Alcohol-history taking by nurses and doctors — how accurate are they really?

The aim of this study was to look at how nurses and doctors record alcohol histories on the patients under their care and the frequency and appropriateness of the way they use an alcohol withdrawal scale in the acute hospital setting. To achieve these aims patient records were audited and compared at two points in time, in 1992 and 1994. Results of the study showed that nurses and doctors took alcohol histories from patients on approximately three-quarters of occasions and that this level of recording has not changed over time. The adequacy of alcohol-history taking has, however, increased for both nurses and doctors since 1992. At that time, 71% of the alcohol histories taken by nurses and 74% of alcohol histories taken by doctors were judged to be adequate. By 1994, however, 79% of alcohol histories taken by nurses and 77% of histories by doctors were rated as adequate. The increase in the adequacy of history taking by nurses was significant ( x ²= 5. 05; d.f. = 1; P <0.05) and the increase by doctors was not significant ( x ²= 1.03; d.f. = 1; P > 0.05). These results are seen as being positively associated with the major governmental nursing initiative in New South Wales, Australia, the New South Wales Strategic Plan for the Nursing Management of Alcohol and Other Drugs.     

Identifying and collecting pertinent medical records for centralized abstraction in a multi-center randomized clinical trial: The model used by the American College of Radiology arm of the National Lung Screening Trial

BackgroundIn clinical trials and epidemiologic studies, information on medical care utilization and health outcomes is often obtained from medical records. For multi-center studies, this information may be gathered by personnel at individual sites or by staff at a central coordinating center. We describe the process used to develop a HIPAA-compliant centralized process to collect medical record information for a large multi-center cancer screening trial.MethodsThe framework used to select, request, and track medical records incorporated a participant questionnaire with unique identifiers for each medical provider. De-identified information from the questionnaires was sent to the coordinating center indexed by these identifiers. The central coordinating center selected specific medical providers for abstraction and notified sites using these identifiers. The site personnel then linked the identifiers with medical provider information. Staff at the sites collected medical records and provided them for central abstraction.ResultsMedical records were successfully obtained and abstracted to ascertain information on outcomes and health care utilization in a study with over 18,000 study participants. Collection of records required for outcomes related to positive screening examinations and lung cancer diagnosis exceeded 90%. Collection of records for all aims was 87.32%.ConclusionsWe designed a successful centralized medical record abstraction process that may be generalized to other research settings, including observational studies. The coordinating center received no identifying data. The process satisfied requirements imposed by the Health Insurance Portability and Accountability Act and concerns of site institutional review boards with respect to protected health information.     

Use of time studies for determining intervention costs

BACKGROUND: Cost-effectiveness analyses are increasingly recommended to evaluate the effectiveness of health interventions. Determining the costs associated with delivery of a particular intervention is essential in conducting a cost-effectiveness analysis. Yet, there are few guidelines available to assist investigators in how to assess intervention costs associated with the personnel portion of an intervention. OBJECTIVES: To describe the use of time studies in calculating the program costs of personnel for use in future cost-effectiveness analysis of health interventions. METHODS: The literature on calculating intervention costs for use in cost-effectiveness analyses is reviewed. The process for conducting a time study for determining personnel costs in delivering an intervention and a step-by-step example from a time study are used to illustrate how personnel costs associated with delivery of the intervention can be separated from those costs associated with implementation of research procedures in the determination of research costs. CONCLUSIONS: Time studies provide a good estimate of part of the cost of implementing an intervention that is often difficult to determine-personnel time. The design of the time study should consider intervention components, staff involvement, and the time period for data collection.     

Polypharmacy

In today's managed healthcare environment two issues are at the forefront of concern: patient safety and patient confidentiality. Both of these share a common element in their relationship with medical and pharmaceutical health data. Patient safety depends upon access to this information, and yet ironically, medical and pharmaceutical records are now more difficult to access. This article looks at a case study of patients in Appalachia and how various issues influence patient safety, information that is needed and how to use these resources to reduce medical risk, especially in pharmaceutical therapies of the elderly.     

