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Moriwaki M, Tanaka M, Toba M, Ozasa Y, Ogata Y, Obayashi S. Relationship Between Unit Characteristics and Fall Incidence: A Cross-Sectional Survey Using Administrative Data in Japan. J Nurs Res 2024; 32:e333. [PMID: 38814998 DOI: 10.1097/jnr.0000000000000615] [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: 06/01/2024] Open
Abstract
BACKGROUND Falls are the most frequent accident experienced by inpatients in hospitals. As falls affect patient outcomes, high fall risk factors should be studied to prevent falls and improve patient safety. However, the relationship between hospital unit characteristics and fall risk has never been assessed. PURPOSE This study was designed to identify the unit characteristics significantly related to fall risk. METHODS A cross-sectional study was conducted on the medical records of patients hospitalized in a Japanese academic hospital between 2018 and 2019. This study quantified unit activities and utilized Diagnosis Procedure Combination data to examine unit characteristics related to falls based on unit day. RESULTS Data on 16,307 patients were included in the analysis, and 355 unit days were certified as fall events. Based on patient condition and medical treatment, the results identified antineoplastic injections, radiation therapy, aseptic treatment room, and functional status of partly assisted transfers, meals, and oral care as unit characteristics associated with increased fall events. Decreased nursing time per patient at night (odds ratio [OR] = 0.75, p = .04) and higher numbers of partially assisted transfer patients were also identified as unit characteristics associated with higher fall incidence rates (OR = 5.56, p = .01). CONCLUSIONS The results of this study are expected to assist nurses to predict falls based on unit characteristics; reducing nursing time in the units was found to be a factor associated with higher fall risk. Nurse managers must understand the unit-related fall risk factors, appropriately assign nurse staffing numbers, and demonstrate nursing leadership to prevent falls in their units.
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Affiliation(s)
- Mutsuko Moriwaki
- PhD, RN, Associate Professor, Quality Management Center, Tokyo Medical and Dental University Hospital, Japan
| | - Michiko Tanaka
- PhD, RN, Lecturer, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Japan
| | - Mikayo Toba
- PhD, MD, Associate Professor, Quality Management Center, Tokyo Medical and Dental University Hospital, Japan
| | - Yuka Ozasa
- PhD, RN, Head Nurse, Clinical Research Center, Tokyo Medical and Dental University Hospital, Japan
| | - Yasuko Ogata
- PhD, RN, Professor, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Japan
| | - Satoshi Obayashi
- PhD, MD, Professor, Department of Obstetrics & Gynecology, Dokkyo Medical University, Japan
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Bernet NS, Everink IHJ, Hahn S, Müller M, Schols JMGA. Risk-adjusted trend in national inpatient fall rates observed from 2011 to 2019 in acute care hospitals in Switzerland: a repeated multicentre cross-sectional study. BMJ Open 2024; 14:e082417. [PMID: 38754884 PMCID: PMC11097859 DOI: 10.1136/bmjopen-2023-082417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES This study aimed to investigate whether a significant trend regarding inpatient falls in Swiss acute care hospitals between 2011 and 2019 could be confirmed on a national level, and whether the trend persists after risk adjustment for patient-related fall risk factors. DESIGN A secondary data analysis was conducted based on annual multicentre cross-sectional studies carried out between 2011 and 2019. SETTING All Swiss acute care hospitals were obliged to participate in the surveys. Except for emergency departments, outpatient wards and recovery rooms, all wards were included. PARTICIPANTS All inpatients aged 18 or older who had given their informed consent and whose data were complete and available were included. OUTCOME MEASURE Whether a patient had fallen in the hospital was retrospectively determined on the survey day by asking patients the following question: Have you fallen in this institution in the last 30 days? RESULTS Based on data from 110 892 patients from 222 Swiss hospitals, a national inpatient fall rate of 3.7% was determined over the 9 survey years. A significant linear decreasing trend (p=0.004) was observed using the Cochran-Armitage trend test. After adjusting for patient-related fall risk factors in a two-level random intercept logistic regression model, a significant non-linear decreasing trend was found at the national level. CONCLUSIONS A significant decrease in fall rates in Swiss hospitals, indicating an improvement in the quality of care provided, could be confirmed both descriptively and after risk adjustment. However, the non-linear trend, that is, an initial decrease in inpatient falls that flattens out over time, also indicates a possible future increase in fall rates. Monitoring of falls in hospitals should be maintained at the national level. Risk adjustment accounts for the observed increase in patient-related fall risk factors in hospitals, thus promoting a fairer comparison of the quality of care provided over time.
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Affiliation(s)
- Niklaus S Bernet
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Irma H J Everink
- Department of Health Services Research, Maastricht University; Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Sabine Hahn
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Marianne Müller
- School of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University; Care and Public Health Research Institute, Maastricht, The Netherlands
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Higgins JT, Charles RD, Fryman LJ. Original Research: Breaking Through the Bottleneck: Acuity Adaptability in Noncritical Trauma Care. Am J Nurs 2024; 124:24-34. [PMID: 38511707 DOI: 10.1097/01.naj.0001010176.21591.80] [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: 03/22/2024]
Abstract
BACKGROUND Achieving efficient throughput of patients is a challenge faced by many hospital systems. Factors that can impede efficient throughput include increased ED use, high surgical volumes, lack of available beds, and the complexities of coordinating multiple patient transfers in response to changing care needs. Traditionally, many hospital inpatient units operate via a fixed acuity model, relying on multiple intrahospital transfers to move patients along the care continuum. In contrast, the acuity-adaptable model allows care to occur in the same room despite fluctuations in clinical condition, removing the need for transfer. This model has been shown to be a safe and cost-effective approach to improving throughput in populations with predictable courses of hospitalization, but has been minimally evaluated in other populations, such as patients hospitalized for traumatic injury. PURPOSE This quality improvement project aimed to evaluate implementation of an acuity-adaptable model on a 20-bed noncritical trauma unit. Specifically, we sought to examine and compare the pre- and postimplementation metrics for throughput efficiency, resource utilization, and nursing quality indicators; and to determine the model's impact on patient transfers for changes in level of care. METHODS This was a retrospective, comparative analysis of 1,371 noncritical trauma patients admitted to a level 1 trauma center before and after the implementation of an acuity-adaptable model. Outcomes of interest included throughput efficiency, resource utilization, and quality of nursing care. Inferential statistics were used to compare patients pre- and postimplementation, and logistic regression analyses were performed to determine the impact of the acuity-adaptable model on patient transfers. RESULTS Postimplementation, the median ED boarding time was reduced by 6.2 hours, patients more often remained in their assigned room following a change in level of care, more progressive care patient days occurred, fall and hospital-acquired pressure injury index rates decreased respectively by 0.9 and 0.3 occurrences per 1,000 patient days, and patients were more often discharged to home. Logistic regression analyses revealed that under the new model, patients were more than nine times more likely to remain in the same room for care after a change in acuity and 81.6% less likely to change rooms after a change in acuity. An increase of over $11,000 in average daily bed charges occurred postimplementation as a result of increased progressive care-level bed capacity. CONCLUSIONS The implementation of an acuity-adaptable model on a dedicated noncritical trauma unit improved throughput efficiency and resource utilization without sacrificing quality of care. As hospitals continue to face increasing demand for services as well as numerous barriers to meeting such demand, leaders remain challenged to find innovative ways to optimize operational efficiency and resource utilization while ensuring delivery of high-quality care. The findings of this study demonstrate the value of the acuity-adaptable model in achieving these goals in a noncritical trauma care population.
