The Utility of the Modified Dionne's Egress Test as a Predictor of Falls in Adult Medical and Surgical Patients.

OBJECTIVE: The aim of this study was to compare the efficacy of a modified Dionne's Egress Test (Egress) as a predictor of falls with the Morse Fall Scale (MFS) in adult medical and surgical patients in an acute care setting. BACKGROUND: Nurses must identify fall risk while balancing fall prevention and early mobility in their care delivery. Fall risk screening tools alone are not enough to assist nurses in predicting patients at risk of falling. METHODS: A retrospective observational study design was used to compare the Egress as a predictor of falls to the MFS. The sample included data abstracted from 197 electronic health records and internal falls data. RESULTS: The Egress and the MFS are moderately and negatively correlated; however, only Egress was a significant predictor of falls. Passing the Egress, not being on benzodiazepines, and having a longer length of stay (LOS) results were associated with being less likely to fall. CONCLUSION: Egress is a better predictor of falls than MFS when benzodiazepines and LOS are controlled in the model.

Achieving Disease-Specific Care Joint Commission Certification: The Impact of Clinical Nurse Specialist Practice.

PURPOSE: The aims of this study are to describe a program to achieve disease-specific care (DSC) certification from The Joint Commission and highlight the value of the advanced practice nurse in the certification outcome. DESCRIPTION OF PROGRAM: The expertise in clinical practice, performance improvement, and leadership skills demonstrated by the clinical nurse specialist (CNS) can be instrumental in building a strong foundation for a DSC certification program. As an organization prepares for a DSC on-site review, the CNS can guide the program stakeholders in identifying gaps in care, developing action plans to meet certification standards, and preparing team members for the DSC on-site review. OUTCOME: At this Midwestern, 504-bed facility, The Joint Commission DSC certifications were achieved in 5 separate categories: diabetes, stroke, sepsis, total hip replacement, and total knee replacement. CONCLUSION: By influencing a certain patient population throughout the organization, population-focused CNSs are in a unique role to lead an interprofessional team or serve as an expert consultant in pursuing DSC certification from The Joint Commission.

CE: Original Research: Identifying Hospitalized Patients at Risk for Harm: A Comparison of Nurse Perceptions vs. Electronic Risk Assessment Tool Scores.

: Objective: In many hospitals, nurse-led "safety huddles" are used to relay patient safety information, although whether this effectively identifies patients at risk for harm has not been determined. New electronic risk assessment tools are designed to identify patients at risk for harm during hospitalization, based on specific markers in the electronic health record. This study sought to compare the results of both methods. The findings may help to enhance decision making at the level of care delivery. METHODS: A nonexperimental correlational study was conducted over a three-week period in 2015 in a large metropolitan acute care community hospital. Nurses on three units-a medical-surgical unit, a progressive care unit, and an orthopedic unit-constituted the convenience sample. Designated safety huddle leaders collected data using the daily census sheet to record the nurses' perceived risk of harm for each patient and the reason for risk concern. Separately, designated advanced practice nurses collected the electronic risk assessment tool's reports from the same units. Data were paired as they were entered into the database and analyzed to determine correlation. Perceptions of harm from the nurses, recorded as yes or no responses, were compared with the electronic tool's identification of high risk or moderate-to-low risk. RESULTS: In 746 data pairs, differences between the nurses' harm risk perceptions and the electronic tool's harm risk reports were statistically significant, supporting our prediction that there would be no correlation. The most significant difference was seen in instances when a nurse identified a patient as being at higher risk than the electronic tool did, often citing behavioral or psychosocial issues as the reason for concern. CONCLUSIONS: Nurses perceived harm risk differently than the electronic tool did. In situations when the electronic tool cited risk and the nurse perceived no risk, the risks were currently being addressed in the plan of care. In situations when the nurse perceived higher risk than the electronic tool did, the nurse often cited behavioral or psychosocial issues (which frequently lacked defined data points in the electronic health record and thus were not available to the tool). Changes in data mining algorithms must incorporate and weight the impact of psychosocial and behavioral elements together with other risk factors in order to provide meaningful practice recommendations.

Research evidence for the use of preoperative exercise in patients preparing for total hip or total knee arthroplasty.

Preoperative exercise/rehabilitation is currently being considered to improve outcomes for orthopaedic surgery. This article presents an evidence-based practice review of the current research literature from 1998 to 2008 to determine whether preoperative exercise alone will be beneficial to patients preparing for total knee or hip arthroplasty. Only 3 studies met the inclusion criteria of preoperative exercise as the sole intervention. Each of these studies indicated that preoperative exercise had some postoperative benefit to total knee or hip arthroplasty patients. In general, the results are inconclusive due to the lack of strong research evidence, and only a pragmatic recommendation for preoperative exercise prior to total hip or knee arthroplasty is supported. More research is needed in the area of preoperative exercise for persons preparing for total hip or knee arthroplasty.