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Journal of Nursing Care Quality

Mary Still, Jennifer Vanderlaan, Courtenay Brown, Melissa Gordon, Kimberly Graham, Carolyn Holder, James P McMurtry, Ellen Meyer, Vicki Morelock, Susan Shapiro
This study explored the trajectory of patients who remained on a general unit after medical emergency team activation. Of those who had a second activation within 24 hours, 80% occurred within 12 hours of the baseline activation. Chest pain and recent intensive care unit discharge were associated with having a second activation. There were statistically, not clinically, significant associations between mean vital signs and second activations; however, the patterns of change may be clinically useful.
June 27, 2017: Journal of Nursing Care Quality
Gillian Strudwick, Emilene Reisdorfer, Caroline Warnock, Kamini Kalia, Heather Sulkers, Carrie Clark, Richard Booth
In an effort to prevent medication errors, barcode medication administration technology has been implemented in many health care organizations. An integrative review was conducted to understand the effect of barcode medication administration technology on medication errors, and characteristics of use demonstrated by nurses contribute to medication safety. Addressing poor system use may support improved patient safety through the reduction of medication administration errors.
June 27, 2017: Journal of Nursing Care Quality
Debra K Hall, Kathie S Zimbro, Ralitsa S Maduro, Deborah Petrovitch, Patricia Ver Schneider, Merri Morgan
Restraint use has been linked to longer lengths of stay and other undesirable outcomes. This evidence-based project explored the impact of a restraint management bundle on restraint use, quality, and safety outcomes. Results indicated that the proportion of intensive care unit patients restrained decreased significantly (24.3% vs 20.9%) following program implementation. Project results suggest that the restraint management bundle may provide a framework for guiding the process to reduce restraint use, minimize harm, and improve patient safety...
June 27, 2017: Journal of Nursing Care Quality
Nancy N H McGough, Trevor Keane, Avneesh Uppal, Maritoni Dumlao, Wendy Rutherford, Kristen Kellogg, Erin Ward, Courtney Kendal, Willa Fields
Uncontrolled noise in the hospital setting can have a negative physiological and psychological impact on patients and nurses. To reduce unit noise levels and create a quiet patient and nurse experience, an evidence-based practice project was conducted in 4 progressive care units in a community hospital. The Quiet Time Bundle implementation improved patient satisfaction and patient and nurse perceptions of noise even though the decrease in noise levels may not be discernible.
June 27, 2017: Journal of Nursing Care Quality
Rebecca Saxton, Rebecca Cahill
No abstract text is available yet for this article.
June 23, 2017: Journal of Nursing Care Quality
Beth King, Yinong Young-Xu, William J Lee, Robertus van Aalst, Brian Shiner, Peter Mills, Leah Eickhoff, Julia Neily
The Veterans Health Administration implemented The Daily Plan (TDP) to improve patient safety. We compared length of stay and readmission between intervention and control units. Length of stay decreased for both groups. Readmission rates increased for controls (21.3%-25.0%, P = .02) and barely changed for TDP units (21.7%-22.5%, P = .37). Although there were no efficiency improvements, TDP's ultimate goal was safety. Not all patient safety actions improve efficiency; nonetheless, their value continues.
June 23, 2017: Journal of Nursing Care Quality
Lianne Jeffs, Julie McShane, Alyssa Indar, Maria Maione
A qualitative study was undertaken to explore the experiences and perceptions of project leaders, clinicians, managers, and mentors associated with the implementation of a strategy aimed at enhancing clinicians' ability to use data to guide quality improvement projects. Our study findings elucidated the value and benefits including (1) using data to understand local context and move forward and (2) improving care and engaging in collaborative professional practice.
June 23, 2017: Journal of Nursing Care Quality
Jacqueline E Crawford, Colleen Garvin Coyne, Katherine Calder
Noncompliance in obtaining daily weights leads to delays in establishing treatment and discharge plans in pediatric populations. An inpatient gastrointestinal and endocrine nursing unit aimed to increase compliance of obtaining daily weights from baseline of 38% to 80%. The time daily weights were obtained was changed from 8 AM to an interval of time 4 PM to 6 PM. The compliance rate increased to 96% and has been sustained at an average of 94% over 24 months. This report describes a low-risk intervention that took minimal effort to implement but yielded high results to exceed the goal...
June 23, 2017: Journal of Nursing Care Quality
Samantha Johnson, Mallory McNeal, Joel Mermis, Deepika Polineni, Stephanie Burger
Patients with cystic fibrosis have increased risk of pulmonary infections, and reducing spread of microorganisms is critical. To improve hospital-staff adherence to infection control guidelines, we implemented brightly colored Safe Zone floor decals, staff compliance contracts, and an infection control in-service video. Audits of staff adherence conducted pre and postintervention demonstrated an increased and sustainable improvement among each group (P < .05). These effective measures may be implemented to improve infection control compliance elsewhere...
June 23, 2017: Journal of Nursing Care Quality
Anne Mørk, Anna Krupp, Jennifer Hankwitz, Ann Malec
This article describes the planning, implementation, and outcomes of 2 complementary quality initiatives, bedside handoff and nurse-initiated interdisciplinary bedside rounds, in a 24-bed medical/surgical intensive care unit. Systematic approaches such as Kotter's change model and unit-based champions were used to redesign care processes and standardize daily communication and workflows. Active partnership with the patient and the family during these changes promoted a strong intensive care unit culture of patient- and family-centered care...
