Abstract P301: Evaluating the Impact of a Pharmacist-Managed Hypertension Collaborative Care Model in Vascular Neurology Patients in an Inpatient Acute Care Setting

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ann Smith ◽  
Kathleen Bledsoe ◽  
Thomas Madden ◽  
Jamie Artale ◽  
Ted Sindlinger
Keyword(s):  
Blood Pressure ◽  
Acute Care ◽  
Care Setting ◽  
Management Practice ◽  
Primary Objective ◽  
Adverse Outcomes ◽  
Acute Care Setting ◽  
Percentage Reduction ◽  
Improvement Project ◽  
The Impact

Introduction: The utility of pharmacist-managed collaborative practice agreements (CPA) in the management of hypertension is well established in the outpatient setting. There has been little evaluation of the use of CPAs in the inpatient acute care setting, and none described specifically in the vascular neurology population. Treatment of hypertension is a critical intervention for the secondary prevention of acute ischemic stroke. This quality improvement project evaluated the implementation of a CPA for the inpatient acute care management of hypertension in vascular neurology patients at University of Virginia Health. Methods: A CPA was developed between the neurosciences clinical pharmacist group and the inpatient vascular neurology service, legally vetted, and implemented in June 2019. All vascular neurology patient charts in which an electronic CPA referral was placed from June 2019 through June 2020 were reviewed. Patients were excluded if they were discharged within 24 hours of the referral being placed. The primary objective was to describe and evaluate the implementation of a pharmacist-driven hypertension management practice in the inpatient acute care setting. All patient demographic and clinical data were analyzed using descriptive statistics. Secondary safety outcomes included documented hypotensive events (SBP <90) and acute kidney injury (AKI, increase in SCr by 0.3 mg/dl within 48 hours). Results: During the study period, 26 referrals were placed, and 19 patients were included for review. On average, patients were on 2 anti-hypertensive medications prior to admission. From the time of referral to discharge (mean 6 days), systolic blood pressure (SBP) was reduced on average by 36 mmHg (mean percentage reduction 20%) and diastolic blood pressure (DBP) by 12 mmHg (mean percentage reduction 7%). Ten patients (53%) met the goal of SBP < 140 at discharge. There were 5 hypotensive events and 4 instances of AKI, all of which were mild and recovered prior to discharge. Conclusion: A pharmacist-managed hypertension CPA was successfully implemented in vascular neurology patients in the inpatient acute care setting. The practice demonstrated improved blood pressure control and minimal adverse outcomes.

What factors affect nursing retention in the acute care setting?

2011 ◽  
Vol 16 (6) ◽  
pp. 489-500 ◽  
Author(s):  
Cynthia L. Cummings
Keyword(s):  
Acute Care ◽  
Care Setting ◽  
Moral Distress ◽  
Intent To Stay ◽  
Institutional Setting ◽  
Acute Care Setting ◽  
Nursing Retention ◽  
Acute Care Nurses ◽  
Professional Stress ◽  
The Impact

Moral distress and professional stress affect the lives of acute care nurses everyday. The impact of these stressors may be causing nurses to leave the acute care setting. This paper will outline the findings from a descriptive study of acute care nurses in Northeast Florida. The research was conducted in an effort to highlight some of the critical factors that impact nurses in the acute care setting and affect their intent to stay at an institution. The concepts of moral distress and professional stress in relation to nursing retention are highlighted and some strategies for lessening of these stressors are proposed. The study was correlational and conducted among 234 nurses in an institutional setting. The study included an online survey based on established Moral Distress and Professional Stress tools. In addition, a qualitative section was included to explore the nurses’ experiences of stressful inpatient situations. The results of this study demonstrated that when combined, both professional stress and moral distress items were predictive of the nurses’ intent to stay at the institution ( p <.001).

Improving the final year of life at the institutional level: Quality dying initiative (QDI).

