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Challenges of Implementing the Choosing Wisely® Guideline to Promote Sleep and Rest at Night for Hospitalized Patients

Video Author: Graham, Kimberly DNP, APRN, ACNS-BC; Ogbuji, Grace BSN, RN; Williams, Zainab BSN, RN; Crain, Maria BSN, RN, BMTCN; Rolin, Barbara MSN, RN-BC; Juala, Jeremy BSN, RN, CMSRN; Larbi, Ida BSN, RN, OCN; Bernard, Noreen EdD, RN, NEA-BC, FAAN; Oster, Cynthia A. P
Published on: 11.10.2020

On inpatient units, patients experience lack of sleep due to noise and multiple interruptions at night. A pilot intervention to support the initiative, “Don't wake the patient for routine care unless the patient's condition or care specifically requires it,” was implemented on 3 units in 3 hospitals. Nurses implemented the project using a purposeful strategy of sleep masks, earplugs, noise detectors, and bundling care. The experiences across the 3 hospital units were positive for providers, patients, and patients' families.

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Preventing Healthcare-Acquired Infections through Implementation of Interprofessional Visual Management Using Safety Tracker

Creator: Frist Avila, Patricia MSN, RN, NE-BC, OCN, AOCNS; Twibell, K. Renee PhD, RN, CNE; Demaree, Heather MSN, RN, CMSRN

Duration: 1:58

The management of healthcare-acquired infections (HAIs) challenges acute care facilities due to variability in practices. The purpose of this QI project was to decrease central line-associated bloodstream infection, catheter-associated urinary tract infection, and Clostridioides difficile using a visual management (VM) tool, called the Safety Tracker, to address practice variations. In 12 months, HAIs decreased from 9 events to 1 with a corresponding reduction of indwelling urinary catheter utilization and central line utilization. More than $160,000 were avoided in health care costs.

Play Video |

CLABSI Rounding Team: A Collaborative Approach to Prevention

Creator: Pate, Kimberly DNP, RN, ACCNS-AG, PCCN-K; Brelewski, Kiersten MSN, RN, AGCNS-BC, OCN; Rutledge, Sarah R. MSN, RN, ACCNS-AG, CCRN, OCN; Rankin, Veronica DNP, RN-BC, NP-C, CNL, NE-BC; Layell, Jessica BSN, RN, CIC

Duration: 4:43

Central line–associated bloodstream infections (CLABSIs) are an ongoing concern in health care. This was a QI project including a collaborative rounding approach supported by specialty nursing roles. In addition to implementing a variety of evidence-based interventions, the rounding team performed audits to assess performance and created focused education tools to address the identified opportunities within each individual unit. High levels of engagement as evidenced by increased audit completion resulted in CLABSI reductions. However, 2 peaks in CLABSI rates were associated with higher volumes of coronavirus disease (COVID-19) hospitalizations and decreased audits.

Play Video |

Improving Lung Cancer Screening Rates Through an Evidence-based Electronic Health Record Smoking History

Creator: Russell, Cynthia K. DNP, RN-BC; McNeill, Margaret PhD, RN, APRN-CNS, CCRN-K, TCRN, CPAN, NE-BC, NHDP-BC, FCNS, FAAN

Duration: 3:53

Lung cancer is prevalent worldwide, with 2.1 million new cases and 1.8 million deaths in 2020. Our community residents were more likely to be diagnosed with lung cancer in later stages (62%) compared with 56% nationally, resulting in an increased community mortality rate. Evidence-based changes in an electronic health record system supported identification and referral of high-risk patients for low-dose computer tomography to improve early lung cancer detection rates. Early-stage lung cancer detection increased 24%. Learn more in this video and article about how the authors improved early-stage lung cancer detection.

Play Video |

Perceptions of Nurses Who Are Second Victims in a Hospital Setting

Creator: Draus, Catherine DNP, RN, ACNS-BC, CCRN, MSNBC; Mianecki, Therese B. PhD, RN; Musgrove, Hannah MSN, APRN, AGCNS-BC, PMGT-BC; Bastien, Danielle J. DNP, APRN, FNP-BC; Greggs, Dana MSN, RN, ACNS-BC; Halash, Christine BSN, RN, CCRN; (Larry-Osman) Bellamy, Che

Duration: 4:34

Second victims (SVs) are health care workers traumatized by unanticipated, adverse patient events. These experiences can have personal and professional effects on SVs. The purpose of the study was to determine the prevalence of nurses who identified as SVs. Of 359 participants, 159 (44.3%) identified as SVs. There was a significant relationship between work tenure and SVs (P = .009). A relationship was found between SVs and awareness and use of support resources, with debriefing being the preferred method after an event.

