Empowerment Through Academia.

This is the sixth article in a series on nurse innovators, which focuses on nurse-engineer partnerships and outlines working, replicable models of collaboration between the two disciplines. In this installment, we describe the role of academia in building the next generation of nurse-engineers, highlighting three novel academic programs that have reimagined nursing and engineering education to promote interdisciplinary partnership and innovation.

Data-based program management of system-wide IV smart pump integration.

PURPOSE: Smart pump bidirectional interoperability offers automated infusion programming and documentation that can improve patient safety and workflow efficiency. This technology has been poorly implemented across US hospitals, and there is little guidance on the tracking or monitoring of interoperability systems. The purpose of this report is to describe the successful implementation of intravenous (IV) smart pump interoperability in a large health system. SUMMARY: Bidirectional IV smart pump interoperability and compliance monitoring were implemented across a large Midwestern health system using ICU Medical's Plum 360 and LifeCare PCA devices and Smith Medical's MedFusion 4000 Syringe Pump devices. The hospital system's experience in implementing and monitoring IV smart pump compliance using automated reports and a dedicated medication safety integration nurse is described. Compliance trends suggest that the implementation of IV smart pump interoperability has achieved a reduction in programming outside of the dose error reduction system, manual overrides, and IV medication administration error rates. CONCLUSION: The monitoring of smart pump compliance has had demonstrated benefits in investigating usability concerns, recognizing system errors, and identifying increased needs for nurse training. This program can serve as an example for other healthcare systems adopting IV smart pump interoperability.

Impact of hospital-acquired pneumonia on the Medicare program.

OBJECTIVE: Patient safety organizations and researchers describe hospital-acquired pneumonia (HAP) as a largely preventable hospital-acquired infection that affects patient safety and quality of care. We provide evidence regarding the consequences of HAP among 2019 Medicare beneficiaries. DESIGN: Retrospective case-control study. PATIENTS: Calendar year 2019 Medicare beneficiaries with HAP during an initial hospitalization, defined by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding on inpatient claims (n = 2,457). Beneficiaries with HAP were matched using diagnosis-related group (DRG) codes with beneficiaries who did not experience HAP (n = 2,457). METHODS: The 2019 calendar year Medicare 5% Standard Analytic Files (SAF), for inpatient, outpatient, physician, and all postacute hospital settings. The case group (HAP) and control group (non-HAP) were matched on disease severity, age, sex, and race and were compared for hospital length of stay, costs, and mortality during the initial hospitalization and across settings for 30, 60, and 90 days after discharge. The 2019 fiscal year MedPAR Claims data were used to determine Medicare costs. RESULTS: Medicare beneficiaries with HAP were 2.8 times more likely to die within 90 days compared with matched beneficiaries who did not develop HAP. Among those who survived, beneficiaries with HAP spent 6.6 more days in the hospital (69%) and cost the Medicare program an average of $14,487 (24%) more per episode of care across initial inpatient and postdischarge services. CONCLUSIONS: The findings of higher mortality and cost among Medicare beneficiaries who develop HAP suggest that HAP prevention should be prioritized as a patient safety and quality initiative for the Medicare program.

Comparative analysis of signal accuracy of three SpO2 monitors during motion and low perfusion conditions.

To compare pulse oximetry performance during simulated conditions of motion and low perfusion in three commercially available devices: GE HealthCare CARESCAPE ONE TruSignal SpO2 Parameter, Masimo RADICAL-7 and Medtronic Nellcor PM1000N. After IRB approval, 28 healthy adult volunteers were randomly assigned to the motion group (N = 14) or low perfusion (N = 14) group. Pulse oximeters were placed on the test and control hands using random assignment of digits 2-5. Each subject served as their own control through the series of repeated pair-wise measurements. Reference co-oximetry oxyhemoglobin (SaO2) measurements from the radial artery were also obtained in the motion group. SpO2 readings were compared between the test and control hands in both groups and to SaO2 measurements in the motion group. Accuracy was assessed through testing of accuracy root-mean squared (ARMS) and mean bias. In the simulated motion test group the overall Accuracy Root Mean Square (ARMS) versus SaO2 was 1.88 (GE), 1.79 (Masimo) and 2.40 (Nellcor), with overall mean bias of - 0.21 (Masimo), 0.45 (GE), and 0.78 (Nellcor). In the motion hand, ARMS versus SaO2 was 2.45 (GE), 3.19 (Masimo) and 4.15 (Nellcor), with overall mean bias of - 0.75 (Masimo), - 0.01 (GE), and 0.04 (Nellcor). In the low perfusion test group, ARMS versus the control hand SpO2 for low PI was 3.24 (GE), 3.48 (Nellcor) and 4.76 (Masimo), with overall bias measurements of - 0.53 (Nellcor), 0.96 (GE) and 1.76 (Masimo). Experimental results for all tested devices met pulse oximetry regulatory and testing standards requirements. Overall, SpO2 device performance across the three devices in this study was similar under both motion and low perfusion conditions. SpO2 measurement accuracy degraded for all three devices during motion as compared to non-motion. Accuracy also degraded during normal to low, very low, or ultra low perfusion and was more pronounced compared to the changes observed during simulated motion. While some statistically significant differences in individual measurements were found, the clinical relevance of these differences requires further study.