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Affiliation(s)
- Jacob T Higgins
- Jacob T. Higgins is an assistant professor at the University of Kentucky (UK) College of Nursing, Lexington, as well as a nurse scientist in trauma/surgical services at UK HealthCare, Lexington, where Rebecca D. Charles is a patient care manager and Lisa J. Fryman is the nursing operations director. Contact author: Jacob T. Higgins, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Li H, Liu C, Ge Z, Mu X, Wang X, Xiu M, Wang X, Li Z. Efficacy of standard operating procedures for fall protection in hospitalized patients with schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:73. [PMID: 37848486 PMCID: PMC10582107 DOI: 10.1038/s41537-023-00396-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023]
Abstract
Fall-related injury is the most common cause of functional disability and mortality in the older population. Falls in patients with schizophrenia are one of the major concerns in psychiatric hospitals. This study aimed to examine the impact of standardized operating procedures (SOP) on falls in veterans with schizophrenia. Veterans with schizophrenia were allocated to the control group (n = 345) and to the fall protection standardized operating procedures (FP-SOP) group (n = 342). Patients in the control group were given routine nursing for falls, and patients in the FP-SOP group were intervened with FP-SOP plus routine nursing. All patients were observed for one year. The study methods comply with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. We found a fall rate of 1.5% in the FP-SOP group and 4.6% in the control group, with a significant difference in the fall rate between the two groups. In addition, the difference in patient satisfaction between the two groups was statistically significant. Our findings suggest that FP-SOP is an effective strategy for fall prevention in psychiatric hospitals.
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Affiliation(s)
- Hui Li
- Hebei Province Veterans Hospital, Baoding, China
| | - Caixing Liu
- Qingdao Mental Health Center, Qingdao, China
| | - Zengyun Ge
- Qingdao Mental Health Center, Qingdao, China
| | - Xishu Mu
- Hebei Province Veterans Hospital, Baoding, China
| | - Xuan Wang
- Hebei Province Veterans Hospital, Baoding, China
| | - Meihong Xiu
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing, China
| | - Xinfu Wang
- Hebei Province Veterans Hospital, Baoding, China
| | - Zezhi Li
- Department of Nutritional and Metabolic Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
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Lee SW, Elsakr C, Ayutyanont N, Lee S, Oh-Park M. Clinical Characteristics and Outcomes of Inpatient Falls During Inpatient Rehabilitation: A Case-Control Study. Am J Phys Med Rehabil 2023; 102:715-719. [PMID: 37104642 DOI: 10.1097/phm.0000000000002262] [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: 04/29/2023]
Abstract
ABSTRACT Inpatient falls have a significant impact on the outcomes of older patients during inpatient rehabilitation. A retrospective case-control study was conducted using data of 7066 adults aged 55 yrs or older to evaluate significant predictors of inpatient falls during inpatient rehabilitation and the association of inpatient falls with discharge destination and length of stay. A stepwise logistic regression was used to model odds of inpatient falls and home discharge with demographic and clinical characteristic variables and a multivariate linear regression to evaluate the association between inpatient falls and length of stay.Nine hundred thirty-one of 7066 patients (13.18%) had inpatient falls during inpatient rehabilitation. The group with inpatient falls had longer length of stay (14.22 ± 7.82 vs. 11.85 ± 5.33 days, P < 0.0001) and a decreased proportion of home discharges when compared with the group without inpatient falls. There were increased odds of inpatient falls among patients with diagnoses of head injury, other injuries, a history of falls, dementia, a divorced marital status, and a use of laxatives or anticonvulsants. Inpatient falls were associated with an increased length of stay (coefficient = 1.62, confidence interval = 1.19-2.06) and decreased odds of home discharge (odds ratio = 0.79, confidence interval = 0.65-0.96) after inpatient rehabilitation. This knowledge may be incorporated into strategies for reducing inpatient falls during inpatient rehabilitation.
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Affiliation(s)
- Se Won Lee
- From the Sunrise Health GME Consortium, Las Vegas, Nevada (SWL, CE, NA); Yeshiva University, New York, New York (SL); and Burk Rehabilitation Hospital/Albert Einstein College of Medicine, White Plains, New York (MO-P)
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Hamadi H, Borkar SR, Moody L, Tafili A, Wilkes JS, Moreno Franco P, McCaughey D, Spaulding A. Hospital-Acquired Conditions Reduction Program, Patient Safety, and Magnet Designation in the United States. J Patient Saf 2021; 17:e1814-e1820. [PMID: 32217925 DOI: 10.1097/pts.0000000000000628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the association between hospitals' nursing excellence accreditation and patient safety performance-measured by the Hospital-Acquired Conditions Reduction Program (HACRP). METHODS We linked data from the American Nursing Credentialing Center Magnet Recognition Program, Centers for Medicare and Medicaid Services HACRP, and the American Hospital Association annual survey from 2014 to 2016. We constrained the analysis to hospitals participating in Centers for Medicare and Medicaid Services' HACRP and deployed propensity score matching models to calculate the coefficients for our HACRP patient safety measures. These measures consisted of (a) patient safety indicator 90, (b) hospital-associated infection measures, and (c) total HAC scores. In addition, we used propensity score matching to assess HACRP scores between hospitals achieving Magnet recognition in the past 2 versus longer and within the past 5 years versus longer. RESULTS Our primary findings indicate that Magnet hospitals have an increased likelihood of experiencing lower patient safety indicator 90 scores, higher catheter-associated urinary tract infection and surgical site infection scores, and no different total HAC scores. Finally, when examining the impact of Magnet tenure, our analysis revealed that there were no differences in Magnet tenure. CONCLUSIONS Results indicate that the processes, procedures, and educational aspects associated with Magnet recognition seem to provide important improvements associated with care that is controlled by nursing practice. However, because these improvements do not differ when comparing total HAC scores nor Magnet hospitals with different tenure, there are likely opportunities for Magnet hospitals to continue process improvements focused on HACRP scores.
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Affiliation(s)
- Hanadi Hamadi
- From the Department of Health Administration, Brooks College of Health, University of North Florida
| | - Shalmali R Borkar
- Department of Health Sciences Research, Division of Health Care Policy, and Research, Mayo Clinic Robert D., and Patricia E. Kern, Center for the Science of Health Care Delivery, Mayo Clinic
| | - LaRee Moody
- Bachelor of Health Administration Program, Books College of Health, University of North Florida
| | - Aurora Tafili
- From the Department of Health Administration, Brooks College of Health, University of North Florida
| | - J Scott Wilkes
- From the Department of Health Administration, Brooks College of Health, University of North Florida
| | | | - Deirdre McCaughey
- Department of Community Health Sciences Affiliate, W21C Research and Innovation Centre, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aaron Spaulding
- Department of Health Sciences Research, Division of Health Care Policy, and Research, Mayo Clinic Robert D., and Patricia E. Kern, Center for the Science of Health Care Delivery, Mayo Clinic
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Jones KJ, Haynatzki G, Sabalka L. Evaluation of Automated Video Monitoring to Decrease the Risk of Unattended Bed Exits in Small Rural Hospitals. J Patient Saf 2021; 17:e716-e726. [PMID: 33009181 PMCID: PMC8612902 DOI: 10.1097/pts.0000000000000789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to evaluate the effectiveness of using 1 to 4 mobile or fixed automated video monitoring systems (AVMSs) to decrease the risk of unattended bed exits (UBEs) as antecedents to unassisted falls among patients at high risk for falls and fall-related injuries in 15 small rural hospitals. METHODS We compared UBE rates and fall rates during baseline (5 months in which patient movement was recorded but nurses did not receive alerts) and intervention phases (2 months in which nurses received alerts). We determined lead time (seconds elapsed from the first alert because of patient movement until 3 seconds after an UBE) during baseline and positive predictive value and sensitivity during intervention. RESULTS Age and fall risk were negatively associated with the baseline patient rate of UBEs/day. From baseline to intervention: in 9 hospitals primarily using mobile systems, UBEs/day decreased from 0.84 to 0.09 (89%); in 5 hospitals primarily using fixed systems, UBEs/day increased from 0.43 to 3.18 (649%) as patients at low risk for falls were observed safely exiting the bed; and among 13 hospitals with complete data, total falls/1000 admissions decreased from 8.83 to 5.53 (37%), and injurious falls/1000 admissions decreased from 2.52 to 0.55 (78%). The median lead time of the AVMS was 28.5 seconds, positive predictive value was nearly 60%, and sensitivity was 97.4%. CONCLUSIONS Use of relatively few AVMSs may allow nurses to adaptively manage UBEs as antecedents to unassisted falls and fall-related injuries in small rural hospitals. Additional research is needed in larger hospitals to better understand the effectiveness of AVMSs.
