Implementation of a Vital Sign Alert System to Improve Outcomes.

BACKGROUND: Patients at risk for clinical deterioration often show changes in vital signs up to 24 hours before a critical event. Use of modified early warning scores has demonstrated effectiveness in identifying patients at risk for clinical deterioration and improving outcomes. LOCAL PROBLEM: Documentation of vital signs, timely recognition of clinical deterioration, and compliance with the sepsis bundles remained a challenge. METHODS: An interprofessional team developed an electronic vital sign alert (VSA) system with a concurrent running sepsis screen, along with clinical protocols. INTERVENTIONS: Education was provided and the VSA system was implemented on 3 nursing units. RESULTS: After implementation, the number of unplanned transfers to the intensive care unit increased. Mortality rate and length of stay in the intensive care unit for patients transferred for respiratory failure and sepsis significantly decreased. There was a 21% increase in identification of sepsis. CONCLUSIONS: The VSA system was an effective tool to identify patients at risk for clinical deterioration and help to improve outcomes.

Use of Scheduled Nonopioid Analgesia to Decrease Inpatient Opioid Consumption After Scheduled Cesarean Birth.

OBJECTIVE: To compare opioid use and pain scores in women who had scheduled cesarean birth before and after implementing a scheduled nonopioid analgesia practice guideline. DESIGN: Quality improvement project with a comparison of pre-/postintervention. SETTING/LOCAL PROBLEM: A 170-bed community hospital where the administration of postcesarean pain medications was unstandardized. PARTICIPANTS: Convenience sample of 175 individuals who were scheduled for cesarean birth (106 in preintervention group and 69 in postimplementation group). INTERVENTION/MEASUREMENTS: All participants had received a dose of 150 mcg of intrathecal morphine intraoperatively. Care of participants in the postimplementation group included a new practice guideline using preoperative oral acetaminophen 1 g and postoperative intravenous ketorolac 30 mg that transitioned to ibuprofen 600 mg orally every 6 hours until discharge. Acetaminophen 1 g every 6 hours also continued until discharge. For breakthrough pain, oxycodone 5 mg to 10 mg was available. RESULTS: Results were analyzed using the chi-square and t test. There was a statistical difference in the mean milligram morphine equivalent consumed after scheduled cesarean birth (preintervention = 21.15 vs. postintervention = 3.91, p < .001). Postimplementation, 84.1% of participants did not consume any opioids beyond the intrathecal dose compared to 47.2% of participants preintervention. Mean pain scores decreased from 2.49 to 1.62 (p < .001), and there was an observed decrease of the highest reported pain score from 5.39 to 4.03 (p < .001). CONCLUSION: The results of this project support the current literature indicating that the administration of a scheduled nonopioid multimodal analgesia regimen to individuals with scheduled cesarean birth is an effective postoperative pain management strategy. This approach to managing surgical birth pain can decrease subjective reports of pain and overall opioid consumption during the hospital stay.

Nursing Care of the Patient Undergoing an Anterior Approach to Total Hip Arthroplasty.

The anterior, anterolateral, direct lateral, transtrochanteric, and posterior techniques have historically been the surgical approach to a total hip arthroplasty; however, a forthcoming technique called the direct anterior approach has been demonstrated to produce many patient and physician quality outcomes. These favorable outcomes can include shorter hospital stay, earlier mobility and functionality, decreased medical costs, and increased patient satisfaction scores. Appropriate nursing care during the preoperative, intraoperative, and postoperative phases is essential. The purpose of this article is to describe the nursing care for a patient undergoing a direct anterior approach to hip arthroplasty.

Implementing Evidence-Based Practice to Reduce Infections Following Arthroplasty.

Surgical site infections can have a devastating effect on a patient's morbidity impacting their quality of life and productivity in society. Financial burdens are placed on healthcare organizations because of surgical site infections as well. Evidence has shown that it is a worthwhile endeavor to implement a practice to screen and treat patients who are nasal carriers of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus. Implementing evidence-based practices to combat surgical site infections can help ensure quality healthcare, while producing best possible patient outcomes; however, getting evidence to the bedside can be a challenge. The Johns Hopkins nursing evidence-based practice model is designed to help nurses translate evidence into practice. This article describes the steps one community hospital took to implement an evidence-based practice using the Johns Hopkins model to decrease the likelihood of methicillin-resistant Staphylococcus aureus surgical site infections in patients undergoing total knee arthroplasty and total hip arthroplasty.

Bone up your program: certification process for the total knee replacement and total hip replacement center.

Knee and hip osteoarthritis, combined with the increased aging population, obesity, and other health-related risk factors, has led to a great need for joint replacement procedures. Joint replacement programs have been developed within hospitals to meet this demand. Joint replacement programs have been designed to provide an efficient and structured delivery of care. Facilities can demonstrate, to those seeking care, their quality programs by applying for and obtaining certification. Joint replacement certifications can guide facilities in providing a solid structure of improved care, quality, and superior outcomes. This article describes the steps that a community hospital took to attain the Blue Distinction Centers for Knee and Hip Replacement as well as The Joint Commission Disease-Specific Care Certification in Total Knee Replacement and Total Hip Replacement.