Play Video |

Fall Prevention and Injury Reduction Utilizing Continuous Video Monitoring in Hospitalized Patients: A Quality Improvement Initiative

Creator: Hogan Quigley, Beth DNP, MSN, RN, CRNP; Renz, Susan M. PhD, DNP, RN, GNP-BC; Bradway, Christine PhD, CRNP, FAAN, AGSF

Duration: 3:25

Reduction of falls in hospital patients remains a priority. Although fall rates were in the acceptable national safety standard guidelines, interventions were explored to further decrease falls using continuous video monitoring (CVM). Two-way cameras and a virtual sitter were used to observe fall risk patients. CVM with virtual sitters depicted a 14% decline in fall rates and a 6% decrease in fall-related injury rates with positive budget implications. Learn more about this QI project in the video and article. This article is offered for CE (see link at the end of the article).

Play Video |

Workplace Predictors of Quality and Safe Patient Care Delivery Among Nurses Using Machine Learning Techniques

Creator: Havaei, Farinaz PhD, RN, MERM; Ji, Xuejun Ryan PhD, MEd; Boamah, Sheila A. PhD, RN

Duration: 3:05

Working in unhealthy environments is associated with negative nurse and patient outcomes. The purpose of this study was to identify the most important workplace factors predicting nurses’ provision of quality and safe patient care. A cross-sectional correlational survey involving 4029 direct care nurses in British Columbia was conducted using random forest data analytics methods. Nurses’ reports of healthier workplaces, particularly workload management, psychological protection, physical safety and engagement, were associated with higher ratings of quality and safe patient care. After watching the video. read the article – it is Open Access

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Modeling Patient Risk for Hospital Acquired Pressure Injuries During COVID-19: A Retrospective Study

Creator: Montgomery, Aoyjai P. PhD, BSN; Patrician, Patricia A. PhD, RN; Hall, Allyson PhD, MBA, MHS; Miltner, Rebecca S. PhD, RN, CNL, NEA-BC; Enogela, Ene M. MPH; Polancich, Shea PhD, RN

Duration: 2:36

COVID-19 negatively impacts many organ systems including the skin. The aim of this study was to determine risk factors that would place hospitalized patients at a higher risk for hospital-acquired pressure injuries (HAPIs) during the COVID-19 pandemic. There were 247 out of 23,093 patients who had pressure injuries and 1053 patients who had a positive COVID-19 diagnosis. Diagnosis of COVID-19, age, male gender, risk of mortality, severity of illness, and length of stay were statistically significant factors associated with the development of HAPIs. Learn more about this study in the video and article.

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Nurse Burnout Syndrome and Work Environment Impact Patient Safety Grade

Creator: Montgomery, Aoyjai P. PhD, BSN; Patrician, Patricia A. PhD, RN, FAAN; Azuero, Andres PhD, MBA

Duration: 2:02

This study examined nurse-reported patient safety grade and its relationship to both burnout and the nursing work environment. A cross-sectional electronic survey was conducted among 928 nurses in acute care Alabama hospitals. All burnout dimensions of the Copenhagen Burnout Inventory and work environment were related to patient safety grade after controlling for nurse characteristics. Health care organizations can reduce negative patient safety ratings by reducing nurse burnout and improving the work environment at the organization level. Learn more about this study in the video and article.

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Reducing Cardiac Telemetry Nuisance Alarms Through Evidence-based Interventions

Creator: Karapas, Eleftheria T. DNP, RN; Bobay, Kathleen PhD, RN, NEA-BC, FAAN

Duration: 02:29

Interventions were directed at reducing nuisance alarms on a 32-bed, non–intensive care - a cardiac telemetry unit. A nursing staff education module with evidence-based practices for reducing nuisance alarms, a daily care protocol for patients on cardiac telemetry monitoring, and daily audits of protocol adherence were implemented. Staff knowledge increased, and daily audits for 7 weeks demonstrated an average of 58.46% staff adherence. Telemetry technician call volume reduction was 16% postimplementation, but nuisance alarms were not reduced significantly.