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 124-124
Author(s):  
Jeff Myers ◽  
Tracey DasGupta
Keyword(s):  
Acute Care ◽  
Large Scale ◽  
Care Setting ◽  
Family Members ◽  
Care Plan ◽  
Acute Care Setting ◽  
Improvement Project ◽  
Implementation Phase ◽  
Dying Patients ◽  
Care Of The Dying

124 Background: For a tertiary academic health sciences and comprehensive cancer centre, care of the dying is a significant element of the institution’s overall patient and family care experience. The aim for this large-scale quality improvement project was to improve the quality of the experience for a patient in the final year of life and their family members. Methods: This is descriptive study involves one institution and the characterization of three distinct patient populations: A - Imminently dying patients for whom care goals have been clarified to be comfort, B - Patients for whom death “this admission” would not be a surprise and C - Among patients being discharged, death “within the next year” would not be a surprise, linking in the outpatient cancer care setting. Results: On average 19 deaths per week are in some way expected for the institution’s acute care setting. Phase 1 of the QDI included a review of evidence and best practices in care of the dying as well as comprehensive plans for both organizational engagement and communications. Phase 2 of the QDI (i.e. “Implementation Phase”) involved interventions for each patient population. A corporate-wide “Comfort Strategy” was developed to address Population A. Components include standardized order sets, standardized interprofessional “Comfort Assessment and Documentation”, the palliative care team’s “Coaching Consult”, a “Family Member Education” process and an evaluation plan that includes an experience survey routinely sent to family members following a patient’s death. The intervention was piloted on and subsequently rolled out to all inpatient oncology units. Interventions for Population B and C are the triggering of Goals of Care and Advance Care Plan discussions respectively. Key metrics have been identified for all three patient populations and are based on care elements considered important by dying patients and their family members. These now comprise a dashboard, which has been endorsed for roll out to all patient care units in the acute care setting. Conclusions: A quality framework can be effectively applied for the institutional context of developing an approach to improving the final year of life for a cancer patient.

The Impact of Intrainstitutional Relocation on Morbidity in an Acute Care Setting

1995 ◽  
Vol 35 (2) ◽  
pp. 217-224 ◽  
Author(s):  
J. Mirotznik ◽  
T. G. Lombardi
Keyword(s):  
Acute Care ◽  
Care Setting ◽  
Acute Care Setting ◽  
The Impact

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.

Examination of the Use of Healing Touch by Registered Nurses in the Acute Care Setting

2016 ◽  
Vol 35 (1) ◽  
pp. 97-107 ◽  
Author(s):  
Joel G. Anderson ◽  
Mary Ann Friesen ◽  
Diane Swengros ◽  
Anna Herbst ◽  
Lucrezia Mangione
Keyword(s):  
Patient Care ◽  
Registered Nurses ◽  
Acute Care ◽  
Care Setting ◽  
Care Delivery ◽  
Acute Care Setting ◽  
Healing Touch ◽  
The Impact ◽  
Acute Care Nursing ◽  
Care Nursing

Acute care nursing is currently undergoing unprecedented change, with health systems becoming more open to nonpharmacological approaches to patient care. Healing Touch (HT) may be a valuable intervention for acute care patients. Research has shown that HT helps both the patient and the caregiver; however, no study to date has examined the impact that the education of nurses in and their use of HT have on daily care delivery in the acute care setting. The purpose of the current qualitative study was to examine the use of HT by registered nurses in the acute care setting during their delivery of patient care, as well as the impact of education in and use of HT on the nurses themselves. Five themes were identified: (1) use of HT techniques, processes, and sequence; (2) outcomes related to HT; (3) integration of HT into acute care nursing practice; (4) perceptions of HT, from skepticism to openness; and (5) transformation through HT. Education in HT and delivery of this modality by nurses in the acute care setting provide nurses with a transformative tool to improve patient outcomes.

