Showing papers in "Journal of Nursing Care Quality in 2013"
TL;DR: Extended shift lengths were associated with higher odds of reporting poor quality and safety, and policies aimed at reducing the use of extended shifts may be advisable.
Abstract: The objective of this study was to analyze hospital staff nurses' shift length, scheduling characteristics, and nurse reported safety and quality. A secondary analysis of a large nurse survey linked with hospital administrative data was conducted. More than 22 000 registered nurses' reports of shift length and scheduling characteristics were examined. Extended shift lengths were associated with higher odds of reporting poor quality and safety. Policies aimed at reducing the use of extended shifts may be advisable.
96 citations
TL;DR: This article describes a quality improvement rapid-cycle change approach to explore the benefits of changing electrodes daily on the number of cardiac monitor alarms, and finds that daily electrocardiogram electrode change reduces the number.
Abstract: Frequent monitor alarms are distracting and interfere with clinicians performing critical tasks. This article describes a quality improvement rapid-cycle change approach to explore the benefits of changing electrodes daily on the number of cardiac monitor alarms. Eight days of baseline and intervention data were compared for 2 adult acute care units. Average alarms per bed per day were reduced by 46% on both units. Daily electrocardiogram electrode change reduces the number of cardiac monitor alarms.
69 citations
TL;DR: Comparisons between baseline and postimplementation data indicated increased patient satisfaction and nurse perception of accountability and patient involvement but reduced nurse perceptions of efficiency and effectiveness of report.
Abstract: Nursing shift report on the medical-surgical units of a large teaching hospital was modified from a recorded report to a blend of both recorded and bedside components. Comparisons between baseline and postimplementation data indicated increased patient satisfaction and nurse perception of accountability and patient involvement but reduced nurse perceptions of efficiency and effectiveness of report. Patient falls at shift change and medication errors were reduced, whereas nurse overtime remained unchanged.
68 citations
TL;DR: An integrative literature review of the effect of medical errors on nurses is reported and a model derived from the findings illustrates the concept of nurses' experience ofMedical errors.
Abstract: Medical errors are a substantial problem in health care. Understanding the effect of medical errors on health care providers as the "second victims" is necessary to maintain safe, quality patient care for the good of both patients and providers. We report an integrative literature review of the effect of medical errors on nurses. A model derived from the findings illustrates the concept of nurses' experience of medical errors. Specific recommendations for improving that experience are offered.
58 citations
TL;DR: There were significant differences in nurses' perceptions of patient safety culture based on gender, age, years of experience, Arabic versus non-Arabic speaking, and length of shift.
Abstract: The purpose of this study was to identify factors that nurses perceive as contributing to the culture of patient safety in a hospital in Saudi Arabia. A total of 498 registered nurses employed in the hospital completed the survey. The majority of nurses perceived a positive patient safety culture. There were significant differences in nurses' perceptions of patient safety culture based on gender, age, years of experience, Arabic versus non-Arabic speaking, and length of shift.
54 citations
TL;DR: A bundle of safety interventions was described that reduced the average number of interruptions during medication administration by 2.11 interruptions per encounter and decreased reported medication errors by a total of 28 incidents over a 3-month period.
Abstract: In the fast-paced environment of a cardiac and thoracic surgery telemetry unit, nurses are interrupted hundreds of times per day. These interruptions can have a detrimental effect on patient safety during medication administration. This article describes a bundle of safety interventions that reduced the average number of interruptions during medication administration by 2.11 interruptions per encounter and decreased reported medication errors by a total of 28 incidents over a 3-month period.
48 citations
TL;DR: A study was undertaken to explore nurses' experiences and perceptions associated with implementation of bedside nurse-to-nurse shift handoff reporting and two themes emerged that illustrated the value of bed side shift reporting.
Abstract: A study was undertaken to explore nurses' experiences and perceptions associated with implementation of bedside nurse-to-nurse shift handoff reporting. Interviews were conducted with nurses and analyzed using directed content analysis. Two themes emerged that illustrated the value of bedside shift reporting. These themes included clarifying information and intercepting errors and visualizing patients and prioritizing care. Nurse leaders can leverage study findings in their efforts to embed nurse-to-nurse bedside shift reporting in their respective organizations.
48 citations
TL;DR: This quality improvement study investigated the effects of nurse manager rounding, postdischarge phone follow-up, and improved discharge teaching skills on patients' ratings of their care.
