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Providing Care to COPD Patients Using In-Home Visits by Nurse Practitioners


Published on: 07.09.2018
Associated with: July/September 2018, Volume 33, Issue 3;

The purpose of this project was to determine whether patients with COPD receiving in-home visits by a nurse practitioner (NP) in a program called Community Cares had fewer hospital encounters such as ED visits, observation stays, and inpatient admissions. With in-home NP visits, inpatient encounters decreased by 71%; ED visits decreased by 68%; and there was an 84% reduction in 30-day readmissions. Learn more about this program (from a patient and NPs). Don’t miss this video and then read the article.

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Duration: 2:33
The purpose of this project was to determine whether patients with COPD receiving in-home visits by a nurse practitioner (NP) in a program called Community Cares had fewer hospital encounters such as ED visits, observation stays, and inpatient admissions. With in-home NP visits, inpatient encounters decreased by 71%; ED visits decreased by 68%; and there was an 84% reduction in 30-day readmissions. Learn more about this program (from a patient and NPs). Don’t miss this video and then read the article.
Creator:
Duration: 3:54
Two major cost concerns related to joint replacement surgery are patient length of stay (LOS) and 30-day hospital readmission rates. Dr Ashcraft describes a QI project to evaluate the impact of a joint replacement program on patient readmissions and hospital LOS. A total of 1425 patients older than 50 years participated. At the end of the project period, readmission rates decreased from 6.19% to 2.8%, and average LOS decreased from 5.87 days to 2.7 days. After watching the video be sure to read the article. The authors share strategies for adopting this program in your own setting.
Creator:
Duration: 2:49
This study explored the trajectory of patients who remained on a general unit after medical emergency team activation. Of those who had a second activation within 24 hours, 80% occurred within 12 hours of the baseline activation. Chest pain and recent ICU discharge were associated with having a second activation. The authors share their study and discuss implications of interest to nurses across settings. Watch the video and be sure to read the full article.
Creator:
Duration: 2:55
The demand for acute care clinical sites, along with the need to prepare CNLs for a role in health promotion, disease prevention, and population health management, created an opportunity for these authors to expand the CNL role outside of the acute care setting. The goal was to allow CNL students to develop competencies in improving patient and population health. Learn how they developed and implemented the course: after watching the video, read the full article. Be sure to access the supplemental content on strategies for clinical site development for CNL in primary care.
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Duration: 4:14
As part of an outcome improvement initiative in an intermediate ICU at the Health Sciences Centre, Winnipeg, Manitoba, Canada, patients participated in an innovation on the effects of collaborative goal setting and activity tracking through a visual display of the goals achieved. Patients had a high degree of engagement in setting their goals. Displaying patients’ progress had an effect on their quality of life and self-efficacy. Learn more about this project in the video and article: this is a project you can easily implement in your settings, and the authors explain how to do it.
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Duration: 3:11
Patient safety checklists are ubiquitous in health care. Nurses bear significant responsibility for ensuring checklist adherence. To report nonadherence to a checklist and stop an unsafe procedure, a workplace climate of psychological safety is needed. The author analyzed organizational data to examine the relationship between psychological safety and reports of nonadherence to the central line bundle checklist. Results showed varied perceptions of psychological safety but no relationship with nonadherence. You will enjoy watching this innovative video and will learn a lot from it (and be sure to also read the article).
Creator:
Duration: 4:31
The Consolidated Framework for Implementation Research guided the formative evaluation of the implementation of a redesigned interprofessional team rounding process. The redesigned process was intended to improve health team communication about hospital discharge. Themes emerging from interviews of patients, nurses, and providers revealed the inherent value and positive characteristics of the new process, but also workflow, team hierarchy, and process challenges to successful implementation. The evaluation identified actionable recommendations for modifying the implementation process. Ms. Bahr summarizes the study in this video but be sure to read the full article in JNCQ.
Creator:
Duration: 4:08
Clinical nurse leaders (CNLs) improve care at the microsystem level. Learn about the use of the CNL role in an academic medical center for evaluating pressure ulcer reporting – watch this video and be sure to read the article. The authors used the Plan-Do-Study-Act cycle as the methodology for the study. The CNL assessment of pressure ulcers resulted in a 21% to 50% decrease in the number of hospital-acquired pressure ulcers reported in a 3-month time period. The CNL role has potential for improving the validity and reliability of pressure ulcer reporting.
