Noise Reduction in Progressive Care Units.

Uncontrolled noise in the hospital setting can have a negative physiological and psychological impact on patients and nurses. To reduce unit noise levels and create a quiet patient and nurse experience, an evidence-based practice project was conducted in 4 progressive care units in a community hospital. The Quiet Time Bundle implementation improved patient satisfaction and patient and nurse perceptions of noise even though the decrease in noise levels may not be discernible.

Implementation of Interdisciplinary Rapid Rounds in Observation Units.

Lack of collaboration and communication can lead to medical errors, increased length of stay, and diminished patient satisfaction. The purpose of this project was to improve nurse efficiency, interdisciplinary communication and collaboration, and patient satisfaction with the discharge process through Rapid Rounds. The results demonstrated that interdisciplinary communication and collaboration improved coordination of care, as evidenced by improved Press Ganey percentile rankings for readiness for discharge and speed of the discharge process, increased pharmaceutical interventions, and fewer phone calls to physicians.

Creating a Standardized Process to Meet Core Measure Compliance.

A standardized process to improve compliance with venous thromboembolism prophylaxis and hospital-based inpatient psychiatric services Core Measures was developed, implemented, and evaluated by a clinical nurse specialist team. The use of a 1-page tool with the requirements and supporting evidence, combined with concurrent data and feedback, ensured success of improving compliance. The initial robust process of education and concurrent and retrospective review follow-up allowed for this process to be successful.

Nurses' knowledge and comfort levels using the Physician Orders for Life-sustaining Treatment (POLST) form in the progressive care unit.

Many patients are admitted to the hospital with an active Physician Orders for Life-sustaining Treatment (POLST) Form; however, not all registered nurses (RNs) are familiar with the form or comfortable with initiating a discussion about end-of-life care. Evidence indicates that an education program increases RNs' knowledge and utilization of the POLST form. The purpose of this evidence-based practice project was to answer the question: among the RNs in a progressive care unit (PCU), does implementing a formal evidence-based practice POLST program compared to current practice increase RNs' knowledge and comfort level using the POLST form? A pre-post education survey was used. Results indicated a POLST education program increased PCU RNs' knowledge and comfort level in using the POLST form. It is recommended to include POLST form education for PCU RNs in workplace education programs.

An Educational Intervention to Increase Nurse Adherence in Eliciting Patient Daily Goals.

BACKGROUND: The literature suggests that nurse and patient collaborative goal setting demonstrates better patient outcomes. The SMART goal evaluation method (Specific, Measureable, Attainable, Relevant, and Timely) is a strategy to develop effective and measureable goals. PURPOSE: The purpose of this educational project was to improve nurse collaborative goal-setting skills. METHODS: A pre- and postevaluation of an educational intervention was accomplished by patient interviews and observation for adherence to obtaining patient daily goals. RESULTS: Results of nurse adherence in writing SMART collaborative goal setting increased from 11% preeducation to 63% posteducation. Patients' perceptions of feeling well informed by their nurses and physicians increased from 57% preeducation to 91% posteducation. CONCLUSION: Nurses continued to need reminding to collaborate with their patients, but their goal writing skills greatly improved. CLINICAL RELEVANCE: The results of this educational project demonstrated nurses' improved ability to cowrite collaborative patient goals which resulted in better informed patients.

Evaluation of an inpatient heart failure screening tool.

Heart failure is increasing in incidence, prevalence, and mortality. The purpose of this study was to test the predictive accuracy of a screening tool to identify inpatients with heart failure. The tool demonstrated statistical significance for predictability, with 68.3% sensitivity, 86% specificity, and overall accuracy of 77.5%. The tool facilitated heart failure screening and subsequent implementation of evidence-based therapies.

The Impact of prehospital 12-lead electrocardiograms on door-to-balloon time in patients with ST-elevation myocardial infarction.