Abstract: Staff on a 28-bed surgical unit in a suburban 461-bed medical center implemented 3 interventions to improve patient satisfaction. This quality improvement study investigated the effects of nurse manager rounding, postdischarge phone follow-up, and improved discharge teaching skills on patients' ratings of their care. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey scores demonstrated a steady upward trend over 18 months following implementation of the changes.
44 citations
TL;DR: Implementing bedside handover may enhance nursing care for hospitalized patients by improving several nursing care tasks and documentation, whereas there was no variation in handover duration.
Abstract: Bedside handover has been proposed as a patient-focused nursing practice model with the potential to reduce adverse events and improve standards of care. This pre-/postintervention study examined changes in completion of nursing care tasks and documentation after the implementation of bedside handover. Analysis of 754 cases revealed significant improvements in several nursing care tasks and documentation, whereas there was no variation in handover duration. Implementing bedside handover may enhance nursing care for hospitalized patients.
40 citations
TL;DR: Changes to hand hygiene auditing and response processes demonstrate ability to improve and sustain adherence rates within a clinical microsystem.
Abstract: Hand hygiene occurs at the intersection of habit and culture. Psychological and social principles, including operant conditioning and peer pressure of conforming social norms, facilitate behavior change. Participatory leadership and level hierarchies are needed for sustainable patient safety culture. Application of these principles progressively and significantly improved hand hygiene compared with the hospital aggregate control. Changes to hand hygiene auditing and response processes demonstrate ability to improve and sustain adherence rates within a clinical microsystem.
38 citations
TL;DR: It was found that RNs experienced a significantly higher frequency of disruptive behaviors and triggers than MDs; MDs and RNs reported that their peer's disruptive behavior affected them most negatively.
Abstract: This study investigated registered nurses' (RNs) and physicians' (MD) experiences with disruptive behavior, triggers, responses, and impacts on clinicians, patients, and the organization. Using the Disruptive Clinician Behavior Survey for Hospital Settings, it was found that RNs experienced a significantly higher frequency of disruptive behaviors and triggers than MDs; MDs (45% of 295) and RNs (37% of 689) reported that their peer's disruptive behavior affected them most negatively. The most frequently occurring trigger was pressure from high census, volume, and patient flow; 189 incidences of harm to patients as a result of disruptive behavior were reported. Findings provide organizational leaders with evidence to customize interventions to strengthen the culture of safety.
TL;DR: The authors' hospital system used Lean strategies to develop a new process for the change-of-shift bedside handoff titled ISHAPED, and the findings from the study were used to develop education modules on implementing patient-centered handoffs.
Abstract: Our hospital system used Lean strategies to develop a new process for the change-of-shift bedside handoff titled ISHAPED (I = Introduce, S = Story, H = History, A = Assessment, P = Plan, E = Error Prevention, and D = Dialogue). Several teams collaborated with a Parent Advisory Council and a Patient/Family Advisory Council to design a study to explore patient perceptions of the handoff. The findings from the study along with recommendations from the councils were used to develop education modules on implementing patient-centered handoffs.
TL;DR: The most frequently observed risk factors were confusion, gait problems, Alzheimer disease, disorientation, and inability to follow safety instructions as discussed by the authors, and the most effective interventions were keeping hospital bed brakes locked, keeping floor surfaces clean/dry, using appropriate footwear for patients, maintaining a call light within reach, and reducing tripping hazards
Abstract: There is an urgent need to prioritize the risk factors for injurious falls and effective interventions in nursing practice Registered nurses perceived that the most frequently observed risk factors were confusion, gait problems, Alzheimer disease, disorientation, and inability to follow safety instructions The most effective interventions were keeping hospital bed brakes locked, keeping floor surfaces clean/dry, using appropriate footwear for patients, maintaining a call light within reach, and reducing tripping hazards
TL;DR: Comparative analysis demonstrated no significant differences for risk-adjusted rates for pressure ulcers and failure to rescue, and future investigation should examine what clinical benefits might exist that distinguish Magnet from non-Magnet hospitals.
Abstract: The purpose of this study was to explore whether Magnet hospitals had better nursing-sensitive outcomes than non-Magnet hospitals. Eighty Magnet hospitals were identified in the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project databases and matched with 80 non-Magnet hospitals on 12 hospital characteristics. Comparative analysis demonstrated no significant differences for risk-adjusted rates for pressure ulcers and failure to rescue. Future investigation should examine what clinical benefits might exist that distinguish Magnet from non-Magnet hospitals.
TL;DR: A structural equation model demonstrated a positive association between teamwork climate and safety attitudes and confirmed that teamwork climate is the most important determinant for patient safety attitudes among nurses.
