Evaluation of Electronic Health Records on the Nursing Process and Patient Outcomes Regarding Fall and Pressure Injuries.

Digitalizing the nursing process has become a trend in medical care. The purpose of this study was to evaluate implementation of the Standardized Computerized Nursing Process Documentation System and patient outcomes. We analyzed hospitalized patients' electronic health record database with a total of 19 659 patients in 2015. The analysis focused on nurses' selection of nursing care plans for patients with a high risk of falls or pressure injuries through admission assessments. The effectiveness of implemented nursing care plans following falls or pressure injuries was explored. The results reveal that 55% of the hospitalized patients had a risk of falling, and 27.85% of patients were at risk of pressure injuries. Patients receiving nursing care plan who experienced falls or pressure injuries were significantly higher than those without a nursing care plan (P < .001). This study could not provide direct evidence for the effect of nursing care plans on reducing the incidence of falls and pressure injuries, which may be attributable to patient characteristics. Furthermore, an analysis on data from 2007 to 2017 using a run chart revealed that the mean incidence rate for pressure injuries decreased, whereas that for falls remained stable. The results indicate that the system did not increase the occurrence of such incidences.

Cat, dog and house dust mite allergen levels on children's soft toys.

OBJECTIVE: Children's soft toys are known to harbour house dust mite (HDM) allergens, but little is known whether they harbour cat or dog allergens. The objective of the study was to measure cat (Fel d 1), dog (Can f 1) and HDM allergens on children's soft toys. METHODS: Dust was collected from 40 children's soft toys and their mattresses. Data were collected on pet ownership. Dust samples were analysed for Fel d 1, Can f 1, Der p 1 and Der f 1 by enzyme-linked immunosorbent assay (ELISA) and results are expressed as median levels with inter-quartile ranges. RESULTS: Thirty-five (87.5%) soft toys had detectable Fel d 1 levels (median: 0.73 µg/g; inter-quartile range: 0.26-2.56 µg/g) while 34 (85%) had detectable Can f 1 levels (1.20 µg/g; 0.53-2.68). Correspondingly, 32 (80%) mattresses had detectable Fel d 1 levels (0.18 µg/g, 0.07-1.01) while 34 (85%) had detectable Can f 1 levels (0.50 µg/g; 0.33-1.06). All mattresses and soft toys had detectable HDM allergen (Der p 1 + Der f 1) levels with soft toys containing about three times higher levels than mattresses. In homes with cats (n = 10) Fel d 1 levels were higher on soft toys than homes without cats (2.49 versus 0.48 µg/g; p = 0.0009). In homes with dogs (n = 25) Can f 1 levels were generally higher on soft toys (1.38 versus 0.63 µg/g; p = 0.10). CONCLUSIONS: This study has shown that soft toys can harbour cat and dog allergen as well as HDM allergens, some with very high levels. Cat and dog ownership resulted in higher Fel d 1 and Can f 1 levels on soft toys and mattresses. The levels of Fel d 1, Can f 1 and HDM allergens on soft toys could be of importance to sensitized asthmatic children.

Comparison of creatinine based and kidney volume based methods of estimating glomerular filtration rates in potential living kidney donors.

PURPOSE: Accurate assessment of kidney function is critical to evaluate living kidney donors. Direct glomerular filtration rate measurement using isotopes is currently the gold standard but it is complex and costly. We evaluated the performance of surrogate markers of the glomerular filtration rate in living kidney donors by comparing direct measurement of the rate to the creatinine based equation estimated rate, the kidney volume based estimated rate using a newly developed equation and creatinine clearance. MATERIALS AND METHODS: We first statistically compared direct glomerular filtration rate measurement to the results of the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) creatinine based equations, and to creatinine clearance in 54 potential renal donors from 2006 to 2010. In 32 donors with cross-sectional computerized tomography available we used measured functional renal volume with age, gender, weight and serum creatinine to estimate the rate based on kidney volume according to a previously reported model. Kidney volume based measurement was compared to direct glomerular filtration rate measurement and assessed against the results of the best performing creatinine based equation. RESULTS: In the first group of 54 donors the correlation index of the estimated glomerular filtration rate according to MDRD and CKD-EPI creatinine based equations, and to creatinine clearance was low compared to direct measurement. In the subset of 32 potential donors the kidney volume based estimated rate correlated better with direct measurement than MDRD equation results with higher accuracy (estimated 87.5% and 75.0% within 30% and 10% of direct rate measurement, respectively). CONCLUSIONS: To estimate the glomerular filtration rate in healthy individuals a volume based model correlated better than the MDRD equation, which is the best performing creatinine based equation used to estimate the rate. By providing a more robust estimation of the glomerular filtration rate in healthy potential kidney donors, the volume based model adds value to routine preoperative computerized tomography above that of anatomical evaluation.

Evaluation of a mobile shift report system on nursing documentation quality.

Nursing shift report is vital for patient care. Accordingly, healthcare facilities have made great efforts to establish a standardized nurse-to-nurse shift handoff process to ensure patient care quality. The purpose of this study was to determine whether the use of a standardized mobile intershift handoff system would affect the quality of nursing documentation. The study is based on nursing handoff records from 19 inpatient units in four major care areas (internal medicine, general surgery, obstetrics/pediatrics, and long-term care) of a medical center in central Taiwan. Data collection was performed before and after implementation of the mobile, point-of-care handoff system in 2010. A medical review tool was used to compare 25-item charting compliance on 228 charts. Results show that the designed content of the handoff system was related to a corresponding compliance change in initial assessment, pain reassessment, and use of accurate abbreviation. Although overall compliance rates among inpatient units varied, the statistical test showed that the pattern of changes was consistent. As more items were added to the new handoff system for reminder purposes, documentation compliance increased; however, since the new handoff system did not include nursing diagnosis, patient outcome tracking compliance was reduced. The results of the study reveal that implementing a standardized point-of-care handoff system could improve nursing documentation compliance and quality.