Creator:
Duration: 3:53
Approximately a quarter of medication errors in the hospital occur at the administration phase, which is solely under the purview of the bedside nurse. Dr. Gail Armstrong reports on her study that assessed bedside nurses' perceived skills and attitudes about updated safety concepts and examined their impact on medication administration errors and adherence to safe medication administration practices. Findings supported the premise that medication administration errors result from an interplay among system-, unit-, and nurse-level factors. Watch this video and then read Dr. Armstrong’s articles about the study and tool development.
Creator:
Duration: 4:40
The QSEN RN-BSN Task Force developed recommendation for a systems-based practice competency. Recommendations are to integrate systems-based practice into both education and practice settings. Watch the video and read the article to learn more about this proposed QSEN competency.
Creator:
Duration: 4:11
Learn more about this study to test an intervention to reduce medication omissions without documentation. The authors are using nurse-initiated recall cards and medication chart checking at handover. Watch the video and then read the full article.
Creator:
Duration: 2:10
Most health care quality improvement (QI) studies focus on the engagement of executive leadership and frontline staff as key factors for success. Little work has been done on understanding how mid-level unit/program managers perceive their role in QI and how capacity could be built at this level to increase success. In this video and article, the authors present an ethnographic study on the experience of hospital middle managers to consider how the expectations and capacity of their current position might influence QI progress organizationally.
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Duration: 5:57
Telemetry monitoring is a limited resource. This quality improvement project describes a nurse managed telemetry discontinuation protocol to stop telemetry monitoring when it is no longer indicated. After implementing the protocol, data were collected for 6 months and compared to preintervention. There was a mean decrease in telemetry monitor usage and likelihood of remaining on a telemetry monitor until discharge. Learn about this nurse-managed telemetry discontinuation protocol – watch the video and then read the article.
Creator:
Duration: 3:41
Learn about this project to develop and implement a nurse-driven protocol to remove urinary catheters using evidence-based criteria. The specific aim was to decrease average catheter dwell time with the use of a nurse-driven protocol in MICU patients. In this video the author explains the need for the practice change and how she improved care on the unit. After watching the video, be sure to read the article.
Creator:
Duration: 7:53
Assessing high risk for falling among psychiatric inpatients is particularly challenging in that assessments with strong sensitivity and specificity are not available. The author explains their study to validate use of the Baptist Health High Risk Falls Assessment (BHHRFA), a medical-surgical fall risk assessment, with a psychiatric inpatient population. Data collected on 5910 psychiatric inpatients using the BHHRFA showed acceptable sensitivity, specificity, and diagnostic odds ratio. After you watch the video, take time to read the article.
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Duration: 4:03
Limited research has been conducted on how nurses perceive “quality nursing care.” The authors conducted focus groups to identify nurses' perceptions of quality care at a Midwestern academic medical center. Transcripts of the focus group sessions were analyzed using thematic analysis techniques, and 11 themes emerged: Leadership, Staffing, Resources, Timeliness, Effective Communication/Collaboration, Professionalism, Relationship-Based Care, Environment/Culture, Simplicity, Outcomes, and Patient Experience. Learn how nurses define quality care: watch the video and read the article.
Creator:
Duration: 3:15
Many readers are interested in transitional care. This video and article provide the information you need. The authors describe their project to reduce readmissions through the establishment of a pilot program using the C-TraC program, which is a phone-based, protocol-driven, low-cost, nurse-led, transitional care model. The goal was to connect with the patients telephonically up to 30 days postdischarge to mitigate current confusion regarding the discharge plan and identify potential medication discrepancies. Learn about this effective transitional care model.
Creator:
Duration: 2:41
Medication errors are a source of serious patient harm. A unique approach, Socio-Technical Probabilistic Risk Assessment, was used to analyze medication errors in this pediatric setting. Three steps were identified that should be taken with every intravenous medication or fluid administration. Nurses check for the 3Cs: Connections, Clamps, and Confirming pump settings. Preliminary analysis revealed a 22% reduction in errors. This video is prepared with a pediatric theme!
Creator:
Duration: 4:04
Learn more about this study that examined the implementation of handoff as part of TeamSTEPPS initiatives for improving shift-change communication. The authors conducted on-site interviews and made observations in 8 critical access hospitals. Facilitators and barriers were different between high and low performing hospitals. Staff involvement and being part of the “big picture” were important facilitators to change management and buy-in. After viewing this video, read the article to learn more about this important study.



Creator:
Duration: 2:33
The purpose of this project was to determine whether patients with COPD receiving in-home visits by a nurse practitioner (NP) in a program called Community Cares had fewer hospital encounters such as ED visits, observation stays, and inpatient admissions. With in-home NP visits, inpatient encounters decreased by 71%; ED visits decreased by 68%; and there was an 84% reduction in 30-day readmissions. Learn more about this program (from a patient and NPs). Don’t miss this video and then read the article.