Improving Bruise Detection in Patients with Dark Skin Tone.

This is the fifth article in a series on nurse innovators, which focuses whenever possible on nurse-engineer partnerships and outlines working, replicable models of collaboration between the two disciplines. In this installment, we profile Katherine N. Scafide, a forensic nurse and researcher, who has partnered with engineers over many years to improve bruise detection in patients with dark skin tone.

Nurse-Engineer Partnerships in Academia.

This is the fourth article in a series on nurse innovators, which focuses whenever possible on nurse-engineer partnerships and outlines working, replicable models of collaboration between the two disciplines. In this installment, we explore the work of four engineers who are forging a path to strengthen nurse-engineer partnerships through their work in academia. Their experiences exemplify the work of nurse-engineer teams, inform ways to employ these teams, and reveal the insights that result when these disciplines collaborate in real time to solve health care problems.

Incidence, mortality, and cost trends in nonventilator hospital-acquired pneumonia in medicaid beneficiaries, 2015-2019.

Nonventilator hospital-acquired pneumonia is associated with substantial morbidity, mortality, and costs during an episode of acute care. We examined NVHAP incidence, mortality, and costs of Medicaid beneficiaries over a 5-year period (2015-2019). Overall NVHAP incidence was 2.63 per 1,000 patient days, and mortality was 7.76%, with an excess cost per NVHAP case of $20,189.

The association between accessing dental services and nonventilator hospital-acquired pneumonia among 2019 Medicaid beneficiaries.

In this 2019 cross-sectional study, we analyzed hospital records for Medicaid beneficiaries who acquired nonventilator hospital-acquired pneumonia. The results suggest that preventive dental treatment in the 12 months prior or periodontal therapy in the 6 months prior to a hospitalization is associated with a reduced risk of NVHAP.

A Nurse Innovator Paves the Way for Other Nurses.

This is the third article in a series on nurse innovators, which focuses whenever possible on nurse-engineer partnerships and outlines working, replicable models of collaboration between the two disciplines. In this installment, we profile Brian Mohika, BSN, RN, creator of CathWear-a wearable medical device that supports patients with catheter drainage leg bags. His nine-year journey of successes and challenges highlights the value of early, real-time collaboration with an interdisciplinary team, and underscores the need for nurses to see themselves as innovators.

Intravenous Smart Pumps at the Point of Care: A Descriptive, Observational Study.

OBJECTIVE: This study was conducted to advance understanding of intravenous (IV) smart pump medication administration practices using the Baxter Spectrum IQ. The primary objective was to observe adherence with manufacturer required IV smart pump system setup at the point of care during actual clinical use. METHODS: The study was conducted in a 285-bed acute care community hospital near Boston, Massachusetts. The study design was observational and noninterventional, and all data were collected by a single observer. Observations included measurement and documentation of adherence with the Baxter Spectrum IQ system setup requirements. RESULTS: A total of 200 primary and secondary IV medication administration observations were included: 101 in critical care and 99 in medical-surgical. Overall adherence was found to be: 6.5% with IV smart pump position relative to the patient (aim 1); 6.5% with required position of the primary infusion bag (aim 2); and 69.5% adherence with required position of the secondary medication infusion bag (aim 3). Additional exploratory data were also collected. CONCLUSIONS: These results add to the emerging body of knowledge, which support that adherence to required system setup for head-height dependent IV smart pumps is low and difficult to achieve during actual clinical use. Consideration of alternative human factors-designed technology to replace the current manual setup requirements is needed to improve the process of acute care IV medication administration in this very important area of patient safety.

Collaborative Nurse-Engineer Product Innovation.

This is the second article in a series on nurse innovators, which focuses whenever possible on nurse-engineer partnerships and outlines working, replicable models of collaboration between the two disciplines. In this installment, we profile Lindsey Roddy, a nurse, and Kyle Jansson, an engineer-partners who collaborated on an innovative medical device called SecureMove-TLC, designed to improve caregiver workflow, reduce health care costs associated with line dislodgment, and promote safety for both patients and caregivers.

A qualitative analysis of intravenous smart pump usability.

AIM: To understand the experience of critical care nurses when performing common, yet error-prone, programming tasks on two unfamiliar intravenous smart pumps. DESIGN: A qualitative descriptive study using data collected during a previous quantitative pilot study. METHODS: Following completion of common intravenous programming tasks each participant was interviewed using a semi-structured interview guide. All interview data were coded line-by-line and thematic analysis revealed themes across all participants' interviews. RESULTS: The following four themes were identified: appreciation for attractive design features, the need for efficiency, the importance of intuitive use and concern for patient outcomes. Overall, these themes provide evidence that nurses strongly prefer a more usable intravenous smart pump interface that integrates safeguards to efficiently improve patient outcomes. Findings support the need for intravenous smart pump technology to be developed with an intuitive interface that decreases the level of cognitive demand and will lead to improved patient safety.

