A stepped-wedge randomised controlled trial to assess efficacy and cost-effectiveness of a care-bundle to prevent falls in older hospitalised patients.

BACKGROUND: Patient accidental falls in a hospital environment are a serious problem for patient safety, and for the additional costs due to associated medical interventions. OBJECTIVE: The endpoints of this study were the assessment of the fall incidence in the hospital before and after the implementation of a multidisciplinary care-bundle, along with a cost-effectiveness evaluation. DESIGN: A stepped-wedge trial was conducted between April 2015 and December 2016 in Bologna University Hospital. METHODS: Incidence rates (IRs) of falls in both the control and intervention periods were calculated. A multilevel mixed-effects generalised linear model with logit link function, adjusted for age, sex, cluster cross-over timing and patients' clinical severity was used to estimate odds ratios (OR) of fall risk of patients of the intervention group respect to the controls.Intervention costs associated with the introduction of the care-bundle intervention were spread between patients per cluster-period-group of exposure. Incremental cost-effectiveness ratio was evaluated using total costs in the intervention and control groups. RESULTS: IRs of falls in control and intervention periods were respectively 3.15 and 2.58 for 1,000 bed-days. After adjustment, the subjects receiving the intervention had a statistically significant reduced risk of falling with respect to those who did not (OR = 0.71, 95% confidence interval: 0.60-0.84). According to the cost-effectiveness analysis, the incremental cost per fall prevented was €873.92 considering all costs, and €1644.45 excluding costs related falls. CONCLUSIONS: Care-bundle had a protective effect on patients, with a statistically significant reduction of the fall risk. This type of intervention appears cost-effective compared to routine practices.

Training in infection prevention and control: survey on the volume and on the learning demands of healthcare-associated infections control figures in the Emilia-Romagna Region (Northern Italy).

Background: In the context of Infections Prevention and Control activities, the training of healthcare-associated infection control figures is crucial; the COVID-19 pandemic further emphasized the necessity of ensuring a widespread and stable level of skills over time for such professionals. The present work aims to identify the number and training needs of the personnel working in the Emilia-Romagna Region's healthcare facilities as "healthcare-associated infection control figures". Methods: Data were collected through a survey created by experts from the Regional Group "Training in the prevention and control of antibiotic resistance". The questionnaire explored the number, professional and educational background, and training requirements of Healthcare-associated infections control figures in Emilia-Romagna. Results: With 73 figures dedicated to Healthcare-associated infections control, the Emilia-Romagna Region appears to be in line with the European standard ratio (1 professional every 125 beds). Professionals with a nursing background, over 50 years old and of female sex prevail in the group, while the training needs expressed include both theoretical and practical aspects. Conclusions: Healthcare assistants and nursing staff represent a fundamental resource for the implementation of infection prevention and control programs in our healthcare facilities; continuous, multidisciplinary and targeted training of these professionals is confirmed as necessary.

[How nurses update their knowledge: a survey in three north Italian hospitals]. / Come gli infermieri aggiornano le proprie conoscenze: indagine in tre ospedali del nord Italia.

INTRODUCTION: Evidence based nursing (EBN) implies the application of the best knowledge to clinical practice but nurses may rely on different sources of knowledge. AIMS: To gain knowledge on methods and sources nurses use to update their knowledge. METHODS: A self completed closed question questionnaire was administered to the nursing personnel of three north Italian hospitals. For each item a level of agreement (never (0) always, 5) was expressed. RESULTS: Over 2642 questionnaires, 1549 (58.5%) were completed. Nurses mostly rely on their experience (mean 4), information obtained from protocols and guidelines (mean 3.94) and during basic education (mean 3.82). Nurses that had attended courses of research or EBN read more frequently articles published in nursing or medical journals. CONCLUSIONS: Experience an important source of knowledge and education to research or EBN may impact on how nurses update their knowledge.

[Cohort study of peripheral catheter related complications and identification of predictive factors in a population of orthopedic patients]. / Studio di coorte sulla popolazione ortopedica delle complicanze correlate all'utilizzo del catetere venoso periferico e identificazione dei fattori predittivi.

