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Nibbelink CW, Dunn Lopez K, Reeves JJ, Horman S, El-Kareh RE. Nurse and Physician Perceptions and Decision Making During Interdisciplinary Communication: Factors That Influence Communication Channel Selection. Comput Inform Nurs 2024; 42:267-276. [PMID: 38335993 DOI: 10.1097/cin.0000000000001108] [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: 02/12/2024]
Abstract
Errors in decision making and communication play a key role in poor patient outcomes. Safe patient care requires effective decision making during interdisciplinary communication through communication channels. Research on factors that influence nurse and physician decision making during interdisciplinary communication is limited. Understanding influences on nurse and physician decision making during communication channel selection is needed to support effective communication and improved patient outcomes. The purpose of the study was to explore nurse and physician perceptions of and decision-making processes for selecting interruptive or noninterruptive interdisciplinary communication channels in medical-surgical and intermediate acute care settings. Twenty-six participants (10 RNs, 10 resident physicians, and six attending physicians) participated in semistructured interviews in two acute care metropolitan hospitals for this qualitative descriptive study. The Practice Primed Decision Model guided interview question development and early data analysis. Findings include a core category, Development of Trust in the Communication Process, supported by three main themes: (1) Understanding of Patient Status Drives Communication Decision Making; (2) Previous Interdisciplinary Communication Experience Guides Channel Selection; and (3) Perceived Usefulness Influences Communication Channel Selection. Findings from this study provide support for future design and research of communication channels within the EHR and clinical decision support systems.
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Affiliation(s)
- Christine W Nibbelink
- Author Affiliations: Hahn School of Nursing and Health Science, University of San Diego (Dr Nibbelink), CA; College of Nursing, The University of Iowa (Dr Dunn Lopez), Iowa City; University of California, San Diego; Department of Surgery (Dr Reeves), Division of Hospital Medicine (Dr Horman), and Clinical Professor, School of Medicine (Dr El-Kareh), La Jolla
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Krecko LK, Stalter LN, Quamme SRP, Steege LM, Zelenski AB, Greenberg CC, Jung S. Discussion-based interprofessional education: A positive step toward promoting shared understanding between surgical residents and nurses. J Interprof Care 2023; 37:974-989. [PMID: 37161400 PMCID: PMC10636242 DOI: 10.1080/13561820.2023.2206434] [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: 07/07/2022] [Revised: 01/30/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
Interprofessional education during medical training may improve communication by promoting collaboration and the development of shared mental models between professions. We implemented a novel discussion-based intervention for surgical residents and nurses to promote mutual understanding of workflows and communication practices. General surgery residents and inpatient nurses from our institution were recruited to participate. Surveys and paging data were collected prior to and following the intervention. Surveys contained original questions and validated subscales. Interventions involved facilitated discussions about workflows, perceptions of urgency, and technology preferences. Discussions were recorded and transcribed for qualitative content analysis. Pre and post-intervention survey responses were compared with descriptive sample statistics. Group characteristics were compared using Fisher's exact tests. Eleven intervention groups were conducted (2-6 participants per group) (n = 38). Discussions achieved three aims: Information-Sharing (learning about each other's workflows and preferences), 2) Interpersonal Relationship-Building (establishing rapport and fostering empathy) and 3) Interventional Brainstorming (discussing strategies to mitigate communication challenges). Post-intervention surveys revealed improved nurse-reported grasp of resident schedules and tailoring of communication methods based on workflow understanding; however, communication best practices remain limited by organizational and technological constraints. Systems-level changes must be prioritized to allow intentions toward collegial communication to thrive.
