The CLABSI Playbook: Design and Implementation of a Multipronged Approach to Decrease CLABSIs.

ABSTRACT: Central line-associated blood stream infections (CLABSIs) are a quality marker for the critical care environment. They have become an area of particular interest because they cost the healthcare system close to a billion dollars per year and have a significant impact on patient safety. Through a preliminary analysis of our system's CLABSI rates, we found significantly higher rates than the national average, prompting further investigation. We decreased our CLABSI rate by over 40% from 2021 (1.6 per 1,000 line days) to the fourth quarter of 2022 (0.91) and kept the rate below or around the national rate (0.86) for the last three quarters of 2022. Through looking at current outcome data, identifying key stakeholders, developing dedicated committees, conducting root cause analyses, monitoring progress, adjusting procedures, scaling to the system, and continuously monitoring and reporting results, we have shown the efficacy of this kind of quality improvement structure and strive to reduce our hospital system's impact on avoidable healthcare-associated patient harm.

Efficacy of the Crisis Risk Triage Scale in Inpatient Units Within the United States.

ABSTRACT: Patient violence toward others, including doctors and nurses, is a serious concern worldwide. A wealth of literature supports the assertion that violent behavior can be prevented with proper screening and management policies. This project aimed to evaluate the Crisis Triage Rating Scale (CTRS) within a 12-hospital integrated healthcare delivery system located in the southeastern United States. An initial sample of 112,708 unique patient visits between January 2019 and December 2020 was included in this retrospective review of electronic health records. We found that the CTRS harm triage question and risk levels were significant predictors of harm to others. Consistent with previous literature, positive predictive values ranged between 0.025 and 0.070 and negative predictive values ranged between 0.991 and 0.995. Our results support the assertion that clinicians should make balanced judgments about using a positive risk score to allocate safety measures. Variations in practice were evident across our healthcare systems. Improving appropriate assessment procedures may improve the diagnostic tools and risk stratification. When documented correctly, the CTRS performed as expected in an environment where harm to others occurred infrequently.

Women RISE: Empowering Women to Manage Chronic Pain and Informing Provider Opioid Prescribing Practices.

BACKGROUND: The Women RISE program, educating women and health care providers along with technology support, may reduce opioid use. LOCAL PROBLEM: Opioid use presented health concerns for women in Virginia's Central Shenandoah Valley. METHODS: We evaluated the impact of Women RISE on self-management of chronic pain and opioid use, provider prescribing practices, and opioid reduction within our community. INTERVENTIONS: We implemented the Chronic Pain Self-Management Program (CPSMP), educated women and providers, and streamlined access to the Prescription Management Program. Opioid best practice alerts informed providers about their prescribing practices. RESULTS: The CPSMP was beneficial in improving women's coping skills, knowledge about opioid use, and overall quality of life. Opioid prescriptions were reduced 34%. We also reduced unneeded opioid analgesics within our community. CONCLUSIONS: Women were better able to manage chronic pain and stressors impacting opioid misuse. Opioid prescribing practices improved, limiting opioid availability in our community.

A Randomized Trial Comparing Outcomes of 3 Types of Peripheral Intravenous Catheters.

BACKGROUND: There was an increase in peripheral intravenous catheter (PIVC) complications and adverse patient events after product conversion during the merger between a rural hospital and a larger hospital system. A review of the existing literature identified a gap in evidence evaluating 2 closed PIVC systems compared with an open PIVC system. PURPOSE: The purpose of the current project was to ascertain whether open or closed PIVCs are best for patients, staff, and the health care system in terms of 3 main criteria: quality, safety, and cost. METHODS: A prospective, 2-site randomized controlled trial was used to compare outcomes. RESULTS: There were no differences in the complication rates between catheter types. There was a statistically significant increase in blood leakage and a decrease in clinician satisfaction with the open-system catheter. CONCLUSIONS: Our project supports current clinical recommendation that a closed PIVC system, regardless of type, is not only safer and cost-effective but also preferred by patients and clinicians.

Care delivery models: Challenge to change.

AIM: The purpose of this project was to evaluate a partnership model of care delivery on nurse and patient satisfaction and clinical outcomes. BACKGROUND: Care delivery models result in practical staff assignment decisions based on perceived fairness. The division of labour lies in social interaction of participants. Research notes that partnership team models require effective communication skills and delegation abilities to sustain. METHOD: This project used multiple methods in two study sites. A convenience sample was used to assess measures. Institutional Review Board approval obtained. RESULTS: Nurse satisfaction statistically increased in one setting and statistically decreased in the other setting. One statistically significant difference in a clinical outcome was noted. Patient satisfaction, nurse turnover and vacancy rates failed to reveal anything of statistical significance. Observed operational care components improved in both settings. CONCLUSIONS: Care delivery models are determined by a variety of factors of resource availability, unit culture, and quality and patient safety priorities. Identification of preferential structural approaches to guide nursing workflow is needed. IMPLICATIONS FOR NURSING MANAGEMENT: Innovative models of care delivery must be predicated on new role skills of delegation and negotiation for nurses, purposeful oversight and mentoring for sustainable success. Staffing can influence the integrity of care delivery models.