent errors, studies show that iatrogenic, or health care-related, errors continue to occur. Understandably, these errors, which can range in severity from near-misses to serious harm, can be devastating for the health care professionals involved, creating a potential second set of victims, in addition to the patient(s) that were harmed directly. Studies show that individuals struggling with second-victim syndrome (SVS) can be at increased risk for depression, burnout, and poor work performance. However, programs designed to develop peer mentors to support individuals struggling with SVS are poorly described.

Methods: Following a review of the literature, our team designed a program that involved training for leaders to serve as mentors and provide ongoing emotional support to their staff. Mentorship training included a 90 to 120-minute training, involvement in monthly mentoring meetings, and materials and training on potential support modalities, such as journaling, aromatherapy, walking paths, and other stress relief activities.

Results: Thirty SVS peer mentors at our facility completed the training, with plans to expand to 50 SVS peer mentors by the end of 2025. Plans to expand the program to other facilities, add additional metrics, and evaluate both mentor and staff outcomes are underway.

Conclusion: The mentor training program was designed to support health care professionals experiencing SVS and build support for colleagues through the development of mentors to help with psychological support. Additional research on the short- and long-term outcomes for facilities implementing similar SVS peer-mentoring programs is needed.

Background: Surgical site infections (SSI) result in increased morbidity and mortality, prolonged recovery, longer hospital length of stay for medication or possible additional surgeries, and escalated health care costs. The purpose of this randomized controlled trial was to compare SSI rates and overall skin flora burden between those using chlorhexidine (CHG) cloths versus soap and water preoperatively in the adult spine surgery population.

Methods: Subjects were randomized preoperatively to use 2% CHG cloths versus soap and water the night before and morning of surgery prior to the operation. A skin culture was obtained at enrollment prior to any cleansing, again at post-operation day 4 or hospital discharge (whichever came first), and finally at the surgeons' postoperative visits. A blinded advanced practice nurse served as the assessor for SSI.

Results: Those enrolled in the research arm had more growth on their screening skin culture than the control arm (P = .02). While there was no difference in rates of SSI between groups, the CHG group had lower skin flora burden at hospital discharge (P = .004), indicating residual protection.

Conclusion: Surgical incisions are most vulnerable to bacterial entry prior to 72 hours post-operation before completion of epithelialization, which establishes a barrier from microbes. The use of CHG, which has a residual impact for up to 4 days, could offer additional risk reduction for SSI development.

Description Two years ago, I held my uncle's hand in the final moments of his life in ICU. I often reflect on this time and wonder if he could hear us or feel our presence in the room. As an ICU nurse myself, I see this scene frequently with families comforting their loved ones in death. I am grateful to be in this unique position and share my care and compassion for those who may or may not have family present in these final moments. We may never know the impact of these simple acts of kindness, but I will do whatever I can to provide peace for my patients and family members during these difficult times.

Description I have been drawing since I was old enough to hold a crayon. I love creating medical art and frequently make cartoons or illustrations of procedures, but I also use art as a way to show appreciation for fellow colleagues, surgeons, and other health care professionals by creating their likenesses on the cards from surgical gowns. My goal is to draw all of my colleagues at the 3 HCA Healthcare hospitals in western North Carolina where I work.

Description HCA Healthcare has been a pioneer in evidence-based practice (EBP) in nursing for over 20 years. Nursing leaders overcame 2 major challenges, generating useful data to inform practice and disseminating EBP across their vast network. These challenges were overcome by using data outside the electronic health record (EHR) while advancing the standardization of data within the EHR. Standardizing data had a significant impact on nurse-led research, leading to improvements in patient outcomes and changes in practice including medication dispensing, patient fall reporting, and scheduling guidelines. This retrospective shares some of these important innovations in nursing practice.

Background: Central line-associated bloodstream infections (CLABSI) increase morbidity, mortality, and healthcare costs. Central venous access device (CVAD) dressing integrity is critical to prevent CLABSI. From the First Quarter to the Third Quarter of 2023, CLABSI rates related to disruption in CVAD dressing integrity increased significantly at our facility. Despite the delivery of education, competency validation, and checklist implementation, CLABSI rates remained high, making this our top strategic priority.The purpose of this quality improvement initiative was to determine if gum mastic adhesive and hemostatic powder would improve dressing integrity and decrease CLABSI rates related to disruption of central line dressings.

Methods: With pre- and post-CVAD dressing data, utilizing rapid Plan-Do-Study-Act methodology to drive improvement, this quality improvement initiative was conducted in a 603-bed, tertiary level I trauma center. A multidisciplinary team was formed consisting of infection prevention, quality, nursing, and vascular access personnel, with the goal of improving central line dressing integrity and increasing dressing life. In-depth training included standardized CLABSI prevention bundles and central line dressing change guidelines to include the application of gum mastic adhesive and topical hemostatic product, and was tested on pilot units before implementation.

Results: Bleeding at the central line insertion site reduced by 23.6% with the use of a hemostatic powder. Central line dressing integrity was improved by 33.5% with the use of a liquid gum mastic adhesive and dressing life improved by 140.7%. Additionally, there was only 1 CLASBI and no medical adhesive-related skin injuries reported since the implementation of the bundle (October 2023).

Conclusion: Topical hemostatic powder and liquid gum mastic adhesive paired with the adhesive remover for safe removal were shown to be effective in improving integrity in central line dressings for the prevention of CLABSIs. In October 2023, the dressing change integrity bundle was scaled to all units within the facility.

Description I love the statement, "Nursing is an art and a science." I practiced at the bedside for 30 years, caring for my patients physically and mentally through all of life's stages. Quilting became my go-to activity when the work became too stressful and I needed to decompress. When I became a nurse educator, I made this quilted wall hanging for my office to remind me of those years and the reasons I became a nurse. The nurse applique was made from one of my scrub tops and replicates my work uniform, down to the ponytail I wore when I was younger, and my maroon stethoscope. It also includes nursing fabric that I have collected over the years, a bandana from the American Association of Critical-Care Nurses' National Teaching Institute and a t-shirt I received as a gift when I was getting my Master's degree in nursing education. When I look at the quilt, I remember all the hard work of nursing school, the uncertainty during my first year as a nurse, and the changes in myself as I grew from novice to expert. I think of the patients we lost, the ones we saved, the family members that I laughed with, and those that I cried with. Nursing really chose me, not the other way around, and I am proud to say that I answered that call.