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Ali M, Masood F, Erickson L, Adefisoye J, Kanani J, Walczak S, Ajam T, Kieu A, Premjee M, Jan MF, Allaqaband SQ, Bajwa T, Khitha J, Zilinski J, Jahangir A, Djelmami-Hani M, Sra J, Niazi I, Mortada ME. Suture closure AFtEr large bore vein access (SAFE-VEIN): A randomized, prospective study of the efficacy and safety of venous closure device. Catheter Cardiovasc Interv 2024; 104:820-828. [PMID: 39087741 DOI: 10.1002/ccd.31173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/10/2024] [Accepted: 07/20/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Perclose ProGlide (PPG) Suture-Mediated Closure System™ is safe and can reduce time to hemostasis following procedures requiring arterial access. AIMS We aimed to compare PPG to figure of 8 suture in patients who underwent interventional catheter procedures requiring large bore venous access (LBVA) (≥13 French). METHODS In this physician-initiated, randomized, single-center study [clinicaltrials.gov ID: NCT04632641], single-stick venous access was obtained under ultrasound guidance. Eligible patients were randomized 1:1, and 100 subjects received allocated treatment to either PPG (n = 47) or figure of 8 suture (n = 53). No femoral arterial access was used in any patient. Primary outcomes were time to achieve hemostasis (TTH) and time to ambulation (TTA). Secondary outcomes were time to discharge (TTD) and vascular-related complications and mortality. Wilcoxon rank-sum test was used to compare TTH, TTA, and TTD. RESULTS TTH (minutes) was significantly lower in PPG versus figure of 8 suture [median, (Q1, Q3)] [7 (2,10) vs. 11 (10,15) respectively, p < 0.001]. TTA (minutes) was significantly lower in PPG compared to figure of 8 suture [322 (246,452) vs. 403 (353, 633) respectively, p = 0.005]. TTD (minutes) was not significantly different between the PPG and figure of 8 suture arms [1257 (1081, 1544) vs. 1338 (1171,1435), p = 0.650]. There was no difference in minor bleeding or access site hematomas between both arms. No other vascular complications or mortality were reported. CONCLUSION PPG use had lower TTH and TTA than figure of 8 suture in a population of patients receiving LBVA procedures. This may encourage same-day discharge in these patients.
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Affiliation(s)
- Mahmoud Ali
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
| | - Faisal Masood
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
| | - Lynn Erickson
- Academic Affairs, Cardiovascular Research, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
| | - James Adefisoye
- Academic Affairs, Aurora UW Medical Group, Center for Urban Population Health, Aurora Sinai Medical Center, Aurora Health Care, Milwaukee, Wisconsin, USA
| | - Jim Kanani
- Academic Affairs, Cardiovascular Research, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
| | - Sara Walczak
- Academic Affairs, Cardiovascular Research, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
| | - Tarek Ajam
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
| | - Andy Kieu
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
| | - Mohammed Premjee
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
| | - M Fuad Jan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Suhail Q Allaqaband
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Tanvir Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Jayant Khitha
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Jodi Zilinski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Arshad Jahangir
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Mohamed Djelmami-Hani
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Jasbir Sra
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - Imran Niazi
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
| | - M Eyman Mortada
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin, USA
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee Clinical Campus, Milwaukee, Wisconsin, USA
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Guest M, Craven K, Tellson AM, Porter M, James N, Turley L, Smitherman J. Reigniting Intensive Care Unit Liberation. Crit Care Nurse 2024; 44:19-26. [PMID: 39084672 DOI: 10.4037/ccn2024629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND The Society of Critical Care Medicine has established guidelines to manage pain, sedation, delirium, immobility, family participation, and sleep disruption in the intensive care unit, a set of interventions known as the intensive care unit liberation (ABCDEF) bundle. Adherence to these guidelines has shown positive results. LOCAL PROBLEM In the intensive care units of a level I trauma academic teaching hospital in central Texas, the rate of bedside nursing staff adherence to the ABCDEF bundle was only 67.1% in January 2022. The aim of this quality improvement project was to improve adherence to the bundle. METHODS Knowledge gaps were found to be the driver of the low adherence rate. Two primary needs were identified: (1) education on the elements of the ABCDEF bundle and (2) increased awareness and recognition of incomplete and incorrect documentation. Interventions included focused education on intensive care unit liberation. RESULTS From February to June 2022, overall adherence to the ABCDEF bundle increased from 67.1% to 95.3%, ventilator use decreased by approximately 10%, and restraint use dropped by about 9%. The incidence of delirium increased, but this increase was due to incorrect patient assessment before the interventions. CONCLUSION The results of this project are consistent with literature demonstrating that a multifaceted approach to improving ABCDEF bundle adherence can produce sustainable improvement in patient outcomes. This report may help other organizations facing similar challenges improve adherence to the bundle in a postpandemic environment.