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Affiliation(s)
- Laura K Krecko
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Lily N Stalter
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sudha R Pavuluri Quamme
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Amy B Zelenski
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Caprice C Greenberg
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sarah Jung
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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Okeke CJ, Ogunjimi MA, Jeje EA, Obi AO, Uzoma C. Urinary Catheter Documentation in a Nigerian Teaching Hospital: Are We Recording Enough? JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:45-48. [PMID: 37228889 PMCID: PMC10204908 DOI: 10.4103/jwas.jwas_288_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/16/2022] [Indexed: 05/27/2023]
Abstract
Background Urinary catheters are an important armamentarium of urologic practice. Several indications for their use exist. A good knowledge of the details surrounding every urinary catheter inserted is necessary for the proper management of the patients. Inadequate documentation can lead to complications such as urinary tract infection or even forgotten catheters. Objectives This study aimed at auditing the practice of documentation of urinary catheter parameters in our hospital as a means to improving the standard of care and aligning with international best practices with respect to the use of urinary catheters in our hospital. Materials and Methods This study was a 3-month audit on the quality of documentation on the parameters of each urinary catheter use in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. The parameters included the indication for catheterisation, route of catheterisation, staff who catheterised, size of catheter, type of catheter, volume of water used for inflating catheter balloon, volume of urine drained, if aseptic technique was followed during catheterisation, informed consent and complications encountered. Data were summarised as frequencies and means. Statistical significance was pegged at P < 0.05. Results Seventy-four patients were men, whereas two were women. The mean age of the patients was 67.29 ± 15.17 years. Overall, sex (76 [100%]), age (76 [100%]) and route of catheterisation (68 [89.5%]) were the three most commonly documented information. The documentation on complications and volume of fluid instilled to inflate the catheter balloon were the least-documented parameters (6 [7.9%] and 11 [14.5%], respectively). The following parameters were better documented in the SPC arm: The staff who passed the catheter p = 0.000), the type of catheter passed (p = 0.004), asepsis (p = 0.001) and acquisition of informed consent (p = 0.043). Conclusions Documentation following urinary catheter use was noted to be poor in this study. Documentation of catheter parameters was noted to be higher in patients who had SPC than those who had urethral catheterisation.
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Affiliation(s)
- Chike John Okeke
- Department of Urology, Epsom and St Helier University Hospitals NHS Trust, Surrey, London
| | - Moses Adebisi Ogunjimi
- Department of Surgery of the College of Medicine of the University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Surulere, Lagos, Nigeria
| | - Emmanuel Ajibola Jeje
- Department of Surgery of the College of Medicine of the University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Surulere, Lagos, Nigeria
| | - Anselm Okwudili Obi
- Department of Surgery, Ebonyi State University/Alex-Ekwueme Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Chukwuebuka Uzoma
- Royal Cornwall Hospital, Ebonyi State University/Alex-Ekwueme Federal Teaching Hospital, Truro, United Kingdom
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Krecko LK, Pavuluri Quamme SR, Carnahan S, Steege LM, Tipple S, Bavery L, Greenberg CC, Jung S. To page or not to page? A qualitative study of communication practices of general surgery residents and nurses. Surgery 2022; 172:1102-1108. [PMID: 35871106 DOI: 10.1016/j.surg.2022.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Communication errors contribute to preventable adverse hospital events; however, communication between general surgery residents and nurses remains insufficiently studied. The purpose of our study was to use qualitative methods to characterize communication practices of surgical residents and nurses on inpatient general and intermediate care units to inform best practices and future interprofessional interventions. METHODS Our study cohort consisted of 14 general surgery residents and 13 inpatient nurses from a tertiary academic medical center. Focus groups were conducted via a secure video platform, recorded, and transcribed. Two authors performed open coding of transcripts for qualitative analysis. Codes were reviewed iteratively with themes generated via abductive analysis, contextualizing results within 3 domains of an established communication space framework: organizational, cognitive, and social complexity. RESULTS Communication practices of general surgery residents and inpatient nurses are affected by workflow differences, disruptive communication patterns, and communication technology. Barriers to effective communication, as well as strategies used to mitigate challenges, were characterized, with select communication practices found to negatively affect the well-being of patients, nurses, and residents. CONCLUSION Communication practices of general surgery residents and inpatient nurses are influenced by entrenched and interrelated organizational, technological, and interpersonal factors. Given that current communication practices negatively affect patient and provider well-being, collaboration between surgeons, nurses, systems engineers, health information technology experts, and other stakeholders is critical to (1) establish communication best practices, and (2) design interventions to assess and improve multiple areas (rather than isolated domains) of surgical interprofessional communication.
