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1.
J Am Geriatr Soc ; 2019 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-31721145

RESUMEN

The US population is aging faster than at any other time in our history. This growth, coupled with a slow adaptive health policy framework, is creating an urgent need to reengineer and improve the quality, safety, and cost-effectiveness of health systems to meet the needs of older adults and embrace the success we have achieved with longevity. Without rapid adoption of evidence-based models that are known to improve safety and health outcomes, we significantly jeopardize the lives of thousands of older adults receiving care under our current health systems' processes and models. This article describes an innovation and operations infrastructure that was successfully tested in two independent and geographically distinct community health systems. This operations and implementation framework can be scaled and used to accelerate the changes needed to improve care for older adults in health systems throughout the United States.

2.
BMJ Open Qual ; 7(4): e000417, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30515469

RESUMEN

Background: One in three people over the age of 65 fall every year, with 1/3 sustaining at least moderate injury. Falls risk reduction requires an interprofessional health team approach. The literature is lacking in effective models to teach students how to work collaboratively in interprofessional teams for geriatric falls prevention. The purpose of this paper is to describe the development, administration and outcome measures of an education programme to teach principles of interprofessional care for older adults in the context of falls prevention. Methods: Students from three academic institutions representing 12 health disciplines took part in the education programme over 18 months (n=237). A mixed method one-group pretest and post-test experimental design was implemented to measure the impact of a multistep education model on progression in interprofessional collaboration competencies and satisfaction. Results: Paired t-tests of pre-education to posteducation measures of Interprofessional Socialization and Valuing Scale scores (n=136) demonstrated statistically significant increase in subscales and total scores (p<0.001). Qualitative satisfaction results were strongly positive. Discussion: Results of this study indicate that active interprofessional education can result in positive student attitude regarding interprofessional team-based care, and satisfaction with learning. Lessons learnt in a rapid cycle plan-do-study-act approach are shared to guide replication efforts for other educators. Conclusion: Effective models to teach falls prevention interventions and interprofessional practice are not yet established. This education model is easily replicable and can be used to teach interprofessional teamwork competency skills in falls and other geriatric syndromes.

3.
Res Gerontol Nurs ; 10(4): 155-161, 2017 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-28742924

RESUMEN

Managing missing data in a secondary analysis is daunting, particularly if the data of interest were not included in the parent study design. The current study describes the use of geocoding to replace missing data from a parent study for a secondary analysis of socioeconomic and neighborhood characteristics in community-dwelling older adults who are dually eligible for Medicare and Medicaid. Geocoding was used to link participants' addresses to data from the American Community Survey to replace missing income and neighborhood data. After geocoding, data completeness was 100% for neighborhood poverty and education composition, and 99.9% for income. Using geocoding provides the gerontological nurse researcher with a sample that is more reflective of the population. The current findings can be used to tailor neighborhood-centered interventions to promote health in low-income older adults. [Res Gerontol Nurs. 2017; 10(4):155-161.].


Asunto(s)
Actividades Cotidianas , Recolección de Datos/métodos , Evaluación Geriátrica/estadística & datos numéricos , Vida Independiente/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Sesgo , Femenino , Humanos , Masculino , Clase Social , Apoyo Social , Estados Unidos
4.
Geriatr Nurs ; 36(2 Suppl): S16-20, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25784082

RESUMEN

Dually enrolled Medicare-Medicaid older adults are a vulnerable population. We tested House's Conceptual Framework for Understanding Social Inequalities in Health and Aging in Medicare-Medicaid enrollees by examining the extent to which disparities indicators, which included race, age, gender, neighborhood poverty, education, income, exercise (e.g., walking), and physical activity (e.g., housework) influence physical function and emotional well-being. This secondary analysis included 337 Black (31%) and White (69%) older Medicare-Medicaid enrollees. Using path analysis, we determined that race, neighborhood poverty, education, and income did not influence physical function or emotional well-being. However, physical activity (e.g., housework) was associated with an increased self-report of physical function and emotional well-being of ß = .23, p < .001; ß = .17, p < .01, respectively. Future studies of factors that influence physical function and emotional well-being in this population should take into account health status indicators such as allostatic load, comorbidity, and perceived racism/discrimination.


