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https://www.readbyqxmd.com/read/28099788/deploying-and-measuring-a-risk-and-patient-safety-program
#1
Howard Orel, Molly McGroarty, Heather Marchegiani
Health care continues to evolve at a rapid rate. Over just the past decade, the industry has seen the introduction and widespread implementation of an electronic health record, increase in presence of nurse practitioners and physician assistants to help manage the shortage of physicians, and the introduction of accountable care organizations. It is with these changes that new challenges and opportunities emerge. One such challenge is the increase in the severity of medical malpractice claims throughout the nation...
January 2017: Journal of Healthcare Risk Management: the Journal of the American Society for Healthcare Risk Management
https://www.readbyqxmd.com/read/28033136/permissive-hypotension-and-trauma-can-fluid-restriction-reduce-the-incidence-of-ards
#2
Melissa Kolarik, Eric Roberts
Emergency care, including the resuscitation of patients involved in traumatic events, has evolved over the years. A prior practice of utilizing large volumes of crystalloids has been found to contribute to complications such as coagulopathy, fluid overload, and adult respiratory distress syndrome (ARDS). In contrast, permissive hypotension is a method of fluid restriction that allows for low blood pressure and mean arterial pressure during the resuscitation period. When permissive hypotension occurs and fluids are restricted in trauma patients, the incidence of ARDS can be reduced significantly with improvement in patient outcomes...
January 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28012799/clinic-personnel-facilitator-and-parent-perspectives-of-ehealth-familias-unidas-in-primary-care
#3
Lourdes Molleda, Monica Bahamon, Sara M St George, Tatiana Perrino, Yannine Estrada, Deborah Correa Herrera, Hilda Pantin, Guillermo Prado
INTRODUCTION: The purpose of this qualitative study was to understand the feasibility and acceptability of implementing eHealth Familias Unidas, an Internet-based, family-based, preventive intervention for Hispanic adolescents, in primary care. METHODS: Semistructured individual interviews with clinic personnel and facilitators (i.e., physicians, nurse practitioners, administrators, and mental health workers; n = 9) and one focus group with parents (n = 6) were audiorecorded, transcribed verbatim, and analyzed using a general inductive approach...
December 21, 2016: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/28005173/diabetes-education-of-patients-and-their-entourage-out-of-hospital-national-study-educated-2
#4
Frédéric Lapostolle, Nadia Hamdi, Majed Barghout, Louis Soulat, Anna Faucher, Yves Lambert, Nicolas Peschanski, Agnès Ricard-Hibon, Carine Chassery, Maryline Roti, Vincent Bounes, Guillaume Debaty, Tarak Mokni, Gérald Egmann, Pierre-Arnaud Fort, Karim Boudenia, Laurent Alayrac, Mohamed Safraou, Michel Galinski, Frédéric Adnet
AIMS: To determine the contributing factors in the successful diabetes education of patients and their entourage. METHODS: Prospective observational study conducted in a pre-hospital setting by 17 emergency services across France (September 2009-January 2011) included all insulin-treated patients (≥18 years) provided that at least one family member was present on scene. Data were collected from patients and their entourage: (1) personal details including language proficiency and educational attainment, (2) treatments, (3) diabetes-related data (log sheets, glucose meter, glucagon, glycated hemoglobin, prior hypoglycemic episodes); (4) care by diabetologist, general practitioner and/or visiting nurse...
December 22, 2016: Acta Diabetologica
https://www.readbyqxmd.com/read/27997577/spatial-accessibility-to-health-care-services-identifying-under-serviced-neighbourhoods-in-canadian-urban-areas
#5
Tayyab Ikram Shah, Scott Bell, Kathi Wilson
BACKGROUND: Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC) in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods. METHODS: This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA) method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings...
2016: PloS One
https://www.readbyqxmd.com/read/27955985/quarterly-reporting-of-computed-tomography-ordering-history-reduces-the-use-of-imaging-in-an-emergency-department
#6
Richard Ehrlichman, Zachary Dezman, Joel Klein, Jean Jeudy, Daniel Lemkin
BACKGROUND: Computed tomography (CT) is a useful and necessary part of many emergency department (ED) assessments. However, the costs of imaging and the health risks associated with radiation exposure have sparked national efforts to reduce CT ordering in EDs. STUDY OBJECTIVE: We analyzed CT ordering habits prior to and following implementation of a feedback tool at a community hospital. METHODS: In this intervention study, we identified the CT-ordering habits of physicians and mid-level care providers (physician assistants and nurse practitioners) at baseline and after implementation of a system that sent quarterly feedback reports comparing their ordering habits with those of their peers...
