Bedside Nurses: Champions of Antimicrobial Stewardship.

TOPIC: Microbial organisms include bacteria, viruses, fungi, and parasites. Antimicrobial medications are currently overused or misused, which has resulted in multidrug resistance. Hospitalized patients in the intensive care unit have the highest risk for infections leading to poor outcomes and require successful treatment options. CLINICAL RELEVANCE: Inappropriate prescription of antimicrobials places patients and the community at risk for more resistant infections in the future. To prevent misapplication of these important medications, interdisciplinary antimicrobial stewardship programs promote appropriate and safe antimicrobial medication use. Members of these programs are called to be good stewards of antimicrobial medications, incorporating the scope of practice and knowledge of each specialty and the evidence from the literature to develop strategies and protocols for safe and effective antimicrobial medication use. PURPOSE OF PAPER: Nurse involvement in antimicrobial stewardship programs is inadequate, limiting the programs' potential. Support for increased direct-care nurse participation in antimicrobial stewardship programs is key to improve program targets and patient outcomes. CONTENT COVERED: This article calls for increased nursing awareness of the importance of antimicrobial stewardship programs in clinical practice and greater direct-care nurse involvement in these programs.

The Effects of Implementing a Patient Acuity Tool on Nurse Satisfaction in a Pulmonary Medicine Unit.

In response to nurses' concerns of equity and satisfaction with patient assignments in a pulmonary medicine unit, a Patient Acuity Tool (PAT) was implemented. The impact of the PAT on nurse satisfaction and perceived equity of patient assignments was measured using a pre-/postsurvey design. Findings of the investigation indicate that a PAT supports nurse satisfaction and equity. In addition, qualitative data suggested that the PAT improved perceived professional autonomy and nurse-to-nurse communication.

Impact of a Modified Early Warning Score on Rapid Response and Cardiopulmonary Arrest Calls in Telemetry and Medical-Surgical Units.

To reduce the number of cardiac arrests in telemetry and medical- surgical units, a 70-bed community hospital integrated a weighted, aggregate, electronic modified early warning score into the elec- tronic medical record. Impact was evaluated via a quality improvement initiative.

Postthoracotomy Pain Syndrome Following Surgery for Lung Cancer: Symptoms and Impact on Quality of Life.

Postthoracotomy pain syndrome (PTPS) is a common complication following thoracic surgery. Most studies examining the influence of PTPS on patient-reported symptoms include few patients managed using a minimally invasive approach. Associated sensory changes, potentially neuropathic in origin, are not well described. We therefore examined the symptoms and quality of life (QOL) of patients with and without PTPS who underwent a standard thoracotomy (n = 43) or minimally invasive surgery (n = 54). Patients in this prospective, cross-sectional study completed questionnaires to assess pain (McGill Pain Questionnaire), neuropathic symptoms (Neuropathic Symptom Questionnaire), symptom distress (Symptom Distress Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and QOL (Functional Assessment Cancer Therapy-Lung). Excepting younger age (p = .009), no demographic or surgical characteristic differentiated patients with and without PTPS. Patients with PTPS described discomfort as pain only (15.1%), neuropathic symptoms only (30.2%) or pain and neuropathic symptoms (54.7%). Scores differed between patients with and without PTPS for symptom distress (p < .001), anxiety and depression (p < .001), and QOL (p = .009), with higher distress associated with PTPS. Despite new surgical techniques, PTPS remains common and results in considerable distress. A focused assessment is needed to identify all experiencing this condition, with referral to pain management specialists if symptoms persist.

Impact of Magnet Culture in Maintaining Quality Outcomes During Periods of Organizational Transition.

Organizational transition presents substantial risk to maintaining quality outcomes. The leadership style and culture present during periods of change and transition empower the frontline staff to react quickly and identify opportunities. The culture of Magnet develops the skill set that enables staff to be leaders in problem solving and identifying creative care delivery approaches. Objectives of this study were to analyze the impact of organizational transition on patient and staff satisfaction, quality, and safety in a Magnet-designated hospital and determine key factors contributing to these outcomes.

Implementing an acuity-adaptable care model in a rural hospital setting.

