Enhanced SAIL Program: Evaluation of an Evidence-based Fall Prevention Program for Community Dwelling Elders

Aims: Evaluate the effectiveness of an enhanced version of the SAIL program on occupational performance, falls efficacy, motor agility and dynamic balance in community dwelling older adults.

Methods: A one-group pre-post design was implemented for older adults living in the surrounding community, and took place in the setting of a community rehabilitation hospital. Outcome measures used were: Canadian Occupational Performance Measure (COPM); Falls Efficacy Scale-International (FES-I); 8-Foot Up-and-Go; Biceps Curl Test; Chair Stand Test.

Results: Five of eight participants reported a clinically significant change using the COPM; Six of eight program participants reported an improvement in the FES-I. All participants showed improvement in the 8?Foot Up-and-Go and Chair Stand tests; and one participant showed improvement in the number of biceps curls.

Conclusions: The Enhanced SAIL positively impacted: lower extremity strength and overall agility, perceived occupational performance, and fall self-efficacy.     

Doctor-Related Medication Safety Incidents on a Specialist Palliative Medicine Inpatient Unit: A Retrospective Analysis of Three Years of Voluntary Reporting

Patients receiving palliative care and those at the end of life are known to be susceptible to medical errors. Errors related to medications are the most avoidable cause of patient harm. This retrospective study examined reported anonymized medication safety incidents, related to physician errors, assessed by the risk committee in a specialist palliative care unit over a 3-year time period. The aim of the study was to describe medication errors, with specific attention paid to what type of errors occurred and when these errors happened. Of the 218 reported medication safety incidents 28% (n = 62) were related to doctor prescribing. The data showed that there was a wide variation per year in the numbers of reported medication safety incidents. Medication prescribing errors were the most common error, followed by medication omissions. Medication safety incidents are at least in part dependent on staff reporting. Fostering a culture of openness that is blame free is crucial to medication error reporting. Formal reporting may help to increase patient safety and forms an essential element in the clinical governance and risk management of an institution.     

Implementation of a Comprehensive Safety Bundle to Support Newborn Fall/Drop Event Prevention and Response

ObjectiveTo create a comprehensive newborn fall/drop event prevention and response strategy in the form of a Newborn Fall Safety Bundle and to reduce newborn fall/drop events across an eight-hospital health system.DesignA performance improvement initiative guided by the Plan–Do–Study–Act model.Setting/Local ProblemA nonprofit health system consisting of one tertiary care center, three community hospitals, and four critical access hospitals. An increase in newborn fall/drop events was noted at one community hospital, with more than double the number of events being reported during fiscal year 2016 (five events) compared with fiscal year 2015 (two events). Injuries included skull fracture and hematoma, resulting in NICU admission and prolonged hospitalization.ParticipantsBedside registered nurses, educators, physicians, and nursing leadership representatives from tertiary, community, and critical access settings who formed a task force to identify and mitigate contributing factors, improve patient safety, and reduce newborn fall/drop events.Intervention/MeasurementsAn evaluation of the problem was undertaken using root cause analysis and Pareto principles. Gaps were prioritized, and focus areas were identified. Evidence-based interventions were organized into a Newborn Fall Safety Bundle. Process and outcome metrics were tracked as measures of improvement.ResultsPractice alignment with the Newborn Fall Safety Bundle was sustained at 90% or greater. Overall, the organization realized a 36% reduction in the newborn fall/drop event rate between fiscal year 2016 and fiscal year 2017. Rates declined from 6.66 to 4.06 newborn fall/drop events per 10,000 births. At the pilot site, newborn fall/drop event rates decreased from 21.95 to 0 events per 10,000 births over the same time period.ConclusionA reduction in newborn fall/drop events was observed after implementation of a comprehensive Newborn Fall Safety Bundle.     