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Universal Depression Screen of Ambulatory Heart Transplant Recipients with Referral for Mental Health Intervention: A Quality Improvement Project

Creator: Peters, Laura L. DNP, RN, FNP; Ambardekar, Amrut V. MD; Rosenthal, Laura D. DNP, RN, ACNP, FAANP; McIlvennan, Colleen K. DNP, RN, ANP

Duration: 06:28

Patients with a heart transplant and depression have higher rates of graft failure and noncompliance. The heart transplant clinic implemented routine use of the Patient Health Questionnaire (PHQ). From July 2018 to February 2019, there were 834 visits; PHQ2 screens were completed during 779 (93%) of those visits with 40 (5%) positive screens. All 40 patients had PHQ9 assessment, with 33 patients (4%) exhibiting moderate or severe depressive symptoms. All 33 patients were provided with mental health resources and received follow-up. Implementation of universal depression screening in a heart transplant clinic is feasible, identifies patients with depression, and does not add significant clinical burden.

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Keeping Patients under the Damage Threshold for Pressure Injury: Addressing Microclimate Through Allostasis

Creator: Tanner, Laurel MA; Rappl, Laurie DPM, CWS; Oberg, Craig PhD; Call, Evan MS, CSM-NRM

Duration: 02:25

Patient microclimate is a contributing risk factor for pressure injuries (PI). However, the acceptable range for microclimate is unknown, in part because the body adapts to changing conditions. Addressing microclimate, when coupled with an increasing awareness of the cumulative effect of individual patient risk factors, can help resolve the risk of PI by lowering the cumulative inputs to keep patients under the threshold for tissue damage. Learn more about this in the video and article.

Play Video |

Universal Depression Screen of Ambulatory Heart Transplant Recipients with Referral for Mental Health Intervention: A Quality Improvement Project

Creator: Peters, Laura L. DNP, RN, FNP; Ambardekar, Amrut V. MD; Rosenthal, Laura D. DNP, RN, ACNP, FAANP; McIlvennan, Colleen K. DNP, RN, ANP

Duration: 6:28

Patients with a heart transplant and depression have higher rates of graft failure and noncompliance. The heart transplant clinic implemented routine use of the Patient Health Questionnaire (PHQ). From July 2018 to February 2019, there were 834 visits; PHQ2 screens were completed during 779 (93%) of those visits with 40 (5%) positive screens. All 40 patients had PHQ9 assessment, with 33 patients (4%) exhibiting moderate or severe depressive symptoms. All 33 patients were provided with mental health resources and received follow-up. Implementation of universal depression screening in a heart transplant clinic is feasible, identifies patients with depression, and does not add significant clinical burden.

Play Video |

Keeping Patients under the Damage Threshold for Pressure Injury: Addressing Microclimate Through Allostasis

Creator: Tanner, Laurel MA; Rappl, Laurie DPM, CWS; Oberg, Craig PhD; Call, Evan MS, CSM-NRM

Duration: 2:25

Patient microclimate is a contributing risk factor for pressure injuries (PI). However, the acceptable range for microclimate is unknown, in part because the body adapts to changing conditions. Addressing microclimate, when coupled with an increasing awareness of the cumulative effect of individual patient risk factors, can help resolve the risk of PI by lowering the cumulative inputs to keep patients under the threshold for tissue damage. Learn more about this in the video and article.

Play Video |

Patients’ and Nurses’ Perceptions of the Quality of Nursing Care in Surgical Clinics: A Multicenter Study in Turkey

Creator: Mert, Selda PhD; Kersu, Özlem MSc; Aydin Sayilan, Aylin PhD; Baydemir, Canan PhD; Ilter, Gonca MSc

Duration: 4:49

The aim of this study was to determine patients' (n=503) and nurses' (n=308) perceptions of the quality of nursing care in surgical clinics and influencing factors. Characteristics of patients such as age, gender, complications, and nursing care scores, and characteristics of the nurses such as being satisfied with the current clinic and work affected perceptions of care quality. Patients' perceptions were lower than those of nurses, and some factors belonging to the patients and nurses negatively influenced the quality of care. Dr. Mert shares her study in this video and the article.