December 9, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27926623/clinician-perceptions-of-teamwork-in-the-emergency-department-does-nurse-and-medical-provider-workspace-placement-make-a-difference
#7
Amy L Weaver, Susan Hernandez, Daiwai M Olson
OBJECTIVE: This study was intended to determine whether positioning emergency department (ED) physicians, physician assistants, and nurse practitioners at the same workstations as registered nurses (RNs) improved communication and teamwork. BACKGROUND: Historically in this organization, providers and staff had separate physical locations (workstations). Construction of a new ED provided the opportunity to redesign the physical layout and to study whether a new design improved the perception of communication and teamwork among medical providers...
January 2017: Journal of Nursing Administration
https://www.readbyqxmd.com/read/27919865/shared-decision-making-in-patients-with-low-risk-chest-pain-prospective-randomized-pragmatic-trial
#8
Erik P Hess, Judd E Hollander, Jason T Schaffer, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Nilay D Shah, Jonathan Inselman, Jeph Herrin, Ana Castaneda-Guarderas, Victor M Montori
OBJECTIVE:  To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. DESIGN:  Multicenter pragmatic parallel randomized controlled trial. SETTING:  Six emergency departments in the United States. PARTICIPANTS:  898 adults (aged >17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain...
December 5, 2016: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/27918408/full-practice-authority-for-nurse-practitioners
#9
Deborah Dillon, Faye Gary
Implementation of the Affordable Care Act (2010) enabled more than 30 million people to have new access to primary care services. On the basis of current utilization patterns, demand for primary care providers is expected to grow more rapidly than physician supply. This imbalance is expected to worsen, as the aging population requires more health care resources. In addition, more patients are requiring critical care services and physician numbers are not keeping with this growing need. Restrictions on resident physician practice hours have impacted inpatient care as well...
January 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/27918402/leading-dnp-professionals-practice-competencies-for-organizational-excellence-and-advancement
#10
Kathy Malloch
The doctorate in nursing practice (DNP) role is quickly emerging across the United States in numerous practice settings, especially in hospitals, outpatient services, and academic institutions. There is now a need for guidelines to evaluate the enactment of the standards used to create DNP education and practice, competencies expected in practice, and the outcomes and value created by this role. This article presents a DNP Performance Demonstration and Impact template created on the basis of the AACN (American Association of Colleges of Nursing), NONPF (National Organization of Nurse Practitioner Faculties), and AONE (American Organization of Nurse Executives) standards to assist leaders in evaluating DNP performance from a standards-driven perspective...
January 2017: Nursing Administration Quarterly
https://www.readbyqxmd.com/read/27910294/medication-management-in-the-older-adult-a-narrative-exploration
#11
Johnanna Hernandez
BACKGROUND AND PURPOSE: The purpose of this study was to characterize the meaning nurse practitioners (NPs) ascribed to personal experiences providing care to older adults who take multiple medications to manage complex conditions. The study illuminated the NP experience in caring for the older adult while addressing the complexities of medication management through narrative stories in practice. METHODS: NPs self-identifying as caring for older adults were interviewed (N=15)...
December 2, 2016: Journal of the American Association of Nurse Practitioners
https://www.readbyqxmd.com/read/27906471/negotiated-safety-components-context-and-use-an-integrative-literature-review
#12
REVIEW
NataIie M Leblanc, Jason W Mitchell, Joseph P De Santis
AIM: To examine the components and use of negotiated safety in the context of HIV prevention and to identify reported factors associated with the concept. BACKGROUND: There is an emerging interest in dyadic approaches to address HIV transmission. Although there are theoretical foundations for how interpersonal relationships influence individual behaviour, how these dyadic processes influence on health is still not wholly understood. DESIGN: Integrative review of empirical and theoretical literature...
December 1, 2016: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/27890530/provider-perspectives-on-adding-biomarker-screening-for-tobacco-smoke-exposure-to-lead-screening-at-well-child-visits
#13
Winta Ghidei, Gail Brottman, Eline Lenne, Tukhanh Quan, Anne Joseph
INTRODUCTION: Measurement of cotinine, a biomarker of tobacco smoke exposure, can accurately identify children at risk of health consequences from secondhand smoke. This study reports perspectives from pediatric health care providers on incorporating routine cotinine screening into well-child visits. METHODS: Key informant interviews (N = 28) were conducted with pediatric primary care providers: physicians, nurse practitioners, and registered nurses. RESULTS: Themes identified in the interviews included the following: (a) Cotinine screening would assess children's exposure to tobacco smoke more reliably than parental report; (b) Addressing positive cotinine screening results might require additional resources; (c) Wheezing and a history of emergency department visits increased the salience of cotinine screening; and (d) A better understanding of the significance of specific cotinine test values would improve utility...
