ABSTRACT
BACKGROUND: Understanding patients' cognitive functional status is critical to prevent adverse outcomes, such as falls and injuries. However, there is variation in nurses' proficiency in assessing patients' cognitive status, and cognitive screening tools often do not provide guidance on safety interventions to keep patients safe. PROBLEM: Lack of appropriate cognitive screening and interventions may have contributed to increased fall rates on an acute care trauma unit. APPROACH: A comprehensive 6-level Cognitive Pyramid, including guidance on safety interventions for each level, was developed and used during interprofessional Rapid Safety Rounds to assess patients' cognitive status. OUTCOMES: The Cognitive Pyramid demonstrated appropriate face validity from 12 subject matter experts. After implementing the Cognitive Pyramid during interdisciplinary rounds, the fall rate decreased to 0 per 1000 admissions. CONCLUSIONS: Assessment of patients' cognition using the Cognitive Pyramid, and implementing appropriate interventions, may help improve patient safety.
Subject(s)
Teaching Rounds , Humans , Critical Care , Patient Safety , CognitionABSTRACT
Electronic health record-generated work intensity scores represent state-of-the art functionality for dynamic nursing workload estimation in the hospital setting. In contrast to traditional stand-alone patient classification and acuity tools, electronic health record-based tools eliminate the need for dedicated data entry, and scores are automatically updated as new information is entered into patient records. This paper summarizes the method and results of evaluation of electronic health record-generated work intensity scores on six hospital patient care units in a single academic medical center. The correlation between beginning-of-shift work intensity scores and self-reported registered nurse rating of appropriateness of patient assignment was assessed using Spearman rank correlation. A weak negative correlation (-0.09 to -0.23) was observed on all study units, indicating that nurse appropriateness ratings decrease as work intensity scores increase. Electronic health record-generated work intensity scores provide useful information that can augment existing data sources used by charge nurses to create equitable nurse-patient assignments. Additional research is needed to explain observed variation in nurses' appropriateness ratings across similar work intensity point ranges.
Subject(s)
Electronic Health Records , Workload , Humans , Nurse-Patient Relations , Nursing Staff, Hospital , PerceptionABSTRACT
BACKGROUND: The COVID-19 pandemic resulted in the need for hospitals to plan for a potential "surge" of COVID-19 patients. PROBLEM: Prior to the onset of the COVID-19 pandemic, our hospital adult acute care capacity ranged 90% to 100%, and a potential hospital surge was projected for Oregon that would exceed existing capacity. APPROACH: A multidisciplinary team with stakeholders from nursing leadership, nursing units, nurse-led case management, and physicians from hospital medicine was convened to explore the conversion of an ambulatory surgical center to overflow patient acute care capacity. OUTCOMES: A protocol was rapidly created and implemented, ultimately transferring 12 patients to an ambulatory surgery unit. CONCLUSIONS: This project highlighted the ability for stakeholders and innovators to work together in an interprofessional, multidisciplinary way to rapidly create an overflow unit. While this innovation was designed to address COVID-19, the lessons learned can be applied to any other emerging infectious disease or acute care capacity crisis.
