Telemedicine for Interfacility Nurse Handoffs.

OBJECTIVE: To compare nurse preparedness and quality of patient handoff during interfacility transfers from a pretransfer emergency department to a PICU when conducted over telemedicine versus telephone. DESIGN: Cross-sectional nurse survey linked with patient electronic medical record data using multivariable, multilevel analysis. SETTING: Tertiary PICU within an academic children's hospital. PARTICIPANTS: PICU nurses who received a patient handoff between October 2017 and July 2018. INTERVENTIONS: None. MAIN RESULTS AND MEASUREMENTS: Among 239 eligible transfers, 106 surveys were completed by 55 nurses (44% survey response rate). Telemedicine was used for 30 handoffs (28%), and telephone was used for 76 handoffs (72%). Patients were comparable with respect to age, sex, race, primary spoken language, and insurance, but handoffs conducted over telemedicine involved patients with higher illness severity as measured by the Pediatric Risk of Mortality III score (4.4 vs 1.9; p = 0.05). After adjusting for Pediatric Risk of Mortality III score, survey recall time, and residual clustering by nurse, receiving nurses reported higher preparedness (measured on a five-point adjectival scale) following telemedicine handoffs compared with telephone handoffs (3.4 vs 3.1; p = 0.02). There were no statistically significant differences in both bivariable and multivariable analyses of handoff quality as measured by the Handoff Clinical Evaluation Exercise. Handoffs using telemedicine were associated with increased number of Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver components (3.3 vs 2.8; p = 0.04), but this difference was not significant in the adjusted analysis (3.1 vs 2.9; p = 0.55). CONCLUSIONS: Telemedicine is feasible for nurse-to-nurse handoffs of critically ill patients between pretransfer and receiving facilities and may be associated with increased perceived and objective nurse preparedness upon patient arrival. Additional research is needed to demonstrate that telemedicine during nurse handoffs improves communication, decreases preventable adverse events, and impacts family and provider satisfaction.

Correlating family nurse practitioners' perspectives of adult ADD/ADHD with employed pharmacotherapy: a pilot study.

PURPOSE: This study explores how family nurse practitioners (FNPs) in the state of Washington view adulthood attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD) and how these views affect the pharmacotherapy FNPs employ. DATA SOURCES: A confidential survey containing 30 questions was mailed to self-selected FNPs who practice in the state of Washington (N= 126). Descriptive and Kendall's rank correlations coefficient statistical methods were used for data analysis. CONCLUSIONS: The majority of respondents do not hold negative views toward adults with ADD/ADHD and are aware that their personal views may affect how they treat the disorder. Most of the respondents agreed that given the likelihood of co-morbidity of adult ADD/ADHD, it can be a challenge to diagnose the disorder. The predominant prescribed medications for adult ADD/ADHD are consistent with current pediatric guidelines, with the exception of buproprion, which was identified by 40% of the respondents as either their primary or secondary drug of choice for treating adult ADD/ADHD. IMPLICATIONS FOR PRACTICE: Research effort needs to focus on the efficacy of buproprion for treating ADD/ADHD in adults. Moreover, exploration of the effectiveness of current pediatric guidelines to treat ADD/ADHD in adults must be assessed.