精细化管理在门诊输液安全防范流程中应用的效果

目的探讨精细化管理在门诊静脉输液安全防范流程中的应用效果。方法学习精细化管理的相关理论知识,应用根本原因分析法分析以往静脉输液发生的问题,制定各环节安全防范流程;进行培训与考核后,实施并评价其效果。结果精细化管理实施后各环节输液护理缺陷发生明显降低,与实施前相比差异有统计学意义(P<0.05或P<0.01);患者对输液工作的满意度由82%上升到98%。结论精细化管理在门诊静脉输液安全防范流程中的应用,能指导和帮助护士有效规避护理不良事件的发生,保障患者的输液安全,增加护士落实安全防范工作的责任心,促进护理质量的提高和护患关系的改善。     

Promoting a Culture of Safety: Nursing and Radiology Management of the Pediatric Patient With an Implanted Cardiac Device

Pediatric patients with cardiovascular implantable electronic devices are a low-volume, high-risk group in the radiological setting. Knowledge of the clinical indications for the implanted device, coupled with device-specific considerations for radiologic procedures, is necessary to achieve the standard for quality of care. Implanted cardiac devices include loop recorders, pacemakers, and defibrillators. Safe imaging of children can be enhanced by the nurse's knowledge of the developmental considerations for age-appropriate care. This child-focused nursing care will improve the staff, child, and caregivers' experience. Comprehensive preparation and teamwork promote safety and ensures successful radiological experiences and quality imaging of the pediatric patient.     

Strategies for Enhancing Perioperative Safety: Promoting Joy and Meaning in the Workforce

Workforce safety is a precondition of patient safety, and safety from both physical and psychological harm in the workplace is the foundation for an environment in which joy and meaning can exist. Achieving joy and meaning in the workplace allows health care workers to continuously improve the care they provide. This requires an environment in which disrespectful and harmful behaviors are not tolerated or ignored. Health care leaders have an obligation to create workplace cultures that are characterized by respect, transparency, accountability, learning, and quality care. Evidence suggests, however, that health care settings are rife with disrespectful behavior, poor teamwork, and unsafe working conditions. Solutions for addressing workplace safety problems include defining core values, tasking leaders to act as role models, and committing to becoming a high-reliability organization.     

The Influence of Patient Safety Culture and Patient Safety Error Experience on Safety Nursing Activities of Emergency Nurses in South Korea

IntroductionThe unique nature of the space and environment of emergency departments is a threat to patient safety. Enhancing patient safety and minimizing safety-related issues are important tasks for ED health care staff. The purpose of this study was to examine the relationships among patient safety culture, patient safety error, and safety nursing activities of emergency nurses in South Korea.MethodsA convenience sample of 200 emergency nurses working in 12 general hospitals in South Korea were surveyed for safety nursing activities using the Hospital Survey of Patients’ Safety Culture, a 4-item questionnaire for patient safety error and ED safety management items in the Guidelines for Patient Safety (seventh revision).ResultsHierarchical regression analysis revealed that the potential factors associated with safety nursing activities were safety training experience (β = 0.180, P=.01), organizational learning–continuous improvement (β = 0.170, P=.04), age (β = 0.160, P=.02), and implementation of domestic and foreign accreditation (β = 0.147, P=.03).DiscussionTo improve patient safety, it is essential to identify problems in medical institutions, determine areas of improvement, and improve the organization’s patient safety activity system on the basis of patient safety error experience reports. After training the emergency nurses for continuous improvement, the effect of patient safety activities must be analyzed.     