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Affiliation(s)
- Margaret Guest
- Margaret Guest is a charge nurse in the surgical trauma intensive care unit at Baylor Scott & White Medical Center-Temple, Texas
| | - Kevin Craven
- Kevin Craven is Director of Nursing for Critical Care at Baylor Scott & White Medical Center-Temple and a DNP student at Baylor University in Waco, Texas
| | - Alaina M Tellson
- Alaina M. Tellson is System Director for Nursing Research and the Transition to Practice program at Baylor Scott & White Health, Dallas, Texas
| | - Marlene Porter
- Marlene Porter is a nurse-scientist at Baylor Scott & White Medical Center-Temple
| | - Nakeitha James
- Nakeitha James is a nurse manager of the medical and neurologic intensive care units, Baylor Scott & White Medical Center-Temple
| | - Lisa Turley
- Lisa Turley is Manager of the surgical trauma intensive care unit at Baylor Scott & White Medical Center-Temple
| | - Jeremy Smitherman
- Jeremy Smitherman is Regional Director for Pulmonary/ECMO Services at Baylor Scott & White Medical Center-Temple and a member of the Baylor Scott & White System Cardiopulmonary Council
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Knight T, Bruzzi B, Wright A, Bohnenkamp SK. Impact of the MOVE (Mobility Optimizes Virtually Everything) Program. Nursing 2024; 54:48-51. [PMID: 39051960 DOI: 10.1097/nsg.0000000000000044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
ABSTRACT Early mobility of hospitalized patients has been associated with improved postoperative results and psychological outcomes, decreased length of stay, and other benefits. This article discusses Mobility Optimizes Virtually Everything (MOVE), an interactive bingo-like activity for patients, and its impact on patient satisfaction, mobility documentation, and decompensation rates.
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Affiliation(s)
- Tara Knight
- At Banner University Medical Center South, Tara Knight is the Director in Nursing, Bethany Bruzzi is a Chief Medical Officer, Angela Wright is the Chief Nursing Officer, and Susan Bohnenkamp is a Clinical Nurse Specialist
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Gilson S. Deconditioning in Hospitalized Patients with Cancer. Semin Oncol Nurs 2024; 40:151676. [PMID: 38945732 DOI: 10.1016/j.soncn.2024.151676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES Provide an overview of hospital-associated deconditioning in hospitalized patients with cancer, including risk factors and trajectory of deconditioning. Discuss interdisciplinary roles in preventing deconditioning, best practices, and oncology nursing implications. METHODS A literature search was conducted in PubMed and on Google Scholar using search terms Hospital*, Mobility, Immobility, Deconditioning, Cancer, and Oncology. Peer-reviewed research studies, review articles, and websites of professional organizations were reviewed to provide an overview on mobility concerns in hospitalized patients with cancer. RESULTS Thirty-eight references were included in this overview of hospital-associated deconditioning (HAD) in patients with cancer. HAD is a widespread phenomenon with grave consequences. Patients with cancer are particularly vulnerable to HAD due to their cancer diagnosis and treatment effects. Physical activity in hospitalized patients is one of the most important practices to prevent HAD and is achieved through standardized mobility assessment and interdisciplinary collaboration. CONCLUSIONS Promoting mobility in hospitalized patients with cancer is essential to prevent the complications of HAD. IMPLICATIONS FOR NURSING PRACTICE Nurses are leaders of the interdisciplinary approach to enhance inpatient mobility. As they are most often at the bedside, nurses assess patients' level of mobility, recognize risk factors for HAD, and implement safe mobility interventions. Nurses experience barriers to promoting mobility including workforce shortages, high workloads, and competing priorities.
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Affiliation(s)
- Savanna Gilson
- PIH Health Whittier Hospital, Clinical Nurse Specialist, Medical Oncology, Whittier, CA.
