Know your tools: Improving the effectiveness of nurses using the confusion assessment method (CAM) to detect delirium
|
|
- Marilynn Rose
- 6 years ago
- Views:
Transcription
1 Know your tools: Improving the effectiveness of nurses using the confusion assessment method (CAM) to detect delirium 1 Julie Plagenhoef, MPH, RN, CMSRN
2 Preparing for Improvement: Why Delirium? Increases patient mortality Increases patient morbidity before and after hospitalization Increases patient and family distress Increases length of stay in hospital (Duppils, et al 2004; Inouye, et al 1998; McCusker, et al 2002; Maldonado as cited in Maldonado, et al 2008 and Ely, 2 et al 2001)
3 Change Management CAP: Change Acceleration Process Leading Change Creating a Shared Need Shaping a Vision Mobilizing Commitment Current State Transition State Making Change Last Improved State Monitoring Progress Changing Systems & Structures 3
4 Preparing for Improvement Using CAP Shaping a vision Hospital Goals CESP Unit Goals patient safety and experience Mobilizing commitment Unit manager, staff RNs, PPLs, staff educators, data experts 4
5 Assessment: The State of the CAM Baseline data Completeness of CAM assessments Reliability of CAM assessments Knowledge survey Gaps and strengths Barriers to completion and reliability Available resources Time, money, staff coverage 5
6 Diagnosis: What Needs to Change? Aim of project: Change practice to improve effectiveness of nurses using the CAM to detect delirium by increasing completeness of the tool and enhancing assessment of its features and outcome (reliability) 6
7 Planning: How to Improve? Best practices for RN education to improve completeness and reliability Predisposing: One hour discussion sessions, case vignettes Enabling: Flow sheets, champions Reinforcing: Feedback, pop-ups, re-train (Mamata, et al 2013 and Devlin, et al 2008) 7
8 Planning: How to Improve? Methods overview Knowledge survey results inform targeted education Paired CAM assessments of staff/expert RNs to assess reliability Chart audit to assess completeness Test period 2/11-3/7/2014 pre and 6/12-6/23/2014 post-training 2.5 weeks to complete education sessions Outcomes measured % completeness of CAM assessments Inter-rater reliability 8
9 Intervention: Implement Improvement Plan Knowledge survey 18 questions e.g., what is the CAM, how do you assess each feature, what are biggest barriers to using it? 23/34 (68%) RNs eligible for training responded Survey showed need for: Review of expectations (74% correct) Review of features (60-91% correct) Using CAM for TBI patients (30% listed as barrier) 9
10 Evaluation: Patient Demographics Pre/Post Training Pre-Training Post-Training P-value N % N % Total Patients Total Assessments Average Age Sex Males Females Mech of Injury Falls MVC/MCC Assault Other Brain Injury
11 Evaluation of CAM Completeness Pre/Post Training 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Percent CAM Assessments Complete *85% 73% Pre-Training Post-Training *Z= 2.36, p=
12 Evaluation of Inter-Rater Reliability Pre/Post Training 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 84% Pre-Training Overall CAM Agreement *97% Post-Training *Kappa= 0.059, p=
13 Evaluation: Making Change Last Follow-up knowledge survey 1 year later 16/36 (44%) RNs responded, 4/16 (25%) new hires Strengths: Understanding CAM features (81-100% correct) Risks for delirium (94% correct) Feeling comfortable using CAM (94% correct) Gaps: Using CAM for TBI patients (50% listed as barrier) 13
14 Evaluation of CAM Completeness at One Year 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Percent CAM Assessments Complete 85% 90% 73% Pre-Training Post-Training Follow-up 14
15 Evaluation of Inter-Rater Reliability at One Year 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% CAM Agreement, Overall and by Type of Injury 89% 88% 84% 100% 97% 100% 70% 58% Pre-Training Post-Training Follow-up Brain Injured Non-Brain Injured Overall 83% 15
