Validation of nursing documentation regarding in-hospital falls: a cohort study

Background In-hospital fall incidents are common and sensitive to nursing care. It is therefore important to have easy access to valid patient data to evaluate and follow-up nursing care. The aim of the study was to validate the nursing documentation, using a specific term in the registered nurses´ (RNs´) discharge note, regarding inpatient falls according to the outcome of a digitalized data extraction tool and the discharge note itself. Methods At a teaching hospital, 31,571 episodes of care were eligible for inclusion in this retrospective cohort study. A stratified sampling including five groups was used, two with random sampling and three with total sampling. In total, 1232 episodes of care were reviewed in the electronic patient record using a study-specific protocol. Descriptive statistics were used. Results In total, 590 episodes of care in the study cohort included 714 falls. When adjusted for the stratified sampling the cumulative incidence for the study population was 1.9%. The positive predictive value in total for the data extraction tool regarding the presence of any fall, in comparison with the record review, was 87.4%. Discrepancies found were, for example, that the RNs, at discharge, stated that the patient had fallen but no documented evidence of that could be detected during admission. It could also be the opposite, that the RNs correctly had documented that no fall had occurred, but the data extraction tool made an incorrect selection. When the latter had been withdrawn, the positive predictive value was 91.5%. Information about minor injuries due to the fall was less accurate. In the group where RNs had stated that the patient had fallen without injury, minor injuries had actually occurred in 28.3% of the episodes of care. Conclusions The use of a specific term regarding fall in the RNs´ discharge note seems to be a valid and reliable data measurement and can be used continuously to evaluate and follow-up nursing care.

Sediment displacement evolution after dam removal in a mountain river (Oioki dam, Leitzaran River)

<p>Bedload sediment transport was monitored from 2016 to 2020 in the Leitzaran River, in a reach affected by the removal of 7-meters high dam (Oioki dam). The removal was accomplished in two phases, the 3 first meters were removed in September 2018 and the second phase (September 2019) involved the removal of the remaining 4 meters. The study area was divided into three subreaches: control (unaffected by the dam), upstream and downstream of the dam. A sample of 300 RFID-tagged stones were seeded every year (100 at each reach).. Prior to this, the grain-size distribution of the surface sediment was characterized using the Wolman method. Then, the grain-size chosen for the tracer stones was distributed according to three Wentworth intervals: that corresponding to the surface d<sub>50</sub>, d<sub>50</sub>+1 (immediate upper interval), and d<sub>50</sub>-1 (immediate lower interval). It was not possible to follow completely, and the lower interval had to be dismissed as the sediment was very small or narrow to insert the tracer.</p><p>We conducted an extensive surveying field campaign every summer.</p><p>The number of retrieved tracers was relatively high, around 40-70% (considering all field campaigns), although with differences amongst the different sub-reaches. The obtained results were organized by displacements and volumes of sediment moved. The maximum (3,500 meters) and higher mean displacement (~1,550 meters) were registered in the hydrologic year 2019/20. These values are from the upstream reach of the dam and match simultaneously with (i) the whole removal of the dam, and (ii) the period showing a lower discharge (note the critical discharge for the movement of our particles is ~25-30 m<sup>3</sup>·s<sup>-1</sup> (d<sub>50</sub> = 64.0≥Ø<90.5 mm); mean discharge and peak flow from 2013 to 2020 were ~5.3 m<sup>3</sup>·s<sup>-1</sup> and ~125.0 m<sup>3</sup>·s<sup>-1</sup>, respectively and at the end of the watershed).</p><p>We also estimated the bulk bedload volumes during the time spanned by this research and we report how the hydrologic year 2019/20 was the more active in terms of displaced volumes, moving up to 27,500 tons in the upstream reach. In fact, this year also presents the maximum for the downstream reach.</p><p>At this moment, besides the raw data of displacements and volumes, our observations highlight how the fact that a copious load of sediment was made available with the dam removal seemed to be more determinant than the magnitude of the flow to get larger tracer displacements.</p>

