Falls prevention strategies for patients over 65 years in a neurology ward: a best practice implementation project.

OBJECTIVES: The aim of this project was to promote evidence-based practice with regard to fall prevention and management, by implementing the recommendations from the best available evidence to reduce fall rates. INTRODUCTION: Falls are a main cause of disability in older people and the most common adverse event in all hospital patients. It is essential to implement the recommendations from evidence-based interventions to reduce these events. METHODS: A pre and post implementation audit method was used in a neurology ward, which employed the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research Into Practice (GRiP) module. The 15-month project evaluated between 20-30 patients from a sample at each audit (baseline in April 2016 and during three follow-up cycles in December 2016, March 2017 and June 2017). The data were inputted into an informatics system from nursing records and audited according to evidence-based processes and outcomes criteria. RESULTS: The baseline outcomes identified five barriers: incomplete fall registration, lack of an established fall prevention protocol for at-risk patients, limited knowledge about the fall prevention protocol, lack of a fall risk assessment scale and lack of multifactorial individual plans for fall prevention. Strategies were carried out and implemented following GRiP and all the criteria improved from baseline. CONCLUSIONS: The project successfully increased evidence-based practice on falls and provided mechanisms for sustaining evidence-based practice changes. Further audits are needed to improve some outcomes.

Evaluación económica de un nuevo modelo de compra centralizada de apósitos: el caso del País Vasco / Economic evaluation of a new model of dressings centralized purchase: the case of the Basque Country

Solamente en apósitos para prevención y tratamiento de las heridas crónicas en Osakidetza-Servicio Vasco de Salud y el Departamento de Salud del Gobierno Vasco se invirtieron 7 millones de euros en 2009. Fue necesario el trabajo interdepartamental entre profesionales de enfermería expertos en este tipo de materiales y el Departamento de Suministros para llevar a cabo un concurso centralizado de apósitos y productos de cura en ambiente húmedo (APCAH). El objetivo de este trabajo es describir la nueva metodología seguida en el último concurso centralizado de estos materiales en el País Vasco, así como analizar el impacto económico que esto ha tenido en el gasto

Osakidetza-Basque Health Service and the Basque Health Department invested 7 million Euros in 2009 only in dressings for prevention and treatment of chronic wounds. Interdepartmental working among expert nurses at these products and the Supply Department to conduct a centralized purchase of dressing and products for moisture enviroment in wounds (DPMEW). The aim is to describe the new methodology followed in the last centralized purchase of DPMEW in the Basque Country, and also analyze the economic impact that this has had on expense

Características de los pacientes diana de la enfermera de enlace hospitalaria para insuficiencia cardiaca / Characteristics of target patients for hospital liaison nurses in cardiac failure

Objetivos: identificar las características demográficas, de cronicidad, adherencia al tratamiento y el nivel de conocimientos y autocuidados de los pacientes con diagnóstico de insuficiencia cardiaca congestiva (ICC) atendidos por la enfermera de enlace hospitalaria. Método: estudio descriptivo transversal realizado en el Hospital Universitario Araba (Álava), sede Txagorritxu y sede Santiago, entre mayo de 2011 y enero de 2012. Criterios para selección de la muestra: pacientes ingresados con diagnóstico de IC, estadio C y D de (AHA), clase III, IV de (NYHA), supervivencia esperada mayor de seis meses y capacidad potencial para el autocuidado. Variables: edad, sexo, debut de la IC, comorbilidad (Yesavage, Hospital Anxiety and Depression Scale, Memory Impairment Screen) dependencia(Barthel, Lawton y Brody), riesgo social (Duke), nivel de conocimientos de la enfermedad, adherencia al tratamiento (Escala Morinsky) y autocuidado (European Heart Failure Self Behaviour Scale).Resultados: 35 pacientes incluidos. Edad media: 80,40 años; media de 7,5patologías asociadas; 82,85% polimedicados; 25,71% no presentaban adherencia al tratamiento; 47,06%. dependientes para AVD y 45,71% para actividades instrumentales; el 71,42% con ninguno o escaso conocimiento sobre manejo de ICC. No existe relación significativa entre el debut reciente deI CC y los conocimientos (p= 0,46); autocuidado moderado, expresado por media de 33,03 (± 6,07).Conclusiones: el paciente con ICC objeto del cuidado de la enfermera de enlace hospitalaria es un enfermo complejo y de elevada fragilidad por su pluripatología, polimedicación y edad avanzada. Posee conocimientos escasos para el manejo de su situación de salud (AU)

Objectives: to identify the demographic and chronicity characteristics of patients diagnosed with Congestive Heart Failure (CHF) seen by the hospital liaison nurse, as well as their treatment compliance and their level of know -ledge and self-care. Method: descriptive transversal study conducted in the Hospital Universitario Araba (Álava), both in Txagorritxu and Santiago, between May, 2011and January, 2012. Criteria for sample selection: Patients hospitalized with CF diagnosis, AHA stages C and D, NYHA Class III and IV, life expectancy above 6 months, and potential self-care abilities. Variables: age, gender, CF start, comorbidity (Yesavage, Hospital Anxiety and Depression Scale, Memory Impairment Screen), dependence (Barthel, Lawton y Brody), social risk(Duke), level of knowledge about the disease, treatment compliance (Morinsky Scale) and self-care (European Heart Failure Self Behaviour Scale).Outcomes: 35 patients were included. Median age: 80.4 years; a median of7.5 associated conditions; 82.85% were poly-medicated; 25.71% with no treatment compliance; 47.06% dependent for DLAs and 45.71% for instrumental activities; 71.42% of patients had poor or no knowledge about CHF management. There is no significant link between the recent start of CHF and knowledge (p= 0.46); moderate self-care, expressed by a median 33.03(± 6.07).Conclusions: CHF patients subject to hospital liaison nurse care are complex patients, highly fragile due to their pluripathology, poly-medication, and advanced age. They have poor knowledge in order to manage their health condition (AU)