16 Evaluation: What the Data Show Effectiveness of intervention Completeness and reliability of CAM assessments increased post-training One year later completeness was maintained but overall reliability decreased Opportunities for improvement Increase reliability for TBI patients Provide education reinforcement 16
17 Sustainability: Cost Analysis Staff RN education hours (34 RNs, 40 min education, $51.20/hr) Staff educator hours (1 presenter, 2 covering floor, $51.20/hr) Chart auditing (12 hrs, $51.20/hr) Implementation Cost Sustainability $1, Ed Day New Hires $2, Ed Day New Hires $ Repeat 1x/year CAM accuracy verification (2 PPLs, 10 hours) Fixed Cost Evaluate Need Total $3,
18 Sustainability: Benefit Analysis Delirium increases length of stay (LOS) by 4-10 days (Ely, et al., 2001) $2500/day = $10,000 to $25,000 cost Early recognition and intervention can decrease LOS by 4-10 days (Maldonado, et al., 2008; Lundstrom, et al., 2007) Cost avoidance of $10,000- $25,000 18
19 Next Steps Present follow-up data to 13A staff Incorporate into continuing education Incorporate into new staff orientation Periodic chart audits? Improve patient care outcomes (e.g., decrease length of stay, decrease fall rates) Prevention - Let s stop delirium! Interventions 19
20 Limitations Challenges of linking CAM+ assessments with delirium diagnoses Little definitive evidence for effectiveness of intervention strategies Resource constraints 20
21 Acknowledgements Anne Larkin, MSN, RN, NE-BC Dianne Wheeling, MNE, RN-C ED Michelle Dedeo, DNP, RN, ACCNS-AG, CCRN Kristen Richards, RN Barb Sells, RN Mariah Hayes, RN, MN, ONC Barbara Bonnice, DNP, RN Debi Eldredge, PhD, RN Denise Maierle, MSN, RN, CNS 13A Staff 21
22 References Devlin JW, et al. Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside. Critical Care 2008; 12:R19. Duppils GS, Wikbald K. Cognitive function and health-related quality of life after delirium in connection with hip surgery. A six-month follow-up. Orthop Nurs 2004; 23(3): Inouye SK, Rushing JT, Foreman MD, Palmer RM, Pompei P. Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. J Gen Intern Med 1998;13(4): Ely EW. Gautam S. Margolin R. Francis J. May L. Speroff T. Truman B. Dittus R. Bernard R. Inouye SK. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Medicine 2001; 27(12):
23 References Lundstrom M, Olofsson B, Stenvall M, Karlsson S, Nyberg L, Englund U, Borssen B, Svensson O, Gustafson Y. Postoperative delirium in old patient with femoral neck fracture: a randomized intervention study. Aging-Clinical & Experimental Research 2007; 19(3): Maldonado, JR. Delirium in the acute care setting: characteristics, diagnosis and treatment. Crit Care Clin 2008; 24: Mamata Y, Wieland D, Heflin M. Educational Interventions to Improve Recognition of Delirium: A Systematic Review. JAGS 2013; 61: McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. Arch Intern Med 2002; 162(4):
Delirium is under-recognized
Factors Influencing the Implementation of a Point-of-Care Screening Tool for Delirium Beth Ann Swan, Julie Becker, Rickie Brawer, and Christopher N. Sciamanna Delirium is under-recognized and not documented
More informationICU Restraint Reduction: Development of Evidence Based Tools to Guide Interventions
ICU Restraint Reduction: Development of Evidence Based Tools to Guide Interventions January 2012 Sandy Maag, BSN, RN Manager of Nursing Quality Malissa Mulkey, MSN, APRN, CCRN, CCNS Neuroscience ICU &
More informationImplementing a Five Level Triage in the Emergency Department
Implementing a Five Level Triage in the Emergency Department Enhancing Safety and Satisfaction Poster Presenter: Eileen Gallagher MSN, RN, ACNS-BC, PCCN Title: Clinical Nurse Specialist Objectives Discuss
More informationImproving Patient Satisfaction in the Orthopaedic Trauma Population
ORIGINAL ARTICLE Improving Patient Satisfaction in the Orthopaedic Trauma Population Brent J. Morris, MD,* Justin E. Richards, MD, Kristin R. Archer, PhD, Melissa Lasater, MSN, ACNP, Denise Rabalais, BA,
More informationInnovation Diffusion: The start of a good idea, initiating a fall prevention teach back tool.