Interventions used for Rehabilitation and Prevention of Patellar Tendinopathy in athletes: a survey of Brazilian Sports Physical Therapists

Objectives(1) To identify the type and frequency of interventions used by Brazilian physical therapists to treat and prevent the occurrence of patellar tendinopathy in athletes and the criteria used to return to sport; (2) to compare the interventions used to the grade of recommendation of current evidence.MethodsDesign: cross-sectional study. Setting: online survey throughout sports physical therapy association. Participants: Physical therapists who were invited to complete a structured questionnaire. Main Outcome Measures: Interventions more frequently used for treating and preventing PT in athletes and the criteria used to define return to sport.ResultsOne-hundred and twenty-one physical therapists participated in this study. Quadriceps eccentric strengthening (75.2%), education (61.2%) and lower limb joint/lumbo-pelvic stabilization/hamstrings stretching (59.5%) were more frequently cited for prevention purposes, while lower limb joint stabilization (81.8%), education (80.2%) and myofascial release (78.5%) were more frequently reported for treatment. The majority of the physical therapists based their decision of athlete discharge on a combination of pain intensity, function and functional test results (44.6%).ConclusionThere was inconsistency between interventions used in clinical practice and interventions recommended by the best available evidence.     

Profile of Patients at Admission into an Inpatient Stroke Rehabilitation Programme: Cardiorespiratory Fitness and Functional Characteristics

Purpose:

The purposes of this study were to characterize the cardiorespiratory capacity of individuals on admission to inpatient rehabilitation following stroke and to examine the relationship between measures of cardiorespiratory capacity and standard indices of neurological deficit and functional status.

Methods:

We recruited 45 patients within the first 10 days of admission to rehabilitation. We performed measures of aerobic fitness (VO₂peak), functional status (Functional Independence Measure [FIM] and Clinical Outcomes Variable Score [COVS]), and neurological deficit (National Institutes of Health Stroke Scale [NIHSS] and Chedoke-McMaster Stroke Assessment scale [CMSA]).

Results:

Nineteen women and 26 men with a mean (SD) age of 65.2 (14.5) years were admitted to rehabilitation 16.2 (11.9) (minimum 3, maximum 62) days post-stroke. Average VO₂peak was less than half the value expected in age-matched healthy individuals at 11.1 (3.1) ml/kg/min. The associations between VO₂peak and FIM, NIHSS, and COVS were weak (r = 0.25, -0.12, and 0.26 respectively, p = 0.12, 0.46, and 0.10 respectively). There were no differences in VO₂peak in higher-functioning individuals with CMSA leg scores of 5 and 6 compared to lower-functioning individuals with scores of 3 and 4 (p = 0.30).

Conclusion:

Cardiorespiratory capacity is extremely low in individuals during the first 3 months after stroke. Alternative measures of functional or clinical status do not adequately reflect this cardiorespiratory state; thus, routine measurement of cardiorespiratory capacity should be considered, along with a risk-factor profile.     

Transfusion Safety Officers in the United States: Survey of characteristics and approaches to implementation

BackgroundTransfusion safety officers (TSO) function as liaisons between the blood bank and clinical staff, utilizing audits, quality improvement, reviews, communication, education, and general vigilance to enhance transfusion safety. While hospitals in Europe and Canada have long employed TSOs, a majority of institutions in the United States (US) have yet to implement this resource, despite the mounting evidence to support their effectiveness.Study design and methodsAn anonymous 20-question survey was administered to 104 hospitals with valid email contact information. Survey questions addressed the presence of a TSO, characteristics, backgrounds, and education of TSOs, the reporting and funding structure of the position, and role responsibilities.Results53 responses were received, with 52 surveys completed (51 % response rate). The majority of responding institutions have a patient blood management (PBM) program (n = 40, 77 %) and 33 (63 %) have at least 1 TSO. 61 % of TSOs report an educational background in nursing, with 11 additional unique training backgrounds identified. TSO responsibilities are varied and include quality improvement, education, transfusion safety event analysis, and participation in PBM initiatives. Barriers to implementing a TSO position include lack of resources, financial impediments, and a lack of understanding of the position and its value by administrators and clinicians.DiscussionThe results of this survey highlight how TSOs contribute to transfusion safety and PBM and may provide guidance to hospitals interested in implementing a TSO position. It also elucidates the range of TSO responsibilities and approaches that institutions utilize to advocate for, and implement, this position in the US.