Abstract: The TeamSTEPPS Teamwork Attitudes Questionnaire and Safety Attitudes Questionnaire were distributed to the nurses in a county hospital in Taiwan. Nurses (n = 407) had lower scores in Team Structure, Communication, and Situation Monitoring than physicians (n = 76). A structural equation model demonstrated a positive association between teamwork climate and safety attitudes (β = 0.78, P < .01). Teamwork climate is the most important determinant for patient safety attitudes among nurses.
TL;DR: This integrative review examined research evidence regarding implemented family presence protocols for adults in the hospital setting—specifically, the use of protocols and providers' feedback, finding a positive trend in family presence practice.
Abstract: Family presence during resuscitation or invasive procedures is controversial, but research suggests multiple benefits. Professional organizations recommend developing family presence protocols; however, few hospitals have them. This integrative review examined research evidence regarding implemented family presence protocols for adults in the hospital setting-specifically, the use of protocols and providers' feedback. Four key findings include a positive trend in family presence practice, varying provider attitudes, problems with family facilitators, and factors inhibiting or facilitating protocol implementation.
TL;DR: It is reported that health care workers experience some of the highest rates of nonfatal occupational illness and injury— exceeding even construction and manufacturing firms.
Abstract: THE INSTITUTE OF MEDICINE report that medical errors claim the lives of 44 000 to 98 000 patients annually1 has prompted many health care safety initiatives during the past decade. These initiatives often focus solely on patients, although many safety issues also place nurses and other health care workers at risk for harm. In fact, the National Institute for Occupational Safety and Health2 and US Department of Labor3 report that health care workers experience some of the highest rates of nonfatal occupational illness and injury— exceeding even construction and manufactur-
TL;DR: The type of hospital and the amount of education nurses obtained about patient safety and quality improvement were positively associated with patient safety culture and the type of work unit negatively affected workers' behaviors and adverse event reporting in terms of patient safetyculture.
Abstract: This descriptive and cross-sectional study included 561 nurses in hospitals located in Istanbul, Turkey. The Patient Safety Questionnaire was used for data collection. The type of hospital and the amount of education nurses obtained about patient safety and quality improvement were positively associ
TL;DR: The purpose of this article was to describe the successful implementation of a quality improvement initiative focusing on a hand hygiene program that used the multimodal interventions of tailored education, monthly feedback, and reminders.
Abstract: The purpose of this article was to describe the successful implementation of a quality improvement initiative focusing on a hand hygiene program that used the multimodal interventions of tailored education, monthly feedback, and reminders. Compliance rates improved from July 2011 to December 2012 by 57.4%. Efforts are continuing to ensure program sustainability.
TL;DR: The Veterans Affairs National Quality Scholars program is introduced and examples of learning activities and fellows' accomplishments are provided to improve the quality of health care.
Abstract: The Quality and Safety Education for Nurses (QSEN) project is enhancing the emphasis on quality care and patient safety content in nursing schools. A partnership between QSEN and the Veterans Affairs National Quality Scholars program resulted in a unique experiential, interdisciplinary fellowship for both nurses and physicians. This article introduces the Veterans Affairs National Quality Scholars program and provides examples of learning activities and fellows' accomplishments. Interprofessional quality and safety education at the doctoral and postdoctoral levels is germane to improving the quality of health care.
TL;DR: Factors associated with nurses' adoption of an evidence-based practice to reduce the duration of catheterization and potential for catheter-associated urinary tract infections in hospitalized adults are identified.
Abstract: Hospitalized adult patients are at increased risk for adverse outcomes, particularly when undergoing invasive procedures that include indwelling urinary catheterization. This study identified factors associated with nurses' adoption of an evidence-based practice to reduce the duration of catheterization and potential for catheter-associated urinary tract infections in hospitalized adults.
TL;DR: This implementation of a formalized safety program in a critical care unit highlights the importance of the “voice of the caregiver,” as it relates to patient safety, and indicates the clinical significance of nurse-led patient safety programs.
Abstract: This implementation of a formalized safety program in a critical care unit highlights the importance of the "voice of the caregiver," as it relates to patient safety. This nurse-led program featured executive walkrounds and a multidisciplinary core team whose goal was to prioritize and resolve safety issues identified during the 6-month study period. Unit nurses' scores on the Safety Attitudes Questionnaire remained stable from July 2011 to February 2012. Staff identified 77 safety issues during executive walkrounds; 57% were resolved during the study period. Results indicate the clinical significance of nurse-led patient safety programs.
