Operating Room Delays: Meaningful Use in Electronic Health Record.

Perioperative areas are the most costly to operate and account for more than 40% of expenses. The high costs prompted one organization to analyze surgical delays through a retrospective review of their new electronic health record. Electronic health records have made it easier to access and aggregate clinical data; 2123 operating room cases were analyzed. Implementing a new electronic health record system is complex; inaccurate data and poor implementation can introduce new problems. Validating the electronic health record development processes determines the ease of use and the user interface, specifically related to user compliance with the intent of the electronic health record development. The revalidation process after implementation determines if the intent of the design was fulfilled and data can be meaningfully used. In this organization, the data fields completed through automation provided quantifiable, meaningful data. However, data fields completed by staff that required subjective decision making resulted in incomplete data nearly 24% of the time. The ease of use was further complicated by 490 permutations (combinations of delay types and reasons) that were built into the electronic health record. Operating room delay themes emerged notwithstanding the significant complexity of the electronic health record build; however, improved accuracy could improve meaningful data collection and a more accurate root cause analysis of operating room delays. Accurate and meaningful use of data affords a more reliable approach in quality, safety, and cost-effective initiatives.

Does perioperative documentation transfer reliably?

In the complex and multiphasic perioperative process, there are many opportunities to transfer information between providers and settings. Previous studies have shown that information transfer and communication are vital to minimize risks in the perioperative setting. The aim of this study was to explore the incidence of failure to communicate vital information as the patient progressed through the six phases of the perioperative process. The systematic sample included ambulatory surgery patient records from one quarter. A failure to communicate rate was calculated as 10.2% for the 5586 entries. In the absence of a comprehensive electronic health record, a consistent method for information transfer must be used to minimize risks.

Building a Transition Program for Senior Nurse Leaders.

Professional development educators undertake a primary role in building organizational transition programs for nurses. Transitions of senior nurse leaders are complex and poorly understood. A Hermeneutic phenomenological study was conducted to investigate the lived experiences of nine novice senior nurse leaders. Four principle themes and five subthemes are identified so that professional development educators may customize situation-specific learning for senior nurse leader onboarding.

Relationship between in-hospital angiotensin converting enzyme inhibitors and Angiotensin receptor blockers administration and delirium in the cardiac ICU.

OBJECTIVES: Delirium may be associated with neuroinflammation and reduced blood-brain barrier (BBB) stability. ACE Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) reduce neuroinflammation and stabilize the BBB, thus slowing the progression of memory loss in patients with dementia. This study evaluated the effect of these medications on delirium prevalence. METHODS: This was a retrospective study of data from all patients admitted to a Cardiac ICU between 1 January 2020-31 December 2020. The presence of delirium was determined based on the International Classification of Diseases (ICD) 10 codes and nurse delirium screening. RESULTS: Of the 1684 unique patients, almost half developed delirium. Delirious patients who did not receive either ACEI or ARB had higher odds (odds ratio [OR] 5.88, 95% CI 3.7-9.09, P < .001) of in-hospital death and experienced significantly shorter ICU lengths of stay (LOS) (P = .01). There was no significant effect of medication exposure on the time to delirium onset. CONCLUSIONS: While ACEIs and ARBs have been shown to slow the progression of memory loss for patients with Alzheimer's disease, we did not observe a difference in time to delirium onset.

Findings From the 2021 Organizational Value of Nursing Professional Development Practice, Part 3: A Comparison of Pediatric and Adult Hospitals.

In 2021, the Association for Nursing Professional Development commissioned a national study to examine relationships between nursing professional development (NPD) staffing and organizational outcomes and to compare NPD staffing in pediatric and adult hospitals. This report compares data from children's and adult hospitals, which indicate that children's hospitals, in general, have significantly more staffing resources, including NPD practitioners. Insufficient data were obtained to examine relationships between NPD staffing in children's hospitals and organizational outcomes.

