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Gillian Ray-Barruel Amanda J. Ullman Claire M. Rickard Marie Cooke 《Australian critical care》2018,31(2):106-109
Clinical audits are an essential part of the cycle designed to ensure that patients receive the best quality of care. By measuring the care delivered against established best practice standards, it becomes possible to identify shortcomings and to plan targeted strategies and processes for continuous improvement. The success of a clinical audit depends upon defined goals, motivation of stakeholders, appropriate tools and resources, and clear communication.In part 1 of this series, an overview of the structures and processes needed to prepare and collect data for clinical audits in the critical care setting was provided [A.J. Ullman, G. Ray-Barruel, C.M. Rickard, M. Cooke, Clinical audits to improve critical care: Part 1 Prepare and collect data, Aust Crit Care, 2017, in press]. In part 2, we discuss how to analyse the collected audit data, benchmark findings with internal and external data sets, and feedback audit results to critical care clinicians to promote evidence-based practice and improve patient outcomes. 相似文献
74.
Indiara Soares Oliveira Leonardo Oliveira Pena Costa Alessandra Narciso Garcia Gisela Cristiane Miyamoto Cristina Maria Nunes Cabral Lucíola da Cunha Menezes Costa 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2018,22(4):328-335
Objective
To identify potential prognostic factors that may predict clinical improvement of patients treated with different physical therapy interventions in the short-term.Methods
This is a prospective cohort study. A total of 616 patients with chronic non-specific low back pain treated with interventions commonly used by physical therapists were included. These patients were selected from five randomized controlled trials. Multivariate linear regression models were used to verify if sociodemographic characteristics (age, gender, and marital status), anthropometric variables (height, body mass, and body mass index), or duration of low back pain, pain intensity at baseline, and disability at baseline could be associated with clinical outcomes of pain intensity and disability four weeks after baseline.Results
The predictive variables for pain intensity were age (β = 0.01 points, 95% CI = 0.00 to 0.03, p = 0.03) and pain intensity at baseline (β = 0.23 points, 95% CI = 0.13 to 0.33, p = 0.00), with an explained variability of 4.6%. Similarly, the predictive variables for disability after four weeks were age (β = 0.03 points, 95% CI = 0.00 to 0.06, p = 0.01) and disability at baseline (β = 0.71 points, 95% CI = 0.65 to 0.78, p = 0.00), with an explained variability of 42.1%.Conclusion
Only age, pain at baseline and disability at baseline influenced the pain intensity and disability after four weeks of treatment. The beta coefficient for age was statistically significant, but the magnitude of this association was very small and not clinically important. 相似文献75.
Background
Further efforts are warranted to identify innovative approaches to best implement competencies in nursing education. To bridge the gap between competency-based education, practice, and implementation of knowledge, skills, and attitudes, one emerging approach is entrustable professional activities (EPAs).Purpose
The objective of this study was to introduce the concept of EPAs as a framework for curriculum and assessment in graduate nursing education and training.Methods
Seven steps are provided to develop EPAs for nurses through the example of a quality and safety EPA. The example incorporates the Quality and Safety Education for Nurses (QSEN) patient safety competencies and evidence-based literature.Findings
EPAs provide a practical approach to integrating competencies in nursing as quality and safety are the cornerstones of nursing practice, education, and research.Discussion
Introducing the EPA concept in nursing is timely as we look to identify opportunities to enhance nurse practitioner (NP) training models and implement nurse residency programs. 相似文献76.
