Implementation of a Brief Abuse and Basic Needs Tool: Impact on Utilization of Social Services in Ambulatory Medical Clinics.

Domestic violence (DV) screening has become increasingly common in recent years; however, many organizations still do not practice universal screening, and there is considerable debate concerning the best screening tool for detecting DV. The current research suggests that a brief tool would be ideal and that existing brief tools are comparable to more extensive instruments. Per Joint Commission standards, the ambulatory clinics at West Virginia University Hospitals instituted the use of the Functional Health Screening (FHS), a three-item tool that screens for unexplained weight changes, DV, and basic needs deficits. This tool is administered at the beginning of every outpatient clinic visit. This study includes a retrospective chart review to investigate the detection rate of this tool for DV and basic needs deficits, the increased utilization of social services, and nursing attitudes concerning FHS.

Impact of Tissue Plasminogen Activator Dosing on Patients Weighing More Than 100 kg on 3-Month Outcomes in Acute Ischemic Stroke.

BACKGROUND AND PURPOSE: The landmark National Institute of Neurological Disorders and Stroke (NINDS) tissue plasminogen activator (tPA) trial established the effectiveness and dosing of intravenous tPA for acute ischemic stroke (AIS) at .9 mg/kg with a maximum dose of 90 mg. Since the publication of the NINDS trial in 1995, there has been a drastic increase in the amount of obesity and the average weight of adults in the United States, which has caused an increase in the number of patients receiving 90 mg of alteplase for AIS. This retrospective trial was an attempt to see if reduced-dose tPA is as effective as full .9 mg/kg dosing. METHODS: We performed a single-center retrospective analysis to assess the dosing rate and 90-day outcomes comparing maximum dosage (90 mg) and standard dosage (.9 mg/kg) of tPA. RESULTS: A total of 301 patients were included in the analysis with 64 (21%) receiving less than .9 mg/kg dosing. The adjusted binary logistic regression model showed a statistically significant association toward a good outcome for increases in tPA dose rate (odds ratio = 1.7, P = .027) when compared against a poor outcome. Our analysis showed that patients receiving doses of alteplase closer to .9 mg/kg had a higher likelihood of a modified Rankin Scale score of 0-1 at 90 days. CONCLUSIONS: With the growth of obesity in the United States and the lack of data supporting dose capping of alteplase, it remains unclear if this dosing practice should continue to be accepted without question. Further studies are needed to assess optimum dosing practices particularly given the obesity epidemic.

A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation.

AIMS AND OBJECTIVES: To quantify quantitative outcomes of a practice change to a blended form of bedside nursing report. BACKGROUND: The literature identifies several benefits of bedside nursing shift report. However, published studies have not adequately quantified outcomes related to this process change, having either small or unreported sample sizes or not testing for statistical significance. DESIGN: Quasi-experimental pre- and postimplementation design. METHODS: Seven medical-surgical units in a large university hospital implemented a blend of recorded and bedside nursing report. Outcomes monitored included patient and nursing satisfaction, patient falls, nursing overtime and medication errors. RESULTS: We found statistically significant improvements postimplementation in four patient survey items specifically impacted by the change to bedside report. Nursing perceptions of report were significantly improved in the areas of patient safety and involvement in care and nurse accountability postimplementation. However, there was a decline in nurse perception that report took a reasonable amount of time after bedside report implementation; contrary to these perceptions, there was no significant increase in nurse overtime. Patient falls at shift change decreased substantially after the implementation of bedside report. An intervening variable during the study period invalidated the comparison of medication errors pre- and postintervention. There was some indication from both patients and nurses that bedside report was not always consistently implemented. CONCLUSIONS: Several positive outcomes were documented in relation to the implementation of a blended bedside shift report, with few drawbacks. Nurse attitudes about report at the final data collection were more positive than at the initial postimplementation data collection. RELEVANCE TO CLINICAL PRACTICE: If properly implemented, nursing bedside report can result in improved patient and nursing satisfaction and patient safety outcomes. However, managers should involve staff nurses in the implementation process and continue to monitor consistency in report format as well as satisfaction with the process.

Investigating bedside nursing report: a synthesis of the literature.

A systematic review of the literature was completed to investigate advantages and drawbacks of bedside nursing report. Qualitative evidence indicated several benefits, but quantitative evidence was not generalizable.

Incorporating bedside report into nursing handoff: evaluation of change in practice.

Nursing shift report on the medical-surgical units of a large teaching hospital was modified from a recorded report to a blend of both recorded and bedside components. Comparisons between baseline and postimplementation data indicated increased patient satisfaction and nurse perception of accountability and patient involvement but reduced nurse perceptions of efficiency and effectiveness of report. Patient falls at shift change and medication errors were reduced, whereas nurse overtime remained unchanged.