A retrospective audit of nursing-related morbidity recorded in a state hospital in KwaZulu-Natal.

BACKGROUND:  Health care professionals are expected to deliver safe and effective health services; however there is increased realisation that adverse events in the health system are a major cause of preventable morbidity and mortality. OBJECTIVES:  To conduct a retrospective audit of nursing-related morbidities in a state hospital in KwaZulu-Natal, South Africa. METHOD:  A retrospective audit of nursing-related morbidities documented by the surgical service was carried out using the Hybrid Electronic Medical Registry data for a period of 3 years - 01 November 2013 to 31 October 2016. RESULTS:  There were a total of 12 444 admissions to surgical service during the study period, with 461 nursing-related morbidities reported. There was an increase in the number of documented nursing-related morbidities noted during November 2015 to October 2016, with 79% of all reported nursing-related morbidities documented during this period. A total of 54% of nursing-related morbidities were associated with males (n = 248) and 46% (n = 213) with females. The most commonly documented nursing-related morbidity was drugs/medication (n = 167, 36%) with the second most common being adjunct management (n = 130, 28%). CONCLUSION:  The study has identified the most commonly documented nursing-related morbidities in the surgical service of a state hospital. The findings of the study could provide direction for further research and educational initiatives.

Pressure ulcer prevalence and prevention rates in Abu Dhabi: an update.

OBJECTIVE: This article compares the results from a recent pressure ulcer (PU) prevalence audit at the Sheikh Khalifa Medical City (SKMC) hospital in Abu Dhabi to identify the impact of new prevention initiatives introduced around 2013 and establish the effectiveness of PU prevention strategies, judged quality of nursing care, and costs associated with patients developing a hospital-acquired pressure ulcer (HAPU). METHOD: The methods used were based on a previous point prevalence study involving 441 acute care patients, who were assessed using the International Pressure Ulcer Prevalence (IPUP) Survey. Following pre-selection of a 24-hour period for data capture, hospital staff collected PU data. Hill-Rom provided SKMC with an electronic report comprising various epidemiological and financial outputs. RESULTS: PU prevalence was 10.4% in 2018 versus 6.4% in 2013. The 2018 HAPU prevalence was 1.8% versus 2% in 2013. The 2018 findings were in line with IPUP's international benchmarks. In 2018, 99% of patients had their skin assessed and PU risk documented within 24 hours of admission, leading to rapid implementation of a prevention care plan. Most patients who developed a HAPU (n=8) were female (62%) and aged 20-29 years old (25%) or 70-79 years old (25%). All HAPU patients lay on three layers of linen, most on their side (88%) and 75% were hospitalised for >30 days. Costs were estimated for the eight HAPU patients; weighted average cost (per case) was around US$8035.32, giving a total estimated cost of US$64,282.54. Total annual cost (average length of stay basis) for the eight patients was estimated at US$1,830,082.32. CONCLUSION: The PU prevention plan at SKMC proved to be effective, reflected by a low HAPU prevalence rate, suggesting an excellent quality of patient care.

Impact of a hand hygiene audit on hand hygiene compliance in a tertiary care public sector teaching hospital in South India.

BACKGROUND: Hand hygiene (HH) practice is considered the most simple, cost-effective, and efficient way to prevent device-associated infections. Continuous auditing plays a vital role in the conversion of HH knowledge into practice. METHODS: An HH audit was carried out October 2015-September 2016 in 18 locations for a total of 1,080 observation periods and 64,800 minutes of observation. HH complete adherence rate (HHCAR) and HH partial adherence rate were analyzed. RESULTS: The HHCAR, HH partial adherence rate, and nonadherence rate were 45.5%, 21.17%, and 33.3%, respectively. There was gradual statistically significant increase in monthly HHCAR during the study period from 37.5%-51.7% (P = .001). HHCAR was found to be highest among nurses (58.9%) followed by other staff (46.7%) and doctors (46.6%). World Health Organization Moments 3 and 4 had statistically significant compliance (78.5% and 71.8%, respectively; P < .001) compared with Moments 1, 2, and 5. As the HHCAR increases there is statistically significant decrease in device-associated infection rate from 10.6-3.9 per 1,000 device days (P = .042). CONCLUSIONS: HH audit has a significant influence on HH compliance. More emphasis needs to be given on compliance with HH practice by doctors and with the World Health Organization "before" Moments, especially. HH audits should be a part of the infection control manual of every hospital.