It Takes a Village: Turning a Pilot Project into Part of the Culture Jennifer P Colwill MSN, APRN, CCNS, PCCN Dianna Copley MSN, APRN, ACCNS-AG, CCRN Shannon Rives, MSN, APRN, ACNS-BC, CCRN, CMSRN Innovation
More informationMobilisation of Vulnerable Elders in Ontario: MOVE ON. Sharon E. Straus MD MSc FRCPC Tier 1 Canada Research Chair
Mobilisation of Vulnerable Elders in Ontario: MOVE ON Sharon E. Straus MD MSc FRCPC Tier 1 Canada Research Chair Competing interests I have no relevant financial COI to declare I have intellectual/academic
More informationDefinitions. Using Physician Extenders on Inpatient Resident Teams to help meet. Kathleen Finn, MD. ACGME Requirements. Physician Extenders
Using Physician Extenders on Inpatient Resident Teams to help meet ACGME Requirements Kathleen Finn, MD John Moriarty, MD Definitions ACGME Requirements Physician Extenders Clerical Assistants Nurse Practitioners
More informationDevelopment & Implementation of A Progressive Mobility Protocol for Hospitalized Veterans
Development & Implementation of A Progressive Mobility Protocol for Hospitalized Veterans Presented by: Rebecca R. Parks MSN, RN, ANP-BC Earlie Hale DNP, RN, CNS-BC, CMSRN, VHA-CM Richard L. Roudebush
More informationInpatient 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 informationBarriers 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 informationABCDEF Bundle Implementation
ABCDEF Bundle Implementation Anne Putzer, MS, RN, ACNS-BC, CCRN Cat Zyniecki, BSN, RN, CCRN Columbia St. Mary s Wisconsin Association of Clinical Nurse Specialists CNO/CNS/Shared Governance Breakfast September
More informationPost operative pain assessment and delirium in the orthopaedic patient A Review of the literature
Post operative pain assessment and delirium in the orthopaedic patient A Review of the literature Caroline Costello Orthopaedic and Plastic surgery Department Cork University Hospital Presentation overview
More informationProgressive Mobility in the ICU: Improving the Patient Experience. Rachel Lewis-Bayliss BSN, RN Theresa M. Davis PhD, RN, NE-BC
Progressive Mobility in the ICU: Improving the Patient Experience Rachel Lewis-Bayliss BSN, RN Theresa M. Davis PhD, RN, NE-BC Early Progressive Mobility Team Jason Vourlekis MD, MBA: Medical Director
More informationMichelle A. Dedeo DNP, RN, ACCNS-AG, CCRN Linfield College Office Peterson Hall 323
Education University of Washington Seattle, WA Doctorate in Nursing Practice (DNP) December 2014 Masters in Nursing (MN) March 2014 University of Wisconsin Madison, WI Bachelors of Science in Nursing (BSN)
More informationStrategies to Reduce Readmissions, Sepsis, and Health-Care Associated Infections
C10 This presenter has nothing to disclose Strategies to Reduce Readmissions, Sepsis, and Health-Care Associated Infections David Renfro, MS, RN NE BC Kelly Farnam, BSN, RN Gloria Martinez, MS, RN, NEA
More informationScaling 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 informationGetting Answers about Concussions: CDC to Pilot a National Concussion Surveillance System
Getting Answers about Concussions: CDC to Pilot a National Concussion Surveillance System National Center for Injury and Prevention and Control Division of Unintentional Injury Prevention Lace DePadilla,
More informationPatients 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 informationSepsis Screening Tools
ICU Rounds Amanda Venable MSN, RN, CCRN Case Mr. H is a 67-year-old man status post hemicolectomy four days ago. He was transferred from the ICU to a medical-surgical floor at 1700 last night. Overnight
More information2018 DOM HealthCare Quality Symposium Poster Session
Winner - Outstanding Faculty Project Author Hillary Lum, MD, Faculty Division/Department Geriatric Medicine / Department of Medicine UCHealth Patient use of a Medical Power of Attorney via My Health Connection
More informationORL Head and Neck Nursing Winter 2016 / Volume 34, Number 1
Winter 2016 / Volume 34, Number 1 Improving Tracheostomy Care Delivery: Instituting Clinical Care Pathways and Nursing Education to Improve Patient Outcomes Maria Colandrea, DNP, NP-C, CORLN, CCRN and