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Affiliation(s)
- Katherine J. Jones
- From the Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center and Jones Health Services Consulting
| | - Gleb Haynatzki
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha
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Davis J, Casteel C, Peek-Asa C. In-Hospital Fall and Fracture Risk With Conditions in the Elixhauser Comorbidity Index: An Analysis of State Inpatient Data. J Patient Saf 2021; 17:e1779-e1784. [PMID: 32168270 DOI: 10.1097/pts.0000000000000637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In-hospital falls (IHFs) are a significant burden to the healthcare industry and patients seeking inpatient care. Many falls lead to injuries that could be considered a hospital-acquired condition (HAC). We demonstrated how administrative data can be used to quantify how many IHFs occur and identify what conditions increase the risk for these falls. METHODS Iowa State Inpatient Database records from 2008 to 2014 for adults older than 50 years were used to quantify IHFs, falls resulting in an HAC (HAC IHFs), and fractures during in-hospital treatment. The medical conditions used in the Elixhauser Comorbidity Index were evaluated for the risk of the separate fall-related outcomes using Poisson regression. RESULTS There were 1770 records that had an IHF for an IHF rate of 0.26 per 1000 patient days. Psychoses (rate ratio = 1.95, 95% confidence interval = 1.63-2.34) and alcohol abuse (rate ratio = 1.77, 95% confidence interval = 1.40-2.24) showed the greatest increase in IHF risk. These conditions also increased the risk of HAC IHFs and in-hospital fractures. Fluid and electrolyte disorders, deficiency anemias, and chronic pulmonary disease increased the risk for IHFs/HAC IHFs but did not increase the risk of in-hospital fractures. CONCLUSIONS Administrative data can be used to track various fall-related outcomes occurring during inpatient treatment. Several conditions of the Elixhauser Comorbidity Index were identified as increasing the risk of fall-related outcomes and should be considered when evaluating a patient's risk of falling.
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Affiliation(s)
- Jonathan Davis
- From the University of Iowa Injury Prevention Research Center
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Keith AC, Warshawsky N, Talbert S. Factors That Influence Millennial Generation Nurses' Intention to Stay: An Integrated Literature Review. J Nurs Adm 2021; 51:220-226. [PMID: 33734182 DOI: 10.1097/nna.0000000000001001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To synthesize literature exploring the expectations of millennial nurses and factors that influence their retention. BACKGROUND Long-anticipated nursing shortages are happening nationwide in part from boomer retirements. These supply issues are expected to worsen because of an aging population who will require complex healthcare going forward. Millennial nurse turnovers, however, represent the biggest threat to supply. METHODS This extensive literature review was conducted following published guidelines. Thirteen publications regarding millennials' expectations of work were analyzed. RESULTS Millennials expect strong leadership, advancement opportunities, alignment of organizational and personal values, good coworker relationships, healthy work-life balance, recognition, and cutting-edge technology. CONCLUSIONS Millennials have specific expectations for work, and they will leave if these go unmet. Findings from this review provide valuable insight into this generation of nurses to help leaders create appropriate retention strategies. The limited literature on this topic highlights the need for more research.
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Affiliation(s)
- Angela C Keith
- Author Affiliations: Doctoral Candidate (Ms Keith), Professor and Interim Director of Nursing PhD Program (Dr Talbert), and Professor (Dr Warshawsky), President of Association for Leadership Science in Nursing, College of Nursing, University of Central Florida, Orlando
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Olds D, Cramer E. Predictors of physical restraint use on critical care units: An observational structural equation modeling approach. Int J Nurs Stud 2021; 118:103925. [PMID: 33853022 DOI: 10.1016/j.ijnurstu.2021.103925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Modifiable unit characteristics, including nurse work environment, education, certification, and staffing have been shown to impact patient safety. Physical restraints are an important patient safety issue, however the relationships between these modifiable unit characteristics and physical restraint use on critical care units has not been explored. OBJECTIVES Our objective was to determine the role of nursing work environment, nurse education and certification, and nurse staffing on physical restraint use. DESIGN The study was a secondary analysis of 2017-2018 unit-level restraint rates from the National Database of Nursing Quality Indicators linked to Registered Nurse survey and hospital characteristics data. METHODS Work environment was examined at the unit-level using total Practice Environment Scale of the Nursing Work Index and subscale scores. Unit-level nurse expertise included the percent of nurses with at least a Bachelor of Science in Nursing degree and percent with certification. Nurse staffing was the unit-level Registered Nurse hours per patient day and skill mix. Analyses included descriptive statistics, bivariate correlations, and Structural Equation Modeling. We used a first order model to estimate predicted restraint use from the five subscales of the Practice Environment Scale of the Nursing Work Index. A higher order model predicted restraint use from a total work environment factor score. RESULTS The sample included 408 critical care units from 226 hospitals. Mean restraint rate was 15% (SD 12, range 0-53%). In the first-order model, the Collegial Nurse-Physician Relations subscale had a positive relationship with restraint use (β = 0.167, 95% confidence interval 0.010-0.333). In the higher order model, the total work environment score had a negative relationship with restraint use (β = -0.088, 95% confidence -0.178- -0.014). Registered Nurse hours per patient day had a negative relationship to restraint use in both the first order (β = -0.114, 95% confidence interval -0.222--0.025) and higher order models (β = -0.117, 95% confidence interval -0.223- -0.012). CONCLUSION We found that better nurse-physician relationships were associated with higher restraint use. This finding is supported by previous literature and may reflect physician trust in nursing judgement when using restraints. However, a better work environment overall was associated with lower restraint rates. Further, Registered Nurse hours per patient day, but not skill mix, was associated with lower restraint rates. We conclude that improving the overall nurse work environment and nurse staffing, as well as using interprofessional interventions, may be successful in decreasing restraint use on critical care units.