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Smith LM, Campbell D, Prush N, Trojanowski S, Sherman E, Yost E. Implementation and Mixed-Methods Assessment of an Early Mobility Interprofessional Education Simulation. Dimens Crit Care Nurs 2024; 43:158-167. [PMID: 38564459 DOI: 10.1097/dcc.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Extended periods of bed rest and mechanical ventilation (MV) have devastating effects on the body. BACKGROUND Early mobility (EM) for patients in respiratory failure is safe and feasible, and an interprofessional team is recommended. Using simulation to train EM skills improves student confidence. The purpose of this study was to enable health care student collaboration as an interprofessional team in providing safe management and monitoring during an EM simulation for a patient requiring MV. METHODS Nursing (n = 33), respiratory (n = 7), occupational (n = 24), and physical therapist students (n = 55) participated in an EM interprofessional education (IPE) simulation experience. A mixed-methods analytic approach was used with pre/post quantitative analysis of the Student Perceptions of Interprofessional Clinical Education-Revised, Version 2 instrument and qualitative analysis of students' guided reflection papers. RESULTS Pre/post surveys completion rate was 39.5% (n = 47). The Student Perceptions of Interprofessional Clinical Education-Revised, Version 2 instrument indicated a significant improvement (P = .037) in students' perceptions of interprofessional collaborative practice. Qualitative data showed a positive response to the EM simulation IPE. Themes reflected all 4 Interprofessional Education Collaborative competencies. DISCUSSION This study demonstrated improved perception of interprofessional collaborative practice and better understanding of the Interprofessional Education Collaborative competencies. CONCLUSION Students collaborated in the simulation-based IPE to provide EM for a patient requiring MV and reported perceived benefits of the experience.
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Haylett R, Grant J, Williams MA, Gustafson O. Does the level of mobility on ICU discharge impact post-ICU outcomes? A retrospective analysis. Disabil Rehabil 2024:1-6. [PMID: 38293804 DOI: 10.1080/09638288.2024.2310186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE Mobilisation is a common intervention in Intensive Care (ICU). However, few studies have explored the relationship between mobility levels and outcomes. This study assessed the association of the level of mobility on ICU discharge with discharge destination from the hospital and hospital length of stay. MATERIALS AND METHODS A retrospective analysis of data from 522 patients admitted to a single UK general ICU who were ventilated for ≥5 days was performed. The level of mobility was assessed using the Manchester Mobility Score (MMS). Multivariable regression analysed demographic and clinical variables for the independence of association with discharge destination and hospital length of stay. RESULTS MMS ≥5 on ICU discharge was independently associated with discharge destination and hospital LOS (p < 0.001). Patients achieving MMS ≥5 on ICU discharge were more likely to be discharged home (OR 3.86 95% CI 2.1 to 6.9, p < 0.001), and had an 11.8 day shorter hospital LOS (95% CI -17.6 to -6.1, p < 0.001). CONCLUSIONS The ability to step transfer to a chair (MMS ≥5) before ICU discharge was independently associated with discharge to usual residence and hospital LOS, irrespective of preadmission morbidity. Increasing the level of patient mobility at ICU discharge should be a key focus of rehabilitation interventions.
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Affiliation(s)
- Rebekah Haylett
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jonathan Grant
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mark A Williams
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Institute of Applied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Owen Gustafson
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Centre for Movement, Occupational and Rehabilitation Sciences (MOReS), Oxford Institute of Applied Health Research (OxINAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Schafthuizen L, van Dijk M, van Rosmalen J, Ista E. Mobility level and factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms. BMC Nurs 2024; 23:11. [PMID: 38163905 PMCID: PMC10759502 DOI: 10.1186/s12912-023-01648-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Although stimulating patients' mobility is considered a component of fundamental nursing care, approximately 35% of hospitalized patients experience functional decline during or after hospital admission. The aim of this study is to assess mobility level and to identify factors affecting mobility status in hospitalized patients admitted in single-occupancy patient rooms (SPRs) on general wards. METHODS Mobility level was quantified with the Johns Hopkins Highest Level of Mobility Scale (JH-HLM) and EQ-5D-3L. GENEActiv accelerometer data over 24 h were collected in a subset of patients. Data were analyzed using generalized ordinal logistic regression analysis. The STROBE reporting checklist was applied. RESULTS Wearing pajamas during daytime, having pain, admission in an isolation room, and wearing three or more medical equipment were negatively associated with mobilization level. More than half of patients (58.9%) who were able to mobilize according to the EQ-5D-3L did not achieve the highest possible level of mobility according to the JH-HLM. The subset of patients that wore an accelerometer spent most of the day in sedentary behavior (median 88.1%, IQR 85.9-93.6). The median total daily step count was 1326 (range 22-5362). CONCLUSION We found that the majority of participating hospitalized patients staying in single-occupancy patient rooms were able to mobilize. It appeared, however, that most of the patients who are physically capable of walking, do not reach the highest possible level of mobility according to the JH-HLM scale. Nurses should take their responsibility to ensure that patients achieve the highest possible level of mobility.