More informationPreventing 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 informationNational Priorities for Improvement:
National Priorities for Improvement: Standardization of Performance Measures, Data Collection, and Analysis Dale W. Bratzler, DO, MPH Principal Clinical Coordinator Oklahoma Foundation Contracting for
More informationA Healthy Work Environment Endeavor Postoperative Handover from the OR to CTICU
A Healthy Work Environment Endeavor Postoperative Handover from the OR to CTICU Anna Dermenchyan RN, BSN, CCRN-CSC Clinical Nurse III, Cardiothoracic ICU Ronald Reagan UCLA Medical Center adermenchyan@mednet.ucla.edu
More informationEarly 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 informationUsing 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 informationCognitive Aids to Improve Crisis Management
Cognitive Aids to Improve Crisis Management Alexander A. Hannenberg, M.D. Council on Surgical & Perioperative Safety Emergency Manual Implementation Collaborative Past President American Society of Anesthesiologists
More informationBenefits of a pathway: The experience of utilizing a NOF pathway. Megan Yeomans Clinical Nurse Consultant Pain Team, Austin Health
Benefits of a pathway: The experience of utilizing a NOF pathway Megan Yeomans Clinical Nurse Consultant Pain Team, Austin Health Our health service # NOF Presentations 2010-2011: 262 2011-2012: 246 Management
More informationREDUCING READMISSIONS through TRANSITIONS IN CARE
REDUCING READMISSIONS through TRANSITIONS IN CARE Christina R. Whitehouse, PhD, CRNP, CDE Postdoctoral Research Fellow NewCourtland Center for Transitions and Health University of Pennsylvania School of
More informationGet UP to Drive Harm Down. ND Webinar March 29, 2018 Maryanne Whitney RN CNS MSN Cynosure Health
Get UP to Drive Harm Down ND Webinar March 29, 2018 Maryanne Whitney RN CNS MSN Cynosure Health What is your role in your organization? Quality Leader RN MD Rehab specialist RT Other- please chat in your
More informationIMPACT OF SIMULATION EXPERIENCE ON STUDENT PERFORMANCE DURING RESCUE HIGH FIDELITY PATIENT SIMULATION
IMPACT OF SIMULATION EXPERIENCE ON STUDENT PERFORMANCE DURING RESCUE HIGH FIDELITY PATIENT SIMULATION Kayla Eddins, BSN Honors Student Submitted to the School of Nursing in partial fulfillment of the requirements
More informationRita Hunsucker, DNP, Nicole Cornell, MS, Gerald Hobbs, PhD, Jorge Con, MD & Alison Wilson, MD WVU Medicine, J.W. Ruby Memorial Hospital
Rita Hunsucker, DNP, Nicole Cornell, MS, Gerald Hobbs, PhD, Jorge Con, MD & Alison Wilson, MD WVU Medicine, J.W. Ruby Memorial Hospital The authors have nothing to disclose. Post extubation dysphagia (PED)
More informationPatient with Total Hip Replacement: Bedside Simulation and Implications for Collaborative Practice and Improved Patient Safety
Patient with Total Hip Replacement: Bedside Simulation and Implications for Collaborative Practice and Improved Patient Safety Laurie Brogan, PT, DPT, CEEAA, GCS, Gina Capitano M.S.,R.T.(R), Audrey Cunfer,
More informationHealthcare 9/15/2017. Learning Outcomes. Transforming Clinical and Fiscal Outcomes through Staff Nurse Driven Change
Transforming Clinical and Fiscal Outcomes through Staff Nurse Driven Change Marian Altman RN, MS, CNS-BC, CCRN-K,ANP American Association of Critical Care Nurses Clinical Practice Specialist Learning Outcomes
More informationThank you for joining us today!
Thank you for joining us today! Please dial 1.800.732.6179 now to connect to the audio for this webinar. To show/hide the control panel click the double arrows. 1 Emergency Room Overcrowding A multi-dimensional
More informationA Resident-led PICU Morbidity and Mortality Conference
A Resident-led PICU Morbidity and Mortality Conference James Moses, MD, MPH Associate Program Director Boston Combined Residency Program Director of Patient Safety and Quality Department of Pediatrics
More informationED Care Coordination Pathway Partnership
