The Missouri Quality Initiative is a 4-year demonstration of care coordination using advanced practice registered nurses (APRNs) in 16 nursing homes. Rantz et al. describe this initiative and share the perceptions of staff in a nursing home that reduced hospital transfers, reduced polypharmacy and antipsychotic medication use, increased care discussions and completion of advance directives, and introduced electronic transfer of resident health information among health care providers, nursing homes, and hospitals. These goals were achieved as a result of APRNs becoming an integral part of the nursing home. Many articles have reported interventions to reduce heart failure (HF) readmissions, but few have involved multiple health systems across a region. Ten hospitals participated in a multisystem collaborative that led to reduced 30-day HF readmission rates in the collaborating hospitals. Other studies in this issue report on hospital-acquired conditions in rural compared to non rural hospitals, missed nursing care among 729 inpatients and relationship to staffing, a new tool for assessing a hospital’s culture related to in-hospital transitions in care, correlates of nurse staffing levels in inpatient psychiatric units, the impact of Magnet® culture during organizational change, and the National Nursing Quality Report Initiative in Canada. Some other papers that will be of interest to readers are on creating a standardized process to meet core measure compliance, using systems engineering to evaluate a hospital wide bathing intervention, improving medication safety in a community hospital, a proposal for a staff nurse sabbatical, and QI in long term care, among others. I think you will enjoy reading this issue of JNCQ.
Marilyn H. Oermann, PhD, RN, ANEF, FAAN