Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE): An Evidence-Based Wellness Program.

Poor well-being and burnout among the nursing workforce were heightened by the COVID-19 pandemic. The purpose of this study was to deliver, spread, and sustain an evidence-based wellness program, Workforce Engagement for Compassionate Advocacy, Resilience, and Empowerment (WE CARE), for nurse leaders, staff registered nurses (RNs), and patient care technicians (PCTs) to ameliorate or prevent burnout, promote resilience, and improve the work environment. The program included Community Resiliency Model (CRM) training provided by a certified 6-member wellness team. A baseline and 6-month follow-up survey included measures of well-being, moral distress, burnout, resilience, perceived organizational support (POS), job satisfaction, intent to leave (ITL), and work environment. A total of 4900 inpatient RNs, PCTs, and leaders of a 1207-bed academic medical center in the southeastern United States were analyzed. From baseline (n = 1533) to 6-month follow-up (n = 1457), well-being, moral distress, burnout, job satisfaction, and work environment improved; however, resilience, POS, and ITL did not. Although we have seen some improvements in well-being and mental health indicators, it is still early in the intervention period to have reached a critical mass with the training and other interventions. The mental health and work environment issues among nurses are so complex, no one-size-fits-all intervention can resolve.

The QSEN Competency Legacy Threaded Through the Entry-Level AACN Essentials: Shaping the Future.

BACKGROUND: For the last 17 years, the Quality and Safety Education for Nurses (QSEN) prelicensure competencies and knowledge, skill, and attitude (KSA) statements were integrated into nursing curricula. PROBLEM: With the publication of the competency-based American Association of Colleges of Nursing (AACN) Essentials , it is important to determine the overlap of the QSEN competencies. APPROACH: We developed a QSEN-AACN prelicensure crosswalk to help faculty map and integrate the 2021 AACN Essentials into their curriculum. OUTCOMES: The 6 QSEN competencies match to the 10 AACN Essentials domains except for evidence-based practice, which is listed as a concept. Fifty graduate-level QSEN KSAs were found to better align with prelicensure education and therefore important to integrate into the crosswalk. All but 1 of the original prelicensure QSEN KSA statements and all but 2 of the 50 transferred graduate-level QSEN KSAs were found in the AACN Essentials . CONCLUSION: Faculty implementing the QSEN framework can use the QSEN-AACN competency crosswalk and QSEN teaching strategies to guide their AACN Essentials journey.

Successful de-implementation of an ineffective practice: The fall of docusate.

BACKGROUND: Reducing wasteful practices optimizes value in medicine. Docusate lacks treatment efficacy yet is widely prescribed. This quality improvement project aimed to de-implement docusate in place of a new evidence-based order set. METHODS: This is an ambidirectional study of inpatient laxative orders from 2018 to 2022 â€‹at one institution. We stratified docusate data by service/unit to target prospective deimplementation initiatives. A new evidence-based constipation order set was embedded in Cerner. RESULTS: There were 701,732 docusate orders across 75 services on 68 units. Top docusate ordering services were Trauma, Obstetrics and Hospitalist. Docusate administration rates were higher than for other laxatives. Our efforts reduced docusate orders by 44% over 4 months. PEG and senna orders increased by 58% and 35%. CONCLUSION: Docusate has no efficacy yet is widely prescribed. A structured de-implementation strategy can drive systematic change by leveraging technology and applying multidisciplinary improvement efforts. Our work removed docusate from the inpatient formulary.

Key Strategies to Publishing Your Quality Improvement Work.

BACKGROUND: Improving quality and safety is a goal in health care, and sharing quality improvement (QI) work with internal and external audiences is key to spreading knowledge and ideas for change. Peer-reviewed journals are interested in manuscripts reporting QI work. METHODOLOGY: Although QI work is methodologically different from traditionally published research articles, it can be publishable if conducted in a way that is scholarly and well-planned. The authors suggest that key strategies to producing publishable, scholarly improvement work exist within two broad categories: rigorous work and compelling writing. Rigorous improvement work includes the following four key components: (1) understanding baseline processes, (2) developing a solid methodology and measurement plan, (3) analyzing and describing context, and (4) clearly explaining the intervention. Creating compelling writing includes clear team expectations that are defined early in the process, including authorship and division of the work. The team should identify a journal early in the process and follow a clear plan for team writing that includes an outline and frequent feedback. CONCLUSION: Elements of rigorous QI work and compelling writing align to develop strong material for publishing scholarly QI work.

Reducing hospital acquired pressure injury in a learning health center: Making the case for quality.