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Affiliation(s)
- Danielle Olds
- Research Assistant Professor, University of Kansas School of Nursing USA.
| | - Emily Cramer
- Research Associate Professor, University of Kansas School of Nursing USA
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Effect of preventive care interventions on pressure ulcer rates in a national sample of rural and urban nursing units: Longitudinal associations over 4 years. Int J Nurs Stud 2019; 105:103455. [PMID: 32203754 DOI: 10.1016/j.ijnurstu.2019.103455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/22/2019] [Accepted: 10/25/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pressure ulcer rates are persistently high despite years of research and practice policies focused on prevention. Prior research found crosssectional associations between care interventions, hospital and nursing unit characteristics and pressure ulcer rates. Whether these associations persist over time is unknown. Finally, comparisons of quality measures across rural and urban location have mixed findings. OBJECTIVE Our study examined effects of care interventions on unit-acquired pressure ulcer rates over 4 years controlling for community, hospital, and nursing unit characteristics in rural and urban locations. DESIGN Guided by contingency theory a longitudinal study was conducted to examine associations between context, staffing, care interventions, nurse outcomes, and pressure ulcer rates, using unit-level data from the National Database of Nursing Quality IndicatorsⓇ 2010-2013 (16 quarters) augmented with data on rural classifications and case mix index. Ulcer rates were measured as percentage of patients with a nursing unit-acquired pressure ulcer. The three care interventions were unit-percentage of patients receiving skin assessment on admission, receiving risk assessment on admission, and receiving any risk assessment before the pressure ulcer. Nursing unit characteristics were RN staffing, education, and experience. Nurse outcomes were job satisfaction and intent-to-stay. PARTICIPANTS We included 5761 units (332 rural and 5429 urban) in 772 hospitals (89 rural and 683 urban) that reported ulcer rates in two or more quarters during the study period. METHODS Rural and urban units were examined separately using multilevel binomial regression in which within-unit changes in pressure ulcer rates were related to the within-unit changes in the explanatory variables, controlling for region, hospital size, unit type, case mix index, and percentage of patients at risk for pressure ulcers. RESULTS An increase in the three care interventions, RN skill mix, and the two nurse outcomes were associated with a decrease in unit-acquired pressure ulcers. For example, in rural units a 10% increase in unit-percentage of any risk assessment and in urban units a 10% increase in skin assessment on admission were associated with a 21% and 5% decrease in the odds of developing an ulcer. A 10% increase in RN skill mix was associated with 17-18% and 5-6% decrease in ulcer rates in rural and urban units respectively. CONCLUSION Hospitals aiming to improve pressure ulcer prevention should focus on organizational structures that support improved nurses work environments and workflow that will enhance nursing care interventions. Future studies should include both contextual and patient characteristics along with care interventions.
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Abstract
Falls in hospitalized patients are a pressing patient safety concern, but there is a limited body of evidence demonstrating the effectiveness of commonly used fall prevention interventions in hospitals. This article reviews common study designs and the evidence for various hospital fall prevention interventions. There is a need for more rigorous research on fall prevention in the hospital setting.
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Baernholdt M, Hinton ID, Yan G, Xin W, Cramer E, Dunton N. Fall Rates in Urban and Rural Nursing Units: Does Location Matter? J Nurs Care Qual 2018; 33:326-333. [PMID: 29346186 PMCID: PMC6047925 DOI: 10.1097/ncq.0000000000000319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient falls remain a leading adverse event in hospitals. In a study of 65 rural hospitals with 222 nursing units and 560 urban hospitals with 4274 nursing units, we found that geographic region, unit type, and nurse staffing, education, experience, and outcomes were associated with fall rates. Implications include specific attention to fall prevention in rehabilitation units, creating better work environments that promote nurse retention, and provide RN-BSN educational opportunities.
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Affiliation(s)
- Marianne Baernholdt
- Department of Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University, Richmond, Virginia
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King B, Pecanac K, Krupp A, Liebzeit D, Mahoney J. Impact of Fall Prevention on Nurses and Care of Fall Risk Patients. THE GERONTOLOGIST 2018; 58:331-340. [PMID: 28011591 DOI: 10.1093/geront/gnw156] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 07/11/2016] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study Falls are common events for hospitalized older adults, resulting in negative outcomes both for patients and hospitals. The Center for Medicare and Medicaid (CMS) has placed pressure on hospital administrators by identifying falls as a "never event", resulting in a zero falls goal for many hospitals. Staff nurses are responsible for providing direct care to patients and for meeting the hospital no falls goal. Little is known about the impact of "zero falls" on nurses, patients and the organization. Design and Methods A qualitative study, using Grounded Dimensional Analysis (GDA) was conducted to explore nurses' experiences with fall prevention in hospital settings and the impact of those experiences on how nurses provide care to fall risk patients. Twenty-seven registered nurses and certified nursing assistants participated in in-depth interviews. Open, axial and selective coding was used to analyze data. A conceptual model which illustrates the impact of intense messaging from nursing administration to prevent patient falls on nurses, actions nurses take to address the message and the consequences to nurses, older adult patients and to the organization was developed. Results Intense messaging from hospital administration to achieve zero falls resulted in nurses developing a fear of falls, protecting self and unit, and restricting fall risk patients as a way to stop messages and meet the hospital goal. Implications Results of this study identify unintended consequences of fall prevention message on nurses and older adult patients. Further research is needed understand how nurse care for fall risk patients.
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Affiliation(s)
- Barbara King
- School of Nursing, University of Wisconsin-Madison
| | | | - Anna Krupp
- School of Nursing, University of Wisconsin-Madison
| | | | - Jane Mahoney
- Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin-Madison
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Mobilizing older adults: A multi-site, exploratory and observational study on patients enrolled in the Hospital Elder Life Program (HELP). Geriatr Nurs 2018; 40:239-245. [PMID: 30413275 DOI: 10.1016/j.gerinurse.2018.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 01/21/2023]
Abstract
The aim of this study was to explore and describe the characteristics of the Hospital Elder Life Program (HELP) sites and how they mobilize patients with volunteers in the United States and other countries. The purpose was to describe: the number of enrollments, modalities, fall and injury rates, and to identify barriers to mobilization. A survey was distributed to 228 international sites. The responding sites enrolled an average of 53.9 (SD 35.3) patients per month. The majority (76%) reported that mobilization included 'active range of motion exercises' and 'ambulation'. Eighteen percent identified volunteer training, safety and liability concerns as barriers. Falls with injury on HELP units was 0-3%, with an average rate of 0.46 per 1,000 patient days. No patient falls while ambulating with the HELP team and/or volunteers were reported. More research and evidence are needed to further determine barriers and safety of mobilization with the HELP during hospitalization.
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Kouatly IA, Nassar N, Nizam M, Badr LK. Evidence on Nurse Staffing Ratios and Patient Outcomes in a Low-Income Country: Implications for Future Research and Practice. Worldviews Evid Based Nurs 2018; 15:353-360. [PMID: 30129163 DOI: 10.1111/wvn.12316] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Conclusive evidence on the effect of nurse staffing ratios on nurse-sensitive outcomes (NSOs) has not yet been achieved worldwide. AIMS To describe the relationship between nurse staffing and NSOs at a Magnet designated, university hospital a low-income country. METHODS A 48-month prospective study assessed the relationship between nurse staffing and six patient outcomes or NSOs in medical-surgical units and critical care units (CCUs). Nurse staffing was measured by nursing hours per patient day (NHPPD) and skill mix, whereas NSOs were total falls and injury falls per 1,000 patient days, percent of surveyed patients with hospital-acquired pressure injuries (HAPI), catheter-associated urinary tract infections, ventilator-associated pneumonia, and central line-associated bloodstream infections (CLABSI) per 1,000 central line days. RESULTS The odds for total falls, injury falls, HAPI, and CLABSI in the medical-surgical units were higher with lower NHPPD ratios, OR = 4.67, p = .000; OR = 4.33, p = .001; OR = 3.77, p = .004 and OR = 2.61, p = .006, respectively. For the CCUs, lower rates of NHPPD increased the odds for total falls, OR = 6.25, p = .0007, HAPIs OR = 3.91, p = .001 and CLABSI, OR = 4.78, p = .000. Skill mix was associated with total falls, OR = 2.40, p = .005 and HAPIs OR = 2.07, p = .03 in the medical-surgical units but had no effect in any NSOs in the CCUs. LINKING EVIDENCE TO ACTION Higher rates of nurses per patient were effective in improving some NSOs but not others. Skill mix had no effect on any of the six NSOs in the CCUs. As such, the results remain inconclusive as the benefits of the higher nurse to patient ratios in this low-income country warranting further multisite studies in different settings and countries.