INTRODUCTION: Multiple strategies have been implemented to reduce door-to-balloon times. The purpose of this study was to compare door-to-balloon times between ST-elevation myocardial infarction (STEMI) patients who arrived at the emergency department by ambulance with a pre-hospital electrocardiogram (ECG), to those who self-transported and had an ECG on ED arrival. METHODS: This retrospective, comparative study evaluated differences in door-to-balloon times from October 2006 to December 2009 between STEMI patients that had a 12-lead ECG done in the ambulance prior to ED arrival and patients who self-transported and had an ECG on ED arrival. RESULTS: Of the 367 patients, 62% (n = 228) arrived by ambulance and 38% (n = 139) self-transported to the emergency department. Door-to-balloon times were 30 minutes less (P < .001) than patients who were self-transported. DISCUSSION: Door-to-balloon times can be reduced when chest pain patients are transported to the emergency department by ambulance. The paramedics are equipped to perform an ECG, thereby making a preliminary diagnosis of STEMI. The emergency department can them prepare for potential angioplasty or percutaneous coronary intervention. An opportunity exists for emergency nurses to educate the public about the importance of calling 911 for chest pain.

Preparing community Level II neonatal intensive care unit nurses to deliver Level IIIA care.

The purpose of this quality initiative was to increase NICU nurse competency to meet the care needs of higher acuity infants. A multifaceted educational approach with individual bedside education, a clinical practicum, inservices, and case presentations was based on results from a needs assessment, observational feedback, and chart audits. Results of this educational intervention included increased nurse competency and a change in admission criteria to care for higher acuity infants without transporting them to another hospital miles away. As the admission criteria changed, the volume of higher acuity infants increased, and the nurses were able to maintain their competency in caring for these infants.

Physical attributes of endoscopy nurses related to musculoskeletal problems.

The purpose of this research study was to determine whether specific attributes of endoscopy nurses such as age, body mass, or height contribute to neck, shoulder, or back problems. Study participants included endoscopy nurses who physically assist with endoscopic procedures (hands-on assist). Participants with preexisting neck, shoulder, or back injury prior to employment in endoscopy were excluded. Study participants completed the Standardized Nordic Questionnaire. Results suggested that age or height of less than 68 inches were not contributing factors to neck, shoulder, or back problems. Nurses with a body mass index (BMI) of 25 or more had significantly more upper back problems in the past 12 months. Nurses with BMI of 25 or more and/or those who were taller than 68 inches had a significantly higher incidence of upper and lower back problems that prevented work in the previous 12 months and occurred within the previous 7 days. Nurses with a BMI of 25 or more and/or who are 68 inches or taller should be aware of their higher risk for upper and lower back problems, and adjustments need to be made to their work practice and environment.

Evaluation of Education and Patient Screening for Delirium Among Patients With Stroke: Knowledge, Confidence, and Patient Outcomes.

BACKGROUND: Clinical staff showed a knowledge deficit with identifying and managing delirium. The effect of a validated assessment tool and delirium education on staff knowledge and confidence and patient outcomes was analyzed. METHOD: A descriptive qualitative and quantitative pre- and postintervention study analyzed the demographics of patients with stroke and clinical outcomes pre- and postimplementation of an assessment tool and delirium staff education. RESULTS: Early and frequent delirium assessments, use of an assessment tool, a delirium order set, and education for clinical staff resulted in increased knowledge and confidence with identifying and managing patients with stroke, an increase in the number of patients with stroke discharged home, and decreased incidence of hospital-acquired urinary tract infection and pneumonia. CONCLUSION: Delirium education positively impacts staff knowledge and confidence with the identification and management of delirium. Patients with an acute stroke may benefit from early and frequent delirium assessments. Staff education, structured assessment frequency with a validated assessment tool, and specific interventions affect patient outcomes, such as infection rates and discharge level of care. [J Contin Educ Nurs. 2023;54(2):61-70.].

Evaluation of emergency department evidence-based practices to prevent the incidence of ventilator-acquired pneumonia.

