Evaluation of the Patient Sitter Assessment Tool

Mapping Intimacies ◽

10.28971/532011dt61 ◽

2011 ◽

Author(s):

Tamara DeSousa

Keyword(s):

Acute Care ◽

Assessment Tool ◽

Care Facility ◽

Strong Relationship ◽

Cognitive Status ◽

Ease Of Use ◽

Contributing Factors ◽

Improvement Project ◽

Patient Falls ◽

Telemetry Unit

<p>Maintaining the safety of hospitalized patients is a top priority in healthcare. Evidence has demonstrated that most patient injuries associated with falls are preventable. Despite major, sustained national initiatives related to fall prevention, fall rates continue to be problematic in acute care settings. Patient sitters are often used to observe/and or assist those that are identified as at a high risk for falls; however evidence to support the effectiveness of this intervention in reducing fall risk is lacing. A committee charged with revising the sitter policy in an acute care facility discovered inconsistencies by nurses when assessing this patient population. A literature review revealed common contributing factors to a change in cognition and delirium, both having strong relationship to patient falls. A Patient Sitter Assessment tool was developed and pilot tested on a 27 bed medical surgical telemetry unit. The purpose of this process improvement project was to determine the ease of use,utility, and staff satisfaction of the tool. Evaluation from 12 staff nurses who participated were favorable. Overall, nurses indicated satisfaction with the tool, and provided feedback that more education on delirium and contributing factors that impact cognition was needed. It is expected that use of the tool will result in earlier detection and treatment of change in cognitive status and improved sitter use. Implications and recommendations are presented and discussed.</p>

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566. Reduction of Hospital-Onset Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia in an Acute Care Hospital: Impact of Bundles and Universal Decolonization

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.635 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S268-S268

Author(s):

Adriana Jimenez ◽

Kathleen Sposato ◽

Alicia de Leon-Sanchez ◽

Regina Williams ◽

Reynande Francois ◽

...

Keyword(s):

Hand Hygiene ◽

Acute Care ◽

Care Facility ◽

The United States ◽

Adult Patients ◽

Care Hospital ◽

Icu Patients ◽

Improvement Project ◽

Contact Precautions ◽

The Impact

Abstract Background MRSA is a major concern for hospitalized patients in the United States. Hospital-Onset (HO) MRSA bacteremia is used as a proxy measurement of MRSA healthcare acquisition, exposure, and infection burden. HO MRSA bacteremia standardized infection ratio (SIR) is used by several national agencies as a quality report metric. Our institution had more than expected HO MRSA bacteremia cases despite several interventions. We describe the impact of a bundle of interventions aimed to decrease HO MRSA bacteremia in an acute care facility. Methods This quality improvement project was implemented in a 380-bed community hospital in Miami, FL from January 2015 to March 2019. HO MRSA bacteremia was defined as non-duplicate MRSA isolated from a blood culture collected >3 days after admission. SIR was calculated dividing the number of observed events by the number of predicted events; predicted events were obtained from the NHSN report. During baseline period (Figure1 Phase 1 January 2015–August 2016) all adult patients in the intensive care unit (ICU) were screened for MRSA nasal colonization on admission and weekly thereafter, ICU patients received daily Chlorhexidine (CHG) bathing, and colonized/infected patients with MRSA were placed in contact precautions. In Phase 2 (September 2016–June 2017)daily CHG bathing was switched from 2% wipes to 4% soap foam and expanded to all adult patients; ICU patients also received nasal decolonization with mupirocin. Nasal mupirocin in ICU was replaced with alcohol-based nasal sanitizer for all adult units in July 2017 (Phase 3). In April 2017 we discontinued using contact precautions for MRSA patients; nasal surveillance cultures were discontinued in October 2017. In May 2018 (Phase 4) we introduced alcohol-based wipes for patient hand hygiene at the bedside. SIR were compared by exact binomial test. Results We observed 48 HO MRSA bacteremia cases during the study period. The SIR decreased from 3.66 to 0.97 from baseline to postintervention periods (P = 0.003). The largest decrease in cases and SIR was attained using combined hospital-wide daily CHG bathing, alcohol-based nasal sanitizer, and alcohol wipes for patient hand hygiene during Phase 4 (Table 1). Conclusion Our bundle of interventions for universal decolonization was successful in decreasing HO MRSA bacteremia. Disclosures All authors: No reported disclosures.

