A Quality Improvement Project to Enhance Emergency Nurse Workplace Violence Reporting.

INTRODUCTION: Workplace violence is a pervasive, perpetual, and underreported problem in the emergency department. Nurses experience devastating physical and psychological consequences owing to workplace violence exposure. Understanding workplace violence is challenging due to nurse underreporting. Improvement in capturing workplace violence cases can help drive data-informed, sustainable solutions to workplace violence prevention. The purpose of this project was to better capture the full extent of workplace violence in the emergency department through enhanced nurse workplace violence reporting. METHODS: In collaboration with emergency nurses and management, the project team used a multi-interventional approach and designed a feasible electronic reporting instrument to capture workplace violence events in real time by reducing nurse reporting barriers. Participating nurses accessed the instrument by scanning a quick-response code with their mobile phones. This code was strategically located on wall flyers and individual name badge stickers. Data were collected using Qualtrics software and analyzed using SPSS Statistics, which summarized the descriptive statistics. RESULTS: Two months after implementation, the electronic reporting instrument recorded 94 quick response code scans and 59 workplace violence reports, resulting in a 1080% increase in ED workplace violence reporting compared with the 2 months prior to implementation. The 59 workplace violence reports comprised 78% registered nurses, 19% emergency medical technicians, and 3% other health care workers. Workplace violence events were most frequent from 12:01 pm to 6:00 pm in treatment rooms (37%), triage (29%), waiting room (19%), behavioral health section (15%), and hallway (12%). DISCUSSION: A multi-interventional approach, coupled with a feasible, readily available electronic reporting instrument, enhanced ED workplace violence reporting and facilitated a better capture of ED workplace violence. Although nurse underreporting is still likely occurring, an emergence of workplace violence data trends can provide data-driven solutions in workplace violence prevention. Continued efforts to reduce the barriers that inhibit reporting are needed to foster a safe and supportive culture surrounding workplace violence reporting.

Nonpharmacological Therapies for Musculoskeletal Injury in Military Personnel: A Systematic Review/Meta-Analysis.

INTRODUCTION: Musculoskeletal (MSK) injury is an inherent risk for military personnel that can potentially impact job performance, productivity, and military readiness. Evidence is needed to show the efficacy of nonpharmacological, self-managed therapies to reduce MSK symptoms at common injury sites that are feasible for use during expeditionary operations and home stations. This systematic review and meta-analysis identified, summarized, and synthesized available evidence from randomized and non-randomized trials on the effectiveness of self-managed, home-use therapies to improve pain, muscle strength, and physical performance in military personnel with MSK injuries, when compared to controls. METHODS: The electronic databases of MEDLINE ALL Ovid, Embase.com, Cochrane Library, Scopus, Clinicaltrial.gov, and CINAHL Complete via EBSCO were systematically searched for relevant reports published in English. Utilizing the Covidence platform and consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, multiple reviewers, using pre-determined data fields, screened for eligibility, assessed risk of bias (RoB), and performed data extraction. Evaluation of treatment effectiveness was determined using multilevel mixed-effects meta-analysis. RESULTS: The database and register search yielded 1,643 reports that were screened for eligibility. After screening of titles/abstracts and full texts, 21 reports were identified for evidence synthesis. Of these, two reports were excluded and two described the same study, resulting in a final list of 18 studies (19 reports). For quality assessment, the overall RoB for the 18 studies was categorized as 33.3% low risk, 55.6% with some concerns, and 11.1% high risk. Across the five domains of bias, 70% of the reports were classified as low risk. This systematic review found that the differences in interventions, outcome measures, and design between the studies were associated with a substantial degree of heterogeneity (I2 = 60.74%), with a small overall improvement in outcomes of the interventions relative to their specific control (standard mean difference 0.28; 95% CI, 0.12 to 0.45). There were varying degrees of heterogeneity for individual body regions. This was due, in part, to a small number of studies per bodily location and differences in the study designs. For the neck/shoulder, heterogeneity was moderate, with the clearest positive effect being for physical performance outcomes via other medical devices. For the back, there was substantial heterogeneity between studies, with modest evidence that pain was favorably improved by other medical devices and exercise interventions. For the leg, one study showed a clear large effect for other medical devices (shockwave treatment) on pain with substantial heterogeneity. The best evidence for positive effects was for the knee, with mainly negligible heterogeneity and some benefits from bracing, electrotherapy, and exercise. CONCLUSION: Evidence showed small beneficial effects in pain, strength, and physical performance by individual body regions for some interventions, compared to controls. The best evidence for a positive effect was for the knee. The findings suggest that some benefit may be obtained by including several treatments during deployment in austere environments and prolonged casualty care scenarios of military personnel with MSK injuries. Further research is warranted to better assess the potential benefits of using these treatments during deployments in austere environments as part of an individualized, multimodal approach for MSK injuries.

Preoperative Chlorhexidine Gluconate Bathing on a Military Medical-Surgical Unit.

INTRODUCTION AND SCOPE OF THE PROBLEM: Surgical site infections (SSIs) are associated with increased length of hospital stays, poor patient outcomes, and increased health care costs making prevention of SSI a high priority for the U.S. Military Health Care System. The focus of this project was to develop and pilot a preoperative antiseptic bathing regimen on an inpatient medical-surgical telemetry unit using 4% chlorhexidine gluconate (CHG), and to compare SSI rates with this new protocol to previous SSI rates on the unit. MATERIALS AND METHODS: A literature review guided the development of the protocol and clinical question. A unit project was conducted using SSI rates from an inpatient military medical-surgical telemetry unit over 4 yr. From 2014 to 2016, 3 yr before implementing the protocol, a non-standardized CHG scrub was compared to 12 mo after implementing the standardized 4% CHG protocol in 2017 using up to four daily washings (three evenings and one morning surgery) on inpatient admissions to the unit. SSI rates were compared. RESULTS: After implementing a 4-d preoperative bathing regimen with 4% CHG for patients scheduled for surgery, SSI rates decreased from an average rate of 0.0072 infections (7.2 infections per 1,000 surgeries) to 0.0035 infections (3.5 infections per 1,000 surgeries) in the subsequent year of data collection. Although not a statistically significant change, further analysis using a Bayesian Poisson regression model found an 84% probability the new protocol would lower SSI rate by 1 or more cases per 1,000 surgeries on this inpatient unit. CONCLUSION: The findings suggest the proposed approach to control infection that may reduce the number of SSIs on a military medical-surgical unit, but this needs to be demonstrated through further longitudinal research on military surgical units.