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Implementing and Sustaining Bedside Shift Report for Quality Patient Centered Care

Creator: Becker, Sherry MSN-Ed, RN-BC, CWOCN; Hagle, Mary PhD, RN-BC, FAAN; Amrhein, Andra BSN, RN; Bispo, Jeffrey MSN, RN, CNL; Hopkins, Sarah MSN, RN, CNL; Kogelmann, Mary BSN, RN; Porras, Elizabeth BSN, RN; Smith, Melissa M. BSN, RN

Duration: 4:15

Two evidence-based practice projects and an innovative model provided best evidence and a framework for the implementation and sustainment of a bedside shift report (BSR) quality improvement project. Facilitators and barriers were identified and addressed during planning. Key elements of BSR were incorporated. Implementation was completed in 4 months for 11 units. After 15 months, there was consistent BSR on 82% of the units and improved patient satisfaction with nurses taking time to listen. This is an excellent example of sustainability of a practice change: watch the video and be sure to read the article.

Play Video |

Implementing Prone Positioning for COVID-19 Patients Outside the Intensive Care Unit

Creator: Francisco, Mary Ann MSN, APN, AGCNS-BC, CCRN-K; Pierce, Nicole L. PhD, RN; Ely, Elizabeth PhD, RN; Cerasale, Matthew T. MD, MPH; Anderson, Daniela MD; Pavkovich, David MD, FACP, FAAP; Puello, Frances MD; Tummala, Sandeep MD; Tyker, Albina MD; D'Souza, Fel

Duration: 4:22

Proning intubated ICU patients for the management of acute respiratory distress syndrome is an accepted standard of practice. We examined the nursing climate in 4 units and its impact on implementing a novel self-proning protocol to treat COVID-19 patients outside the ICU. Nurses from 4 nursing units were surveyed about the implementation process on the self-proning protocol. Their perception of unit implementation was assessed via the Implementation Climate Scale. Consistent education on the protocol, belief in the effectiveness of the intervention, and a strong unit-based climate of evidence-based practice contributed to greater implementation of the protocol.

Play Video |

Reducing Delirium in Hospitalized Adults Through a Structured Sleep Promotion Program

Creator: Gode, Autumn MS, APRN-CNS; Kozub, Elizabeth MS, APRN-CNS, CCNS, CNRN, CCRN; Joerger, Kyla BSN, RN-BC; Lynch, Cassandra BSN, NE-BC, OCN; Roche, Maren BSN, RN; Kirven, Justin MD

Duration: 2:15

Delirium affects approximately 1 in 4 patients during their hospitalization and is associated with numerous complications. An evidence-based practice project was implemented to reduce the development of delirium through sleep promotion on 2 inpatient units. A dedicated time was selected, and key strategies were identified to promote sleep with minimal interruptions. Delirium decreased by 33% and 45% on the 2 units over 1 year. Overall, patient satisfaction for quietness at night survey responses also increased (P = .0005; CI, 0.05 to 0.67) with ongoing sustainment. Learn about this project in this video and article.

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Impact of a Real-Time, Pharmacist-Led, Intensive Care Unit-based Feedback Intervention on Analgesia and Sedation Quality Among Mechanically Ventilated Patients

Creator: Mancheril, Benjamin PharmD, BCPS, BCCCP; Kram, Bridgette PharmD, BCPS, BCCCP; Schultheis, Jennifer PharmD, BCPS, BCCCP; Kram, Shawn PharmD, BCPS, BCCCP; Trammel, Morgan PharmD, BCCCP; Liu, Beiyu PhD, MS; Jordan, Weston MS; Cox, Christopher E. MD, MPH

Duration: 4:00

Consensus guidelines for pain, agitation, and delirium (PAD) in mechanically ventilated patients recommend maintaining a light level of sedation. Consistent attainment of target PAD assessments in these patients is often challenging. This was a single-center, prospective study. In the intervention group, a pharmacist provided weekly feedback to nurses on their success in achieving target PAD assessments compared with a historical cohort without feedback. Overall, 478 patients and 205 nurses were included. Weekly feedback to nurses on PAD assessments did not impact the achievement of PAD goals..