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Affiliation(s)
- Iman Al Kouatly
- Nursing Director, Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada Nassar
- Nurse Quality Manager, Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Nizam
- Executive Assistant, Nursing Services Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lina Kurdahi Badr
- Professor, School of Nursing, Azusa Pacific University, Asuza, CA, USA
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Myers H, Pugh JD, Twigg DE. Identifying nurse-sensitive indicators for stand-alone high acuity areas: A systematic review. Collegian 2018. [DOI: 10.1016/j.colegn.2017.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Temporal Trends in Fall Rates with the Implementation of a Multifaceted Fall Prevention Program: Persistence Pays Off. Jt Comm J Qual Patient Saf 2018; 44:75-83. [PMID: 29389463 DOI: 10.1016/j.jcjq.2017.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/15/2017] [Accepted: 08/21/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most fall prevention programs are only modestly effective, and their sustainability is unknown. An academic medical center implemented a series of fall prevention interventions from 2001 to 2014. METHODS The medical center's series of fall prevention interventions were as follows: reorganized the Falls Committee (2001), started flagging high-risk patients (2001), improved fall reporting (2002), increased scrutiny of falls (2005), instituted hourly nursing rounds (2006), reorganized leadership systems (2007), standardized fall prevention equipment (2008), adapted to a move to a new hospital building (2008), routinely investigated root causes (2009), mitigated fall risk during hourly nursing rounds (2009), educated patients about falls (2011), and taught nurses to think critically about risk (2012). To evaluate temporal trends in falls and injury falls, piecewise negative binomial regression with study unit-level random effects was used to analyze structured validated data sets available since 2003. RESULTS From July 2003 through December 2014, the crude fall rate declined from 3.07 to 2.22 per 1,000 patient days, and injury falls declined from 0.77 to 0.65 per 1,000 patient days. Nonsignificant increases in falls occurred after nurses started rounding hourly and after the move to the new hospital. On the basis of regression models, significant declines occurred after nurses began to mitigate fall risk during hourly rounds (p = 0.009). CONCLUSION Instituting incremental changes for more than a decade was associated with a meaningful (about 28%) and sustained decline in falls, although the rate of decline varied over time. Hospitals interested in reducing falls but concerned about competing clinical and financial priorities may find an incremental approach to be effective.
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Falling Through the Crack (in the Bedrails). AORN J 2017; 106:576-547. [DOI: 10.1016/j.aorn.2017.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/29/2017] [Indexed: 11/26/2022]
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Clinical Effectiveness and Cost of a Hospital-Based Fall Prevention Intervention. ACTA ACUST UNITED AC 2017; 47:571-580. [DOI: 10.1097/nna.0000000000000545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Falls in acute care medical patients are a complex problem impacted by the constantly changing risk factors affecting this population. This integrative literature review analyzes current evidence to determine factors that continue to make falls a top patient safety problem within the medical unit microsystem. The goal of this review is to develop an evidence-based structure to guide process improvement and effective use of organization resources.
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The Relationship Between Magnet Designation, Electronic Health Record Adoption, and Medicare Meaningful Use Payments. Comput Inform Nurs 2017; 35:385-391. [PMID: 28252514 DOI: 10.1097/cin.0000000000000336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to examine the relationship between nursing excellence and electronic health record adoption. Of 6582 US hospitals, 4939 were eligible for the Medicare Electronic Health Record Incentive Program, and 6419 were eligible for evaluation on the HIMSS Analytics Electronic Medical Record Adoption Model. Of 399 Magnet hospitals, 330 were eligible for the Medicare Electronic Health Record Incentive Program, and 393 were eligible for evaluation in the HIMSS Analytics Electronic Medical Record Adoption Model. Meaningful use attestation was defined as receipt of a Medicare Electronic Health Record Incentive Program payment. The adoption electronic health record was defined as Level 6 and/or 7 on the HIMSS Analytics Electronic Medical Record Adoption Model. Logistic regression showed that Magnet-designated hospitals were more likely attest to Meaningful Use than non-Magnet hospitals (odds ratio = 3.58, P < .001) and were more likely to adopt electronic health records than non-Magnet hospitals (Level 6 only: odds ratio = 3.68, P < .001; Level 6 or 7: odds ratio = 4.02, P < .001). This study suggested a positive relationship between Magnet status and electronic health record use, which involves earning financial incentives for successful adoption. Continued investigation is needed to examine the relationships between the quality of nursing care, electronic health record usage, financial implications, and patient outcomes.
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Morita K, Matsui H, Fushimi K, Yasunaga H. Association between Nurse Staffing and In-Hospital Bone Fractures: A Retrospective Cohort Study. Health Serv Res 2017; 52:1005-1023. [PMID: 27453490 PMCID: PMC5441478 DOI: 10.1111/1475-6773.12529] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine if sufficient nurse staffing reduced in-hospital fractures in acute care hospitals. DATA SOURCES/STUDY SETTING The Japanese Diagnosis Procedure Combination inpatient (DPC) database from July 2010 to March 2014 linked with the Surveys for Medical Institutions. STUDY DESIGN We conducted a retrospective cohort study to examine the association of inpatient nurse-to-occupied bed ratio (NBR) with in-hospital fractures. Multivariable logistic regression with generalized estimating equations was performed, adjusting for patient characteristics and hospital characteristics. DATA COLLECTION/EXTRACTION METHODS We identified 770,373 patients aged 50 years or older who underwent planned major surgery for some forms of cancer or cardiovascular diseases. We used ICD-10 codes and postoperative procedure codes to identify patients with in-hospital fractures. Hospital characteristics were obtained from the "Survey of Medical Institutions and Hospital Report" and "Annual Report for Functions of Medical Institutions." PRINCIPAL FINDINGS Overall, 662 (0.09 percent) in-hospital fractures were identified. Logistic regression analysis showed that the proportion of in-hospital fractures in the group with the highest NBR was significantly lower than that in the group with the lowest NBR (adjusted odd ratios, 0.67; 95 percent confidence interval, 0.44-0.99; p = .048). CONCLUSIONS Sufficient nurse staffing may be important to reduce postsurgical in-hospital fractures in acute care hospitals.
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Affiliation(s)
- Kojiro Morita
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Kiyohide Fushimi
- Department of Health Policy and InformaticsGraduate School of MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthGraduate School of MedicineThe University of TokyoTokyoJapan
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He J, Staggs VS, Bergquist-Beringer S, Dunton N. Nurse staffing and patient outcomes: a longitudinal study on trend and seasonality. BMC Nurs 2016; 15:60. [PMID: 27757068 PMCID: PMC5064797 DOI: 10.1186/s12912-016-0181-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 10/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Time trends and seasonal patterns have been observed in nurse staffing and nursing-sensitive patient outcomes in recent years. It is unknown whether these changes were associated. METHODS Quarterly unit-level nursing data in 2004-2012 were extracted from the National Database of Nursing Quality Indicators® (NDNQI®). Units were divided into groups based on patterns of missing data. All variables were aggregated across units within these groups and analyses were conducted at the group level. Patient outcomes included rates of inpatient falls and hospital-acquired pressure ulcers. Staffing variables included total nursing hours per patient days (HPPD) and percent of nursing hours provided by registered nurses (RN skill-mix). Weighted linear mixed models were used to examine the associations between nurse staffing and patient outcomes at trend and seasonal levels. RESULTS At trend level, both staffing variables were inversely associated with all outcomes (p < 0.001); at seasonal level, total HPPD was inversely associated (higher staffing related to lower event rate) with all outcomes (p < 0.001) while RN skill-mix was positively associated (higher staffing related to higher event rate) with fall rate (p < 0.001) and pressure ulcer rate (p = 0.03). It was found that total HPPD tended to be lower and RN skill-mix tended to be higher in Quarter 1 (January-March) when falls and pressure ulcers were more likely to happen. CONCLUSIONS By aggregating data across units we were able to detect associations between nurse staffing and patient outcomes at both trend and seasonal levels. More rigorous research is needed to study the underlying mechanism of these associations.
