Multidisciplinary Temperature Management in Patients with Hemorrhagic and Ischemic Stroke

Size: px
Start display at page:

Download "Multidisciplinary Temperature Management in Patients with Hemorrhagic and Ischemic Stroke"

Transcription

1 Multidisciplinary Temperature Management in Patients with Hemorrhagic and Ischemic Stroke Cecelia Ratay RN BSN CCRN CNRN Senior Professional Staff Nurse, Neurovascular ICU UPMC Presbyterian 11 th Annual Acute Stroke Management Conference April 22, 2016

2 Background of the Problem o o o No protocol existed for management of a patient s fever, or temperature control complications such as shivering. Quality Improvement (QI) project completed in conjunction with the University of Pittsburgh School of Nursing QI Committee Members o Marilyn Hravnak PhD RN ACNP-BC FCCM FAAN o Jane Guttendorf DNP RN ACNP-BC CRNP o Lori Shutter MD o Kyra Klein MSN ACNP-BC CRNP o Benjamin Morrow MSN RN CCRN o Also reviewed by Joseph Durkin, PharmD

3 Background o Body temperature is regulated by feedback mechanisms in temperature sensitive, insensitive, and effector preoptic-anterior neurons of hypothalamus. Bader, 2013 o For each 1 C body temp, cerebral metabolic demands by 6-8%. Mrozek et al, 2012 o Meta-analysis of fever impact in patients with stroke and neurologic injury (n=14,431) o fever was associated with worse outcome in 7 measures of clinical, functional, and economic outcomes. Greer et al, 2008 o 2013 AHA/ASA guidelines for acute ischemic stroke management recommend: o causes of fever 38 C be identified o hyperthermia should be treated. Jauch et al, AHA/ASA Guideline, 2013

4 Background o Fever in neurologically injured patients causes: o Elevated levels of excitatory amino acids (like glutamate and dopamine) o Increased ischemic depolarizations (neurons repeatedly fire and die) o Blood-brain barrier breakdown o Impaired function of enzymes o Reduced cytoskeletal stability o Therefore, controlling fever may be beneficial Greer et al, 2008 o Interventions to control fever can include antipyretics, sedatives, surface cooling, internal blood cooling with endovascular catheters, and even pharmacological paralysis

5 Background: Temperature Control o o Cohort study of 18 aneurysmal SAH patients with refractory fever, therapeutic normothermia reduced cerebral metabolic distress o decreased lactate/pyruvate ratio (LPR: 40±24 versus 32±9, P<0.01) measured through cerebral microdialysis o lowered intracranial pressure (ICP: 32±11 versus 28±12 mmhg, P<0.05) Oddo et al, 2009 Comparative cohort study of TBI patients concluded that induced normothermia is effective in reducing fever burden and may reduce secondary injury, since it was shown to reduce intracranial pressure Puccio et al, 2009 o Case-control study of the impact of induced normothermia following aneurysmal SAH o compared 80 SAH patients undergoing aggressive vs conventional fever control. o Aggressive fever control patients trended to lower rate poor outcome at 3 months (AFC 44% vs CFC 60%, p = 0.1) o Trend became statistically significantly at 12 months (AFC 21% vs CFC 46%, p = 0.03). Badjatia et al, 2010

6 Background: Shivering o Receptors sense decreased temperature, leading to increased firing of cold sensitive neurons signaling heat production effector neurons o Shivering results in increased systemic metabolism (Bedside Shivering Assessment Scale correlates with Hypermetabolic Index) causes the patient to rewarm o Shivering is associated with significant reduction in brain tissue oxygenation Bader, 2013 o Increased expenditure of energy, consumption of oxygen, and production of carbon dioxide Badajita et al, 2008 o Limited interventions for shivering in the NVICU prior to this project.

7 Purpose o The purpose of this project was to: o increase the knowledge of critical care nurses regarding the importance of early recognition and intervention of fever in the critically ill patient with ischemic and hemorrhagic stroke o use multidisciplinary collaboration to develop, implement, and evaluate an evidence-based protocol for critical care nurses to initiate and maintain fever management in this patient population.

8 Specific Aims 1.With multidisciplinary collaboration, develop an evidence-based protocol for critical care nurses to initiate and maintain fever management, including management of shivering and infection surveillance. 2. Assess nursing knowledge of complications of fever in the neurologically injured patient, as well as knowledge of shivering and its management before an educational intervention and immediately after, as well as during the post-implementation phase. 3. Implement the protocol. 4. Evaluate the impact of the protocol on cumulative fever burden (total time patients are 38 C), frequency of infection surveillance, use of tiered shivering interventions. In addition, patient outcomes of patient length of stay in the NVICU and hospital, NIHSS on admission and unit/hospital discharge, GCS on admission and unit/hospital discharge, mrs as available from outpatient clinic follow-up will be evaluated before and after protocol implementation.

9 National Institute of Health Stroke Scale (NIHSS)

10 Glasgow Coma Scale (GCS)

11 Modified Rankin Scale (mrs)

12 Cumulative fever burden in this patient is 2 hrs + 2 hrs + 3 hrs = 7 hrs Explanation of cumulative fever burden

13 Methods

14 Methods: Site o Setting o 20 Bed Neurovascular ICU (NVICU), UPMC Presbyterian o Medical care of these patients was directed by the Critical Care Medicine team, as well as Neurology and Neurosurgery o Institutional project approval by: o UPMC Quality Improvement Committee o UPMC Evidence-Based Practice Committee

15 Methods: Nursing Sample o NVICU Staff o ~60 registered nurses o Supervised by o Unit Director, two Clinicians, and two Clinical Resource Specialists

16 Methods: Patient Sample o Patients o Six month pre-implementation and post-implementation phases o The NVICU admits approximately 60 stroke patients per month o About 20% of these patients are expected to become febrile Rincon et al 2014 o Eligible were all consecutive adult patients registering at least one temperature >37.5 o C (this was the treatment threshold in the postimplementation group) in the NVICU and diagnosed with hemorrhagic or ischemic stroke who survived their hospitalization and to outpatient clinic follow-up.

