Use of PDSA Cycles to Increase Aspiration Risk and Swallow Screening Documentation in the Hospitalized General Medical Patient Care Population.

BACKGROUND: Aspiration, while hospitalized, can lead to increases in length of stay and health care costs. Nurses must identify patients at risk of aspiration early to initiate appropriate precautions. LOCAL PROBLEM: An increase in-hospital patient aspirations at a Midwestern hospital prompted a review of events, which identified opportunities to improve identification of patients' risk factors and completion of the bedside swallow screening. METHODS: Interventions were identified via a causal factor tree analysis and an impact-effort grid then deployed using the Plan-Do-Study-Act (PDSA) methodology. INTERVENTIONS: Interventions deployed included game based-learning, a unit-based champion, and the use of visual cues to identify patients at risk for aspiration. RESULTS: After 3 PDSA cycles, documentation of patients' aspiration risk factors on admission increased by 40%, with a 51.3% increase in bedside swallow screening results. CONCLUSION: Iterative PDSA cycles successfully tested staff engagement strategies to improve aspiration risk and swallow screening documentation compliance.

Nursing strategies to reduce length of stay for persons undergoing total knee replacement: integrative review of key variables.

Decreasing the length of stay for persons undergoing total knee replacement surgery can improve patient and organizational outcomes while reducing health care costs. This integrative review examined selected nurse-driven variables that assist the interdisciplinary team to reduce length of stay. Findings suggest that a targeted clinical pathway including comprehensive preoperative patient education, physical therapy on the day of surgery, multimodal pain control, and proactive discharge planning may provide the best practice with this patient population.

Enhancing Sepsis Outcomes: A 7-Year Multidisciplinary Endeavor.

Regulatory bodies in the United States have implemented quality metrics aimed at improving outcomes for patients with severe sepsis and septic shock. The current study was a quality improvement (QI) project in a community-based academic center aimed at improving adherence to sepsis quality metrics, time to antibiotic administration, and patient outcomes. Electronic health record systems were utilized to capture sepsis-related data. Regular audits and feedback sessions were conducted to identify areas for improvement, with a focus on the timely administration of antibiotics. Interventions included improving access to antibiotics, transitioning from intravenous piggyback to intravenous push formulations, and providing continuous staff education and training. This multidisciplinary QI initiative led to significant improvements in the mortality index, length of stay index, and direct cost index for patients with sepsis. Targeted multidisciplinary QI interventions resulted in improved quality metrics and patient outcomes.

Measurement of Ejection Fraction by Cardiac Magnetic Resonance Imaging and Echocardiography to Monitor Doxorubicin-Induced Cardiotoxicity.

Doxorubicin is a standard treatment option for breast cancer, lymphoma, and leukemia, but its benefits are limited by its potential for cardiotoxicity. The primary objective of this study was to compare cardiac magnetic resonance imaging (CMRI) versus echocardiography (ECHO) to detect a reduction in left ventricular ejection function, suggestive of doxorubicin cardiotoxicity. We studied eligible patients who were 18 years or older, who had breast cancer or lymphoma, and who were offered treatment with doxorubicin with curative intent dosing of 240 to 300 mg/m 2 body surface area between March 1, 2009 and October 31, 2013. Patients underwent baseline CMRI and ECHO. Both imaging studies were repeated after four cycles of treatment. Ejection fraction (EF) calculated by both methods was compared and analyzed with the inferential statistical Student's t test. Twenty-eight eligible patients were enrolled. Two patients stopped participating in the study before undergoing baseline CMRI; 26 patients underwent baseline ECHO and CMRI. Eight of those 26 patients declined posttreatment studies, so the final study population was 18 patients. There was a significant difference in EF pre- and posttreatment in the CMRI group ( p = 0.009) versus the ECHO group that showed no significant differences in EF ( p = NS). It appears that CMRI is superior to ECHO for detecting doxorubicin-induced reductions in cardiac systolic function. However, ECHO is less expensive and more convenient for patients because of its noninvasive character and bedside practicality. A larger study is needed to confirm these findings.

Care of the trauma patient beyond the emergency department: a patient care standard to guide bedside nurses.

Injuries sustained from illicit drug use or alcohol intoxication are common in emergency departments. Ongoing assessments of psychosocial issues in trauma patients are imperative, even after the patient leaves the specialized area of the emergency department. Oftentimes, bedside nurses are ill prepared to identify the subtle clues of deeper psychosocial issues in complex patients such as trauma patients. This article focuses on the rationale for the development of a patient care standard to guide the bedside staff nurse in the care of the trauma patient. An example of a multiple trauma diagnosis-related patient care standard is presented.