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Affiliation(s)
- Jianghua He
- Department of Biostatistics, University of Kansas Medical Center, MS 1026, 3901 Rainbow BLVD, Kansas City, KS 66160 USA
| | - Vincent S Staggs
- Health Services & Outcomes Research, Children's Mercy Hospitals & Clinics, 2401 Gillham Rd, Kansas City, MO 64108 USA
| | - Sandra Bergquist-Beringer
- School of Nursing, University of Kansas Medical Center, 3901 Rainbow BLVD, Kansas City, KS 66160 USA
| | - Nancy Dunton
- School of Nursing, University of Kansas Medical Center, 3901 Rainbow BLVD, Kansas City, KS 66160 USA
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Weed-Pfaff SH, Nutter B, Bena JF, Forney J, Field R, Szoka L, Karius D, Akins P, Colvin CM, Albert NM. Validation of Predictors of Fall Events in Hospitalized Patients With Cancer. Clin J Oncol Nurs 2016; 20:E126-31. [PMID: 27668383 DOI: 10.1188/16.cjon.e126-e131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A seven-item cancer-specific fall risk tool (Cleveland Clinic Capone-Albert [CC-CA] Fall Risk Score) was shown to have a strong concordance index for predicting falls; however, validation of the model is needed. OBJECTIVES The aims of this study were to validate that the CC-CA Fall Risk Score, made up of six factors, predicts falls in patients with cancer and to determine if the CC-CA Fall Risk Score performs better than the Morse Fall Tool. METHODS Using a prospective, comparative methodology, data were collected from electronic health records of patients hospitalized for cancer care in four hospitals. Risk factors from each tool were recorded, when applicable. Multivariable models were created to predict the probability of a fall. A concordance index for each fall tool was calculated. FINDINGS The CC-CA Fall Risk Score provided higher discrimination than the Morse Fall Tool in predicting fall events in patients hospitalized for cancer management.
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Affiliation(s)
| | | | - James F Bena
- Department of Quantitative Health Sciences, Cleveland Clinic in Ohio
| | | | | | | | | | | | | | - Nancy M Albert
- Nursing Research and Innovation, Cleveland Clinic in Ohio
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Taylor E, Hignett S. The SCOPE of Hospital Falls: A Systematic Mixed Studies Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2016; 9:86-109. [PMID: 27240563 DOI: 10.1177/1937586716645918] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE This systematic mixed studies review on hospital falls is aimed to facilitate proactive decision-making for patient safety during the healthcare facility design. BACKGROUND Falls were identified by the Centers for Medicare & Medicaid Services as a nonreimbursed hospital-acquired condition (HAC) due to volume and cost, and additional financial penalties were introduced with the 2014 U.S. HAC reduction program. In 2015, the Joint Commission alert identified patient falls as one of the top reported sentinel events, and the Occupational Safety & Health Administration (OSHA) added slips, trips, and falls as a focus for investigators' healthcare inspections. Variations in fall rates at both the hospital and the unit level are indicative of an ongoing challenge. The built environment can act as a barrier or enhancement to achieving the desired results in safety complexity that includes the organization, people, and environment. METHODS The systematic literature review used Medical Subject Heading terms and key word alternates for hospital falls with searches in MEDLINE, Web of Science, and CINAHL. The search was limited to English-language papers. RESULTS Following full-text review, 27 papers were included and critically appraised using an evaluation matrix that included a mixed methods appraisal tool. Themes were coded by broad categories of factors for organization (policy/operations), people (caregivers/staff, patients), and the environment (healthcare facility design). Subcategories were developed to define the physical environment and consider the potential interventions in the context of relative stability. CONCLUSIONS Conditions of hospital falls were identified and evaluated through the literature review. A theoretical model was developed to propose a human factors framework while considering the permanence of solutions.
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Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators. BMC Health Serv Res 2016; 16:120. [PMID: 27052745 PMCID: PMC4823846 DOI: 10.1186/s12913-016-1372-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/01/2016] [Indexed: 11/21/2022] Open
Abstract
Background Nurse-sensitive indicators and nurses’ satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive screening indicators and nurse-perceived quality of care. Methods To calculate a composite performance score for each of six Dutch non-university teaching hospitals, the percentage scores of the publicly reported nurse-sensitive indicators: screening of delirium, screening of malnutrition, and pain assessments, were averaged (2011). Nurse-perceived quality ratings were obtained from staff nurses working in the same hospitals by the Dutch Essentials of Magnetism II survey (2010). Concordance between the quality measures was analyzed using Spearman’s rank correlation. Results The mean screening performances ranged from 63 % to 93 % across the six hospitals. Nurse-perceived quality of care differed significantly between the hospitals, also after adjusting for nursing experience, educational level, and regularity of shifts. The hospitals with high-levels of nurse-perceived quality were also high-performing hospitals according to nurse-sensitive indicators. The relationship was true for high-performing as well as lower-performing hospitals, with strong correlations between the two quality measures (rS = 0.943, p = 0.005). Conclusions Our findings showed that there is a significant positive association between objectively measured nurse-sensitive screening indicators and subjectively measured perception of quality. Moreover, the two indicators of quality of nursing care provide corresponding quality rankings. This implies that improving factors that are associated with nurses’ perception of what they believe to be quality of care may also lead to better screening processes. Although convergent validity seems to be established, we emphasize that different kinds of quality measures could be used to complement each other, because various stakeholders may assign different values to the quality of nursing care.
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A 10-year journey in sustaining fall reduction in an academic medical center in Singapore. INT J EVID-BASED HEA 2016; 14:24-33. [DOI: 10.1097/xeb.0000000000000066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quigley PA. Evidence Levels: Applied to Select Fall and Fall Injury Prevention Practices. Rehabil Nurs 2016; 41:5-15. [DOI: 10.1002/rnj.253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2015] [Indexed: 11/06/2022]
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Staggs VS. Reliability assessment of a hospital quality measure based on rates of adverse outcomes on nursing units. Stat Methods Med Res 2015; 26:2951-2961. [DOI: 10.1177/0962280215618688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to develop methods for assessing the reliability of scores on a widely disseminated hospital quality measure based on nursing unit fall rates. Poisson regression interactive multilevel modeling was adapted to account for clustering of units within hospitals. Three signal-noise reliability measures were computed. Squared correlations between the hospital score and true hospital fall rate averaged 0.52 ± 0.18 for total falls (0.68 ± 0.18 for injurious falls). Reliabilities on the other two measures averaged at least 0.70 but varied widely across hospitals. Parametric bootstrap data reflecting within-unit noise in falls were generated to evaluate percentile-ranked hospital scores as estimators of true hospital fall rate ranks. Spearman correlations between bootstrap hospital scores and true fall rates averaged 0.81 ± 0.01 (0.79 ± 0.01). Bias was negligible, but ranked hospital scores were imprecise, varying across bootstrap samples with average SD 11.8 (14.9) percentiles. Across bootstrap samples, hospital-measure scores fell in the same decile as the true fall rate in about 30% of cases. Findings underscore the importance of thoroughly assessing reliability of quality measurements before deciding how they will be used. Both the hospital measure and the reliability methods described can be adapted to other contexts involving clustered rates of adverse patient outcomes.
