Outcomes management最新文献

Staff nurses have a key role in ensuring that practice is evidenced-based. This article discusses the application of a model for evidence-based practice change by staff nurses in an acute care setting who examined the practice of using sterile gloves for postoperative wound dressing changes. This initiative was in response to the challenge that it was unnecessary to use sterile instead of nonsterile gloves. Extensive literature search revealed insufficient evidence to justify a practice change to nonsterile gloves.

Reduction of dietary fat intake and increased physical activity are first-line interventions for elevated total serum cholesterol (TC) and low-density lipoprotein (LDL) serum cholesterol, which are major and modifiable risk factors for coronary heart disease. This retrospective study reports on the effects of a nurse-managed behavioral intervention (NMBI) program on TC and LDL levels in hyperlipidemic patients. Survival analysis indicated that NMBI patients had a significantly higher probability of attaining normal TC and LDL levels than did patients who received only standard nursing care. Additional analysis showed that actual TC and LDL values declined significantly across the study period with marginally significant group by time interactions. These findings provide preliminary evidence of the effectiveness of the behavioral intervention program with hyperlipidemic patients.

The purpose of this pilot study was to determine whether a significant difference in outcome ratings exists from admission to discharge for selected populations. Two acute care sites that have standardized nursing languages in their computerized clinical documentation systems participated. These data are an important start in using patient outcomes to determine the effect of nursing interventions. These data clearly suggest that nursing care did make a difference in patient outcomes.

In an era of dwindling reimbursement and rising healthcare costs, the impact of nurse staffing models on patient outcomes is a key concern. This study used a descriptive comparison design to examine the effects of a change in the staffing model on length of stay, variable cost, patient satisfaction, incidence of urinary tract infection and penumonia, and pain management in bowel resection patients. There were significant differences in the pain management outcomes between the two staffing models. Other patient outcomes were comparable despite decreasing the total number of caregivers on the unit. Recommendations for further research are discussed.

This article describes a process change designed to increase the safety of prescribing and interpreting complex order sets. All chemotherapy orders written for pediatric oncology patients at a major teaching hospital in the Eastern United States and the affiliated ambulatory clinic from June 1998 through February 2000 (n = 1792) were reviewed to evaluate a new process for communication of chemotherapy orders. The multidisciplinary check (MDC) is a forum where all disciplines simultaneously review and change complex order sets. Evaluation of the MDC included monthly completion rate and classification of changes made to orders at MDC. Over the study period, 96% of eligible orders received a multidisciplinary check, and 44% were changed. The most common change was to clarify discrepancies between the order and the protocol. Changes were made to avoid medication errors in 99 of 451 orders. Changes to avoid medication errors were more likely to involve nonchemotherapy medications. The MDC is an efficient and feasible process to increase safety at the beginning of the medication system.