OBJECTIVE: This study examined the effects of an acuity-adaptable care model in a rural hospital setting on nurse satisfaction, patient satisfaction, patient safety, and quality indicators (events, falls, and medication errors), patient length of stay (LOS), and worked hours per patient-day (WHPPD). BACKGROUND: Acuity-adaptable care models have been implemented as a nursing strategy to improve workflow through the elimination of unit-to-unit patient handoffs. However, to our knowledge, this model of care has not been studied in a rural hospital setting. METHODS: A descriptive, comparative design with repeated measures was utilized for this study. A professional nurse survey was created to measure staff satisfaction; separate t tests for percentages were utilized to evaluate patient satisfaction and patient safety/quality indicators. Financial data were examined to perform the analysis of patient LOS and WHPPD. RESULTS: The nurse satisfaction survey demonstrated a decrease in weekly floating and cancellations due to low census. There was a statistically significant improvement in patient satisfaction for overall rating and willingness to recommend the hospital. No significant difference was noted in patient quality indicators or LOS; however, there was a favorable trend for all events and medication errors. This study also found a decrease in WHPPD, with a corresponding salary expense reduction reported. CONCLUSION: Acuity-adaptable units may be a viable strategy for rural facilities.

The influence of goal setting and SmartRoom patient education videos on readmission rate, length of stay, and patient satisfaction in the orthopedic spine population.

The SmartRoom technology, a system now owned by TeleTracking Technologies, aims to transform the delivery of patient care in the inpatient environment. The purpose of this project was to use goal setting and SmartRoom patient education videos to examine whether the videos more effectively engaged patients and their families in their discharge plan and encouraged them to take a more active role in their care while hospitalized. This study used a descriptive design to analyze the effect of goal setting and patient education videos on patient satisfaction at discharge, hospital average length of stay, and 30-day readmission rate in the orthopedic spine surgical care setting. Comparisons were made among three patient groups. No statistically significant difference was found for average length of stay and 30-day readmission across these three groups. However, patient satisfaction with discharge, as measured by the Hospital Consumer Assessment of Health Providers and Systems, revealed an increase in five items regarding discharge with statistically significant differences on two of the five items.

Utilizing bedside shift report to improve the effectiveness of shift handoff.

Handoff of patient information during shift report between nurses is a time of risk and liability. A quality improvement project was conducted on a 23-bed inpatient unit to measure the value of a bedside change-of-shift report in improving the effectiveness of shift report. Indicators including end-of-shift overtime, call light usage, nurse perceptions, and patient satisfaction were impacted by the change in process.

From onsite to online: lessons learned from faculty pioneers.

As the demand for online courses grows, academic settings that do not offer this option risk losing potential students to universities that adopt more innovative approaches to education. Understanding strategies that will prepare faculty to meet the challenges associated with this transformation is essential to developing a quality online program. Most basic to this transition is the philosophic acceptance of online learning as an educational method equivalent to traditional didactic lecture. Because the knowledge and skills associated with navigating Web-based tools and resources are perceived as a barrier by many faculty, focused efforts must be undertaken to assess faculty learning needs and to provide formal and informal education related to recommended teaching strategies and available technology. Collaboration with course design experts and participation in faculty work groups will facilitate acceptance and promote a sense of involvement. Administrative support is also imperative to produce satisfactory student outcomes that meet the needs for accreditation agencies, certification, or higher education standards.

Study of nurse workarounds in a hospital using bar code medication administration system.

This study analyzed registered nurse workarounds in an academic medical center using bar code medication administration technology. Nurse focus groups and a survey were used to determine the frequency and potential causes of workarounds. More than half of the nurses surveyed indicated that they administered medications without scanning the patient or medications during the last shift worked. Benefits of this study include considerations when implementing bar code medication administration technology that may minimize the development of these workarounds in practice.

The nurse's role in the causation of compensable injury.

Mistakes can be life-threatening and result in malpractice claims. There are few studies that discuss malpractice claims and nursing. The purpose was to identify possible relationships between the actions, behaviors, or characteristics of RNs and the injury suffered by a patient involved in a compensable event. Claims were analyzed retrospectively. Using the Fischer exact test, nurse inaction yielded a higher patient outcome severity score. No single nurse behavior or characteristic was significantly related to the patient outcome severity score. Findings support the belief that system problems may be a contributing factor.

Actions, behaviors, and characteristics of RNs involved in compensable injury.

Malpractice claims analysis offers valuable insight into nursing practice. A review of 16 malpractice claims involving 19 RNs identified their characteristics, actions, and behaviors that contributed to monetary compensation. Most events involved failure to perform a timely assessment and intervention. Relationships were found among nurses' characteristics and the severity of patient injury. Malpractice claims analysis affords nursing leaders the opportunity to involve RNs in correcting deficiencies that contribute to practice errors.

Building an evidence-based practice infrastructure and culture: a model for rural and community hospitals.

The need to address the disparity between healthcare research findings and the implementation of findings into clinical practice is an essential factor in healthcare reform. Exponential growth over the past decade in health-related knowledge and technology has made access to research findings increasingly available. The authors describe a process initiated at a rural community hospital to support the integration of evidence-based practice into daily nursing practice.