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July/September 2018 - Volume 33 - Issue 3

  • Marilyn H. Oermann, PhD, RN, FAAN
  • 1057-3631
  • 1550-5065
  • 4 issues / year
  • 58/118
  • 1.191

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.

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Articles in this issue highlight the work being done in and out of hospitals to improve patient safety. A good place to start reading is the Commentary from the Agency for Healthcare Research and Quality (AHRQ). The AHRQ has developed multiple resources and toolkits to improve patient safety practices in ambulatory and long term care settings – resources nurses should know about. One of the new toolkits is designed to help ambulatory care teams actively engage patients and families to prevent errors during transitions and new appointments. Care transitions can result in fragmented care and can pose significant challenges for patients. Be sure to read the article by Hung et al. on their hospital-community partnership to reduce readmissions for older adults. They describe their care transitions program, its implementation, intervention successes, barriers, and outcomes. In another study, authors report on how they changed their referral practices in a nurse-managed Patient-Centered Medical Home primary care clinic. The findings confirm the need for a well-organized referral tracking system that is centralized and contains safety nets for patients to reduce the number of delayed or missed referrals. Other articles report on the effectiveness of delirium screening, prevention, and treatment initiatives in an acute care setting (continuing education offering); the effectiveness of the Braden Scale in ICUs; research that identified trends in information technology (IT) adoption in nursing homes (this is the first national assessment of nursing home quality measures and trends in IT adoption); a QI study to improve oral hygiene for patients with dementia in residential long term care settings; and the outcomes of other studies and projects you can use to guide your practice. 

Marilyn H. Oermann, Editor-in-Chief


Effectiveness of a Multifaceted Delirium Screening, Prevention, and Treatment Initiative on the Rate of Delirium Falls in the Acute Care Setting

Ferguson, Alice; Uldall, Karina; Dunn, Jessica; More

Journal of Nursing Care Quality. 33(3):213-220, July/September 2018.

Effectiveness of a Multifaceted Delirium Screening, Prevention, and Treatment Initiative on the Rate of Delirium Falls in the Acute Care Setting

Hospital-Community Partnerships to Aid Transitions for Older Adults: Applying the Care Transitions Framework

Hung, Dorothy; Truong, Quan; Yakir, Maayan; More

Journal of Nursing Care Quality. 33(3):221-228, July/September 2018.

Hospital-Community Partnerships to Aid Transitions for Older Adults: Applying the Care Transitions Framework

Improving Oral Hygiene for Veterans With Dementia in Residential Long-term Care

McConnell, Eleanor S.; Lee, Kyung Hee; Galkowski, Lorraine; More

Journal of Nursing Care Quality. 33(3):229-237, July/September 2018.

Improving Oral Hygiene for Veterans with Dementia in Residential Long-Term Care

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​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​.
​​​​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.
​Learn about a study on the nature of interruptions during medication administration and strategies nurses use to manage them. Most interruptions (78%) were predictable. Nurse-adopted strategies included blocking, engaging, mediating, multitasking, and preventing. The authors developed educational content to help nurses manage predictable and unpredictable interruptions. Watch the video but be sure to also read the full article​: it will be helpful no matter what setting you are in.​
​​​​​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​.
​​​​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.