Getting It Right: Putting the ‘QI’ in Quality Improvement Reports

Towards a Safer Health System

Photo of AJN editor-in-chief Shawn KennedyEver since the famous report To Err is Human: Building a Safer Health System was issued by the Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine) in 1999, health care institutions have been pushed towards reducing errors and increasing safety.

Changes have been spurred by accrediting and government organizations like the Joint Commission and the Centers for Medicare and Medicaid Services, by independent and professional initiatives like the Institute for Healthcare Improvement and the Magnet Recognition Program, and by consumer advocacy groups like the The Leapfrog Group and the National Patient Safety Foundation.

Nursing Education and Quality Improvement

Nursing, as the largest department in hospitals and the one tasked with shepherding patients through the system, is a key player in any system redesign and many nursing departments are playing an active role in improving the safety and quality of care.

Nursing education has also embraced the QI movement, adopting the Quality and Safety in Nursing (QSEN) program in many curriculums and also making it a hallmark of its doctor of nursing practice (DNP) programs. Developing and implementing QI projects is frequently a requirement for completing these programs. […]

Injurious Falls in the Hospital Setting

by Maureen Shawn Kennedy, AJN editor-in-chief

PatOriginal.00000446-201609000-00022.FF1ient falls are, unfortunately, a frequent occurrence in hospitals and the consequences can vary from none to serious life-threatening injuries. There has been a lot of attention focused on identifying those at high risk for falls and effective prevention measures, but according to our September CE feature, there’s been little attention focused on falls that cause injuries. In this original research study, Predicting Injurious Falls in the Hospital Setting: Implications for Practice, Amy Hester and colleagues at the University of Arkansas for Medical Sciences conducted a retrospective review of medical records to see if they could pinpoint which patient factors were associated with falls with injuries. Their results may surprise you.

Here’s the abstract:

Background: Despite years of research and increasingly evidence-based practice, falls continue to be the most commonly reported adverse events experienced by hospitalized adults. Yet a majority of the relevant research has focused on predicting and preventing falls in general; there has been little focus on injurious falls.

Purpose: The purpose of this retrospective study was to determine which patient factors are associated with injurious falls in hospitalized adults.

Methods: The study site’s adverse event reporting database was used to identify 1,369 patients who fell between January 1, 2006, and October 31, 2013. Of these, 381 (27.8%) subjects suffered injurious falls. Variables of interest included age, sex, fall history, use of diuretics, use of central nervous system medications, cognitive impairment, primary discharge diagnoses, abnormal laboratory values, impaired mobility, and […]

August 31st, 2016|Nursing, nursing research|0 Comments

AJN in July: Opioids and Chronic Pain, Moral Distress, Prediabetes, More

CE Feature: Appropriate Use of Opioids in Managing Chronic Pain.”

Unintentional death related to prescription opioids has been identified as a public health crisis, owing in part to such factors as insufficient professional training and medication overprescription, misuse, and diversion. The authors discuss current best practices for prescribing opioids for chronic pain, emphasizing patient assessment and essential patient teaching points regarding safe medication use, storage, and disposal.

CE Feature: “Moral Distress: A Catalyst in Building Moral Resilience.”

Moral distress is a pervasive problem in nursing: an inability to act in alignment with one’s moral values is detrimental not only to the nurse’s well-being but also to patient care and clinical practice as a whole. Moral distress has typically been characterized in terms of powerlessness and victimization. This article offers an alternate view: ethically complex situations and experiences of moral distress can become opportunities for growth, empowerment, and increased moral resilience.
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Intimate Partner Violence: ‘Troubling Knowledge and Practice Gaps’ among Rural Providers

By Sylvia Foley, AJN senior editor

Table 8. Perceived self-efficacy on a 1-to-5 scale (mean score above 2.5 indicates greater sense of self-efficacy). Table 8. Perceived self-efficacy on a 1-to-5 scale (higher score indicates greater self-efficacy).

Intimate partner violence (IPV) remains a widespread health and social problem in the United States, affecting an estimated one in three women during her lifetime.

Health care providers can make a critical difference in the lives of these women, yet a lack of IPV-related knowledge, negative attitudes and beliefs, and low rates of screening are common. And women in rural areas face particular challenges.

To learn more about rural providers with regard to IPV, nurse researchers Karen Roush and Ann Kurth conducted a study. They report their findings in this month’s CE–Original Research feature, “Intimate Partner Violence: The Knowledge, Attitudes, Beliefs, and Behaviors of Rural Health Care Providers.” Here’s an overview:

Methods: Health care providers working in a large rural health network were asked to complete electronic surveys that examined their IPV-related knowledge, attitudes, beliefs, and behaviors. Descriptive and correlational statistical analyses of the data were conducted.
Results: A total of 93 providers returned completed surveys. In general, the respondents demonstrated good overall knowledge, judicious attitudes, and beliefs congruent with the available evidence. Of concern were their knowledge and practice gaps regarding the prevalence of IPV, the higher risk of injury faced by women who leave their abusers, the ability of women to make appropriate choices about their situations, and what actions to take when someone discloses abuse.
Conclusion: The results were encouraging with regard to the IPV-related knowledge, attitudes, beliefs, and behaviors of rural health care providers. But they also indicated important knowledge and practice gaps. Preparing providers to deliver compassionate, effective care to women who experience IPV is essential for the health and well-being of women and their families.

Implications. Pointing to confusion stemming from variation in state laws regarding mandated reporting of IPV, the authors call for the creation of a uniform national law. They recommend that health care organizations develop formal IPV policies with clear goals and procedures; and they urge organizations to provide IPV-related education for all staff.
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Napping on the Night Shift: What a Pilot Study Revealed

By Sylvia Foley, AJN senior editor

Table 1. Guidelines for Hospital Nurses on Implementing Naps on the Night Shift (click to enlarge)Nurses who work the night shift often struggle with high levels of sleepiness. But while onsite napping is effectively used to counter worker fatigue in other safety-sensitive industries, the practice has yet to win wide acceptance in nursing.

Curious about why this is so, nurse researchers Jeanne Geiger-Brown and colleagues recently conducted a pilot study. They report their findings in this month’s CE–Original Research feature, “Napping on the Night Shift: A Two-Hospital Implementation Project” (for some night shift napping ground rules, see, at right, Table 1: Guidelines for Hospital Nurses on Implementing Naps on the Night Shift—click table to enlarge).

Here’s an overview:

Purpose: To assess the barriers to successful implementation of night-shift naps and to describe the nap experiences of night-shift nurses who took naps.

Methods: In this two-hospital pilot implementation project, napping on the night shift was offered to six nursing units. Unit nurse managers’ approval was sought, and further explanation was given to a unit’s staff nurses. A nap experience form, which included the Karolinska Sleepiness Scale, was used to assess pre-nap sleepiness level, nap duration and perceived sleep experience, post-nap sleep inertia, and the perceived helpfulness of the nap. Nurse managers and staff nurses were also interviewed at the end of the three-month study period.

Results: Successful implementation occurred on only one of the six units, with partial success seen on […]