Category Archives: Patient safety and outcomes
This is part of the July 2013 issue of Sharing Nursing's Knowledge.
NP-Doctor Co-Management of Geriatric Cases Leads to Improved Outcomes
New research finds that geriatric patients with chronic conditions may have better outcomes if their cases are co-managed by a nurse practitioner (NP) and a physician than by a physician alone.
David Reuben, MD, chief of the Geriatrics Division in the Department of Medicine at the David Geffen School of Medicine at the University of California, Los Angeles, reports on the research leading to that conclusion in the June 2013 issue of the Journal of the American Geriatrics Society. Reuben and colleagues studied the cases of 485 patients who had one of four chronic conditions: falls; urinary incontinence (UI); dementia/Alzheimer's disease; or depression. Some of their cases were managed by doctors alone, and others were co-managed by doctors and NPs.
The researchers then examined individual patients' charts, assessing the quality of their care using several specific quality indicators. They found that patients whose cases were co-managed generally had better care, and significantly better care for some conditions. "Quality scores for all conditions (falls, 80 percent vs. 34 percent; UI, 66 percent vs. 19 percent; dementia, 59 percent vs. 38 percent) except depression (63 percent vs. 60 percent) were higher for individuals who saw a NP," they wrote.
Tracey L. Yap, PhD, RN, CNE, WCC, is an assistant professor at the Duke University School of Nursing, a John A. Hartford Foundation Claire M. Fagin Fellow, and a senior fellow at the Duke University Center for Aging and Human Development. With funding from the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI), Yap and her co-investigators developed a cost-effective, nurse-led intervention that aimed to reduce the prevalence of pressure ulcers in long-term care facilities by increasing resident mobility through a musical prompting system specifically tailored to each facility. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.
It started with a boombox and the Byrds.
Those are hardly the first things that come to mind when you think about pressure ulcers, also referred to as bed sores—the wounds that are caused by continuous, unrelieved pressure on the skin and that often develop in people who have impaired mobility. Yet that’s just how my husband, a physician who has a large population of patients in long-term care, inspired this research by suggesting that I pursue a grant related to this serious issue.
At one long-term care facility, my husband had a maintenance person use a boombox over the public address system to play “Turn, Turn, Turn” at two-hour intervals. It was a creative, simple, and fun way to remind staff to move patients, and it appeared to be effective in preventing pressure ulcers.
We were in Kentucky at the time, and I was teaching at the University of Cincinnati College of Nursing. When I took my husband’s suggestion and applied for an INQRI grant, it radically changed my life—and the lives of many long-term care residents—for good. In my PhD studies, I’d focused on occupational health, and the INQRI grant helped me apply that knowledge in a new way and ultimately led to my current work at Duke University.
This is part of the April 2013 issue of Sharing Nursing's Knowledge.
Survey of Nurses: Hospitals’ Patient Safety Programs Lacking
A new survey of hospital nurses in the United States, the United Kingdom, and China finds that nurses lack confidence in their hospitals’ safety programs.
The online survey, conducted by a research firm for the American Nurses Association (ANA) and GE Healthcare, included 500 respondents from the United States and 200 each from the United Kingdom and China. Each country's responses were given equal weight in the final results. Among the findings:
- Ninety-four percent of nurses report that their hospitals have programs in place that promote patient safety, but only 57 percent believe those programs are effective.
- Just 41 percent describe their hospital as “safe.”
- Ninety percent of nurses believe it is important that nurses not be penalized for reporting errors or near misses, but 59 percent agree that nurses often hold back in reporting patient errors in fear of punishment (67 percent in the United States, 62 percent in the United Kingdom, and 49 percent in China). Sixty-two percent agree that nurses often hold back in reporting near misses for the same reason (69 percent in the United States, 65 percent in the United Kingdom, and 54 percent in China).