November 24, 2016: Journal of Pediatric Health Care
https://www.readbyqxmd.com/read/27883873/doctors
#14
Gaya Sritharan, Amber C Mills, Michele R Levinson, Anthea L Gellie
Objectives The aims of the present study were to investigate doctors' attitudes regarding the discussion and writing of not for resuscitation (NFR) orders and to identify potential barriers to the completion of these orders.Methods A questionnaire-based convenience study was undertaken at a tertiary hospital. Likert scales and open-ended questions were directed to issues surrounding the discussion, timing, understanding and writing of NFR orders, including legal and personal considerations.Results Doctors thought the presence of an NFR order both should and does alter care delivered by nursing staff, particularly delivery of pain relief, nursing observations and contacting the medical emergency team...
November 25, 2016: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/27860034/understanding-help-seeking-in-older-people-with-urinary-incontinence-an-interview-study
#15
Natalie Vethanayagam, Alison Orrell, Lena Dahlberg, Kevin J McKee, Susan Orme, Stuart G Parker, Mary Gilhooly
The prevalence of urinary incontinence (UI) increases with age and can negatively affect quality of life. However, relatively few older people with UI seek treatment. The aim of this study was to explore the views of older people with UI on the process of seeking help. Older people with UI were recruited to the study from three continence services in the north of England: a geriatrician-led hospital outpatient clinic (n = 18), a community-based nurse-led service (n = 22) and a consultant gynaecologist-led service specialising in surgical treatment (n = 10)...
November 16, 2016: Health & Social Care in the Community
https://www.readbyqxmd.com/read/27856140/impact-of-scribes-on-emergency-department-patient-throughput-one-year-after-implementation
#16
Heather A Heaton, David M Nestler, Christine M Lohse, Annie T Sadosty
OBJECTIVES: Assess the impact of scribes on an academic emergency department's (ED) throughput one year after implementation. METHODS: A prospective cohort design compared throughput metrics of patients managed when scribes were and were not a part of the treatment team during pre-defined study hours in a tertiary academic ED with both an adult and pediatric ED. An alternating-day pattern one year following scribe implementation ensured balance between the scribe and non-scribe groups in time of day, day of week, and patient complexity...
November 5, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27852879/examining-the-sources-of-occupational-stress-in-an-emergency-department
#17
S Basu, C Yap, S Mason
BACKGROUND: Previous work has established that health care staff, in particular emergency department (ED) personnel, experience significant occupational stress but the underlying stressors have not been well quantified. Such data inform interventions that can reduce cases of occupational mental illness, burnout, staff turnover and early retirement associated with cumulative stress. AIMS: To develop, implement and evaluate a questionnaire examining the origins of occupational stress in the ED...
December 2016: Occupational Medicine
https://www.readbyqxmd.com/read/27825345/reconfiguring-health-workforce-a-case-based-comparative-study-explaining-the-increasingly-diverse-professional-roles-in-europe
#18
Antoinette de Bont, Job van Exel, Silvia Coretti, Zeynep Güldem Ökem, Maarten Janssen, Kristin Lofthus Hope, Tomasz Ludwicki, Britta Zander, Marie Zvonickova, Christine Bond, Iris Wallenburg
BACKGROUND: Over the past decade the healthcare workforce has diversified in several directions with formalised roles for health care assistants, specialised roles for nurses and technicians, advanced roles for physician associates and nurse practitioners and new professions for new services, such as case managers. Hence the composition of health care teams has become increasingly diverse. The exact extent of this diversity is unknown across the different countries of Europe, as are the drivers of this change...
November 8, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27811596/qualitative-study-about-the-experiences-of-colleagues-of-health-professionals-involved-in-an-adverse-event
#19
Lena Ferrús, Carmen Silvestre, Guadalupe Olivera, José Joaquín Mira
OBJECTIVES: Identify what occurs among health-care providers (HCPs) after an adverse event (AE) and what colleagues could do to help them. METHOD: A qualitative study with participation by physicians and nurses from hospitals and primary care facilities. RESULTS: Fifteen HCPs and 12 health professionals with quality management responsibilities with between 8 and 30 years of experience participated; 15 (56%) were physicians (9 general practitioners, 3 surgeons, 2 intensivists, and 1 from an emergency unit), and 12 (44%) were nurses (5 worked in primary care and 7 in hospitals)...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27803809/experiences-of-hand-hygiene-among-acute-care-nurses-an-interpretative-phenomenological-analysis
#20
Sheryl L Chatfield, Rachael Nolan, Hannah Crawford, Jeffrey S Hallam
OBJECTIVE: Occurrences of healthcare-associated infections are associated with substantial direct and indirect costs. Improvement in hand hygiene among acute care nurses has potential to reduce incidence of healthcare-associated infections. Findings from reviews of intervention research have not conclusively identified components that are more or less efficient or effective. Much prior qualitative research has focused on descriptive analysis of policies and practices rather than providing interpretive explorations of how individuals' perceptions of hygiene might drive practices...
2016: SAGE Open Medicine
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