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


Published on: 04.11.2017
Associated with: April/June 2017, Volume 32, Issue 2; Journal of Nursing Care Quality. 32(2):114-119, April/June 2017

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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Creator: Francisco, Mary Ann MSN, APN, AGCNS-BC, CCRN-K; Gesell, Travis MSN, MBA, RN, CCRN-K, NE-BC; Meletis, Stephanie DNP, RN, AGNP-BC; Bohr, Nicole L. PhD, RN; Gleason, Lauren J. MD, MPH
Duration: 4:06

Delirium is associated with increased hospital length of stay, discharge to skilled care, cost, morbidity, and mortality. At our organization, there was no formal delirium assessment performed by the nursing staff outside of the intensive care unit. Staff nurse delirium education and a nurse-driven delirium screening protocol were implemented. No change in nursing knowledge occurred pre/post intervention. Falls, falls with injury, and restraint and sitter usage decreased. Changes in length of stay varied over the intervention period. The trend to discharge to home increased, while the trend to discharge to skilled nursing care decreased. Learn more about this initiative in the video and article.

Play
Creator: Johnson, Tirzah DNP, CRNA; Simmons, Virginia C. DNP, CRNA, CHSE-A, FAAN, FAANA; Figer Schwartz, Sharon MNA, CRNA; Tola, Denise H. DNP, CRNA, CHSE
Duration: 4:17
Malignant hyperthermia (MH) is a potentially lethal pharmacogenetic disorder triggered by certain anesthetic agents. There is currently no standardized preoperative screening tool to identify MH-susceptible individuals. This prospective descriptive QI project evaluated the success of implementing an MH screening tool preoperatively and its impact on the anesthesia plan. A total of 95 patients at site A and 234 patients at site B were screened using the MH tool: 21 patients were positively screened with the anesthetic plan altered. This screening tool has the potential to prevent MH episodes when used consistently by staff.
Play
Creator: Salinas, Brianna MSN, RN, CNL
Duration: 6:21

Practice variations, unstructured leader rounds, and unfavorable patient experience outcomes with Responsiveness of Hospital Staff prompted leaders to adopt Kamishibai cards (K-cards). Evidence-based practices such as timeliness of answering call lights, purposeful rounding, communication, and engaging patients were used to develop these cards. Percentile rank for Responsiveness of Hospital Staff had a sustained increase. Four of 6 hospital units using Responsiveness K-cards achieved 80% rank or better in every patient experience domain for the entire fiscal year. This video provides an introduction to how the author used K-cards. Be sure to read the full article.

Play
Creator: Drake, Emily E. PhD, RN, FAAN; DeGennaro, Gina DNP, RN, CNL; Kuhn, Dillon MEd
Duration: 1:57
The authors studied the career path of CNL graduates (N=109) and measured their satisfaction 2 to 10 years after graduation. Respondents were primarily Direct Entry CNL graduates. The majority were still working full- or part-time in nursing. Most (over 90%) were satisfied or extremely satisfied with their decision to become a nurse. Life satisfaction was also high. These results help describe CNL career trajectories and provide useful suggestions for education and practice. This information can help build the business case for the CNL. Learn more in this video and article.
Play
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
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
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
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
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
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
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.
Play
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
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.
Play
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.
Play
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
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
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
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.
Play
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
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
Creator: Francisco, Mary Ann MSN, APN, AGCNS-BC, CCRN-K; Gesell, Travis MSN, MBA, RN, CCRN-K, NE-BC; Meletis, Stephanie DNP, RN, AGNP-BC; Bohr, Nicole L. PhD, RN; Gleason, Lauren J. MD, MPH
Duration: 4:06

Delirium is associated with increased hospital length of stay, discharge to skilled care, cost, morbidity, and mortality. At our organization, there was no formal delirium assessment performed by the nursing staff outside of the intensive care unit. Staff nurse delirium education and a nurse-driven delirium screening protocol were implemented. No change in nursing knowledge occurred pre/post intervention. Falls, falls with injury, and restraint and sitter usage decreased. Changes in length of stay varied over the intervention period. The trend to discharge to home increased, while the trend to discharge to skilled nursing care decreased. Learn more about this initiative in the video and article.

