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Recommendations for Fall Related Injury Prevention: A 1-Year Review of Fall Related Root Cause Analyses in the Veterans Health Administration

Video Author: Soncrant, Christina MPH; Neily, Julia RN, MS, MPH; Bulat, Tatjana MD, CMD; Mills, Peter D. PhD, MS
Published on: 05.26.2020
Associated with: January/March 2020, Volume 35, Issue 1;

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.

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Creator: Kucera, Patricia MSN, RN; Kingston, Eileen DNP, BSN, RN, MPA; Ferguson, Tysa DNP, RN, CNML; Jenkins, Katie MSN, RN; Fogarty, Melissa MSN, RN; Sayles, Harlan MS; Cohen, Marlene Z. PhD, RN, FAAN
Duration: 10:37
Staff shortages, reduced budgets, and high acuity of violent psychiatric patients create challenges in psychiatric intensive care units. Staffing in our unit was based on patient census rather than evidence-based practices. A pre-/postintervention design was used to examine changes in nursing satisfaction and patient outcomes after implementing a psychiatric specific acuity tool. NDNQI survey results improved with the largest increase for the quality-of-care summary measure. An acuity tool can help standardize practice, determine fair patient assignments among staff, increase nurse satisfaction, and promote best practices for patient safety. Read the full article after watching this video.
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.
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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.
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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.
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Creator: Montgomery, Aoyjai P. PhD, BSN; Patrician, Patricia A. PhD, RN, FAAN; Azuero, Andres PhD, MBA
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Creator: Karapas, Eleftheria T. DNP, RN; Bobay, Kathleen PhD, RN, NEA-BC, FAAN
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Creator: Peters, Laura L. DNP, RN, FNP; Ambardekar, Amrut V. MD; Rosenthal, Laura D. DNP, RN, ACNP, FAANP; McIlvennan, Colleen K. DNP, RN, ANP
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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
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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
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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: Kucera, Patricia MSN, RN; Kingston, Eileen DNP, BSN, RN, MPA; Ferguson, Tysa DNP, RN, CNML; Jenkins, Katie MSN, RN; Fogarty, Melissa MSN, RN; Sayles, Harlan MS; Cohen, Marlene Z. PhD, RN, FAAN
Duration: 10:37
Staff shortages, reduced budgets, and high acuity of violent psychiatric patients create challenges in psychiatric intensive care units. Staffing in our unit was based on patient census rather than evidence-based practices. A pre-/postintervention design was used to examine changes in nursing satisfaction and patient outcomes after implementing a psychiatric specific acuity tool. NDNQI survey results improved with the largest increase for the quality-of-care summary measure. An acuity tool can help standardize practice, determine fair patient assignments among staff, increase nurse satisfaction, and promote best practices for patient safety. Read the full article after watching this video.
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: 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: 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: 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: 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: 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: Allen, Alicia MSN, RN, BC; Frederick, Logan MS, RHIA; Hovey, Susan L. PhD, RN
Duration: 3:18
A community hospital recognized patients with multiple chronic conditions had higher rates of inpatient stays and emergency department visits. Patients with multiple chronic conditions enrolled in a supportive care program. Palliative care nurses were assigned to patients enrolled in the program. There was a significant decrease in hospital utilization and inpatient stays following the implementation of the supportive care program. Learn more about this program and how to implement it in your own setting by watching the video and be sure to read the article.
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: McClain, Jesse V. IV DNP, APRN, ACNS-BC, CCRN, MSCN, SCRN; Chance, Elisha A. BSAS, CCRC
Duration: 2:45
An advanced practice registered nurse (APRN) led a transitional care clinic for stroke survivors. The goal was to improve transitions from hospital to home. Patients seen in the clinic had a lower 30-day readmission rate (1.5%) compared to non clinic patients (13.4%), p = .003). The 90-day readmission proportion was also higher in nonclinic patients (12.8%) vs those seen in the clinic (4.4%), p = .058. The results suggest the APRN-led clinic may impact hospital readmissions in stroke/transient ischemic attack survivors.
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.
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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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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.
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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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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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Duration: 3:34
Providing appropriate and timely mealtime assistance to hospitalized patients should be part of a multifaceted and multidisciplinary approach to optimizing the patient's nutritional care plan. The combined interventions of staff engagement, redesigning the model of care to reprioritize activities at mealtimes, clarifying nutritional care roles and responsibilities, introducing a protected mealtime and a novel 2-tiered colored tray system, and implementing an awareness and education program have resulted in significant improvements in mealtime assistance. Learn more about this project from the authors in the video and their article.
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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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Learn about this interesting study that used a process evaluation methodology. The aim was to examine the effectiveness of implementing same day discharge (SDD) following percutaneous coronary intervention. During implementation, 22 patients were discharged home the same day. It was found, however, that staff did not follow the guideline consistently, with an overall adherence of 77.3%. The study is important as it provides direction for future improvement both in the criteria and implementation process. After watching this video, be sure to read the article.
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A goal in many health systems is to improve heart failure (HF) core measure (CM) scores. Learn how an interdisciplinary team analyzed the processes in their setting, implemented an accurate reporting system, redesigned the process for identifying patients with HF, and changed the EHR. There was a decrease in readmissions from 12% to 8%, and HF CM compliance score increased from 88% to 100%. increased from 88% to 98%. Watch the video and then be sure to read the full article (for CE)
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Learn more about this study of 1933 RNs in 24 hospitals with shared leadership and the nurses’ perceptions of their decisional involvement. The author explains the study and its implications for nurses. Be sure to read the article for details about this important study and how you can use the findings in your own health care setting.
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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: 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.
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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: 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: 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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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: 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: 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.
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Creator: Sabrina Orique and Christopher Patty
Duration: 5:08
Watch this video and read the article to learn more about the nature and causes of missed nursing care and how it relates to unit-level nurse workload. This study was conducted in California, which legally mandates nurse staffing ratios. There were no significant relationships between patient turnover and missed nursing care.
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Creator: Dr. Sung-Heui Bae
Duration: 7:19
Preventable adverse patient outcomes and hospital characteristics in rural versus non rural US hospitals under the new Centers for Medicare & Medicaid Services reimbursement policy were examined using the American Hospital Association Annual Survey and Hospital Compare data. Under the new policy, rural hospitals tended to have fewer hospital-acquired conditions than non rural hospitals except for patient falls. Case mix was consistently related to falls after controlling for hospital characteristics.
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Creator: Dawn Becker
Duration: 2:53
Medication discrepancies occur in 70% of hospital patients, especially during discharge. The author initiated a bag medication reconciliation process in the hospital to decrease medication discrepancies by encouraging evaluation of medication adherence, side effects, and monitoring at posthospitalization follow-up. After implementation, a 7% decrease in reportable errors was noted.
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Creator: Paula Restrepo
Duration: 2:52
Deep vein thrombosis (DVT) remains a source of adverse outcomes in surgical patients. Nurses created a guideline for using non-invasive mechanical modalities for prophylaxis. Read more about this project.
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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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