Many hands, light work: A partnership approach to reducing Clostridioides difficile burden on an oncology unit.

An increase in hospital-onset Clostridioides difficile prompted an interprofessional team to implement enhanced environmental service cleaning practices and adopt a routine cleaning program undertaken by clinical staff. These interventions resulted in a reduction of hospital-onset Clostridioides difficile from 7.27 cases per 10,000 patient days to 1.54 cases per 10,000 patient days.

Increasing COVID-19 Immunization Awareness in Rural Communities Through a Multimedia Campaign.

PURPOSE/OBJECTIVES: The purpose of this project was to implement a multimedia campaign to increase COVID-19 vaccine awareness and acceptance in rural communities. DESCRIPTION OF PROJECT: This project was created and implemented in partnership with a public university in Michigan and targeted to rural Michigan communities. The campaign consisted of digital advertisements and video interviews with nurses from rural areas. Interview questions were developed using knowledge of the health belief model and allowed the nurses to share their COVID-19 stories. Video interviews were published to social media, and digital advertisements were targeted to rural areas via geofencing. A viewer response survey was provided to measure likelihood of behavior change after viewing. OUTCOME: The campaign advertisements and videos reached 602 980 people during the implementation period, and 239 surveys were completed. Of the 53 unvaccinated respondents, 87% stated an increased likelihood to vaccinate. CONCLUSION: This project supports the ability of the clinical nurse specialist to lead a multimedia campaign partnership that can reach thousands of people and increase the likelihood of vaccination. As the popularity of digital media continues to rise, clinical nurse specialists can embrace these channels to disseminate critical health information.

Credentialed and Privileged Clinical Nurse Specialists.

PURPOSE/OBJECTIVES: The purpose of this article is to illustrate, using exemplars, the practice of clinical nurse specialists (CNSs) in Michigan who are credentialed and privileged as providers by hospital/healthcare agencies to practice in acute inpatient and ambulatory settings. DESCRIPTION: The CNS provides expert specialty direct patient care to improve patient outcomes. They hold a graduate degree as a CNS, are professionally certified as a CNS in a specialty practice population, and are licensed or otherwise recognized to practice as an advanced practice nurse by the state nursing practice regulatory agency. OUTCOME: The exemplars illustrate CNS practice as an independent provider within a health system. CONCLUSION: Hospital-based credentialing and privileging facilitates CNS practice within the full scope of practice authority that consists of education, certification, and licensure and is a valuable contribution to cost-effective, high-quality clinical care for specialty populations.

An Integrative Review of Team Nursing and Delegation: Implications for Nurse Staffing during COVID-19.

BACKGROUND: During the COVID-19 pandemic, providing care for critically ill patients has been challenging due to the limited number of skilled nurses, rapid transmission of the virus, and increased patient acuity in relation to the virus. These factors have led to the implementation of team nursing as a model of nursing care out of necessity for resource allocation. Nurses can use prior evidence to inform the model of nursing care and reimagine patient care responsibilities during a crisis. PURPOSE: To review the evidence for team nursing as a model of patient care and delegation and determine how it affects patient, nurse, and organizational outcomes. METHODS: We conducted an integrative review of team nursing and delegation using Whittemore and Knafl's (2005) methodology. RESULTS: We identified 22 team nursing articles, 21 delegation articles, and two papers about U.S. nursing laws and scopes of practice for delegation. Overall, team nursing had varied effects on patient, nursing, and organizational outcomes compared with other nursing care models. Education regarding delegation is critical for team nursing, and evidence indicates that it improves nurses' delegation knowledge, decision-making, and competency. LINKING EVIDENCE TO ACTION: Team nursing had both positive and negative outcomes for patients, nurses, and the organization. Delegation education improved team nursing care.

Intravascular Targeted Temperature Management: One Hospital's Experience.

Sudden cardiac arrest (SCA) is one of the leading causes of death in adults around the world. And in some patients, SCA is followed by a return of spontaneous circulation (ROSC) and remain unresponsive. International guidelines recommend therapeutic hypothermia within 4 hours of ROSC for patients' survival. A medium-sized tertiary teaching hospital in the Midwestern United States was not achieving the recommendations of therapeutic hypothermia therapy. A root cause analysis identified multiple factors contributed to therapy delay. In March 2019, this hospital embarked on a 6-month trial of an intravascular targeted temperature management (ITTM) system to meet the recommendations. Donabedian's model guided the trial and included patients who suffered an SCA, with ROSC and remained unresponsive. Descriptive analysis was completed to compare the patients before and after the trial. The trial included interprofessional education of the ITTM system, policies, orders, and new process for initiating the therapy. A total of nine patients were included in the trial and with an average time to target temperature was 3.28 hours compared with 8.81 hours before the trial. The trial demonstrated ITTM was successful in meeting the recommendations. Paired with the promising research on the system's effectiveness, we have demonstrated that intravascular cooling can be implemented to reach the international recommendations. These reductions in treatment delays may prompt improved outcomes for individuals in the post-SCA population.

