Targeting Sepsis as a Performance Improvement Metric

Sepsis is the body’s systemic response to infection that can be complicated by acute organ dysfunction and is associated with high mortality rates and adverse outcomes for acute and critically ill patients. The 2012 Surviving Sepsis Campaign guidelines advocated for implementation of evidence-based practice care for sepsis, with a focus on quality improvement. Nurses are directly involved in identification and management of sepsis. Implementing performance improvement strategies aimed at early recognition and targeted treatment can further improve sepsis care and patient outcomes. This article presents an overview of the process of implementing performance improvement initiatives for sepsis care, highlighting the significant contribution of nursing care.

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Research Consumerism 101: Evaluating External Evidence of Treatment Effectiveness

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd17.2.43 ◽

2008 ◽

Vol 17 (2) ◽

pp. 43-49

Author(s):

James L. Coyle

Keyword(s):

Treatment Effectiveness ◽

Code Of Ethics ◽

Oropharyngeal Dysphagia ◽

Clinical Importance ◽

Professional Services ◽

Adverse Outcomes ◽

Professional Judgment ◽

Evidence Based ◽

Intervention Selection ◽

Published Research

Abstract The modern clinician is a research consumer. Rehabilitation of oropharyngeal impairments, and prevention of the adverse outcomes of dysphagia, requires the clinician to select interventions for which evidence of a reasonable likelihood of a successful, important outcome exists. The purpose of this paper is to provide strategies for evaluation of published research regarding treatment of oropharyngeal dysphagia. This article utilizes tutorial and examples to inform and educate practitioners in methods of appraising published research. It provides and encourages the use of methods of efficiently evaluating the validity and clinical importance of published research. Additionally, it discusses the importance of the ethical obligation we, as practitioners, have to use evidence-based treatment selection methods and measurement of patient performance during therapy. The reader is provided with tactics for evaluating treatment studies to establish a study's validity and, thereby, objectively select interventions. The importance of avoiding subjective or unsubstantiated claims and using objective methods of generating empirical clinical evidence is emphasized. The ability to evaluate the quality of research provides clinicians with objective intervention selection as an important, essential component of evidence-based clinical practice. ASHA Code of Ethics (2003): Principle I, Rule F: “Individuals shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed…” (p. 2) Principle I, Rule G: “Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected.” (p. 2) Principle IV, Rule G: “Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.” (p. 4)

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Faculty Opinions recommendation of The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.4792956.4698054 ◽

2010 ◽

Author(s):

Bruce Greenwald

Keyword(s):

Severe Sepsis ◽

Performance Improvement ◽

International Guideline ◽

Surviving Sepsis Campaign ◽

Improvement Program

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Laryngeal cancer

InnovAiT Education and inspiration for general practice ◽

10.1177/17557380211010564 ◽

2021 ◽

pp. 175573802110105

Author(s):

Kelvin Miu

Keyword(s):

Head And Neck Cancer ◽

Early Diagnosis ◽

Head And Neck ◽

Patient Outcomes ◽

Laryngeal Cancer ◽

Neck Cancer ◽

Early Recognition ◽

Signs And Symptoms ◽

Diagnosis And Treatment

Laryngeal cancer is a common head and neck cancer and typically presents with voice hoarseness in patients older than 60 years. Early recognition of signs and symptoms of laryngeal cancer can lead to early diagnosis and treatment, therefore improving patient outcomes. This article aims to provide an overview of the anatomy of the larynx, presentation and management of laryngeal cancer, and common follow-up problems.

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Recognition and management of neonatal sepsis

British Journal of Nursing ◽

10.12968/bjon.2021.30.7.410 ◽

2021 ◽

Vol 30 (7) ◽

pp. 410-415

Author(s):

Luke William Crocker ◽

Ayesha White ◽

Paul Anthony Heaton ◽

Débora Pascoal Horta ◽

Siba Prosad Paul

Keyword(s):

Neonatal Sepsis ◽

Early Recognition ◽

Signs And Symptoms ◽

Evidence Based ◽

Suspected Sepsis ◽

Serious Illness ◽

Prompt Treatment ◽

Serious Infection ◽

Common Causes ◽

Red Flag

Neonatal sepsis results from acute bacterial or viral infection occurring in the first 28 days of life. It causes significant morbidity and mortality, although the outcome can be improved by early recognition and prompt treatment by health professionals. This article describes the most common causes of sepsis, and explains why neonates are particularly vulnerable to infection. It highlights the non-specific way in which an infant with a serious infection may present, indicating the crucial features to elicit during history taking and examination, and emphasising the ‘red-flag’ signs and symptoms that should increase suspicion of a serious illness. The authors have adapted National Institute for Health and Care Excellence guidelines to produce an evidence-based approach to the management of an infant with suspected sepsis, and describe the roles of nurses in ensuring effective treatment and best outcomes for these babies.

