Nurse Staffing and Veteran Outcomes in the Veterans Health Administration's Community Living Centers.

BACKGROUND: The demand for nursing care is rising in the long-term care setting. Nurse staffing is a crucial measure linked to health care quality measure outcomes. PURPOSE: To assess for associations between nursing hours per patient day (NHPPD) and outcome measures in the Veterans Health Administration Community Living Centers. METHODS: A retrospective data review of NHPPD and quality measures for 134 community living centers was conducted. Linear regression was used to assess for linear associations between average total NHPPD and 6 quality measures. RESULTS: A significant linear association was found between average total NHPPD and falls with major injury ( P = .02) and help with activities of daily living ( P = .01). No associations were found between nurse staffing and 4 other quality measures. CONCLUSIONS: This study adds to the body of literature regarding the impact of nurse staffing on quality measures.

Achieving Optimal Therapeutic Hypothermia on Transport.

BACKGROUND: Early initiation of therapeutic hypothermia (TH) for the treatment of hypoxic ischemic encephalopathy (HIE) has been shown to improve outcomes. Many of these patients require transport to treatment facilities. At the time of the study, there were no servo-controlled devices approved for flight that allowed for active cooling of the neonate during air transport. PURPOSE: To introduce a clinical bundle for safe, active, or passive cooling and to achieve targeted, accurate temperature control with application for air or ground transport. METHODS: After meeting criteria, a facsimile is sent to the referring center with instructions for passive cooling. Strict protocols are initiated, guiding the transport team in reaching and maintaining target temperature range of 33°C to 35°C. RESULTS: From June 2010 to January 2014, a total of 22 neonates who qualified for TH were transported using the care bundle. Eight were actively cooled, whereas 14 were passively cooled. Of note, 8 infants required warming for temperatures below the acceptable range. The average temperature before turning off the warmer at the referral center was 36.0°C (SD = 1.1). The average temperature upon arrival of the transport team was 34.9°C (SD = 1.4). The average temperature upon arrival to the receiving facility was 33.5°C (SD = 0.7). IMPLICATION FOR PRACTICE: By utilizing a care bundle for the initiation of TH on transport, neonates can be safely delivered to a treatment center with an average temperature well within treatment range, all while avoiding extreme fluctuations. IMPLICATIONS FOR RESEARCH: The number of qualified participants limited the study. Future research should focus on the effectiveness of the bundle in larger treatment populations, with inclusion of additional transport teams.