Creator:
Duration: 3:54
Two major cost concerns related to joint replacement surgery are patient length of stay (LOS) and 30-day hospital readmission rates. Dr Ashcraft describes a QI project to evaluate the impact of a joint replacement program on patient readmissions and hospital LOS. A total of 1425 patients older than 50 years participated. At the end of the project period, readmission rates decreased from 6.19% to 2.8%, and average LOS decreased from 5.87 days to 2.7 days. After watching the video be sure to read the article. The authors share strategies for adopting this program in your own setting.
Creator:
Duration: 2:49
This study explored the trajectory of patients who remained on a general unit after medical emergency team activation. Of those who had a second activation within 24 hours, 80% occurred within 12 hours of the baseline activation. Chest pain and recent ICU discharge were associated with having a second activation. The authors share their study and discuss implications of interest to nurses across settings. Watch the video and be sure to read the full article.
Creator:
Duration: 2:55
The demand for acute care clinical sites, along with the need to prepare CNLs for a role in health promotion, disease prevention, and population health management, created an opportunity for these authors to expand the CNL role outside of the acute care setting. The goal was to allow CNL students to develop competencies in improving patient and population health. Learn how they developed and implemented the course: after watching the video, read the full article. Be sure to access the supplemental content on strategies for clinical site development for CNL in primary care.
Creator:
Duration: 3:11
Patient safety checklists are ubiquitous in health care. Nurses bear significant responsibility for ensuring checklist adherence. To report nonadherence to a checklist and stop an unsafe procedure, a workplace climate of psychological safety is needed. The author analyzed organizational data to examine the relationship between psychological safety and reports of nonadherence to the central line bundle checklist. Results showed varied perceptions of psychological safety but no relationship with nonadherence. You will enjoy watching this innovative video and will learn a lot from it (and be sure to also read the article).
Creator:
Duration: 4:31
The Consolidated Framework for Implementation Research guided the formative evaluation of the implementation of a redesigned interprofessional team rounding process. The redesigned process was intended to improve health team communication about hospital discharge. Themes emerging from interviews of patients, nurses, and providers revealed the inherent value and positive characteristics of the new process, but also workflow, team hierarchy, and process challenges to successful implementation. The evaluation identified actionable recommendations for modifying the implementation process. Ms. Bahr summarizes the study in this video but be sure to read the full article in JNCQ.
Creator:
Duration: 4:08
Clinical nurse leaders (CNLs) improve care at the microsystem level. Learn about the use of the CNL role in an academic medical center for evaluating pressure ulcer reporting – watch this video and be sure to read the article. The authors used the Plan-Do-Study-Act cycle as the methodology for the study. The CNL assessment of pressure ulcers resulted in a 21% to 50% decrease in the number of hospital-acquired pressure ulcers reported in a 3-month time period. The CNL role has potential for improving the validity and reliability of pressure ulcer reporting.
Creator:
Duration: 3:53
Approximately a quarter of medication errors in the hospital occur at the administration phase, which is solely under the purview of the bedside nurse. Dr. Gail Armstrong reports on her study that assessed bedside nurses' perceived skills and attitudes about updated safety concepts and examined their impact on medication administration errors and adherence to safe medication administration practices. Findings supported the premise that medication administration errors result from an interplay among system-, unit-, and nurse-level factors. Watch this video and then read Dr. Armstrong’s articles about the study and tool development.
Creator:
Duration: 4:40
The QSEN RN-BSN Task Force developed recommendation for a systems-based practice competency. Recommendations are to integrate systems-based practice into both education and practice settings. Watch the video and read the article to learn more about this proposed QSEN competency.
Creator:
Duration: 4:11
Learn more about this study to test an intervention to reduce medication omissions without documentation. The authors are using nurse-initiated recall cards and medication chart checking at handover. Watch the video and then read the full article.
Creator:
Duration: 3:41
Learn about this project to develop and implement a nurse-driven protocol to remove urinary catheters using evidence-based criteria. The specific aim was to decrease average catheter dwell time with the use of a nurse-driven protocol in MICU patients. In this video the author explains the need for the practice change and how she improved care on the unit. After watching the video, be sure to read the article.
Creator:
Duration: 2:41
Medication errors are a source of serious patient harm. A unique approach, Socio-Technical Probabilistic Risk Assessment, was used to analyze medication errors in this pediatric setting. Three steps were identified that should be taken with every intravenous medication or fluid administration. Nurses check for the 3Cs: Connections, Clamps, and Confirming pump settings. Preliminary analysis revealed a 22% reduction in errors. This video is prepared with a pediatric theme!