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Affiliation(s)
- Laura Schafthuizen
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Monique van Dijk
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine, section Nursing Science, Erasmus University Medical Center, Rotterdam, The Netherlands
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Broadway K, Nuila CM. Implementation of an Interprofessional Mobility Program in a Neurosurgical Intensive Care Unit. J Neurosci Nurs 2023; 55:205-210. [PMID: 37738106 DOI: 10.1097/jnn.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
ABSTRACT BACKGROUND: Emerging research suggests the need for implementation of mobility protocols and consistent evaluation of the impact on patient outcomes. Standardized mobility guidelines may be a solution for promoting nurse-driven mobility efforts and influencing a shift in the culture of mobility among nursing teams. In a 36-bed neurosurgical intensive care unit, 2 key areas of opportunity were identified related to patient mobility: strengthening of frontline nursing engagement in mobility and accuracy of documented early and safe mobilization. METHODS: Using a plan-do-study-act performance improvement framework, an interprofessional team developed a comprehensive early patient mobility program. Defined criteria and mobility rounds assisted in identifying the patient's functional ability and level of assistance. Nursing staff received education in case study format to enhance understanding and improve practical application of the phases of mobility. Chart reviews served as continuous assessment of documented mobilizations within the appropriate phases of mobility, and surveys evaluated staff perceptions of program success. RESULTS: On a rating scale of 1 to 5, clinicians reported a rating of 4.32 in overall observation that patients are safely mobilized earlier and more frequently and 4.48 on overall improvement in the neurosurgical intensive care unit culture of mobility. CONCLUSION: An interprofessional mobility program focusing on safe and early mobilization may improve overall culture, confidence, and empowerment of the frontline clinicians.
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Affiliation(s)
- Katie Broadway
- Cristina M. Nuila, MSN RN CNL, is Manager, Quality and Performance Improvement, Houston Methodist Hospital, Houston, TX
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Fuchita M, Ridgeway KJ, Sandridge B, Kimzey C, Abraham A, Melanson EL, Fernandez-Bustamante A. Comparison of postoperative mobilization measurements by activPAL versus Johns Hopkins Highest Level of Mobility scale after major abdominal surgery. Surgery 2023; 174:851-857. [PMID: 37580218 PMCID: PMC10530478 DOI: 10.1016/j.surg.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/22/2023] [Accepted: 07/08/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The Johns Hopkins Highest Level of Mobility scale is a validated tool for assessing patient mobility in the hospital. It has excellent inter-rater and test-retest reliabilities, but it is unknown how accurately Johns Hopkins Highest Level of Mobility documentation reflects the patients' mobility performance in the immediate postoperative period compared to objective measures such as accelerometers. METHODS In this single-center observational study, consented adults undergoing open abdominal surgery wore a research-grade accelerometer, activPAL, starting immediately postoperatively until hospital discharge or up to 7 days. We collected the Johns Hopkins Highest Level of Mobility scores documented by hospital staff via retrospective chart review and evaluated their accuracy in describing the type, frequency, and volume of postoperative out-of-bed mobilization using the activPAL as the criterion. RESULTS We analyzed data from 56 participants. The activPAL showed that participants spent 97.7% of their time lying in bed or sitting in a chair. Meanwhile, the Johns Hopkins Highest Level of Mobility documentation of preambulatory activities (scores 1-5) was rare. The activPAL detected 4 times more out-of-bed mobilization than routine Johns Hopkins Highest Level of Mobility documentation. Whereas the frequency of activPAL-measured out-of-bed mobilization increased steadily to a median of 9 sessions by postoperative day 6, the number of Johns Hopkins Highest Level of Mobility documentation remained around twice daily. ActivPAL measurements demonstrated that Johns Hopkins Highest Level of Mobility documentation of ambulatory sessions (scores 6-8) was accurate. CONCLUSIONS We found that routine Johns Hopkins Highest Level of Mobility documentation did not accurately detect preambulatory activities or the overall frequency of out-of-bed mobility sessions, poorly reflecting the highly sedentary behaviors of the acute postoperative inpatients and highlighting the need to improve clinical documentation or use alternative methods to track postoperative mobilization.
