...J Nurs Care Qual Vol. 27, No. 1, pp. 6–12 Copyright c 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Missed Nursing Care, Staffing, and Patient Falls Beatrice J. Kalisch, PhD, RN, FAAN; Dana Tschannen, PhD, RN; Kyung Hee Lee, MPH, RN Patient falls in hospitals continue to be a major and costly problem. This study tested the mediating effect of missed nursing care on the relationship of staffing levels (hours per patient day [HPPD]) and patient falls. The sample was 124 patient units in 11 hospitals. The HPPD was negatively associated with patient falls (r = − 0.36, P < .01), and missed nursing care was found to mediate the relationship between HPPD and patient falls. Key words: falls, missed nursing care, staffing P to 12% of hospitalized patients experience at least 1 fall during their hospital stay.1 A fall is defined as any event in which patients are found on the floor (observed or unobserved) or an unplanned lowering of the patient to the floor by staff or visitors.2 In 2008, and 2010, falls were identified as one of the top 10 sentinel event categories by the Joint Commission.3 Fall rates in hospitals range from 4 to 14 falls per 1000 patient days.4 With the adoption of the Centers of Medicare and Medicaid rule, which no longer reimburses hospitals at the higher diagnosis related group for the care and treatment associated with patient falls that occur during hospitalization, a clearer understanding of what factors U Author Affiliations: School of Nursing...
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...REDUCING FALLS IN THE HOSPITAL SETTING Abstract “Falls and fall related injuries are the most commonly reported adverse event among adults admitted to inpatient setting. Up to twenty percentages of patients admitted, reported falling of at least once during an inpatient hospital stay period” (Oliver, Healey, & Haines, 2010). The author works at a city hospital located in Gilbert, Arizona and encounters a great amount of orthopedic patients along with other general surgery patients. All patients that are on that floor are at a risk of falls during the first 48 hours after surgery due to anesthesia that is still in the system and pain medication that is scheduled to help ease the patient during the post-surgical time frame. One of the side effects of anesthesia exiting the body is nausea and vomiting which can make the patient feel dizzy and lightheaded, thus making them a great risk for falls. This has been the reason that the topic was chosen; to attempt to improve this issue in the hospital setting and to provide a system in which all hospital staff collaborate to help increase the quality of patient care. The location that is being observed is the post-surgical/orthopedic floor where the author is currently working. A description of risks and concerns are provided and patient outcomes depend on implementing the proposed interventions. The two solutions that are presented are hourly rounding and the importance of an improved nurse call light button and education on proper...
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... Research Summary and Ethical Considerations “Nursing Staff’s Awareness of Keeping Beds in the Lowest Position to Prevent Falls and Fall Injuries In an Adult Acute Surgical Inpatient Care Setting” Huey-Ming Tzeng, Chang-Yi Yin, Allison Anderson, and AtuI Prakash Background: In medical care centers and in hospitals a major concern is falling of inpatients from their bed. This problem becomes more serious while dealing with old age patients in care for acute surgical or post op care. Presented study has addressed these issues and suggested that most of these fall related injuries [Anderson, Boshier and Hanna (2012)] could be prevented by examining the factors which could be controlled and applying measures to control them. Also those factors which could not be controlled measures to prevent them according to need of individual and specific medical setting should be applied. This study is very important and significant to nursing practice as according to Quigley and associates (2007) has pointed out that severity of injuries due to fall could be minimized with the help of an interdisciplinary team of which nurses are most important part. It help the nurse to provide the education how to prevent from fall and any serious injury through the falling time. On other hand it helps the nurse to aware the nurse about the proper bed position to prevent from fall and helps to prevent the injury in old age patients, because staff nurse know about the patient’s condition and who patient’s...
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...99,000 HAI- associated deaths in the hospital. The report stated that the four largest categories of HAI, responsible for more than 80% of all reported HAI, are central line-associated bloodstream infections (CLABSI, 14%), ventilator-associated pneumonia (VAP, 15%), surgical site infections (SSI, 22%), and catheter-associated urinary tract infections (CAUTI, 32%). HAI are a great financial costs to health care facilities. The Centers for disease Control and Prevention (CDC) estimates the medical cost of HAI in the U.S. hospitals as $6.65 billion in 2007, and that number has increased to almost $10 billion a year currently. Statement and Significance of the Problem One in 20 patients who are admitted to a hospital will be a victim to an infectious agent they are exposed to during their hospitalization according to the Centers for Disease Control (CDC) (Goodman, Brenda, 201, Hospital-Acquired Infections cost $10 Billion a year). The five most common infections are surgical site infections, infections associated with the use of devices like central lines, catheters, ventilators and clostridium dificile are costing the health care System in the USA almost $10 billion a year to treat. In the article Vitamin D has the potential to reduce the risk of Hospital-Acquired Infections, the writer stated that HAI is the leading cause of death in the USA with an overall estimated annual incidence of 1.7 million cases and 100,000 deaths. The writer also...
