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Journal of Nursing Care Quality

Ari Min, Linda D Scott, Chang Park, Catherine Vincent, Catherine J Ryan
BACKGROUND: Few studies have evaluated technical efficiency of nursing care, and no such studies have been conducted in intensive care units (ICUs). PURPOSE: To explore relative technical efficiency of US ICUs and identify organizational factors associated with efficiency in providing quality of nursing care. METHODS: A total of 404 adult ICUs from the 2014 National Database of Nursing Quality Indicators were included. Data envelopment analysis was used to estimate technical efficiency, and multilevel modeling was employed to determine effects of organizational factors on efficiency...
September 11, 2018: Journal of Nursing Care Quality
Maria Creed, Michelle McGuirk, Ruth Buckley, Aoife De Brún, Marie Kilduff
BACKGROUND: Hospital controlled drug processes are established to adhere to legislation, with little consideration of efficiency of processes. LOCAL PROBLEM: A controlled drug process existed, where nurses requested a porter to collect a hand-written order; however, only 19% of drug orders were processed this way. Instead, an unscheduled, ad hoc process led to an average of 17 nurse journeys to pharmacy daily. We aimed to reduce nurse journeys to the pharmacy by 25% to release nursing time...
September 6, 2018: Journal of Nursing Care Quality
Cynthia R Herrington, Mikel W Hand
BACKGROUND: Nursing peer review (NPR) is essential in evaluating nursing practice. A common theme throughout the literature is that NPR holds nurses accountable for their practice. PROBLEM: The nursing profession has struggled to conduct peer review consistently due to lack of a standardized framework. APPROACH: A NPR program was developed, implemented, and evaluated in a 355-bed acute care hospital in the Midwestern United States. OUTCOMES: A pre- and postdesign using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used for evaluation...
September 6, 2018: Journal of Nursing Care Quality
Franklin Schwartz, Pamela Bjorklund
BACKGROUND: The study of workplace violence has focused on quantifying the problem and profiling perpetrators and victims. Intervention studies are scarce. The diverse nature of violence risk in hospitals highlights the need for broad training in risk recognition and de-escalation. LOCAL PROBLEM: A violence management program was piloted on a general medical unit following staff requests for measures to protect them from patient and visitor violence. METHODS: An independent pre/posttest design measured changes in participant knowledge...
September 6, 2018: Journal of Nursing Care Quality
Christine Hedges, Candice Hunt, Pamela Ball
BACKGROUND: A quiet environment promotes rest and healing but is often challenging to provide in a busy acute care setting. Improving quiet in the hospital for designated hours improves patient satisfaction. Such efforts have typically been the primary responsibility of the nursing staff. LOCAL PROBLEM: Two medical units with consistently low Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) "always quiet" scores were chosen for this study...
September 6, 2018: Journal of Nursing Care Quality
Dian Baker, Barbara Quinn, Victoria Ewan, Karen K Giuliano
BACKGROUND: Hospital-acquired pneumonia is now the number one hospital-acquired infection. Hospitals have addressed ventilator-associated pneumonia; however, patients not on a ventilator acquire more pneumonia with significant associated mortality rates. LOCAL PROBLEM: In our hospital, non-ventilator-associated pneumonia was occurring on all types of units. METHODS: The Influencer Model was used to reduce nonventilator hospital-acquired pneumonia rates...
September 6, 2018: Journal of Nursing Care Quality
Lauraine Spano-Szekely, Anne Winkler, Cathy Waters, Susana Dealmeida, Kathy Brandt, Marsha Williamson, Christina Blum, Lori Gasper, Fay Wright
BACKGROUND: A 245-bed community hospital established patient fall prevention as its patient safety priority. PROBLEM: The hospital's fall prevention program was not consistently effective. The baseline fall rate was 3.21, higher than the National Database of Nursing Quality Indicators' median of 2.91. APPROACH: An interprofessional fall prevention team evaluated the hospital's fall program using the evidence-based practice improvement model...