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Affiliation(s)
- Mikita Fuchita
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Kyle J Ridgeway
- Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, University of Colorado Health, Aurora, CO; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO. http://www.twitter.com/Dr_Ridge_DPT
| | | | | | - Alison Abraham
- Department of Epidemiology, University of Colorado School of Public Health, Aurora, CO
| | - Edward L Melanson
- Division of Endocrinology and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Rocky Mountain Regional VA Medical Center, Aurora, CO
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Camilo Ferreira R, Moorhead SA, Zuchatti BV, Correia MDL, Montanari FL, Duran ECM. Nursing interventions and activities for patients with multiple traumas: An integrative review. Int J Nurs Knowl 2023; 34:254-275. [PMID: 36269059 DOI: 10.1111/2047-3095.12401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/02/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to identify nursing interventions and activities for patients with multiple traumas who have variations in physical mobility. METHODS We used integrative literature review following Whittemore and Knafl method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses' guidelines and adopting the Oxford Center for Evidence-Based Classification Medicine - Levels of Evidence. The data collection was carried out between October and December 2019 and updated in May 2022, in the following databases: Virtual Health Library, Cochrane Library, Excerpta Medica dataBASE, Medical Literature Analysis and Retrieval System Online, PubMed®, SciVerse Scopus, The Cumulative Index to Nursing and Allied Health Literature, and Web of Science. FINDINGS There were 103 articles to be fully read and evaluated. From these, 34 publications were selected. Most nursing interventions and activities identified were placed in the NIC class Activity and Exercise Management in the Physiological: Basic domain, which has interventions to organize or to assist with physical activity, energy conservation, and expenditure; followed by Elimination Management (interventions to establish and maintain regular bowel and urinary elimination patterns and manage complications due to altered patterns); Immobility Management (interventions to manage restricted body movement and the sequelae); Nutrition Support (interventions to modify or maintain nutritional status); Physical Comfort Promotion (interventions to promote comfort using physical techniques); and Self-Care Facilitation (interventions to provide or assist with routine activities of daily living). CONCLUSIONS The interventions and nursing activities found in this research were not only related to the change in mobility in victims of multiple traumas but also aimed to prevent the consequences of immobility and to take care of already established conditions. IMPLICATIONS FOR THE NURSING PRACTICE This research enables the taxonomy's development and the validation of interventions for selected groups of patients. This allows the contribution to the development of the NIC-an important resource to improve nursing practice in teaching, research, and care.
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Affiliation(s)
| | - Sue Ann Moorhead
- Emeritus professor and past Director for the Center for Nursing Classification & Clinical Effectiveness, College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | | | | | - Fabio Luis Montanari
- Specialist in oncology nursing, Master Student at Program at School of Nursing, State University of Campinas and Jaguariúna University Center - UniFAJ, Campinas, Brazil
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Thatch KA, Kays DW. Advances in pulmonary management and weaning from ECLS. Semin Pediatr Surg 2023; 32:151329. [PMID: 37866170 DOI: 10.1016/j.sempedsurg.2023.151329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
ECMO for neonatal and pediatric respiratory failure provides gas exchange to allow lung recovery from reversible pulmonary ailments. This is a comprehensive discussion on the various strategies and advances utilized by pediatric ECLS specialists today. ECMO patients require continual monitoring, serial gasses and radiographs, near-infrared spectroscopy (NIRS - to monitor oxygen delivery to regional tissue beds), and more quality ECLS directed care. As the foundation to lung recovery, good EMCO closely monitors ECLS flow rates, sweep gasses, and membrane lung function. Mixed venous oxygen saturation (Sv02) greater than 65% indicates good oxygen delivery and sweep gas adjustments maintain PaCO2 of 40-45 mm Hg. Lung recovery ventilatory settings do not fully rest the lungs but maintain normal or nontoxic pressure and oxygen levels. Neonatal recovery settings are PIP (cm H20) of 15-20, PEEP of 5-10, ventilator rate of 12-20 and an inspiratory time of 0.5-1 s, and FiO2 of 0.3-0.5. Pediatric recovery settings are PIP (cm H20) < 25, PEEP of 5-15, ventilator rate of 10-20 and an inspiratory time of 0.8-1 s, and FiO2 of <0.5. Some studies demonstrate a higher recovery PEEP level decreases duration of ECMO, but do not demonstrate a mortality difference. Multiple adjunctive therapies such as surfactant, routine pulmonary clearance and respiratory physiotherapy, iNO, prone positioning, bronchoscopy, POCUS, CT imaging, and extubation or "awake ECLS" can significantly affect pulmonary recovery. Patience is necessary as lung recovery may take weeks or even months on the nontoxic settings. On these settings, dynamic recovery will be revealed by improvement in tidal volume, minute ventilation and radiographic pulmonary aeration, prompting discussion about weaning. When this pulmonary compliance recovery becomes evident, decreasing ECLS flow while also decreasing circuit FiO2 and/or sweep gas are common components to ECMO weaning strategies.