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Teaching Evidence-Based Sepsis Care: A Sepsis Escape Room

The Journal of Continuing Education in Nursing ◽

10.3928/00220124-20210414-05 ◽

2021 ◽

Vol 52 (5) ◽

pp. 217-225

Author(s):

Paula M. Gabriel ◽

Casey L. Lieb ◽

Sara Holland ◽

James Ballinghoff ◽

Pamela Z. Cacchione ◽

...

Keyword(s):

Evidence Based ◽

Sepsis Care

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Lower extremity osteoarthritis: optimising musculoskeletal health is a growing global concern: a narrative review

British Journal of Sports Medicine ◽

10.1136/bjsports-2017-098051 ◽

2018 ◽

Vol 53 (13) ◽

pp. 806-811 ◽

Cited By ~ 4

Author(s):

Richard D Leech ◽

Jillian Eyles ◽

Mark E Batt ◽

David J Hunter

Keyword(s):

Patient Outcomes ◽

Key Management ◽

Structural Changes ◽

Healthcare Professionals ◽

Disease Process ◽

Evidence Based ◽

Musculoskeletal Health ◽

Proactive Approach ◽

Global Concern ◽

Improve Patient

The burden of non-communicable diseases, such as osteoarthritis (OA), continues to increase for individuals and society. Regrettably, in many instances, healthcare professionals fail to manage OA optimally. There is growing disparity between the strength of evidence supporting interventions for OA and the frequency of their use in practice. Physical activity and exercise, weight management and education are key management components supported by evidence yet lack appropriate implementation. Furthermore, a recognition that treatment earlier in the disease process may halt progression or reverse structural changes has not been translated into clinical practice. We have largely failed to put pathways and procedures in place that promote a proactive approach to facilitate better outcomes in OA. This paper aims to highlight areas of evidence-based practical management that could improve patient outcomes if used more effectively.

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The Value Equation: Three complementary propositions for reconciling fidelity and adaptation in evidence-based practice implementation

BMC Health Services Research ◽

10.1186/s12913-019-4668-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 8

Author(s):

Ulrica von Thiele Schwarz ◽

Gregory A. Aarons ◽

Henna Hasson

Keyword(s):

Patient Outcomes ◽

Theoretical Approach ◽

Internal Validity ◽

Implementation Strategies ◽

Implementation Process ◽

Evidence Based ◽

A Value ◽

The One ◽

Practice Implementation ◽

Fidelity And Adaptation

Abstract Background There has long been debate about the balance between fidelity to evidence-based interventions (EBIs) and the need for adaptation for specific contexts or particular patients. The debate is relevant to virtually all clinical areas. This paper synthesises arguments from both fidelity and adaptation perspectives to provide a comprehensive understanding of the challenges involved, and proposes a theoretical and practical approach for how fidelity and adaptation can optimally be managed. Discussion There are convincing arguments in support of both fidelity and adaptations, representing the perspectives of intervention developers and internal validity on the one hand and users and external validity on the other. Instead of characterizing fidelity and adaptation as mutually exclusive, we propose that they may better be conceptualized as complimentary, representing two synergistic perspectives that can increase the relevance of research, and provide a practical way to approach the goal of optimizing patient outcomes. The theoretical approach proposed, the “Value Equation,” provides a method for reconciling the fidelity and adaptation debate by putting it in relation to the value (V) that is produced. The equation involves three terms: intervention (IN), context (C), and implementation strategies (IS). Fidelity and adaptation determine how these terms are balanced and, in turn, the end product – the value it produces for patients, providers, organizations, and systems. The Value Equation summarizes three central propositions: 1) The end product of implementation efforts should emphasize overall value rather than only the intervention effects, 2) implementation strategies can be construed as a method to create fit between EBIs and context, and 3) transparency is vital; not only for the intervention but for all of the four terms of the equation. Summary There are merits to arguments for both fidelity and adaptation. We propose a theoretical approach, a Value Equation, to reconciling the fidelity and adaptation debate. Although there are complexities in the equation and the propositions, we suggest that the Value Equation be used in developing and testing hypotheses that can help implementation science move toward a more granular understanding of the roles of fidelity and adaptation in the implementation process, and ultimately sustainability of practices that provide value to stakeholders.