How advanced practice registered nurse practice barriers impact health care access in Michigan.

ABSTRACT: Despite the Affordable Care Act increasing the number of insured individuals in Michigan, many individuals cannot access care as the state continues to have a provider shortage that is likely to get worse. It is well documented that when individuals lack primary care access, their health suffers. Advanced practice registered nurses (APRN) could help reduce the state's health care shortage, as the care they provide is safe, cost effective, and high quality. Unfortunately, Michigan's APRN practice restrictions limit these professionals from autonomously providing care to the underserved and rural populations that need them the most. Indeed, Michigan is behind other states that offer full practice authority to APRNs, and its health outcomes reflect this stance. Eliminating the restrictive practice environment in Michigan will give citizens better access to primary care.

A Clinical Nurse Specialist-Led Emergency Department Naloxone Distribution Program.

PURPOSE: This article describes the implementation of a clinical nurse specialist-led emergency department overdose education and naloxone distribution program. The program's purpose is to increase naloxone availability to reduce opiate overdose mortality rates within the local community. DESCRIPTION OF PROGRAM: The program distributes naloxone kits to patients in the emergency department after an opioid overdose. The kits are designed to help recipients prevent, recognize, and respond to an opioid overdose. OUTCOME: The program, which includes naloxone take-home kits and clinical guidelines outlining a standard of care for naloxone distribution and coprescribing, was successfully implemented across 11 emergency departments within an integrated health system. More than 250 kits were dispensed within the first year of program implementation along with an online patient education video that received more than 1600 views. In 2017, the county reported an opioid-related overdose death rate of 16.5 (per 100 000 residents). From January 2018 to June 2019, the opioid-related death rate per 100 000 residents was reported at 9.6. CONCLUSION: Although emergency department naloxone distribution programs are feasible in the acute care setting, it was critical for clinical nurse specialists to enlist an interdisciplinary team and engage executive leadership to ensure program success. For others considering such a program, early consideration should be given to determining financial support and evaluating the compliance and regulatory aspects of dispensing medications from emergency settings.

A Model of Academic and Service Partnership Focused on the Clinical Nurse Specialist.

Advancing healthcare transformation includes recommendations for transforming healthcare through enhanced partnerships between academia and health centers. This article describes an innovative approach to building a partnership through the joint appointment of a full-time faculty member in a contracted clinical nurse specialist position in a community hospital. Readers will learn how a successful partnership was achieved and met the needs of the university, hospital, and clinical nurse specialist.

Implications of Transitional Care Interventions on Hospital Readmissions in Patients With Destination Therapy Left Ventricular Assist Devices.

BACKGROUND: The rising number of patients with a left ventricular assist device (LVAD) require care management to successfully transition home after implantation. These patients and their families need to manage their heart failure, and the complexities of an LVAD and the associated lifestyle modifications. Translating knowledge of transitional care interventions in patients with chronic diseases to those with an LVAD may provide valuable insight. To help inform the furthering of care transitions in the LVAD patient population, an integrative review was conducted. AIM: The aim of this review was to explore the transitions of care interventions of care in patients and its potential for application in the destination therapy LVAD. METHODS: This integrative review was guided by the Whittemore and Knafl's methodology. RESULTS: A total of 12 articles from 264 retrieved articles met inclusion criteria and were included in the literature review. DISCUSSION: This review identified that evidence-based transitional care interventions have been shown to decrease avoidable rehospitalization, the associated costs, and improve quality of life when compared to usual care. IMPLICATIONS FOR PRACTICE: A common feature of transitional care interventions is the inclusion of nurse leadership. Nurses should be prepared to participate in transitional care interventions to optimally improve outcomes for patients with heart failure and potentially those with an LVAD. Additionally, to make transitional care interventions more effective they should be implemented with moderate intensity or greater. CONCLUSION: This review provided information supporting the trialing of transitional care interventions in patients with an LVAD and suggests pilot research to optimize interventions for this population.