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Affiliation(s)
- Keith A Thatch
- Department of Pediatric Surgery, John Hopkins All Children's Hospital, St. Petersburg, FL, USA.
| | - David W Kays
- Department of Pediatric Surgery, John Hopkins All Children's Hospital, St. Petersburg, FL, USA
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Gabele D, Mendez S, Giuliano KK. Early and progressive mobility in a community hospital: A new interdisciplinary safe patient handling and mobility model. Nurs Manag (Harrow) 2023; 54:22-27. [PMID: 36795081 PMCID: PMC9977411 DOI: 10.1097/01.numa.0000919068.76409.b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
An early mobility program in a small community hospital resulted in high levels of staff engagement and decreased rates for falls and heel and sacral pressure injuries.
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Affiliation(s)
- Danielle Gabele
- Danielle Gabele is the chief nurse executive at Ventura County Medical Center and Santa Paula Hospital in Ventura, Calif., and a former CNO at Cedars Sinai Marina del Rey Hospital in Marina del Rey, Calif. Sheriee Mendez is the program manager, Safe Patient Handling and Falls at Cedars Sinai Marina del Rey Hospital in Marina del Rey, Calif. Karen K. Giuliano is a professor and the co-director of the Elaine Marieb Center for Nursing and Engineering Innovation at the University of Massachusetts Amherst in Amherst, Mass
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13
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Besa JJV, Masamayor EMI, Tamondong-Lachica DR, Palileo-Villanueva LM. Prevalence and predictors of prolonged length of stay among patients admitted under general internal medicine in a tertiary government hospital in Manila, Philippines: a retrospective cross-sectional study. BMC Health Serv Res 2023; 23:50. [PMID: 36653777 PMCID: PMC9850543 DOI: 10.1186/s12913-022-08885-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/24/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Prolonged hospitalization leads to poorer health outcomes and consumes limited hospital resources. This study identified factors associated with prolonged length of stay (PLOS) among internal medicine patients admitted in a tertiary government hospital. METHODS We reviewed the medical records of 386 adult patients admitted under the primary service of General Internal Medicine at the Philippine General Hospital from January 1 to December 31, 2019. PLOS was defined as at least 14 days for emergency admissions or 3 days for elective admissions. Sociodemographics, clinical characteristics, admission- and hospital system-related factors, disease-specific factors, outcome on the last day of hospitalization, and hospitalization costs were obtained. We determined the proportion with PLOS and reviewed reasons for discharge delays. We conducted multiple logistic regression analyses to assess associations between various factors and PLOS. RESULTS The prevalence of PLOS is 19.17% (95% CI 15.54, 23.42). Positive predictors include being partially dependent on admission (aOR 2.61, 95% CI 0.99, 6.86), more co-managing services (aOR 1.26, 95% CI 1.06, 1.50), and longer duration of intravenous antibiotics (aOR 1.36, 95% CI 1.22, 1.51). The only negative predictor is the need for intravenous antibiotics (aOR 0.14, 95% CI 0.04, 0.54). The most common reason for discharge delays was prolonged treatment. The median hospitalization cost of patients with PLOS was PHP 77,427.20 (IQR 102,596). CONCLUSIONS Almost a fifth of emergency admissions and a quarter of elective admissions had PLOS. Addressing factors related to predictors such as functional status on admission, number of co-managing services, and use of intravenous antibiotics can guide clinical and administrative decisions, including careful attention to vulnerable patients and judicious use of resources.