An academic-health service partnership in nursing: lessons from the field.

PURPOSE: To describe the development of an academic-health services partnership undertaken to improve use of evidence in clinical practice. APPROACH: Academic health science schools and health service settings share common elements of their missions: to educate, participate in research, and excel in healthcare delivery, but differences in the business models, incentives, and approaches to problem solving can lead to differences in priorities. Thus, academic and health service settings do not naturally align their leadership structures or work processes. We established a common commitment to accelerate the appropriate use of evidence in clinical practice and created an organizational structure to optimize opportunities for partnering that would leverage shared resources to achieve our goal. FINDINGS: A jointly governed and funded institute integrated existing activities from the academic and service sectors. Additional resources included clinical staff and student training and mentoring, a pilot research grant-funding program, and support to access existing data. Emergent developments include an appreciation for a wider range of investigative methodologies and cross-disciplinary teams with skills to integrate research in daily practice and improve patient outcomes. CONCLUSIONS: By developing an integrated leadership structure and commitment to shared goals, we developed a framework for integrating academic and health service resources, leveraging additional resources, and forming a mutually beneficial partnership to improve clinical outcomes for patients. CLINICAL RELEVANCE: Structurally integrated academic-health service partnerships result in improved evidence-based patient care delivery and in a stronger foundation for generating new clinical knowledge, thus improving patient outcomes.

Findings From the 2021 Organizational Value of Nursing Professional Development Practice Study, Part 1: Overview and Descriptive Data.

A 2015 study exploring the correlations between nursing professional development (NPD) staffing and organizational outcomes was replicated in 2021. Part 1 of this two-part report provides background information and descriptive data, including organizational characteristics, NPD department structures, and NPD practitioner ratios per employee, per RN, and per hospital bed. Findings reflect the proliferation of hospital systems, expansion of NPD practice to include other professions and all employees, and little change in NPD certification.

Findings From the 2021 Organizational Value of Nursing Professional Development Practice Study, Part 2: Relationships Between Nursing Professional Development Staffing and Organizational Outcomes.

A 2015 study exploring the relationship between nursing professional development (NPD) staffing and organizational outcomes was replicated in 2021. The background, including literature review, methods, and descriptive statistics, were presented in Part 1 of this report. Part 2 explores the relationships between NPD staffing and organizational outcomes. Evidence suggests that higher levels of NPD staffing are associated with many positive nursing and patient outcomes and provide financial benefit to the organization.

The prevalence of nurse burnout and its association with telomere length pre and during the COVID-19 pandemic.

BACKGROUND: Burnout is a work-related stress syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. Nurse burnout is related to nurses' deteriorating mental health and poorer patient care quality and thus, is a significant concern in healthcare. The Coronavirus Disease 2019 (COVID-19) pandemic has swept the world and distressed the healthcare systems. Because of the body's stress mechanism, it is vital to examine the current prevalence of nurse burnout and understand it at a biological level, using an epigenetic biomarker, telomere length. PURPOSE: To determine the prevalence of burnout among nurses in the Peri-Operative and Labor & Delivery settings pre and during the COVID-19 pandemic and to examine the effects of burnout on absolute telomere length. METHODS: This is a cross-sectional study assessing the prevalence of nurses' burnout and the relationships between nurses' burnout and telomere length. Due to the COVID-19 pandemic, we had to stop the study during the mid of data collection. Even though the study was not designed to capture changes before and during the pandemic, we analyzed two groups' data before and during the pandemic. The study took place in a US hospital. Nurses in the hospital's Operating Room, Post-Anesthesia Care Unit, and Labor & Delivery Unit participated in the study. Maslach Burnout Inventory survey and nurses' demographics were administered online. Telomere length was measured via finger-prick blood. RESULTS: 146 nurses participated in the study, with 120 participants' blood samples collected. The high-level burnout rate was 70.5%. Correlation analysis did not reveal a direct correlation between nurse burnout and telomere length. However, in a multiple regression analysis, the final model contained the burnout subscale of emotional exhaustion, years as an RN, and work unit's nursing care quality. There was a low degree of departure from normality of the mean absolute telomere length in the pre-pandemic group and a substantial degree of departure in the during-pandemic group. CONCLUSIONS: Nurse burnout is a prevalent phenomenon in healthcare, and this study indicates that nurses currently experience high levels of burnout. Nurses' cellular biomarker, telomere length, is shorter in the group of nurses during the COVID-19 pandemic than before. Appropriate measures should be implemented to decrease nurses' burnout symptoms and improve nurses' psychological and physical health. Nurses, especially those younger than 60, report higher burnout symptoms, particularly emotional exhaustion. This study indicates the need for intervention to promote nurses' health during the pandemic and beyond. If not appropriately managed, nurse burnout may continue to be a significant issue facing the healthcare system.