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...Assessment Stable Vitals Aging process Muscle strength Equilibrium Environmental Stress Modification Prevention Fall among elderly in the inpatient setting FALL is a sudden and non-intentional change of posture to the ground or a lower level, onto an object, floor, pavement, ground, or any other type of surface, and includes slipping, tripping (stumbling), falling on other people, loss of balance, and accidental stooping (crouching)(Tommasini,c.,Talamini, R.,Bidoli, E.,Sicolo, N.,& Palese, A(2008).Falls are the second leading cause of accidental death.As a nurse I have always worked with the adult & geriatric population in the hospitals and falls have been a significant issue. It increases the morbidity and mortality of the patients and at the same time causes frustration for the family and ,increases the hospital stay and dollar amounts for the hospitals.Mutliple measures including assessment on admission & per shift to identify early precursors, restraints, sitters, chair sensors, family at bedside are used in inpatient settings .Despite implementation of various measures Falls keep happening. Case management and social work also has responsibility in preventing falls by safely discharging the patients by providing appropriate assistive devices and modifying the living situations like safely discharging to an assisted facility than home (This does not mean that falls does not happen in assisted facilities).The Goal should be to provide maximum autonomy to the person as...
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... Professor Somi Nagaraj, MSN, DNP. June 5, 2013. Introduction The nurse call light is an important tool in which patients used to get the attention of nurses during hospitalization. It is one of the many means by which patients can exercise control of their health care. It is done to seek the nurses’ attention for help during inpatient hospitalization. The ideal situation is that when the patient pushes the call light, the nurse or the staff will be there to find out what assistance the patient needs. However, when these calls are made by patients, and there were delays in response time, this will in turn lead to frustration in most cases, and the patient will attempt activities that threatened their safety, thereby leading to falls and other safety issues. In most inpatient hospital or other health care facilities, call lights are made by residents or patients who need bathroom or bedpan assistance. The problem associated with call lights can be so frustrating that nurses spend most of the times attending to call lights as spill over from the previous shifts. These calls lights were from clients who are in pain, and need to take their pain medications. The others came from clients who want to make use of the bathrooms, or just want to be turned over. IV pumps and feeding...
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...Delirium in the Older Adult Population Delirium is a common issue found in older adults in the hospital and often not recognized until the illness develops, showing more evident and severe symptoms. Delirium is most commonly seen in the intensive care unit (ICU) and its frequency suggests an evident need for increased prevention. This paper will review an article by Susan Seliger, Another Hospital Hazard for the Elderly (see Appendix for more information), and look at various other perspectives focussing on the main arguments, as well as looking at personal understandings and biases, to better relate to and work with delirious older adults. Summary of the Article To summarize Susan’s article, “Another Hospital Hazard for the Elderly”, it...
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...000 people suffer from an acute MI (heart attack) each year (British Heart Foundation Statistics Website). To put this figure in to perspective this equates to one person every 2 minutes. Mortality is at approximately 30% which is 68,100 deaths in the UK per year. The National Service Framework (NSF) for Coronary Heart disease (CHD) is a 10-year programme published by the Department of Health in 2000 and has set key standards for the prevention and treatment of CHD. Access to the right treatment for those who suffer from an AMI, is essential to reduce morbidity and mortality and improve clinical outcomes. People with diabetes mellitus constitute a group of patients who have a higher risk of having an MI and also a poorer prognosis post infarction. The higher death and complication rates appear to be multifactorial but a significant finding in the Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) Trial showed to reduce one year mortality by 30% (Malberg et al., 1995). It’s recommended 1.1 Primary Objective To determine the relationship between HbA1c and prognosis of patients in East Lancashire having a myocardial infarction. 1.2 Secondary Objectives To assess the prognosis of patients below the glucose cut off threshold for DIGAMI treatment and whether or not this borderline category falls in to the highest risk group in terms of mortality and morbidity. To determine if there is both a clinical and analytical case to use fluoride oxalate tubes...
