scholarly journals Holding and Mobility of Pediatric Patients With Transthoracic Intracardiac Catheters

2020 ◽  
Vol 40 (4) ◽  
pp. 16-24
Author(s):  
Amy Jo Lisanti ◽  
Stephanie Helman ◽  
Andrea Sorbello ◽  
Jamie Fitzgerald ◽  
Annemarie D’Amato ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Bed Rest ◽  
Fiscal Year ◽  
Nursing Documentation ◽  
Patient Mobility ◽  
Health Records ◽  
Improvement Project ◽  
Policies And Procedures ◽  
New Policies ◽  
Intracardiac Catheters

Background Nursing care of pediatric patients after cardiac surgery consists of close hemodynamic monitoring, often through transthoracic intracardiac catheters, requiring patients to remain on bed rest and limiting holding and mobility. Objectives The primary aim of this quality improvement project was to determine the feasibility of safely mobilizing pediatric patients with transthoracic intracardiac catheters out of bed. Once feasibility was established, the secondary aim was to increase the number of days such patients were out of bed. Methods and Interventions New standards and procedures were implemented in July 2015 for pediatric patients with transthoracic intracardiac catheters. After initiation of the new policies, complications were tracked prospectively. Nursing documentation of activity and positioning for all patients with transthoracic intracardiac catheters was extracted from electronic health records for 2 fiscal years before and 3 fiscal years after the new policies were implemented. The Cochran-Armitage test for trend was used to determine whether patterns of out-of-bed documentation changed over time. Results A total of 1358 patients (approximately 250 to 300 patients each fiscal year) had activity and positioning documented while transthoracic intracardiac catheters were in place. The Cochran-Armitage test for trend revealed that out-of-bed documentation significantly increased after the new policies and procedures were initiated (P < .001). No major complications were noted resulting from patient mobility with transthoracic intracardiac catheters. Conclusion Pediatric patients with transthoracic intracardiac catheters can be safely held and mobilized out of bed.

scholarly journals Patient participation in electronic nursing documentation: an interview study among community nurses

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Kim De Groot ◽  
Elisah B. Sneep ◽  
Wolter Paans ◽  
Anneke L. Francke
Keyword(s):  
Data Collection ◽  
Electronic Health Records ◽  
Thematic Analysis ◽  
Patient Participation ◽  
Medical Condition ◽  
Nursing Documentation ◽  
Health Records ◽  
Technical Problems ◽  
Care Plans ◽  
Electronic Health

Abstract Background Patient participation in nursing documentation has several benefits like including patients’ personal wishes in tailor-made care plans and facilitating shared decision-making. However, the rise of electronic health records may not automatically lead to greater patient participation in nursing documentation. This study aims to gain insight into community nurses’ experiences regarding patient participation in electronic nursing documentation, and to explore the challenges nurses face and the strategies they use for dealing with challenges regarding patient participation in electronic nursing documentation. Methods A qualitative descriptive design was used, based on the principles of reflexive thematic analysis. Nineteen community nurses working in home care and using electronic health records were recruited using purposive sampling. Interviews guided by an interview guide were conducted face-to-face or by phone in 2019. The interviews were inductively analysed in an iterative process of data collection–data analysis–more data collection until data saturation was achieved. The steps of thematic analysis were followed, namely familiarization with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and reporting. Results Community nurses believed patient participation in nursing documentation has to be tailored to each patient. Actual participation depended on the phase of the nursing process that was being documented and was facilitated by patients’ trust in the accuracy of the documentation. Nurses came across challenges in three domains: those related to electronic health records (i.e. technical problems), to work (e.g. time pressure) and to the patients (e.g. the medical condition). Because of these challenges, nurses frequently did the documentation outside the patient’s home. Nurses still tried to achieve patient participation by verbally discussing patients’ views on the nursing care provided and then documenting those views at a later moment. Conclusions Although community nurses consider patient participation in electronic nursing documentation important, they perceive various challenges relating to electronic health records, work and the patients to realize patient participation. In dealing with these challenges, nurses often fall back on verbal communication about the documentation. These insights can help nurses and policy makers improve electronic health records and develop efficient strategies for improving patient participation in electronic nursing documentation.