Hospital value-based purchasing: How acute care advanced practice nurses demonstrate value.

ABSTRACT: Hospital value-based purchasing (HVBP) is a budget neutral initiative from the Centers for Medicare & Medicaid Services designed to adjust the hospital payment system based on health care quality data. Hospital value-based purchasing is designed to promote improved clinical outcomes and better patient experience in the acute care setting. Advanced practice registered nurses (APRNs) in the acute care setting are instrumental to the success of health care institutions under the current payer model in the United States health care system. When APRNs use their advanced knowledge and leadership skills to champion quality improvement and patient experience projects, they may increase financial reimbursement within the HVBP system, thus demonstrating value to the health care institution. Four basic steps could help APRNs demonstrate value to the organization, understand the standard, evaluate your performance compared with the standard, identify opportunities, and implement projects or participate in projects. This article provides a broad overview of the HVBP structure and describes how APRNs can positively influence performance measures, thereby potentially increasing hospital reimbursement.

SARS-CoV-2 Seroprevalence among a Southern U.S. Population Indicates Limited Asymptomatic Spread under Physical Distancing Measures.

Characterizing the asymptomatic spread of SARS-CoV-2 is important for understanding the COVID-19 pandemic. This study was aimed at determining asymptomatic spread of SARS-CoV-2 in a suburban, Southern U.S. population during a period of state restrictions and physical distancing mandates. This is one of the first published seroprevalence studies from North Carolina and included multicenter, primary care, and emergency care facilities serving a low-density, suburban and rural population since description of the North Carolina state index case introducing the SARS-CoV-2 respiratory pathogen to this population. To estimate point seroprevalence of SARS-CoV-2 among asymptomatic individuals over time, two cohort studies were examined. The first cohort study, named ScreenNC, was comprised of outpatient clinics, and the second cohort study, named ScreenNC2, was comprised of inpatients unrelated to COVID-19. Asymptomatic infection by SARS-CoV-2 (with no clinical symptoms) was examined using an Emergency Use Authorization (EUA)-approved antibody test (Abbott) for the presence of SARS-CoV-2 IgG. This assay as performed under CLIA had a reported specificity/sensitivity of 100%/99.6%. ScreenNC identified 24 out of 2,973 (0.8%) positive individuals among asymptomatic participants accessing health care during 28 April to 19 June 2020, which was increasing over time. A separate cohort, ScreenNC2, sampled from 3 March to 4 June 2020, identified 10 out of 1,449 (0.7%) positive participants.IMPORTANCE This study suggests limited but accelerating asymptomatic spread of SARS-CoV-2. Asymptomatic infections, like symptomatic infections, disproportionately affected vulnerable communities in this population, and seroprevalence was higher in African American participants than in White participants. The low, overall prevalence may reflect the success of shelter-in-place mandates at the time this study was performed and of maintaining effective physical distancing practices among suburban populations. Under these public health measures and aggressive case finding, outbreak clusters did not spread into the general population.

