Redesigning nurse staffing plans for acute care hospitals.

Johnson City Medical Center's approach to maximizing staffing in nursing units, particularly in acute care settings, had four primary goals: Identify opportunities to maximize the effectiveness of nurse staffing based on a review of core staffing schedules. Reduce cost duplication and improve workflow. Decrease the use of contract labor (with the goal of eliminating the use of contract labor). Develop financial dashboards for staffing that could be used by nursing managers.

Family and staff responses to a scripted introduction to tissue donation for hospice inpatients on admission.

PURPOSE: To implement and evaluate a change in practice regarding the timing of introducing donation for inpatient hospice staff and families whereby scripted information about tissue/organ donation was given by the nurse upon admission as part of the normal admission process and then repeated at the time of death per usual protocol. METHODS: Data were collected from staff for 6 months (January to June 2006). The hospice staff agreed to complete a donor services comment log at the admission and at the death of each patient to relay any concerns with the change in practice rather than just writing down complaints as was the previous practice. Data were supplemented with staff input during regular meetings. Donation rates were compiled as usual for 6 months and compared with the preceding 6 months. RESULTS: Data were analyzed from the written interactions. Trends identified were limited by the small sample size. The results confirmed that both nursing staff and potential donor families supported the change in practice. No families or staff called the organ procurement organization with complaints during the 6-month period. Corneal donations increased from 2 to 7, a 250% increment for the 6-month period. CONCLUSION: The assumption that discussing donation when hospice patients are admitted will lead to a decrease in donation is not supported by the results of this study. The findings suggest the need for a methodologically rigorous, theoretically driven examination of hospice donor families' reactions to the introduction of donation at admission and the subsequent decrease in stress and increase in donation rates.

Community education on preterm birth. Does it change practice?

OBJECTIVE: To evaluate how well physicians and other prenatal care providers educate women about early recognition of and appropriate response to the signs and symptoms of preterm labour (PTL). To assess use of antenatal steroids for babies born at less than 34 weeks' gestation. DESIGN: Before-after study using a population-based approach. SETTING: Health care providers' offices, hospitals, and prenatal classes in Ottawa, Ont. PARTICIPANTS: Prenatal care providers, women in hospital after giving birth, prenatal class participants. INTERVENTIONS: Prenatal care providers received information and educational materials on PTL and preterm birth (PTB). They passed this information on to pregnant women at their 18- to 20-week prenatal visits. Teachers of prenatal classes gave the same information in early-series classes. Clinical practice guidelines were developed, and hospital staff received education on appropriate response to PTL. MAIN OUTCOME MEASURES: Use of educational materials and steroid treatment. RESULTS: Statistically significant increases were seen in the numbers of care providers who had educational material about PTL and PTB, who reported giving the educational material to all women, and who reported discussing signs and symptoms of PTL and PTB with all women; women who reported that their care providers talked with them about PTL and PTB, and women delivering preterm (< 34 weeks) babies who received steroids. CONCLUSION: Providing knowledge and standardized educational materials to health care providers can help improve preventive practice for PTL and educate women about PTL.

A prospective clinical audit of neonatal resuscitation practices in Canada.

PURPOSE: This is a prospective audit to determine the frequency of resuscitation interventions in the clinical setting and to compare self-reports of clinical performance with the existing Neonatal Resuscitation Program (NRP) and Canadian National Guidelines for Neonatal Resuscitation. SUBJECTS: Fifty-six level I, II, and III hospitals in Canada participated. Any infant requiring resuscitation, as defined by the need for at least positive pressure ventilation (PPV), was eligible for inclusion (n = 783 resuscitations). DESIGN AND METHODS: A prospective self-report audit was chosen and data were collected over a 6-month period in 1998. The audit focused on the use of PPV, intubation, chest compressions, free-flow oxygen, or medications during the resuscitation. The infant's temperature at the end of resuscitation was also noted. The data were analyzed with descriptive statistics. The composition of the resuscitation team and their NRP certification status were recorded. PRINCIPAL RESULTS: The need for resuscitation was not anticipated in 76% of the cases (596 of 783). Errors in the sequencing of care, such as delays in initiating PPV, provision of chest compressions before or without establishing an airway and ventilatory support, and administering naloxone before PPV, were reported. Resuscitations attended by a team of NRP certified providers had improved sequencing when compared with those in which only some individual providers were certified. Chest compressions were provided in 8% of the cases (65 of 783). Medications were used in 14% (113/783) of all cases. Providers in level I hospitals performed chest compressions more frequently than those in level II and III settings. At the end of the resuscitation, 27% of the infants were hypothermic (142 of 520), and 25% were hyperthermic (128 of 520). Overall, 52% were out of the normal neutral range. CONCLUSIONS: Clear differences between the NRP guidelines and actual clinical practice were shown. A high rate of unanticipated resuscitations, delivery room medications, and chest compressions was described. Postresuscitation hypothermia or hyperthermia were common. Improved sequencing was noted when the entire resuscitation team was NRP certified. Certification in NRP does not assure competency, nor does it ensure compliance with established standards of care.