- Thirty-three percent of nurses said that "poor communication among nurses at handoff" has increased the risk of patient safety incidents in their hospitals in the past 12 months. Thirty-one percent said "poor communication with doctors" has also increased the risk of patient safety incidents.
This is part of the March 2013 issue of Sharing Nursing's Knowledge.
“[W]e continue to be stretched in terms of being able to fill the demand... I know, particularly in the Dayton area, there is a need for mental health nurse practitioners. We have recently partnered with the Veterans Administration to develop a pysch mental health practitioner program that will help meet the need of all our returning veterans, many of whom have depression, post-traumatic stress disorder and other problems related to having served in a particular conflict and who are trying to re-integrate into society.”
-- Rosalie Mainous, PhD, APRN, NNP-BC, dean, School of Nursing, Wright State University and RWJF Executive Nurse Fellow, Wanted: Specialty Nurses, Springfield News-Sun, February 22, 2013
“We need to be keeping more data, recording our expertise and speaking up for ourselves so when people say quality of care, they will also say, quality of nursing.”
-- Susan B. Hassmiller, PhD, RN, FAAN, RWJF senior adviser for nursing, Nurses Need to Pull Up a Seat at the Table, Hassmiller Says, Lund Report, February 20, 2013
The Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI) will host the next webinar in its “Translating Research Into Practice” series on February 14, 2013.
INQRI investigators Linda Flynn, PhD, RN, FAAN, and Joel Cantor, ScD, will discuss their research and the intervention they designed to increase patient safety by enhancing the leadership and team building skills of nurse managers.
The webinar will be held from 3-4 p.m. EST.
Michael D. Cohen, PhD, is the recipient of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research, and the William D. Hamilton Professor of Complex Systems, Information and Public Policy at the University of Michigan School of Information.
Handoffs are a critical link in maintaining continuity of care during a hospital stay. Whenever there is a shift change, or when a patient moves between departments (such as from an Emergency Room to an inpatient unit), there should be communication between the personnel who have been caring for the patient, and those who are to assume responsibility. These handoffs have to be done effectively. Root cause analyses of sentinel events find communication breakdowns to be major contributing factors nearly two-thirds of the time, and a large fraction of those problems occur during handoffs.
It seems logical that nurses and doctors should receive some training in how to conduct these vital conversations, but in interviews during my research on handoffs, it has been rare to find a practitioner who learned anything in nursing or medical school about how to hand off effectively.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? This post is by RWJF Investigator Award in Health Policy Research recipients Robert L. Wears, MD, PhD, a professor in the Department of Emergency Medicine at the University of Florida, and Kathleen M. Sutcliffe, PhD, The Gilbert and Ruth Whitaker Professor of Business Administration at the University of Michigan’s Ross School of Business.
There are many aspects to the problem of what is or is not working in health professionals’ education today, and the changes needed to address them. From our view as researchers studying issues of safety, resilience, and managing for the unexpected, some of the more important are that health professionals’ education is seriously deficient in the social sciences; is limited almost exclusively to largely positivist ideas about what counts as scientific activity; and is almost totally devoid of the humanities.
None of these deficiencies are new, and that is what concerns us. The lack of engagement with the sciences of safety, and of human and organizational performance, has implications for practice, for safety, and for understanding and creating actionable knowledge.
With respect to practice, for example, without sufficient exposure to humanities and social sciences we risk socializing people to become authoritative but inhuman techno-nerds, even if they didn’t start out that way.
With respect to safety, we risk training people in positivistic methods and research approaches that oversimplify and even miss local contextual specifics that create real threats to safety.
With respect to understanding and knowledge creation, we risk training people to revere scientific and technical rationality and ‘objectivity’ at the expense or even denial of any sort of constructivist or interpretive understanding.
Linda Cronenwett, PhD, RN, FAAN, is the Beerstecher-Blackwell Professor and former dean, School of Nursing, University of North Carolina at Chapel Hill. Since its creation in 2005, she has led the Robert Wood Johnson Foundation (RWJF) Quality and Safety Education for Nurses (QSEN) project at the University of North Carolina at Chapel Hill.