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...stroke as a health care priority. Several government agencies developed clinical guidelines which are being implemented today in local health care settings (Williams et al, 2010a). This essay will focus on stroke as the cause of impaired mobility and will tackle on the patient-centered rehabilitation care plan along with its evidence-based rationales. Health and social care policies and its effect on the patient’s chosen journey will also be discussed. PATIENT PROFILE This is a case of a 68 year-old, married female who lives in the south of England. Mrs. G was admitted on 12 October 2010 with a presenting complaint of left-sided weakness. Prior to admission, she experienced persistent pain on the back of the head for 2 days, which was unrelieved by Paracetamol intake. On the morning of admission, she collapsed in the bathroom and was found by the husband after 3 hours. She was brought to the hospital via ambulance and upon initial assessment, no shortness of breath, slurred speech, dizziness, palpitation and chest pain were noted. Her vital signs were as follows: blood pressure of 169/59 mmHg, pulse rate of 80 bpm, respiratory rate of 18 breaths per minute, body temperature of 37.5 degrees Celsius, Glasgow Coma Scale of 15, blood sugar level of 5.2 mmol/L, oxygen saturation of 100% on room air. Neurologic assessment revealed neglect on left lateral vision and mild mouth droop. Her laboratory test showed a 0.55 ug/L Troponin I level, an indication of an acute infarct. A small...
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...Community Interest Company: a Social Enterprise Organisation Project Report Health Needs Assessment: Stroke in South West and South East London Author: Version: Date: Client: Ref No: Dr John Hayward, Sarah Martin, Dr Michael Soljak Final Version 16.03.09 South West and South East London Cardiac and Stroke Network Boards P132 A Social Enterprise organisation and Community Interest Company Registered office: PO Box 1295, 20 Station Road, Gerrards Cross, Buckinghamshire, SL9 8EL English Company Number: 06480440 VAT Registration: 926 9466 78 www.phast.org.uk E&OE Final Project Report P132 Health Needs Assessment: Stroke in South West and South East London Public Health Action Support Team (PHAST) The Public Health Action Support Team (PHAST) is a Community Interest Company. This is a type of social enterprise that is committed to using its surpluses and assets for the public good. Social enterprises are social mission driven organisations which trade in goods or services for a social purpose.1 PHAST is based at Imperial College, London. It has over 60 experienced and expert public health professionals whose aim is to improve the health of the population and reduce inequalities. Many have worked at high level in the NHS, the Department of Health or in academia. Quality assurance and due diligence processes are in place to ensure all associates work to the highest standard. PHAST also has associates with economic, ethical and legal expertise. For further details see www.phast...
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...CLINICAL ISSUES Acute care management of older people with dementia: a qualitative perspective Wendy Moyle, Sally Borbasi, Marianne Wallis, Rachel Olorenshaw and Natalie Gracia Aim and objectives. This Australian study explored management for older people with dementia in an acute hospital setting. Background. As the population ages, increasing numbers of older people with dementia are placed into an acute care hospital to manage a condition other than dementia. These people require special care that takes into account the unique needs of confused older people. Current nursing and medical literature provides some direction in relation to best practice management; however, few studies have examined this management from the perspective of hospital staff. Design. A descriptive qualitative approach was used. Method. Data were collected using semi-structured audio-taped interviews with a cross section of thirteen staff that worked in acute medical or surgical wards in a large South East Queensland, Australia Hospital. Results. Analysis of data revealed five subthemes with the overarching theme being paradoxical care, in that an inconsistent approach to care emphasised safety at the expense of well-being and dignity. A risk management approach was used rather than one that incorporated injury prevention as one facet of an overall strategy. Conclusion. Using untrained staff to sit and observe people with dementia as a risk management strategy does not encourage an evidence-based approach...
