Challenges of Implementing the Choosing Wisely Guideline to Promote Sleep and Rest at Night for Hospitalized Patients.

BACKGROUND: Evidence suggests that a lack of sleep among patients during hospitalization can impact their health and well-being. LOCAL PROBLEM: On inpatient units, patients experience lack of sleep due to noise and multiple interruptions at night. METHODS: A pilot intervention to support the initiative, "Don't wake the patient for routine care unless the patient's condition or care specifically requires it," was implemented on 3 units in 3 hospitals. All the 3 units had experienced patient concerns about lack of sleep at night. INTERVENTIONS: Nurses implemented the project using a purposeful strategy of sleep masks, earplugs, noise detectors, and bundling care. RESULTS: Positive experiences of those patients who participated in the sleep intervention. CONCLUSIONS: There was multidisciplinary support to promote a better patient experience of nighttime sleep. The experiences across the 3 hospital units were positive for providers, patients, and patients' families.

Using Evidence to Create a Toolkit to Enable Sleep Among Hospitalized Patients.

Studies show sleep deprivation impacts patients' ability to perform physical activities and can lead to delirium, depression, and other psychiatric impairments. One of the Choosing Wisely® recommendations is "Do not wake the patient for routine care unless the patient's condition requires it." The authors discuss the development of an evidence-based toolkit to facilitate opportunities for patients to sleep during hospitalization, exemplifying the translation of a Choosing Wisely recommendation into clinical practice.

Practical Application of High-Reliability Principles in Healthcare to Optimize Quality and Safety Outcomes.

Application of high-reliability (HR) principles into daily healthcare processes can drive culture change, safety, and quality outcomes. Understanding foundational practices to full HR principle integration in an organization's quality and safety programs strengthens evidence-based practices, reduces clinical variation, and improves nurse-sensitive patient outcomes. Quantifying the cost impact of reduction in preventable harm and improved nurse-sensitive patient outcomes is an initial attempt to formulate an empiric measure of nursing value.

Description of Nurse Scientists in a Large Health Care System.

Replicating a research study that described the work of nurse scientists in children's hospitals, the purpose of the study was to describe the role, activities, and outcomes of nurse scientists employed in a national health care organization. The characteristics of nurses filling the nurse scientist role in clinical settings and outcomes associated with the role have not been extensively described. The setting of this study is ideal since the organization includes facilities of various sizes located in rural, urban, and suburban areas in 18 states. Names and contact information of nurse scientists were obtained from nurse executives at each of the 110 affiliated organizations. Nurse scientists completed an anonymous survey. The primary role of the nurse scientists is to facilitate the work of others. Recommendations to strengthen the research infrastructure are provided.

Developing, Implementing, Evaluating Electronic Apparent Cause Analysis Across a Health Care System.

An interdisciplinary team developed, implemented, and evaluated a standardized structure and process for an electronic apparent cause analysis (eACA) tool that includes principles of high reliability, human factors engineering, and Just Culture. Steps include assembling a team, describing what happened, determining why the event happened, determining how defects might be fixed, and deciding which defects will be fixed. The eACA is an intuitive tool for identifying defects, apparent causes of those defects, and the strongest corrective actions. Moreover, the eACA facilitates system learning by aggregating apparent causes and corrective action trends to prioritize and implement system change(s).

Research Outcomes of Implementing CEASE: An Innovative, Nurse-Driven, Evidence-Based, Patient-Customized Monitoring Bundle to Decrease Alarm Fatigue in the Intensive Care Unit/Step-down Unit.

INTRODUCTION: The research literature is replete with evidence that alarm fatigue is a real phenomenon in the clinical practice environment and can lead to desensitization of the need to respond among nursing staff. A few studies attest to the effectiveness of incorporating parts of the American Association of Critical-Care Nurses recommended nursing practices for alarm management. No studies could be found measuring the effectiveness of the American Association of Critical-Care Nurses recommendations in their entirety or the effectiveness of a nursing-driven, evidence-based, patient-customized monitoring bundle. PURPOSE/RESEARCH QUESTION: The purpose of this study was to describe the effect of implementing CEASE, a nurse-driven, evidence-based, patient-customized monitoring bundle on alarm fatigue. CEASE is an acronym for Communication, Electrodes (daily changes), Appropriateness (evaluation), Setup alarm parameters (patient customization), and Education (ongoing). RESEARCH QUESTIONS: (1) In a 36-bed intensive care unit/step-down unit (ICU/SDU) with continuous hemodynamic and respiratory monitoring, does application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by the number of hemodynamic and respiratory monitoring alarms? (2) In a 36-bed ICU/SDU with continuous hemodynamic and respiratory monitoring, does application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by duration of alarms? and (3) In a 36-bed ICU/SDU with continuous hemodynamic and respiratory monitoring, does application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by nurse perception? METHODS: This was an institutional review board approved exploratory, nonrandomized, pretest and posttest, 1-group, quasi-experimental study, without-comparators design describing difference in pretest and posttest measures following CEASE Bundle implementation. The study was conducted over a 6-month period. Convenience sample of 74 registered nurses staffing a 36-bed ICU/SDU using the CEASE Bundle participated. Preimplementation/postimplementation number of alarms and alarm duration time for a 30-day period were downloaded from the monitoring system and compared. Nurses completed an electronic 36-item Clinical Alarms Survey provided by the Healthcare Technology Foundation: 35 before implementation and 18 after implementation. Researchers measured CEASE alarm bundle adherence. χ and t-tests determined statistical significance. RESULTS: Total number of monitoring alarms decreased 31% from 52 880 to 36 780 after CEASE Bundle implementation. Low-priority Level 1 alarms duration time significantly decreased 23 seconds (t = 1.994, P = .045). Level 2 duration time did not change. High-priority Level 3 alarms duration time significantly increased to 246 seconds (t = 4.432, P < .0001). CEASE alarm bundle adherence significantly improved to 22.4% (χ = 5.068, P = .0244). Nurses perceived a significant decrease in nuisance alarm occurrence (68% to 44%) postimplementation (χ = 3.243, P = .0417). No adverse patient events occurred. CONCLUSIONS: Decreased total number of monitoring alarms improved nurse perception of alarm fatigue. Continued monitoring of CEASE Bundle adherence by nursing staff is required. Longer high-priority Level 3 alarms duration suggests need for further research.

Special needs population: Care of the geriatric patient population in the perioperative setting.

The geriatric population, defined as people 65 years of age and older, undergoing surgical procedures is a vulnerable population. Age, once considered a contraindication for a surgical procedure, is no longer a constraint for individuals requiring surgical intervention. However, older adult patients are at increased risk for developing a variety of complications. This article reviews age-related physiological changes and discusses the special needs of the geriatric population across the perioperative continuum of care.