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Affiliation(s)
- Laura K Krecko
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. https://twitter.com/LauraKrecko
| | - Sudha R Pavuluri Quamme
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. https://twitter.com/DrSRPQ
| | - Shannon Carnahan
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, WI. https://twitter.com/linseysteege
| | - Susan Tipple
- School of Nursing, University of Wisconsin-Madison, WI. https://twitter.com/smtipple
| | - Leah Bavery
- School of Nursing, University of Wisconsin-Madison, WI
| | - Caprice C Greenberg
- Department of Surgery, Medical College of Georgia at Augusta University, GA. https://twitter.com/CapriceGreenber
| | - Sarah Jung
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Developing a Nurse-Driven Vascular Access Device Order Set Using the Electronic Medical Record. JOURNAL OF INFUSION NURSING 2021; 45:20-26. [PMID: 34941606 DOI: 10.1097/nan.0000000000000450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The creation of an electronic order set to identify appropriate vascular access device utilization was the basis of this prospective quality improvement investigation, at a Level 1 trauma center in southeastern Pennsylvania. The data used in this investigation were gathered over a 36-month time frame from January 2017 through December 2019. This patient-centered approach utilized the evidence-based guidelines developed from The Michigan Appropriateness Guide for Intravenous Catheters and recommendations from the Infusion Therapy Standards of Practice. The algorithmic approach developed by vascular access nurses led to statistically significant reductions in unnecessary peripherally inserted central catheter placement. The results also demonstrated an increase in appropriately placed peripheral intravenous catheters. Leveraging the electronic medical record with nursing expertise fosters patient safety across the continuum of care.
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Sankaran RR, Ameling JM, Cohn AE, Grum CM, Meddings J. A Practical Guide for Building Collaborations Between Clinical Researchers and Engineers: Lessons Learned From a Multidisciplinary Patient Safety Project. J Patient Saf 2021; 17:e1420-e1427. [PMID: 32011429 PMCID: PMC7392784 DOI: 10.1097/pts.0000000000000667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Engineering and operations research have much to contribute to improve patient safety, especially within complex, highly regulated, and constantly evolving hospital environments. Despite new technologies, clinical checklists, and alarm systems, basic challenges persist that impact patient safety, such as how to improve communication between healthcare providers to prevent hospital-acquired complications. Because these collaborations are often new territory for both clinical researchers and engineers, the aim of the study was to prepare research teams that are embarking on similar collaborations regarding common challenges and training needs to anticipate while developing multidisciplinary teams. METHODS Using a specific patient safety project as a case study, we share lessons learned and research training tools developed in our experience from recent multidisciplinary collaborations between clinical and engineering teams, which included many nonclinical undergraduate and graduate students. RESULTS We developed a practical guide to describe anticipated challenges and solutions to consider for developing successful partnerships between engineering and clinical researchers. To address the extensive clinical, regulatory, data collection, and laboratory education needed for orienting multidisciplinary team members to join research projects, we also developed and shared a checklist for project managers as well as the training materials as adaptable resources to facilitate other teams' initiation into these types of collaborations. These resources are appropriate and tailorable for orienting both clinical and nonclinical team members, including faculty and staff as well as undergraduate and graduate students. CONCLUSIONS We shared a practical guide to prepare teams for new multidisciplinary collaborations between clinicians and engineers.
