Development of quality standards in inflammatory bowel disease management and design of an evaluation tool of nursing care.

BACKGROUND AND AIMS: nursing management of inflammatory bowel disease (IBD) is highly relevant for patient care and outcomes. However, there is evidence of substantial variability in clinical practices. The objectives of this study were to develop standards of healthcare quality for nursing management of IBD and elaborate the evaluation tool "Nursing Care Quality in IBD Assessment" (NCQ-IBD) based on these standards. METHODS: a 178-item healthcare quality questionnaire was developed based on a systematic review of IBD nursing management literature. The questionnaire was used to perform two 2-round Delphi studies: Delphi A included 27 IBD healthcare professionals and Delphi B involved 12 patients. The NCQ-IBD was developed from the list of items resulting from both Delphi studies combined with the Scientific Committee´s expert opinion. RESULTS: the final NCQ-IBD consists of 90 items, organized in13 sections measuring the following aspects of nursing management of IBD: infrastructure, services, human resources, type of organization, nursing responsibilities, nurse-provided information to the patient, nurses training, annual audits of nursing activities, and nursing research in IBD. Using the NCQ-IBD to evaluate these components allows the rating of healthcare quality for nursing management of IBD into 4 categories: A (highest quality) through D (lowest quality). CONCLUSION: the use of the NCQ-IBD tool to evaluate nursing management quality of IBD identifies areas in need of improvement and thus contribute to an enhancement of care quality and reduction in clinical practice variations.

Use of failure mode, effect and criticality analysis to improve safety in the medication administration process.

RATIONALE, AIMS AND OBJECTIVES: To critically evaluate the causes of preventable adverse drug events during the nurse medication administration process in inpatient units with computerized prescription order entry and profiled automated dispensing cabinets in order to prioritize interventions that need to be implemented and to evaluate the impact of specific interventions on the criticality index. METHODS: This is a failure mode, effects and criticality analysis (FMECA) study. A multidisciplinary consensus committee composed of pharmacists, nurses and doctors evaluated the process of administering medications in a hospital setting in Spain. By analysing the process, all failure modes were identified and criticality was determined by rating severity, frequency and likelihood of failure detection on a scale of 1 to 10, using adapted versions of already published scales. Safety strategies were identified and prioritized. RESULTS: Through consensus, the committee identified eight processes and 40 failure modes, of which 20 were classified as high risk. The sum of the criticality indices was 5254. For the potential high-risk failure modes, 21 different potential causes were found resulting in 24 recommendations. Thirteen recommendations were prioritized and developed over a 24-month period, reducing total criticality from 5254 to 3572 (a 32.0% reduction). The recommendations with a greater impact on criticality were the development of an electronic medication administration record (-582) and the standardization of intravenous drug compounding in the unit (-168). Other improvements, such as barcode medication administration technology (-1033), were scheduled for a longer period of time because of lower feasibility. CONCLUSION: FMECA is a useful approach that can improve the medication administration process.

Prevalence of medication administration errors in two medical units with automated prescription and dispensing.

OBJECTIVE: To identify the frequency of medication administration errors and their potential risk factors in units using a computerized prescription order entry program and profiled automated dispensing cabinets. DESIGN: Prospective observational study conducted within two clinical units of the Gastroenterology Department in a 1537-bed tertiary teaching hospital in Madrid (Spain). MEASUREMENTS: Medication errors were measured using the disguised observation technique. Types of medication errors and their potential severity were described. The correlation between potential risk factors and medication errors was studied to identify potential causes. RESULTS: In total, 2314 medication administrations to 73 patients were observed: 509 errors were recorded (22.0%)-68 (13.4%) in preparation and 441 (86.6%) in administration. The most frequent errors were use of wrong administration techniques (especially concerning food intake (13.9%)), wrong reconstitution/dilution (1.7%), omission (1.4%), and wrong infusion speed (1.2%). Errors were classified as no damage (95.7%), no damage but monitoring required (2.3%), and temporary damage (0.4%). Potential clinical severity could not be assessed in 1.6% of cases. The potential risk factors morning shift, evening shift, Anatomical Therapeutic Chemical medication class antacids, prokinetics, antibiotics and immunosuppressants, oral administration, and intravenous administration were associated with a higher risk of administration errors. No association was found with variables related to understaffing or nurse's experience. CONCLUSIONS: Medication administration errors persist in units with automated prescription and dispensing. We identified a need to improve nurses' working procedures and to implement a Clinical Decision Support tool that generates recommendations about scheduling according to dietary restrictions, preparation of medication before parenteral administration, and adequate infusion rates.

Nursing resources and responsibilities according to hospital organizational model for management of inflammatory bowel disease in Spain.