17 Methods: Development of the Protocol o Review of the literature o Protocol reviewed by committee members (CR, MH, JG, LS, SC, BM, KK) and NVICU PharmD (JD) o 9-round iterative review process

18

19

20

21

22

23 Methods: Education o Developed standardized nurse education and knowledge surveys o Conducted unit-based journal club (Greer et al 2008 Meta-analysis) o Staff in-servicing, individual and small group basis o Over two weeks, for 20 minutes during scheduled shifts o Administered knowledge surveys (before journal club, after in-service, and again following protocol implementation)

24 Methods: Protocol Implementation o Protocols at every work station o Bedside nurses responsible for initiating protocol o Support from management and project leader (CR)

25 Methods: Evaluation o Nursing: o de-identified pre- and post-implementation knowledge survey scores o Patients (de-identified): o Cumulative fever burden in minutes before and after protocol implementation o Documentation of shivering assessment and management o Frequency of infection surveillance o Unit and hospital LOS, admission and ICU/hospital discharge NIHSS and GCS, and mrs from follow-up clinic as available

26 Data analysis o Staff Knowledge Survey Scores o Percent change from baseline o Patient data o Chi-Square for categorical and t-test for continuous variables, with statistical significance considered p < o IBM SPSS

27 RESULTS

28 Results: Characteristics of patients (n = 67) Pre-Protocol n = 33 Post-Protocol n = 34 p value Age (mean years ±SD) 56.2 ± ± Gender n (%) Female Male 21 (63.6%) 12 (36.4%) 16 (47.1%) 18 (52.9%) Diagnosis n (%) Subarachnoid Hemorrhage Cerebrovascular Accident Intracranial Hemorrhage 16 (48.5%) 9 (27.3%) 8 (24.2%) 13 (38.2%) 15 (44.1%) 6 (17.6%) Admission NIHSS 12.8 ± ± Admission GCS 9.9 ± ±

29 Results: Cumulative Fever Burden Cumulative Fever Burden in Minutes ALL (Mean ±Standard Deviation) Pre Post p value n = ± n = ± Diagnosis SAH n = ± n = ± CVA n = ± n = ±545 ICH n = ± n = ±848.5

30 Results: Outcomes of Patients Length of Stay (Days) ICU Hospital NIHSS At ICU Discharge Pre-Protocol Post-Protocol p value n = ± ±13.2 n = ±8.2 n = ± ±7.9 n = ± At Hospital Discharge n = ±7.1 n = ± GCS At ICU Discharge n = ±2.3 n = ± At Hospital Discharge n = ±1.9 n = ± Modified Rankin Scale (1 to 4 months post injury)* n = ±1.6 n = ±

31 Results: Interventions to manage shivering Intervention Tier 1 Acetaminophen Buspirone Magnesium sulfate Warming blanket Tier 2 (Fentanyl or Dexmedetomidine) Tier 3 (both Fentanyl and Dexmedetomidine) Tier 4 (Propofoland Neuromuscular Blockade in an intubated patient) Post-protocol (n=34) n (%) 34 (100%) 9 (26.4%) 8 (23.5%) 11 (32.4%) 5 (14.7%) 0 (0%) 0 (0%)

32 Results: Patient infection surveillance Blood Cultures > 48h Pre-Protocol Post-Protocol p value n = ±0.9 n = ± Blood Cultures < 48h n = ±0.9 n = ± Urinalysis > 48h n = ±1 n = ± Urinalysis < 48h n = 4 3 ±0.8 n = ±

33 Results: Staff Knowledge Score Pre n = 56 Post n = 50 3 months n = 43 Average score 70.7% 96.2% 80.5% Percentage of change from baseline 36.1% 13.9%

34 Clinical Implications o Use of an evidence-based, multidisciplinary protocol resulted in: o Statistically significant reduction in cumulative fever burden measured in minutes 38 C o Clinically significant reduction in ICU and hospital LOS by approximately 2 days

35 Limitations o Sample size may have been too small to detect meaningful changes in the GCS, NIHSS, or mrs scores, or we chose too short of an interval for follow-up assessment. o Since this was conducted as a quality improvement project and not as a research protocol with more stringent measurement validity and reliability, we experienced missing data points as well as retrospective score assignments. o Metrics may have been too blunt to assess and detect change in neurologic status and function. o May have been remiss to exclude patients who died in-hospital from the analysis. o May have contaminated our LOS assessments o Eliminating patients with neurologic deterioration then leading to death from the assessment also eliminated patients with poor scores

36 Conclusion o Demonstrated that a nurse-driven, evidence-based multidisciplinary protocol to apply fever and shivering management in a systematic and stepwise fashion was able to significantly reduce the time patients spent in a hyperthermic state o Trended towards shorter ICU and hospital lengths of stay by approximately two days. o A larger sample size, longer interval of follow-up, use of more sensitive outcome measures, and not excluding patients who died from the analysis would have been helpful in determining the protocol s impact on patient outcomes.

37 Acknowledgements o Thanks are extended to the Neurovascular ICU Staff, Katherine Spiering RN, MSN, Betsy George RN, PhD, and Joseph Durkin PharmD for contributing their expertise and support of this project. o My patient s father, referencing this Wall Street Journal article from November 23, 2005:

38 References Bader MK. (2013 November 15). All shook-up: Managing shivering in therapeutic in therapeutic hypothermia [Webinar]. American Association of Critical-Care Nurses Webinar Series Badjatia N, Strongilis E, Gordon E, et al. Metabolic impact of shivering during therapeutictemperature modulation: The bedside shivering assessment scale. Stroke. 2008; 29: doi: /STROKEAHA Badjatia N, Fernandez L, Schmidt JM, et al. Impact of induced normothermia on outcome after subarachnoid hemorrhage: A case-control study. Neurosurgery. 2010:66(4) doi: /01.NEU AA Choi H, Ko S, Presciutti M, et al. Prevention of shivering during therapeutic temperature modulation: The Columbia anti-shivering protocol. Neurocritical Care. 2011;14: doi: /s Greer DM, Funk SE, Reaven NL, Ouzounelli M, Uman GC. Impact of fever on outcome in patients with stroke and neurologic injury: A comprehensive meta-analysis. Stroke. 2008; 39: doi: /STROKEAHA Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early doi: /STR.0b013e a Mrozek S, Vardon, F, Geeraerts T. Brain temperature: Physiology and pathophysiology after brain injury. Anesthesiology Research and Practice doi: /2012/ Oddo M, Frangos S, Maloney-Wilensky E, et al. Effects of shivering on brain tissue oxygenation during induced normothermia in patients with severe brain injury. Neurocritical Care. 2010; 16: doi: /s Oddo M, Frangos S, Milby A, et al. Induced normothermia attenuates cerebral metabolic distress in patients with aneurysmal subarachnoid hemorrhage and refractory fever. Stroke. 2009; 40: doi: /strokeaha Presciutti M, Bader MK, Hepburn M. Shivering management during therapeutic temperature modulation: Nurses perspective. Critical Care Nurse. 2012; 32(1): doi: /ccn Puccio AM, Fisher MR, Jankowitz BT, et al. Induced normothermia attenuates intracranial hypertension and reduces fever burden after severe traumatic brain injury. Neurocritical Care. 2009; 11(1): doi: /s Rincon F, Hunter K, Schorr C, Dellinger RP, Zanotti-Cavazzoni S. The epidemiology of spontaneous fever and hypothermia on admission of brain injury patients to intensive care units: a multicenter cohort study. Journal of Neurosurgery. 2014; 121: Images from: and

Comparison of a Nurse-Driven Mobility Protocol to Multidisciplinary Mobility Protocol for Subarachnoid Hemorrhage Patients

Comparison of a Nurse-Driven Mobility Protocol to Multidisciplinary Mobility Protocol for Subarachnoid Hemorrhage Patients The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based

More information

Alsius Intravascular Temperature Management. Temperature is Vital

Alsius Intravascular Temperature Management. Temperature is Vital Alsius Intravascular Temperature Management Temperature is Vital Intravascular Temperature Management (IVTM) Temperature Management Is Vital to Life Temperature is one of the four main vital signs. Management

More information

Using the Trauma Quality Improvement Program (TQIP) Metrics Data to Change Clinical Practice Abigail R. Blackmore, MSN, RN Pamela W.