INTRODUCTION: Peripheral venous catheters (PVC) may cause complications, specifically local. Their management varies across health care workers and wards, and guidelines recommendations are often weak and based on experts' opinion. AIM: To measure the incidence of PVCs phlebitis, occlusions, accidental removal and infiltrations and their predictive factors in an orthopedic population. METHODS: From may 4 2009 to 30, in an orthopedic hospital, data on patients to whom a PVC was inserted were collected: patient's and PVC characteristics, management and securing strategies, until one of the following outcomes: phlebitis, occlusion, accidental removal, infiltration or end of treatment. RESULTS: Overall, 873 patients were recruited and 139 PVCs. The following complications occurred: phlebitis 10.9%; occlusions 16.8%; accidental removals 5.8%, local infiltrations 14.4%; 648 PVCs (46.5%) were removed without complications. The risk for all complications (multivariate analysis) increased with age and for the other complications also with the administration of blood transfusions thorough PVC, irritant drugs and use >3 times/day for phlebitis; small gauge, not using PVC and surgical site infections for occlusions; positioning the PVC in the hand and fixing the PVC with the Chevron method for accidental removals; and female sex, transfusions and thromboembolic therapy for infiltrations. CONCLUSIONS: The incidence of phlebitis is high compared to the gold standard of 5%. Knowing the incidence of main complications is a requirement for any improvement strategy and may favor the abandonment of useless or dangerous practices.

[The assessment of nurses satisfaction for an organization that values posts and professional responsibilities]. / Contributi valutazione della soddisfazione per l'organizzazione basata sulla valorizzazione di posizioni funzionali, tra gli infermieri del Policlinico S. Orsola-Malpighi.

UNLABELLED: To assess the effectiveness of a new organizational model for professional development, that assigns and financially rewards 12 positions that encompass specific responsibilities (such as responsible of Evidence based Nursing; expert in pressure ulcers, responsible of the newly employed nurses), nurses' satisfaction was measured. METHOD: From November to December 2003 the MC Closey Muller Satisfaction Questionnaire was administered to all the nurses in service in the wards. Levels of satisfaction of nurses with and without specific responsibilities were compared. The answers for each item are on a five points Likert scale. RESULTS: The questionnaire was administered to 1.167 nurses (58.9% of the nurses of the hospital); 602 were assigned positions with specific responsibilities. Overall, nurses with positions assigned were more satisfied (2.76 vs 2.61, p.0.01) and statistically significant differences were obtained for 14/31 items of the scale, and for 5/8 subscales. CONCLUSIONS: The results obtained, although the level of satisfaction is lower compared to other studies, confirm the strategy of professional development adopted in the Hospital. The analysis of results for each position allowed some reflections and to identify strategies to improve the organizational support to some positions.

[Evaluation of 2 tools for measuring the risk of falls among patients]. / Valutazione di due strumenti di misura del rischio di cadute dei pazienti.

To select a risk assessment tool to predict which elderly inpatients will fall, two widely used risk assessment scales (Conley and Stratify) were compared to evaluate their sensibility and specificity. A sample of 2651 patients were included in the survey (1620 evaluated with the Conley; 1181 with the Stratify and 173 with both scales). One hundred and 33 patients fell during the hospital stay (5% of the sample but 1% of all the hospital admissions). Both scales show low values of sensibility (0.69 Conley and 0.20 Stratify) or specificity (0.41 Conley and 0.87 Stratify) with a likely hood ratio of 1.18 and 1.55 respectively. Neither scale is more predictive for stratifying at risk patients. The Conley scale is more sensible in discriminating at risk patients but its use must be accompanied by the clinical assessment of the patients.

[Evidence based nursing and distance learning in the Italian hospital S. Orsola-Malpighi]. / Disseminazione delle prove di efficacia e formazione a distanza nel policlinico S. Orsola-Malpighi.

An experience of distance learning on Evidence Based Nursing is being implemented at the Policlinico Sant'Orsola Malpighi of Bologna. Commented evidence based abstracts on nursing techniques or problems are produced by a resource group of 80 nurses who attended specific courses. An abridged version of the recommendations is distributed to the 2300 health care professionals of the hospital with information on the distance learning session that consists in reading an extended review of the literature on one of the topics chosen and in an evaluation session. The materials are actually on paper but in the near future the electronic format will be used. After the experimental phase, Continuing education credits will be assigned to each initiative. In the evaluation session the theoretical knowledge and problem solving abilities are assessed. The 30 participants to the first 2 initiatives expressed an high level of satisfaction for the materials received. New sessions on more that 10 topics are planned for the 2003-2004.

[Where and how to retreive clinical practice guidelines]. / Dove e come reperire le linee guida.

Indications on how to retrieve clinical practice guidelines are offered, presenting the main agencies that produce guidelines and the trip database. A google search with the key word nursing guidelines, after a selection of agencies with multiprofessional groups, with an explicit process of bibliographic search and a grading of recommendations produced the selection of 4 agencies.