Asunto(s)
Ejercicio , Disparidades en el Estado de Salud , Medicaid , Medicare , Salud Mental , Anciano , Anciano de 80 o más Años , Emociones , Femenino , Humanos , Masculino , Factores Socioeconómicos , Estados Unidos
5.
Am J Hosp Palliat Care ; 32(5): 510-5, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24711574

RESUMEN

Organizational characteristics may impede the uniform adoption of advance care planning (ACP) best practices. We conducted telephone interviews with site directors of a Midwestern state's Medicaid waiver program administered by the Area Agencies on Aging and surveyed the 433 care managers (registered nurses and social workers) employed within these 9 agencies. Care managers at 2 agencies reported more frequent ACP discussions and higher levels of confidence. Both sites had ACP training programs, follow-up protocols, and informational packets available for consumers that were not consistently available at the other agencies. The findings point to the need for consistent educational programs and policies on ACP and more in depth examination of the values, beliefs, and resources that account for organizational differences in ACP.


Asunto(s)
Planificación Anticipada de Atención/organización & administración , Adulto , Planificación Anticipada de Atención/normas , Protocolos Clínicos/normas , Estudios Transversales , Femenino , Humanos , Capacitación en Servicio/organización & administración , Masculino , Medicaid/estadística & datos numéricos , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estados Unidos
6.
Popul Health Manag ; 17(2): 106-11, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24156664

RESUMEN

The specific aim of the PEACE pilot study was to determine the feasibility of a fully powered study to test the effectiveness of an in-home geriatrics/palliative care interdisciplinary care management intervention for improving measures of utilization, quality of care, and quality of life in enrollees of Ohio's community-based long-term care Medicaid waiver program, PASSPORT. This was a randomized pilot study (n=40 intervention [IG], n=40 usual care) involving new enrollees into PASSPORT who were >60 years old. This was an in-home interdisciplinary chronic illness care management intervention by PASSPORT care managers collaborating with a hospital-based geriatrics/palliative care specialist team and the consumer's primary care physician. This pilot was not powered to test hypotheses; instead, it was hypothesis generating. Primary outcomes measured symptom control, mood, decision making, spirituality, and quality of life. Little difference was seen in primary outcomes; however, utilization favored the IG. At 12 months, the IG had fewer hospital visits (50% vs. 55%, P=0.65) and fewer nursing facility admissions (22.5% vs. 32.5%, P=0.32). Using hospital-based specialists interfacing with a community agency to provide a team-based approach to care of consumers with chronic illnesses was found to be feasible. Lack of change in symptom control or quality of life outcome measures may be related to the tools used, as these were validated in populations closer to the end of life. Data from this pilot study will be used to calculate the sample size needed for a fully powered trial.


Asunto(s)
Planificación Anticipada de Atención/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Cuidados a Largo Plazo/organización & administración , Calidad de Vida , Anciano , Anciano de 80 o más Años , Femenino , Anciano Frágil , Evaluación Geriátrica/métodos , Promoción de la Salud , Servicios de Salud para Ancianos/organización & administración , Humanos , Comunicación Interdisciplinaria , Masculino , Ohio , Cuidados Paliativos/organización & administración , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Valores de Referencia , Resultado del Tratamiento
7.
Am J Infect Control ; 41(9): 793-8, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23433982