Using the Trauma Quality Improvement Program (TQIP) Metrics Data to Change Clinical Practice Abigail R. Blackmore, MSN, RN Pamela W. Using the Trauma Quality Improvement Program (TQIP) Metrics Data to Change Clinical Practice Abigail R. Blackmore, MSN, RN Pamela W. Bourg, PhD, RN, TCRN, FAEN Learning Objectives Explain the importance

More information

Reducing Fever and Improving Outcomes In The Neurologically Compromised Patient

Reducing Fever and Improving Outcomes In The Neurologically Compromised Patient Lehigh Valley Health Network LVHN Scholarly Works Patient Care Services / Nursing Reducing Fever and Improving Outcomes In The Neurologically Compromised Patient Rachel Gross RN Lehigh Valley Health Network,

More information

Creating a Virtual Continuing Care Hospital (CCH) to Improve Functional Outcomes and Reduce Readmissions and Burden of Care. Opportunity Statement

Creating a Virtual Continuing Care Hospital (CCH) to Improve Functional Outcomes and Reduce Readmissions and Burden of Care. Opportunity Statement Creating a Virtual Continuing Care Hospital (CCH) to Improve Functional Outcomes and Reduce Readmissions and Burden of Care Robert D. Rondinelli, MD, PhD Paulette Niewczyk, MPH, PhD AlphaFIM, FIM, SigmaFIM,

More information

ICU. Rotation Goals & Objectives for Urology Residents

ICU. Rotation Goals & Objectives for Urology Residents THE UNIVERSITY OF BRITISH COLUMBIA Department of Urologic Sciences Faculty of Medicine Gordon & Leslie Diamond Health Care Centre Level 6, 2775 Laurel Street Vancouver, BC, Canada V5Z 1M9 Tel: (604) 875-4301

More information

INCLUSION CRITERIA. REMINDER: Please ensure all stroke and TIA patients admitted to hospital are designated as "Stroke Service" in Cerner.

INCLUSION CRITERIA. REMINDER: Please ensure all stroke and TIA patients admitted to hospital are designated as Stroke Service in Cerner. ACUTE STROKE CLINICAL PATHWAY The clinical pathway is based on evidence informed practice and is designed to promote timely treatment, enhance quality of care, optimize patient outcomes and support effective

More information

Evaluation of Telestroke Services

Evaluation of Telestroke Services Evaluation of Telestroke Services 2013 Telestroke Summit Heart and Stroke Foundation of New Brunswick and the Canadian Stroke Network Dr. Patrice Lindsay Director Best Practices and Performance, Stroke

More information

Patients Being Weaned From the Ventilator: Positive Effects of Guided Imagery. Authors McVay, Frank; Spiva, Elizabeth; Hart, Patricia L.

Patients Being Weaned From the Ventilator: Positive Effects of Guided Imagery. Authors McVay, Frank; Spiva, Elizabeth; Hart, Patricia L. The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based

More information

at UCLA January 20-21, 2011 UCLA Neuroscience Research Building Paul M. Vespa, MD, FCCM

at UCLA January 20-21, 2011 UCLA Neuroscience Research Building Paul M. Vespa, MD, FCCM Neurocritical Care in the Symposium January 20-21, 2011 UCLA Neuroscience Research Building (NRB Auditorium) 635 Charles E. Young Drive, South Los Angeles, California, 90095 Course Director Paul M. Vespa,

More information

Tracking Functional Outcomes throughout the Continuum of Acute and Postacute Rehabilitative Care

Tracking Functional Outcomes throughout the Continuum of Acute and Postacute Rehabilitative Care Tracking Functional Outcomes throughout the Continuum of Acute and Postacute Rehabilitative Care Robert D. Rondinelli, MD, PhD Medical Director Rehabilitation Services Unity Point Health, Des Moines Paulette

More information

END-TIDAL CARBON DIOXIDE AS A MEASURE

END-TIDAL CARBON DIOXIDE AS A MEASURE Critical Care Techniques END-TIDAL CARBON DIOXIDE AS A MEASURE OF STRESS RESPONSE TO CLUSTERED NURSING INTERVENTIONS IN NEUROLOGIC PATIENTS By Laura Genzler, RN, BSN, Pamela Jo Johnson, MPH, PhD, Neha

More information

Decreasing Mortality in Head Strike Patients on Anticoagulants with a Head Strike Protocol

Decreasing Mortality in Head Strike Patients on Anticoagulants with a Head Strike Protocol Decreasing Mortality in Head Strike Patients on Anticoagulants with a Head Strike Protocol TraumaCon 2017 Society of Trauma Nurses April 5-8, 2017 St. Louis, MO 2.0 hours after onset 6.5 hours after onset

More information

Saving Lives: EWS & CODE SEPSIS. Kim McDonough RN and Margaret Currie-Coyoy MBA Last Revision: August 2013

Saving Lives: EWS & CODE SEPSIS. Kim McDonough RN and Margaret Currie-Coyoy MBA Last Revision: August 2013 Saving Lives: EWS & CODE SEPSIS Kim McDonough RN and Margaret Currie-Coyoy MBA Last Revision: August 2013 Course Objectives At the conclusion of this training, you will be able to Explain the importance

More information

The How to Guide for Reducing Surgical Complications

The How to Guide for Reducing Surgical Complications The How to Guide for Reducing Surgical Complications Post operative wound (surgical site) infections Maintaining perioperative normothermia Main contacts for Reducing Surgical Complications Campaign Director:

More information

Learning Objectives. Registration and Continental Breakfast 7:00 AM -7:30 AM

Learning Objectives. Registration and Continental Breakfast 7:00 AM -7:30 AM Fundamental Critical Care Support Provided by USF Health Date: Program Number SF2014136B At CLS (Center for Advanced Medical Learning and Simulation) Tampa, Florida Day One Schedule Session Learning Format