Introduction: The purpose of this descriptive study is to examine a learning health system (LHS) continuous improvement and learning approach as a case for increased quality, standardized processes, redesigned workflows, and better resource utilization. Hospital acquired pressure injuries (HAPI) commonly occur in the hospitalized patient and are costly and preventable. This study examines the effect of a LHS approach to reducing HAPI within a large academic medical center. Methods: Our learning health center implemented a 6-year series of iterative improvements that included both process and technology changes, with robust data and analytical reforms. In this descriptive, observational study, we retrospectively examined longitudinal data from April 1, 2018 to March 31, 2022, examining the variables of total number of all-stage HAPI counts and average length of stay (ALOS). We also analyzed patient characteristics observed/expected mortality ratios, as well as total patient days, and the case-mix index to determine whether these factors varied over the study period. We used the Agency for Healthcare Research and Quality cost estimates to identify the estimated financial benefit of HAPI reductions on an annualized basis. Results: HAPI per 1000 patient days for FY 20 (October 1-September 30) and FY 21, decreased from 2.30 to 1.30 and annualized event AHRQ cost estimates for HAPI decreased by $4 786 980 from FY 20 to FY 21. A strong, statistically significant, negative and seemingly counterintuitive correlation was found (r = -.524, P = .003) between HAPI and ALOS. Conclusions: The LHS efforts directed toward HAPI reduction led to sustained improvements during the study period. These results demonstrate the benefits of a holistic approach to quality improvement offered by the LHS model. The LHS model goes beyond a problem-based approach to process improvement. Rather than targeting a specific problem to solve, the LHS system creates structures that yield process improvement benefits over a continued time period.

Curriculum Mapping Post-Baccalaureate Registered Nurse Residency Curriculum to Accrediting Agency Standards.

This article examines the process of mapping a post-baccalaureate registered nurse residency curriculum with Commission on Collegiate Nursing Education standards for nurse residencies. Curriculum mapping revealed gaps and redundancies in the curriculum as well as documented compliance with accreditation standards. Curriculum mapping is instrumental to developing, evaluating, and refining curricular elements. Mapping curriculum with accreditation standards simultaneously fulfills accreditation requirements and can increase confidence in readiness within organizations undergoing accreditation site visits.

Value of Using a Structured Improvement Approach: A Dedicated Education Unit Exemplar.

ABSTRACT: Using a structured approach to improvement that integrates methodological frameworks and commonly used improvement tools and techniques allows an improvement team to systematically implement and evaluate an intervention. Authors from one academic medical center will describe our four-step structured improvement approach in the design of a dedicated education unit (DEU) pilot to potentially meet a critical post-COVID-19 workforce need. Using our structured improvement approach, we successfully piloted a DEU with a unit-based clinical educator and 16 nursing students over 26 clinical days and received 13 preintervention surveys from participants. Although the DEU pilot was small with limited data, the structured improvement approach resulted in an organized and systematic way of designing, implementing, and evaluating improvement.

Quality Matters: Examining the Impact of Nurse Staffing Challenges on Clinical Outcomes.

GOAL: The purpose of this study was to examine nurse staffing while describing the relationships that exist in staffing and quality associated with nursing care during the COVID-19 pandemic, a significantly challenging time for nurse staffing. We examined the relationship between permanent registered nurse (RN) and travel RN staffing during the pandemic and the nursing-sensitive outcomes of catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), falls, and hospital-acquired pressure injuries (HAPIs) and length of stay and compared the cost of CAUTIs, CLABSIs, falls, and HAPIs in fiscal years 2021 and 2022. METHODS: We used a descriptive, observational design to retrospectively examine permanent nurse staffing volume and CAUTI, CLABSI, HAPI, and fall counts from October 1, 2019, to February 28, 2022, and travel nurse volume for the most current 12 months, April 1, 2021, to March 31, 2022. Descriptive statistics, Pearson correlation, and statistical process control analyses were completed. PRINCIPAL FINDINGS: Pearson correlation showed a statistically significant, moderately strong negative correlation (r = -0.568, p = .001) between the active registered nurse full-time equivalents (RN FTEs) and average length of stay (ALOS), and a moderately strong positive correlation (r = 0.688, p = .013) between the travel RN FTEs and ALOS. Pearson correlations were not statistically significant, with low to moderate negative correlations for CAUTIs (r = -0.052, p = .786), CLABSIs (r = -0.207, p = .273), and falls (r = -0.056, p = .769). Pearson correlation for active RN and HAPI showed a moderately strong, statistically significant positive correlation (r = 0.499, p = .003). We observed common cause variation in CAUTIs and CLABSIs, with HAPIs and falls showing special cause variation via statistical process control. PRACTICAL APPLICATIONS: Despite the challenges associated with the lack of available nurse staffing accompanied by increasing responsibilities including unlicensed tasks, positive clinical outcomes can be maintained by staff adherence to evidence-based quality improvement.