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Incidence and Predictors of Nonventilator Hospital-Acquired Pneumonia in a Community Hospital

Creator: Patty, Christopher M. DNP, RN, CPPS; Sandidge-Renteria, Alisha MSN, FNP-C, RN-CMSRN; Orique, Sabrina PhD, RN, AOCNS; Dixon, Craig MSN, FNP-C, RN; Camarena, Emma DNP, CNS, RN, ACCNS-AG; Newsom, Rose MSN, RN, NE-BC; Schneider, Alicia MSN, AGCNS-BC, RN-BC, C

Duration: 3:49

The purpose of this study was to determine the incidence of nonventilator hospital–acquired pneumonia NV-HAP in our community hospital and to identify patient and nursing care factors associated with its development. A retrospective study identified possible NV-HAP cases and then validated cases using CDC criteria. The incidence of NV-HAP was 0.64 cases per 1000 patient-days. Patient factors most strongly associated with NV-HAP were age and the presence of underlying disease. Head-of-bed elevation reduced by 26% the odds of developing NV-HAP. Dr. Patty explains the study in the video - learn more in the article.

Play Video |

Challenges of Implementing the Choosing Wisely® Guideline to Promote Sleep and Rest at Night for Hospitalized Patients

Creator: Graham, Kimberly DNP, APRN, ACNS-BC; Ogbuji, Grace BSN, RN; Williams, Zainab BSN, RN; Crain, Maria BSN, RN, BMTCN; Rolin, Barbara MSN, RN-BC; Juala, Jeremy BSN, RN, CMSRN; Larbi, Ida BSN, RN, OCN; Bernard, Noreen EdD, RN, NEA-BC, FAAN; Oster, Cynthia A. P

Duration: 2:40

On inpatient units, patients experience lack of sleep due to noise and multiple interruptions at night. A pilot intervention to support the initiative, “Don't wake the patient for routine care unless the patient's condition or care specifically requires it,” was implemented on 3 units in 3 hospitals. Nurses implemented the project using a purposeful strategy of sleep masks, earplugs, noise detectors, and bundling care. The experiences across the 3 hospital units were positive for providers, patients, and patients' families.

Play Video |

Preventing Healthcare-Acquired Infections through Implementation of Interprofessional Visual Management Using Safety Tracker

Creator: Frist Avila, Patricia MSN, RN, NE-BC, OCN, AOCNS; Twibell, K. Renee PhD, RN, CNE; Demaree, Heather MSN, RN, CMSRN

Duration: 1:58

The management of healthcare-acquired infections (HAIs) challenges acute care facilities due to variability in practices. The purpose of this QI project was to decrease central line-associated bloodstream infection, catheter-associated urinary tract infection, and Clostridioides difficile using a visual management (VM) tool, called the Safety Tracker, to address practice variations. In 12 months, HAIs decreased from 9 events to 1 with a corresponding reduction of indwelling urinary catheter utilization and central line utilization. More than $160,000 were avoided in health care costs.

Play Video |

CLABSI Rounding Team: A Collaborative Approach to Prevention

Creator: Pate, Kimberly DNP, RN, ACCNS-AG, PCCN-K; Brelewski, Kiersten MSN, RN, AGCNS-BC, OCN; Rutledge, Sarah R. MSN, RN, ACCNS-AG, CCRN, OCN; Rankin, Veronica DNP, RN-BC, NP-C, CNL, NE-BC; Layell, Jessica BSN, RN, CIC

Duration: 4:43

Central line–associated bloodstream infections (CLABSIs) are an ongoing concern in health care. This was a QI project including a collaborative rounding approach supported by specialty nursing roles. In addition to implementing a variety of evidence-based interventions, the rounding team performed audits to assess performance and created focused education tools to address the identified opportunities within each individual unit. High levels of engagement as evidenced by increased audit completion resulted in CLABSI reductions. However, 2 peaks in CLABSI rates were associated with higher volumes of coronavirus disease (COVID-19) hospitalizations and decreased audits.

Play Video |

Improving Lung Cancer Screening Rates Through an Evidence-based Electronic Health Record Smoking History

Creator: Russell, Cynthia K. DNP, RN-BC; McNeill, Margaret PhD, RN, APRN-CNS, CCRN-K, TCRN, CPAN, NE-BC, NHDP-BC, FCNS, FAAN

Duration: 3:53

Lung cancer is prevalent worldwide, with 2.1 million new cases and 1.8 million deaths in 2020. Our community residents were more likely to be diagnosed with lung cancer in later stages (62%) compared with 56% nationally, resulting in an increased community mortality rate. Evidence-based changes in an electronic health record system supported identification and referral of high-risk patients for low-dose computer tomography to improve early lung cancer detection rates. Early-stage lung cancer detection increased 24%. Learn more in this video and article about how the authors improved early-stage lung cancer detection.