Capturing district nursing through a knowledge-based electronic caseload analysis tool (eCAT).

The Electronic Caseload Analysis Tool (eCAT) is a knowledge-based software tool to assist the caseload analysis process. The tool provides a wide range of graphical reports, along with an integrated clinical advisor, to assist district nurses, team leaders, operational and strategic managers with caseload analysis by describing, comparing and benchmarking district nursing practice in the context of population need, staff resources, and service structure. District nurses and clinical lead nurses in Northern Ireland developed the tool, along with academic colleagues from the University of Ulster, working in partnership with a leading software company. The aim was to use the eCAT tool to identify the nursing need of local populations, along with the variances in district nursing practice, and match the workforce accordingly. This article reviews the literature, describes the eCAT solution and discusses the impact of eCAT on nursing practice, staff allocation, service delivery and workforce planning, using fictitious exemplars and a post-implementation evaluation from the trusts.

Measures of cultural competence in nurses: an integrative review.

BACKGROUND: There is limited literature available identifying and describing the instruments that measure cultural competence in nursing students and nursing professionals. DESIGN: An integrative review was undertaken to identify the characteristics common to these instruments, examine their psychometric properties, and identify the concepts these instruments are designed to measure. METHOD: There were eleven instruments identified that measure cultural competence in nursing. Of these eleven instruments, four had been thoroughly tested in either initial development or in subsequent testing, with developers providing extensive details of the testing. RESULTS: The current literature identifies that the instruments to assess cultural competence in nurses and nursing students are self-administered and based on individuals' perceptions. The instruments are commonly utilized to test the effectiveness of educational programs designed to increase cultural competence. CONCLUSIONS: The reviewed instruments measure nurses' self-perceptions or self-reported level of cultural competence but offer no objective measure of culturally competent care from a patient's perspective which can be problematic. Comparison of instruments reveals that they are based on a variety of conceptual frameworks and that multiple factors should be considered when deciding which instrument to use.

[Determining the quality of long-term care. A comparative analysis of transparency criteria, resident-related indicators, and staff assessment]. / Messung der Pflegequalität in der Langzeitpflege. Eine vergleichende Analyse von Pflegetransparenzkriterien, bewohnerbezogenen Indikatoren und Beurteilungen der Mitarbeiter.

INTRODUCTION: From 2009, the quality of care in nursing homes in Germany is inspected, rated, and publicized. This study investigates the association between staff-perceived nursing quality, clinical quality indicators, and ratings of health insurance medical services based on the transparency of stationary care agreement (PTVS). METHODS: This was a cross-sectional study merging publicly reported data, clinical quality indicators of a national health provider system, and data from staff surveys. Data from 83 nursing homes were adjusted for sample size, age, and care level and analyzed using Kendall's tau coefficients and scatter plots. RESULTS: There were pronounced differences in staff-perceived nursing quality and some of the clinical indicators between facilities that were not detected by the PTVS. There was a weak association between staff-perceived quality and care quality rated by external inspections. No associations were found between the PTVS and clinical quality indicators. CONCLUSIONS: Differences between nursing home providers were detected to varying degrees by the three approaches and were if at all weakly associated. Given the aims followed by public reporting initiatives of nursing home providers, the results stress the importance of revising the PTVS.