September 6, 2018: Journal of Nursing Care Quality
Liz Lees-Deutsch, Jane Robinson
BACKGROUND: This article reports on a systematic review conducted to critique safety, quality, length of stay, and implementation factors regarding criteria-led discharge. PURPOSE: Improving patient flow and timely bed capacity is a global issue. Criteria-led discharge enables accelerated patient discharge in accordance with patient selection. METHODS: A systematic review was conducted to identify literature on criteria-led discharge from 2007 to 2017...
September 6, 2018: Journal of Nursing Care Quality
Kari Sand-Jecklin, Jennifer Johnson, Amanda Tringhese, Christine Daniels, Freda White
BACKGROUND: Although video monitoring has been shown to reduce falls among at-risk hospitalized patients, there are no identified best practices for the monitoring process. PURPOSE: The purpose of this study was to evaluate the monitoring process at a large teaching hospital, with the goal of making improvements and standardizing monitoring practices. METHODS: Patients and nursing staff perceptions about the video monitoring process were elicited via survey, and perceptions of monitor technicians were obtained through structured interview...
September 6, 2018: Journal of Nursing Care Quality
Sin-Yuan Chang, Wen-Shiang Chen, Ting Teng, Chien-Yu Yeh, Hsiao-Ching Yen
BACKGROUND: The incidence of falls on inpatient oncology units indicated the need for quality improvement. This project aimed to reduce falls by implementing a fall reduction plan including the "Traffic Light" Fall Risk Assessment Tool (TL-FRAT). LOCAL PROBLEM: We retrospectively reviewed the oncology unit fall data from January 2013 to September 2014 and found that the average fall incidence was high. METHODS: The project used a program evaluation design, and the process was guided by Kotter's 8-step change model...
September 6, 2018: Journal of Nursing Care Quality
Elizabeth C Schenk, Ruth A Bryant, Catherine R Van Son, Tamara Odom-Maryon
BACKGROUND: Patient safety-focused research may be strengthened by the inclusion of patients and family members in research design; yet, published methodologies for doing so are scarce. PURPOSE: This study engaged patients and families in research design of an intervention to increase patient/family engagement, with reduction of harm in hospitalized patients. METHODS: The study design team convened a Patient Safety Advisory Panel to explore potential testable interventions to increase patient/family engagement with safety...
September 6, 2018: Journal of Nursing Care Quality
Pamela Sykes, Ian Norris, Megan Cook, Aaron Woods, Rachel Boughton, Kylie Chilcott, Kenneth Walsh
BACKGROUND: Providing appropriate and timely mealtime assistance to hospitalized patients should be part of a multifaceted and multidisciplinary approach to optimizing a patient's nutritional care plan. PROBLEM: There was anecdotal evidence at the study hospital that patients did not receive adequate and/or timely assistance at mealtimes. APPROACH: A best practice implementation project, using a proven strategy of audit, feedback, and reaudit, was used to effect practice change on an acute general medical ward...
September 6, 2018: Journal of Nursing Care Quality
Jenny A Prochnow, Sonja J Meiers, Martha M Scheckel
BACKGROUND: Patients and caregivers are often not adequately informed about new medications. Nurses can lead innovations that improve new medication education. LOCAL PROBLEM: Healthcare Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores on medication questions trailed state and national levels in one Midwestern hospital. METHODS: This quality improvement project, guided by the Ottawa Model of Research Use and the Always Use Teach-back! innovative toolkit, used a 1-group pre- and posteducation design with RNs, patients, and caregivers...
September 6, 2018: Journal of Nursing Care Quality
Heather Gilmartin, Emily Lawrence, Chelsea Leonard, Marina McCreight, Lynette Kelley, Brandi Lippmann, Andrew Coy, Robert E Burke
BACKGROUND: Many health care interventions encounter implementation challenges because of inadequate stakeholder engagement and identification of barriers. The brainwriting premortem technique is the silent sharing of written ideas about why an intervention failed. The method can engage stakeholders and identify barriers more efficiently than traditional brainstorming focus groups. PURPOSE: We evaluated the method during a transition of care intervention in the Veterans Health Administration (VA)...
