Selection of employee personal protective equipment based on aggressive behavior in pediatric neuropsychiatry

PURPOSE

Hospitalized patients with a developmental or intellectual disability and a psychiatric disorder (dual-diagnosis) often pose a risk to themselves or others leading to high injury rates for their providers. Therefore, evidence-based strategies to reduce employee injuries resulting from interactions are necessary.

METHODS

To reduce injuries resulting from interactions with dual-diagnosis patients, the Initial Behavioural Assessment (IBA) and Protective Equipment Decision Key (PEDK) were used in inpatient neuropsychiatry. The IBA-PEDK identify patients' aggressive behaviors to provide employees with personal protective equipment (PPE). Inter-rater reliability, validity, and adherence were examined.

RESULTS

Injuries significantly decreased after implementing the IBA-PEDK. The average kappa coefficient was 0.64 with a 90.6% agreement. Ninety-three percent of respondents reported wearing PPE at the time of injury.

CONCLUSIONS

A quick, user-friendly tool that provides a standardized method for determining PPE based on patient-specific behavior can significantly reduce aggression-related injuries.

Measurable results: Reducing staff injuries on a specialty psychiatric unit for patients with developmental disabilities

BACKGROUND

Quality improvement initiative focused on staff injury reduction on a specialized inpatient psychiatric unit which offers acute stabilization for children and adolescents with complex high-risk behaviors.

OBJECTIVE

To utilize quality improvement principles and interventions to reduce staff injuries on a specialized inpatient child/adolescent psychiatric unit.

PARTICIPANTS

Direct care clinical staff within an inpatient psychiatric unit for patients with co-occurring developmental disabilities and psychiatric illness were the focus of the initiative. Direct care clinical staff and clinical administrators were the active participants in the quality improvement initiative, focusing upon the interactions between staff and patients.

METHODS

OSHA-recordable injuries were documented to guide initiatives and measure outcomes on weekly run charts with raw data measures of all staff injuries and the number of days elapsed between injuries. Rapid Plan, Do, Study, Act (PDSA) cycles were utilized to test interventions and guide decision making.

RESULTS

Three months of a structured and systematic intervention trial produced the first adopted interventions in August 2011. The following six months reflected a 65% reduction of staff injuries (from 2.2 injuries per week to 0.77 injuries per week). Between January and August 2011, there were eight OSHA-recordable injuries with an average of 26.5 days between injuries. The average number of days between OSHA-recordable injuries has increased from 26.5 days at baseline to 124 days.

CONCLUSIONS

An initiative utilizing quality improvement principles reduced staff injuries on an inpatient specialized psychiatric unit. Reliability principles, system adaption, and engagement of the frontline nursing clinicians have proven to be foundational and vital to guide the initiative.

Renewable surface fluorescence sandwich immunoassay biosensor for rapid sensitive botulinum toxin detection in an automated fluidic format

A renewable surface biosensor for rapid detection of botulinum neurotoxin serotype A is described based on fluidic automation of a fluorescence sandwich immunoassay, using a recombinant protein fragment of the toxin heavy chain ( approximately 50 kDa) as a structurally valid simulant. Monoclonal antibodies AR4 and RAZ1 bind to separate non-overlapping epitopes of the full botulinum holotoxin ( approximately 150 kDa). Both of the targeted epitopes are located on the recombinant fragment. The AR4 antibody was covalently bound to Sepharose beads and used as the capture antibody. A rotating rod flow cell was used to capture these beads delivered as a suspension by a sequential injection flow system, creating a 3.6 microL column. After perfusing the bead column with sample and washing away the matrix, the column was perfused with Alexa 647 dye-labeled RAZ1 antibody as the reporter. Optical fibers coupled to the rotating rod flow cell at a 90 degrees angle to one another delivered excitation light from a HeNe laser (633 nm) using one fiber and collected fluorescent emission light for detection with the other. After each measurement, the used Sepharose beads are released and replaced with fresh beads. In a rapid screening approach to sample analysis, the toxin simulant was detected to concentrations of 10 pM in less than 20 minutes using this system.

Evaluating unplanned endotracheal extubations

Unplanned extubation is a complication of endotracheal intubation that occurs despite close patient monitoring in the intensive care unit. The authors describe one method of analyzing unplanned extubations that critical care nurses can use to determine the quality of care provided. This method uses a data collection tool that focuses on incidence of unplanned extubation, structure, process and outcome as indicators of quality of care. This article will help you identify patient characteristics that determine if a particular patient population is at greater risk for unplanned extubations.