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Affiliation(s)
- Vincent S Staggs
- Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
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Lower Nurse Staffing Levels Are Associated With Occurrences of Inpatient Falls at a Large Pediatric Hospital. Health Care Manag (Frederick) 2015; 34:359-66. [PMID: 26506298 DOI: 10.1097/hcm.0000000000000083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
No previous research has been published regarding the relationship between nurse staffing levels and inpatient pediatric falls, and previous research in the adult population has yielded conflicting results, probably due in many instances to suboptimal study design. The objective of this study was to examine the relationship between nurse staffing levels and pediatric patient falls in a large children's hospital. A case-control study design was used to compare the nurse staffing level during the shift of patient falls to the staffing level in the same units on shifts when patient falls did not occur. Nurse staffing levels were significantly lower in units when patient falls occurred, particularly during night shift. Targeted nurse staffing interventions in high-risk units could reduce the incidence of inpatient pediatric falls.
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Longitudinal Association of Registered Nurse National Nursing Specialty Certification and Patient Falls in Acute Care Hospitals. Nurs Res 2015; 64:291-9. [PMID: 26049719 PMCID: PMC4894769 DOI: 10.1097/nnr.0000000000000107] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is available in the text Background Researchers have studied inpatient falls in relation to aspects of nurse staffing, focusing primarily on staffing levels and proportion of nursing care hours provided by registered nurses (RNs). Less attention has been paid to other nursing characteristics, such as RN national nursing specialty certification. Objective The aim of the study was to examine the relationship over time between changes in RN national nursing specialty certification rates and changes in total patient fall rates at the patient care unit level. Methods We used longitudinal data with standardized variable definitions across sites from the National Database of Nursing Quality Indicators. The sample consisted of 7,583 units in 903 hospitals. Relationships over time were examined using multilevel (units nested in hospitals) latent growth curve modeling. Results The model indices indicated a good fit of the data to the model. At the unit level, there was a small statistically significant inverse relationship (r = −.08, p = .04) between RN national nursing specialty certification rates and total fall rates; increases in specialty certification rates over time tended to be associated with improvements in total fall rates over time. Discussion Our findings may be supportive of promoting national nursing specialty certification as a means of improving patient safety. Future study recommendations are (a) modeling organizational leadership, culture, and climate as mediating variables between national specialty certification rates and patient outcomes and (b) investigating the association of patient safety and specific national nursing specialty certifications which test plans include patient safety, quality improvement, and diffusion of innovation methods in their certifying examinations.
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dit Dariel OP, Regnaux JP. Do Magnet®-accredited hospitals show improvements in nurse and patient outcomes compared to non-Magnet hospitals: a systematic review. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513060-00014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Staggs VS, Mion LC, Shorr RI. Consistent differences in medical unit fall rates: implications for research and practice. J Am Geriatr Soc 2015; 63:983-7. [PMID: 25940548 DOI: 10.1111/jgs.13387] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the proportion of variation in long-term fall rates attributable to variability between rather than within hospital units and to identify unit- and hospital-level characteristics associated with persistently low- and high-fall units. DESIGN Retrospective study of administrative data on inpatient falls. Eighty low-fall and 74 high-fall units were identified based on monthly rankings of fall rates. Unit- and hospital-level characteristics of these units were compared. SETTING U.S. general hospitals participating in the National Database of Nursing Quality Indicators. PARTICIPANTS Nonsubspecialty medical units (n=800) with 24 consecutive months of falls data. MEASUREMENTS Monthly self-reported unit fall rates (falls per 1,000 patient-days). RESULTS An estimated 87% of variation in 24-month fall rates was due to between-unit differences. With the exception of patient-days, a proxy for unit bed size, low- and high-fall units did not differ on nurse staffing or any other unit or hospital characteristic variable. CONCLUSION There are medical units with persistently low and persistently high fall rates. High-fall units had higher patient volume, suggesting patient turnover as a variable for further study. Understanding additional factors underlying variability in long-term fall rates could lead to sustainable interventions for reducing inpatient falls.
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Affiliation(s)
- Vincent S Staggs
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.,Department of Pediatrics, University of Missouri- Kansas City, Kansas City, Missouri
| | - Lorraine C Mion
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Ronald I Shorr
- Department of Epidemiology, University of Florida, Gainesville, Florida.,Geriatric Research, Education and Clinical Center, Malcom Randall Veterans Administration Medical Center, Gainesville, Florida
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Grealish L, Chaboyer W. Older, in hospital and confused - the value of nursing care in preventing falls in older people with cognitive impairment. Int J Nurs Stud 2015; 52:1285-7. [PMID: 25726429 DOI: 10.1016/j.ijnurstu.2015.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/23/2015] [Accepted: 02/05/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Laurie Grealish
- Associate Professor Subacute and Aged Nursing, Research Centre for Health Practice Innovation, Griffith Health Institute, Griffith University and Gold Coast Health, Gold Coast, Australia
| | - Wendy Chaboyer
- Professor of Nursing and Director, NHMRC Centre of Research Excellence in Nursing, Research Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Gold Coast, Australia
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Waters TM, Daniels MJ, Bazzoli GJ, Perencevich E, Dunton N, Staggs VS, Potter C, Fareed N, Liu M, Shorr RI. Effect of Medicare's nonpayment for Hospital-Acquired Conditions: lessons for future policy. JAMA Intern Med 2015; 175:347-54. [PMID: 25559166 PMCID: PMC5508870 DOI: 10.1001/jamainternmed.2014.5486] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE In 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. The regulation's effect on these events has not been well studied. OBJECTIVE To measure the association between Medicare's nonpayment policy and 4 outcomes addressed by the HACs Initiative: central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls. DESIGN, SETTING, AND PARTICIPANTS Quasi-experimental study of adult nursing units from 1381 US hospitals participating in the National Database of Nursing Quality Indicators (NDNQI), a program of the American Nurses Association. The NDNQI data were combined with American Hospital Association, Medicare Cost Report, and local market data to examine adjusted outcomes. Multilevel models were used to evaluate the effect of Medicare's nonpayment policy on never events. EXPOSURES United States hospitals providing treatment for Medicare patients were subject to the new payment policy beginning in October 2008. MAIN OUTCOMES AND MEASURES Changes in unit-level rates of HAPUs, injurious falls, CLABSIs, and CAUTIs after initiation of the policy. RESULTS Medicare's nonpayment policy was associated with an 11% reduction in the rate of change in CLABSIs (incidence rate ratio [IRR], 0.89; 95% CI, 0.83-0.95) and a 10% reduction in the rate of change in CAUTIs (IRR, 0.90; 95% CI, 0.85-0.95), but was not associated with a significant change in injurious falls (IRR, 0.99; 95% CI, 0.99-1.00) or HAPUs (odds ratio, 0.98; 95% CI, 0.96-1.01). Consideration of unit-, hospital-, and market-level factors did not significantly alter our findings. CONCLUSIONS AND RELEVANCE The HACs Initiative was associated with improvements in CLABSI and CAUTI trends, conditions for which there is strong evidence that better hospital processes yield better outcomes. However, the HACs Initiative was not associated with improvements in HAPU or injurious fall trends, conditions for which there is less evidence that changing hospital processes leads to significantly better outcomes.
