Partnering With Patients: Fall Prevention Agreement.

A fall prevention agreement was developed in a cardiac progressive care unit to engage patients and families on admission as partners in fall prevention. The postimplementation of the fall prevention agreement showed significant decreases in falls on this unit.

Readmitted Patients With Heart Failure Sick, Tired, and Symptomatic: A Qualitative Descriptive Study From a Quaternary Academic Medical Center.

BACKGROUND AND OBJECTIVE: Heart failure (HF) readmissions will continue to grow unless we have a better understanding of why patients with HF are readmitted. Our purpose was to gain an understanding, from the patients' perspective, of how patients with HF viewed their discharge instructions and how they felt when they got home and were then readmitted in less than 30 days. METHODS AND RESULTS: We used a qualitative descriptive approach using semistructured interviews with 22 patients with HF. Most participants had multimorbidities, were classified as New York Heart Association class III (n = 13) with reduced ejection fraction (n = 20), and were on home inotrope therapy (n = 13). The overarching theme that emerged was that these participants were sick, tired, and symptomatic. Additional categories within this theme highlight discharge instructions as being clear and easily understood; rich descriptions of physical, emotional, and other symptoms leading up to readmission; and reports of daily activities including what "good" and "not good" days looked like. Moreover, when participants experienced an exacerbation of their HF symptoms, they were sick enough to be readmitted to the hospital. CONCLUSION: Our findings confirm ongoing challenges with a complex group of sick patients with HF, with the majority on home inotropes with reduced ejection fraction, who developed an unavoidable progression of their illness and subsequent hospital readmission.

Two Sides to Every Fall: Patient and Nurse Perspectives.

BACKGROUND: Despite vast evidence describing risk factors associated with falls and fall prevention strategies, falls continue to present challenges in acute care settings. OBJECTIVE: To describe and categorize patient and nurse perspectives on falls and nurses' suggestions for preventing falls. METHODS: To improve transparency about the causes of falls, nurses interviewed patients in a 48-bed progressive cardiac care unit who had experienced a fall. A content analysis approach was used to examine responses to 3 open-ended items: why patients said they fell, why nurses said the patients fell, and nurses' reflections on how each fall could have been prevented. RESULTS: Over a 2-year period, 67 falls occurred. Main themes regarding causes of falls were activity (41 falls, 61%), coordination (16 falls, 24%), and environment (10 falls, 15%). Patients said they fell because they slipped, had a medical issue, were dizzy, or had weak legs. Nurses said patients fell because they had a medical issue or did not call for assistance. CONCLUSIONS: Nurses and patients agreed on the causes of assisted falls but disagreed on the causes of unassisted falls. Nurses frequently said that the use of a bed alarm could have prevented the fall.

An Innovative Action-Learning Plan Designed for the Struggling Orientee.

When an orientee is struggling, early identification and intervention is key. Implementing an action-learning plan refocuses the orientee, placing the accountability on them, targeting specific areas that will develop them as a competent nurse. The action-learning plan factors in holistic measures that help the orientee in processing their experience. The action-learning plan can be individualized to any unit and organization.

Beyond Socks, Signs, and Alarms: A Reflective Accountability Model for Fall Prevention.

Despite standard fall precautions, including nonskid socks, signs, alarms, and patient instructions, our 48-bed cardiac intermediate care unit (CICU) had a 41% increase in the rate of falls (from 2.2 to 3.1 per 1,000 patient days) and a 65% increase in the rate of falls with injury (from 0.75 to 1.24 per 1,000 patient days) between fiscal years (FY) 2012 and 2013. An evaluation of the falls data conducted by a cohort of four clinical nurses found that the majority of falls occurred when patients were unassisted by nurses, most often during toileting. Supported by the leadership team, the clinical nurses developed an accountability care program that required nurses to use reflective practice to evaluate each fall, including sending an e-mail to all staff members with both the nurse's and the patient's perspective on the fall, as well as the nurse's reflection on what could have been done to prevent the fall. Other program components were a postfall huddle and guidelines for assisting and remaining with fall risk patients for the duration of their toileting. Placing the accountability for falls with the nurse resulted in decreases in the unit's rates of falls and falls with injury of 55% (from 3.1 to 1.39 per 1,000 patient days) and 72% (from 1.24 to 0.35 per 1,000 patient days), respectively, between FY2013 and FY2014. Prompt call bell response (less than 60 seconds) also contributed to the goal of fall prevention.

CE: Catheter Ablation of Atrial Fibrillation.