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Implementation of a Quality Improvement Role for Unlicensed Assistive Personnel and Effects on Infection Prevention

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.144 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s73-s74

Author(s):

Natalie Schnell ◽

Lauren DiBiase ◽

Amy Selimos ◽

Lisa Stancill ◽

Shelley Summerlin-Long ◽

...

Keyword(s):

Quality Improvement ◽

Data Collection ◽

Patient Care ◽

Patient Outcomes ◽

Infection Prevention ◽

Central Line ◽

Direct Patient Care ◽

Evidence Based ◽

Infection Rates ◽

Process Measure

Background: Care bundles comprise evidence-based practices and interventions that are easily and consistently implemented while improving patient outcomes. As patient acuity and task overload continue to increase, infection prevention bundle and process measure compliance and data collection may become a lower priority for registered nurses (RNs). In early 2019, a certified nursing assistant (CNA) began full-time quality liaison work on a 53-bed inpatient adult oncology unit at UNC Medical Center to provide targeted compliance data collection and to correct deficits in real time when possible and within the appropriate scope of practice. Methods: The quality liaison CNA is highly motivated, with a relevant clinical background and effective communication skills. After conducting a gap analysis, the unit developed specific responsibilities for several areas of quality improvement, including infection prevention. In addition to rounding on all patients daily, the quality liaison (1) performs direct patient care tasks like Foley catheter care, (2) conducts patient education on topics such as chlorhexidine gluconate treatments, (3) performs all relevant process measure audits, and (4) easily relays missed or needed care to RNs with a door sign created as part of this initiative. High-risk findings, such as a loose central-line dressing, prompt immediate communication to the RN, with follow-up and escalation when necessary. Results: Patients and staff received the quality liaison well, and the increased attention to care bundle components and auditing ensured consistent, evidence-based care along with accurate and reliable data collection. Compared to the previous calendar year, the number of central-line audits on the unit increased by >1,400 by the end of 2019. Patient outcomes improved, and during 1 fiscal year, the unit achieved rate reductions between 40% and 55% for central-line–associated bloodstream infections, catheter-associated urinary tract infections, and healthcare-associated C. difficile infections. Staffing and logistical challenges imposed by the COVID-19 global pandemic have hampered this work because the quality liaison was redeployed to direct patient care intermittently. Correspondingly, from July to October 2020, the same infection rates increased between 30% and 353%. Conclusions: Having a designated quality liaison is an effective means to achieving quality improvements while remaining an integral member of the patient care team. As staffing has improved on this unit, the quality liaison has refocused efforts, and infection rates are beginning to improve. Given the success of the quality liaison role in improving quality outcomes on this unit, the hospital is exploring expansion of this model to additional units.Funding: NoDisclosures: None

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A Review of Current and Emerging Approaches to Address Failure-to-Rescue

Anesthesiology ◽

10.1097/aln.0b013e318219d633 ◽

2011 ◽

Vol 115 (2) ◽

pp. 421-431 ◽

Cited By ~ 91

Author(s):

Andreas H. Taenzer ◽

Joshua B. Pyke ◽

Susan P. McGrath ◽

David S. Warner

Keyword(s):

Patient Safety ◽

Adverse Events ◽

Patient Outcomes ◽

Early Recognition ◽

General Ward ◽

Hospital Quality ◽

Retrospective Data ◽

Failure To Rescue ◽

Limited Success ◽

Hospital Deaths

Failure-to-Rescue, defined as hospital deaths after adverse events, is an established measure of patient safety and hospital quality. Until recently, approaches used to address failure-to-rescue have been focused primarily on improvement of response to a recognized patient crisis, with limited success in terms of patient outcomes. Less attention has been paid to improving the detection of the crisis. A wealth of retrospective data exist to support the observation that adverse events in general ward patients are preceded by a significant period (on the order of hours) of physiologic deterioration. Thus, the lack of early recognition of physiologic decline plays a major role in the failure-to-rescue problem.

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