Articles in this issue guide readers in improving quality at the health system level. Trail-Mahan et al describe a QI project to improve inpatient pain management across 21 medical centers. Using human-centered design principles, they bundled 6 individual and team nursing practices and assessed their impact on patient satisfaction with pain management. Pain composite scores increased from the 25th to just under the 75th national percentile. Another group of authors describes an initiative they developed, the Race, to empower frontline staff to assume responsibility for their quality metrics and foster peer-to-peer accountability. Over the last 5 years, the Race has become a sustainable QI approach to engage staff and improve outcomes. Despite use of prevention strategies, falls in hospitals and long term care continue to be a significant problem. This issue includes 4 articles on innovations to prevent falls. Based on analysis of fall prevention strategies across multiple inpatient units in 6 medical centers, Quigley et al describe an operational strategic plan to enhance fall and injury prevention and improve program infrastructure at the organizational and unit levels. Another health system implemented centralized video monitoring to prevent falls among patients at high risk for falls across the acute care setting. In another article the authors report the validity and reliability of the Marianjoy Fall Risk Assessment Tool. Reducing falls requires a knowledgeable nursing workforce: read the paper by Gray-Miceli et al to learn how they used validated vignettes to assess nurses’ knowledge of causes of falls in 3 nursing homes.
There are some other must-read articles in this issue. What are the consequences of disruptive behaviors of clinicians on patients and clinicians themselves? An article in this issue reports a study of 1559 clinicians in a medical center in the US. Psychological aggression caused by disruptive behavior or incivility increased the likelihood of patient harm and clinicians’ job dissatisfaction and physical symptoms. Nurses’ ability to correctly interpret numeric and graphical trends in EHR data is critical to making good decisions about patient care. In a study by Lopez et al, more than half of the nurses scored low for either numeracy or graph literacy. Tarver and Stuenkel explored factors that led to rapid response team (RRT) interventions. They found 5 significant differences between medical-surgical patients who had an RRT intervention and those who did not. Most studies of interruptions have focused on those that occur during medication administration. What about interruptions and their duration during other nursing-directed interventions? A study in this issue reports that nurses experience an average of 5.6 interruptions per hour, occurring most frequently in the afternoon shift, among other findings. These are just a few of our articles in the April June issue: there are many others that you will find applicable to your own health setting. Read our articles and share them with colleagues.
Marilyn H. Oermann, PhD, RN, ANEF, FAAN