Predictors of Second Medical Emergency Team Activation Within 24 Hours of Index Event.

This study explored the trajectory of patients who remained on a general unit after medical emergency team activation. Of those who had a second activation within 24 hours, 80% occurred within 12 hours of the baseline activation. Chest pain and recent intensive care unit discharge were associated with having a second activation. There were statistically, not clinically, significant associations between mean vital signs and second activations; however, the patterns of change may be clinically useful.

Comparison of a silver-coated needleless connector and a standard needleless connector for the prevention of central line-associated bloodstream infections.

OBJECTIVE: To assess the impact of a novel, silver-coated needleless connectors (NCs) on central-line-associated bloodstream infection (CLABSI) rates compared with a mechanically identical NCs without a silver coating. DESIGN: Prospective longitudinal observation study SETTING Two 500-bed university hospitals PATIENTS: All hospitalized adults from November 2009 to June 2011 with non-hemodialysis central lines INTERVENTIONS: Hospital A started with silver-coated NCs and switched to standard NCs in September 2010; hospital B started with standard NCs and switched to silver-coated NCs. The primary outcome was the difference revealed by Poisson multivariate regression in CLABSI rate using standard Centers for Disease Control and Prevention surveillance definitions. The secondary outcome was a comparison of organism-specific CLABSI rates by NC type. RESULTS: Among 15,845 hospital admissions, 140,186 central-line days and 221 CLABSIs were recorded during the study period. In a multivariate model, the CLABSI rate per 1,000 central-line days was lower with silver-coated NCs than with standard NCs (1.21 vs 1.79; incidence rate ratio=0.68 [95% CI: 0.52-0.89], P=.005). A lower CLABSI rate per 1,000 central-line days for the silver-coated NCs versus the standard NCs was observed with S. aureus (0.11 vs 0.30, P=.02), enterococci (0.10 vs 0.27, P=.03), and Gram-negative organisms (0.28 vs 0.63, P=.003) but not with coagulase-negative staphylococci (0.31 vs 0.36) or Candida spp. (0.42 vs 0.40). CONCLUSIONS: The use of silver-coated NCs decreased the CLABSI rate by 32%. CLABSI reduction efforts should include efforts to minimize contamination of NCs.

Prevention, detection and intervention with delirium in an acute care hospital: a feasibility study.

Background. The prevalence of delirium in acute care hospitals ranges from 5-86%. Delirious patients are at greater risk of negative health outcomes and their care is often more costly. Aim. To determine the feasibility of a full-scale trial to test the effectiveness of an intervention designed to improve delirium prevention, detection and intervention in an acute care hospital. Design. A delirium prevention protocol was designed by an interdisciplinary group of clinicians and implemented on intervention unit patients who passed a mental status screen, were at high risk for delirium according to the modified NEECHAM scale, and met other eligibility criteria. These patients were reviewed at daily interdisciplinary team meetings and team recommendations were placed in the patient's chart. On the usual care unit, physicians were notified if their patients were at high risk, but the delirium protocol was not implemented. Methods. The delirium protocol was pilot tested with 35 high risk patients on an Acute Care for Elders (ACE) unit. Outcomes were compared to 35 high risk patients on a similar medical unit without the delirium protocol. Results. The main outcome examined whether there is a difference in average day 3 modified NEECHAM scores comparing the intervention and control groups. The mean modified NEECHAMs on day 3 were not statistically significantly different (intervention group 3.76 and control group 3.24) (P= 0.368). Baseline NEECHAM scores did not correlate well with development of delirium (P = 0.204). A history of confusion during a previous hospitalization was the strongest predictor of developing delirium during the current hospitalization. Conclusion. This pilot study was not powered to detect an effect of the intervention, however, feasibility for a fully powered trial was established. Relevance to clinical practice. Completion of the NEECHAM screen every shift was not considered burdensome for either nurses or patients and may help identify acute delirium.

Clinical nurse specialist practice within the Acute Care for Elders interdisciplinary team model.

As the complexity of care increases for hospitalized older adults, the clinical nurse specialist is essential for ongoing development of nursing practice and care standards. This article describes the Acute Care of the Elderly (ACE) model for interdisciplinary management of older adults and clinical specialist responsibilities within this interdisciplinary team. Within the model, clinical care specialists utilize clinical expertise and consultation skills reflecting three spheres of practice related to care of high-risk community-dwelling older adults admitted an acute medical unit. The goal for this patient group is to achieve medical stability while preserving maximum functioning. The Acute Care of the Elderly team members include primary nurses (staff nurses), physicians, clinical care specialists, therapies, social workers, dietitians, pharmacists, and a discharge planner. Under the leadership of the primarily nurse, the team develops a comprehensive care and discharge plan, implemented across a care continuum. Using protocols and working together, the team delivers cost-effective, coordinated care that promotes process improvement resulting in practice that is in alignment with current standards of care.

A strategy to decrease the use of risky drugs in the elderly.

Many medications that are safe in most patients pose serious risks in older patients, including functional decline, delirium, falls, and poorer outcomes. We describe our institution's program of "academic detailing," designed to reduce the use of three high-risk drugs in elderly patients.

Developing a stroke unit using the acute care for elders intervention and model of care.

The Acute Care for Elders (ACE) model of care is a multicomponent intervention that improves outcomes for older patients hospitalized for acute medical illnesses. Likewise, stroke units improve outcomes for patients with acute stroke, yet the descriptions of their structure and approach to stroke management are heterogeneous. The purpose of this article is to describe how implementing the ACE model of care, using a continuous quality-improvement process, can serve as a foundation for a successful stroke unit aimed at improving stroke care. The ACE intervention (a prepared environment, interdisciplinary team management, patient-centered nursing care plans, early discharge planning, and review of medical care) was amplified in a community teaching hospital for stroke-specific care by creating a stroke interdisciplinary team, evidence-based stroke orders and protocols, and a redesigned environment. Administrative data show that the ACE model can be successfully adapted to create a disease-specific program for stroke patients, having the potential to improve the process of care and clinical stroke outcomes.