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Affiliation(s)
- John Jefferson V. Besa
- grid.11159.3d0000 0000 9650 2179Department of Medicine, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Ella Mae I. Masamayor
- grid.417272.50000 0004 0367 254XDepartment of Medicine, University of the Philippines Manila - Philippine General Hospital, Manila, Philippines
| | - Diana R. Tamondong-Lachica
- grid.11159.3d0000 0000 9650 2179Department of Medicine, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Lia M. Palileo-Villanueva
- grid.11159.3d0000 0000 9650 2179Department of Medicine, College of Medicine, University of the Philippines Manila, Manila, Philippines
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14
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Restrepo A, Saha AK, Khanna AK, Huang E, Clark CJ. Use of a Multi-Sensor Monitoring Device in an Early Post-operative Mobilization Program. Am Surg 2022; 88:1861-1867. [PMID: 35430918 DOI: 10.1177/00031348221087196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The current study aimed to evaluate the validity and feasibility of using a multi-sensor device to monitor patient mobility in a large postoperative population. METHODS In this IRB-approved study, postoperative patient posture was recorded using a multi-sensor monitoring device (ViSi Mobile®) and compared with direct observations of patient physical activity. Retrospective cohort analysis of postoperative patient posture data from January to December 2019 was then performed. Patterns of postoperative mobilization were evaluated. RESULTS Multi-sensor real-time posture monitoring with the ViSi Mobile® system consistently differentiate between rest and upright posture (sensitivity and specificity, both 100%). During observation of ambulatory events, ViSi Mobile® system correctly recorded a patient's position as upright at each validation time point in 72.7% (8 of 11) of walks. Clinical data from 562 postoperative patients were linked with posture monitoring data. Median duration of posture monitoring was 64 hours (IQR 52.5) and median number of posture positions recorded per patient was 15,370 (IQR 12,685). Median duration of upright position per day was 148.6 minutes (IQR 192.8). Duration in active upright position per day was not associated with risk of readmission (P > .05). CONCLUSION Real-time posture data from a multi-sensor monitoring device (ViSi Mobile®) was shown to consistently differentiate rest and active upright position. This novel technology can provide useful insight into adherence and clinical benefit of early mobilization programs.
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Affiliation(s)
| | - Amit K Saha
- Department of Anesthesiology, 544415Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, 544415Wake Forest School of Medicine, Winston-Salem, NC, USA.,Outcomes Research Consortium, Cleveland, OH, USA
| | - Emily Huang
- Department of Mathematics and Statistics, 8676Wake Forest University, Winston-Salem, NC, USA
| | - Clancy J Clark
- Department of Surgery, 12279Wake Forest School of Medicine, Winston-Salem, NC
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15
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Hiser S, Urbanek J, Young DL, McLaughlin KH, Colantuoni E, Brotman DJ, Needham DM, Hoyer E. Improving patient selection for use of consumer grade physical activity monitors in the hospital. Braz J Phys Ther 2022; 26:100447. [PMID: 36183578 PMCID: PMC9530475 DOI: 10.1016/j.bjpt.2022.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 09/08/2022] [Accepted: 09/15/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Bedrest is toxic for inpatients and consumer grade physical activity monitors offer an economical solution to monitor patient ambulation. But these devices may not be accurate in debilitated hospitalized patients who frequently ambulate very slowly. OBJECTIVE To determine whether measures of physical capacity can help identify inpatients for whom wearable physical activity monitors may accurately measure step count. METHODS Prospective observational study of 54 adult inpatients with acute neurological diagnoses. Patients were assessed using 2 physical capacity assessments (Activity Measure for Post-Acute Care Inpatient Mobility Short Form [AM-PAC IMSF] and Katz Activities of Daily Living [ADL] scale). They also completed a 2-minute walk test (2MWT) wearing a consumer grade physical activity monitor. RESULTS The wearable activity monitor recorded steps (initiated) in 33 (61%) of the inpatients, and for 94% of inpatients with gait speeds >0.43 m/s. Physical capacity assessments correlated well with gait speed, AM-PAC IMSF r = 0.7, and Katz ADL r = 0.6, p < 0.05. When the physical activity monitor initiated, the mean absolute percent error (SD) comparing device calculated steps to observed steps, was 10% (13). AM-PAC IMSF (T-score >45) and Katz ADL (>5) cutoff scores identified inpatients for whom physical activity monitors initiated with a sensitivity of 94 and 91%, respectively. CONCLUSIONS Physical capacity assessments, such as AM-PAC, and Katz ADL, may be a useful and feasible screening strategy to help identify inpatients where wearable physical activity monitors can measure their mobility.
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Affiliation(s)
- Stephanie Hiser
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jacek Urbanek
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel L. Young
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Kevin H. McLaughlin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel J Brotman
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M. Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erik Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA.