Catching Quality Before It Falls: Preventing Falls and Injuries in the Adult Emergency Department.

PROBLEM: Although hospital falls and injuries are a significant patient safety concern, research is limited regarding falls and injuries in the emergency department. The purpose of this quality improvement project is to identify and implement evidence-based interventions to prevent patient falls and injuries in the emergency department. METHODS: Literature was reviewed to identify best practices for fall prevention in the emergency department. Data sources included Journal Storage, PubMed, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Database of Systematic Reviews. A retrospective chart review and root cause analysis was completed on fall-related risk reports over a 19-month period at a specific emergency department. Multifactorial fall prevention interventions were implemented in March 2017, which included nursing educational sessions, patient education handout, and high-fall-risk patient identification signs. RESULTS: Post-implementation, zero falls were sustained in April 2017. The average number of falls between April and December 2017 was 5.2 falls/month. Completion of the fall-risk assessment tool ranged between 47 to 90 percent. The patient education handout was provided up to 40 percent of the time. The use of fall risk signs outside patient rooms occurred up to 43 percent of the time. DISCUSSION: The emergency department is a unique environment with complex patient populations. Multifactorial interventions should be used to identify and prevent patient falls and injuries. Multiple change strategies and leadership support are essential to sustain changes. Future research should be conducted regarding the use of fall risk assessments and fall prevention strategies specific to the emergency department.

Performance Improvement to Decrease Readmission Rates for Patients With a Left Ventricular Assist Device.

BACKGROUND: The 30-day readmission rate for patients with a left ventricular assist device implantation at a large, urban, Midwest hospital system (from October 2013 to September 2014) was estimated at 32.1%. PROBLEM STATEMENT: Readmission rates were a concern at this facility. Review of the readmissions, change in practice, and home expectations of patients and families have identified an opportunity to improve the transitions of care for this left ventricular assist device (LVAD) program. Therefore, the purpose of this project was to evaluate the effectiveness and feasibility of a transitional care model (TCM) for care of patients with left ventricular devices. METHODS: Ten patients were enrolled in the pilot that was implemented in June 2015. A transitional care nurse trained to support patients with ventricular assist devices was used to facilitate patient flow. The goal was to create an individualized plan for the development or improvement of self-management skills to decrease readmission rates. The transitional care nurse collaborated with the ventricular device team. OUTCOMES: The 30-day readmission rate during the pilot was 14.3% compared to the previous annual overall rate of 42.6%. IMPLICATIONS FOR PRACTICE: Based on these results, further research is recommended into interventions consistent with the TCM to advance care coordination and to facilitate care transition in the this fragile patient population.

Developing a kit and video to standardize changes of left ventricular assist device dressings.

Context-Driveline infection is a major cause of morbidity and mortality in the patients with a left ventricular assist device (LVAD). Our center developed 2 LVAD dressing change kits and instructional videos for the purpose of standardizing a protocol for the dressing changes. Objective-To develop 2 different types of driveline dressing kits and videos to help in standardizing the education of our patients, caregivers, and staff. Design-A survey to evaluate patient, caregiver, and staff satisfaction and ease of use relating to the newly implemented dressing kits and videos. A comparison of driveline infection rates before and after the quality improvement project also was conducted. Patients/Participants, Settings-LVAD patients, their caregivers, and staff from Spectrum Health in Grand Rapids, Michigan. Results-Surveys were sent to 80 patient/caregiver pairs and 330 staff members. A total of 5 patients, 10 caregivers, and 48 staff members completed the surveys. All participants agreed that patients' driveline sites looked about the same, if not better than, they did before the kits were made available. They also overwhelmingly agreed that the kits were convenient (98%) and easy to use (99%). Patients and their caregivers gave favorable responses to the videos. The project experienced a slight increase in driveline infection rates, but the difference was not statistically significant. Conclusion-Standardizing and producing a driveline kit facilitates the delivery of care in an LVAD program.

The relationship of bedside nurses' emotional intelligence with quality of care.

Emotional intelligence, a predictor of productivity and success, may impact behaviors responsible for quality of care. This study examined if emotional intelligence of units' bedside nurses is related to the quality of care delivered to the patients. In this study, emotional intelligence was found to be correlated to the number of Clostridium difficile infections, MRSA infections, patient falls with injury, and pressure ulcer screenings (P < .001) in the inpatient acute care setting.