Psychometric Testing of the Caregiver Attitudes on Substance Use in Pregnancy Instrument.

OBJECTIVE: To modify an existing instrument used to measure the attitudes of perinatal nursing caregivers about pregnant women with substance use disorder (SUD) and to psychometrically test the new instrument: Caregiver Attitudes on Substance Use in Pregnancy (CASUD-OB). DESIGN: Instrument modification and psychometric testing of results from a modified instrument. SETTING: Multi-hospital health care system in the midwestern United States. PARTICIPANTS: A total of 147 perinatal nursing caregivers (perinatal nurses: n = 131; unlicensed assistive personnel: n = 16) who worked on obstetric and neonatal nursing units. METHODS: We modified the existing instrument, and 12 experts in perinatal nursing (1 who also had expertise in SUD in the perinatal period) evaluated the items for content validity. We administered the CASUD-OB via online survey between November 2019 and December 2019. We used item reduction, calculated item-total correlations, and conducted exploratory factor analysis to modify the instrument and assessed its internal consistency. RESULTS: After psychometric testing, we reduced the number of items from 26 to 16. Through item reduction and exploratory factor analysis, we identified three subscales (Caregiver Bias, Caregiver Self-Awareness, and Caregiver Perception of Parental Fitness). The Cronbach's alpha for the overall instrument was .92. CONCLUSION: This study provides preliminary evidence to suggest that the CASUD-OB may be a valid and reliable instrument for measuring nurses' attitudes toward pregnant women with SUD. Through additional testing, this instrument has the potential to become a valuable resource to evaluate quality improvement initiatives, staff education programs, and other interventions designed to transform the attitudes of nursing caregivers toward pregnant women with SUD.

Does an Insulin Double-Checking Procedure Improve Patient Safety?

OBJECTIVE: The aim of this study was to examine the effectiveness of a subcutaneous insulin double-checking preparation intervention on insulin administration errors. BACKGROUND: Insulin accounts for 3.5% of medication-related errors. The Joint Commission and Institute for Safe Medication Practices recommend a 2-nurse double-checking procedure when preparing insulin. METHODS: This study used a randomized, controlled, nonblinded, intent-to-treat methodology. RESULTS: In total, 266 patients were enrolled, and over 4 weeks of data collection, there were 5238 opportunities for insulin administration. Overall, 3151 insulin administration opportunities had no errors; the double-checking group had more no-error periods than usual care. Of error types, wrong time was predominant, but less prevalent in the double-checking group. Omission errors were uncommon and occurred less in the double-checking group. CONCLUSIONS: The subcutaneous insulin double-checking preparation procedure led to less insulin administration errors; however, timing errors were most prevalent and are not resolved with double-checking interventions.

Close observation unit to prevent falls and minimize use of patient care companions.

Fall rates and patient companion use were examined after opening a close observation unit (COU) for patients with internal medicine diagnoses. Of 2023 patients (COU, n = 145; internal medicine unit, n = 1878), COU patients had more neurologic and psychiatric problems, had a longer mean length of stay, and were discharged home less often than internal medicine unit patients. Although COU patients had higher acuity, there were no differences between groups in fall rates per 100 patient-days and no use of patient companions in the COU.