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16
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Li CY, Haas A, Pritchard KT, Karmarkar A, Kuo YF, Hreha K, Ottenbacher KJ. Functional Status Across Post-Acute Settings is Associated With 30-Day and 90-Day Hospital Readmissions. J Am Med Dir Assoc 2021; 22:2447-2453.e5. [PMID: 34473961 PMCID: PMC8627458 DOI: 10.1016/j.jamda.2021.07.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the association between cocalibrated functional scores across post-acute care settings and the subsequent risk of hospital readmission. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS We analyzed 781,021 fee-for-service Medicare beneficiaries discharged to either inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), or home health agencies (HHA) after an acute hospital stay for stroke (N = 143,277), lower extremity joint replacements (512,577), and hip/femur fracture (125,167) between January 1, 2013, and August 31, 2014. MEASURES Functional items from IRF-PAI, MDS, and OASIS were categorized into self-care and mobility domains. We cocalibrated admission functional scores across post-acute settings and divided scores into 4 functional levels using quartiles (Q1-Q4, with Q4 representing the most independent function). The primary outcomes were 30-day and 90-day hospital readmissions (yes/no) after an initial post-acute stay. RESULTS Patients who were more dependent in self-care and mobility at the initial post-acute setting were significantly more likely to experience hospital readmission [eg, hazard ratios of 30-day readmission in stroke: 1.54 (95% confidence interval [CI] 1.47-1.61), 1.18 (95% CI 1.14-1.23), and 1.12 (95% CI 1.08-1.16) for Q1, Q2 and Q3, compared to Q4]. We found similar results for risk of 90-day hospital readmission across impairment conditions. CONCLUSIONS AND IMPLICATIONS Patients who were more functionally dependent at the initial post-acute setting had a higher risk to readmit to the hospitals after discharging from the post-acute setting for 30 and 90 days, compared with patients who were more functionally independent. This finding is consistent across impairment conditions and post-acute settings. Future research should determine effective strategies of maintaining and facilitating functional performance across post-acute settings to optimize long-term patient outcomes.
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Affiliation(s)
- Chih-Ying Li
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX, USA.
| | - Allen Haas
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Kevin T Pritchard
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Amol Karmarkar
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA; Sheltering Arms Institute, 2000 Wilkes Ridge Pl Drive, Richmond, VA, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, TX, USA
| | - Kimberly Hreha
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, TX, USA
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17
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Reese SM, Johnson J, Edwards J, Oliveti M, Buszkiewic S. Innovative Partnership Between Intensive Care Unit Nurses and Therapists to Care for Patients With COVID-19. Crit Care Nurse 2021; 42:44-54. [PMID: 34382078 DOI: 10.4037/ccn2021152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND When patients with COVID-19 began presenting to hospitals in early 2020, medical professionals were unprepared to handle the severity of disease and the number of severely ill patients. LOCAL PROBLEM In response to critical needs of patients with COVID-19 and the threat of nurse burnout, a special operations team comprising physical and occupational therapists was convened to (1) provide help to intensive care unit nurses, (2) help therapists be productive, and (3) use therapists' specialties for critical patients. METHODS Two therapists teamed up each shift to work with every critical patient with COVID-19, performing numerous nursing and therapy activities. Activity frequency was documented by the therapists daily, and duration was estimated and data were summarized by nursing leadership. RESULTS During the 9-week program, 35 critical patients with COVID-19 were included in the special operations program. During the program, the teams performed 10 activities, including prone positioning, turning, and mobilization, 1937 times with the patients with COVID-19. The partnership saved between 5 and 40 minutes of intensive care nurse time per activity, which resulted in a total of 677.2 hours of nursing time saved. DISCUSSION Implementation of the special operations program had a positive impact on patients, nurses, and therapists. Patients benefited both clinically and socially from additional time with special operations teams. Nurses benefited from having help caring for critical patients, and therapists benefited from increased productivity during redeployment. CONCLUSION Deployment of nonnursing clinical staff could be an effective strategy to leverage available resources while maintaining clinical standards of care and reducing nursing burden during a pandemic or crisis surge.
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Affiliation(s)
- Sara M Reese
- Sara M. Reese is the infection prevention manager at Swedish Medical Center, Englewood, Colorado
| | - Jennifer Johnson
- Jennifer Johnson is a labor and delivery nurse at Swedish Medical Center
| | - Jennifer Edwards
- Jennifer Edwards is the Director of therapy and wound care at Swedish Medical Center
| | - Michelle Oliveti
- Michelle Oliveti is the Assistant Director of therapy and wound care at Swedish Medical Center
| | - Susan Buszkiewic
- Susan Buszkiewic is the Nursing Director of the intensive care units at Swedish Medical Center
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