RESUMO
BACKGROUND: Rising acuity levels in inpatient settings have led to growing reliance on observers and increased the cost of care. OBJECTIVES: Minimizing use of observers, maintaining quality and safety of care, and improving bed access, without increasing cost. DESIGN: Nursing staff on two inpatient psychiatric units at an academic medical center pilot-tested the use of a "milieu manager" to address rising patient acuity and growing reliance on observers. Nursing cost, occupancy, discharge volume, unit closures, observer expense, and incremental nursing costs were tracked. Staff satisfaction and reported patient behavioral/safety events were assessed. RESULTS: The pilot initiatives ran for 8 months. Unit/bed closures fell to zero on both units. Occupancy, patient days, and discharges increased. Incremental nursing cost was offset by reduction in observer expense and by revenue from increases in occupancy and patient days. Staff work satisfaction improved and measures of patient safety were unchanged. CONCLUSIONS: The intervention was effective in reducing observation expense and improved occupancy and patient days while maintaining patient safety, representing a cost-effective and safe approach for management of acuity on inpatient psychiatric units.
Assuntos
Pacientes Internados , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Centros Médicos Acadêmicos , Ocupação de Leitos/economia , Ocupação de Leitos/estatística & dados numéricos , Humanos , Recursos Humanos de Enfermagem Hospitalar/economia , Alta do Paciente/economia , Alta do Paciente/estatística & dados numéricos , Segurança do Paciente/economia , Segurança do Paciente/estatística & dados numéricos , Projetos Piloto , Unidade Hospitalar de Psiquiatria/economia , Carga de Trabalho/economiaRESUMO
Basing practice decisions on sound scientific research and best available evidence is an optimal approach for making practice changes. A five-member team of nursing leaders formed an evidence-based practice (EBP) steering committee and developed an EBP model and process. This article describes the educational approaches and the development of mentors used to provide the staff nurse with the necessary knowledge and skills to use EBP successfully.
Assuntos
Medicina Baseada em Evidências/educação , Mentores , Recursos Humanos de Enfermagem Hospitalar/educação , Desenvolvimento de Pessoal , Ensino/métodos , Baltimore , Humanos , Modelos de Enfermagem , Aprendizagem Baseada em Problemas , Desenvolvimento de ProgramasRESUMO
Organizations often do not have processes in place to support nurses through a systematic approach for developing and evaluating nursing interventions, protocols, critical pathways, and policies that are derived from scientific evidence. The development of a framework to guide inquiry will have a positive impact on patients. This process may foster a higher level of professional engagement by nurses that may, in the long-term, help improve nurse retention and recruitment. The authors discuss a nursing evidence-based practice model and guidelines that were developed by a team of hospital and academic nurse leaders and is practical and easy to use. This model has been successfully implemented across the department of nursing as a strategic initiative. Results of the implementation have shown that staff nurses can effectively use this model with the help of knowledgeable mentors.
