Systematic Identification of Familial Hypercholesterolaemia in Primary Care—A Systematic Review

Familial hypercholesterolaemia (FH) is a common inherited cause of premature cardiovascular disease, but the majority of patients remain undiagnosed. The aim of this systematic review was to assess the effectiveness of interventions to systematically identify FH in primary care. No randomised, controlled studies were identified; however, three non-randomised intervention studies were eligible for inclusion. All three studies systematically identified FH using reminders (on-screen prompts) in electronic health records. There was insufficient evidence that providing comments on laboratory test results increased the identification of FH using the Dutch Lipid Clinic Network (DLCN) criteria. Similarly, using prompts combined with postal invitation demonstrated no significant increase in definite FH identification using Simon-Broome (SB) criteria; however, the identification of possible FH increased by 25.4% (CI 17.75 to 33.97%). Using on-screen prompts alone demonstrated a small increase of 0.05% (95% CI 0.03 to 0.07%) in identifying definite FH using SB criteria; however, when the intervention was combined with an outreach FH nurse assessment, the result was no significant increase in FH identification using a combination of SB and DLCN criteria. None of the included studies reported adverse effects associated with the interventions. Currently, there is insufficient evidence to determine which is the most effective method of systematically identifying FH in non-specialist settings.

Behind the clock: elucidating factors contributing to longer clinic appointment duration and patient wait time

Background Longer wait time in ambulatory clinics can disrupt schedules and decrease satisfaction. We investigated factors associated with patient wait time (WT, check-in to examination room placement), approximate clinician time (ACT, completion of nurse assessment to check-out), and total appointment length (TAL, check-in to check-out). Methods A single-institution retrospective study was conducted of breast surgery clinic patients, 2017–2019, using actual encounter times. A before/after analysis compared a five-day 8 hour/day (from a four-day 10 hour/day) advanced practice provider (APP) work-week. Non-parametric tests were used, and medians with interquartile ranges (IQRs) reported. Results 15,265 encounters were identified. Overall WT was 15.0 minutes (IQR:6.0–32.0), ACT 49.0 minutes (IQR:31.0–79.0) and TAL 84.0 minutes (IQR:57.0-124.0). Trainees were associated with 30.0 minutes longer ACT (p < 0.0001); this increased time was greatest for follow-up appointments, least for new patients. Patients arriving > 5 minutes late (versus on-time) experienced shorter WT (11.0 vs. 15.0 minutes, p < 0.0001) and ACT (43.0 vs. 53.0 minutes, p < 0.0001). Busier days (higher encounter volume:APP ratios) demonstrated increased encounter times. After transitioning to a five-day APP work-week, ACT decreased. Conclusions High-volume clinics and trainee involvement prolong ambulatory encounters. Increasing APP assistance, altering work schedules, and assigning follow-up appointments to non-trainees may decrease encounter time.

Pengaruh Buku Modul Praktik Clinical Skill Terhadap Kemampuan Mahasiswa Keperawatan Dalam Melakukan Pemeriksaan Fisik Dada

Background: the competencies that must be possessed by a nursing student when they practice on the clinics or hospital, they must be able to carry out about physical examinations, determine nursing diagnoses, plan, implement, and evaluate nursing actions.Purpose: to know the effect of the clinical skills practice module on the nursing student’s ability in a chest physical examinationMethod: this research used True Experimental in the form of Posttest Only Control Design. Using two groups selected randomly into the control and treatment group. Where the control group will be given a conventional method and treatment group will be given a clinical skill module that is made by researchers.Result: t value was -6,625 < t table (1,658), so that it can be concluded that there is different between the treatment group and control group. Recommendation: Nursing process always interest to be discussed, hopefully the next research can explore about nurse’s physical assessment ability in another Keywords:Clinical skill module, nurse assessment, lungs physical assessment

Optimizing infusion wait time: Redesigning medication order verification/approval at a comprehensive cancer center.

e14042 Background: Nationwide, many cancer centers experience challenges with infusion center efficiency while maintaining high safety standards. Many factors contribute to long wait times for patients on the day of their infusion appointments. At University of New Mexico Comprehensive Cancer Center (UNMCCC), a contributing factor is the delays in verification or approval of medications. We conducted a project to improve order verification/approval workflow within a Plan-Do-Study-Act (PDSA) framework with the objective to decrease the infusion wait time. Methods: A multidisciplinary working group was formed consisting of the infusion floor physician lead, nurse lead, pharmacy lead, and analytics and process improvement leads. Upon exploring the infusion workflow database, disruptions in verification or approval of orders had a large impact on wait times. Order verification workflow was broken down into 3 steps: 1) physician assessment of patient and approval of orders, 2) infusion nurse assessment of patient, 3) pharmacist verification of order. Beginning Feb 2019, the following interventions were implemented in each section: 1) once patient was assessed by physician and orders approved, the patient was marked as “ready-to-treat”. 2) Pharmacist verified the order once “ready-to-treat” was communicated and initiated preparation of medications prior to arrival of patient to the infusion suit. 3) Infusion nurse assessment occurred once patient was seated on infusion chair. 4) Physicians were encouraged to pre-approve selected injections by the morning of patient appointment. Results: Prospective wait time was gathered for May 2019 using the real-time data available in the electronic medical record. Wait times were analyzed for patients receiving chemotherapy or flat dose injections. By marking appropriate patients “ready-to-treat” and moving pharmacist verification prior to infusion nurse assessment, there was an immediate decrease in wait time from 79 to 60 min. Selected injections which did not require mixing were pre-approved by the physician and stored in the medication dispensing system (Pyxis). This resulted in decrease in the injection wait time by 8.5 minutes, without wasting of drugs. Conclusions: Redesigning the medication order verification/approval workflow resulted in reduced wait times for patients receiving infusions or injections. We aim to further refine our PDSA cycles and ensure sustainability of change.

Skills of the head nurse: assessment, analysis, improvement

The professional activity of the leaders of nursing services requires from them not just theoretical and practical training, but the assessment, analysis and improvement of competencies that leaders need. The article analyzes the formation of professional skills among heads of nursing services.

Decreasing Duration of Mechanical Restraint Episodes by Increasing Registered Nurse Assessment and Surveillance in an Acute Psychiatric Hospital

INTRODUCTION: The application of mechanical restraints is a high-risk emergency measure that requires psychiatric intensive care to assure patient safety and expedite release at the earliest opportunity. While current Centers for Medicare & Medicaid Services regulations require trained staff to continuously observe restrained individuals, assessment by a registered nurse is required only once an hour. The experience of an acute psychiatric hospital demonstrates that more frequent registered nurse assessments can decrease duration of mechanical restraint episodes. AIMS: The aim of this three-part quality improvement project was to decrease duration of mechanical restraint episodes by increasing the frequency of registered nurse assessment and surveillance. METHODS: First, the requirement for frequency of face-to-face registered nurse assessment during episodes of mechanical restraint was increased from once every hour to once every 30 minutes. Second, the frequency of assessment was increased on half the hospital’s units, from every 30 minutes to continuous registered nurse presence during restraint. Finally, the remaining units adopted 1:1 registered nurses during restraint. Mean hours of restraint per episode were measured and compared before and after each practice change. RESULTS: Mean duration of restraint episodes decreased 23% in the first change cycle, 12% in the second, and 44% in the third. Overall, there was a statistically significant 30% decrease in mean duration of restraint episodes. CONCLUSIONS: Increased frequency of registered nurse assessment and surveillance can significantly decrease duration of mechanical restraint episodes. Nurses are encouraged to adopt mechanical restraint practice standards that provide continuous psychiatric intensive care by a registered nurse.