More information

Educational Goals & Objectives

Educational Goals & Objectives Educational Goals & Objectives The Neurology rotation will provide residents with an opportunity to evaluate and treat patients with neurological disorders. The goal is for residents to feel comfortable

More information

Neurocritical Care Audit in A Tertiary Institution

Neurocritical Care Audit in A Tertiary Institution Neurocritical Care Audit in A Tertiary Institution O.E. Idowu 1, S.O. Oyeleke 2, A.A. Olaoya 1 1 Neurosurgery Unit, Department of Surgery and 2 Department of Anaesthesia, Lagos State University College

More information

Stopping Sepsis in Virginia Hospitals and Nursing Homes Hospital Webinar #2 - Tuesday, March 21, 2017

Stopping Sepsis in Virginia Hospitals and Nursing Homes Hospital Webinar #2 - Tuesday, March 21, 2017 Stopping Sepsis in Virginia Hospitals and Nursing Homes Hospital Webinar #2 - Tuesday, March 21, 2017 Welcome and Introductions Today s objectives: Introduce Sepsis Practice Collaborative Model Tier 1

More information

Neurocritical Care Rotation - EUH

Neurocritical Care Rotation - EUH Preceptor: Bill Asbury, B.S., Pharm.D. Office: EUH- EG35 Hours: ~ 8:00am-4:30pm Desk: 404-712-7491 Pager: 404-686-5500 pic 14028 ICU cell phone: 404-326-8256 PGY-2 Residency Training Program Neurocritical

More information

19th Annual. Challenges. in Critical Care

19th Annual. Challenges. in Critical Care 19th Annual Challenges in Critical Care A Multidisciplinary Approach Friday August 22, 2014 The Hotel Hershey 100 Hotel Road Hershey, Pennsylvania 17033 A continuing education service of Penn State College

More information

Nursing Care for Acute Ischemic Stroke Patients

Nursing Care for Acute Ischemic Stroke Patients Nursing Care for Acute Ischemic Stroke Patients Highlights of lessons learned 2016 Annie Sanford MSN, RN Stroke Program Manager Swedish Medical Center, Seattle, WA 1 Learning Objectives: By attending this

More information

Assessment and Reassessment of Patients

Assessment and Reassessment of Patients Approved by: Assessment and Reassessment of Patients Senior Director, Operations, Emergency, Medicine, Critical Care & Respiratory - GNCH Senior Director, Operations, Emergency, Medicine, Critical Care

More information

ASCO s Quality Training Program

ASCO s Quality Training Program ASCO s Quality Training Program Project Title: Treatment of febrile neutropenia at the University of Virginia Presenter s Name: Tri Le, MD, Tanya Thomas, RN, Michael Keng, MD Institution: University of

More information

CRITICAL CARE POLICY AND PROCEDURE MANUAL

CRITICAL CARE POLICY AND PROCEDURE MANUAL CRITICAL CARE POLICY AND PROCEDURE MANUAL Page 1 of 10 Title: Adult Therapeutic Hypothermia Policy No. CC-8.03 Joint Commission Chapter/Section: Effective Date: June, 2014 Source (e.g. document, award,

More information

Chan Man Yi, NC (Neonatal Care) Dept. of Paed. & A.M., PMH 16 May 2017

Chan Man Yi, NC (Neonatal Care) Dept. of Paed. & A.M., PMH 16 May 2017 The implementation of an integrated observation chart with Newborn Early Warning Signs (NEWS) to facilitate observation of infants at risk of clinical deterioration Chan Man Yi, NC (Neonatal Care) Dept.

More information

Evaluation of Simulation Courseware in Pediatric Nursing Practicum

Evaluation of Simulation Courseware in Pediatric Nursing Practicum Evaluation of Simulation Courseware in Pediatric Nursing Practicum * Hyunsook Shin, PhD, APN, CPNP, Associate professor * KaKa Shim, Doctoral candidate, RN, Lecturer * Yuna Lee, MSN, RN, Clinical instructor

More information

CA-1 NEUROANESTHESIA ROTATION University of Minnesota Medical Center Rotation Site Director: Dr. Thomas Kozhimannil Rotation Duration: 4 weeks

CA-1 NEUROANESTHESIA ROTATION University of Minnesota Medical Center Rotation Site Director: Dr. Thomas Kozhimannil Rotation Duration: 4 weeks CA-1 NEUROANESTHESIA ROTATION Medical Center Rotation Site Director: Dr. Thomas Kozhimannil Rotation Duration: 4 weeks Introduction: The goal of the Neurosurgical Anesthesia Rotation at the is to train

More information

Early Recognition of In-Hospital Patient Deterioration Outside of The Intensive Care Unit: The Case For Continuous Monitoring

Early Recognition of In-Hospital Patient Deterioration Outside of The Intensive Care Unit: The Case For Continuous Monitoring Early Recognition of In-Hospital Patient Deterioration Outside of The Intensive Care Unit: The Case For Continuous Monitoring Israeli Society of Internal Medicine Meeting July 5, 2013 Eyal Zimlichman MD,

More information

Objectives 10/09/2015. Screen and Intervene: Improved Outcomes From a Nurse-Initiated Sepsis Protocol C935

Objectives 10/09/2015. Screen and Intervene: Improved Outcomes From a Nurse-Initiated Sepsis Protocol C935 Screen and Intervene: Improved Outcomes From a Nurse-Initiated Sepsis Protocol C935 2015 ANCC National Magnet Conference October 9, 2015 Kristin Drager MSN RN CNL CEN William S. Middleton Memorial Veterans

More information

Neurocritical Care Fellowship Program Requirements

Neurocritical Care Fellowship Program Requirements Neurocritical Care Fellowship Program Requirements I. Introduction A. Definition The medical subspecialty of Neurocritical Care is devoted to the comprehensive, multisystem care of the critically-ill neurological

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012.

More information

Element(s) of Performance for DSPR.1

Element(s) of Performance for DSPR.1 Prepublication Issued Requirements The Joint Commission has approved the following revisions for prepublication. While revised requirements are published in the semiannual updates to the print manuals

More information

Use of water swallowing test as a screening tool in acute stroke unit

Use of water swallowing test as a screening tool in acute stroke unit Use of water swallowing test as a screening tool in acute stroke unit Amy Wong 1, Fanny Ip 2 & Ripley Wong 1 Queen Mary Hospital Presentation quote 1: Speech Therapists, Speech Therapy Department 2: Ward

More information

Stroke Coordinator Boot Camp

Stroke Coordinator Boot Camp Stroke Coordinator Boot Camp Gena Kreiner RN BSN FHS Stroke Coordinator Karen C. Kiesz MN RN CNRN SCRN MHS Stroke Program Manager Lisa Shumaker, BSN, RN, CMSRN (Moderator) PRMC- Everett Stroke Program

More information

Neurocritical Care. Does it make a difference?