A Retrospective Analysis of the Impact of the Coronavirus Disease 2019 Pandemic on Health Care Workers in a Tertiary Hospital in Turkey

IntroductionSeveral vaccines have been developed and approved for use against severe acute respiratory syndrome coronavirus-2; however, the use of personal protective equipment remains important owing to the lack of effective specific treatment and whole community immunity. Hydroxychloroquine sulfate was a treatment option in the early days of the pandemic; however, it was subsequently removed owing to a lack of evidence as an effective treatment.We aimed to evaluate the testing and infection characteristics of coronavirus disease 2019 among health care personnel and determine the effectiveness of prophylactic hydroxychloroquine sulfate use to prevent transmission.MethodsThis retrospective observational study was conducted between May 1 and September 30, 2020. The health care personnel included in the study were physicians, nurses, and paraprofessional support personnel. The health records of health care personnel who had been tested for severe acute respiratory syndrome coronavirus-2 using polymerase chain reaction were retrospectively analyzed.ResultsIn total, 508 health care personnel were included in the study. A total of 152 (29.9%) health care personnel were diagnosed with coronavirus disease 2019. The positive polymerase chain reaction rate was 80.3% (n = 122). A comparison of infected and uninfected health care personnel showed a difference in age and occupation and no difference in sex, working area, and prophylactic hydroxychloroquine sulfate use.DiscussionProtective measures in low-risk areas of our hospital require improvements. All health care personnel should be trained on personal protective equipment use. There was no evidence to support the effectiveness of prophylactic hydroxychloroquine sulfate against severe acute respiratory syndrome coronavirus-2 transmission.     

Typology of High Users of Health Services Among a Rural Medicaid Population

ABSTRACT Objectives: To identify a typology for high system users among a rural Medicaid population that could assist policy makers and providers in better and more efficiently serving this population.
Design and Sample: Exploratory secondary data analysis of a large integrated Medicaid database in a western state. Five hundred and thirty-nine Medicaid recipients receiving 2 or more state services and receiving 10 or more unique medications.
Measures: Data analysis examining health care use, medication use, and demographic characteristics using SAS to identify patterns of use of services in the population. Results were confirmed with a statewide sample of 2,287 Medicaid users.
Results: 3 characteristics—(1) use of 36 or more health care services in a year; (2) no gap in health care service use over the entire year; and (3) use of >12 health care services in 1 month—describe high-risk groups of Medicaid users.
Conclusions: Public health nurses, particularly as case managers and program planners, can look at service use patterns through client histories and their own agency records, in order to identify high-risk groups who may benefit the most from programs that address their support, education, and coordination of health care needs.     

Nurse prescribing in low-resource settings: professional considerations

AIM: This paper reviews the professional issues relating to nurse prescribing in low-resource countries. BACKGROUND: In order to meet community healthcare need, nurses in low-resource settings often perform roles such as prescribing medication, for which they may not have had adequate training, often in the absence of supervision, legislation and regulation. In general, however, there is a paucity of published evidence relating to nurse prescribing in low-resource settings. Several studies have demonstrated improved health and social outcomes resulting from nurse-prescribing interventions. Alternatively, other studies have shown unsatisfactory nurse-prescribing patterns, such as overuse of antibiotics and poor adherence to national treatment guidelines. There are several examples of how nurse prescribing in low-resource countries has been recognized and addressed at national level; these are discussed in detail. However, given that it is widely acknowledged how crucial nurses are for the delivery of health care in regions where there are no medical personnel, international policy and guidance relating to this issue is only just beginning to acknowledge and address the relevant issues. CONCLUSION: Where there is a need for nurses to extend their role in the ordering of medicines and other treatments, the responsibilities, training, rights and roles of these nurses need to be clearly defined and recognized at all levels of the health service. There is a need for rigorous evaluations incorporating health, social and economic outcomes of nurse-prescribing interventions, in addition to close monitoring of legislative and regulatory changes related to nursing roles.     

Health risks and occupational exposure to volatile anaesthetics--a review with a systematic approach