Validation of Nursing Documentation Regarding in-hospital Falls: A Cohort Study

BackgroundIn-hospital fall incidents are common and sensitive to nursing care. It is therefore important to have easy access to valid patient data to evaluate and follow-up nursing care. The aim of the study was to validate the nursing documentation, using a specific term in the registered nurses´ (RNs´) discharge note, regarding inpatient falls according to the outcome of a digitalized data extraction tool and the discharge note itself.MethodsAt a teaching hospital, 31,571 episodes of care were eligible for inclusion in this cohort study. A stratified sampling including five groups was used, two with random sampling and three with total sampling. In total, 1,232 episodes of care were reviewed in the electronic patient record using a study-specific protocol. Descriptive statistics were used. ResultsIn total, 590 episodes of care in the study cohort included 712 falls. When adjusted for the stratified sampling the cumulative incidence for the study population was 1.9%.The positive predictive value in total for the data extraction tool regarding the presence of any fall, in comparison with the record review, was 87.4%. Discrepancies found were, for example, that the RNs, at discharge, stated that the patient had fallen but no documented evidence of that could be detected during admission. It could also be the opposite, that the RNs correctly had documented that no fall had occurred, but the data extraction tool made an incorrect selection. When the latter had been withdrawn, the positive predictive value was 91.5%.Information about minor injuries due to the fall was less accurate. In the group where RNs had stated that the patient had fallen without injury, minor injuries had actually occurred in 28.3% of the episodes of care. Conclusions The use of a specific term regarding fall in the RNs´ discharge note seems to be a valid and reliable data measurement and can be used continuously to evaluate and follow-up nursing care.

Documentation That Works

Clinical documentation allows the speech-language pathologist to chart the events, findings, and clinical impressions gleamed from the patient encounter. Good record keeping enhances clinical follow through with the transfer of information from evaluation findings to therapeutic invention or from session to session to ensure the progression of therapy. Poor record keeping poses a threat to evaluation and therapy follow-through, to insurance reimbursement, and to the development of a clinical record that meets legal standards. The purpose of this article is to provide a streamlined reference for those documenting voice evaluations and therapy encounters. Clinical documentation meeting the guidelines proposed by ASHA (1994, 2006, 2007a), and with regard to Medicare requirements for the documentation of evaluation, plan of care, treatment note, progress note, and discharge note is presented. The use of templates to reduce documentation load is discussed as is the advent of electronic medical record. Documentation can be overwhelming and the amount of information required in documentation of a single therapy session seems to increase each year. Assuring that documents meet medical/legal guidelines and individual payer guidelines is paramount. ASHA resources for assisting clinicians in the development of documentation are highlighted in the article.

Cost-effectiveness analysis of medical documentation alternatives

Objectives:The delay between patient discharge and the completion of the final discharge note have prompted hospitals to consider new information technologies. This study compared the relative cost-effectiveness of an automated medical documentation system to the current system in place at a Canadian hospital. There are significant expenditures associated with the choice of medical documentation system, yet the benefit to the patient population has not been studied.Methods:A systematic review of the literature was carried out. Cost data for the current documentation system were obtained from the study hospital. The costs of purchasing the automated system were obtained from the manufacturer. Other resource cost implications of the automated system were estimated based on information obtained from the Centre for Applied Health Informatics at the study hospital. The outcome was determined to be the average time (days) between patient discharge and note completion. A cost-effectiveness analysis was conducted. Sensitivity analyses were used to determine the robustness of the results.Results:The automated documentation system was associated with higher costs but better outcomes than the current system. The incremental cost-effectiveness ratio used for comparing the automated medical documentation system with the traditional system indicated that the incremental daily cost for decreasing a day in average note completion time per discharge note was 0.331 Canadian $/day over the study period (4 years).Conclusions:Although the automated documentation system was more expensive than the current system, it also provided qualitative benefits that were not considered in the cost-effectiveness analysis.