Avaliação da qualidade das anotações de enfermagem em unidade semi-intensiva / Quality assessment of nursing records in a semi-intensive care unit / Evaluaión de la calidad de las anotaciones de enfermería en una unidad semeintensiva

A anotação de enfermagem é um dos meios para se avaliar os cuidados prestados. O objetivo do estudo foi avaliar a qualidade das anotações de enfermagem em uma unidade semi-intesiva. Os dados, coletados com um roteiro para auditoria retrospectiva, são referentes a 16 pacientes que aguardavam vaga para Unidade de Terapia Intensiva, internados em dezembro de 2009 e janeiro de 2010, por um período médio de oito dias. No quesito identificação, o percentual de preenchimento foi de 74,8% o que é bem próximo dos valores considerados satisfatórios (80%); porém o percentual de preenchimento completo dos itens: registros, procedimentos e prescrição de enfermagem, terapia intensiva e execução de ordens médicas alcançaram respectivamente 54,7%, 41,1%, 39,3%, 34,9% e 25%. Os baixos índices de preenchimento completo revelam falha grave no registro da assistência prestada nesta unidade, o que pode estar prejudicando a continuidade do cuidado e a legitimação do trabalho da enfermagem.

Nursing records can be used as a method to assess quality of care. The aim of this study was to assess quality of nursing records in a semi-intensive care unit. Data were collected using a guide for retrospective audit, gathering information from 16 patients awaiting admittance into an Intensive Care Unit, admitted in the period of December 2009 to January 2010, with an average of 8 days of hospitalization. Regarding identification, the percentage of filled in records was 74.8%, which is close to acceptable standards (80%). However, the percentage of complete filled in items were respectively: nursing records, procedures and nursing prescription, intensive care and execution of medical orders accounting for 54.7%, 41.1%, 39.3%, 34.9% and 25%. The reduced levels of complete filled in records reveal a major flaw in recording care provided in this unit which may be hindering the continuance of care and is prejudicial to the legitimization of care provided by nurses.

La anotación de la enfermería es un medio de evaluar la atención recibida. El objetivo de este estudio fue evaluar la calidad de las notas de enfermería en una unidad semeintensiva. Los datos, recogidos con una hoja de ruta para la auditoría retrospectiva, se refieren a 16 pacientes en espera de vacante para la Unidad de Cuidados Intensivos, admitió en diciembre de 2009 y enero de 2010, para un promedio de ocho días. Sobre la identificación, el porcentaje de avance fue de 74,8%, lo cual es muy similar a los valores considerados satisfactorios (80%), pero el porcentaje de llenado completo de los artículos, los registros, procedimientos y la prescripción de enfermería, cuidados intensivos y la ejecución de las órdenes del médico llegaron, respectivamente, a 54,7%, 41,1%, 39,3%, 34,9% y un 25%. Las bajas tasas de llenado completo del registro revelan incumplimiento grave de la atención en esta unidad, que puede ser perjudicial para la continuidad de la atención y la legitimación del trabajo de enfermería.

Auditoria de enfermagem: conhecimento de profissionais em hospital público de referência / Nursing audit: profissionals’ knowledge in a public hospital of reference

Auditoria de enfermagem é a avaliação da qualidade da assistência prestada, o que beneficia tanto paciente quanto equipe de enfermagem e instituição. Visamos identificar o conhecimento do enfermeiro sobre o processo da auditoria. Estudo exploratório, descritivo e quantitativo, realizado entre os meses de setembro e dezembro de 2007, com participação de 36 enfermeiros de hospital público de referência para doenças cardiovasculares, em Fortaleza, Ceará. Foi utilizado um questionário autorrespondido, composto por questões relativas ao conhecimento do participante sobre o conceito, a finalidade e os benefícios da auditoria de enfermagem. Os resultados foram classificados segundo o grau de conhecimento, seguindo a literatura específica adotada no estudo. A percepção dos participantes do estudo revelou-se limitada, demonstrando pouco conhecimento sobre a temática, sugerindo a necessidade de investir na formação profissional, procurando despertar a importância da auditoria de enfermagem.