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Continuous glucose monitoring in older people with diabetes receiving home care - A feasibility study

10.21203/rs.3.rs-39986/v3 ◽

2020 ◽

Author(s):

Annette Bævre Larsen ◽

Monica Hermann ◽

Marit Graue

Keyword(s):

Risk Assessment ◽

Home Care ◽

Older People ◽

Assessment Tool ◽

Glucose Monitoring ◽

Cognitive Status ◽

Ease Of Use ◽

Quality Of Data ◽

Care Services

Abstract BackgroundHypoglycemic incidents in older people can cause severe health problems, enhance general age-related disabilities and cause frailty. Little is known about incidences of hypoglycemia in older home-dwelling people with diabetes. Thus, the aim of this study was to examine the feasibility of capturing hypoglycemia and issues associated with increased risk of hypoglycemia by use of continuous glucose monitoring (CGM) and standardized questionnaires among older home dwelling individuals with diabetes type 2 receiving home care.MethodsCGM with the Ipro2 blinded monitoring system were performed for five days in six home-dwelling individuals ≥ 75 years diagnosed with diabetes and receiving home care. Demographic (age, gender, living arrangements) and clinical data (diabetes diagnoses and duration, diabetes medication, documented treatment goal, available glycosylated hemoglobin (HbA1c),) were collected from electronic patient records in home care services. Feasibility (ease of use, quality of data, time spent) of standardized questionnaires to identify the risk of hypoglycemia (the McKellar Risk Assessment Tool), risk of malnutrition (the Mini Nutritional Assessment (MNA)), functional status (the Individual-based Statistics for Nursing and Care Services (IPLOS)) and cognitive status (the Mini Mental Status Exam (MMSE)) was also assessed. Questionnaire data was collected by a study nurse in the individuals’ home.ResultsThe practical use of CGM was satisfactory, with no major remarks about discomfort or technical errors, except for one participant with skin reaction (redness). Collecting data with the McKellar Risk Assessment Tool, MNA and IPLOS worked well according to quality of data, time spent and ease of use. The MMSE survey required extensive training of personnel to be conducted.ConclusionThe feasibility study informs an upcoming study on the incidence and risk factors of hypoglycemia in home dwelling older individuals. We will ascertain that personnel who will use the MMSE questionnaire to collect cognitive status and skills are familiar with the tool and adequately educated and trained before study start. The use of blinded CGM in this population was well tolerated and can be used ‘as is’ for future studies.

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Transitions in Care From Acute Care Telemetry Unit to Home: An Evidence-Based Quality Improvement Project

Critical Care Nurse ◽

10.4037/ccn2018217 ◽

2018 ◽

Vol 38 (5) ◽

pp. 77-80 ◽

Cited By ~ 1

Author(s):

Theresa M. Soltis ◽

Kerry A. Milner ◽

Denise Buonocore

Keyword(s):

Quality Improvement ◽

Acute Care ◽

Quality Improvement Project ◽

Evidence Based ◽

Improvement Project ◽

Transitions In Care ◽

Telemetry Unit

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Continuous glucose monitoring in older people with diabetes receiving home care—a feasibility study

Pilot and Feasibility Studies ◽

10.1186/s40814-020-00754-3 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Annette Bævre Larsen ◽

Monica Hermann ◽

Marit Graue

Keyword(s):