Incidence of percutaneous injuries and non-reporting rates among first-aid responders in Taiwan.

We determined the incidence of percutaneous (needlestick and sharps) injuries among emergency medical technicians (EMTs) in one county in Taiwan, compared this with the official reporting rate, and sought reasons for non-reporting. An anonymous questionnaire was distributed to all EMTs in that county, eliciting percutaneous injuries occurrences, reasons why, and reporting data. Data were analyzed by logistic regression. A total of 329 out of 353 EMTs completed the questionnaire, giving a response rate of 93.2%. Thirty-nine EMTs (11.9%) experienced at least one percutaneous injury in the preceding 12 months. Older, less experienced EMTs were at greater risk of percutaneous injuries. None of the EMTs officially reported their percutaneous injuries primarily because they thought reporting was not mandatory and that the reporting process was too complicated. About one in eight EMTs had experienced at least one percutaneous injury in the preceding year. None of these injuries was officially reported to their organization. Ways to make reporting more user friendly are required, along with resources to minimize percutaneous injuries among EMTs in Taiwan.

Daily vacuuming of mattresses significantly reduces house dust mite allergens, bacterial endotoxin, and fungal ß-glucan.

BACKGROUND AND AIMS: Atopic patients are advised to cover their mattresses with occlusive coverings; however, these are not cheap. We investigated whether daily vacuum cleaning of mattresses significantly reduces content of house dust mite allergens, bacterial endotoxin, and fungal ß-glucan. METHODS: Twenty volunteers vacuumed their mattress daily for 8 weeks. Dust samples collected at two weekly intervals were analyzed for house dust mite allergens (Der p 1 and Der f 1) by double monoclonal antibody ELISA and for endotoxin and ß-glucan by the Limulus amoebocyte lysate kinetic assay. Results are presented as geometric means with 95% confidence interval (CI). RESULTS: Total house dust mite allergens (Der p 1 + Der f 1) significantly reduced from a geometric mean (95% CI) of 4.07 µg (2.44-6.79) at the start to 0.42 µg (0.21-0.81) at week 8. Total endotoxin and ß-glucan were also significantly reduced from 13.6 EU (8.6-21.4) to 3.4 EU (2.3-5.0) and from 94.4 µg (57.1-156.2) to 19.7 µg (10.2-37.9), respectively (p for trend >.0001). Percentage reductions in total house dust mite allergens, endotoxin, and ß-glucan after 8 weeks of daily vacuum cleaning were 85.1% (80.1-90.1), 71.0% (70.4-81.0), and 75.7% (70.4-81.0), respectively. This was mainly due to a 77.7% (70.8-84.7) reduction in total dust. CONCLUSION: Daily vacuum cleaning of mattresses over time significantly reduces house dust mite allergens, endotoxin, and ß-glucan. This gives atopic patients a practical and cheaper alternative to reduce their exposure to indoor house dust mite allergens and microbial bio-contaminants.

Endotoxin and ß-(1,3)-glucan levels in automobiles: a pilot study.

Exposure to bacterial endotoxin and fungal ß-(1,3)-glucan in the indoor environment can induce respiratory symptoms. Automobiles are an exposure source of allergens but it is not known if, and how much exposure there is to endotoxin and fungal ß-(1,3)-glucan. The objective of the study was to determine whether automobiles are a potential source of exposure to these microbial products. Dust was sampled from the passenger seats of 40 automobiles. Specific Limulus amoebocyte kinetic assays were used to measure endotoxin and ß-(1,3)-glucan, respectively. Endotoxin and ß-(1,3)-glucan was detected in all samples ranging from 19.9-247.0 EU/mg and 1.6-59.8 µg/g, respectively. There were no significant differences in endotoxin levels between automobiles of smokers and non-smokers, but ß-(1,3)-glucan levels were about two-fold higher in the automobiles of non-smokers. In conclusion, endotoxin and ß-(1,3)-glucan exposure in automobiles at levels found in our study may be of importance for asthmatics.

Indoor allergens and microbial bio-contaminants in homes of asthmatic children in central Taiwan.

Indoor allergens and microbial bio-contaminants play a significant role in asthma symptoms. The aim of the study was to determine levels of house dust mite allergens, bacterial endotoxin, and fungal beta-glucan in homes of 120 asthmatic children in central Taiwan. Dust samples from 120 mattresses (67 double-sided) were analyzed for house dust mite allergens (Der p 1, Der f 1, and Blo t 5), endotoxin, and beta-glucan. Pillows (n = 118) were analyzed for house dust mite allergens only. Kitchen dust samples were analyzed for the cockroach allergen, Bla g 1. Blo t 5 was detected in 9.3% pillows and 82.2% mattresses, Der p 1 in 95.8% pillows and 93.2% mattresses, and Der f 1 in 82.2% pillows and 83.1% mattresses. Geometric mean levels (95% confidence interval) of endotoxin and beta-glucan in mattresses were 108.4 Eu/mg (81.4-144.2) and 25.2 microg/g (22.7-28.0), respectively. House dust mite allergens and endotoxin levels were significantly lower on the bamboo side of 67 mattresses, compared to the inner sprung mattress side. Geometric mean of kitchen Bla g 1 was 0.61 U/g (95% CI: 0.43-0.85). Given the presence of Der p 1, Der f 1 and Blo t 5 in central Taiwan, it is advised to measure allergens of all three house dust mite species to obtain a true index of allergen exposure. Bamboo sides of mattresses had significantly lower house dust mite allergens and endotoxin levels.