ED Care Coordination Pathway Partnership 1 SUPER UTILIZER INTERVENTION FOR QUALITY IMPROVEMENT THE HEALTH COLLABORATIVE HEALTH CARE ACCESS NOW UNIVERSITY OF CINCINNATI MEDICAL CENTER MAY 29, 2013 Cincinnati
More informationThe National Association of Clinical Nurse Specialists (NACNS)
The National Association of Clinical Nurse Specialists (NACNS) Response to the Institute of Medicine s Future of Nursing Report This document was prepared by an NACNS appointed task force that was tasked
More informationThe Heart of Care Redesign; Care Protocols. Paul N. Casale, MD, FACC Chief, Division of Cardiology Lancaster General Health
The Heart of Care Redesign; Care Protocols Paul N. Casale, MD, FACC Chief, Division of Cardiology Lancaster General Health Lancaster General Health By the Numbers (Fiscal Year 2012) Beds: 631 in service
More informationPromoting Colorectal Cancer Screening in Rural Emergency Departments
Promoting Colorectal Cancer Screening in Rural Emergency Departments Jennifer Hatcher, RN, MPH, PhD Associate Professor Director of Diversity & Inclusivity College of Nursing University of Kentucky Why
More informationVNAA Blueprint for Excellence PATHWAY TO BEST PRACTICES
VNAA Blueprint for Excellence PATHWAY TO BEST PRACTICES Care Initiation: Critical Interventions VNAA Best Practice for Hospice and Palliative Care The first few days following a patient s admission to
More informationSaving 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 informationPEDIATRIC CRITICAL CARE NURSE CERTIFICATION E-BOOK
20 January, 2018 PEDIATRIC CRITICAL CARE NURSE CERTIFICATION E-BOOK Document Filetype: PDF 537.16 KB 0 PEDIATRIC CRITICAL CARE NURSE CERTIFICATION E-BOOK The Pediatric Nursing Certification Board (PNCB),
More information12/12/2016. The Impact of Shift Length on Mood and Fatigue in Registered Nurses: Are Nurses the Next Grumpy Cat? Program Outcomes: Background
The Impact of Shift Length on Mood and Fatigue in Registered Nurses: Are Nurses the Next Grumpy Cat? Wendy Ungard, DNP, RN, NEA-BC Cincinnati Children s Hospital, Cincinnati, OH Program Outcomes: Review
More informationWhen you have to be right. Increase Competence. Improve Outcomes. Health. Lippincott Professional Development Collection. Lippincott Solutions
When you have to be right Increase Competence. Improve Outcomes. Health Lippincott Professional Development Collection Lippincott Solutions Lippincott Professional Development Collection Lippincott Professional
More informationObjectives 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 informationEliminating Catheter-Associated Urinary Tract Infections: Implementing a Quality Improvement Project
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 informationCase-mix Analysis Across Patient Populations and Boundaries: A Refined Classification System
Case-mix Analysis Across Patient Populations and Boundaries: A Refined Classification System Designed Specifically for International Quality and Performance Use A white paper by: Marc Berlinguet, MD, MPH
More informationSolution Title: Reduction Nurse Sensitive Conditions: Utilizing an Observational and Retrospective Review Methodology
Methodology 1 Organization: Sinai Hospital of Baltimore Solution Title: Reduction Nurse Sensitive Conditions: Utilizing an Observational and Retrospective Review Methodology Focus Area: Clinical Nurse
More informationProblem The Joint Commission (JC) and Institute of Medicine (IOM) identify inpatient falls as a significant patient safety risk However research regar
A Closer Look at Pediatric Falls: A CHCA Multi-site study Patricia R. Messmer, PhD, RN-BC, FAAN Miami Dade College Deborah Hill-Rodriguez, ARNP, MSN, PCNS-BC Miami Children s Hospital Patricia A. Jamerson,
More informationProfessional Development: Certification & Level III Project Promotion. Shelee Padhiar, MSN, RN, CCRN, CCDS EBP Fellow UPMC Shadyside Hospital
Professional Development: Certification & Level III Project Promotion Shelee Padhiar, MSN, RN, CCRN, CCDS EBP Fellow UPMC Shadyside Hospital Purpose To identify existing knowledge deficits Develop staff