Play
Creator: Johnson, Tirzah DNP, CRNA; Simmons, Virginia C. DNP, CRNA, CHSE-A, FAAN, FAANA; Figer Schwartz, Sharon MNA, CRNA; Tola, Denise H. DNP, CRNA, CHSE
Duration: 4:17
Malignant hyperthermia (MH) is a potentially lethal pharmacogenetic disorder triggered by certain anesthetic agents. There is currently no standardized preoperative screening tool to identify MH-susceptible individuals. This prospective descriptive QI project evaluated the success of implementing an MH screening tool preoperatively and its impact on the anesthesia plan. A total of 95 patients at site A and 234 patients at site B were screened using the MH tool: 21 patients were positively screened with the anesthetic plan altered. This screening tool has the potential to prevent MH episodes when used consistently by staff.
Play
Creator: Salinas, Brianna MSN, RN, CNL
Duration: 6:21

Practice variations, unstructured leader rounds, and unfavorable patient experience outcomes with Responsiveness of Hospital Staff prompted leaders to adopt Kamishibai cards (K-cards). Evidence-based practices such as timeliness of answering call lights, purposeful rounding, communication, and engaging patients were used to develop these cards. Percentile rank for Responsiveness of Hospital Staff had a sustained increase. Four of 6 hospital units using Responsiveness K-cards achieved 80% rank or better in every patient experience domain for the entire fiscal year. This video provides an introduction to how the author used K-cards. Be sure to read the full article.