PP163-SUN THE IMPACT OF LENGTH OF STAY ON THE NUTRITIONAL STATUS OF LONG-TERM PATIENTS IN THE ACUTE CARE SETTING

2011 ◽  
Vol 6 (1) ◽  
pp. 85-86
Author(s):  
J. Bauer ◽  
K. Hiscocks ◽  
R. Fichera ◽  
P. Horsley ◽  
J. Martineau ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Nutritional Status ◽  
Acute Care ◽  
Care Setting ◽  
Acute Care Setting ◽  
The Impact

scholarly journals 60. Penicillin Allergy Delabeling Program in the Post-acute Care Setting

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S148-S148
Author(s):  
Joseph Galipean ◽  
Jerry Jacob
Keyword(s):  
Acute Care ◽  
Care Setting ◽  
Significant Proportion ◽  
Adverse Outcomes ◽  
Penicillin Allergy ◽  
Acute Care Setting ◽  
Beta Lactam ◽  
History Of ◽  
Ige Mediated ◽  
Post Acute Care

Abstract Background A significant proportion of inpatients labeled with penicillin allergies do not have a true IgE-mediated hypersensitivity, which may unnecessarily limit options for treatment of infection and lead to suboptimal antibiotic selection. Post-acute care settings may provide a unique opportunity to capture patients at risk for adverse outcomes related to penicillin allergy labels. The objective of the study was to assess the feasibility and impact of a penicillin delabeling program in an inpatient rehab setting. Methods We conducted a prospective observational study. Inpatients with penicillin allergies were identified weekly by manual review of electronic medical records. A clinical pharmacist reviewed each patient’s chart and identified patients for inclusion. Patients were excluded if they had a history of IgE-mediated hypersensitivity to penicillin within last 5 years, a history of a non-IgE mediated hypersensitivity, were severely immunocompromised, or were prescribed a contraindicated medication. Results A total of 72 charts were reviewed over nine months, and 37 (51.4%) had their penicillin allergy updated to reflect prior beta-lactam tolerance. Of the 72 patient that were evaluated, 28 (38.9%) were eligible for potential penicillin allergy delabeling, and 44 (61.1%) were ineligible. 59 (81.9%) of the patients had a moderate-high risk allergy, 12 (16.6%) had a low risk allergy, and 1 (1.4%) had an intolerance. Of the 28 eligible patients, 11 (39.3%) had their allergy removed, 13 (46.4%) deferred testing, and 4 (14.2%) could not be tested due to staffing. Of the 28 patients that had their allergy delabeled, 7 (21.4%) had their allergy removed by MAR review, 2 (7.2%) had a skin test with a negative result, and 2 (7.2%) had a direct oral challenge with a negative result. Conclusion A penicillin allergy delabeling program using a collaborative physician-pharmacist team model efficiently removed reported allergies in post-acute care patients. The post-acute care setting is an opportune environment to conduct a penicillin allergy delabeling program for patients not currently needing acute medical treatment. Disclosures All Authors: No reported disclosures

scholarly journals Nurses' Perception of Mobile Communication in an Acute Care Setting

2017 ◽  
Author(s):  
David Gardner
Keyword(s):  
Patient Safety ◽  
Response Time ◽  
Acute Care ◽  
Mobile Communication ◽  
Care Setting ◽  
Unintended Consequences ◽  
Acute Care Setting ◽  
Personal Impact ◽  
Communication Devices ◽  
The Impact

Communication is at the center of providing health with care. Good communication between nurses, patients, and among members of the health care team is paramount in delivering patient-centered care. The literature has demonstrated that mobile communication devices can improve quality and efficiency of communication among clinicians, mobilize information, improve clinical workflow, improve response time, and provide cost savings. The research has also revealed unintended consequences such as interruptions in care, increase in errors, caregiver distractions, and reductions in workflow processes. There is currently limited evidence in the literature regarding the perceptions of nurses regarding the use and satisfaction of mobile communication devices. This study examined a convenience sample of nurses (n=64) working in an acute care setting. Donabedian’s process, structure, and outcome model was used to guide this exploratory research. Registered Nurses (RNs) participated in a self-reported one-time survey on perceptions of the use of wireless mobile communication devices. The survey consisted of a 34 response Likert questionnaire which included questions about the mobile devices’ impact on communication, the personal impact the device had on nurses, the perceptions of training and implementation, the devices’ involvement in patient safety, and the overall impact of using the device. The results suggest an increase in the speed and reliability of communication with the use of a mobile communication device, improved response time to patient issues, and improved communication. However, nurses responded unfavorably regarding the impact on patient safety. Trends in data demonstrated nurses with less experience scoring more favorably than nurses with more experience. Most nurses responded unfavorably to the overall impact these devices had.

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