In Tucson last week, more than 400 educators from nursing education and practice settings celebrated a transition in leadership for the Quality and Safety Education for Nurses (QSEN) website and National Forum. As of August 2012, support for these important resources will transfer from the University of North Carolina at Chapel Hill to Case Western Reserve University’s (CWRU) Frances Payne Bolton School of Nursing.
Seven years ago, a small committed group of people began work aimed at altering nursing professional identity formation so that a new type of nursing school graduate would be developed—someone who would come into the workforce with the knowledge and skills necessary to both deliver excellent care to individuals and continuously improve the health care systems in which they work. We worked hard to build the will to change, generate ideas about how to develop each of six quality and safety competencies, and support execution through changes in accreditation of programs. And just before our third QSEN National Forum, publishers Wiley-Blackwell released the new book, Quality and Safety in Nursing, edited by Gwen Sherwood, PhD, RN, FAAN, and Jane Barnsteiner, PhD, RN, FAAN.
Happy National Nurses Week! The Robert Wood Johnson Foundation (RWJF) has a proud history of supporting nurses and nurse leadership, so this week, the RWJF Human Capital Blog is featuring posts by nurses, including leaders from some of our nursing programs. This post is by Mary Naylor, PhD, RN, FAAN, director of the RWJF Interdisciplinary Nursing Quality Research Initiative program and the Marian S. Ware Professor in Gerontology at the University of Pennsylvania School of Nursing.
Nurses—the largest group of health professionals in the country—have a tremendous impact on health and health care. But despite the immense size and influence of the nursing workforce, we don’t know enough about how nurses can improve the quality and safety of care and reduce costs.
Nurse scientists have been exploring these questions for decades, but large gaps in knowledge remain. Since it was established in 2005, the Interdisciplinary Nursing Quality Research Initiative (INQRI), funded by RWJF, has worked to address those gaps in our knowledge of nursing care.
Over the last seven years, INQRI grantees—teams of nurse scientists and scholars from other disciplines—have conducted groundbreaking research focused on the ways in which nurses affect the quality of care patients receive and how they improve patient care and outcomes.
The interdisciplinary nature of the project has been key to its success; when scholars from multiple disciplines come together to solve problems in nursing care, they generate solutions that are grounded in rigorous evidence, that take into account diverse perspectives, and that use various methodological techniques. In short, interdisciplinary research leads to more robust findings. And more robust findings are more likely to attract investments in nursing resources, which will, in turn, improve health outcomes while reducing costs.
As program leaders, we don’t just talk the interdisciplinary talk; we walk it too.
Ten years ago, the Institute of Medicine (IOM) issued Crossing the Quality Chasm, a landmark report calling for major quality and safety improvements in the nation’s health care system. It came on the heels of the IOM’s 1999 To Err Is Human Report, which estimated that there are 44,000 to 98,000 error-induced hospital deaths each year. That report made an urgent and compelling case that improvement was needed.
In the years since, quality and safety have been top-of-the-agenda priorities for researchers, clinicians and policy-makers alike. With funding from the Robert Wood Johnson Foundation (RWJF), this April’s issue of Health Affairs takes a look at where things stand today, assessing a decade’s worth of progress toward safer, more effective, patient-centered health care. In a series of articles, several by RWJF scholars and alumni, the issue examines a range of related topics supporting the theme of the issue, “still crossing the quality chasm.” In an overview, Editor-in-Chief Susan Dentzer writes,
As a number of articles in the issue demonstrate, there’s no doubt we’ve made progress—but it’s also clear that making any headway has been agonizingly slow. If ever the state of high-quality health care appeared to be an achievable end point, we recognize now that—to paraphrase Ralph Waldo Emerson—quality, like life, is not a destination but a journey.