Incidence and Predictors of Nonventilator Hospital-Acquired Pneumonia in a Community Hospital.

BACKGROUND: Nonventilator hospital-acquired pneumonia (NV-HAP) is a common hospital-acquired condition that is amenable to basic nursing care interventions. PURPOSE: The purpose of this study was to determine the incidence of NV-HAP in a California community hospital and to identify the patient and nursing care factors including missed nursing care associated with its development. METHODS: A retrospective study identified possible NV-HAP cases with ICD-10 (International Classification of Diseases, Tenth Revision) codes and then validated cases using Centers for Disease Control and Prevention confirmatory criteria. RESULTS: The incidence of NV-HAP in our hospital was 0.64 cases per 1000 patient-days. Patient factors most strongly associated with NV-HAP were age (each year of increased age was associated with a 4% increased likelihood of developing NV-HAP) (OR = 1.04-1.07) and the presence of underlying disease, which reduced odds of developing NV-HAP by 36% (OR = 0.36; 95% CI, 0.12-0.98). Head-of-bed elevation reduced by 26% the odds of developing NV-HAP (OR = 0.26; 95% CI, 0.07-0.08). CONCLUSIONS: NV-HAP can be predicted and potentially prevented. Paradoxically, the presence of underlying disease was not positively associated with the development of NV-HAP in this study.

Impact of a pharmacist-directed pain management service on inpatient opioid use, pain control, and patient safety.

PURPOSE: To evaluate the impact of a pharmacy-directed pain management service (PPMS) designed to optimize analgesic pharmacotherapy, minimize adverse events, and improve patients' experience of pain management. METHODS: A retrospective analysis was conducted to evaluate the PPMS consisting of 3 dedicated pain management clinical pharmacists who perform both consult-based and stewardship functions. Multiple measures of opioid use and associated patient satisfaction outcomes during 3-year periods before and after implementation of the PPMS were compared. RESULTS: Significant decreases in use of institutionally defined high-risk opioid medications (e.g., parenteral hydromorphone, fentanyl, transdermal fentanyl patches), a decrease in total institutional opioid use, increased coanalgesic and adjunctive medication use, and a decrease in rapid response team (RRT) and code blue events associated with opioid-induced oversedation were seen after service implementation. Despite decreased opioid use, available patient satisfaction data suggested ongoing improvement in associated Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey domains. CONCLUSION: Our data highlights the impact of a pharmacy directed pain management service on institutional opioid use with available data suggesting improved patient satisfaction scores and indirect cost savings. Despite decreased opioid use, available patient satisfaction data suggested ongoing improvement in associated HCAHPS survey pain management domains.

Quantifying Missed Nursing Care Using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey.

OBJECTIVE: The aim of this article is to describe the use of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data to measure missed nursing care and construct a missed nursing care metric. BACKGROUND: Missed nursing care varies widely within and between US hospitals. Missed nursing care can be measured utilizing the HCAHPS data. METHODS: This cross-sectional study used HCAHPS data to measure missed care. RESULTS: This analysis includes HCAHPS data from 1125 acute care patients discharged between January 2014 and December 2014. A missed care index was computed by dividing the total number of missed care occurrences as reported by the patient into the total number of survey responses that did not indicate missed care. The computed missed care index for the organization was 0.6 with individual unit indices ranging from 0.2 to 1.4. CONCLUSIONS: Our methods utilize existing data to quantify missed nursing care. Based on the assessment, nursing leaders can develop interventions to decrease the incidence of missed care. Further data should be gathered to validate the incidence of missed care from HCAHPS reports.

Missed Nursing Care and Unit-Level Nurse Workload in the Acute and Post-Acute Settings.

This study replicates previous research on the nature and causes of missed nursing care and adds an explanatory variable: unit-level nurse workload (patient turnover percentage). The study was conducted in California, which legally mandates nurse staffing ratios. Findings demonstrated no significant relationship between patient turnover and missed nursing care.

New approach to assessment of medication safety in a community hospital.

Use of medications for hospitalized patients is nearly universal, and medication-related injuries are common. Accurate assessment of harm is foundational to development of effective hospital medication safety plans. Using methods nearly identical to those in large national studies, the author examined incidence and typology of medication-related injury. This practice innovation provided a community hospital with its first systematic assessment of medication-related injury. The information gained provided a clearer picture of injury and promoted collaboration.