INNOVATE: Preparing Nurses to Be Health Care Innovation Leaders.

A new certificate program has been designed that augments the traditional undergraduate nursing education with a curriculum of innovation and entrepreneurship. The goal of the Integrated Innovation & Entrepreneurship Certificate in Nursing Program (INNOVATE) is to empower nurses to collaboratively solve health care challenges and become thought leaders in health care products, technologies, and processes, as well as service and delivery methods, with a particular focus on the needs of vulnerable populations. Toward this goal, INNOVATE is built on an integrative, immersive curriculum, experiential learning, intentional cohort building, peer and faculty support, real-world connections, and the prioritization of diversity, inclusivity, and equity to build of a cohort of nursing students ready for careers in clinical and health care innovation. In this article, we provide the outline for the proposed curriculum, program strategies, anticipated outcomes, and evaluation criteria that we believe can serve as a national model for innovation and entrepreneurship in undergraduate nursing education.

Reprint from AJN: Secondary Medication Administration and IV Smart Pump Setup: What every nurse needs to know.

Secondary infusion by large-volume iv smart pump is used extensively in the acute care setting for one-time or intermittent administration of medications such as antibiotics, electrolyte replacements, and some oncology drugs. Consistent and accurate delivery of secondary medications requires a full understanding of the system and setup requirements. Unfortunately, it is not uncommon for nurses to find a secondary medication only partially administered when their programming should have resulted in a complete infusion. This article discusses the technical requirements that every nurse should know when administering secondary medications using an iv smart pump.

Oral health status and the etiology and prevention of nonventilator hospital-associated pneumonia.

Nonventilator hospital-associated pneumonia has recently emerged as an important preventable hospital-associated infection, and is a leading cause of healthcare-associated infection. Substantial accumulated evidence links poor oral health with an increased risk of pneumonia, which can be caused by bacterial, viral, or fungal pathogens, each with their own distinct mechanisms of transmission and host susceptibility. These infections are frequently polymicrobial, and often include microbes from biofilms in the oral cavity. Evidence documenting the importance of oral care to prevent nonventilator hospital-associated pneumonia is continuing to emerge. Reduction of oral biofilm in these populations will reduce the numbers of potential respiratory pathogens in the oral secretions that can be aspirated, which in turn can reduce the risk for pneumonia. This review summarizes up-to-date information on the role of oral care in the prevention of nonventilator hospital-associated pneumonia.

Health Care Innovation: Embracing the Nurse-Engineer Partnership.

This article introduces a series on nurse innovators, focusing whenever possible on nurse-engineer partnerships and outlining working, replicable models of collaboration between the two disciplines. This first column highlights the similarities between nursing and engineering, provides a case example, and discusses barriers to nurse-engineer partnerships as well as recommendations for success. Listen to a podcast with the authors at www.ajnonline.com.

Secondary Medication Administration and IV Smart Pump Setup.

ABSTRACT: Secondary infusion by large-volume IV smart pump is used extensively in the acute care setting for one-time or intermittent administration of medications such as antibiotics, electrolyte replacements, and some oncology drugs. Consistent and accurate delivery of secondary medications requires a full understanding of the system and setup requirements. Unfortunately, it is not uncommon for nurses to find a secondary medication only partially administered when their programming should have resulted in a complete infusion. This article discusses the technical requirements that every nurse should know when administering secondary medications using an IV smart pump.

Nonventilator hospital-acquired pneumonia: A call to action.

In 2020 a group of U.S. healthcare leaders formed the National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP) to issue a call to action to address non-ventilator-associated hospital-acquired pneumonia (NVHAP). NVHAP is one of the most common and morbid healthcare-associated infections, but it is not tracked, reported, or actively prevented by most hospitals. This national call to action includes (1) launching a national healthcare conversation about NVHAP prevention; (2) adding NVHAP prevention measures to education for patients, healthcare professionals, and students; (3) challenging healthcare systems and insurers to implement and support NVHAP prevention; and (4) encouraging researchers to develop new strategies for NVHAP surveillance and prevention. The purpose of this document is to outline research needs to support the NVHAP call to action. Primary needs include the development of better models to estimate the economic cost of NVHAP, to elucidate the pathophysiology of NVHAP and identify the most promising pathways for prevention, to develop objective and efficient surveillance methods to track NVHAP, to rigorously test the impact of prevention strategies proposed to prevent NVHAP, and to identify the policy levers that will best engage hospitals in NVHAP surveillance and prevention. A joint task force developed this document including stakeholders from the Veterans' Health Administration (VHA), the U.S. Centers for Disease Control and Prevention (CDC), The Joint Commission, the American Dental Association, the Patient Safety Movement Foundation, Oral Health Nursing Education and Practice (OHNEP), Teaching Oral-Systemic Health (TOSH), industry partners and academia.