TL;DR: The article describes components of the Quality Assurance and Performance Improvement Initiative, the unique contributions of registered nurses to its implementation, and data collection strategies using direct observation and evidence-based measures and protocols in a quality improvement program.
Abstract: The Quality Assurance and Performance Improvement Initiative, a component of the Affordable Care Act (2010), is a new approach to quality improvement for US nursing homes. The article describes components of the Quality Assurance and Performance Improvement Initiative, the unique contributions of registered nurses to its implementation, and data collection strategies using direct observation and evidence-based measures and protocols in a Quality Assurance and Performance Improvement program.
TL;DR: Evidence of mobilization safety was found in 4 clinical settings (medical, surgical, cardiac procedure, and intensive care), and the findings from these studies suggest that early mobilization of hospitalized adults is safe.
Abstract: This article examines literature that provides evidence about the safety of mobilizing hospitalized adults. A search of electronic databases and hand searches yielded 24 studies that were included in the review. Evidence of mobilization safety was found in 4 clinical settings (medical, surgical, cardiac procedure, and intensive care), and the findings from these studies suggest that early mobilization of hospitalized adults is safe.
TL;DR: This project goal was to determine whether a ventilator-associated pneumonia care bundle checklist embedded into an existing electronic health record would increase completeness of nursing documentation in an intensive care unit setting.
Abstract: Ventilator-associated pneumonia is a hospital-acquired infection that may develop in patients 48 hours after mechanical ventilation. The project goal was to determine whether a ventilator-associated pneumonia care bundle checklist embedded into an existing electronic health record would increase completeness of nursing documentation in an intensive care unit setting. With the embedded checklist, there were significant improvements in nursing documentation and a decreased incidence of ventilator-associated pneumonia.
TL;DR: There were no differences between the 2 cohorts across 14 measured activities, except for their reported use of appropriate strategies to improve hand-washing compliance to reduce nosocomial infection rates.
Abstract: We surveyed 2 cohorts of early-career registered nurses from 15 states in the US, 2 years apart, to compare their reported participation in hospital quality improvement (QI) activities. We anticipated differences between the 2 cohorts because of the growth of several initiatives for engaging nurses in QI. There were no differences between the 2 cohorts across 14 measured activities, except for their reported use of appropriate strategies to improve hand-washing compliance to reduce nosocomial infection rates.
TL;DR: Examination of baseline and changes in patient health outcomes between admission and discharge using data from 59 157 acute-care hospital-based patient records at 44 hospitals in Canada found standardized indicators offer a mechanism for evaluating the effectiveness and quality of nursing care interventions.
Abstract: Clinical databases comprising data that are available at a national level provide the opportunity to explore the relationships between nursing interventions and patient health outcomes. This research examined baseline and changes in patient health outcomes between admission and discharge using data from 59 157 acute-care hospital-based patient records at 44 hospitals in Canada. Statistically significant improvements in all of the health outcomes were noted, with the exception of pressure ulcers. The standardized indicators offer a mechanism for evaluating the effectiveness and quality of nursing care interventions.
TL;DR: Early removal of urinary catheters afterThoracic surgery in patients with thoracic epidurals was safe, with minimal urinary retention, and patients were given up to 8 hours to void before further intervention.
Abstract: The purpose of this study was to determine whether early removal of urinary catheters in patients with thoracic epidurals resulted in urinary retention (>500 mL by bladder scanner). Patients were given up to 8 hours to void before further intervention. Of 61 patients, only 4 (6.6%) required urinary catheter reinsertion due to urinary retention. Early removal of urinary catheters after thoracic surgery in patients with thoracic epidurals was safe, with minimal urinary retention.
TL;DR: NURSES, other health care and quality improvement professionals, and health care executives across the country are focusing more-than-usual attention on identifying the factors that cause a high volume of hospital readmissions.
Abstract: NURSES, other health care and quality improvement professionals, and health care executives across the country are focusing more-than-usual attention on identifying the factors that cause a high volume of hospital readmissions. Their activity is being driven in large part by the Hospital Readmissions Reduction Program, which was enacted as part of the Affordable Care Act. Effective October 1, 2012, organizations with high 30-day readmission rates for acute myocardial infarction, heart failure, and pneumonia could see their annual hospital Medicare payments reduced by up to 1%, according to a final rule from the Centers for Medicare & Medicaid Services (CMS).1 Hospital readmissions occur frequently, have major cost and quality implications, and can often be prevented. A major study2 found that nearly 1 in 5 Medicare patients discharged from the hospital is readmitted within 30