RESUMEN

BACKGROUND: Transmission of health care-associated infections (HAIs) has been primarily attributed to health care workers, and hand hygiene is considered the most important means to reduce transmission. Whereas hand hygiene research has focused on reducing health care worker hand contamination and improving hand hygiene compliance, contamination of patients' hands and their role in the transmission of HAIs remains unknown. METHODS: Patients' hands were sampled by a "glove juice" recovery method and enumerated for the presence of common health care-associated pathogens. Patient demographics and other covariates were collected to determine their association with patient hand contamination. Patient attitudes and practices toward hand hygiene were also surveyed and analyzed. RESULTS: Of the 100 patients in the study, 39% of hands were contaminated with at least 1 pathogenic organism, and 8% were contaminated with 2 or more pathogens 48 hours after admission. Patient admission from or discharge to an outside institution and self-reported functional limitations were the only covariates that were significantly associated with hand contamination. CONCLUSION: Pathogenic organisms can be frequently detected on hands of acute care patients. Future studies are needed to better understand the relationship between patient hand contamination and the acquisition of HAIs in addition to the role patient hand hygiene can play in reducing HAIs.


Asunto(s)
Infección Hospitalaria/epidemiología , Infección Hospitalaria/transmisión , Adhesión a Directriz/estadística & datos numéricos , Higiene de las Manos , Conocimientos, Actitudes y Práctica en Salud , Cooperación del Paciente/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Infección Hospitalaria/prevención & control , Femenino , Mano/microbiología , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Prevalencia , Adulto Joven
8.
Am J Hosp Palliat Care ; 30(8): 759-63, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23395955

RESUMEN

BACKGROUND: Initiating advance care planning (ACP) discussions in the home may prevent avoidable hospitalizations by elucidating goals of care. Area agencies on aging care managers (AAACMs) work in the home with high-risk consumers. PURPOSE: To determine which AAACM characteristics contribute to an increased frequency of ACP discussions. METHOD: Cross-sectional investigator-generated surveys administered to AAACMs at 3 AAAs in Ohio. RESULTS: Of 289 AAACMs, 182 (63%) responded. The more experience and comfort AAACMs felt with ACP discussions, the more likely they were to initiate ACP discussions. DISCUSSION: It may be necessary to build interactive educational experiences where, for example, AAACMs are asked to fill out their own advance directives and/or facilitate others in ACP discussions to improve experience and comfort with ACP discussions.


Asunto(s)
Planificación Anticipada de Atención , Directivas Anticipadas , Estudios Transversales , Humanos , Ohio
9.
Am J Hosp Palliat Care ; 30(5): 419-24, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22798634

RESUMEN

PURPOSE: To evaluate primary care physicians' understanding of and experience with advance care planning (ACP), palliative care, and hospice and how this might affect their utilization of these services. METHODS: Investigator-generated survey. RESULTS: Older age, more years in practice, and more personal and professional experience with ACP were correlated with an increase in the percentage of patients with progressive, chronic life-limiting diseases with whom physicians discussed advance directives. Overall, 97.5% of physician's expressed comfort in discussing ACP yet reported discussing advance directives with only 43% of appropriate patients. DISCUSSION: Often, discussions about ACP or referrals to palliative care or hospice do not occur until the patient is near the end of life. Our results indicate that primary care physician's personal and professional experience with ACP may be contributing to some of the barriers to these discussions.


Asunto(s)
Planificación Anticipada de Atención/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Cuidados Paliativos/estadística & datos numéricos , Médicos/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Actitud del Personal de Salud , Recolección de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ohio/epidemiología , Relaciones Médico-Paciente , Pautas de la Práctica en Medicina/estadística & datos numéricos , Cuidado Terminal/estadística & datos numéricos
10.
Am J Hosp Palliat Care ; 30(7): 717-25, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23125397

RESUMEN

Factorial surveys were used to examine community-based long-term care providers' judgments about consumers' need for advance care planning (ACP) and comfort levels in discussing ACP. Providers (448 registered nurses and social workers) judged vignettes based on hypothetical consumers. Hierarchical linear models indicated providers judged consumers who were older, had end-stage diagnoses, multiple emergency department visits, and uninvolved caregivers as most in need of ACP. These variables explained 10% of the variance in judgments. Providers' beliefs about ACP predicted judgments of need for ACP and comfort level in discussing ACP. Provider characteristics explained more variance in comfort levels (44%) than in judgments of need (20%). This study demonstrates the need for tailored educational programs to increase comfort levels and address ACP misconceptions.