OVERVIEW: Catheter ablation of atrial fibrillation is a complex procedure. Although complications are rare and their incidence is decreasing, early recognition and appropriate nursing care can prevent an adverse event from spiraling into a major complication. A thorough understanding of complications associated with the ablation of atrial fibrillation and prompt recognition when they occur will help nurses to minimize the substantial morbidity, mortality, and hospital costs associated with them. This article gives an overview of the procedure, its possible complications, and best practices for nursing care.

Increasing the odds, using peer review promotes successful abstract submission.

PURPOSE/OBJECTIVES: Supporting clinical nurses to participate in professional growth and development is rewarding and grooms our future leaders. This is especially true during Magnet designation, as the bar gets higher. This article provides the structure and process required to develop a clinical nurse specialist-led peer review abstract workshop. BACKGROUND: Abstract writing is complex. It is a self-contained summary of completed work in only a few words. Writing winning abstracts for submission at local, regional, and national conferences can be a daunting task, but using peer review provides the author with guidance, self-assurance, peer support, and encouragement. RATIONALE: Clinical nurse specialists, as expert clinician, consultant, educator, and researcher, influence organizational outcomes across the 3 spheres of influence, reducing hospital-acquired complications and improving patient outcomes. Clinical nurse specialists need to mentor nurses in disseminating these outcomes at nursing conferences. DESCRIPTION: A 3-part workshop was designed to give the participants time to bring to light their ideas, put them on paper, and receive valuable peer feedback. In the first session, the ground rules are set. In the second session, the first draft is reviewed and constructive peer review is provided. In the final session, the abstract is polished and it is ensured that the abstract is complete, concise, clear and cohesive. OUTCOME: Implementing an abstract workshop provides opportunities to enhance team building and collaboration skills. It provides peer support and encouragement as well as generates innovating ideas. CONCLUSION: Implementing an abstract workshop sets the stage for successful abstract submission while ensuring that participants are prepared and ready for the challenge. This type of format can be used globally or on individual units and tailored for the needs and interests of the participants. IMPLICATIONS: The process used for developing an abstract workshop serves as a template to implement in any setting.

Managing risk of complications at femoral vascular access sites in percutaneous coronary intervention.

Percutaneous coronary intervention for acute coronary syndrome or non-ST-elevation myocardial infarction requires the use of potent oral and intravenous anti-platelet and antithrombin medications. Although these potent antithrombotic agents and regimens may increase the effectiveness of percutaneous coronary intervention, they are also generally associated with an increased risk of vascular access complications such as hematoma, retroperitoneal hematoma, pseudoaneurysm, arterial occlusion, and arteriovenous fistula, which in turn are associated with increased morbidity, mortality, and costs. Risk factors predisposing patients to these complications are both modifiable (procedure technique, medications, hemostasis method) and nonmodifiable (sex, age, body mass index, blood pressure, renal function). Patients' risks can be reduced by nurses who are knowledgeable about these risk factors and identify complications before they become problematic.

Predictors of complications following sheath removal with percutaneous coronary intervention.

BACKGROUND AND RESEARCH OBJECTIVES: Complex antiplatelet and antithrombotic regimens used in conjunction with percutaneous coronary intervention may increase the risk of vascular complications. The purpose of this study was to examine predictors of vascular complications following sheath removal for percutaneous coronary intervention. SUBJECTS AND METHODS: This prospective cohort study enrolled 413 patients during a 7-month period. Data elements were collected by chart abstraction. Practice variable included pharmacological agents and method and duration of sheath removal procedure. Patient outcomes included hematoma formation, bleeding occurrence, pseudoaneurysm prevalence, incidence of arteriovenous fistula formation, and thrombosis. RESULTS AND CONCLUSIONS: Of the 413 patients, 68 (16.5%) had a complication. Sixty-four (15.5%) developed hematomas ranging in size from 1 to 5 cm (n = 35, 8.5%) to greater than 5 cm (n = 29, 7.0%), 6 experienced bleeding (1.5%), 4 (1%) had arteriovenous fistulas, and 3 (0.7%) developed pseudoaneurysms. There were no significant differences for complications using manual, C-clamp, or arterial vascular closure device. Patients with a higher systolic blood pressure (135 vs 129; df = 410, P = .025) and of older age (66 vs 63; df = 411, P = .016) were significantly more likely to have complications. Clinically significant major vascular complications were low. Arterial closure devices, mechanical C-clamp, and manual compression all provide low and comparable complication risks following sheath removal in the era of antiplatelet and antithrombotic therapies. Patients who are older and those with elevated blood pressure should have their femoral access site closely monitored and be observed for vascular complications.