Implementing a Frailty-Specific Postoperative Order Set to Improve Postoperative Outcomes in Frail Adults After Elective Thoracic Surgery.

BACKGROUND: Frailty is independently associated with adverse patient outcomes after surgery. The current standards of postoperative care rarely consider frailty status. LOCAL PROBLEM: There was no standardized protocol to optimize specialized postoperative care for frail patients at an academic medical center. METHODS: A quasi-experimental pre-/postimplementation study design, using the Reach, Effectiveness, Adoption, Implementation, Maintenance implementation framework, was utilized. INTERVENTIONS: A frailty-specific postoperative order set (FPOS) was developed, including tailored nursing care, activity levels, and nutritional goals. RESULTS: There were significant improvements in nurse's self-reported familiarity with frailty (P = .003) and FPOS awareness (P < .001). The number of orders for delirium prevention, elimination, nutrition, sleep promotion, and sensory support increased (P < .001). CONCLUSIONS: Implementing an FPOS showed improvements in nurse frailty knowledge, awareness, and order set utilization.

Evaluation of computer-based training and high-fidelity simulation to improve early recognition of sepsis on the adult general ward.

This quality improvement project involved developing, implementing and evaluating an educational intervention using computer-based training (CBT) and high-fidelity simulation (HFS) to increase knowledge, confidence and compliance of nurses identifying sepsis. A one-group pretest-posttest design was used. Participants were nurses on a general ward of an academic medical centre. Study variables were measured over three timepoints: 2 weeks before, immediately after and 90 days after implementation. Data were collected from January 30, 2018, to June 22, 2018. SQUIRE 2.0 checklist for quality improvement reporting used. Improvements in knowledge of sepsis (F(2,83)  = 18.14, p < 0.001, ηp 2  = 0.30) and confidence in early recognition of sepsis (F(2,83)  = 13.67, p < 0.001, ηp 2  = 0.25) were found. Additionally, compliance with sepsis screening improved between the preimplementation and postimplementation period (χ2  = 13.633, df = 1, p < 0.001). Overall, the nurses evaluated their experience with the CBT and HFS as strongly positive. When designing and implementing an educational intervention on sepsis, a process for follow-up which provides reinforcement should be considered to retain nurses' knowledge.

Nurse-Driven Assessment, Prevention, and Management of Delirium on an Acute Inpatient Neurology Unit.

BACKGROUND: Delirium commonly affects hospitalized patients and is associated with increased hospital length of stay, discharge to skilled care, cost, morbidity, and mortality. LOCAL PROBLEM: At our organization, there was no formal delirium assessment performed by the nursing staff outside of the intensive care unit. METHODS: Assessment of nurses' knowledge about delirium, a nurse-driven delirium screening protocol, and patient education were implemented on an adult inpatient neurology unit. Knowledge change, protocol implementation, and patient-level outcomes were assessed. INTERVENTIONS: Staff nurse delirium education and a nurse-driven delirium screening protocol were implemented. RESULTS: No change in nursing knowledge occurred pre/postintervention. Falls, falls with injury, and restraint and sitter usage decreased. Changes in length of stay varied over the intervention period. The trend to discharge to home increased, while the trend to discharge to skilled nursing care decreased. CONCLUSIONS: Formal delirium screening protocols may add organizational value by positively impacting patient outcomes.

Implementing Prone Positioning for COVID-19 Patients Outside the Intensive Care Unit.

BACKGROUND: Proning intubated intensive care unit patients for the management of acute respiratory distress syndrome is an accepted standard of practice. We examined the nursing climate in 4 units and its impact on implementing a novel self-proning protocol to treat COVID-19 patients outside the intensive care unit. LOCAL PROBLEM: Nursing units previously designated for medical/surgical populations had to adjust quickly to provide evidence-based care for COVID-19 patients attempting self-proning. METHODS: Nurses from 4 nursing units were surveyed about the implementation process on the self-proning protocol. Their perception of unit implementation was assessed via the Implementation Climate Scale. INTERVENTIONS: A new self-proning nursing protocol was implemented outside the intensive care unit. RESULTS: Consistent education on the protocol, belief in the effectiveness of the intervention, and a strong unit-based climate of evidence-based practice contributed to greater implementation of the protocol. CONCLUSIONS: Implementation of a new nursing protocol is possible with strong unit-based support, even during a pandemic.

Effectiveness of SIESTA on Objective and Subjective Metrics of Nighttime Hospital Sleep Disruptors.