Neurocritical Care. Does it make a difference? Neurocritical Care Does it make a difference? Dr Hilary Madder Neurosciences Intensive Care Unit John Radcliffe Hospital, Oxford ANZCA Neuroanaesthesia SIG July 2013 Neurocritical Care Capacity 32 neurosurgical

More information

SEPSIS RESEARCH WSHFT: THE IMPACT OF PREHOSPITAL SEPSIS SCREENING

SEPSIS RESEARCH WSHFT: THE IMPACT OF PREHOSPITAL SEPSIS SCREENING SEPSIS RESEARCH WSHFT: THE IMPACT OF PREHOSPITAL SEPSIS SCREENING Dr. Duncan Hargreaves QI Fellow Worthing Hospital Allied Health Sciences Network 2017 SEPSIS IMPROVEMENT AT WSHFT QUESTcollaboration ->

More information

SAHS Critical Care Residency Program

SAHS Critical Care Residency Program SAHS Critical Care Residency Program Sherry Parks BSN, MS, NEA-BC VP &CNO Teri Woychick BSN, RN Director of Critical Care Cindy Malinowski RN, MN, CCRN, Nurse Educator Perfect Storm High CC turnover Lack

More information

DNV GL - Healthcare Advisory Notice Notice No:

DNV GL - Healthcare Advisory Notice Notice No: DNV GL - Healthcare Advisory Notice Notice No: 2015-06 DATE: September 3, 2015 SUBJECT: New Version Comprehensive Stroke Center Standards 2.0 DISTRIBUTION: All DNV GL - Healthcare Customers, Employees

More information

Inpatient Rehabilitation Program Information

Inpatient Rehabilitation Program Information Inpatient Rehabilitation Program Information The Inpatient Rehabilitation Program at TIRR Memorial Hermann The Woodlands has a team of physicians, therapists, nurses, a case manager, neuropsychologist,

More information

Collaboration in the Donation Process Karen Kennedy, BSN, RN, CPTC, CTBS, CHSE November 1, 2016

Collaboration in the Donation Process Karen Kennedy, BSN, RN, CPTC, CTBS, CHSE November 1, 2016 Collaboration in the Donation Process Karen Kennedy, BSN, RN, CPTC, CTBS, CHSE November 1, 2016 1 2 3 Good People, Doing Good Things 4 The Need is Great Our Service Area 34 Acute Care Hospitals 2 Transplant

More information

IMPACT OF RN HYPERTENSION PROTOCOL

IMPACT OF RN HYPERTENSION PROTOCOL 1 IMPACT OF RN HYPERTENSION PROTOCOL Joyce Cheung, RN, Marie Kuzmack, RN Orange County Hypertension Team Kaiser Permanente, Orange County Joyce.m.cheung@kp.org and marie-aline.z.kuzmack@kp.org Cell phone:

More information

Prepublication Requirements

Prepublication Requirements Issued Prepublication Requirements The Joint Commission has approved the following revisions for prepublication. While revised requirements are published in the semiannual updates to the print manuals

More information

NYS Department of Health Coverdell Stroke Quality Improvement and Registry Program

NYS Department of Health Coverdell Stroke Quality Improvement and Registry Program NYS Department of Health Coverdell Stroke Quality Improvement and Registry Program An Overview with Considerations in Care Transitions for the Acute Stroke Patient Anna Colello, Esq. Director for Regulatory

More information

REFINING, IMPLEMENTING AND EVAUATING A NEURO EARLY MOBILIZATION PROTOCOL IN THE NEUROSCIENCE INTENSIVE CARE UNIT. Megan A. Brissie.

REFINING, IMPLEMENTING AND EVAUATING A NEURO EARLY MOBILIZATION PROTOCOL IN THE NEUROSCIENCE INTENSIVE CARE UNIT. Megan A. Brissie. REFINING, IMPLEMENTING AND EVAUATING A NEURO EARLY MOBILIZATION PROTOCOL IN THE NEUROSCIENCE INTENSIVE CARE UNIT Megan A. Brissie A project submitted to the faculty at the University of North Carolina

More information

Sepsis Care in the ED. Graduate EBP Capstone Project

Sepsis Care in the ED. Graduate EBP Capstone Project Sepsis Care in the ED Graduate EBP Capstone Project University of Mary EBP Graduate Capstone Project Members Alicia Vermeulen- Operations Manager, Avera McKennan Hospital Wendy Moore, RN- Ambulatory Nurse

More information

Admissions with neutropenic sepsis in adult, general critical care units in England, Wales and Northern Ireland

Admissions with neutropenic sepsis in adult, general critical care units in England, Wales and Northern Ireland Admissions with neutropenic sepsis in adult, general critical care units in England, Wales and Northern Ireland Question What were the: age; gender; APACHE II score; ICNARC physiology score; critical care

More information

TRAUMA CENTER REQUIREMENTS

TRAUMA CENTER REQUIREMENTS California Trauma Center Level III Criteria California Code of Regulations,, Chapter 7 - Trauma Care System with American College of Surgeons (Green Book) references; includes FAQ clarifications TRAUMA

More information

GAMUT QI Collaborative Consensus Quality Metrics (v. 05/16/2016)

GAMUT QI Collaborative Consensus Quality Metrics (v. 05/16/2016) 1) Ventilator use in patients 1 with advanced airways reported as Percent of patient transport contacts with an advanced airway 2 supported by a mechanical ventilator. 2) Scene and bedside times for STEMI

More information

UPMC ST. MARGARET CONTINUING EDUCATION PROGRAMS (Classroom and/or Electronic) PROFESSIONAL STANDARDS OF PRACTICE AND PERFORMANCE

UPMC ST. MARGARET CONTINUING EDUCATION PROGRAMS (Classroom and/or Electronic) PROFESSIONAL STANDARDS OF PRACTICE AND PERFORMANCE TOTAL 2010-2013 3761 First Three Minutes 07/09/2010 3 NIHSS - Stroke Scale 08/05/2010 2 CLABS Review 08/05/2010 08/24/2010 08/30/2010 09/07/2010 64 SMH Journal Club: "Conscious Sedation" 09/01/2010 19

More information

An Outcome Analysis of Nurse Practitioners in Acute Care Trauma Services

An Outcome Analysis of Nurse Practitioners in Acute Care Trauma Services RESEARCH An Outcome Analysis of Nurse Practitioners in Acute Care Trauma Services 1.0 ANCC Contact Hours Anna Holliday, MSN, FNP-BC Damayanti Samanta, MS Julie Budinger, MSN, ACNP-BC, GNP-BC Jessica Hardway,