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Affiliation(s)
- Roshun R. Sankaran
- From the Center for Healthcare Engineering and Patient Safety, University of Michigan
- University of Michigan Medical School, University of Michigan
| | - Jessica M. Ameling
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School
- Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System
| | - Amy E.M. Cohn
- From the Center for Healthcare Engineering and Patient Safety, University of Michigan
- Department of Industrial and Operations Engineering, College of Engineering, University of Michigan
| | - Cyril M. Grum
- University of Michigan Medical School, University of Michigan
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School
| | - Jennifer Meddings
- University of Michigan Medical School, University of Michigan
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School
- Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System
- Center for Clinical Management Research, VA Ann Arbor Healthcare System
- Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
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Reducing Central Line Associated Bloodstream Infections (CLABSIs) by Reducing Central Line Days. Curr Infect Dis Rep 2021; 23:23. [PMID: 34744517 PMCID: PMC8562022 DOI: 10.1007/s11908-021-00767-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/27/2022]
Abstract
Purpose of Review While reducing unnecessary days present of central venous catheters (CVCs) is part of central line associated bloodstream infection (CLABSI) best practices, there is limited information regarding compliance with this recommendation as well as addressing barriers to compliance. Recent Findings Significant work has been directed towards daily audits of necessity and improving communication between members of the medical team. Other critical interventions include utilization of the electronic health record (EHR), leadership support of CLABSI reduction goals, and avoiding CVC placement over more appropriate vascular access. Summary Institutions have varied approaches to addressing the issue of removing idle CVCs, and more standardized approaches in checklists as well as communication, particularly on multidisciplinary rounds, will be key to CVC removal. Utilization of the EHR for reminders or appropriate documentation of necessity is a factor. Avoidance of placing a CVC or appropriateness of the CVC is also important to consider.
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O'Leary KJ, Manojlovich M, Johnson JK, Estrella R, Hanrahan K, Leykum LK, Smith GR, Goldstein JD, Williams MV. A Multisite Study of Interprofessional Teamwork and Collaboration on General Medical Services. Jt Comm J Qual Patient Saf 2020; 46:667-672. [PMID: 33228852 DOI: 10.1016/j.jcjq.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/08/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Teamwork and collaboration are essential to providing high-quality care. Prior research has found discrepancies between nurses' and physicians' perceptions in operating rooms, ICUs, and labor and delivery units. Less is known about health care professionals' perceptions of teamwork and collaboration on general medical services. METHODS This cross-sectional study included nurses, nurse assistants, and physicians working on general medical services in four mid-sized hospitals. Researchers assessed teamwork climate using the Safety Attitudes Questionnaire and asked respondents to rate the quality of collaboration experienced with their own and other professional categories. RESULTS Data for 380 participants (80 hospitalists, 13 resident physicians, 193 nurses, and 94 nurse assistants) were analyzed. Hospitalists had the highest median teamwork climate score (83.3, interquartile range [IQR] = 72.3-91.1), and nurses had the lowest (78.6, IQR = 69.6-87.5), but the difference was not statistically significant (p = 0.42). Median teamwork climate scores were significantly different across the four sites (highest = 83.3, IQR = 75.0-91.1; lowest = 76.8, IQR = 66.7-88.4; p = 0.003). Ratings of the quality of collaboration differed significantly based on professional category. Specifically, 63.3% (50/79) of hospitalists rated the quality of collaboration with nurses as high or very high, while 48.7% (94/193) of nurses rated the quality of collaboration with hospitalists as high or very high. CONCLUSION This study found significant differences in perceptions of teamwork climate across sites and in collaboration across professional categories on general medical services. Given the importance in providing high-quality care, leaders should consider conducting similar assessments to characterize teamwork and collaboration on general medical services within their own hospitals.