Aims and objectives. To provide practicing nurse anaesthetists with evidence based knowledge as to whether they are at risk handling volatile anaesthetics by answering the question: What are the health risks threatening health care personnel occupationally exposed to volatile anaesthetics? Background. The interpretations of results from specific scientific studies vary and preliminary research results indicate that occupational exposure to volatile anaesthetics affects the health of operating room personnel. Design. Review of scientific literature with a systematic approach. Method. The review included a systematic search in three major databases, a screening process of abstracts/articles followed by a quality assessment of the included studies. The screening process and the quality assessment were done independently by the six reviewers and followed specific protocols. Results. A systematic search of The Cochrane Library, MedLine and CINAHL resulted in a screening of 413 abstracts of which 31 articles were assessed for quality, all done independently by the reviewers. Finally, the reviewers agreed upon how to interpret the results of the assessed articles. Conclusions. The 31 articles assessed covered areas such as genotoxic effects, neurobehavioural effects, immunology, and general health effects. In the scientific literature reviewed there is no evidence of occupational exposure to volatile anaesthetics either being associated with health risks or being harmless. Studies indicating a potential health risk are all investigating circumstances ignorant of modern environmental regulations and/or with no scavenging equipment. Relevance to clinical practice. Although no answer has been given, this review illuminates the methodological difficulties encountered in designing studies. The result of this review further stresses the need for scientific knowledge in this area and enhances the extensive use of scavenging equipment.     

Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: five case histories and results from a small series of patients

Heterotopic ossification (HO) is excess bone growth in soft tissues that frequently occurs in the residual limbs of combat amputees injured in Operation Iraqi Freedom and Operation Enduring Freedom, or Iraq and Afghanistan wars, respectively. HO can interfere with prosthetic use and walking and delay patient rehabilitation. This article describes symptomatic and/or radiographic evidence of HO in a patient series of combat amputees rehabilitating at a military amputee care clinic (27 patients/33 limbs). We conducted a retrospective review of patient records and physician interviews to document evidence of HO symptoms in these limbs (e.g., pain during prosthetic use, skin breakdown). Results showed HO-related symptoms in 10 of the 33 residual limbs. Radiographs were available for 25 of the 33 limbs, and a physician identified at least moderate HO in 15 of the radiographs. However, 5 of the 15 patients who showed at least moderate radiographic HO did not report adverse symptoms. Five individual patient histories described HO onset, symptoms, treatments, and outcomes. These case histories illustrated how HO location relative to pressure-sensitive/pressure-tolerant areas of the residual limb may determine whether patients experienced symptoms. These histories revealed the uncommon but novel finding of potential benefits of HO for prosthetic suspension.     

Using clinical data for nursing research and management in health services

Nurses generate large quantities of data at different operational levels in a health service organization. Administrative managerial data include the number of nursing hours per patient day and cost data related to nursing services while clinical data include the documentation of direct patient care only. In this paper, we explain standard clinical data elements in the HIS (Hospital Information System). The construction of the data is traced from patients' medical records to coding procedures within ICD (International Classification of Disease) classification and DRG (Diagnostic Related Groups) of casemix. Examples are given from Australian data and definitions, but much of the same information can be found in hospital information systems throughout the world. Practical applications that demonstrate how patient data can be used for research and management purposes in nursing are given. Finally, future directions and issues related to the use of datasets for nursing research are explored.     

HIPAA: past, present and future implications for nurses

Congress enacted Health Insurance Portability and Accountability Act (HIPAA) in 1996 to limit the ability of an employer to deny health insurance coverage to employees with preexisting medical conditions. The law also directed the U.S. Department of Health and Human Services to develop privacy rules, including, but not limited to, the use of electronic medical records. This law has increased patient privacy, but in doing so has added to the financial burden, including personnel costs in health care. Nurses stand at the forefront in the resolution of the dilemma of patient privacy versus health care expediency. The purpose of this article is to assist nurses and other health care professionals to better understand their responsibilities regarding HIPAA regulations. First, responses to HIPAA regulations by covered entities to date, along with responses which are still needed, will be described. It will be noted that HIPAA is a work in progress and not a specific act. Next, future initiatives having HIPAA implications will be presented. In conclusion, the need for all covered entities and their personnel to look broadly at HIPAA as initiating a new way of work in health care will be emphasized.     

How HMOs structure primary care delivery

To promote a shared understanding of how health maintenance organizations (HMOs) deliver primary care, the primary care staffing strategies of 23 HMOs are described: who they use as "gatekeepers," how they use nurse practitioners (NPs) and physician assistants (PAs), their referral policies, and their views on how the scope of practice of primary care may change. The study is based on on-site interviews with senior health plan personnel, and finds wide variations in primary care strategies, from open access to primary care and loose referral policies, to tight gatekeeping systems. In network/independent practice association (IPA) model plans, provider groups and IPAs, not the HMO, often determine who provides primary care. Implications are discussed.     

