The Intensive Care Unit Bundle Board: A Novel Real-Time Data Visualization Tool to Improve Maintenance Care for Invasive Catheters.

BACKGROUND: Critically ill patients are at greater risk of healthcare-associated infections (HAIs). The use of maintenance bundles helps to reduce this risk but also generates a rapid accumulation of complex data that is difficult to aggregate and subsequently act upon. OBJECTIVES: We hypothesized that a digital display summarizing nursing documentation of invasive catheters (including central venous access devices, arterial catheters, and urinary catheters) would improve invasive device maintenance care and documentation. Our secondary objectives were to see if this summary would reduce the duration of problematic conditions, that is, characteristics associated with increased risk of infection. METHODS: We developed and implemented a data visualization tool called the "Bundle Board" to display nursing observations on invasive devices. The intervention was studied in a 28-bed medical intensive care unit (MICU). The Bundle Board was piloted for 6 weeks in June 2022 and followed by a comparison phase, where one MICU had Bundle Board access and another MICU at the same center did not. We retrospectively applied tile color coding logic to prior nursing documentation from 2021 until the pilot phase to facilitate comparison pre- and post-Bundle Board release. RESULTS: After adjusting for time, other quality improvement efforts, and nursing shift, multiple linear regression demonstrated a statistically significant improvement in the completion of catheter care and documentation during the pilot phase (p < 0.0001) and comparison phase (p = 0.002). The median duration of documented problematic conditions was significantly reduced during the pilot phase (p < 0.0001) and in the MICU with the Bundle Board (comparison phase, p = 0.027). CONCLUSION: We successfully developed a data visualization tool that changed ICU provider behavior, resulting in increased completion and documentation of maintenance care and reduced duration of problematic conditions for invasive catheters in MICU patients.

Multimodal Education Program to Improve Nurses' Knowledge and Confidence on Delirium Recognition in a Surgical-Trauma Intermediate-Care Setting.

BACKGROUND: High incidence of delirium in hospitalized patients has been reported in the United States and is significantly associated with increased morbidity and mortality. The lack of knowledge and confidence in performing delirium assessment (KCDA) has led to significant underrecognition of delirium by nurses regardless of evidence-based education intervention. OBJECTIVE: The purpose of this study was to determine the effectiveness of a multimodal educational program (MEP) to enhance nurses' KCDA. METHODS: A MEP including an online didactic with a video-simulation and 1:1 bedside coaching with delirium screening (DS) was conducted in the surgical intermediate-care unit of an academic medical center. A quasi-experimental pre- and post-test design was used. RESULTS: Of 23 nurses, the majority were <41 years old (73.9%) and had at least a bachelor of science in nursing degree (78.3%) with <6 years of experience (60.9%). The overall KCDA scores and the performance of DS improved significantly after the MEP (p < .001). A positive correlation was noted between the changes of the KCDA scores (p = .009). CONCLUSIONS: The MEP demonstrated improvement in nurses' KCDA. The MEP should focus on an individualized learning approach with a targeted patient population, using current delirium screening tools. IMPLICATIONS FOR NURSING: Educational programs are recommended in either an orientation or continuing education program on nursing units. This is also recommended for use in other academic centers that encompass similar clinical settings and could possibly be considered for use in other disease processes.

Educational Intervention to Improve Delirium Recognition by Nurses.

BACKGROUND: Delirium poses increased morbidity and mortality risks for hospitalized patients. Underrecognition by health care providers contributes to poor outcomes for patients. Little has been published about methods used to teach health care providers how to screen for delirium using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). OBJECTIVE: To evaluate the effectiveness of a multimodal educational intervention for nurses in the medical intensive care unit to improve their knowledge and skills regarding delirium and delirium recognition. METHODS: An educational intervention was done in the medical intensive care unit of an academic medical center. Effectiveness was evaluated via a quasi-experimental design and using preintervention and postintervention assessments. Procedural correctness of performing the CAM-ICU delirium screening also was measured. RESULTS: Nurses participated in 1 small-group session (n = 34). Fifteen sessions were conducted from June to September 2016, and assessments were completed before and after the intervention. The sample consisted of predominantly nurses with a bachelor's degree (56%) who had 1 to 5 years' experience (59%). Mean scores overall and on the knowledge subscale differed significantly (P < .001) from before to after the intervention. No correlation was found between demographic groups and score differences. Seventy-nine percent of participants used the tool correctly after the intervention. CONCLUSIONS: The educational intervention provided for these nurses further validated published reports of the benefits of an educational program about delirium. The content of the educational intervention should be targeted for the setting, the risk factors for the patient population in question, and the specific delirium screening tool used.