Anosognosia for Hemiplegia and Falls After Stroke: A Prospective Correlational Study.

PURPOSE: The aim of this study was to explore the association between the presence and severity of anosognosia for hemiplegia (AHP) and falls in stroke survivors. DESIGN: A prospective, correlational research design was utilized. METHODS: Primary instrumentation included demographic information and the Visual-Analogue Test for Anosognosia for motor impairment (VATA-m). Correlational and regression analyses were performed between a priori variables. RESULTS: There was no statistically significant relationship found between AHP and falls. An incidental finding included that clinicians erroneously charted that their patients were aware of their physical limitations 100% of the time, which indicates that there is discord between clinicians and patients regarding physical limitations. CONCLUSIONS: Though no statistically significant relationship was found between AHP and falls, the incidental finding of dissonance between the patient and the clinician has important clinical implications. RELEVANCE: The relationship between AHP and stroke rehabilitation outcomes is still not understood, and incorporating part of the VATA-m into patient assessment could improve clinician understanding of patient awareness.

Utilization of Improvement Methodologies by Healthcare Quality Professionals During the COVID-19 Pandemic.

INTRODUCTION: This study describes the work of healthcare quality professionals during the COVID-19 pandemic, highlighting the successes and challenges they faced when applying their expertise in performance and process improvement (PPI) to help manage the crisis. METHODS: The researchers performed a descriptive analysis of anonymous survey data collected from members of the National Association for Healthcare Quality professional community who were asked about their improvement work during the pandemic response. RESULTS: Most survey respondents used improvement methods to a great or moderate extent to measure what was happening (83%), rapidly review processes and practice (81%), and decide where to focus effort (81%). Fewer respondents used PPI methods to engage with patients and families (58% to a great or moderate extent). Looking to the future, respondents indicated that embedding systematic approaches to improvement within healthcare organizations (59%) and working in a more integrated way across teams (48%) should be prioritized in the post-pandemic recovery. CONCLUSIONS: The results from this study demonstrate why healthcare leaders should recognize the value that performance improvement approaches provide to everyday operations. They must empower PPI experts to lead this critical work and continue building workforce capacity in PPI methods to strengthen staff engagement and achieve better outcomes.

Modeling Patient Risk for Hospital-Acquired Pressure Injuries During COVID-19: A Retrospective Study.

BACKGROUND: COVID-19 negatively impacts many organ systems including the skin. One of the most significant skin-associated adverse events related to hospitalization are pressure injuries. PURPOSE: The aim of this study was to determine 8 risk factors that would place hospitalized patients at a higher risk for hospital-acquired pressure injuries (HAPIs) during the COVID-19 pandemic. METHODS: A retrospective, descriptive analysis was conducted in an urban academic health science center located in the southeastern United States. RESULTS: There were 247 of 23 093 patients who had pressure injuries and 1053 patients who had a positive COVID-19 diagnosis. Based on the generalized estimating equation model, diagnosis of COVID-19, age, male gender, risk of mortality, severity of illness, and length of stay are statistically significant factors associated with the development of HAPIs. CONCLUSIONS: Further study should explore pathology of COVID-19 skin changes and what interventions are effective against HAPIs in the COVID-19 population taking into consideration current treatments.

Improving Obstuctive Sleep Apnea Care in the Postanesthesia Care Unit.

PURPOSE: The purpose of this quality improvement project was to improve care of obstructive sleep apnea (OSA) patients through increased staff recognition of OSA in the postanesthesia care unit (PACU). DESIGN: Retrospective chart review with implementation of best practice guideline form to front of patient's chart. METHODS: Baseline data were collected during June 2020. Staff education was provided on current hospital policy of OSA patients. Implementation of a care guideline sheet was added to the front of patient charts for patients meeting inclusion criteria; it consisted of continuous pulse oximetry, 30-degree head of bed elevation, continuous positive airway pressure (CPAP) therapy, 1 hour minimum postoperative observation, nonopioid analgesics, and referral to polysomnography. A retrospective chart review was performed following the OSA guideline intervention. FINDINGS: Both pre- (N = 413) and postintervention (N = 420) groups had statistically similar demographics. CPAP use increased from 16 to 22 (t = 0.890; P = .336). The number of patients experiencing dyspnea decreased from 10 to 8 (t = 0.263; P = .608). The number of patients experiencing acute respiratory events (AREs) decreased from 24 to 18 (t = 1.012; P = .314). CONCLUSION: There were no significant statistical findings. However, increased recognition of OSA patients by PACU staff can lead to improved care alterations.