scholarly journals Reduction of Central-Line–Associated Bloodstream Infections in a Spinal Cord Injury Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s370-s370
Author(s):  
Stephanie L. Baer ◽  
Amy Halcyon Larsh ◽  
Annalise Prunier ◽  
Victoria Thurmond ◽  
Donna Goins ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Patient Population ◽  
Bloodstream Infections ◽  
Central Line ◽  
Fiscal Year ◽  
Improvement Project ◽  
Central Lines ◽  
Cord Injury ◽  
Bundle Compliance

Background: Central-line–associated bloodstream infections (CLABSIs) are a complication of indwelling central venous catheters, which increase morbidity, mortality, and cost to patients. Objective: Due to increased rates in a spinal cord injury unit (SCIU), a performance improvement project was started to reduce CLABSI in the patient population. Methods: To reduce the incidence of CLABSI, a prevention bundle was adopted, and a peer-surveillance tool was developed to monitor compliance with the bundle. Staff were trained to monitor their peers and submit weekly surveillance. Audits were conducted by the clinical nurse leader with accuracy feedback. Bundle peer-surveillance was implemented in February of 2018 with data being fed back to leadership, peer monitors, and stakeholders. Gaps in compliance were addressed with peer-to-peer education, changes in documentation requirements, and meetings to improve communication and reduce line days. In addition, the use of an antiseptic-impregnated disc for vascular accesses was implemented for dressing changes. Further quality improvement cycles during the first 2 quarters of fiscal year 2019 included service-wide education reinforcement, identification in variance of practice, and reporting to staff and stakeholders. Results: CLABSI bundle compliance increased from 67% to 98% between February and October 2018. The weekly audit reporting accuracy improved from 33% to 100% during the same period. Bundle compliance was sustained through the fourth quarter of 2019 at 98%, and audit accuracy was 99%. The initial CLABSI rates the quarter prior to the intervention were 6.10 infections per 1,000 line days for 1 of the 3 SCIUs and 2.68 infections per 1,000 line days for the service overall. After the action plan was initiated, no CLABSIs occurred for the next 3 quarters in all SCIUs despite unchanged use of central lines (5,726 line days in 2018). The improvement was sustained, and the line days decreased slightly for 2019, with a fiscal year rate of 0.61 per 1,000 line days (ie, 3 CLABSIs in 4,927 central-line days). Conclusions: The incidence of CLABSI in the SCIU was reduced by an intensive surveillance intervention to perform accurate peer monitoring of bundle compliance with weekly feedback, communication, and education strategies, improvement of the documentation, and the use of antiseptic-impregnated discs for dressings. Despite the complexity of the patient population requiring long-term central lines, the CLABSI rate was greatly impacted by evidence-based interventions coupled with reinforcement of adherence to the bundle.Funding: NoneDisclosures: None

scholarly journals Syrian Refugees’ Integration Policies in Jordanian Labor Market

2021 ◽  
Vol 13 (13) ◽  
pp. 7234
Author(s):  
Ahmad AlShwawra
Keyword(s):  
Labor Market ◽  
Syrian Refugees ◽  
Fully Integrated ◽  
Syrian Crisis ◽  
The People ◽  
Policies And Procedures ◽  
The Government ◽  
New Policies ◽  
Desk Research ◽  
London Conference