Incongruence in Perceptions: Identifying Barriers to Patient Satisfaction in the Intensive Care Unit.

BACKGROUND: Patient satisfaction is at the forefront of quality care and patient outcomes. The literature identifies the discrepancy between nurse and patient perceptions in a variety of care settings; few studies have investigated the perceptions of care in a critical care unit. Understanding the perceptions in a critical care unit is necessary to optimize organizational performance related to quality, safety, patient-centered care, and efficiency. OBJECTIVE: The purpose of the study was to determine whether a discrepancy exists between what patients and families perceive as satisfaction with their care as compared with the nurses' perception of what constitutes positive patient satisfaction in a medical critical care unit. METHODS: A cross-sectional, prospective study was conducted to assess patient-perceived satisfaction with nursing care versus nursing perceptions in the medical intensive care unit. A convenience sample of patients and/or family members and the nurses providing their care was conducted. The validated Patient Satisfaction with Nursing Care Quality Questionnaire and Nurse's Assessment of the Patient's Expectations Questionnaire were used to assess perceptions. Patients and/or their family members and nurses' responses were evaluated as matched pairs. The data were analyzed using Spearman correlation. RESULTS: Forty-eight matched pairs of questionnaires were completed. There was not a correlation (r = 0.135; 95% confidence interval, -0.16 to 0.41; P = .363) between the overall patient and nurse averages for common questions. The analysis of the individual patient and nurse items revealed statistically significant correlations between only 2 of the 19 items, information given (P = .027) and recognition of opinions (P = .043).Correlations within patient questionnaires were noted in some areas such as patients' perception of quality of care and expectations, overall quality of nursing care, and patient expectations and patients' likelihood to recommend the hospital to family and friends. Patient satisfaction was influenced by a number of factors, most notably patient expectations. IMPLICATIONS FOR PRACTICE: Nurses' perceptions of positive patient satisfaction in critical care are incongruent with patients' perceptions. Improving nurses' awareness of the patient experience could improve patient satisfaction. Further studies examining patient expectations could be beneficial in improving patient satisfaction in the critical care setting.

Detection of inadvertent airway intubation during gastric tube insertion: Capnography versus a colorimetric carbon dioxide detector.

BACKGROUND: In the medical intensive care unit at the University of Virginia Health System, capnography is used to detect end-tidal carbon dioxide to protect patients from inadvertent airway cannulation during placement of gastric tubes. OBJECTIVES: To compare the method in which capnography is used with a method in which a colorimetric carbon dioxide detector is used and to determine what variables affect accurate placement of gastric tubes. METHODS: A prospective convenience sample of 195 gastric tube insertions was studied in 130 adult patients in a medical intensive care unit. Standard insertions of gastric tubes (done with capnography) were simultaneously monitored by using a disposable colorimetric device, with a color change indicating the presence of carbon dioxide. RESULTS: Insertion variables included tube type (60% Salem sump tubes, 40% soft-bore feeding tubes), route of insertion (71% oral, 29% nasal), mechanical ventilation (81%), and decreased mental status (72%). Carbon dioxide was successfully detected with the colorimetric indicator (within seconds) in all insertions in which carbon dioxide was detected by capnography. When carbon dioxide was detected (27% of insertions), the tubes were withdrawn and reinserted. Carbon dioxide detection during tube placement was significantly associated with nasal insertions (P = .03) and spontaneously breathing/nonintubated status (P = .01) but not with mental status or tube type. CONCLUSIONS: A colorimetric device is as accurate as capnography for detecting carbon dioxide during placement of gastric tubes.