Asunto(s)
Planificación Anticipada de Atención , Cuidados a Largo Plazo , Cuidadores , Humanos , Encuestas y Cuestionarios
11.
J Gerontol Soc Work ; 55(8): 721-37, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-23078607

RESUMEN

To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.


Asunto(s)
Planificación Anticipada de Atención/organización & administración , Personal de Salud , Servicios de Salud para Ancianos , Cuidados a Largo Plazo , Manejo de Atención al Paciente , Servicio Social/normas , Actitud del Personal de Salud , Toma de Decisiones , Grupos Focales , Personal de Salud/psicología , Personal de Salud/normas , Humanos , Relaciones Interpersonales , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/organización & administración , Cuidados a Largo Plazo/psicología , Evaluación de Necesidades , Ohio , Manejo de Atención al Paciente/métodos , Manejo de Atención al Paciente/organización & administración , Educación del Paciente como Asunto , Investigación Cualitativa , Cuidado Terminal/organización & administración , Cuidado Terminal/psicología
12.
Am J Med Qual ; 27(4): 291-6, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22327023

RESUMEN

The objective of this study was to test the efficacy of a standardized form used during transfers between long-term care facilities (LTCFs) and the acute care setting. The intervention consisted of development and implementation of the transfer form and education about its use. Charts from 26 LTCFs and 1 acute care hospital were reviewed at 1 and 6 months prior to initiation of the transfer form (2007) and at 1 and 6 months after initiation of the transfer form (2008); 210 patient charts were reviewed in 2007 and 172 in 2008. There was 79% concordance between documented LTCF advance directives (ADs) and hospital ADs in 2008-an increase from 66.6% in 2007 (P = .038). Inpatient hospice/palliative care admissions rose from 1.5% in 2007 to 7.7% in 2009 (P = .015). The standardized transfer form improved communication of ADs between LTCFs and the hospital. Secondarily, it may have increased admissions to the acute palliative care unit.


Asunto(s)
Continuidad de la Atención al Paciente , Prioridad del Paciente , Transferencia de Pacientes/organización & administración , Registros , Anciano , Comunicación , Continuidad de la Atención al Paciente/organización & administración , Cuidados Críticos/organización & administración , Femenino , Humanos , Cuidados a Largo Plazo/organización & administración , Masculino
13.
J Pain Symptom Manage ; 43(1): 10-9, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21763100

RESUMEN

CONTEXT: There is limited research on how community-based long-term care (CBLTC) providers' personal characteristics and attitudes affect their decisions to initiate advance care planning (ACP) conversations with consumers. OBJECTIVES: To examine judgments by CBLTC providers as to whether a consumer was in need of ACP and to compare the relative influence of situational features of the consumer with the influence of personal characteristics of the CBLTC provider. METHODS: Factorial surveys with vignettes with randomly assigned situational features of a hypothetical consumer were obtained from 182 CBLTC providers at three Area Agencies on Aging located in the Midwestern U.S. Measures included the consumer's situational features, such as demographics, diagnosis, pain level, level of functioning, and caregiver involvement. Personal characteristics of the CBLTC provider included demographics, discipline, past experience with ACP, and attitudes toward ACP. RESULTS: Hierarchical linear models indicated that most variability in ACP decisions was the result of differences among CBLTC providers (64%) rather than consumers' situational features. Positive decisions to discuss ACP were associated with consumers who needed assistance with legal issues and had a cancer diagnosis; these variables explained 8% of the vignette level variance. Significant personal characteristics of the CBLTC provider included a nursing background, less direct contact with consumers, past experience with ACP, and positive attitudes toward ACP; these variables explained 41% of the person-level variance. CONCLUSION: This study shows the lack of normative consensus about ACP and highlights the need for consistent educational programs regarding the role of the CBLTC provider in the ACP process.


