Editor-in-Chief: Marilyn H. Oermann, PhD, RN, FAAN
ISSN: 1057-3631
Online ISSN: 1550-5065
Frequency: 4 issues / year
Ranking: Nursing 66/103
Impact Factor: 1.293 (5-Year)
About Journal of Nursing Care Quality

JNCQ provides practicing nurses, nurses in leadership roles, and other health care professionals with new information and research on patient safety, quality care, evidence-based practice, and more. Sign up for alerts to our Published Ahead-of-Print articles.

Consider publishing your work in JNCQ and benefitting from:
• Fast turnaround time for reviews: Average 4 weeks from submission.
• Fast publication time: Average 4 weeks from acceptance to online publication.
• Read by nurses, QI professionals, and others worldwide.
• JNCQ has a 5-year impact factor of 1.293.   

About This Issue

In this issue, Richard Ricciardi, Healthcare Scientist in the Center for Evidence and Practice Improvement at AHRQ, discusses patient safety in ambulatory environments and the important role of nursing. In another article, Clark and colleagues describe their project to improve the pneumococcal immunization rate within their health system. Using the presurgical testing center, they increased the rate from 24% to 54%:  the authors share their processes and tools. In a small community hospital, nurses developed an At Risk Care Plan to anticipate safety and care needs of patients at risk and communicate those needs to the health care team. This innovative intervention dramatically reduced hospital readmissions, costs, and adverse events for high risk adult inpatients. Prevention of medication errors continues to be a need. Simsic and colleagues describe the outcomes of their QI project that reduced medication errors. They implemented a multidisciplinary ICU quality committee, nursing education, shift change medication double checks, medication error huddles, a safety systems checklist, a distraction-free zone to enter orders, and medication bar coding. Becker started a bag medication reconciliation process in the hospital setting to decrease medication discrepancies at post hospitalization follow up. Patients received a green medication bag on discharge and were taught to bring the bag with all of their medications to their first follow-up appointment. This strategy worked well and is easily implemented elsewhere. Other articles in this issue describe improving delivery of primary care preventative services using Six Sigma methods, a systems redesign to improve dysphagia screening, a new volunteer service to enhance patients’ experiences, best practices for care transitions and for implementing QI interventions, the quality of hospice care, and a QI study to reduce resident pain in nursing homes. Tzeng et al. report on their innovative fall prevention intervention, iEngaging, which involves patients in their own fall prevention during hospital stays. Migration of patients toward the foot of the bed in ICUs may cause shear and friction between the patient and mattress, reduce elevation of the patient's torso, and require frequent repositioning:  take time to read the article by Davis and Kotowski. It is open access so everyone can read and learn from it. 

Marilyn H. Oermann, PhD, RN, ANEF, FAAN

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The authors improved dysphagia-screening processes in a tertiary Veterans Affairs Medical Center. The dysphagia-screening tool was redesigned on the basis of frontline clinician feedback, clinical guidelines, user satisfaction, and multidisciplinary expertise. The revised tool triggered a speech-language consult for positive screens and demonstrated higher scores in user satisfaction and task efficiency. Systems redesign processes were effective for redesigning the tool and implementing practice changes with clinicians involved in dysphagia screening. Read the article here.

Registered nurse (RN) “second victims” are RNs who are harmed from their involvement in medical errors. This study found a relationship between RN involvement in preventable adverse events and 2 domains of burnout: emotional exhaustion (P = .009) and depersonalization (P = .030). Support to RNs involved in preventable adverse events was inversely related to RN emotional exhaustion (P < .001) and depersonalization (P = .003) and positively related to personal accomplishment (P = .002). Read the article here.

    Medication discrepancies occur in 70% of hospital patients, especially during discharge. The author initiated a bag medication reconciliation process in the hospital to decrease medication discrepancies by encouraging evaluation of medication adherence, side effects, and monitoring at posthospitalization follow-up. After implementation, a 7% decrease in reportable errors was noted. Read the article here.


  Reducing hospital readmissions is a priority for health care providers and affects Medicare reimbursement. The purpose of this study was to determine if there was a difference in readmission rates from long-term care (LTC) to hospitals with the implementation of a training program for LTC nurses. The training did not affect hospital readmissions; however, the organization saw a significant decrease in hospital readmissions after 24 months of data collection. Read the article here.


  The goal of an At Risk Care Plan is to improve safety and quality care by proactively anticipating individual needs of patients at risk and to communicate those to the health care team. This innovative intervention has dramatically reduced hospital readmissions, costs, and adverse events for high-risk adult inpatients in a small community hospital. Learn more here.