Risk Assessment ◽

Home Care ◽

Older People ◽

Assessment Tool ◽

Glucose Monitoring ◽

Cognitive Status ◽

Ease Of Use ◽

Quality Of Data ◽

Care Services

Abstract Background Hypoglycemic incidents in older people can cause severe health problems, enhance general age-related disabilities, and cause frailty. Little is known about incidences of hypoglycemia in older home-dwelling people with diabetes. Thus, the aim of this study was to examine the feasibility of capturing hypoglycemia and issues associated with increased risk of hypoglycemia by use of continuous glucose monitoring (CGM) and standardized questionnaires among older home-dwelling individuals with diabetes type 2 receiving home care. Methods CGM with the Ipro2-blinded monitoring system were performed for 5 days in six home-dwelling individuals ≥ 75 years diagnosed with diabetes and receiving home care. Demographic (age, gender, living arrangements) and clinical data (diabetes diagnoses and duration, diabetes medication, documented treatment goal, available glycosylated hemoglobin (HbA1c)) were collected from electronic patient records in home care services. Feasibility (ease of use, quality of data, time spent) of standardized questionnaires to identify the risk of hypoglycemia (the McKellar Risk Assessment Tool), risk of malnutrition (the Mini Nutritional Assessment (MNA)), functional status (the Individual-based Statistics for Nursing and Care Services (IPLOS)), and cognitive status (the Mini Mental Status Exam (MMSE)) was also assessed. Questionnaire data was collected by a study nurse in the individuals’ home. Results The practical use of CGM was satisfactory, with no major remarks about discomfort or technical errors, except for one participant with skin reaction (redness). Collecting data with the McKellar Risk Assessment Tool, MNA and IPLOS worked well according to quality of data, time spent, and ease of use. The MMSE survey required extensive training of personnel to be conducted. Conclusion The feasibility study informs an upcoming study on the incidence and risk factors of hypoglycemia in home-dwelling older individuals. We will ascertain that personnel who will use the MMSE questionnaire to collect cognitive status and skills are familiar with the tool and adequately educated and trained before study start. The use of blinded CGM in this population was well tolerated and can be used “as is” for future studies.

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Continuous glucose monitoring in older people with diabetes receiving home care - A feasibility study

10.21203/rs.3.rs-39986/v4 ◽

2020 ◽

Author(s):

Annette Bævre Larsen ◽

Monica Hermann ◽

Marit Graue

Keyword(s):

Risk Assessment ◽

Home Care ◽

Older People ◽

Assessment Tool ◽

Glucose Monitoring ◽

Cognitive Status ◽

Ease Of Use ◽

Quality Of Data ◽

Care Services

Abstract Background Hypoglycemic incidents in older people can cause severe health problems, enhance general age-related disabilities and cause frailty. Little is known about incidences of hypoglycemia in older home-dwelling people with diabetes. Thus, the aim of this study was to examine the feasibility of capturing hypoglycemia and issues associated with increased risk of hypoglycemia by use of continuous glucose monitoring (CGM) and standardized questionnaires among older home dwelling individuals with diabetes type 2 receiving home care. Methods CGM with the Ipro2 blinded monitoring system were performed for five days in six home-dwelling individuals ≥ 75 years diagnosed with diabetes and receiving home care. Demographic (age, gender, living arrangements) and clinical data (diabetes diagnoses and duration, diabetes medication, documented treatment goal, available glycosylated hemoglobin (HbA1c),) were collected from electronic patient records in home care services. Feasibility (ease of use, quality of data, time spent) of standardized questionnaires to identify the risk of hypoglycemia (the McKellar Risk Assessment Tool), risk of malnutrition (the Mini Nutritional Assessment (MNA)), functional status (the Individual-based Statistics for Nursing and Care Services (IPLOS)) and cognitive status (the Mini Mental Status Exam (MMSE)) was also assessed. Questionnaire data was collected by a study nurse in the individuals’ home. Results The practical use of CGM was satisfactory, with no major remarks about discomfort or technical errors, except for one participant with skin reaction (redness). Collecting data with the McKellar Risk Assessment Tool, MNA and IPLOS worked well according to quality of data, time spent and ease of use. The MMSE survey required extensive training of personnel to be conducted. Conclusion The feasibility study informs an upcoming study on the incidence and risk factors of hypoglycemia in home dwelling older individuals. We will ascertain that personnel who will use the MMSE questionnaire to collect cognitive status and skills are familiar with the tool and adequately educated and trained before study start. The use of blinded CGM in this population was well tolerated and can be used ‘as is’ for future studies.

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Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database

Journal of Neurosurgery Spine ◽

10.3171/2019.9.spine19644 ◽

2020 ◽

Vol 32 (4) ◽

pp. 523-532 ◽

Cited By ~ 1

Author(s):

Praveen V. Mummaneni ◽

Mohamad Bydon ◽

John Knightly ◽

Mohammed Ali Alvi ◽

Anshit Goyal ◽

...