The Government of Jordan declared that there are more than one million Syrian refugees in Jordan while UNHCR statistics show that the number is about 700,000. Nonetheless, it is still a large problem for Jordan, especially since there is no real solution that seems to be looming on the horizon for the Syrian crisis. Consequently, that means that those refugees’ stay in Jordan is indefinite. This fact requires Jordan to work towards solutions to avoid the warehousing of those refugees in camps and to integrate them in Jordanian community to ease their stay in Jordan. To achieve that integration, Jordan must facilitate the Syrians’ access to the Jordanian labor market so they can achieve self-reliance. In February 2016, donors gathered in London for the ‘Supporting Syria and the Region’ conference, known as the London Conference, to mobilize funding for the needs of the people affected by the Syrian crisis. In that conference, Jordan pledged to facilitate Syrian refugees’ access to the labor market. This paper will study the process of Syrian integration in Jordanian society by discussing the policies and the procedures that Jordan has developed to facilitate the Syrians’ access to the labor market. The event study method combined with interviews and desk research were used to evaluate the new policies and procedures developed to facilitate this access. It was found that Jordan succeeded in creating a legal and procedural environment that facilitates Syrians’ access to formal jobs, and the Syrians went a long way toward integration in Jordan. Nonetheless, they are still not fully integrated.

scholarly journals From behavioural simulation to computer models: how simulation can be used to improve healthcare management and policy

2018 ◽  
Vol 6 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Guillaume Lamé ◽  
Rebecca K Simmons
Keyword(s):  
Computer Simulations ◽  
Policy Making ◽  
Simulation Method ◽  
Healthcare Management ◽  
Policies And Procedures ◽  
Simulation Based ◽  
Behavioural Simulation ◽  
Human Participants ◽  
New Policies

Simulation is a technique that evokes or replicates substantial aspects of the real world, in order to experiment with a simplified imitation of an operations system, for the purpose of better understanding and/or improving that system. Simulation provides a safe environment for investigating individual and organisational behaviour and a risk-free testbed for new policies and procedures. Therefore, it can complement or replace direct field observations and trial-and-error approaches, which can be time consuming, costly and difficult to carry out. However, simulation has low adoption as a research and improvement tool in healthcare management and policy-making. The literature on simulation in these fields is dispersed across different disciplinary traditions and typically focuses on a single simulation method. In this article, we examine how simulation can be used to investigate, understand and improve management and policy-making in healthcare organisations. We develop the rationale for using simulation and provide an integrative overview of existing approaches, using examples of in vivo behavioural simulations involving live participants, pure in silico computer simulations and intermediate approaches (virtual simulation) where human participants interact with computer simulations of health organisations. We also discuss the combination of these approaches to organisational simulation and the evaluation of simulation-based interventions.

Beyond the Collection

2016 ◽  
pp. 120-140
Author(s):  
Jill Dixon ◽  
Nancy Abashian
Keyword(s):  
Natural Disasters ◽  
Emergency Planning ◽  
Emergency Plan ◽  
Emergency Situations ◽  
New Information ◽  
Policies And Procedures ◽  
Library Staff ◽  
New Policies

It is inevitable that library staff will need to respond to natural disasters and emergency situations – often with little or no advance warning. An important part of emergency planning is addressing public and staff safety prior, during, and immediately following emergencies. All libraries need to develop a comprehensive emergency plan with clear, consistent, and concise policies and procedures for staff. The plan needs to provide detailed instructions for all types of potential emergency situations and should be periodically re-evaluated and updated to address new concerns or when new information or resources become available. This chapter will discuss the process of creating an emergency plan for public and staff safety, including reviewing resources, consulting with experts, developing new policies and procedures, and disseminating the information to staff.

Can Tissue Expansion Reconstruction in the Trunk of Children Increase the Risk of Scoliosis?

2020 ◽  
pp. 229255032093367
Author(s):  
Paul Yen ◽  
Marija Bucevska ◽  
Christopher Reilly ◽  
Cynthia Verchere
Keyword(s):  
Pediatric Patients ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Radiological Imaging ◽  
Flap Surgery ◽  
Cross Sectional ◽  
Health Records ◽  
Early Management ◽  
X Ray ◽  
Preventative Measures