BACKGROUND: Nurses play an important role in the multidisciplinary management of inflammatory bowel disease (IBD), but little is known about this role and the associated resources. OBJECTIVE: To improve knowledge of resource availability for health care activities and the different organizational models in managing IBD in Spain. METHODS: Cross-sectional study with data obtained by questionnaire directed at Spanish Gastroenterology Services (GS). Five GS models were identified according to whether they have: no specific service for IBD management (Model A); IBD outpatient office for physician consultations (Model B); general outpatient office for nurse consultations (Model C); both, Model B and Model C (Model D); and IBD Unit (Model E) when the hospital has a Comprehensive Care Unit for IBD with telephone helpline, computer, including a Model B. Available resources and activities performed were compared according to GS model (chi-square test and test for linear trend). RESULTS: Responses were received from 107 GS: 33 Model A (31%), 38 Model B (36%), 4 Model C (4%), 16 Model D (15%) and 16 Model E (15%). The model in which nurses have the most resources and responsibilities is the Model E. The more complete the organizational model, the more frequent the availability of nursing resources (educational material, databases, office, and specialized software) and responsibilities (management of walk-in appointments, provision of emotional support, health education, follow-up of drug treatment and treatment adherence) (p<0.05). CONCLUSIONS: Nurses have more resources and responsibilities the more complete is the organizational model for IBD management. Development of these areas may improve patient outcomes.

Contribution of nurses to the quality of care in management of inflammatory bowel disease: a synthesis of the evidence.

BACKGROUND: The purpose of quality of care programs is to improve patient outcomes. In programs targeting patients with inflammatory bowel disease (IBD), nurses play a key role. AIM: To know the available scientific evidence on the quality of care in IBD management, at the levels of structure, process and outcome, in relation to nurses. METHODS: Systematic search in MEDLINE, EMBASE, Índice Médico Español, Cochrane Library, and grey literature. Inclusion criteria were: 1) documents referring IBD; 2) documents providing relevant information on nurses' involvement in the management of IBD; and 3) an original article. RESULTS: A total of 284 documents were identified, 15 of which were included: 8 related with structure, 12 with process, and 6 with outcomes. Some documents treated more than one level. At the level of structure, services should incorporate specialist nurses as part of the multidisciplinary team, as well as resources to facilitate patient access to nursing care. Notable at the process level, organizational aspects and nurses' competencies and skills in the management of IBD have been described. Among the outcomes mentioned are clinical outcomes, quality of life, and patient satisfaction attributable to nursing staff. No evidence was found about the association between structure or process issues with patient outcomes. Most of the studies reviewed have methodological limitations. CONCLUSIONS: The available evidence provide useful information for the design of standards of structure and process relating to nurses' management of IBD. The IBD nurses' challenge is to provide evidence that these standards help improve health outcomes in patients.

Desarrollo de estándares de calidad para la enfermedad inflamatoria intestinal y diseño de un instrumento de evaluación de los cuidados de enfermería / Development of quality standards in inflammatory bowel disease management and design of an evaluation tool of nursing care

Introducción y objetivos: el manejo de la enfermedad inflamatoria intestinal (EII) por enfermería es muy relevante, sin embargo, existe una gran variabilidad en su práctica clínica. El objetivo de esta investigación es desarrollar estándares de calidad asistencial del manejo de la EII por enfermería, para elaborar un “Instrumento de Evalua - ción de la Calidad Asistencial de la EII por Enfermería” (IEC-EII). Métodos: tras una búsqueda bibliográfica del manejo de la EII por enfermería se elaboró un cuestionario de 178 ítems de calidad asistencial. Con este cuestionario, se realizaron dos estudios Delphi a dos rondas: Delphi A dirigido a 27 profesionales sanitarios en EII y Delphi B a 12 pacientes. Con los ítems de ambos estudios Delphi, se elaboró una lista que, junto con la opinión experta del Comité Científico, contribuyó a desarrollar el IEC-EII. Resultados: el IEC-EII se compone de 90 ítems, subdivididos en 13 dimensiones que miden aspectos del manejo de la EII por enfermería como: infraestructura, servicios, recursos humanos, tipo de organización, competencias asumidas por enfermería, información de enfermería al paciente, formación de enfermería, revisiones anuales de la actividad de enfermería e investigación de enfermería de EII. La evaluación de estos aspectos mediante el IEC-EII permite clasificar la calidad asistencial en EII por enfermería en 4 categorías de la A a la D. Siendo A el nivel de calidad superior y D el inferior. Conclusiones: el IEC-EII puede contribuir a aumentar la calidad asistencial de enfermería en EII y reducir su variabilidad, puesto que la evaluación ayudará a detectar sus deficiencias mejorables (AU)

Background and aims: nursing management of inflammatory bowel disease (IBD) is highly relevant for patient care and outcomes. However, there is evidence of substantial variability in clinical practices. The objectives of this study were to develop standards of healthcare quality for nursing management of IBD and elaborate the evaluation tool “Nursing Care Quality in IBD Assessment” (NCQ-IBD) based on these standards. Methods: a 178-item healthcare quality questionnaire was developed based on a systematic review of IBD nursing management literature. The questionnaire was used to perform two 2-round Delphi studies: Delphi A included 27 IBD healthcare professionals and Delphi B involved 12 patients. The NCQ-IBD was developed from the list of items resulting from both Delphi studies combined with the Scientific Committee’s expert opinion. Results: the final NCQ-IBD consists of 90 items, organized in 13 sections measuring the following aspects of nursing management of IBD: infrastructure, services, human resources, type of organization, nursing responsibilities, nurse-provided information to the patient, nurses training, annual audits of nursing activities, and nursing research in IBD. Using the NCQ-IBD to evaluate these components allows the rating of healthcare quality for nursing management of IBD into 4 categories: A (highest quality) through D (lowest quality). Conclusions: the use of the NCQ-IBD tool to evaluate nursing management quality of IBD identifies areas in need of improvement and thus contribute to an enhancement of care quality and reduction in clinical practice variations (AU)