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. […]

2016-11-21T13:00:57-05:00September 29th, 2016|Nursing, nursing perspective, nursing research, patient safety|0 Comments
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Appropriate Use of Opioids in the Management of Chronic Pain

Painted by Martin Edwards as part of the Paint Your Pain program initiated by the Pain Management Center at Overlook Medical Center, Atlantic Health System, Summit, New Jersey. For artwork of other patients in the program, go to http://bit.ly/ 1Ns0PxL.The dangerous misuse of prescription opioids and drugs like heroin has been much in the news, but millions of patients continue to suffer both acute and chronic pain. For many, prescription opioids play a vital role in alleviating that pain. How can health care providers most effectively and safely use opioids in the treatment and management of chronic pain? Some answers can be found in a CE article in the July issue of AJN: “Appropriate Use of Opioids in Managing Chronic Pain.”

Related questions on opioids and chronic pain addressed in the article include:

2016-11-21T13:01:03-05:00July 22nd, 2016|Nursing, pain management, patient safety|0 Comments
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Moral Distress: An Increasing Problem Among Nurses

moral distress

An ICU nurse struggles to reconcile repeated surgeries and transfusions for a comatose patient who has little chance of recovery. An oncology nurse knows a patient wants to refuse treatment but doesn’t do so because his physician and family want him to “fight on.” A nurse on a geriatric unit knows she’s not giving needed care to patients because of poor staffing.

Situations such as these are all too common and can give rise to moral distress. Moral distress occurs when nurses recognize their responsibility to respond to care situations but are unable to translate their moral choices into action.

As explained in “Moral Distress: A Catalyst in Building Moral Resilience,” one of the CE articles in our July issue, this “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.” […]

2016-11-21T13:01:03-05:00July 18th, 2016|Ethics, Nursing, patient safety|0 Comments
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Recent Decline in U.S. Opioid Prescriptions: Good News But Some Concerns

by frankieleon/ via flickr by frankieleon/ via flickr

It was widely reported in the past week that there have been steady declines in the number of opioid prescriptions in the U.S. for the past three years, with the declines the steepest in some of the states considered to have the worst opioid misuse crises.

This is good news, suggesting that efforts to address some problem areas like renegade pain clinics prescribing for profit, patients who go from doctor to doctor seeking opioid prescriptions, and the diversion of legitimate opioid prescriptions may be starting to bear fruit.

A balanced overview of the situation can be found in this New York Times article. The authors also acknowledge that patients in pain are now facing new hurdles to pain relief, quoting the director of one prominent medical school’s program on pain research education and policy: “The climate has definitely shifted. . . . It is now one of reluctance, fear of consequences and encumbrance with administrative hurdles. A lot of patients who are appropriate candidates for opioids have been caught up in that response.”

Much of the reporting on the opioid epidemic lumps all people who take opioids into one big statistical brew. While startling and alarming numbers about overdoses from legal and illegal opioids steal the headlines, little media and scholarly analysis focuses on the lower […]

2016-11-21T13:01:12-05:00May 26th, 2016|health care policy, Nursing, nursing perspective, pain management, patient experience, patient safety, Patients|1 Comment
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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 […]

2016-11-21T13:01:12-05:00May 16th, 2016|Nursing, nursing perspective, nursing research, patient safety|3 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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