Play Video |

Perceptions of Nurses Who Are Second Victims in a Hospital Setting

Creator: Draus, Catherine DNP, RN, ACNS-BC, CCRN, MSNBC; Mianecki, Therese B. PhD, RN; Musgrove, Hannah MSN, APRN, AGCNS-BC, PMGT-BC; Bastien, Danielle J. DNP, APRN, FNP-BC; Greggs, Dana MSN, RN, ACNS-BC; Halash, Christine BSN, RN, CCRN; (Larry-Osman) Bellamy, Che

Duration: 4:34

Second victims (SVs) are health care workers traumatized by unanticipated, adverse patient events. These experiences can have personal and professional effects on SVs. The purpose of the study was to determine the prevalence of nurses who identified as SVs. Of 359 participants, 159 (44.3%) identified as SVs. There was a significant relationship between work tenure and SVs (P = .009). A relationship was found between SVs and awareness and use of support resources, with debriefing being the preferred method after an event.

Play Video |

Fall Prevention and Injury Reduction Utilizing Continuous Video Monitoring in Hospitalized Patients: A Quality Improvement Initiative

Creator: Hogan Quigley, Beth DNP, MSN, RN, CRNP; Renz, Susan M. PhD, DNP, RN, GNP-BC; Bradway, Christine PhD, CRNP, FAAN, AGSF

Duration: 3:25

Reduction of falls in hospital patients remains a priority. Although fall rates were in the acceptable national safety standard guidelines, interventions were explored to further decrease falls using continuous video monitoring (CVM). Two-way cameras and a virtual sitter were used to observe fall risk patients. CVM with virtual sitters depicted a 14% decline in fall rates and a 6% decrease in fall-related injury rates with positive budget implications. Learn more about this QI project in the video and article. This article is offered for CE (see link at the end of the article).

Play Video |

Workplace Predictors of Quality and Safe Patient Care Delivery Among Nurses Using Machine Learning Techniques

Creator: Havaei, Farinaz PhD, RN, MERM; Ji, Xuejun Ryan PhD, MEd; Boamah, Sheila A. PhD, RN

Duration: 3:05

Working in unhealthy environments is associated with negative nurse and patient outcomes. The purpose of this study was to identify the most important workplace factors predicting nurses’ provision of quality and safe patient care. A cross-sectional correlational survey involving 4029 direct care nurses in British Columbia was conducted using random forest data analytics methods. Nurses’ reports of healthier workplaces, particularly workload management, psychological protection, physical safety and engagement, were associated with higher ratings of quality and safe patient care. After watching the video. read the article – it is Open Access

Play Video |

Nurse Burnout Syndrome and Work Environment Impact Patient Safety Grade

Creator: Montgomery, Aoyjai P. PhD, BSN; Patrician, Patricia A. PhD, RN, FAAN; Azuero, Andres PhD, MBA

Duration: 2:02

This study examined nurse-reported patient safety grade and its relationship to both burnout and the nursing work environment. A cross-sectional electronic survey was conducted among 928 nurses in acute care Alabama hospitals. All burnout dimensions of the Copenhagen Burnout Inventory and work environment were related to patient safety grade after controlling for nurse characteristics. Health care organizations can reduce negative patient safety ratings by reducing nurse burnout and improving the work environment at the organization level. Learn more about this study in the video and article.

Play Video |

Implementing and Sustaining Bedside Shift Report for Quality Patient Centered Care

Creator: Becker, Sherry MSN-Ed, RN-BC, CWOCN; Hagle, Mary PhD, RN-BC, FAAN; Amrhein, Andra BSN, RN; Bispo, Jeffrey MSN, RN, CNL; Hopkins, Sarah MSN, RN, CNL; Kogelmann, Mary BSN, RN; Porras, Elizabeth BSN, RN; Smith, Melissa M. BSN, RN

Duration: 4:15

Two evidence-based practice projects and an innovative model provided best evidence and a framework for the implementation and sustainment of a bedside shift report (BSR) quality improvement project. Facilitators and barriers were identified and addressed during planning. Key elements of BSR were incorporated. Implementation was completed in 4 months for 11 units. After 15 months, there was consistent BSR on 82% of the units and improved patient satisfaction with nurses taking time to listen. This is an excellent example of sustainability of a practice change: watch the video and be sure to read the article.