More informationSouth Carolina Nursing Education Programs August, 2015 July 2016
South Carolina Nursing Education Programs August, 2015 July 2016 Acknowledgments This document was produced by the South Carolina Office for Healthcare Workforce in the South Carolina Area Health Education
More informationInpatient Rehabilitation Program Information
Inpatient Rehabilitation Program Information The Inpatient Rehabilitation Program at TIRR Memorial Hermann-Greater Heights has a team of physicians, therapists, nurses, a case manager, neuropsychologist,
More informationSAHS 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 informationTriage. CAPWHN October 23, Nancy Watts, RN, MN, PNC Clinical Nurse Specialist, Perinatal London Health Sciences Centre
Triage CAPWHN October 23, 2014 Nancy Watts, RN, MN, PNC Clinical Nurse Specialist, Perinatal London Health Sciences Centre Rob Gratton, MD, FRCS(C), FACOG Department of Obstetrics and Gynecology Western
More informationPredicting 30-day Readmissions is THRILing
2016 CLINICAL INFORMATICS SYMPOSIUM - CONNECTING CARE THROUGH TECHNOLOGY - Predicting 30-day Readmissions is THRILing OUT OF AN OLD MODEL COMES A NEW Texas Health Resources 25 hospitals in North Texas
More informationHealthcare-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 informationCare Zones Staffing Model: Solving Workflow Barriers to Improve Patient and Nurse Outcomes
Care Zones Staffing Model: Solving Workflow Barriers to Improve Patient and Nurse Outcomes Emory University Hospital Atlanta, Georgia STTI 201 Creating Healthy Work Environments March 1-19 Indianapolis
More informationA Network of Long Term Care Facilities for Conducting Pharmaco-Epi Observational Studies: Experience from USA and Europe
A Network of Long Term Care Facilities for Conducting Pharmaco-Epi Observational Studies: Experience from USA and Europe Vincent Mor, Ph.D. Giovanni Gambassi, M.D. 1 Conflicts of Interest -- Mor F PI of
More informationRunning Head: IMPLEMENTING CONFUSION ASSESSMENT METHOD
Running Head: IMPLEMENTING CONFUSION ASSESSMENT METHOD Implementing the Confusion Assessment Method to Improve the Care of Delirious Patients By Irene Akande A capstone project submitted to the University
More informationCare Transitions Engaging Psychiatric Inpatients in Outpatient Care
Care Transitions Engaging Psychiatric Inpatients in Outpatient Care Mark Olfson, MD, MPH Columbia University New York State Psychiatric Institute New York, NY A physician is obligated to consider more
More informationA Comparison of the Effect of Pre-briefing on Students Performance and Perceived Self Confidence During Simulation Michele Enlow, DNP, RNC-OB Debra
A Comparison of the Effect of Pre-briefing on Students Performance and Perceived Self Confidence During Simulation Michele Enlow, DNP, RNC-OB Debra Horning, MSN, RNC-OB Barb Scherer, MSN, NE-BC Marie Cobb,
More informationRutgers School of Nursing-Camden
Rutgers School of Nursing-Camden Rutgers University School of Nursing-Camden Doctor of Nursing Practice (DNP) Student Capstone Handbook 2014/2015 1 1. Introduction: The DNP capstone project should demonstrate
More informationTHE 2017 QUALIS HEALTH AWARDS OF EXCELLENCE IN HEALTHCARE QUALITY IN WASHINGTON
THE 2017 QUALIS HEALTH AWARDS OF EXCELLENCE IN HEALTHCARE QUALITY IN WASHINGTON Since 2002, Qualis Health has presented the annual Awards of Excellence in Healthcare Quality to outstanding organizations
More informationCommunication with Surrogate Decision Makers. Shannon S. Carson, MD Associate Professor University of North Carolina
Communication with Surrogate Decision Makers Shannon S. Carson, MD Associate Professor University of North Carolina Role of Communication with Families in the ICU Sharing information about illness and
More informationConceptualization Panel rating: 2 Purpose. Completed 04/04 1
Tool: Nursing Assistant-Administered Instrument to Assess Pain in Demented Individuals (NOPPAIN) Tool developer: Snow, A.L., Weber, J.B., O Malley, Cody, M., Beck, C., Bruera, E., Ashton, C., Kunik, M.E.