Asunto(s)
Planificación Anticipada de Atención/estadística & datos numéricos , Actitud del Personal de Salud , Comportamiento del Consumidor/estadística & datos numéricos , Toma de Decisiones , Encuestas de Atención de la Salud , Satisfacción del Paciente/estadística & datos numéricos , Planificación Anticipada de Atención/organización & administración , Humanos , Medio Oeste de Estados Unidos , Modelos Organizacionales , Vigilancia de la Población , Encuestas y Cuestionarios
14.
Popul Health Manag ; 15(2): 71-7, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22088165

RESUMEN

Practice guidelines are available for hospice and palliative medicine specialists and geriatricians. However, these guidelines do not adequately address the needs of patients who straddle the 2 specialties: homebound chronically ill patients. The purpose of this article is to describe the theoretical basis for the Promoting Effective Advance Care for Elders (PEACE) randomized pilot study. PEACE is an ongoing 2-group randomized pilot study (n=80) to test an in-home interdisciplinary care management intervention that combines palliative care approaches to symptom management, psychosocial and emotional support, and advance care planning with geriatric medicine approaches to optimizing function and addressing polypharmacy. The population comprises new enrollees into PASSPORT, Ohio's community-based, long-term care Medicaid waiver program. All PASSPORT enrollees have geriatric/palliative care crossover needs because they are nursing home eligible. The intervention is based on Wagner's Chronic Care Model and includes comprehensive interdisciplinary care management for these low-income frail elders with chronic illnesses, uses evidence-based protocols, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. Our model, with its standardized, evidence-based medical and psychosocial intervention protocols, will transport easily to other sites that are interested in optimizing outcomes for community-based, chronically ill older adults.


Asunto(s)
Enfermedad Crónica , Anciano Frágil , Promoción de la Salud/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Personas Imposibilitadas , Planificación de Atención al Paciente/organización & administración , Anciano , Anciano de 80 o más Años , Determinación de la Elegibilidad , Medicina Basada en la Evidencia , Femenino , Evaluación Geriátrica , Humanos , Masculino , Medicaid , Ohio , Cuidados Paliativos , Proyectos Piloto , Pobreza , Proyectos de Investigación , Apoyo Social , Estados Unidos
15.
Popul Health Manag ; 14(3): 137-42, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21323461

RESUMEN

Interdisciplinary care management is advocated for optimal care of patients with many types of chronic illnesses; however, few models exist that have been tested using randomized trials. The purpose of this report is to describe the theoretical basis for the After Discharge Management of Low Income Frail Elderly (AD-LIFE) trial, which is an ongoing 2-group randomized trial (total n = 530) to test a chronic illness management and transitional care intervention. The intervention is based on Wagner's chronic illness care model and involves comprehensive posthospitalization nurse-led interdisciplinary care management for low income frail elders with chronic illnesses, employs evidence-based protocols that were developed using the Assessing Care of Vulnerable Elders (ACOVE) guidelines, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. The primary aim of the AD-LIFE trial is to test a chronic illness management intervention in vulnerable patients who are eligible for Medicare and Medicaid. This model, with its standardized, evidence-based medical and psychosocial intervention protocols, will be easily transportable to other sites interested in optimizing outcomes for chronically ill older adults. If the results of the AD-LIFE trial demonstrate the superiority of the intervention, then this data will be important for health care policy makers.


Asunto(s)
Continuidad de la Atención al Paciente , Anciano Frágil , Alta del Paciente , Proyectos de Investigación , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Técnicas de Apoyo para la Decisión , Medicina Basada en la Evidencia , Promoción de la Salud , Humanos , Masculino , Modelos Teóricos , Médicos de Atención Primaria , Pobreza/economía , Pobreza/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Autocuidado/métodos , Estados Unidos
16.
J Stroke Cerebrovasc Dis ; 18(6): 443-52, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19900646

