Meta-analysis of fall-risk tools in hospitalized adults.

OBJECTIVE: The aim of the study was to identify which fall-risk tool is most accurate for assessing adults in the hospital setting. BACKGROUND: Falls can have physical, emotional, social, and financial consequences. Risk assessment affords the first opportunity in prevention. METHODS: To standardize the use of a fall-risk tool across the Baylor Health Care System, nurse executives undertook a meta-analysis of published research on fall-risk assessment tools used with adult inpatients. RESULTS: Both random-effects and fixed-effects models showed that Morse Fall Scale had significantly higher sensitivity than St Thomas's Risk Assessment Tool (STRATIFY). Specificity of Morse Fall Scale was significantly lower than that of STRATIFY with the fixed-effects model, but the random-effects model showed the opposite. Morse Fall Scale had a significantly higher Youden index than STRATIFY with the fixed-effects model (P = .001), but the result from random-effects model indicated no significant difference (P = .117). The sensitivity, specificity, and Youden index fell within the 95% confidence intervals. CONCLUSIONS: Meta-analysis is a useful methodology for evaluating current evidence when variation exists in the literature.

Standardization of a surgical site precleansing technique for vascular patients.

Surgical site infection (SSI) is a serious complication that can increase hospital costs and length of stay and may be life threatening. The preoperative chlorhexidine shower is widely recommended to decrease SSI risk, although standardized guidelines for this practice and supporting clinical evidence are lacking. Because vascular patients often have comorbidities that hinder preoperative showering, OR nurses at a specialty hospital in Dallas, Texas, developed and implemented an intraoperative surgical site precleansing technique as standard practice for patients undergoing procedures involving the axilla or groin.

Lessons learned from study of depression in cardiovascular patients in an acute-care heart and vascular hospital.

Depression is highly prevalent in patients with cardiovascular disease, but questions about the effectiveness of screening and intervention remain unanswered. To evaluate the effects of proactive intervention at an acute-care heart and vascular hospital, patients who reported depressive symptoms on admission were randomized to an active, counseling-based depression intervention plus standard care (referral to a primary or psychiatric care physician) or to standard care alone. Despite early termination of patient enrollment because of lower-than-expected recruitment rates, the project had a positive impact. By involving and educating staff, the investigators raised awareness and improved the process of identifying and helping depressed patients. The lessons in study design and execution gained from this experience will help ensure success in future studies of this condition.

Implementation of an informational card to reduce family members' anxiety.

For surgical patients' family members, the wait during surgery can cause anxiety that can be exacerbated if staff members provide inadequate or inconsistent information about the patient's status. Educational interventions and other staff-intensive measures to help reduce family members' anxiety can be time consuming for staff members and impractical in a high-volume facility. To improve communication with patients' families, nurses at a heart and vascular hospital in Dallas, Texas, designed and distributed a card containing estimated procedure times, helpful telephone numbers, and other information. A survey of family members indicated that receiving the card reduced anxiety in a significant proportion of the respondents.

The preadmission packet: a strategy that benefits patients and nurses during the admission process.

At Baylor Jack and Jane Hamilton Heart and Vascular Hospital, we developed a preadmission packet that is given to patients before their procedure date, enabling them to complete much of their paperwork in advance. The results of our subsequent study revealed that nurses save time during the assessment interview when patients arrive at the hospital with their admission database forms completed. In a busy facility with a large number of patients admitted daily, the nursing time saved can translate into a substantial economic benefit. Even more important, however, is the benefit to patients, who feel less rushed and provide a more thorough and accurate medical history when they can fill out the admission database form at home.

Glucose control and opportunities for health care improvement in a hospital setting.

We initiated a study at Baylor Jack and Jane Hamilton Heart and Vascular Hospital to compare the sliding scale insulin (SSI) protocol used in 2006 with the SSI protocol currently used to treat diabetic patients admitted for procedures or surgery. An audit of patients' records revealed greater variation in staff compliance with the current protocol than with the previous one. In addition, it seemed that more patients were refusing insulin coverage under the current protocol than under the prior version. Although the study was aborted, the initial findings motivated us to identify obstacles to glucose control and to launch a health care improvement initiative to increase compliance with the SSI protocol. As a result of this process, the hospital has made several changes, including re-educating staff nurses, initiating competency checks of protocol interpretation, promoting patient education, and implementing early identification of inconsistent glucose control.

Appropriateness of sling immobilization to prevent lead displacement after pacemaker/implantable cardioverter-defibrillator implantation.

After pacemaker/implantable cardioverter-defibrillator (pacemaker/ICD) implantation, patients are often required to immobilize the affected arm with a sling to minimize the risk of lead displacement. We examined whether performing a resistive range-of-motion exercise protocol after pacemaker/ICD surgery would result in lead displacement and, therefore, whether sling immobilization and activity restrictions are justified. Ten subjects who had undergone pacemaker/ICD surgery performed four individual resistive range-of-motion exercises (three sets of 10 repetitions for each: one warm-up set without weight and two sets with a 1- or 2-pound hand weight) with the affected arm prior to hospital discharge. For each subject, an electrophysiology nurse specialist used a noninvasive device programmer to evaluate surgical lead placement before and after the exercises. As an adjunct to the study, we queried clinicians at 48 US hospitals about sling immobilization and activity restrictions after pacemaker/ICD implantation at their institutions. No lead displacement occurred after the weightlifting exercises were performed. Based on these results in a small group of patients, it appears that requiring the use of a joint immobilization sling is overly restrictive, promotes fear, and hinders recovery. We encourage the development of consistent discharge instructions that will promote early mobility and a safe and rapid return to normal activities.