Leah L. Shever

Bio: Leah L. Shever is an academic researcher from University of Iowa. The author has contributed to research in topics: Nursing Interventions Classification & Nursing care. The author has an hindex of 9, co-authored 9 publications receiving 414 citations.

Predictors of medication errors among elderly hospitalized patients.

Abstract: Medication errors are a serious safety concern and most errors are preventable. A retrospective study design was employed to describe medication errors experienced during 10187 hospitalizations of elderly patients admitted to a Midwest teaching hospital between July 1, 1998 and December 31, 2001 and to determine the factors predictive of medication errors. The model considered patient characteristics, clinical conditions, interventions, and nursing unit characteristics. The dependent variable, medication error, was measured using a voluntary incident reporting system. There were 861 medication errors; 96% may have been preventable. Most errors were omissions errors (48.8%) and the source was administration (54%) or transcription errors (38%). Variables associated with a medication error included unique number of medications (polypharmacy), patient gender and race, RN staffing changes, medical and nursing interventions, and specific pharmacological agents. Further validation of this explanatory model and focused interventions may help decrease the incidence of medication errors.

Cost of hospital care for older adults with heart failure: medical, pharmaceutical, and nursing costs.

Abstract: Heart failure, the final common pathway of cardiovascular disease, affects about five million Americans and has been referred to as a global epidemic (Moser and Mann 2002). It is a disabling and costly chronic condition. It is becoming more prevalent as the population ages and survival increases from previously fatal acute cardiac events (Roger et al. 2004). Of the millions living with heart failure, 80 percent are 65 years of age or older. Those with heart failure incur great economic burden, with costs exceeding those of breast and lung cancer combined (Peacock 2003). In 2004, the estimated direct and indirect cost of heart failure in the United States was $25.8 billion, of which $13.6 billion, or 53 percent, was direct hospital cost (American Heart Association 2004). Heart failure is the most expensive of the Medicare diagnoses in the United States and yet, reimbursement often does not keep up with the mean total hospital charges. Mean total charges were $15,293 per visit in 2000, with the average American hospital losing more than $1,000 per visit (Peacock 2003; Ashish et al. 2004). Much has been written in the last decade about the positive collective effects on cost and readmission rates by using multidisciplinary disease management approaches, usually involving the continuum of care within and outside the hospital setting (Balinsky and Muennig 2003). Little is known, however, about the unique interventions or contributions to cost of care by specific disciplines; most of the research has been done with measures that come from the large Medicare data sets that describe medical care and treatments and not those of other health care disciplines. This research study analyzes data from an electronic documentation system that includes medical, nursing, and pharmacy treatments to demonstrate the unique contributions of these providers to hospital cost for older adults with heart failure.

Factors associated with falls during hospitalization in an older adult population.

Abstract: Background:Falls of hospitalized older adults are of concern for patients, family members, third-party payers, and caregivers. Falls are the most common safety incident among hospitalized patients with fall rates from 2.9-13 per 1,000 patient days. Little effectiveness research has been conducted on

Nursing interventions and other factors associated with discharge disposition in older patients after hip fractures.

Abstract: Background: The research on hip fractures has been focused on surgical procedures for hip fracture repair; little is known about the contribution of nursing interventions to outcomes. Objectives: To investigate factors, including nursing interventions, associated with the discharge destination of an older patient population hospitalized for a fractured hip or an elective hip procedure. Nursing interventions used during the hospitalized period are identified. Methods: A design model composed of patient characteristics; clinical conditions; nursing unit characteristics; and medical, pharmacy, and nursing interventions related to the outcome of discharge disposition was tested using generalized estimating equations analysis. A total of 116 variables were examined in a sample of 569 hospitalizations from 524 patients aged 60 years and older admitted for treatment of a hip fracture or elective hip procedure in one tertiary care agency over a 4-year period. Data were obtained retrospectively from five clinical databases. Results: Fifty-four percent of the population was discharged to a location other than to home. The predictors of discharge to home were a younger age, admission from home, and having a spouse, as well as receipt of intravenous solutions, diagnostic ultrasound, a lower number of medications, and moderate use of the nursing intervention of bathing. The identification of nursing interventions indicates that those who received routine nursing care for this condition returned home while those who required interventions for complications or prevention of complications were discharged to an institution. Discussion: Using a standardized nursing language with the hospital's information system can provide nurses and others with information that demonstrates the contribution of nursing care to outcomes, including the outcome of discharge to home.

National and Regional Trends in Heart Failure Hospitalization and Mortality Rates for Medicare Beneficiaries, 1998-2008

Abstract: Context It is not known whether recent declines in ischemic heart disease and its risk factors have been accompanied by declines in heart failure (HF) hospitalization and mortality. Objective To examine changes in HF hospitalization rate and 1-year mortality rate in the United States, nationally and by state or territory. Design, Setting, and Participants From acute care hospitals in the United States and Puerto Rico, 55 097 390 fee-for-service Medicare beneficiaries hospitalized between 1998 and 2008 with a principal discharge diagnosis code for HF. Main Outcome Measures Changes in patient demographics and comorbidities, HF hospitalization rates, and 1-year mortality rates. Results The HF hospitalization rate adjusted for age, sex, and race declined from 2845 per 100 000 person-years in 1998 to 2007 per 100 000 person-years in 2008 (P Conclusions The overall HF hospitalization rate declined substantially from 1998 to 2008 but at a lower rate for black men. The overall 1-year mortality rate declined slightly over the past decade but remains high. Changes in HF hospitalization and 1-year mortality rates were uneven across states.

Abstract 13840: National and Regional Trends in Heart Failure Hospitalization and Mortality Rates for Medicare Beneficiaries: 1998-2008

Abstract: Background: Whether recent declines in ischemic heart disease and its risk factors have been accompanied by declines in heart failure (HF) hospitalization and mortality is not known. We sought to e...

The humanistic and economic burden of chronic wounds: A systematic review.

Abstract: Chronic wounds are a health problem that have devastating consequences for patients and contribute major costs to healthcare systems and societies. To understand the magnitude of this health issue, a systematic review was undertaken. Searches were conducted in MEDLINE, EMBASE, EBM Reviews and Cochrane library, CINAHL, EBSCO, PsycINFO, and Global Health databases for articles published between 2000 and 2015. Included publications had to target adults (≥18 years of age), state wound chronicity (≥3 weeks) and/or label the wounds as chronic, complex, hard-to-heal, or having led to an amputation. The review excluded studies that did not present data on generic health-related quality of life and/or cost data, case studies, randomized controlled trials, economic modeling studies, abstracts, and editorials. Extracted data were summarized into a narrative synthesis, and for a few articles using the same health-related quality of life instrument, average estimates with 95% confidence intervals were calculated. Thirty articles met the inclusion criteria. Findings revealed that health-related quality of life was lowest for physical pathologies, and based on average estimates were scores most inferior in the domain physical role for both patients with chronic wounds and for those with wound-related amputations. The cost burden was mainly attributed to amputations for patients also comorbid with diabetes, where the cost for hospitalization ranged from US$12,851 to US$16,267 (median) for this patient group. Patients with chronic wounds have poor health-related quality of life in general and wound-related costs are substantial. Development and implementation of wound management strategies that focus on increasing health-related quality of life and effectively reduce costs for this patient group are urgently needed.