More information

2010 PQRI REPORTING OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY

2010 PQRI REPORTING OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY Measure #193: Perioperative Temperature Management 2010 PQRI REPTING OPTIONS F INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION: Percentage of patients, regardless of age, undergoing surgical or therapeutic

More information

Know your tools: Improving the effectiveness of nurses using the confusion assessment method (CAM) to detect delirium

Know your tools: Improving the effectiveness of nurses using the confusion assessment method (CAM) to detect delirium Know your tools: Improving the effectiveness of nurses using the confusion assessment method (CAM) to detect delirium 1 Julie Plagenhoef, MPH, RN, CMSRN Preparing for Improvement: Why Delirium? Increases

More information

Effect of DNP & MSN Evidence-Based Practice (EBP) Courses on Nursing Students Use of EBP

Effect of DNP & MSN Evidence-Based Practice (EBP) Courses on Nursing Students Use of EBP Effect of DNP & MSN Evidence-Based Practice (EBP) Courses on Nursing Students Use of EBP Richard Watters, PhD, RN Elizabeth R Moore PhD, RN Kenneth A. Wallston PhD Page 1 Disclosures Conflict of interest

More information

Disease-Specific Care CERTIFICATION PROGRAM. Comprehensive Stroke

Disease-Specific Care CERTIFICATION PROGRAM. Comprehensive Stroke Disease-Specific Care CERTIFICATION PROGRAM Comprehensive Stroke PERFORMANCE MEASUREMENT IMPLEMENTATION GUIDE January 2015 Copyright, The Joint Commission Comprehensive Stroke (CSTK) Set Measures CSTK-01

More information

School of Nursing Applying Evidence to Improve Quality

School of Nursing Applying Evidence to Improve Quality Applying Evidence to Improve Quality Linda A Dudjak PhD RN Associate Professor University of Pittsburgh School of Nursing Compare Two Alternatives Implement a Test of Change (Experiment) to Fix a Broken

More information

Neuro Labs and Best Practices in Stroke Programs. Sarah L. Livesay, DNP, RN, ACNP-BC Associate Professor Rush University College of Nursing

Neuro Labs and Best Practices in Stroke Programs. Sarah L. Livesay, DNP, RN, ACNP-BC Associate Professor Rush University College of Nursing Neuro Labs and Best Practices in Stroke Programs Sarah L. Livesay, DNP, RN, ACNP-BC Associate Professor Rush University College of Nursing Objectives Discuss the evolving best practices for neuro lab practice

More information

The Effect of an Interprofessional Heart Failure Education Program on Hospital Readmissions

The Effect of an Interprofessional Heart Failure Education Program on Hospital Readmissions 1 The Effect of an Interprofessional Heart Failure Education Program on Hospital Readmissions Julia N. Clarkson, Susan D. Schaffer, Joshua J. Clarkson Heart failure (HF) is a pressing concern to public

More information

Determining Like Hospitals for Benchmarking Paper #2778

Determining Like Hospitals for Benchmarking Paper #2778 Determining Like Hospitals for Benchmarking Paper #2778 Diane Storer Brown, RN, PhD, FNAHQ, FAAN Kaiser Permanente Northern California, Oakland, CA, Nancy E. Donaldson, RN, DNSc, FAAN Department of Physiological

More information

Using Predictive Analytics to Improve Sepsis Outcomes 4/23/2014

Using Predictive Analytics to Improve Sepsis Outcomes 4/23/2014 Using Predictive Analytics to Improve Sepsis Outcomes 4/23/2014 Ryan Arnold, MD Department of Emergency Medicine and Value Institute Christiana Care Health System, Newark, DE Susan Niemeier, RN Chief Nursing

More information

STAG TRAUMA. Quality Indicators

STAG TRAUMA. Quality Indicators STAG TRAUMA Quality Indicators Document Control Document Control Version Quality Indicators V3.3.doc Date Issued 03-09-2013 Author(s) Kirsty Ward Other Related Documents Comments to Angela Khan Document

More information

Shalmon SC 1 (Department of Nursing, BLDEA s Shri BM Patil institute of Nursing science, Bijapur/ Rajiv Gandhi university of Health sciences, India)

Shalmon SC 1 (Department of Nursing, BLDEA s Shri BM Patil institute of Nursing science, Bijapur/ Rajiv Gandhi university of Health sciences, India) IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-issn: 2320 1959.p- ISSN: 2320 1940 Volume 3, Issue 1 Ver. III (Jan. 2014), PP 08-12 A study to identify the discomforts as verbalized by patients

More information

Innovation in Self-Care

Innovation in Self-Care Innovation in Self-Care S-OPAT Intro Speakers Kavita Bhavan, MD, MHS Associate Professor of Infectious Diseases at the UTSW, Service Chief Infectious Diseases at Parkland, and Medical Director of Outpatient

More information

Approximately 17 million adults experience an alcohol

Approximately 17 million adults experience an alcohol Original Article Journal of Addictions Nursing & Volume 27 & Number 4, 234Y240 & Copyright B 2016 International Nurses Society on Addictions 2.0 ANCC Contact Hours Embracing a Nurse-Driven Alcohol Withdrawal

More information

Admissions and Readmissions Related to Adverse Events, NMCPHC-EDC-TR

Admissions and Readmissions Related to Adverse Events, NMCPHC-EDC-TR Admissions and Readmissions Related to Adverse Events, 2007-2014 By Michael J. Hughes and Uzo Chukwuma December 2015 Approved for public release. Distribution is unlimited. The views expressed in this

More information

Scaling Up and Validating a Nursing Acuity Tool to Ensure Synergy in Pediatric Critical Care

Scaling Up and Validating a Nursing Acuity Tool to Ensure Synergy in Pediatric Critical Care Scaling Up and Validating a Nursing Acuity Tool to Ensure Synergy in Pediatric Critical Care Jean Connor PhD, RN, CPNP, FAAN Director of Nursing Research, Cardiovascular and Critical Care Services Boston

More information

Organization: Solution Title: Program/Project Description, including Goals: What is this project? Why is this project important?