Pathogens in the oropharynx may be transported to the lung parenchyma during intubation and cause ventilator-acquired pneumonia. This project evaluated 3 post intubation evidence-based practices in the emergency department: oral care, head-of-bed elevation, and suctioning above the endotracheal tube balloon. Ventilator-acquired pneumonia cases decreased 83% after implementing these practices. There is no need to wait for the patient to be admitted to intensive care to begin these evidence-based practices.

Staff practice, attitudes, and knowledge/skills regarding evidence-based practice before and after an educational intervention.

BACKGROUND: Today's clinicians have different levels of knowledge and skill related to evidence-based practice, depending on their educational background, level of experience, and interest. This multidisciplinary study assessed nurses' baseline and posteducation practice, attitudes, and knowledge/skills regarding evidence-based practice. METHODS: A descriptive pre- and postsurvey design study evaluated clinical staff's practice, attitudes, and knowledge/skills regarding evidence-based practice with the Clinical Effectiveness and Evidence-Based Practice Questionnaire. RESULTS: A total of 327 participants (24%) completed the presurvey and 282 (20%) completed the postsurvey. No statistically significant changes were found in practice, attitudes, and knowledge/skills after the online education. In the multivariate analysis, online education was not a significant predictor of practice, attitudes, or knowledge/skills regarding evidence-based practice; graduate educational degree, formal evidence-based practice classes, and registered nurse status were statistically significant positive predictors. CONCLUSION: Administering self-learning online modules may not be the most effective method for expanding evidence-based practice abilities and knowledge/skills of nurses.

A performance improvement project to increase nursing compliance with skin assessments in a rehabilitation unit.

PURPOSE: The aim of this quality improvement project was to increase nursing compliance with skin assessments and ultimately decrease Hospital Acquired Pressure Ulcers (HAPUs) in an acute rehabilitation center. METHODS: Interventions in this quality improvement initiative consisted of education, twice-weekly skin rounds, nursing assistant participation, and sharing of pressure ulcer data. RESULTS: The educational sessions were attended by 80% of the nurses and 95% of the nursing assistants. The remaining nurses and nursing assistants were educated in one-to-one sessions, for a total of 100% of the staff. After the education, skin assessments documentation was completed 100% of the time. The March 2010 CalNOC results demonstrated no patients with HAPUs (Figure 2), which demonstrates a zero incidence of HAPUs since December of 2008. CONCLUSIONS: The education, skin rounds, nursing assistant participation, and sharing of data were instrumental in improving the frequency of skin assessments and the reduction of HAPUs in the rehabilitation unit. CLINICAL RELEVANCE: Skin rounds and staff education not only increased nursing accountability and improved documentation of wounds but also helped promote the healing of patient's current skin issues.

A model for medication safety event detection.

BACKGROUND: Hospital medication safety event detection predominantly emphasizes the identification of preventable adverse drug events (ADEs) through self-reports. These relatively rare events only provide insight into patient harm and self-reports identify only a small portion of ADEs. A broader system-focused approach to medication safety event detection that uses an array of event detection methods is recommended. This approach illuminates medication system deficits and supports improvement strategies that can prevent future patient risk. OBJECTIVE: To: (i) describe a system-focused approach to hospital medication safety event detection, and (ii) present a case illustration of approach application. SYSTEM-FOCUSED MODEL AND METHODOLOGY: A three-level medication safety event detection model that ranges from a narrow harm-focused to broader system-focused approach is described. A standardized cross-level methodology to detect medication safety events is presented. CASE ILLUSTRATION: A Level 3 system-focused methodology that incorporated both voluntary and non-voluntary event detection strategies was used in 17 critical care (n = 4), intermediate care (n = 7) and medical-surgical units (n = 6) across two hospitals. A total of 431 events were detected: 78 (18.1%) ADEs and 353 (81.9%) potential ADEs. Of the 353 PADEs, 302 (70.0%) were non-intercepted events. Non-voluntary detection methods yielded the majority of events (367, 85.1%). CONCLUSIONS: The incidence of ADEs was low when compared with non-intercepted PADEs. This was indicative of medication safety system failures that placed patients at risk for potential harm. Non-voluntary detection methods were much more effective at detecting events than traditional self-report methods.