More informationSimulation to Assess and Improve EHR Safety
Simulation to Assess and Improve EHR Safety Dr. Jeffrey A. Gold, MD 10/18/17 Disclosures No Commercial Conflicts of Interest Research Funding from AHRQ, AAMC/Donaghue Foundation Patient Safety and EHRs
More informationPreventing Heart Failure Readmissions by Using a Risk Stratification Tool
Preventing Heart Failure Readmissions by Using a Risk Stratification Tool Anna Dermenchyan, MSN, RN, CCRN-K Senior Clinical Quality Specialist Department of Medicine, UCLA Health PhD Student, UCLA School
More informationImproving patient satisfaction by adding a physician in triage
ORIGINAL ARTICLE Improving patient satisfaction by adding a physician in triage Jason Imperato 1, Darren S. Morris 2, Leon D. Sanchez 2, Gary Setnik 1 1. Department of Emergency Medicine, Mount Auburn
More informationStopping 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 informationA23/B23: Patient Harm in US Hospitals: How Much? Objectives
A23/B23: Patient Harm in US Hospitals: How Much? 23rd Annual National Forum on Quality Improvement in Health Care December 6, 2011 Objectives Summarize the findings of three recent studies measuring adverse
More informationData, analysis and evidence
1 New Congenital Heart Disease Review Data, analysis and evidence Joanna Glenwright 2 New Congenital Heart Disease Review Evidence for standards Joanna Glenwright Evidence to inform the service standards
More information2/15/2017. Reducing Mislabeled and Unlabeled Specimens In Acuity Adaptable Units
Reducing Mislabeled and Unlabeled Specimens In Acuity Adaptable Units Jennifer Kitchens MSN, RN, ACNS-BC, CVRN Clinical Nurse Specialist Acuity Adaptable Esther Onuorah, MSN, RN, CMSRN Staff Nurse Acuity
More informationMalnutrition Screening Pathway v.1.1
Malnutrition Screening Pathway v.1.1 Approval & Citation Summary of Version Changes Explanation of Evidence Ratings Inclusion Criteria Inpatients age 1 month and older Exclusion Criteria
More informationObjectives. Vessel Health and Preservation: Disclosure. Ms. Moureau has disclosed the following: Angiodynamics, Genentech
Vessel Health and Preservation: What is the Right Line for the Right Patient at the Right Time? Nancy Moureau, BSN, RN, CRNI, CPUI, VA-BC This program is sponsored by Teleflex Saxe Communications 2012
More informationPRESSURE ULCER PREVENTION
PRESSURE ULCER PREVENTION University of South Alabama Medical Center Mobile, AL Becky Pomrenke, RN, MSN, CNL University of South Alabama Medical Center Academic, Urban Hospital Regional Level I Trauma
More informationManaging Patients with Multiple Chronic Conditions
Managing Patients with Multiple Chronic Conditions Sponsored by AMGA and Merck & Co., Inc. 1 Group Pre-work Affinity Medical Group Heart, Lung & Vascular Center COURAGE Clinic 2 Medical Group Profile Affinity
More informationSurveillance: Post-event Strategies
Surveillance: Post-event Strategies Developed by the Florida Center for Public Health Preparedness 1 Program Objectives Understand surveillance purpose and use in post-event epidemiologic investigation
More informationThe Amb Score. A pilot study to develop a scoring system to identify which emergency medical referrals would be suitable for Ambulatory Care.
The Amb Score A pilot study to develop a scoring system to identify which emergency medical referrals would be suitable for Ambulatory Care. Les Ala 1, Jennifer Mack 2, Rachel Shaw 2, Andrea Gasson 1 1.
More informationPredict, prevent & manage AKI: A UK collaboration to detect a devastating condition AKI
Predict, prevent & manage AKI: A UK collaboration to detect a devastating condition AKI Case Study Acute kidney injury (AKI) is a potentially devastating condition, thought to contribute to the deaths
More informationHow to Initiate and Sustain Operational Excellence in Healthcare Delivery: Evidence from Multiple Field Experiments
How to Initiate and Sustain Operational Excellence in Healthcare Delivery: Evidence from Multiple Field Experiments Aravind Chandrasekaran PhD Peter Ward PhD Fisher College of Business Ohio State University
More informationSENTARA HEALTHCARE. Norfolk, VA
SENTARA HEALTHCARE Norfolk, VA 1 Sentara Healthcare Overview 11 Acute Care Hospitals in Virginia with a total of 2572 licensed beds 1E Extended dstay hospital 9 Ambulatory Care Campuses; 5 with freestanding
More informationConnecting the Revenue and Reimbursement Cycles
Connecting the Revenue and Reimbursement Cycles Tuesday, August 19 th, 2014 Toni G. Cesta, Ph.D., RN, FAAN Consultant and Partner Case Management Concepts New York Office And Bev Cunningham, MS, RN Vice
More informationPatient Safety: Fall Prevention. Unlicensed Assistive Personnel
Patient Safety: Fall Prevention Unlicensed Assistive Personnel Purpose and Objectives Purpose: Review the UCH Fall Prevention Program Objectives: 1. Present evidence about patient safety and falls. 2.