Caseload analysis in district nursing: the impact on practice.

This paper describes a ten-year journey in managing a district nursing service using caseload analysis as a method of workforce planning and performance management. Caseload management is at the heart of district nursing practice and the process of measuring and comparing caseload information can be used to improve the quality of care. However, it is crucial to assess the information provided by district nurses for reliability and validity. Allocating staff to teams on the basis of accurate information on patient case-mix, nursing need, and dependency can result in every member of the population gaining equitable access to a consistent quality nursing service.

Part 3: Defining the unique role of the specialist district nurse practitioner.

The third of a series of articles concludes the unique role of the District Nurse. District Nurses are proud of their profession and seek to demonstrate their advanced skills through further case scenarios. As Government policy continues to expect health care providers to keep patients in the community who have complex health and social care needs, District nursing is the obvious profession that remainss constant in ever changing times.

Assessment of the side effects of antipsychotic medication.

BACKGROUND: Antipsychotic medication is the first-line treatment for people with psychosis in the State Hospital, Carstairs: Scotland's only high-security forensic hospital. The Clinical Standards for Schizophrenia (Clinical Standards Board for Scotland 2001) require clinicians to use standardised rating scales to monitor the side effects associated with medication. Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) (Day et al 1995) was implemented in the hospital in December 2003. A baseline audit was carried out following its implementation to establish the incidence of side effects. Of those patients audited (n=152), 87 (57 per cent) reported either low or medium (n=51, 34 per cent) LUNSERS scores, indicating an acceptable level of medication tolerance. CONCLUSION: It is expected that clinicians will continue to use LUNSERS as part of their routine clinical practice to help inform patients and meet national standards.

Nursing unit characteristics and patient outcomes.

In this exploratory cross-sectional study, nursing unit organizational characteristics and how they influenced patient outcomes in the form of nurse-sensitive adverse events and failure to rescue were examined. Results showed significant associations between characteristics and adverse events at the unit level. Autonomy/collaboration was associated with pressure ulcer and failure to rescue, practice control with urinary tract infection, and continuity/specialization with death. Unit-level study provided a better understanding of the effect of unit work environment upon nursing practice and outcomes.

Infection control audit of hand hygiene facilities.

BACKGROUND: The socio-economic costs of healthcare associated infections (HCAIs) are continually rising. The focus for reducing the incidence of HCAIs should be on maintaining a microbiologically safe environment Hand hygiene is of paramount importance in preventing the transmission of infection, as it is a low-tech, low-cost, effective intervention. Hand hygiene is as important in the non-acute care setting as in the acute setting, as community or non-acute patients are often admitted to acute facilities. CONCLUSION: This audit, conducted in 2000-2001, examined hand hygiene facilities at one non-acute trust. The results confirmed that although handwashing is considered the most important factor in preventing the spread of infection, it cannot always be carried out successfully if facilities are inadequate. Recommendations were made that will encourage safe practice, improve service delivery and raise clinical standards.

Preventing falls in older people: charting practice change by audit.

Before an audit project in one trust there was no formal means of assessing the risk of falling among older patients. By raising staff awareness and consulting on the best evidence available, a specific falls-risk assessment has been developed and is now widely used. Follow-up audits have demonstrated a change in practice which it is hoped will bring about a reduction in falls.

Development of a student nurse practitioner computerized clinical log.

A computerized clinical log was developed and revised over a period of three semesters by the family nurse practitioner students at the University of Texas Health Science Center in San Antonio, Texas. Students entered data on a disk formatted in Microsoft Access, and results were analyzed by the Statistical Packages for the Social Sciences (SPSS). More than 4,000 patient encounters were documented during three semesters. The development and refinement of the computerized log are described. Results are presented and the implications of the database for educational, curricular and employment purposes are discussed.