We created Sleep for Inpatients: Empowering Staff to Act (SIESTA), which combines electronic "nudges" to forgo nocturnal vitals and medications with interprofessional education on improving patient sleep. In one "SIESTAenhanced unit," nurses received coaching and integrated SIESTA into daily huddles; a standard unit did not. Six months pre- and post-SIESTA, sleep-friendly orders rose in both units (foregoing vital signs: SIESTA unit, 4% to 34%; standard, 3% to 22%, P < .001 both; sleeppromoting VTE prophylaxis: SIESTA, 15% to 42%; standard, 12% to 28%, P < .001 both). In the SIESTAenhanced unit, nighttime room entries dropped by 44% (-6.3 disruptions/room, P < .001), and patients were more likely to report no disruptions for nighttime vital signs (70% vs 41%, P = .05) or medications (84% vs 57%, P = .031) than those in the standard unit. The standard unit was not changed. Although sleep-friendly orders were adopted in both units, a unit-based nursing empowerment approach was associated with fewer nighttime room entries and improved patient experience.

Awakenings? Patient and Hospital Staff Perceptions of Nighttime Disruptions and Their Effect on Patient Sleep.

STUDY OBJECTIVES: Although important to recovery, sleeping in the hospital is difficult because of disruptions. Understanding how patients, hospital physicians, and nurses perceive sleep disruptions and identifying which disruptions are associated with objective sleep loss can help target improvement initiatives. METHODS: Patients and hospital staff completed the Potential Hospital Sleep Disruptions and Noises Questionnaire (PHSDNQ). Cutoff points were defined based on means, and responses were dichotomized. Perceived percent disrupted for each item was calculated, and responses were compared across groups using chi-square tests. Objective sleep time of patients was measured using wrist actigraphy. The association between patient-reported disruptions and objective sleep time was assessed using a multivariable linear regression model controlling for subject random effects. RESULTS: Twenty-eight physicians (78%), 37 nurses (88%), and 166 of their patients completed the PHSDNQ. Patients, physicians, and nurses agreed that pain, vital signs and tests were the top three disrupters to patient sleep. Significant differences among the groups' perceptions existed for alarms [24% (patients) vs. 46% (physicians) vs. 27% (nurses), p < 0.040], room temperature (15% vs. 0% vs. 5%, p < 0.031) and anxiety (18% vs. 21% vs. 38%, p < 0.031). Using survey and actigraphy data from 645 nights and 379 patients, the presence of pain was the only disruption associated with lower objective sleep duration (minutes) [-38.1 (95% confidence interval -63.2, -12.9) p < 0.003]. CONCLUSION: Hospital staff and patients agreed that pain, vital signs and tests were top sleep disrupters. However, pain was associated with the greatest objective sleep loss, highlighting the need for proactive screening and management of patient pain to improve sleep in hospitals.

Every second counts: innovations to increase timely defibrillation rates.

Early defibrillation is an essential step in the "chain of survival" for patients with in-hospital cardiac arrest. To increase the rate of early defibrillation by nurse first responders in noncritical care areas, our institution employed a quality resuscitation consultant, implemented nursing education programs, and standardized equipment and practices. Automated external defibrillator application by nurse first responders prior to advanced cardiac life support team arrival has improved from 15% in 2011 to 76% in 2013 (P < .001).

Instruments that measure nurses' knowledge about diabetes: an integrative review.

BACKGROUND AND PURPOSE: Diabetes mellitus is an increasingly prevalent disease among hospitalized patients. Educators are challenged to build evidence-based programs for nurses based on sound nursing needs assessments using valid and reliable measures. The purpose of this integrative review is to examine instruments that measure nurses' knowledge about diabetes. METHODS: The Databases PubMed (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Database of Systematic Reviews were searched for articles published between 1983 and 2012 using the keywords: diabetes knowledge; diabetes mellitus; diabetes self-management, nurse, and nursing knowledge. Fifteen articles reflecting the psychometric properties of 7 published instruments were reviewed. RESULTS: The most commonly used instruments are the Diabetes Basic Knowledge Test (DBKT) and Diabetes Self-Report Test (DSRT). Several replication studies using the DBKT and DSRT did not consistently report reliability and validity measures. Five additional investigator-developed tools also lack strong validity and reliability measures. CONCLUSIONS: The findings suggest the need for continued development and psychometric testing of instruments to measure nurses' knowledge about diabetes.

Where's the evidence? An innovative approach to teaching staff about evidence-based practice.

Preparing nurses to incorporate research and evidence-based findings into nursing practice is important to meet the needs of patients and their families in today's healthcare arena. This article highlights the use of a mock trial as an innovative approach to educating staff nurses on evidence-based practice and identifies future implications for educating staff nurses on incorporating evidence into nursing practice.