Length of Catheter Use After Hysterectomy as a Risk Factor for Urinary Tract Infection.

OBJECTIVES: The aims of this study were to determine the effect of length of postoperative catheterization on risk of urinary tract infection (UTI) and to identify risk factors for postoperative UTI. METHODS: This was a retrospective case-control study. Demographic and perioperative data, including duration of indwelling catheter use and postoperative occurrence of UTI within 30 days of surgery, were analyzed for hysterectomies using the Michigan Surgical Quality Collaborative database. Catheter exposure was categorized as low-no catheter placed/catheter removed the day of surgery, intermediate-catheter removed postoperative day 1, high-catheter removal on postoperative day 2 or later, or highest-patient discharged home with catheter. A multivariable logistic regression model was developed to identify factors associated with UTI. An interaction term was included in the final model. RESULTS: Overall, UTI prevalence was 2.3% and increased with duration of catheter exposure (low: 1.3% vs intermediate: 2.1% vs high: 4.1% vs highest: 6.5%, P < 0.0001). High (odds ratio [OR] = 2.54 [1.51-4.27]) and highest (OR = 3.39 [1.86-6.17]) catheter exposure, operative time (OR = 1.15 [1.03-1.29]), and dependent functional status (OR = 4.62 [1.90-11.20]) were independently associated with UTI. Women who had a vaginal hysterectomy with sling/pelvic organ prolapse repair were more likely to have a UTI than those who had a vaginal hysterectomy alone (OR = 2.58 [1.10-6.07]) and more likely to have a UTI than women having an abdominal or laparoscopic hysterectomy with a sling/pelvic organ prolapse repair (OR = 2.13 [1.12-4.04]). CONCLUSIONS: Length of catheterization and operative time are modifiable risk factors for UTI after hysterectomy. An interaction between vaginal hysterectomy and concomitant pelvic reconstruction increases the odds of UTI.

Effective followership: A standardized algorithm to resolve clinical conflicts and improve teamwork.

In healthcare, the sustained presence of hierarchy between team members has been cited as a common contributor to communication breakdowns. Hierarchy serves to accentuate either actual or perceived chains of command, which may result in team members failing to challenge decisions made by leaders, despite concerns about adverse patient outcomes. While other tools suggest improved communication, none focus specifically on communication skills for team followers, nor do they provide techniques to immediately challenge authority and escalate assertiveness at a given moment in real time. This article presents data that show one such strategy, called the Effective Followership Algorithm, offering statistically significant improvements in team communication across the professional continuum from students and residents to experienced clinicians.

Nurses' delivery of the Tobacco Tactics intervention at a Veterans Affairs Medical Center.

AIMS AND OBJECTIVES: To determine (1) factors associated with nurses' perceived confidence in and importance of delivering cessation interventions to patients after receiving the Tobacco Tactics educational module, and (2) whether self-reported delivery of smoking cessation services increased after the Tobacco Tactics educational programme was implemented. BACKGROUND: Intensive nurse-based inpatient smoking cessation interventions are effective; however, due to a lack of nurse confidence, training and time, nurse-administered cessation interventions are seldom implemented. DESIGN: Two cross-sectional surveys among staff trained in the Tobacco Tactics programme, conducted at two months and 15 months post-training. METHODS: Surveys were conducted to determine whether self-reported delivery of smoking cessation services by nursing staff increased after delivery of the Tobacco Tactics training at a Midwestern Veterans Affairs Medical Center. All staff members who attended the training were eligible to complete the surveys at two and 15 months post-training. RESULTS: Having a good understanding of the elements of smoking cessation interventions and satisfaction with training were associated with perceived confidence and importance of delivering smoking cessation interventions. Additionally, 86% of participants reported delivering cessation interventions 15 months post-training compared with 57% prior to training (p < 0·0001). CONCLUSIONS: Training nurses how to deliver tobacco cessation interventions increases delivery of cessation services. RELEVANCE TO CLINICAL PRACTICE: Nurse-delivered cessation interventions have the potential to increase quit rates and decrease morbidity and mortality among patient populations.

A concept analysis of situational awareness in nursing.

AIM: This article reports an analysis of the concept of situational awareness in nursing. BACKGROUND: Situational awareness is a fundamental and well-understood concept used to maintain operational safety in high reliability organizations; however, it has not been studied in nursing. Nurses play a critical role in providing vigilance in health care and what they do or fail to do is directly related to patient outcomes. DATA SOURCES: Multiple databases, including PubMed, CINAHL, JSTOR, and Google Scholar, were searched with the term, 'situational awareness'. The primary search, used to identify all uses of the concept, did not employ date criteria. A secondary search for articles measuring situational awareness as an independent or dependent variable was completed using 2009-2011 articles. DESIGN: Concept Analysis. REVIEW METHODS: The concept of situational awareness was examined using Walker and Avant's eight step method of analysis. RESULTS: Three defining attributes of situational awareness include perception, comprehension, and projection. Situational awareness is defined as the perception of the elements in the environment in a volume of time and space, the comprehension of their meaning and the projection of their status in the near future. Although situational awareness is related to other terms in nursing, there is increasing recognition that the concept, which is likely a consolidation of the related terms, has an impact on healthcare professionals. CONCLUSION: Failures in perception, comprehension, and/or projection can significantly reduce the accuracy and appropriateness of patient care decisions. Therefore, as a precursor to decision making, poor or inadequate levels of situational awareness present serious threats to patient safety. Situational awareness needs to be examined in a theoretical context, studied systematically and openly recognized as a key factor in the delivery of safe patient care.

Nursing crew resource management: a follow-up report from the Veterans Health Administration.

In response to low scores on a patient safety culture survey, the Veterans Health Administration National Center for Patient Safety implemented a comprehensive nursing-focused crew resource management program for frontline nursing staff. This article highlights significant cultural and clinical outcomes from the program.

Improving patient safety using the sterile cockpit principle during medication administration: a collaborative, unit-based project.

AIM: To implement the sterile cockpit principle to decrease interruptions and distractions during high volume medication administration and reduce the number of medication errors. BACKGROUND: While some studies have described the importance of reducing interruptions as a tactic to reduce medication errors, work is needed to assess the impact on patient outcomes. METHODS: Data regarding the type and frequency of distractions were collected during the first 11 weeks of implementation. Medication error rates were tracked 1 year before and after 1 year implementation. RESULTS: Simple regression analysis showed a decrease in the mean number of distractions, (ß = -0.193, P = 0.02) over time. The medication error rate decreased by 42.78% (P = 0.04) after implementation of the sterile cockpit principle. CONCLUSIONS: The use of crew resource management techniques, including the sterile cockpit principle, applied to medication administration has a significant impact on patient safety. IMPLICATIONS FOR NURSING MANAGEMENT: Applying the sterile cockpit principle to inpatient medical units is a feasible approach to reduce the number of distractions during the administration of medication, thus, reducing the likelihood of medication error. 'Do Not Disturb' signs and vests are inexpensive, simple interventions that can be used as reminders to decrease distractions.

The case for training Veterans Administration frontline nurses in crew resource management.

Using cultural analysis, the authors present a rationale for a nursing-focused crew resource management (CRM) program in the Veterans Health Administration. Although the value of CRM in aviation is well documented and CRM has been successfully applied in healthcare settings to improve communication and teamwork, there is little evidence outlining the implementation of CRM on nursing units with nursing as the primary focus. This article describes the preproject data supporting a nursing-focused CRM program called nursing CRM. This is the first in a series of 2 articles highlighting this program.