What's in a Name? Role Clarity Goes Well Beyond a Simple Title.

BACKGROUND: Role clarity is important for patient care but challenging in graduate medical education (GME). METHODS: Badge buddies were integrated for all GME trainees at a single institution, and surveys were conducted prior to and 5 months following implementation. RESULTS: There were 932 pre- and 498 postimplementation respondents. Following implementation, both trainees and nurses reported improved awareness of GME training level, but there were no changes in patient/family perceptions. CONCLUSIONS: Badge buddies improved caregiver awareness of GME training level but did not impact patient/family perception. Patients appear to be focused primarily on relationships with caregivers and communication skills rather than a provider's specific role.

Nursing Professional Development Organizational Value Demonstration Project.

A common question nursing professional development (NPD) practitioners ask is, "How many NPD practitioners should my organization have?" This study examined correlations among facility size and structure, NPD practitioner characteristics and time in service, and organizational outcomes. Organizations with a higher rate of NPD full-time equivalents per bed had higher patient satisfaction with nurses' communication and provision of discharge instruction on their HCAHPS (Hospital Consumer Assessment of Healthcare Provider and Systems) scores.

Assumptions and realities of the NCLEX-RN.

Every three years the National Council of State Boards of Nursing conducts a practice analysis to verify the activities that are tested on the licensure exam (NCLEX-RN). Faculty can benefit from information in the practice analysis to ensure that courses and experiences adequately prepare graduates for the NCLEX-RN. This summary of the practice analysis challenges common assumptions and provides recommendations for faculty.

Assigning readings: faculty perceptions and strategies.

Nursing faculty routinely assign readings to undergraduate, prelicensure students. When asked what types of readings they required, almost all said they required readings from textbooks. Most expect students to either read or skim all the assignments before class. However, experience has taught faculty that often students do not read. Strategies are provided to enhance reading experiences or provide meaningful alternatives.

Obtaining Coagulation Blood Samples From Central Venous Access Devices: A Review of the Literature.

BACKGROUND: Central venous access devices are used for chemotherapy and other medication administration, blood product administration, parenteral nutrition, and for obtaining blood samples in patients where the vasculature is difficult to access. Patients may need additional blood samples prior to invasive procedures and when clinical situations arise during cancer care. In addition, monitoring coagulability through ongoing blood testing is common in patients with cancer and requires repeated sampling to adjust anticoagulant medications. OBJECTIVES: The purpose of this review of the literature is to determine the best practices for collecting coagulation test samples from central venous access devices. METHODS: The authors conducted a systematic review of the literature. FINDINGS: The only method for obtaining reliable coagulation test results from central venous access devices is the flush then waste/discard method. This method has only been studied with peripherally inserted central catheters. Additional randomized, controlled trials with larger sample sizes are needed to determine the most appropriate method for drawing coagulation test results from central venous access devices.

Interprofessional education for personalized medicine through technology-based learning.

The delivery of personalized medicine utilizing genetic and genomic technologies is anticipated to involve many medical specialties. Interprofessional education will be key to the delivery of personalized medicine in order to reduce disjointed or uncoordinated clinical care, and optimize effective communication to promote patient understanding and engagement regarding the use of or need for these services. While several health professional organizations have endorsed and/or developed core competencies for genetics and genomics, the lack of interprofessional guidelines and training may hamper the delivery of coordinated personalized medicine. In this perspective, we consider the potential for interprofessional education and training using technology-based approaches, such as virtual simulation and gaming, compared with traditional educational approaches.

Maintaining competency for float nursing staff.

Orienting staff to multiple areas is challenging, as is maintaining multiple competencies, which might be used infrequently. Creating a strategy to regularly assess needed competencies to maintain a highly skilled pool of nurses, prepared to float to multiple areas, is critical to supporting flexible staffing. A plan for how to achieve this complex analysis is described and can be translated to other complex environments.