Intravascular therapy process improvement in a multihospital system: don't get stuck with substandard care.

Using the process of FOCUS PDSA (a quality improvement format), two clinical nurse specialists reviewed the delivery of intravenous care at a multihospital (4-hospital) system. The clinical nurse specialists formed a multi-facility nursing team to lead the assessment, develop a plan, implement changes, and evaluate the process. This process reflects the use of clinical nurse specialists as experts in using research-based data, national recommendations, and benchmark data to ultimately improve practice and reduce risks and overall costs. This process allows the clinical nurse specialist to be viewed as an innovator, a project manager, and a program developer in a major system. The clinical nurse specialists were selected to lead this process improvement based on their knowledge and competencies in the specific area of intravenous therapy.

An overview of diarrhea in the patient receiving enteral nutrition.

Many healthcare providers associate enteral tube feedings with diarrhea. Research suggests an incidence of diarrhea in patients receiving enteral tube feedings of 2% to 63%. This wide variation in incidence is due, in part, to the lack of a universal definition of diarrhea and other suspected factors that influence stool output such as malabsorption, infection, bacterial contamination of the feeding, medical diagnosis of the patient, medication therapy, or formula-related causes. An understanding of digestion, the role of fiber and fat in the diet, and the control for other influences will aid nurses in identifying interventions that promote a normal stool consistency in patients receiving enteral tube feedings. The need for further research regarding the causes and management of diarrhea is also supported.