Play
Creator: Drake, Emily E. PhD, RN, FAAN; DeGennaro, Gina DNP, RN, CNL; Kuhn, Dillon MEd
Duration: 1:57
The authors studied the career path of CNL graduates (N=109) and measured their satisfaction 2 to 10 years after graduation. Respondents were primarily Direct Entry CNL graduates. The majority were still working full- or part-time in nursing. Most (over 90%) were satisfied or extremely satisfied with their decision to become a nurse. Life satisfaction was also high. These results help describe CNL career trajectories and provide useful suggestions for education and practice. This information can help build the business case for the CNL. Learn more in this video and article.
Play
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
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
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
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
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
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
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
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
Creator: Stichler, Jaynelle F. DNSc, RN, NEA-BC, FACHE, FAAN; Pelletier, Luc R. MSN, APRN, PMHCNS-BC, FAAN
Duration: 2:17
Person-centered care has become a widely used philosophical framework and yet has varying definitions and characteristics. Learn about the new Patient Empowerment, Engagement, and Activation Survey that can be used to evaluate patients' perspectives of care quality (empowerment and engagement) and readiness for discharge (activation).
Play
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.
Play
Creator: Vessey, Judith A. PhD, MBA, RN, FAAN; Williams, Lucinda DNP, RN, PNP, NE-BC
Duration: 6:36
Bullying and lateral violence are pervasive in the nursing workforce and have profound consequences for nurses, their patients, and the overall health care organization. An iterative, multimodal QI initiative was crafted on the basis of the evidence and principles of transformational, adult learning. Six units were designed to foster learning specific to bullying and lateral violence and their prevention. Each unit consisted of formal lecture content, practice exercises, and reflection. This initiative is appropriate for adoption by other nursing units.
Play
Creator: Johnson, Hannah DPT, PT, GCS
Duration: 3:02
Six Sigma was used in a nursing home to improve the functional maintenance program charting/auditing. With the existing staff, capability was increased by 17 residents ($200 000 revenue) and 90% to 100% charting congruence was achieved. Learn more about implementing QI in nursing homes in this video and article.
Play
Creator: Soncrant, Christina MPH; Neily, Julia RN, MS, MPH; Bulat, Tatjana MD, CMD; Mills, Peter D. PhD, MS
Duration: 8:08
Injurious falls continue to challenge health care. Learn about this study that analyzed root cause analysis reports on falls and coded injury type, fall type, location, and root causes. There were 154 reported fall RCAs during the study period. Most (83%, n = 128) falls resulted in major injury: hip fractures (43%, n = 66), other fractures (25%, n = 38), and head injury (16%, n = 24). Most falls were unwitnessed (75%, n = 116). Patients who fell were not wearing hip or head protection. These interventions may help prevent future injurious falls. After you watch this informative video, read the full article.
Play
Creator: Hagle, Mary PhD, RN-BC, FAAN; Dwyer, Darcy DNP, RN, ACNS-BC; Gettrust, Lynn DNP, RN, ACNS-BC; Lusk, Dana DNP, RN, CHPN, AHN-BC; Peterson, Kristen BSN, RN; Tennies, Sherry MSN-Ed, RN-BC, CWOCN
Duration: 2:57
The I3 (Inquiry, Improvement, and Innovation) Model was developed to guide EBP and QI projects, research studies, and innovation. The model provides an algorithm with steps and decision points for nurses to follow based on a question from a clinical issue or problem. The model is used for guiding projects in the health care system.
Play
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).
Play
Creator: Schwartz, Franklin, DNP, APRN, PMHNP-BC; Bjorklund, Pamela, PhD, APRN, PMHNP-BC, CNS-BC
Duration: 3:58
In this video, the author describes a violence management program that she and her coauthor piloted on a general medical unit following staff requests for measures to protect them from patient and visitor violence. An independent pre/posttest design measured changes in participant knowledge. The Staff Observation Assessment Scale Revised (SOAS-R) was used for data collection on aggression pre- and postimplementation. The violence management training program included in situ simulation training in de-escalation techniques. Knowledge of de-escalation techniques to reduce violence risk increased. In the article the authors share important lessons for ongoing program implementation.
Play
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.
Play
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.
Play
Creator: Reynolds, Staci Sue, PhD, RN, ACNS-BC, CCRN, CNRN, SCRN
Duration: 3:56
Evidence supports daily bathing using chlorhexidine gluconate (CHG) cloths to decrease preventable hospital-acquired central line–associated bloodstream infections (CLABSIs). Using the Grol and Wensing Model of Implementation as a guide, this study examined whether using tailored, multifaceted strategies would improve implementation of daily CHG bathing and decrease CLABSIs in a large neuro ICU. Following implementation, infection rates decreased, and improvements were seen across all process measures. After watching the video, read this article to learn more about strategies to implement evidence, which you can use in your own setting.
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Creator: Marilyn Oermann
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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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Creator: Marilyn Oermann
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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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Creator: Marilyn Oermann
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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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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).
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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.
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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.
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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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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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Duration: 6:12
Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. The author implemented a QI program that integrated early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications. Pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced. Watch this video and read the entire article for free: the article is open access so readers can learn about this important QI initiative.
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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.
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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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Creator: Salinas, Brianna MSN, RN, CNL
Duration: 6:21

Practice variations, unstructured leader rounds, and unfavorable patient experience outcomes with Responsiveness of Hospital Staff prompted leaders to adopt Kamishibai cards (K-cards). Evidence-based practices such as timeliness of answering call lights, purposeful rounding, communication, and engaging patients were used to develop these cards. Percentile rank for Responsiveness of Hospital Staff had a sustained increase. Four of 6 hospital units using Responsiveness K-cards achieved 80% rank or better in every patient experience domain for the entire fiscal year. This video provides an introduction to how the author used K-cards. Be sure to read the full article.

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Creator: Hagle, Mary PhD, RN-BC, FAAN; Dwyer, Darcy DNP, RN, ACNS-BC; Gettrust, Lynn DNP, RN, ACNS-BC; Lusk, Dana DNP, RN, CHPN, AHN-BC; Peterson, Kristen BSN, RN; Tennies, Sherry MSN-Ed, RN-BC, CWOCN
Duration: 2:57
The I3 (Inquiry, Improvement, and Innovation) Model was developed to guide EBP and QI projects, research studies, and innovation. The model provides an algorithm with steps and decision points for nurses to follow based on a question from a clinical issue or problem. The model is used for guiding projects in the health care system.
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Duration: 6:12
Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. The author implemented a QI program that integrated early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications. Pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced. Watch this video and read the entire article for free: the article is open access so readers can learn about this important QI initiative.
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