Keyword(s):

Body Mass Index ◽

Acute Care ◽

Body Mass ◽

Care Facility ◽

Older Age ◽

Quality Outcomes ◽

Acute Care Facility ◽

Factors Associated ◽

Patient Reported ◽

The Impact

OBJECTIVEDischarge to an inpatient rehabilitation facility or another acute-care facility not only constitutes a postoperative challenge for patients and their care team but also contributes significantly to healthcare costs. In this era of changing dynamics of healthcare payment models in which cost overruns are being increasingly shifted to surgeons and hospitals, it is important to better understand outcomes such as discharge disposition. In the current article, the authors sought to develop a predictive model for factors associated with nonroutine discharge after surgery for grade I spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis who underwent a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes among patients with grade I spondylolisthesis were evaluated. Nonroutine discharge was defined as those who were discharged to a postacute or nonacute-care setting in the same hospital or transferred to another acute-care facility.RESULTSOf the 608 patients eligible for inclusion, 9.4% (n = 57) had a nonroutine discharge (8.7%, n = 53 discharged to inpatient postacute or nonacute care in the same hospital and 0.7%, n = 4 transferred to another acute-care facility). Compared to patients who were discharged to home, patients who had a nonroutine discharge were more likely to have diabetes (26.3%, n = 15 vs 15.7%, n = 86, p = 0.039); impaired ambulation (26.3%, n = 15 vs 10.2%, n = 56, p < 0.001); higher Oswestry Disability Index at baseline (51 [IQR 42–62.12] vs 46 [IQR 34.4–58], p = 0.014); lower EuroQol-5D scores (0.437 [IQR 0.308–0.708] vs 0.597 [IQR 0.358–0.708], p = 0.010); higher American Society of Anesthesiologists score (3 or 4: 63.2%, n = 36 vs 36.7%, n = 201, p = 0.002); and longer length of stay (4 days [IQR 3–5] vs 2 days [IQR 1–3], p < 0.001); and were more likely to suffer a complication (14%, n = 8 vs 5.6%, n = 31, p = 0.014). On multivariable logistic regression, factors found to be independently associated with higher odds of nonroutine discharge included older age (interquartile OR 9.14, 95% CI 3.79–22.1, p < 0.001), higher body mass index (interquartile OR 2.04, 95% CI 1.31–3.25, p < 0.001), presence of depression (OR 4.28, 95% CI 1.96–9.35, p < 0.001), fusion surgery compared with decompression alone (OR 1.3, 95% CI 1.1–1.6, p < 0.001), and any complication (OR 3.9, 95% CI 1.4–10.9, p < 0.001).CONCLUSIONSIn this multisite study of a defined cohort of patients undergoing surgery for grade I spondylolisthesis, factors associated with higher odds of nonroutine discharge included older age, higher body mass index, presence of depression, and occurrence of any complication.

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A comparison of the Remote Food Photography Method and the Automated Self-Administered 24-hour Dietary Assessment Tool for measuring full day dietary intake among school-aged children

British Journal Of Nutrition ◽

10.1017/s0007114521001951 ◽

2021 ◽

pp. 1-26

Author(s):

Traci A. Bekelman ◽

Corby K. Martin ◽

Susan L. Johnson ◽

Deborah H. Glueck ◽

Katherine A. Sauder ◽

...

Keyword(s):

Dietary Intake ◽

Energy Intake ◽

Mixed Model ◽

Linear Mixed Model ◽

Assessment Tool ◽

Dietary Assessment ◽

Ease Of Use ◽

Self Report ◽

Food Photography ◽

Photography Method

Abstract The limitations of self-report measures of dietary intake are well known. Novel, technology-based measures of dietary intake may provide a more accurate, less burdensome alternative to existing tools. The first objective of this study was to compare participant burden for two technology-based measures of dietary intake among school-age children: the Automated-Self Administered 24-hour Dietary Assessment Tool-2018 (ASA24-2018) and the Remote Food Photography Method (RFPM). The second objective was to compare reported energy intake for each method to the Estimated Energy Requirement for each child, as a benchmark for actual intake. Forty parent-child dyads participated in 2, 3-day dietary assessments: a parent proxy-reported version of the ASA24 and the RFPM. A parent survey was subsequently administered to compare satisfaction, ease of use and burden with each method. A linear mixed model examined differences in total daily energy intake (TDEI) between assessments, and between each assessment method and the EER. Reported energy intake was 379 kcal higher with the ASA24 than the RFPM (p=0.0002). Reported energy intake with the ASA24 was 231 kcal higher than the EER (p = 0.008). Reported energy intake with the RFPM did not differ significantly from the EER (difference in predicted means = −148 kcal, p = 0.09). Median satisfaction and ease of use scores were 5 out of 6 for both methods. A higher proportion of parents reported that the ASA24 was more time consuming than the RFPM (74.4% vs. 25.6%, p = 0.002). Utilization of both methods is warranted given their high satisfaction among parents.

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