Introduction: We hypothesize that treatment of significant truncal lesions with truncal tissue expanders and subsequent flap surgery in pediatric patients may increase the risk of scoliosis. This study aims to investigate any relationship between tissue expansion (TE) and scoliosis and to compare the prevalence of scoliosis in our tissue expander population to the general population. Methods: Health records of patients who underwent truncal TE at BC Children’s Hospital between 1997 and 2017 were retrospectively reviewed and analyzed. The cross-sectional component of the study consisted of radiological imaging to establish the presence or absence of scoliosis. Results: We identified 28 patients who underwent truncal TE over the study period. Ten had a scoliosis X-ray on their chart or as a part of the study. Three (10.7%) patients were identified as having developed scoliosis after TE. Conclusions: We recommend that pediatric TE patients be made aware of the potential complication of scoliosis and be followed closely in the years during and after their treatment, in order to allow for preventative measures, early diagnosis and early management (if required).

Deterring Teen Bullying

2016 ◽  
Vol 16 (2) ◽  
pp. 190-207 ◽  
Author(s):  
Justin W. Patchin ◽  
Sameer Hinduja
Keyword(s):  
Middle Schools ◽  
Deterrence Theory ◽  
Criminological Research ◽  
Policies And Procedures ◽  
New Policies

While decades of criminological research have returned mixed results when it comes to deterrence theory, deterrence-informed policies continue to proliferate unabated. Specific to bullying among adolescents, many U.S. states have recently passed new laws – or updated old ones – increasing potential punishment for youth who abuse others. Police are becoming involved in bullying incidents more than ever before, and schools across the country are implementing new policies and procedures as a result of statewide mandates to crack down on the problem. Parents, too, are being pressured to respond to bullying or risk being prosecuted themselves. To assess whether youth are actually being deterred by these methods and messages, data were collected from approximately 1,000 students from two middle schools on their perceptions of punishment from various sources, as well as their bullying and cyberbullying participation. Results suggest that students are deterred more by the threat of punishment from their parents and the school, and least deterred by the threat of punishment from the police.

Reducing variability in operating room utilization.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 321-321
Author(s):  
Craig S. Owen ◽  
John C. Frenzel ◽  
Garrett L. Walsh
Keyword(s):  
Service Level ◽  
Fixed Number ◽  
Current Data ◽  
Fiscal Year ◽  
Policies And Procedures ◽  
Initial Intervention ◽  
Wide Variability ◽  
Md Anderson ◽  
Multi Disciplinary Team ◽  
Ongoing Monitoring

321 Background: With a fixed number of operating rooms, as well as complexity of cases and volumes continuing to rise, it became important for MD Anderson to more effectively utilize the OR resources that are available. Methods: The initial intervention (4 years ago) was the development of a mechanism for effectively measuring and reporting both In-Block Utilization and Total OR Utilization. Through a systematic process of measuring and reporting OR utilization by day of week, all services began to pay closer attention to their data/utilization and began to engage in the process. The “OR Capacity” application was created, which enabled stakeholders to view overall booked capacity of the OR, as well as at the service level. This created complete transparency for all services to see how effectively they were using their block allocation by day of week, as well as across the month. Results: Reports produced monthly reflect each services overall In-Block Utilization, Total OR Utilization, as well as both of these metrics by case day of week. By viewing this data across all services, it provides transparency of utilization and where possible block swaps between services may occur. At the beginning of fiscal year 2009, the variability by case day of week of In-Block Utilization was 16% and 33% for Total OR Utilization. This wide variability was difficult for perioperative stakeholders to manage. Through a systematic approach of measuring, monitoring, and reporting, the most current data reflects the variability by case day of week of In-Block Utilization and Total OR Utilization has decreased to 3% and 9% respectively. Conclusions: By creating an application that provides transparency of OR capacity, as well as clear policies and procedures for block reallocation and how the measurement and reporting of block utilization would occur, we have demonstrated how a complex and multi-factorial issue of effective block utilization across the days of the week can be solved. This has required a multi-disciplinary team of individuals to work through and understand the issues, develop interventions, as well as the mechanisms to provide sustainable and ongoing monitoring and reporting of the utilization by case day of week. Without strong leadership, this effort would not have been possible.

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