More informationWork In Progress August 24, 2015
Presenter Sarah Wilson MSOTR/L, CHT, CLT 4 th year PhD student at NOVA Southeastern University Practicing OT for 14 years Have worked for Washington Orthopedics and Sports Medicine for the last 8 years
More informationBarriers to Early Mobilization in Critically Ill Patients
Barriers to Early Mobilization in Critically Ill Patients Shannon Goddard, MD Department of Critical Care Medicine, Sunnybrook Health Sciences Centre PhD Student, Institute of Health Policy, Management
More information3/10/2017. Interprofessional Collaboration, In situ Simulation and TeamSTEPPS : A Practice Improvement Initiative
Interprofessional Collaboration, In situ Simulation and TeamSTEPPS : A Practice Improvement Initiative Kathleen Poindexter, PhD, RN, CNE; Jennifer Thompson Wood, MSN, RN, ACNS BC; Gayle Lourens, DNP, MS,
More informationTransitions of Care: From Hospital to Home
Transitions of Care: From Hospital to Home Danielle Hansen, DO, MS (Med Ed) Associate Director, LECOM VP Acute Care Services & Quality/Performance Improvement, Millcreek Community Hospital Objectives Discuss
More informationOR Positioning and Pressure Injury Prevention. September 13, Ann N. Tescher, APRN CNS, PhD, CCRN, CWCN Debra L.
OR Positioning and Pressure Injury Prevention September 13, 2017 Ann N. Tescher, APRN CNS, PhD, CCRN, CWCN Debra L. Fawcett, PhD, RN 2017 National Pressure Ulcer Advisory Panel www.npuap.org NPUAP Mission
More informationDo Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders: Current practice and problems - and a possible solution. Zoë Fritz
Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders: Current practice and problems - and a possible solution Zoë Fritz Consultant in Acute Medicine, Cambridge University Hospitals Wellcome Fellow
More informationPATH: Preview of indicators. A-L. Guisset World Health Organization regional office for Europe
PATH: Preview of indicators A-L. Guisset World Health Organization regional office for Europe agu@euro.who.int Preview of indicators Rationale, generic definition Results and lessons learnt from PATH-pilot
More informationApproximately 180,000 patients die annually in the
PRACTICE IMPROVEMENT SITUATION, BACKGROUND, ASSESSMENT, AND RECOMMENDATION GUIDED HUDDLES IMPROVE COMMUNICATION AND TEAMWORK IN THE EMERGENCY DEPARTMENT Authors: Heather A. Martin, DNP, RN, PNP-BC, and
More informationCER Module ACCESS TO CARE January 14, AM 12:30 PM
CER Module ACCESS TO CARE January 14, 2014. 830 AM 12:30 PM Topics 1. Definition, Model & equity of Access Ron Andersen (8:30 10:30) 2. Effectiveness, Efficiency & future of Access Martin Shapiro (10:30
More informationUsing Pressure Mapping Technology to Reduce Hospital Acquired Pressure Ulcers
Using Pressure Mapping Technology to Reduce Hospital Acquired Pressure Ulcers Kimberly Durham BSN, RN, CCRN, PCCN And Amy L. Sprague MSN, RN, ACNS-BC, CCRN Indianapolis, Indiana Franciscan Alliance St.
More informationGo With The Flow: The Use of Movement Meditation to Reduce Simulation Anxiety in Nursing Students
Go With The Flow: The Use of Movement Meditation to Reduce Simulation Anxiety in Nursing Students Angela Mulcahy, RN, MS, CMSRN, PhD(c) Kevin Gosselin, Ph.D. Brian Holland, Ph.D., RN Alison Pittman, RN,
More informationMeasuring Harm. Objectives and Overview
Patient Safety Research Introductory Course Session 3 Measuring Harm Albert W Wu, MD, MPH Former Senior Adviser, WHO Professor of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health
More informationPatient Safety Research Introductory Course Session 3. Measuring Harm
Patient Safety Research Introductory Course Session 3 Measuring Harm Albert W Wu, MD, MPH Former Senior Adviser, WHO Professor of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health
More informationAssessing an Expanded Definition for Injuries in Hospital Discharge Data Systems. Report from the Injury Surveillance Workgroup (ISW6)
Assessing an Expanded Definition for Injuries in Hospital Discharge Data Systems Report from the Injury Surveillance Workgroup (ISW6) Assessing an Expanded Definition for Injuries in Hospital Discharge
More informationExemplary Professional Practice: Patient Care Delivery Model(s)
Exemplary Professional Practice: Patient Care Delivery Model(s) EP7EO Nurses systematically evaluate professional organizations standards of practice, incorporating them into the organization s professional
More informationValue Conflicts in Evidence-Based Practice
Value Conflicts in Evidence-Based Practice Jeanne Grace Corresponding author: J. Grace E-mail: jeanne_grace@urmc.rochester.edu Jeanne Grace RN PhD Emeritus Clinical Professor of Nursing, University of
More information