Program Evaluation of an Early Nurse Intervention Team.

BACKGROUND: Many hospitals have implemented early rapid response teams to improve detection of patients at risk for decline. However, formal evaluation of these programs is rare. OBJECTIVE: To evaluate the Early Nurse Intervention Team program at a large community hospital in the southeastern United States. METHODS: A retrospective evaluation was performed of unplanned intensive care unit transfers, hospital length of stay, length of stay index, ventilator days, and mortality in 2 patient groups: those with and those without an Early Nurse Intervention Team nurse present. RESULTS: There was a marked decline in unplanned intensive care unit transfers as the Early Nurse Intervention Team nurse staffing increased. There were no significant interaction or main effects for length of stay, length of stay index, ventilator days, or mortality between the 2 groups. CONCLUSIONS: This study showed a positive impact of implementation of an Early Nurse Intervention Team program, with significant savings given the cost of unplanned intensive care unit transfers.

The effect of a nurse manager's authentic leadership intervention on nurses' well-being: A single unit QI project.

INTRODUCTION: Nurse well-being is at the forefront of nursing leadership's focus, particularly with the impact of the ongoing COVID-19 pandemic. Nurse managers, as authentic leaders, should understand their role in supporting the spectrum of nurse well-being. At the negative end of well-being, leaders must address staff burnout as it increases nurse turnover, shortage of nurses, and poor patient outcomes. PURPOSE: The specific aim for this quality improvement (QI) project was to implement a program that could guide a nurse manager of a single inpatient unit on how to improve well-being in their nursing staff as measured by: (a) improved well-being scores to a composite score of 3.5 or greater as indicated by follow-up Culture Pulse surveys distributed in 2021; and (b) reduced absenteeism among nursing staff by 18%. RESULTS: Five surveys identical to the organization's work culture survey, that measures well-being, were sent to staff each month starting in January 2021 and ending in May 2021. The average composite score from all five surveys was 2.8, indicating an overall improvement. Absenteeism was reduced during implementation by 39%. DISCUSSION: This QI project guides nurse managers in the evidence-based interventions that can promote well-being in their staff.

Reducing high-risk medication use through pharmacist-led interventions in an outpatient setting.

OBJECTIVE: This study aimed to reduce high-risk medication (HRM) prescribing by direct electronic medical record messaging to providers. SETTING: Lincoln Community Health Center is a federally qualified health center in the southeast United States. PRACTICE DESCRIPTION: This was a single-center, observational study performed with quality improvement methodology including define, measure, analyze, improve, and control phases. A total of 89 patients, aged 65 years or older, received 115 HRM prescriptions from August 2016 to August 2018. Project follow-up period included September 2018 to April 2019, with 19 additional patients receiving 23 HRM prescriptions. PRACTICE INNOVATION: Shared electronic medical records allowed pharmacists to electronically communicate indication of HRM, possible alternatives to HRM, and pharmacy of choice to providers to reduce HRM prescribing. Pharmacists' recommendations were timed to appear in providers' inboxes 3 to 5 days before the patient's clinic visit. Patients not returning to the clinic in a timely manner were telephoned by pharmacists with medical provider approved HRM alternative recommendations. EVALUATION: Discontinuation of HRMs were verified by chart review and insurance claims. The Cochran-Armitage trend test was used to examine significance of change related to national benchmark prescribing rates. Two-sided z test was used to analyze significance of change from implementation to follow-up period. RESULTS: Fifty-two provider communications sent by clinical pharmacists resulted in a therapy modification rate of 71.2%. National benchmark data that reflected a peak HRM prescribing rate of 10.7% was reduced to 1.9% within 18 months (P = 0.014). The national benchmark goal of less than 3% HRM prescribing was achieved and sustained from February 2019 to May 2019. CONCLUSION: Using interdisciplinary access to electronic medical records resulted in significant rates of HRM discontinuation. Timing messages before patient clinic visits promotes shared decision making.

Implementation of a smart pump champions program to decrease potential patient harm.

Compliance with safety features on smart pumps with drug libraries is a challenge for health care systems. Noncompliance and workarounds heighten the risk for adverse drug events and subsequent costs of patient care. This quality improvement project describes a pump champion innovation implemented over a 6-month period. There was a significant increase in nurses' compliance to drug library software in smart pumps and a decrease in severe harms averted.