August 24, 2018: Journal of Nursing Care Quality
Sue Carol Verrillo, Maria Cvach, Krysia Warren Hudson, Bradford D Winters
BACKGROUND: Episodic vital sign collection (eVSC), as single data points, gives an incomplete picture of adult patients' postoperative physiologic status. LOCAL PROBLEM: Late detection of patient deterioration resulted in poor patient outcomes on a postsurgical unit. METHODS: Baseline demographic and outcome data were collected through retrospective chart review of all patients admitted to the surgical unit for 12 weeks prior to this quality improvement project...
August 7, 2018: Journal of Nursing Care Quality
Laurel E Radwin, Howard J Cabral, Marjorie Nealon Seibert, Kelly Stolzmann, Mark Meterko, Leigh Evans, Anna Barker, Barbara Bokhour
BACKGROUND: Nurse contributions to patient-centered care in primary care clinics are all but ignored in standard patient experience surveys. PURPOSE: The purpose was to conduct a pilot study to develop and psychometrically assess a scale measuring nurses' and other providers' patient-centered care in Veteran Affairs primary care clinics. METHOD: We developed a patient experience survey composed of original items and previous studies' items and scales...
July 24, 2018: Journal of Nursing Care Quality
Huey-Ming Tzeng, James Marcus Pierson, Yu Kang, Anne Barker, Chang-Yi Yin
BACKGROUND: Nurses and other health care providers need to ensure that patients receive care that addresses their specific needs and wants. PURPOSE: This exploratory study examined the associations between patients' self-reported positive and negative affect, the perceived importance of 57 self-care actions, the desire and ability to perform them, and emergency department use in the past 3 months. METHODS: A secondary analysis from a cross-sectional survey project that surveyed 250 community-dwelling adults living in the southern United States, 2015-2016...
July 23, 2018: Journal of Nursing Care Quality
Kelly M Smith, Kelley M Baker, Joan K Bardsley, Patricia McCartney, Michelle Magee
BACKGROUND: Methods to deliver diabetes education are needed to support patient safety and glycemic control in the transition from hospital to home. PURPOSE: This study examined barriers and facilitators of integrating web-based, iPad-delivered diabetes survival skills education (DSSE) into the nursing inpatient unit workflow. METHODS: Nurses, nurse managers, and patient care technicians (PCTs) from 3 medical-surgical and 2 behavioral health units participated in semistructured interviews and focus groups...
July 18, 2018: Journal of Nursing Care Quality
Ángela Sanjuan-Quiles, María Del Pilar Hernández-Ramón, Rocío Juliá-Sanchis, Noelia García-Aracil, Mª Elena Castejón-de la Encina, Juana Perpiñá-Galvañ
BACKGROUND: During the transfer of patients, both ambulance and hospital emergency service professionals need to exchange necessary, precise, and complete information for an effective handover. Some factors threaten a quality handover such as excessive caseload, patients with multiple comorbidities, limited past medical history, and frequent interruptions. PURPOSE: To explore the viewpoint of nurses on their experience of patient handovers, describing the essential aspects of the process and areas for improvement, and establishing standardized elements for an effective handover...
July 18, 2018: Journal of Nursing Care Quality
Kara Misto, Cynthia Padula, Elizabeth Bryand, Kate Nadeau
BACKGROUND: While there are many benefits of electronic medical record documentation, the presence of a computer may adversely affect provider-patient interaction. PURPOSE: The purpose of this project was to examine staff nurses' perception of the impact of electronic documentation in the presence of the patient on the nurse-patient relationship. METHODS: A survey was administered to 276 staff nurses, and open-ended interviews were conducted with 11 novice and 20 expert nurses...
July 2, 2018: Journal of Nursing Care Quality
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