Creator:
Duration: 7:26
Recent changes in the Surgical Care Improvement Project guideline require blood glucose values be less than 180 mg/dL 18 to 24 hours after anesthesia end time after cardiac surgery. The authors studied 2 groups of patients: the first group of patients was transitioned off IV insulin on postoperative day 1, 24 hours after anesthesia end time, whereas the second group was transitioned off IV insulin on the second day, 48 hours after anesthesia end time. The results showed no statistical differences in outcomes between groups. Watch this video and read the article to learn about the study and evidence they gathered from it.
Creator:
Duration: 16:32
A multicomponent intervention was attempted in a pediatric emergency department to increase reporting of workplace aggression committed by patients and visitors. Overall reporting decreased from 53% to 47% (p = .06). Reasons for reporting were severity of incident and being asked to report. However, many incidents were not reported. Watch the video and be sure to read the article.
Creator:
Duration: 3:18
Dr. Rahn examined the relationships between nursing teamwork and NDNQI outcomes including pressure ulcers, falls, and catheter-associated urinary tract infections, and she found some significant relationships. Improving teamwork in medical-surgical acute care units can transform care and impact the occurrence of preventable adverse outcomes. Watch this video and read the article to understand the importance of teamwork on your unit.
Creator:
Duration: 7:21
The Race is led by Clinical Nurse Specialists in partnership with nurse leaders to engage frontline staff in QI. Staff adopts evidence-based practice changes and actively engages in friendly competition to improve selected quality metrics. Data from compliance audits and automated outcome metric reports are used to identify top performing units. The Race project provides a focus for frontline staff by helping to correlate the impact on outcomes of providing quality patient care through best practices. The authors explain the project in this video and their article.
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Duration:
The authors examined the differences between medical-surgical patients who had a Rapid Response Team Intervention (RRTI) and those who did not. There were 5 significant differences between these 2 groups of patients. Watch this video and read the article to learn more about the effectiveness of the Rapid Response Team in this hospital.
Creator:
Duration: 5:48
Many fall prevention strategies exist with some degree of effectiveness. Watch this video and read the article to learn about a staff-driven QI initiative to develop a video in partnership with patients and families to prevent falls when hospitalized. Since the video's release, the fall rate has decreased by 29.4%.
Creator: Eileen Lake
Duration: 4:54
Dr. Lake and colleagues describe their study on the associations between the NICU work environment, quality of care, safety, and patient outcomes. A secondary analysis was conducted of responses of 1247 NICU staff nurses in 171 hospitals to a large nurse survey. Better work environments were associated with lower odds of nurses reporting poor quality, safety, and outcomes. Improving the work environment may be a promising strategy to achieve safer settings for at-risk newborns.
Creator: Jennifer Embree
Duration: 2:47
Seasoned nurses frequently resign from their positions due to burnout. An innovative idea that could support nurse retention is nurse sabbaticals. Balanced scorecards with strategy maps can display financial benefit, positive customer experience, and operational and human capital development required to initiate and sustain a professional nurse sabbatical. A balanced scorecard with strategy map is an effective tool that demonstrates connection between the organizational mission and the outcomes of a nurse sabbatical program.
Creator: Jan Bahle
Duration: 3:12
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.
Creator: Danielle Miller
Duration: 7:54
A follow-up telephone call within 72 hours of discharge reduced the readmission rate. Learn how to do this in your own setting.
Creator: Carol Tuttas
Duration: 2:38
Travel nurses fulfill temporary full-time contracts in hospitals across the US, but little is known about their job performance and factors that influence their adjustment to the work setting. This mixed-methods study by Carol A. Tuttas identified the unique needs and characteristics of travel nurses.
Creator: Shelby Garner and Ramona Traverse
Duration: 4:44
Sleep-disordered breathing can lead to negative health outcomes for patients with heart failure. The authors evaluated a new multifaceted sleep disordered breathing screening protocol in a heart failure disease management clinic. Read their article to learn more about the protocol and its effectiveness.
Creator: Michelle Kimrey
Duration: 4:04
Learn how this team used team training to reduce falls. The intervention group improved on all measures except teamwork perception. A 60% fall reduction rate was reported in the intervention group. Read more about this study.
Creator: Dr. Maria M. Cvach. Video developed by Peter Cardamone
Duration: 3:00
Dr. Maria M. Cvach tested an alarm escalation algorithm for communicating cardiac monitor alarms to pagers. This innovation led to a significant decrease in mean frequency and duration of high-priority monitor alarms and improved nurses' perception of alarm response time. Read more about this study.