Organization: Solution Title: Program/Project Description, including Goals: What is this project? Why is this project important? Organization: Hebrew Home of Greater Washington (The Charles E. Smith Life Communities) The Hebrew Home provides post-acute services and long-term care to a daily average census of 500 residents. The Home

More information

The impact of the heart failure health enhancement program: A retrospective pilot study

The impact of the heart failure health enhancement program: A retrospective pilot study ORIGINAL ARTICLE The impact of the heart failure health enhancement program: A retrospective pilot study Cynthia J. Hadenfeldt, Marilee Aufdenkamp, Caprice A. Lueth, Jane M. Parks Creighton University

More information

Patricia Neal Rehabilitation Center

Patricia Neal Rehabilitation Center Pressure Injuries: Moving from Reporting to Healing Patricia Neal Rehabilitation Center Knoxville, TN Mary Dillon, MD, Medical Director Addie Lowe, MSN, BSN, RN, CNRN, CRRN Nurse Manager Anne Teasley,

More information

Effectiveness of Self Instructional Module on Care of Stroke Patients Among Primary Caregivers

Effectiveness of Self Instructional Module on Care of Stroke Patients Among Primary Caregivers IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-issn: 2320 1959.p- ISSN: 2320 1940 Volume 5, Issue 3 Ver. VI (May. - Jun. 2016), PP 01-07 www.iosrjournals.org Effectiveness of Self Instructional

More information

Critique of a Nurse Driven Mobility Study. Heather Nowak, Wendy Szymoniak, Sueann Unger, Sofia Warren. Ferris State University

Critique of a Nurse Driven Mobility Study. Heather Nowak, Wendy Szymoniak, Sueann Unger, Sofia Warren. Ferris State University Running head: CRITIQUE OF A NURSE 1 Critique of a Nurse Driven Mobility Study Heather Nowak, Wendy Szymoniak, Sueann Unger, Sofia Warren Ferris State University CRITIQUE OF A NURSE 2 Abstract This is a

More information

WAKEMED HEALTH & HOSPITALS STROKE PROGRAM PRESENTS THE TWELFTH ANNUAL. TimeisBrain. Advances in Stroke Care. 7:30 am - 2:45 pm

WAKEMED HEALTH & HOSPITALS STROKE PROGRAM PRESENTS THE TWELFTH ANNUAL. TimeisBrain. Advances in Stroke Care. 7:30 am - 2:45 pm WAKEMED HEALTH & HOSPITALS STROKE PROGRAM PRESENTS THE TWELFTH ANNUAL TimeisBrain Advances in Stroke Care Saturday, November 11, 2017 7:30 am - 2:45 pm The William F. Andrews Conference Center WakeMed

More information

HCS-D Exam Update. Tricia A. Twombly BSN RN HCS-D HCS-O COS-C CHCE AHIMA Approved ICD-10 CM Trainer Senior Director, DecisionHealth CEO, BMSC

HCS-D Exam Update. Tricia A. Twombly BSN RN HCS-D HCS-O COS-C CHCE AHIMA Approved ICD-10 CM Trainer Senior Director, DecisionHealth CEO, BMSC HCS-D Exam Update Lisa Selman-Holman JD, BSN, RN, HCS-D, HCS-O, COS-C AHIMA Approved ICD-10 CMPCS Trainer Owner, Selman-Holman and Associates Chair, BMSC Tricia A. Twombly BSN RN HCS-D HCS-O COS-C CHCE

More information

Proposed Requirements for Comprehensive Stroke Center

Proposed Requirements for Comprehensive Stroke Center Proposed Requirements for Comprehensive Stroke Center Please Note: The current requirements for Disease-Specific Care Advanced Certification Program for Primary Stroke are included in this document. Proposed

More information

CURRICULUM VITAE. EDUCATION AND TRAINING University of Alabama at Birmingham (Birmingham, AL) Masters of Nursing (Family Nurse Practitioner)

CURRICULUM VITAE. EDUCATION AND TRAINING University of Alabama at Birmingham (Birmingham, AL) Masters of Nursing (Family Nurse Practitioner) CURRICULUM VITAE Emmaculate Mmboga Fields, APRN-CNP Department of Neurology The University of Oklahoma Health Sciences Center 920 Stanton L Young Blvd; Suite 2040 Oklahoma City, OK 73104 Phone: (405) 271-4113

More information

Healthcare-Associated Infections in U.S. Nursing Homes: Results from a Prevalence Survey Pilot

Healthcare-Associated Infections in U.S. Nursing Homes: Results from a Prevalence Survey Pilot Healthcare-Associated Infections in U.S. Nursing Homes: Results from a Prevalence Survey Pilot Lisa La Place, MPH, Lauren Epstein, MD, Deborah Thompson, MD, Ghinwa Dumyati, MD, Cathleen Concannon, MPH,

More information

Preventing In-Facility Falls

Preventing In-Facility Falls Preventing In-Facility Falls Presented by Paul Shekelle, M.D., Ph.D. RAND Corporation Evidence-based Practice Center Introduction: Making Health Care Safer II: An Updated Critical Analysis of the Evidence

More information

VJ Periyakoil Productions presents

VJ Periyakoil Productions presents VJ Periyakoil Productions presents Oscar thecare Cat: Advance Lessons Learned Planning Joan M. Teno, MD, MS Professor of Community Health Warrant Alpert School of Medicine at Brown University VJ Periyakoil,

More information

Quality health care in intensive

Quality health care in intensive Clinical outcomes after telemedicine intensive care unit implementation* Beth Willmitch, RN, BSN; Susan Golembeski, PhD, RN, CHRC; Sandy S. Kim, MA, MEd; Loren D. Nelson, MD, FACS, FCCM; Louis Gidel, MD,

More information

STROKE UPDATE 2015 XIX. Friday, September 18, 2015 XIX. Friday, September 18, Location: Westin Convention Center Hotel

STROKE UPDATE 2015 XIX. Friday, September 18, 2015 XIX. Friday, September 18, Location: Westin Convention Center Hotel Nonprofit Org. U.S. Postage PAID Permit No. 425 STROKE UPDATE 2015 200 Lothrop Street, PUH, C-400 15213-2593 UPMC STROKE INSTITUTE Friday, September 18, 2015 STROKE UPDATE 2015 Friday, September 18, 2015

More information

The Power of the Pyramid:

The Power of the Pyramid: The Power of the Pyramid: A Proven Sepsis Implementation Program for Saving Lives SepsisSolutionsInternational 2011 Kathleen Vollman MSN, RN, CCNS, FCCM, FAAN Clinical Nurse Specialist, Educator, Consultant

More information

Surveillance of Health Care Associated Infections in Long Term Care Settings. Sandra Callery RN MHSc CIC

Surveillance of Health Care Associated Infections in Long Term Care Settings. Sandra Callery RN MHSc CIC Surveillance of Health Care Associated Infections in Long Term Care Settings Sandra Callery RN MHSc CIC Why do it? Uses of Surveillance: Improve outcomes and processes Evaluate and reinforce practice Establish

More information

OBJECTIVES PLAN OF LESSON. Upon completion of this unit the student will:

OBJECTIVES PLAN OF LESSON. Upon completion of this unit the student will: Unit: Medical Surgical Nursing-Disorders of the Nervous System Implementation: Linton (2016) Ch. 27 Lesson: 1 Lecture/Discussion, Transparencies, Quizzing Title: Introductory to Neurological Disorders,

