scholarly journals A quantitative systematic review of the association between nurse skill mix and nursing‐sensitive patient outcomes in the acute care setting

2019 ◽  
Vol 75 (12) ◽  
pp. 3404-3423 ◽  
Author(s):  
Diane E. Twigg ◽  
Yvonne Kutzer ◽  
Elisabeth Jacob ◽  
Karla Seaman
Keyword(s):  
Systematic Review ◽  
Acute Care ◽  
Patient Outcomes ◽  
Care Setting ◽  
Acute Care Setting ◽  
Skill Mix ◽  
Quantitative Systematic Review

A Systematic Review of ICU and Non-ICU Clinical Pharmacy Services Using Telepharmacy

2018 ◽  
Vol 52 (12) ◽  
pp. 1250-1258 ◽  
Author(s):  
Kyle Strnad ◽  
Bethany R. Shoulders ◽  
Pamela L. Smithburger ◽  
Sandra L. Kane-Gill
Keyword(s):  
Systematic Review ◽  
Patient Care ◽  
Acute Care ◽  
Patient Outcomes ◽  
Clinical Pharmacy ◽  
Care Setting ◽  
Pharmacy Services ◽  
Acute Care Setting ◽  
Nursing Satisfaction ◽  
Clinical Pharmacy Services

Objective: To assess the impact of telepharmacy services in the acute care setting. Data Sources: EMBase, MEDLINE, and SCOPUS database searches were performed through April 2018. Study Selection and Data Extraction: PRISMA guidelines were applied for this systematic review. All English-language studies meeting the criteria of the following population, intervention, comparison, and outcome question were included: What impact does the provision of inpatient clinical pharmacy services delivered via telemedicine have on patient outcomes compared with standard of care? Data Synthesis: A total of 11 studies were identified for the acute care setting, including 3 for critically ill patients. All studies demonstrated a positive impact on patient outcomes, nursing satisfaction, and disease management. Varying modes of telepharmacy technology were used, such as remote access to electronic medical records, faxing or scanning documents, pictures or webcams. For communication purposes, telepharmacists used email or electronic communication, facsimile, video review, or telephone to speak directly with hospital personnel and patients. Relevance to Patient Care and Clinical Practice: Inpatient telepharmacy is feasible and should be leveraged to further enhance patient care by complementing existing service models. Conclusions: Telepharmacy services enhanced patient outcomes, improved nursing satisfaction, and expanded services within inpatient settings. Similar technologies were leveraged in non–intensive care units (ICUs) and ICUs, but the goals of telepharmacy appeared to differ. ICUs focused on an expansion of services in the ICU and non-ICUs addressed improved patient outreach in rural areas.

scholarly journals LO18: The effectiveness of parenteral agents to reduce relapse in patients with acute migraine in emergency settings: a systematic review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S13
Author(s):  
J. Meyer ◽  
L. Visser ◽  
S. Kirkland ◽  
C. Villa-Roel ◽  
D. Junqueira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Acute Care ◽  
Care Setting ◽  
Grey Literature ◽  
Third Party ◽  
Acute Care Setting ◽  
Acute Migraine ◽  
Common Occurrence ◽  
Headache Recurrence

Introduction: Although a variety of parenteral agents exist for the treatment of acute migraine, relapse after an emergency department (ED) visit is still a common occurrence. The objective of this systematic review was to update a previous review examining the effectiveness of parenteral agents for the treatment of acute migraine in the ED or equivalent acute care setting; our review focused on those studies aiming a reduction in relapse after an ED visit. Methods: A comprehensive search of 10 electronic databases and grey literature was conducted to identify comparative studies to supplement the previous systematic review. Two independent reviewers completed study selection, quality assessment, and data extraction. Any discrepancies were resolved by third party adjudication. Relative risks (RR) with 95% confidence intervals (CIs) were calculated using a random effects model and heterogeneity (I2) was reported. Results: Titles and abstracts of 5039 unique studies were reviewed, of which, 51 studies were included. Sixty-four studies from the original review were included, resulting in a total of 115 included studies. Relapse was reported in 44 (38%) included studies and occurred commonly in patients receiving placebo or no interventions (median = 39%; IQR: 14%, 47%). Overall, no differences in headache relapse were found between patients receiving sumatriptan or placebo (RR = 1.09; 95% CI: 0.55, 2.17; I2 = 93%; n = 8). Conversely, patients receiving neuroleptic agents experienced fewer relapses compared to placebo (RR = 0.27; 95% CI: 0.12, 0.58; I2 = 0%; n = 3); however, patients receiving neuroleptics reported an increase in adverse events (RR = 1.87; 95% CI: 1.17, 3.00; I2 = 0%; n = 3). Compared to placebo, patients receiving dexamethasone were less likely to experience a headache recurrence (RR = 0.71; 95% CI: 0.53, 0.95; I2 = 60%, n = 9); however, no differences were found in reported adverse events (RR = 1.09; 95% CI: 0.81, 1.47; I2 = 0%; n = 3). Conclusion: Relapse is a common occurrence for patients with migraine headaches. This review found patients receiving neuroleptics or dexamethasone experienced fewer headache recurrences. Conversely, triptan agents appear to have minimal effect on reducing the risk for headache recurrence following discharge from an acute care setting. Limited available data on adverse events is an important limitation to inform decision-making. Guidelines should be revised to reflect these results.

scholarly journals 135 The Impact of an Early Mobilisation Initiative Evidence from an Acute Care Setting

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Aileen Horgan ◽  
Michelle Carr ◽  
Aileen Murphy
Keyword(s):  
Acute Care ◽  
Patient Outcomes ◽  
Care Setting ◽  
Functional Decline ◽  
Length Of Hospital Stay ◽  
Hospital Length Of Stay ◽  
Acute Care Setting ◽  
Early Mobilisation ◽  
The Impact ◽  
Improve Patient

Abstract Background Unnecessary bed rest results in a loss of mobility and an increased length of hospital stay. Despite mobilising regularly being acknowledged as an important preventative measure for deconditioning, inpatient functional decline continues to pose a significant challenge in hospital settings. Hospital-based mobility initiatives offer the potential to address issues of functional decline, improve patient outcomes and hospital length of stay. The aim of this research is to examine the impact of an early mobilisation initiative called “End PJ Paralysis”. Methods The research design comprises of three elements: (i) an examination of a period that promoted mobility to all patients on one acute unit (ii) an analysis of the reported number of falls during the study period and (iii) an exploration of perceptions and attitudes of nurses, nurse managers, and patients involved with the initiative. Results Our study demonstrates that following a 10-week promotion of the initiative from April 17th-June 26th 2018 in an acute care setting in south of Ireland, an increase of 15% of patients were mobilising and a decrease in the number of reported falls. In addition, staff participation was found to increase and self-reported patient satisfaction improved. Factors identified as influencing the impact of the initiative included patient and staff behavior, nurse management leadership, and effective communication. Conclusion The study provides evidence to suggest that early mobilisation initiatives can prevent deconditioning and improve patient outcomes. Each day a patient spends in hospital should contribute towards their recovery and discharge and mobilising patients while in hospital has a profound impact on their functional status.

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