RESUMEN
ABSTRACT: Blood availability was uncertain during the COVID-19 pandemic, yet transfusion remained a common and sometimes necessary procedure. Substantial work on optimizing transfusion practices is centered in tertiary hospitals as high utilizers of blood while the care delivered in smaller community hospitals comprises more than half the nation's transfusions. Improving transfusion practices in community hospitals represents a substantial opportunity to enhance patient safety and the availability of blood resources. Clinical specialists developed a dashboard to retrospectively examine transfusion events including an evidence-based analysis of the patient's clinical situation at the time of transfusion to more accurately identify how appropriately blood was used. The compiled data were discussed and shared with transfusing providers. It was hypothesized that the data provided and communication strategies used would educate providers to current evidence-based practice, leading to more appropriate transfusion with an overall reduction in packed red blood cell utilization. There was an 11% increase in transfusion appropriateness (p = <.001) and a 14% decrease in the units transfused (p = .004). Improvement in transfusion practices demonstrates a significant impact on patient safety and the availability of blood resources. Although absolute opportunity may be less in a community hospital, fewer resources are needed to achieve meaningful change.
Asunto(s)
COVID-19 , Hospitales Comunitarios , Humanos , Pandemias , Estudios Retrospectivos , Transfusión SanguíneaRESUMEN
In the midst of the COVID - 19 pandemic, a multidisciplinary team implemented evidence-based strategies to eliminate catheter associated urinary tract infections (CAUTI), as defined by the National Healthcare Safety Network (NHSN) surveillance definition for those units included in the NHSN standardized infection ratio. The team evaluated indwelling urinary catheters daily for indication, implemented a urinary catheter order set, established a urinary catheter insertion checklist, and promoted use of external urinary diversion devices. The facility NHSN standardized infection ratio for CAUTI was 0.37 in 2019, 0.23 in 2020, and 0.00 in 2021. A collaborative approach decreasing hospital acquired infections may be effective even in a climate of increased acuity, increased length of stay, and staffing challenges.
Asunto(s)
COVID-19 , Infecciones Relacionadas con Catéteres , Infección Hospitalaria , Infecciones Urinarias , Humanos , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Pandemias/prevención & control , COVID-19/epidemiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Infecciones Urinarias/epidemiología , Infecciones Urinarias/prevención & control , Cateterismo Urinario/efectos adversos , Catéteres Urinarios/efectos adversos , Hospitales , Centros Médicos Académicos , Grupo de Atención al Paciente , Catéteres de PermanenciaRESUMEN
BACKGROUND: Medication reconciliation is a complex process that occurs during hospitalization at admission, transfer and discharge and at each outpatient clinic visit. Despite numerous quality improvement initiatives implemented by healthcare facilities nationwide to refine the process, medication errors still occur. Medication reconciliation processes are institution specific and undergo constant refinement. Few reports are available on the nursing student's role in this contemporary safety process. PURPOSE: The purpose of this study was to assess the nursing student's education and role in the medication reconciliation process from the perspective of academic faculty and hospital nursing leadership. METHODS: Electronic surveys were sent to 90 nurse academic and 160 nurse practice leaders in Ohio during the first quarter of 2015. Surveys were completed by 47% of the academic leaders (42/90) and 23% of the practice leaders (42/160). Survey questions focused on the nursing curriculum regarding medication reconciliation and the student nurse's role in the process during clinical experiences. RESULTS: Faculty from 75% of the schools of nursing reported that the medication reconciliation curriculum was mostly taught in the classroom. Only 24.4% of the schools taught medication reconciliation in an interdisciplinary context with pharmacy students. During clinical time, 33% of faculty reported that students had direct involvement and 33% had the opportunity to observe the process of medication reconciliation. The majority (80%) of practice nurse leaders reported that their facility does not permit nursing students to perform medication reconciliation. Although medication reconciliation processes are specific to each organization, only 52.8% of the practice leaders reported that they provide faculty or nursing students' formal training on their hospital's medication reconciliation policy or site-specific process. CONCLUSION: Students are not receiving adequate education or opportunity to practice medication reconciliation during clinicals. Future alignment of academia, and practice efforts on medication reconciliation are needed.