Clinical Team Training and a Structured Handoff Tool to Improve Teamwork, Communication, and Patient Safety.

BACKGROUND: Effective communication among healthcare teams is essential for ensuring handoff-related safety and quality care outcomes. PURPOSE: The aim of this project was to improve patient safety through the reduction of communication-related errors on an acute hemodialysis unit (AHU) in an academic medical center. A target was set to reduce by 50 percent the communication-related errors using strategies to improve teamwork and communication. METHODS: Acute hemodialysis unit team members attended Clinical Team Training (CTT) informational sessions on teamwork and communication. A structured handoff tool was implemented in the AHU to improve nurse communication and reduce communication-related patient safety events. Descriptive statistics and comparison of means were conducted to assess the differences between preimplementation and postimplementation audit and safety event data. RESULTS: There was a statistically significant difference between the preintervention and postintervention groups of handoff tool usage and completion as well as a consistent decrease in handoff-related safety events after implementation. CONCLUSIONS/IMPLICATIONS: Findings suggest that CTT and a structured handoff tool used to guide nurse-to-nurse care transitions lead to a reduction in communication-related safety events during handoffs in an AHU.

Why Competency Standardization Matters for Improvement: An Assessment of the Healthcare Quality Workforce.

ABSTRACT: Healthcare transformation requires a healthcare quality workforce with the requisite expertise to lead, oversee, and implement positive change within healthcare organizations. The National Association for Healthcare Quality (NAHQ) Competency Framework, which spans 29 competencies across 8 domains of healthcare quality, outlines the specific knowledge and skills needed to advance personal and organizational quality goals. This study describes 1,671 responses to the NAHQ Professional Assessment survey from a diverse group of healthcare quality professionals representative of NAHQ's professional community. Results show that two-thirds of respondents indicated they are working in 4 or more competency domains, with 85% reporting working in Performance and Process Improvement. Results also indicate that individuals who hold the Certified Professional in Healthcare Quality (CPHQ) certification perform work at more advanced levels across all eight domains of the competency framework. This was statistically significant for 13 of the 29 competencies including all three competency statements within the Performance and Process Improvement domain. Healthcare organizations need a workforce with specialized quality and safety expertise to advance quality goals, and this study suggests that those who invest in continued professional development by attaining the CPHQ certification may be better positioned to contribute meaningfully to advance these goals and improve organizational outcomes.

Medication administration errors: A concept analysis.

AIM: To provide an analysis of the concept of medication errors that occur during the nursing task of medication administration. BACKGROUND: Medication errors occurring during medication administration have an increased risk for an adverse patient outcome. Many terms are associated with medication errors, with limited clarification for a medication administration error at the point of care delivery. DATA SOURCES: Twenty-seven sources were chosen from database searches of PubMed, CINAHL, EMBASE, and Scopus. Key search terms used to narrow the search consist of the following terminology: ("bedside" OR "point-of-care" OR "nursing care*") AND "medication administration errors" AND ("acute care"). REVIEW METHODS: Rodger's evolutionary method of concept analysis was used to clarify the concept of medication administration error. RESULTS: The concept analysis identified three attributes of a medication administration error: nurse-provided care, administration, and point of care. Antecedents identified in the analysis are organizational factors and nurse factors. Consequences identified in the analysis are patient, nurse and organizational themes. CONCLUSION: The continued occurrence of medication administration errors warrants the need for an investigation into existing safety measures. Using this concept analysis may help guide the study of the healthcare environment and determine empirical measures to assess the impact that a medication administration error has.

Learning During Crisis: The Impact of COVID-19 on Hospital-Acquired Pressure Injury Incidence.

ABSTRACT: The impact of COVID-19, on the health and safety of patients, staff, and healthcare organizations, has yet to be fully uncovered. Patient adverse events, such as hospital-acquired pressure injuries (HAPIs), have been problematic for decades. The introduction of a pandemic to an environment that is potentially at-risk for adverse events may result in unintended patient safety and quality concerns. We use the learning health system framework to motivate our understanding of the impact of the COVID-19 pandemic on the incidence of HAPIs within our health system. Using a retrospective, observational design, we used descriptive statistics to evaluate trends in HAPI from March to July 2020. Hospital-acquired pressure injury numbers have fluctuated from a steady increase from March-May 2020, hitting a peak high of 90 cases in the month of May. However, the trend in the total all stage HAPIs began to decline in June 2020, with a low of 51 in July, the lowest number since March 2020. Patients evaluated in this study did not have a longitudinal increase in HAPIs from March-July 2020 during the COVID-19 pandemic, despite similarities in illness severity between the two time points. Our experience has demonstrated the ability of our organizational leaders to learn quickly during crisis.