Improving the Acute Myocardial Infarction Rapid Rule Out process.

Bedside staff nurses are in a unique position to identify implementation problems and ways to improve compliance with evidence-based practice guidelines. The goal of this performance improvement project was to improve compliance with an evidence-based Acute Myocardial Infarction Rapid Rule Out pathway. The purpose of the article is to demonstrate how a bedside staff nurse was able to decrease wait times and length of stay for patients with low-risk chest pain while applying evidence-based practice.

Medication room madness: calming the chaos.

Nurses work in stressful environments, encountering interruptions and distractions at almost every turn. The aim of this medication safety project was to improve the physical design and organizational layout of the medication room, reduce nurse interruptions and distractions, and create a standard medication process for enhanced patient safety and efficiency. This successful change improved the medication administration process, decreased medication errors, and enhanced nursing satisfaction.

Evidence-based practice-focused interactive teaching strategy: a controlled study.

AIM: This paper is a report of a study to evaluate the effectiveness of the evidence-based practice (EBP)-focused interactive teaching (E-FIT) strategy. BACKGROUND: Although EBP is a mandatory competency for all healthcare professionals, little is known about the effectiveness of E-FIT in nursing. METHODS: Aquasi-experimental, controlled, pre- and post-test study involving senior, 4th-year nursing students (N = 208) at two nursing schools in the USA was carried out from August 2007 to May 2008. The experimental group (n = 88) received the E-FIT strategy intervention and the control group (n = 120) received standard teaching. A Knowledge, Attitudes and Behaviors Questionnaire for Evidence-Based Practice was used to assess the effectiveness of the E-FIT strategy. RESULTS: Independent t-tests showed that the experimental group had statistically significant higher post-test Evidence-Based Practice Knowledge (mean difference = 0.25; P = 0.001) and Evidence-Based Practice Use (mean difference = 0.26; P = 0.015) subscale scores compared to the control group, but showed no statistically significant differences in Attitudes toward Evidence-Based Practice and Future Use of Evidence-Based Practice (mean difference = 0.12; P = 0.398 and mean difference = 0.13; P = 0.255 respectively). Hierarchical multiple regression analyses of the post-test data indicated that the intervention explained 7.6% and 5.1% of variance in Evidence-Based Practice Knowledge and Evidence-Based Practice Use respectively. CONCLUSION: The EBP-focused interactive teaching strategy was effective in improving the knowledge and use of EBP among nursing students but not attitudes toward or future use of EBP.

Infusing evidence-based practice into interdisciplinary perinatal morbidity and mortality conferences.

Incorporating evidence-based practice into the hospital setting has been a challenge but is needed to deliver quality healthcare. Interdisciplinary morbidity and mortality conferences are used to discuss perinatal and neonatal care issues with high-risk and low-frequency cases, such as fetal demise, maternal death, or identified areas for improvement. By involving an interdisciplinary team to review the patient's case, a more holistic perspective of the patient's care will be achieved. The purpose of this article is to demonstrate how nurses can be an essential part of the interdisciplinary morbidity and mortality conferences and how to infuse evidence-based practice into the conference. A perinatal morbidity and mortality conference will be described to illustrate how one maternal-neonatal department brought medicine and nursing together to review care.

Standardization of change-of-shift report.

This article describes a clinical nurse-led initiative that changed the traditional group shift report in the conference room to a combination of a written report with a nurse-to-nurse verbal exchange at the patient's bedside. The new process resulted in less time spent in shift report, financial savings from reduced overtime, and a decrease in the number of patient falls and call lights during change of shift.