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Meddings J, Gupta A, Houchens N. Quality & safety in the literature: July 2020. BMJ Qual Saf 2020; 29:608-612. [PMID: 32471857 DOI: 10.1136/bmjqs-2020-011364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Jennifer Meddings
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA .,Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Vaughn VM, Saint S, Greene MT, Ratz D, Fowler KE, Patel PK, Krein SL. Trends in Health Care-Associated Infection Prevention Practices in US Veterans Affairs Hospitals From 2005 to 2017. JAMA Netw Open 2020; 3:e1920464. [PMID: 32022877 DOI: 10.1001/jamanetworkopen.2019.20464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Health care-associated infection (HAI) is associated with substantial harm. To reduce HAI, the largest integrated health care system in the United States-the Veterans Health Administration-was an early adopter of infection prevention policies and initiatives. Whether these efforts translated into increased use of practices to prevent HAI in Veterans Affairs (VA) hospitals is unknown. OBJECTIVE To evaluate changes over time in infection prevention practices and the perception of the importance of infection prevention to hospital leadership. DESIGN, SETTINGS, AND PARTICIPANTS For this survey study, every 4 years between 2005 and 2017, infection preventionists were surveyed at all VA hospitals on use of practices associated with common HAIs, including central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP), and (beginning in 2013) Clostridioides difficile infection. Data analysis was performed from February 1, 2019, to July 1, 2019. MAIN OUTCOMES AND MEASURES Reported regular use of key infection prevention practices and perceived importance of infection prevention to hospital leadership. RESULTS Between 2005 and 2017, 320 total surveys were completed with response rates ranging from 59% (73 of 124) in 2017 to 80% (95 of 119) in 2005. Use of 12 different infection prevention practices increased. Since 2013, 92% (69 of 75) to 100% of VA hospitals reported regular use of key infection prevention practices for C difficile infection and CLABSI. In contrast, adoption of many practices to prevent CAUTI, although increasing, have lagged. Despite reported increases in the use of some practices for VAP such as semirecumbent positioning (89% [79 of 89] in 2005 vs 97% [61 of 63] in 2017, P = .007 for trend) and subglottic secretion drainage (23% [19 of 84] in 2005 vs 65% [40 of 62] in 2017, P < .001), use of other key practices such as daily interruptions of sedation (85% [55 of 65] in 2009 vs 87% [54 of 62] in 2017, P = .66) and early mobilization (81% [52 of 64] in 2013 vs 82% [51 of 62] in 2017, P = .88) has not increased. Antibiotic stewardship programs are now reported in nearly every VA hospital (97% [71 of 73]); however, some hospitals report practices for microbiologic testing for HAIs (eg, 22% [16 of 72] report routine urine culture testing in 2017) that could also contribute to antibiotic overuse. CONCLUSIONS AND RELEVANCE From 2005 to 2017, reported use of 12 different infection prevention practices increased in VA hospitals. Areas for continued improvement of infection prevention practices appear to include CAUTI, certain VAP practices, and diagnostic stewardship for HAI. The reported adoption of many infection prevention practices in VA hospitals was higher than in non-VA hospitals. As hospitals continue to merge and health systems become increasingly integrated, these successes could help inform patient safety broadly.
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Affiliation(s)
- Valerie M Vaughn
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
| | - Sanjay Saint
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
| | - M Todd Greene
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
| | - David Ratz
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
| | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
| | - Payal K Patel
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
- Department of Infectious Diseases, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Sarah L Krein
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor
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Quinn M, Ameling JM, Forman J, Krein SL, Manojlovich M, Fowler KE, King EA, Meddings J. Persistent Barriers to Timely Catheter Removal Identified from Clinical Observations and Interviews. Jt Comm J Qual Patient Saf 2019; 46:99-108. [PMID: 31879072 DOI: 10.1016/j.jcjq.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 09/23/2019] [Accepted: 10/15/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Indwelling urinary and vascular catheters are valuable devices in patient care, but prolonged or unnecessary use increases the risk of infectious and noninfectious catheter harms. METHODS To understand persistent barriers to detecting and removing unnecessary catheters, researchers conducted a multimethod qualitative study that included observations and in-person interviews with clinicians working on a progressive care unit of a large hospital. Observations consisted of shadowing nurses during shift change and while admitting patients, and observing physicians during morning rounds. Observational data were gathered using unstructured field notes. Interviews were conducted using a semistructured guide, audio-recorded, and transcribed. Qualitative content analysis was conducted to identify main themes. RESULTS Barriers to timely removal identified during 19 interviews with clinicians and 133 hours of field observations included physicians not routinely reviewing catheter necessity during rounds, catheters going unnoticed or hidden under clothing, common use of "Do Not Remove" orders, and little or no discussion of catheters among clinicians. Five overall themes emerged: (1) Catheter data are hard to find, not accurate, or not available; (2) Catheter removal is not a priority; (3) Confusion exists about who has authority to remove catheters; (4) There is a lack of agreement on, and awareness of, standard protocols and indications for removal; and (5) Communication barriers among clinicians create challenges. CONCLUSION To address barriers and facilitate detection and timely removal, clinicians need ready access to accurate catheter data, more clearly delineated clinician roles for prompting removal, effective tools to facilitate discussions about catheter use, and standardized catheter removal protocols.
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