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Affiliation(s)
- Teresa M Waters
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Michael J Daniels
- Department of Statistics and Data Sciences, The University of Texas at Austin3Department of Integrative Biology, The University of Texas at Austin
| | - Gloria J Bazzoli
- Department of Health Administration, Virginia Commonwealth University, Richmond
| | - Eli Perencevich
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City6Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | - Nancy Dunton
- School of Nursing, University of Kansas Medical Center, Kansas City, Missouri
| | - Vincent S Staggs
- Department of Biostatistics, School of Medicine, University of Kansas Medical Center, Kansas City, Missouri
| | - Catima Potter
- School of Nursing, University of Kansas Medical Center, Kansas City, Missouri
| | - Naleef Fareed
- Department of Health Policy and Administration, Pennsylvania State University, University Park
| | - Minzhao Liu
- Department of Statistics, University of Florida, Gainesville
| | - Ronald I Shorr
- Department of Epidemiology, University of Florida, Gainesville12Geriatric Research Education & Clinical Center, Malcom Randall Veterans Affairs Medical Center, Gainesville, Florida
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Staggs VS. Trends, Victims, and Injuries in Injurious Patient Assaults on Adult, Geriatric, and Child/Adolescent Psychiatric Units in US Hospitals, 2007-2013. Res Nurs Health 2015; 38:115-20. [DOI: 10.1002/nur.21647] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Vincent S. Staggs
- Senior Biostatistician; Health Services and Outcomes Research; Children's Mercy Hospitals and Clinics
- Assistant Professor; Department of Pediatrics; University of Missouri-Kansas City; 2401 Gillham Road Kansas City MO 64108
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Griffiths P, Bridges J, Sheldon H, Thompson R. The role of the dementia specialist nurse in acute care: a scoping review. J Clin Nurs 2014; 24:1394-405. [DOI: 10.1111/jocn.12717] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Griffiths
- Faculty of Health Sciences; University of Southampton; Southampton and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex); UK
| | - Jackie Bridges
- Faculty of Health Sciences; University of Southampton; Southampton and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex); UK
| | | | - Rachel Thompson
- Royal College of Nursing and Admiral Nurse; Dementia UK
- Royal College of Nursing; London UK
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AL-Rawajfah OM, Aloush S, Hewitt JB. Use of Electronic Health-Related Datasets in Nursing and Health-Related Research. West J Nurs Res 2014; 37:952-83. [DOI: 10.1177/0193945914558426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Datasets of gigabyte size are common in medical sciences. There is increasing consensus that significant untapped knowledge lies hidden in these large datasets. This review article aims to discuss Electronic Health-Related Datasets (EHRDs) in terms of types, features, advantages, limitations, and possible use in nursing and health-related research. Major scientific databases, MEDLINE, ScienceDirect, and Scopus, were searched for studies or review articles regarding using EHRDs in research. A total number of 442 articles were located. After application of study inclusion criteria, 113 articles were included in the final review. EHRDs were categorized into Electronic Administrative Health-Related Datasets and Electronic Clinical Health-Related Datasets. Subcategories of each major category were identified. EHRDs are invaluable assets for nursing the health-related research. Advanced research skills such as using analytical softwares, advanced statistical procedures, dealing with missing data and missing variables will maximize the efficient utilization of EHRDs in research.
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Michalek C, Wehling M, Schlitzer J, Frohnhofen H. Effects of "Fit fOR The Aged" (FORTA) on pharmacotherapy and clinical endpoints--a pilot randomized controlled study. Eur J Clin Pharmacol 2014; 70:1261-7. [PMID: 25128076 DOI: 10.1007/s00228-014-1731-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The feasibility of applying the Fit fOR The Aged (FORTA) list, a drug classification combining positive and negative labeling of drugs, should be studied in geriatric patients and medication quality and clinical endpoints measured. FORTA labels range from A (indispensable), B (beneficial), C (questionable) to D (avoid). METHODS A prospective randomized controlled pilot trial was performed in hospitalized geriatric patients in whom the FORTA instrument or standard care was applied. Patients were randomly admitted to an intervention and a control ward. Changes of FORTA label distributions between admission and discharge, over- and under-prescription rates, clinical endpoints including the number of falls during the hospitalization, and Barthel Index (BI) at admission and discharge were measured. RESULTS Polypharmacy persisted in both groups. At discharge, a higher rate of A drugs was prescribed in the intervention group (58 patients, median age 84 years) vs. standard care (56 patients, median age 83 years, p < 0.02), and both over- and under-prescriptions were significantly lower in the FORTA than in the control group (p < 0.03). Two (3.4%) intervention, but 12 (21.4%) control, patients fell at least once (p < 0.001). The fall rate per 1,000 patient years was 1.5 ± 8.3 in the intervention and 10.6 ± 25.4 in the control group (p < 0.004). CONCLUSIONS This pilot study shows that the application of the FORTA list is feasible in geriatric patients. In this small study, the medication quality improved in the intervention group, but polypharmacy persisted in both groups. The fall rate was significantly lower in the intervention group. These encouraging results must be interpreted carefully.
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Affiliation(s)
- Carina Michalek
- Geriatric Clinic and Center for Geriatric Medicine, Knappschafts-Krankenhaus, Kliniken Essen-Mitte, Teaching Hospital of the University Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany
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Warshawsky N, Rayens MK, Stefaniak K, Rahman R. The effect of nurse manager turnover on patient fall and pressure ulcer rates. J Nurs Manag 2014; 21:725-32. [PMID: 23865925 DOI: 10.1111/jonm.12101] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2013] [Indexed: 11/28/2022]
Abstract
AIMS The purpose of this study was to explore the effects of nurse manager turnover on the occurrence of adverse events. BACKGROUND Nurse managers create professional nurse practice environments to support the provision of quality patient outcomes. Inconsistent findings were reported in the literature testing the relationship between nurse managers and patient outcomes. All prior studies assumed stable nursing management. METHODS A longitudinal quasi-experimental study of 23 nursing units in two hospitals was used to determine whether unit characteristics, including nurse manager turnover, have an effect on patient falls or pressure ulcers. Statistical analyses included repeated measures and hierarchical modelling. RESULTS Patients in medical/surgical units experienced more falls than in intensive care units (F1,11 = 15.9, P = 0.002). Patients in units with a nurse manager turnover [odds ratio: 3.16; 95% confidence interval: 1.49-6.70] and intensive care units (odds ratio: 2.70; 95% confidence interval: 1.33-5.49) were more likely to develop pressure ulcers. CONCLUSIONS Nurse manager turnover and intensive care unit status were associated with more pressure ulcers. Medical/surgical unit status was associated with more falls. The study was limited by a small sample size. IMPLICATIONS FOR NURSE MANAGERS Nurse manager turnover may negatively impact patient outcomes. Stable nursing management, strategic interim management and long-term succession planning may reduce adverse patient events.
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Affiliation(s)
- Nora Warshawsky
- College of Nursing, University of Kentucky, Lexington, KY 40503-0232, USA.
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Lang CE. Do Sitters Prevent Falls?: A Review of the Literature. J Gerontol Nurs 2014; 40:24-33; quiz 34-5. [DOI: 10.3928/00989134-20140313-01] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 02/25/2014] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE The aim of this study was to examine recent trends in nurse staffing levels and nursing staff composition. BACKGROUND Recent trends in hospital nurse staffing have not been well described, and the effects of the 2007 to 2012 recession and 2008 Centers for Medicare & Medicaid Services rule change are unknown. METHODS A longitudinal study of unit-level data from the National Database of Nursing Quality Indicators (NDNQI) and hospital-level data from the American Hospital Association (AHA) annual survey was conducted. RESULTS From 2004 to 2011, total nursing hours per patient day on general care units in NDNQI hospitals increased by 11.5%, and registered nurse (RN) hours per patient day by 22.9%. Trends were similar in AHA hospitals. CONCLUSIONS Hospitals have steadily increased total nurse staffing levels by increasing RN staffing. Use of temporary RNs in hospitals plummeted from mid-2008. There were no apparent changes in staffing levels due to the recession and/or CMS rule change.
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He J, Staggs VS, Bergquist-Beringer S, Dunton N. Unit-level time trends and seasonality in the rate of hospital-acquired pressure ulcers in US acute care hospitals. Res Nurs Health 2013; 36:171-80. [DOI: 10.1002/nur.21527] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2012] [Indexed: 11/11/2022]
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