More information

CMS and NHSN: What s New for Infection Preventionists in 2013

CMS and NHSN: What s New for Infection Preventionists in 2013 CMS and NHSN: What s New for Infection Preventionists in 2013 Joan Hebden RN, MS, CIC Clinical Program Manager Sentri7 Wolters Kluwer Health - Clinical Solutions Objectives Define the current status of

More information

The impact of nighttime intensivists on medical intensive care unit infection-related indicators

The impact of nighttime intensivists on medical intensive care unit infection-related indicators Washington University School of Medicine Digital Commons@Becker Open Access Publications 2016 The impact of nighttime intensivists on medical intensive care unit infection-related indicators Abhaya Trivedi

More information

Pricing and funding for safety and quality: the Australian approach

Pricing and funding for safety and quality: the Australian approach Pricing and funding for safety and quality: the Australian approach Sarah Neville, Ph.D. Executive Director, Data Analytics Sean Heng Senior Technical Advisor, AR-DRG Development Independent Hospital Pricing

More information

Suicide Among Veterans and Other Americans Office of Suicide Prevention

Suicide Among Veterans and Other Americans Office of Suicide Prevention Suicide Among Veterans and Other Americans 21 214 Office of Suicide Prevention 3 August 216 Contents I. Introduction... 3 II. Executive Summary... 4 III. Background... 5 IV. Methodology... 5 V. Results

More information

Type of intervention Secondary prevention of heart failure (HF)-related events in patients at risk of HF.

Type of intervention Secondary prevention of heart failure (HF)-related events in patients at risk of HF. Emergency department observation of heart failure: preliminary analysis of safety and cost Storrow A B, Collins S P, Lyons M S, Wagoner L E, Gibler W B, Lindsell C J Record Status This is a critical abstract

More information

Course Title FUNCTIONAL ASSESSMENT OF PATIENTS WITH CARDIOVASCULAR DISEASES

Course Title FUNCTIONAL ASSESSMENT OF PATIENTS WITH CARDIOVASCULAR DISEASES Course Title FUNCTIONAL ASSESSMENT OF PATIENTS WITH CARDIOVASCULAR DISEASES Director Judith Regensteiner, Ph.D., Professor of Medicine Director, Clinical Treadmill Laboratory, UCHSC Background & Objectives

More information

Can Improvement Cause Harm: Ethical Issues in QI. William Nelson, PhD Greg Ogrinc, MD, MS Daisy Goodman, CNM. DNP, MPH

Can Improvement Cause Harm: Ethical Issues in QI. William Nelson, PhD Greg Ogrinc, MD, MS Daisy Goodman, CNM. DNP, MPH Session Code A4, B4 The presenters have nothing to disclose Can Improvement Cause Harm: Ethical Issues in QI William Nelson, PhD Greg Ogrinc, MD, MS Daisy Goodman, CNM. DNP, MPH December 6, 2016 #IHIFORUM

More information

A Randomized Trial of a Family-Support Intervention in Intensive Care Units

A Randomized Trial of a Family-Support Intervention in Intensive Care Units The new england journal of medicine Original Article A Randomized Trial of a Family-Support Intervention in Intensive Care Units D.B. White, D.C. Angus, A.-M. Shields, P. Buddadhumaruk, C. Pidro, C. Paner,

More information

Quality systems to avoid secondary brain injury in neurointensive care

Quality systems to avoid secondary brain injury in neurointensive care Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1113 Quality systems to avoid secondary brain injury in neurointensive care LENA NYHOLM ACTA UNIVERSITATIS UPSALIENSIS

More information

South London Neonatal Network Hypoxic Ischemic Encephalopathy Transfer Guidelines. Version 1.0

South London Neonatal Network Hypoxic Ischemic Encephalopathy Transfer Guidelines. Version 1.0 South London Neonatal Network Hypoxic Ischemic Encephalopathy Transfer Guidelines Version 1.0 Ratified: 28 th August 2018 Date for Review: 28 th August 2019 Suzanne.sweeney@uclpartners.com South London

More information

Trauma Logistics: The things to know ED Charge RN

Trauma Logistics: The things to know ED Charge RN The University East Bank Campus is verified by the American College of Surgeons as a Level II Trauma Center. We serve the metro and referring areas as a definitive care trauma center for our patients.

More information

An Evaluative Study of Practices Related to Administration of Vasoactive Drugs by Nurses

An Evaluative Study of Practices Related to Administration of Vasoactive Drugs by Nurses IOSR Journal of Nursing and Health Science (IOSRJNHS) eissn: 3 959.p ISSN: 3 9 Volume 3, Issue Ver. III (MarApr. ), PP 9 An Evaluative Study of Practices Related to Administration of Vasoactive Drugs by

More information

Is there an impact of Health Information Technology on Delivery and Quality of Patient Care?

Is there an impact of Health Information Technology on Delivery and Quality of Patient Care? Is there an impact of Health Information Technology on Delivery and Quality of Patient Care? Amanda Hessels, PhD, MPH, RN, CIC, CPHQ Nurse Scientist Meridian Health, Ann May Center for Nursing 11.13.2014

More information

Quality of Care of Medicare- Medicaid Dual Eligibles with Diabetes. James X. Zhang, PhD, MS The University of Chicago

Quality of Care of Medicare- Medicaid Dual Eligibles with Diabetes. James X. Zhang, PhD, MS The University of Chicago Quality of Care of Medicare- Medicaid Dual Eligibles with Diabetes James X. Zhang, PhD, MS The University of Chicago April 23, 2013 Outline Background Medicare Dual eligibles Diabetes mellitus Quality

More information

Barriers to Early Rehabilitation in Critically Ill Patients. Shannon Goddard, MD Sunnybrook Health Sciences Centre

Barriers to Early Rehabilitation in Critically Ill Patients. Shannon Goddard, MD Sunnybrook Health Sciences Centre Barriers to Early Rehabilitation in Critically Ill Patients Shannon Goddard, MD Sunnybrook Health Sciences Centre Disclosures/Funding No financial disclosures or conflicts of interest Work is funding by

More information

Pediatric Intensive Care Unit Rotation PL-2 Residents

Pediatric Intensive Care Unit Rotation PL-2 Residents PL-2 Residents Residents are required to have sufficient knowledge of their patients in order to present them to the team on rounds, and to construct a differential diagnosis and treatment plan. They are

More information

Adult-Gerontology Acute Care Nurse Practitioner Preceptor Manual

Adult-Gerontology Acute Care Nurse Practitioner Preceptor Manual COLLEGE OF HEALTH PROFESSIONS SCHOOL OF NURSING Graduate Programs Adult-Gerontology Acute Care Nurse Practitioner Preceptor Manual The Master of Science in Nursing at Wichita State University School of

More information