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...JAN ORIGINAL RESEARCH Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives Karen Spilsbury1, Andrea Nelson2, Nicky Cullum3, Cynthia Iglesias4, Jane Nixon5 & Su Mason6 Accepted for publication 5 September 2006 Karen Spilsbury PhD RN Research Fellow Department of Health Sciences, University of York, York, England, UK Andrea Nelson PhD RN Reader School of Healthcare, University of Leeds, Leeds, England, UK Nicky Cullum PhD RN Professor Department of Health Sciences, University of York, York, England, UK Cynthia Iglesias PhD Research Fellow Department of Health Sciences, University of York, York, England, UK Jane Nixon PhD RN Deputy Head Clinical Trials Research Unit, University of Leeds, Leeds, England, UK Su Mason PhD RN Principal Research Fellow Clinical Trials Research Unit, University of Leeds, Leeds, England, UK Correspondence to Karen Spilsbury: e-mail: ks25@york.ac.uk 6 5 4 3 2 1 SPILSBURY K., NELSON A., CULLUM N., IGLESIAS C., NIXON J. & MASON S. ( 2 0 0 7 ) Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives. Journal of Advanced Nursing 57(5), 494–504 doi: 10.1111/j.1365-2648.2006.04140.x Abstract Title. Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives Aim. This paper reports a study exploring patients’ perceptions and experiences of the impact of a pressure ulcer and its treatment on their health and quality...
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...Organizational Factors of General Hospital Inpatient Psychiatric Care Environments Nancy P. Hanrahan, Ph.D., R.N. Aparna Kumar, M.A., M.P.H. Linda H. Aiken, Ph.D., R.N. Objective: Although general hospitals receive nearly 60% of all inpatient psychiatric admissions, little is known about the care environment and related adverse events. The purpose of this study was to determine the occurrence of adverse events and examine the extent to which organizing factors of inpatient psychiatric care environments were associated with the occurrence of these events. The events examined were wrong medication, patient falls with injuries, complaints from patients and families, work-related staff injuries, and verbal abuse directed toward nurses. Methods: This cross-sectional study used data from a 1999 nurse survey linked with hospital data. Nurse surveys from 353 psychiatric registered nurses working in 67 Pennsylvania general hospitals provided information on nurse characteristics, organizational factors, and the occurrence of adverse events. Linear regression models and robust clustering methods at the hospital level were used to study the relationship of organizational factors of psychiatric care environments and adverse event outcomes. Results: Verbal abuse toward registered nurses (79%), complaints (61%), patient falls with injuries (44%), and work-related injuries (39%) were frequent occurrences. Better management skill was associated with fewer patient falls and fewer work-related...
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...AUSTRALIAN HEALTH CARE SYSTEM: THE POTENTIAL FOR EFFICIENCY GAINS A REVIEW OF THE LITERATURE Background paper prepared for the National Health and Hospitals Reform Commission June 2009 This paper was prepared at the Commission’s request by staff of the secretariat to the Commission. The lead author was Emily Hurley. Ian McRae Ian Bigg Liz Stackhouse Anne-Marie Boxall and Peter Broadhead provided some input and commented on drafts. This is a paper prepared as background for the NHHRC. The views and findings expressed in it should not be taken to be the views of the NHHRC or of the Australian Government. 2 TABLE OF CONTENTS Introduction ....................................................................................................4 International overview of efficiency .............................................................4 Health status – due to more than the health care system ............................7 An Australian focus ......................................................................................8 Summary ......................................................................................................8 A framework for efficiency............................................................................9 Operational Efficiency .................................................................................10 Health sub-sectors .....................................................................................11 Hospitals..................
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...Positioning and Differentiation Paper Theresa Williams University of Phoenix Marketing for Health Care HCS/539 Marcia Thompson August 30, 2010 General Information The two health care organizations that will be identified in this paper are Central Texas Medical Center (CTMC) and Guadalupe Regional Medical Center (GRMC). These two organizations are within 25 miles of each other and are in Central Texas. CTMC’s major county it serves is Hays for GRMC’s county is Guadalupe. Both organizations will overlap on counties it serves with health care services. A non-for-profit hospital based organization; each hospital has plenty of similarities and differences among them both. This paper will include the similarities and difference as well as some of the marketing and Public Relations each organization is doing. The difference in the two non-for -profit organizations will allow patients in Hays County and the surrounding counties to decide which health care facility is best for him or her. With similarities involved it will just add extra bonus to the patients for if they could not receive results from CTMC they can got to GRMC and vice versa. One of the major marketing tactics that will cause a patient to be faithful to one organization more will be the customer service and how he or she is treated. Similarities First thing first, let’s start with the similarities on the two organizations. We already know that CTMC and GRMC are considered a non-for-profit organization...
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