Play Video |

Implementing Prone Positioning for COVID-19 Patients Outside the Intensive Care Unit

Creator: Francisco, Mary Ann MSN, APN, AGCNS-BC, CCRN-K; Pierce, Nicole L. PhD, RN; Ely, Elizabeth PhD, RN; Cerasale, Matthew T. MD, MPH; Anderson, Daniela MD; Pavkovich, David MD, FACP, FAAP; Puello, Frances MD; Tummala, Sandeep MD; Tyker, Albina MD; D'Souza, Fel

Duration: 4:22

Proning intubated ICU patients for the management of acute respiratory distress syndrome is an accepted standard of practice. We examined the nursing climate in 4 units and its impact on implementing a novel self-proning protocol to treat COVID-19 patients outside the ICU. Nurses from 4 nursing units were surveyed about the implementation process on the self-proning protocol. Their perception of unit implementation was assessed via the Implementation Climate Scale. Consistent education on the protocol, belief in the effectiveness of the intervention, and a strong unit-based climate of evidence-based practice contributed to greater implementation of the protocol.

Play Video |

Reducing Delirium in Hospitalized Adults Through a Structured Sleep Promotion Program

Creator: Gode, Autumn MS, APRN-CNS; Kozub, Elizabeth MS, APRN-CNS, CCNS, CNRN, CCRN; Joerger, Kyla BSN, RN-BC; Lynch, Cassandra BSN, NE-BC, OCN; Roche, Maren BSN, RN; Kirven, Justin MD

Duration: 2:15

Delirium affects approximately 1 in 4 patients during their hospitalization and is associated with numerous complications. An evidence-based practice project was implemented to reduce the development of delirium through sleep promotion on 2 inpatient units. A dedicated time was selected, and key strategies were identified to promote sleep with minimal interruptions. Delirium decreased by 33% and 45% on the 2 units over 1 year. Overall, patient satisfaction for quietness at night survey responses also increased (P = .0005; CI, 0.05 to 0.67) with ongoing sustainment. Learn about this project in this video and article.

Play Video |

Development of the Nursing Quality Improvement in Practice Tool: Advancing Frontline Nursing Practice

Creator: Tschannen, Dana PhD, RN; Alexander, Catherine DNP, MPH, RN; Tovar, Elizabeth G. PhD, APRN; Ghosh, Bidisha MS; Zellefrow, Cindy DNP, MSEd, RN, LSN, PHNA-BC, EBP-C; Milner, Kerry A. DNSc, RN

Duration: 4:35

Frontline nurse engagement in quality improvement (QI) improves nurse-sensitive outcomes. The purpose of this study was to develop and psychometrically evaluate the Nursing Quality Improvement in Practice (N-QuIP) tool to measure nurses' competency, engagement, and barriers/facilitators to QI engagement. Item development was guided by an expert panel and literature review. Factor analysis and reliability indices were assessed through 681 surveys completed by nurses at one medical center. Preliminary data suggest that the N-QuIP is a valid and reliable tool for assessing nurse QI competence and engagement. Watch the video and read the article.

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Preventing Catheter-Associated Urinary Tract Infection: A Multi-Pronged Collaborative Approach

Creator: Mundle, William RN, MN, CMSN(C); Howell-Belle, Carnett RN, MN; Jeffs, Lianne PhD, RN, FAAN

Duration: 4:10

Catheter-associated urinary tract infections (CAUTIs) rates in our unit were higher when compared with the overall hospital rates. An interprofessional working group developed and implemented a QI bundled approach to reduce CAUTIs. There was a 79% reduction in average CAUTI rates following the bundle implementation along with reduced variability in rates.

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Quiet Time Improves the Patient Experience

Creator: Hedges, Christine, PhD, RN, NE-BC; Hunt, Candice, MHA; Ball, Pamela, BSN, RN, NE-BC

Duration: 2:44

A quiet environment promotes rest and healing but is often challenging to provide in a busy acute care setting. A multidisciplinary team used Lean methods and the Model for Improvement to test interventions for Quiet Time (QT) and used HCAHPS “always quiet” scores as the primary outcome measure. The team instituted nighttime and afternoon QT supported by rounding and scripting, dimming lights, lowering staff voices, offering a sleep menu at night, and replacing noisy wheels. Quiet scores improved on both units after 11 months. You will appreciate the level of noise patients experience in hospitals (watch this video for a demonstration) and learn more about QT intervention – you can implement QT in your settings. Don’t miss this video and article (and get your Continuing Education).