Value of Interprofessional Education: The VA Quality Scholars Program.

ABSTRACT: Interprofessional collaboration (IPC) has been shown to improve healthcare quality and patient safety; however, formal interprofessional education (IPE) training is insufficient. The VA Quality Scholars (VAQS) program exists to develop interprofessional leaders and scholars in healthcare improvement. The purpose of this study was to examine the impact of integrating interprofessional healthcare learners and designing an interprofessional curriculum for the national VAQS program. VAQS alumni (graduates from 2001 to 2017) across eight national sites (n = 102 [53.1%]) completed a web-based survey to assess alumni perceptions of IPC skill development during the program and IPC skill utilization in their careers. Alumni from 2009 and earlier were physicians; alumni after 2009 came from diverse health professional backgrounds. Overall, IPC and teamwork was identified as the most used skill (n = 82, 70%) during their career. When comparing the pre-IPE period and the post-IPE period, post-IPE alumni identified IPC and teamwork as the area of greatest skill development (n = 38). Integrating interprofessional trainees and robust IPE curricula enhanced an established and successful quality improvement (QI) training program. VAQS alumni endorsed the importance of IPC skills during their careers. The VAQS program is an example of how health professionals can successfully learn IPC skills in healthcare QI.

Innovations in Evaluating Nursing Academic Practice Partnerships.

Academic-practice partnerships are formalized relationships encouraged by the American Association of Colleges of Nursing to meet healthcare and societal needs. While Academic-practice partnerships have existed for decades, the process for evaluating their outcomes often lacks a robust, standardized structure. The purpose of this article is to describe one organization's process for developing and implementing an evaluation blueprint for appraising an Academic-practice partnership.

Nurse Burnout Predicts Self-Reported Medication Administration Errors in Acute Care Hospitals.

BACKGROUND: Every one out of 10 nurses reported suffering from high levels of burnout worldwide. It is unclear if burnout affects job performance, and in turn, impairs patient safety, including medication safety. The purpose of this study is to determine whether nurse burnout predicts self-reported medication administration errors (MAEs). METHODS: A cross-sectional study using electronic surveys was conducted from July 2018 through January 2019, using the Copenhagen Burnout Inventory. Staff registered nurses (N = 928) in acute care Alabama hospitals (N = 42) were included in this study. Descriptive statistics, correlational, and multilevel mixed-modeling analyses were examined. RESULTS: All burnout dimensions (Personal, Work-related, and Client-related Burnout) were significantly correlated with age (r = -0.17 to -0.21), years in nursing (r = -0.10 to -0.17), years of hospital work (r = -0.07 to -0.10), and work environment (r = -0.24 to -0.57). The average number of self-reported MAEs in the last 3 months was 2.13. Each burnout dimension was a statistically significant predictor of self-reported MAEs (p < .05). CONCLUSIONS: Nurse burnout is a significant factor in predicting MAEs. This study provides important baseline data for actionable interventions to improve nursing care delivery, and ultimately health care, for Alabamians.

Developing Leaders and Scholars in Health Care Improvement: The VA Quality Scholars Program Competencies.

Despite the need for leaders in health care improvement across health professions, there are no standards for the knowledge and skills that should be achieved through advanced interprofessional health care improvement training. Existing health care improvement training competencies focus on foundational knowledge expected of all trainees or for specific career pathways. Health care improvement leaders fill multiple roles within organizations and promote interprofessional improvement practice. The diverse skill set required of modern health care improvement leaders necessitates the development of training competencies specifically for fellowships in applied health care improvement. The authors describe the development of the revised national Veterans Affairs Quality Scholars (VAQS) Program competencies. The VAQS Program is an interprofessional, postdoctoral training program whose mission is to develop leaders and scholars to improve health care. An interprofessional committee of VAQS faculty reviewed and revised the competencies over 4 months beginning in fall 2018. The first draft was developed using 111 competencies submitted by 11 VAQS training sites and a review of published competencies. The final version included 22 competencies spanning 5 domains: interprofessional collaboration and teamwork, improvement and implementation science, organization and system leadership, methodological skills and analytic techniques for improvement and research, and teaching and coaching. Once attained, the VAQS competencies will guide the skill development that interprofessional health care improvement leaders need to participate in and lead health care improvement scholarship and implementation. These broad competencies are relevant to advanced training programs that develop health care improvement leaders and scholars and may be used by employers to understand the knowledge and skills expected of individuals who complete advanced fellowships in applied health care improvement.