Nurses vs. Computers: Predicting Risk of Patient Harm

Not All Signs of Potential Harm Are Quantifiable

From chego101, via Flickr

Hospital nurses have many, many responsibilities and tasks, but one of the most important is to ensure patient safety by assessing patients for changes that can signal worsening of a condition or a new potential harm. Creating special units like ICUs, recovery rooms, and step-down units; flags on charts; various alarmed monitors; and safety huddles are a few of the ways hospitals have tried to identify potential problems. Now we have computerized tools to do this—or do we?

The complaint I have heard most from nurses about the electronic health record (EHR) is its inability to capture all the nuances of patient care or various patient problems, especially those that don’t involve easily quantifiable measures like heart rate or lab values. (For more detail, read our November 2016 report on nurses’ concerns with EHRs.)

One cannot accurately use a check mark to convey certain patient behavioral parameters or the “can’t put my finger on it but something’s going on with this patient” assessment that experienced nurses often make. In the April issue of AJN, we published an important study that investigates just this issue: “Identifying Hospitalized Patients at Risk for Harm: A Comparison of Nurse Perceptions vs. Electronic Risk Assessment Tool Scores”

Deciding Whether […]

2017-04-19T10:43:15-04:00April 19th, 2017|Nursing, nursing research, patient safety|1 Comment
Read More

The Buzz at Nursing Conferences about Quality and Healthy Work Environments

“I was struck by the preponderance of sessions dealing specifically with incivility and bullying (in both academia and practice settings).”

Recent back-to-back nursing meetings gave me a lot of food for thought. After attending conferences, I like to find the overall theme—not just from the scheduled topics, but from the posters and the exhibits and the general “buzz” from conversations. Here’s my take on the two meetings I attended this month.

ANA’s 2017 Translating Quality into Practice Conference

This conference started with an opening session focused on quality from a consumer point of view. Keynote speaker Harry Greenspun asserted that today “it’s the patient or family’s responsibility that the right thing happens at the right time by the right person.” Nurses, he said, are the group that needs to engage and empower consumers (who, he said, should only be called patients when they are receiving care) in improving care.

ANA president Pam Cipriano added that “nurses are the ones doing the work on quality—all the projects and quality improvement is being done on the backs of nurses.”

While some sessions focused on specific clinical practices (reducing hospital-acquired infections or falls, for example), many focused on broader aspects of quality improvement—how systems can support QI change and integrate new technology (mobile apps, simulation).

There was also discussion relating to staffing strategies and teams (though the cynic in me feels that much of the strategies […]

2017-03-29T13:31:16-04:00March 29th, 2017|Nursing|0 Comments
Read More

Nurses and Patient Safety: Parallel Histories

Photo from AJN archives.

I’m especially pleased that one of the CE articles in the February issue focuses on nursing’s role in creating a safe environment for patients: “Nursing’s Evolving Role in Patient Safety.” And in full disclosure, I was excited to see that the authors used the AJN archives to chronicle how nursing addressed (or didn’t address) safety issues around patient care.

From the earliest days of nursing through to the current complex systems in which we practice, nurses have been the health professionals responsible for ensuring safe passage of patients through the health care system. From Nightingale’s criteria for creating a healing environment to the “5 rights of medication administration,” patients rely on nurses to act as sentinels.

The authors reviewed 1,086 AJN articles from 1900 to 2015 and conducted a content analysis to identify patient safety themes. Aside from uncovering many fascinating (and sometimes alarming!) details of former health care practices, the authors drew this general conclusion:

“Emphasis on patient safety increased as patient care became more complex. As nurses developed a professional identity, they often put a spotlight on safety concerns and solutions.”

Here’s a quote from a nurse who wrote in 1908 about nurses’ duties:

2017-02-15T15:46:47-05:00February 15th, 2017|Nursing, nursing history, nursing research, patient safety|0 Comments
Read More

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 […]

2016-11-21T13:00:58-05:00August 31st, 2016|Nursing, nursing research|0 Comments
Read More

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
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

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.
Go to Top