Mental health problems and medically unexplained physical symptoms in adult survivors of childhood sexual abuse: an integrative literature review

People sexually abused in childhood are at higher risk than non-abused people of medically unexplained symptoms such as irritable bowel syndrome or chronic pain, with mental ill health and high healthcare use. Friction and frustration, with high, unproductive healthcare costs, can often develop between these patients and health-care professionals such as general practitioners and nursing staff. The aim of this integrative literature review was to seek a sound evidence base from which to develop helpful interventions, improve relationships and identify gaps in knowledge. It found some theories about interconnections among childhood sexual abuse mental health and medically unexplained symptoms, such as 'somatization' or 'secondary gain', were used prejudicially, stigmatizing survivors. Conflicting theories make more difficult the search for effective interventions. Researchers rarely collaborated with sexual abuse specialists. Emphasis on identifying key risk factors, rather than providing support or alleviating distress, and lack of studies where survivors voiced their own experiences, meant very few targeted interventions for this group were proposed. Recommendations to enable effective interventions include making abuse survivors the prime study focus; qualitative research with survivors, to assist doctors and nursing staff with sensitive care; case histories using medical records; prospective studies with sexually abused children; support for the growing field of neurobiological research.     

Factors affecting children's use of physician services in a prepaid group practice

This paper examines factors affecting children's use of physician services in a prepaid group practice. The independent measures come from questions asked of mothers in a survey interview, while the utilization data come from their children's medical records. All independent variables were measured prior to the period of utilization studied. The results provide some evidence in support of the view that physician utilization for children is affected by characteristics of the mother, as well as the child's age and health status. Somewhat different variables were related to whether health services were used at all as compared with magnitude of use. Special consideration is given to the effect of the mother's level of psychological distress on her propensity to use medical services for children. The results suggest that distress was relevant, but only for the white families included in the sample. Also, distress was more important in explaining extent of use than accounting for whether utilization occurred at all. Various hypotheses are examined to explore white-nonwhite differences.     

Charting the future today: Psychiatric and mental health nurses in cyberspace

The development of the Internet is happening at a staggering pace and promises to have a dramatic impact on human relations. If nursing is to adapt to and benefit from these changes, consideration ought to be given to the experiences and opinions of nurses who have adapted to and use the technology. This paper provides an outline of the findings of an Email survey of psychiatric and mental health nurses who are experienced in using the Internet. Questions focused on what psychiatric and mental health nurses use the Internet for, how their use has changed, work‐related benefits, and what impact they see the Internet having in the future.     

Making the case for nurses as managers of nursing resources

The management of nursing services is challenging, fascinating, demanding and creative, but becomes more so in a country organizing its health care infrastructure from scratch and looking for new innovative solutions. Zimbabwe is such a country. And with nurses comprising 75-80% of its health care personnel and being increasingly given more responsibilities, the task of managing this valuable resource becomes formidable. Below, the author reports on how nurse managers are meeting their new challenge.     

Referral sources in home healthcare.

Home health agencies are dependent on referrals for survival, and sources for referrals are limitless. It is imperative that administrators have systems in place to accept referrals, including all data that are pertinent to the care of the patient, collect and maintain referral source data to use as one aspect of the agency's internal evaluation process, and target its marketing efforts. A home health agency must have approved policies and procedures available that address criteria for admission, continuation, and discharge from service. These must be shared with the personnel of the referral sources. The admission criteria should state the types of referrals that are not appropriate for service and how these referrals will be handled. As part of the overall management of the agency, administrators must also be aware of seasonal trends and how they may affect staffing and total budget. A positive relationship between the staff of the home health agency and the referral source is one way to generate needed referrals. The end result will benefit the patient, the agency, and the referring source.     

Uniform guidance for medical care. A description of the process for preparing guidelines accepted by different levels of care

Advice by telephone is an important part of primary health care service. Telephone advice is given at different levels of care. In order to give people confidence in the health care system it is important that personnel at different levels give similar advice for the same symptom or complaint. In order to establish generally accepted guidelines, discussions were held between personnel at different levels of care. This procedure was laborious but successful. Generally accepted guidelines could be agreed upon for all the symptoms and complaints discussed, altogether more than 60. This paper describes the procedure used during the collaborative work to provide these guidelines. It must be emphasised, though, that the guidelines should be adapted to local circumstances before being used as a practical aid in the health care service at health centres and at other outpatient units.