Tiago S. Jesus Christina Papadimitriou Cátia S. Pinho Helen Hoenig 《Archives of physical medicine and rehabilitation》2018,99(6):1141-1148.e4
Objective
To characterize the peer-reviewed quality improvement (QI) literature in rehabilitation.Data Sources
Five electronic databases were searched for English-language articles from 2010 to 2016. Keywords for QI and safety management were searched for in combination with keywords for rehabilitation content and journals. Secondary searches (eg, references-list scanning) were also performed.Study Selection
Two reviewers independently selected articles using working definitions of rehabilitation and QI study types; of 1016 references, 112 full texts were assessed for eligibility.Data Extraction
Reported study characteristics including study focus, study setting, use of inferential statistics, stated limitations, and use of improvement cycles and theoretical models were extracted by 1 reviewer, with a second reviewer consulted whenever inferences or interpretation were involved.Data Synthesis
Fifty-nine empirical rehabilitation QI studies were found: 43 reporting on local QI activities, 7 reporting on QI effectiveness research, 8 reporting on QI facilitators or barriers, and 1 systematic review of a specific topic. The number of publications had significant yearly growth between 2010 and 2016 (P=.03). Among the 43 reports on local QI activities, 23.3% did not explicitly report any study limitations; 39.5% did not used inferential statistics to measure the QI impact; 95.3% did not cite/mention the appropriate reporting guidelines; only 18.6% reported multiple QI cycles; just over 50% reported using a model to guide the QI activity; and only 7% reported the use of a particular theoretical model. Study sites and focuses were diverse; however, nearly a third (30.2%) examined early mobilization in intensive care units.Conclusions
The number of empirical, peer-reviewed rehabilitation QI publications is growing but remains a tiny fraction of rehabilitation research publications. Rehabilitation QI studies could be strengthened by greater use of extant models and theory to guide the QI work, consistent reporting of study limitations, and use of inferential statistics. 相似文献77.
78.
Kara E. Bischoff David L. O&#x;Riordan Kristyn Fazzalaro Anne Kinderman Steven Z. Pantilat 《Journal of pain and symptom management》2018,55(3):881-889
Context
Pain is a common and distressing symptom. Pain management is a core competency for palliative care (PC) teams.Objective
Identify characteristics associated with pain and pain improvement among inpatients referred to PC.Methods
Thirty-eight inpatient PC teams in the Palliative Care Quality Network entered data about patients seen between December 12, 2012 and March 15, 2016. We examined patient and care characteristics associated with pain and pain improvement.Results
Of patients who could self-report symptoms, 30.7% (4959 of 16,158) reported moderate-to-severe pain at first assessment. Over 40% of these patients had not been referred to PC for pain. Younger patients (P < 0.0001), women (P < 0.0001), patients with cancer (P < 0.0001), and patients in medical/surgical units (P < 0.0001) were more likely to report pain. Patients with pain had higher rates of anxiety (P < 0.0001), nausea (P < 0.0001), and dyspnea (P < 0.0001). Sixty-eight percent of patients with moderate-to-severe pain improved by the PC team's second assessment within 72 hours; 74.7% improved by final assessment. There was a significant variation in the rate of pain improvement between PC teams (P < 0.0001). Improvement in pain was associated with improvement in anxiety (OR = 2.9, P < 0.0001) and dyspnea (OR = 1.4, P = 0.03). Patients who reported an improvement in pain had shorter hospital length-of-stay by two days (P = 0.003).Conclusion
Pain is common among inpatients referred to PC. Three-quarters of patients with pain improve and improvement in pain is associated with other symptom improvement. Standardized, multisite data collection can identify PC patients likely to have marked and refractory pain, create benchmarks for the field, and identify best practices to inform quality improvement. 相似文献79.
80.
Srikant Nannapaneni Sarah J. Lee Markos Kashiouris Jennifer L. Elmer Lokendra K. Thakur Sarah B. Nelson 《Hospital practice (1995)》2015,43(2):94-100
Noise is a significant contributor to sleep disruption in the intensive care unit (ICU) that may result in increased patient morbidity such as delirium and prolonged length of stay in ICU. We conducted a pre-post intervention study in a 24-bed tertiary care academic medical ICU to reduce the mean noise levels. Baseline dosimeter recordings of ICU noise levels demonstrated a mean noise level of 54.2 A-weighted decibels (dBA) and peak noise levels of 109.9 dBA, well above the Environmental Protection Agency’s recommended levels. There were 1735 episodes of “defects” (maximum noise levels > 60 dBA). Following implementation of multipronged interventions, although the mean noise levels did not change significantly between pre- and post-intervention (54.2 vs 53.8 dBA; p = 0.96), there was a significant reduction in the number of “defects” post-intervention (1735 vs 1289, p ≤ 0.000), and the providers felt that the patients were sleeping longer in the ICU post-intervention. 相似文献