RESUMEN

OBJECTIVE: We sought to evaluate whether comprehensive postdischarge care management for stroke survivors is superior to organized acute stroke department care with enhanced discharge planning in improving a profile of health and well-being. METHODS: This was a randomized trial of a comprehensive postdischarge care management intervention for patients with ischemic stroke and National Institutes of Health Stroke Scale scores greater than or equal to 1 discharged from an acute stroke department. An advanced practice nurse performed an in-home assessment for the intervention group from which an interdisciplinary team developed patient-specific care plans. The advanced practice nurse worked with the primary care physician and patient to implement the plan during the next 6 months. The intervention and usual care groups were compared using a global and closed hypothesis testing strategy. Outcomes fell into 5 domains: (1) neuromotor function, (2) institution time or death, (3) quality of life, (4) management of risk, and (5) stroke knowledge and lifestyle. RESULTS: Treatment effect was near 0 SD for all except the stroke knowledge and lifestyle domain, which showed a significant effect of the intervention (P = .0003). CONCLUSIONS: Postdischarge care management was not more effective than organized stroke department care with enhanced discharge planning in most domains in this population. The intervention did, however, fill a postdischarge knowledge gap.


Asunto(s)
Continuidad de la Atención al Paciente , Servicios de Atención a Domicilio Provisto por Hospital , Grupo de Atención al Paciente , Alta del Paciente , Accidente Cerebrovascular/terapia , Anciano , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Tiempo de Internación , Masculino , Actividad Motora , Calidad de Vida , Recurrencia , Conducta de Reducción del Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología , Factores de Tiempo , Resultado del Tratamiento
17.
Int J Older People Nurs ; 4(3): 194-202, 2009 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20925776

RESUMEN

Background. The prevalence of delirium in acute care hospitals ranges from 5-86%. Delirious patients are at greater risk of negative health outcomes and their care is often more costly. Aim. To determine the feasibility of a full-scale trial to test the effectiveness of an intervention designed to improve delirium prevention, detection and intervention in an acute care hospital. Design. A delirium prevention protocol was designed by an interdisciplinary group of clinicians and implemented on intervention unit patients who passed a mental status screen, were at high risk for delirium according to the modified NEECHAM scale, and met other eligibility criteria. These patients were reviewed at daily interdisciplinary team meetings and team recommendations were placed in the patient's chart. On the usual care unit, physicians were notified if their patients were at high risk, but the delirium protocol was not implemented. Methods. The delirium protocol was pilot tested with 35 high risk patients on an Acute Care for Elders (ACE) unit. Outcomes were compared to 35 high risk patients on a similar medical unit without the delirium protocol. Results. The main outcome examined whether there is a difference in average day 3 modified NEECHAM scores comparing the intervention and control groups. The mean modified NEECHAMs on day 3 were not statistically significantly different (intervention group 3.76 and control group 3.24) (P= 0.368). Baseline NEECHAM scores did not correlate well with development of delirium (P = 0.204). A history of confusion during a previous hospitalization was the strongest predictor of developing delirium during the current hospitalization. Conclusion. This pilot study was not powered to detect an effect of the intervention, however, feasibility for a fully powered trial was established. Relevance to clinical practice. Completion of the NEECHAM screen every shift was not considered burdensome for either nurses or patients and may help identify acute delirium.

18.
Rehabil Nurs ; 33(6): 247-52, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-19024239

RESUMEN

Evidence-based guidelines suggest that stroke patients should be screened for dysphagia before oral intake. The purpose of this study was to validate a dysphagia screening tool comparing registered nurses (RNs) with speech therapists (STs). All stroke unit patients who received predetermined scores on specific items of the National Institutes of Health Stroke Scale were eligible for screening. The trial consisted of three parts (with swallow, cough, and vocal quality observed during each part): 1 teaspoon lemon ice, 1 teaspoon applesauce, and 1 teaspoon water RNs performed five screenings that were compared with independent screenings performed on the same patient within 1 hour by a speech therapist (ST). Eighty-three paired screenings were completed, with 94% agreement between the RNs and the STs. This screening identifies patients who are able to swallow and can eat from a safe menu until formally evaluated by an ST while maintaining nothing by mouth (NPO) status for those at risk for aspiration.


