Intentional Rounding With Certified Nursing Assistants in Long-Term Care: A Pilot Project.

Intentional rounding (IR) is a strategy used by predominately acute care nursing staff to proactively address patients' needs at regular and consistent intervals. The current project piloted the use of IR with certified nursing assistants (CNAs) on a 60-bed unit of a 120-bed skilled nursing facility (SNF). Using a pre/post intervention design and the Plan-Do-Study-Act (PDSA) framework, the authors measured knowledge of IR's "4Ps" (potty, position, possessions, and pain) and the incidence of falls and lost possessions. Uptake of IR over 10 weeks of implementation and CNAs' perceptions of intervention were also assessed. The pilot showed positive outcomes for each of the five aims. Data suggest that IR was well received by CNAs and changed practice patterns regarding quality, safety, and satisfaction. Based on these findings, replication of this project in other SNFs is recommended, given the current small and underpowered study. [Journal of Gerontological Nursing, 45(6), 15-21.].

A Systems Approach to Improving Care for All Bereaved Families.

Bereavement services for families are an established part of hospice and palliative care. However, patients also die in the acute care and long-term care environments. Often, hospice is not involved, creating a potential gap in care. This article recounts a journey to improve care for all families of deceased patients, despite the presence or absence of hospice. A palliative care clinical nurse specialist led a quality improvement team, which used a systems thinking approach to develop and implement a downloadable bereavement booklet for families. Expected and unexpected outcomes are discussed for this replicable project.

Facilitating palliative care referrals in the intensive care unit: a pilot project.

BACKGROUND: Palliative care in intensive care units (ICUs) reduces costs and improves outcomes yet is consistently underused; studies suggest that screening tools increase the use of palliative services. AIMS: This project piloted the use of the Palliative Performance Scale, version 2 (PPSv2), as a trigger for palliative care referrals in a 12-bed medical ICU. METHODS: Using a preintervention-postintervention design, the authors measured the effect of the intervention on nurses' comfort and knowledge in assessing palliative care needs, number of palliative care referrals, and number of days between ICU admission and palliative care referral. The authors also measured uptake of the scale over 12 weeks of implementation and asked nurses to share their thoughts about using the PPSv2. RESULTS: Over 610 observations, the rate of uptake increased over time and use of the scale ranged from 24.2% to 85.6%. The nurses' (n = 26) comfort with palliative care issues increased from preintervention to postintervention, albeit not significantly. Knowledge items did not change. There was a 110% increase in the number of palliative care referrals between preintervention and postintervention and a nearly 1-day decrease in the number of days between medical ICU admission and palliative care referral; this reduction was not statistically significant. A majority of nurses (n = 22 [84.5%]) voted to retain the PPSv2 as an official process of care, stating that the tool facilitated assessment of patient needs that might have been previously overlooked. CONCLUSION: Data suggest that the PPSv2 was well received by the bedside nurses and changed practice patterns with regard to facilitating palliative care services.