June 23, 2017: Journal of Nursing Care Quality
Joy M Plamann, Judith Zedreck-Gonzalez, Laura Fennimore
A growing segment of patients in hospitals are considered outpatients, classified as observation. These patients neither have the severity of illness nor the intensity of service to qualify as inpatients, yet are not well enough to be discharged. Hospitals have created observation units to address the clinical needs of this growing patient type to provide care in the right setting by managing emergency department throughput and utilizing the most efficient staffing resources. This article describes the change processes and improvements in quality, length of stay, and patient satisfaction, which occurred following the implementation of an adult observation unit...
May 12, 2017: Journal of Nursing Care Quality
Teresa W Tai, Sherry I Bame, Nitish Patidar
This study examined factors determining hospital compliance to Hospital Quality Alliance's protocol for patients with myocardial infarction. Using a spatially matched sample of 132 Magnet and 264 non-Magnet hospitals, multivariate regressions determined significant hospital characteristics associated with compliance per Hospital Quality Alliance protocol. Adherence to the Hospital Quality Alliance protocols varied widely by hospital characteristics. Registered nurse staffing/bed was a key factor determining patient care quality variation...
May 12, 2017: Journal of Nursing Care Quality
Min-Jeoung Kang, Yinji Jin, Taixian Jin, Sun-Mi Lee
This study developed the Automated Medical Error Risk Assessment System (Auto-MERAS), which was incorporated into the electronic health record system. The system itself maintained high predictive validity for medication errors at the area under the receiver operating characteristic curves of above 0.80 at the time of development and validation. This study has found possibilities to predict the risk of medication errors that are sensitive to situational and environmental risks without additional data entry from nurses...
May 12, 2017: Journal of Nursing Care Quality
Heather M Gilmartin, Paula Langner, Madhura Gokhale, Katerine Osatuke, Rachael Hasselbeck, Thomas M Maddox, Catherine Battaglia
Patient safety checklists are ubiquitous in health care. Nurses bear significant responsibility for ensuring checklist adherence. To report nonadherence to a checklist and stop an unsafe procedure, a workplace climate of psychological safety is needed. Thus, an analysis of organizational data was conducted to examine the relationship between psychological safety and reports of nonadherence to the central line bundle checklist. Results showed varied perceptions of psychological safety but no relationship with nonadherence...
May 12, 2017: Journal of Nursing Care Quality
Maree Johnson, Gabrielle Weidemann, Rebecca Adams, Elizabeth Manias, Tracy Levett-Jones, Vicki Aguilar, Bronwyn Everett
The aim of this qualitative study was to examine the nature of interruptions during medication administration. Focus groups were conducted with medical/surgical nurses (n = 15), critical care nurses (n = 13), and nurse managers/educators/specialists (n = 6). Most interruptions (78%) were predictable. Nurse-adopted strategies included blocking, engaging, mediating, multitasking, and preventing. Educational content was developed that relates behavioral strategies to respond to predictable and unpredictable interruptions...
April 26, 2017: Journal of Nursing Care Quality
Ann M Stalter, Janet M Phillips, Mary A Dolansky
The Quality and Safety Education for Nurses (QSEN) Institute RN-BSN Task Force presents a white paper on Recommendation for a Systems-based Practice Competency. The task force proposes a seventh QSEN competency, systems-based practice, to improve patient quality and safety. Recommendations to integrate systems-based practice into both education and practice settings, consistent with job descriptions and promotion criteria, involve a comprehensive continuing education program for nurses upon interview, orientation, residency programming, performance evaluation, and license renewal...
April 26, 2017: Journal of Nursing Care Quality
Mei Ling Lim, Seng Giap Marcus Ang, Kai Yunn Teo, Yan Hui Celestine Wee, Shu Ping Yee, Shu Hui Lim, Shin Yuh Ang
An exploratory descriptive study was conducted to explore the perspectives of patients who had fallen in the hospital; 100 patients were interviewed. An inductive content analysis approach was adopted. Six themes emerged: Apathetic toward falls, self-blame behavior, reluctance to impose on busy nurses, negative feelings toward nurses, overestimating own ability, and poor retention of information. Patients often downplayed the risks of falls and were reluctant to call for help.
April 26, 2017: Journal of Nursing Care Quality
Rana M Elayan, Muayyad M Ahmad
Nurses as patients or caregivers evaluated their care differently than nonnurses. A qualitative design with content analysis was used to provide an assessment of the quality of nursing care by examining nurses' perceptions as recipients of care. The 231 participants were registered nurses recruited from 8 hospitals in Amman, Jordan. Participants evaluated the quality of nursing care as either high (29.5%) or low (70.5%). Four improvement themes emerged: improving competency, serve with caring, professionalism, and administrative factors...
April 26, 2017: Journal of Nursing Care Quality
Lily Thomas, Patricia Donohue-Porter, Joanna Stein Fishbein
Medication administration errors are difficult to intercept since they occur at the end of the process. The study describes interruptions, distractions, and cognitive load experienced by registered nurses during medication administration and explores their impact on procedure failures and medication administration errors. The focus of this study was unique as it investigated how known individual and environmental factors interacted and culminated in errors.
April 26, 2017: Journal of Nursing Care Quality
Linda W Higgins, Judith A Shovel, Andrew L Bilderback, Holly L Lorenz, Susan C Martin, Debra J Rogers, Tamra E Minnier
The aim of this project was to describe hospital nurses' work activity through observations, nurses' perceptions of time spent on tasks, and electronic health record time stamps. Nurses' attitudes toward technology and patients' perceptions and satisfaction with nurses' time at the bedside were also examined. Activities most frequently observed included documenting in and reviewing the electronic health record. Nurses' perceptions of time differed significantly from observations, and most patients rated their satisfaction with nursing time as excellent or good...
July 2017: Journal of Nursing Care Quality
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