Asunto(s)
Trastornos de Deglución/diagnóstico , Tamizaje Masivo/métodos , Evaluación en Enfermería/métodos , Logoterapia/métodos , Competencia Clínica , Protocolos Clínicos/normas , Trastornos de Deglución/etiología , Educación Continua en Enfermería , Enfermería Basada en la Evidencia , Unidades Hospitalarias , Humanos , Tamizaje Masivo/normas , Evaluación en Enfermería/normas , Investigación en Evaluación de Enfermería , Personal de Enfermería en Hospital/educación , Variaciones Dependientes del Observador , Sistemas de Atención de Punto , Guías de Práctica Clínica como Asunto , Aspiración Respiratoria/etiología , Aspiración Respiratoria/prevención & control , Medición de Riesgo , Logoterapia/normas , Accidente Cerebrovascular/complicaciones
19.
J Nurs Care Qual ; 23(3): 272-6, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18562871

RESUMEN

Contaminated blood cultures result in increased healthcare utilization. Poor skin preparation is usually the cause of contamination. Our study results showed a significant decrease in contamination rates using 2% chlorhexidine and 70% isopropanol (Chloraprep) versus tincture of iodine. Adoption of this technique throughout our institution is expected to result in a savings of 875000 dollars per year, as well as decreased discomfort for the patient.


Asunto(s)
2-Propanol/administración & dosificación , Antiinfecciosos Locales/administración & dosificación , Antisepsia/métodos , Recolección de Muestras de Sangre , Clorhexidina/administración & dosificación , Yodo/administración & dosificación , 2-Propanol/economía , Administración Cutánea , Antiinfecciosos Locales/economía , Benchmarking , Recolección de Muestras de Sangre/métodos , Clorhexidina/economía , Investigación en Enfermería Clínica , Ahorro de Costo , Combinación de Medicamentos , Enfermería de Urgencia , Servicio de Urgencia en Hospital , Humanos , Yodo/economía , Ohio , Piel/microbiología , Cuidados de la Piel/economía , Cuidados de la Piel/métodos , Cuidados de la Piel/enfermería
20.
Subst Use Misuse ; 43(5): 589-95, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18393078

RESUMEN

PURPOSE: This study tests the validity of self-reported illicit substance use against biochemical testing among Emergency Department (ED) patients seeking treatment with narcotics for backache, headache, and toothache and to characterize patients who provide false reports. METHODS: Retrospective chart review comparing the self-reported drug use history obtained during an ED visit during a six-year period (1995-2001) with the results of a biochemical drug screen obtained the same day. RESULTS: 248 patients met screening criteria, 79 (32%) of whom tested positive for unclaimed "drugs of abuse." Patients with a history of "drug abuse" and chronic pain were significantly more likely to test positive for unclaimed drugs than were their counterparts (p=.05 and p<.0001, respectively). No significant difference was found in comparing those with and without multiple ED visits or those requesting a specific narcotic. CONCLUSION: Self-reported drug use is unreliable in this ED subpopulation. When this knowledge is critical for patient care, biochemical testing may be indicated.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Dolor/tratamiento farmacológico , Dolor/orina , Aceptación de la Atención de Salud/psicología , Detección de Abuso de Sustancias/estadística & datos numéricos , Trastornos Relacionados con Sustancias/diagnóstico , Revelación de la Verdad , Dolor de Espalda/tratamiento farmacológico , Dolor de Espalda/orina , Enfermedad Crónica , Comorbilidad , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Cefalea/tratamiento farmacológico , Cefalea/orina , Estado de Salud , Humanos , /orina , Masculino , Narcóticos/uso terapéutico , Dolor/psicología , Estudios Retrospectivos , Factores Sexuales , Detección de Abuso de Sustancias/métodos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Odontalgia/tratamiento farmacológico , Odontalgia/orina
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