The Impact of Hospital-Based In Situ Simulation on Nurses' Recognition and Intervention of Patient Deterioration.

Preparing nurses to recognize the signs and symptoms of a deteriorating patient and to provide appropriate initial interventions is essential. Hospital-based in situ simulation education is an effective evidence-based method that supports adult learning in a safe environment. The purpose of this article is to discuss the development, implementation, and evaluation of an in situ simulation program and the positive impact on nurses' confidence level in the recognition and initiation of interventions for a deteriorating patient.

Using the TRIP model to disseminate an IT-based pressure ulcer intervention.

Pressure ulcers (PUs) are among the most common harms experienced by patients in health care facilities. Despite the existence of evidence-based guidelines and protocols for PU prevention and treatment, the sustained success in reducing the development of PUs is elusive. The purpose of this article is to describe how the Translating Research Into Practice (TRIP) model was used to support implementation of a care management solution (i.e., the Daily Project) aimed at preventing PUs. Using a case study approach, the development and implementation of the Daily Project is described in relation to the TRIP model. Initial success was evidenced by a 34% reduction in PU rates and an 86% reduction in missed patient turns 3 months postimplementation of the Daily intervention. Based on our experiences, the TRIP model successfully can assist with the implementation and diffusion of a tool that addresses a complex clinical issue such as PU prevention and treatment.

Intravascular thrombophlebitis related to the peripheral infusion of amiodarone and vancomycin.

Patients on a telemetry unit experienced an increase in thrombophlebitis in 2004. The purpose of this research was to determine if peripheral IV amiodarone and vancomycin influenced the incidence of thrombophlebitis in an adult cardiothoracic population. Amiodarone phlebitis rates range up to 27%. In December 2004, Pharmacy diluted the amiodarone concentration to 600 mg/500 ml. By 2005, data demonstrated a consistent decrease in the incidence of thrombophlebitis. However, related to institutional policies and patient safety concerns, the amiodarone infusion concentration was reversed back to 900 mg/500 ml in October 2005. Thrombophlebitis increased after the return to a more concentrated amiodarone IV solution. Vancomycin infusion administration did not change during this time period. A retrospective chart review and observational, before and after study, demonstrated a correlation between amiodarone concentration and the incidence of thrombophlebitis. Vancomycin infusions appeared to prevent peripheral thrombophlebitis in the study population. Data was compelling and resulted in the institution standardizing the more dilute amiodarone IV concentration.