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Nurses' Perception of the Impact of Electronic Documentation on the Nurse-Patient Relationship

Creator: Misto, Kara, PhD, RN; Padula, Cynthia, PhD, RN; Bryand, Elizabeth, BSN, RN-BC; Nadeau, Kate, MPH, RN

Duration: 5:16

While there are many benefits of EMR documentation, the presence of a computer may adversely affect provider-patient interaction. The purpose of this project was to examine staff nurses' perception of the impact of electronic documentation in the presence of the patient on the nurse-patient relationship. A survey was administered to 276 staff nurses, and open-ended interviews were conducted with 11 novice and 20 expert nurses. Nurses identified benefits and challenges to EMR documentation and strategies to maintain therapeutic relationships and communication. Dr Misto explains the study in this video and article.

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Individualized Fall Prevention Program in an Acute Care Setting: An Evidence-Based Practice Improvement

Creator: Spano-Szekely, Lauraine, DNP, RN; Winkler, Anne, MA, RN, CCRN; Waters, Cathy, MSN, RN, OCN, NEA-BC; Dealmeida, Susana, MHA, RN-C; Brandt, Kathy, RPh; Williamson, Marsha, MSN, RN-BC, ANP-BC, CCRN-K; Blum, Christina, BSN, RN; Gasper, Lori, BSN, RN; Wright,

Duration: 1:09

Learn how this team evaluated their hospital's fall prevention program and decreased their fall rate – watch the video and be sure to read their article. The team used a clinical practice guideline with 7 key practices to develop an individualized fall prevention program with multiple interventions (nurse-driven mobility assessment, purposeful hourly rounding, video monitoring for confused and impulsive fall-risk patients, and others). The fall rate decreased to 1.14, with a 72% expense reduction based on decreased sitter usage.

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Writing Journal Articles: Tips for your Success Series Video 1: Getting Started: Purpose, Readers, Selecting a Journal

Creator: Marilyn Oermann

Duration:

This is the first video in our writing for publication series. The purpose of the manuscript and intended readers guide your selection of a journal for submission. Learn about directories of nursing and other journals and sending a query email.

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Writing Journal Articles: Tips for your Success Series Video 2: Next Steps: Manuscript Format and Content

Creator: Marilyn Oermann

Duration:

This is the 2nd video in our writing for publication series. Learn about the journal’s Information for Authors and why important, formats for writing different types of manuscripts, and reporting guidelines. The video will prepare you for writing papers about quality improvement and using the SQUIRE guidelines. References and tables/figures also are discussed.

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Writing Journal Articles: Tips for your Success Series Video 3: Submission, Responding to Reviews, and Other Tips

Creator: Marilyn Oermann

Duration:

This is the final video in our writing for publication series. In this video you will get some additional tips on writing your manuscript and will learn about peer review and responding to reviewers’ comments. Other topics include authorship criteria, copyright, open access, and avoiding “predatory journals.”

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Relationship Between Psychological Safety and Reporting Non-adherence to a Safety Checklist

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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).

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Nurse-Driven Protocol to Reduce Indwelling Catheter Dwell Time: A Health Care Improvement Initiative

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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.

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The Baptist Health High Risk Falls Assessment: One Assessment Fits All

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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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Reduction of Medication Errors: A Unique Approach

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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!

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Alarm Fatigue: Use of an Evidence-based Alarm Management Strategy

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Duration: 4:43

The authors developed an evidence-based alarm management strategy and describe their project in this video. The alarm management program reduced alarms up to 30%. Evaluation of patients on continuous cardiac monitoring showed a 3.5% decrease in census. This alarm management strategy has the potential to save $136 500 and 841 hours of registered nurses' time per year. Make sure you read their article too.

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Engaging Direct Care Providers in Improving Infection Prevention and Control Practices using Participatory Visual Methods

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Duration: 3:07

The purpose of this QI project was to determine the feasibility of using provider-led participatory visual methods to scrutinize 4 hospital units' infection prevention and control practices. Methods included provider-led photo walkabouts, photo elicitation sessions, and postimprovement photo walkabouts. Nurses readily engaged in using the methods to examine and improve their units' practices and reorganize their work environment.

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The Race: Quality Assurance Performance Improvement Project Aimed at Achieving Superior Patient Outcomes

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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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Nursing Staff Develop a Video to Prevent Falls: A Quality Improvement Project

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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%.

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