scholarly journals I-DECIDED® – A decision tool for assessment and management of invasive devices in the hospital setting

2021 ◽  
Vol 15 (3) ◽  
pp. 7-14
Author(s):  
Gillian Ray-Barruel
Keyword(s):  
Patient Safety ◽  
Vascular Access ◽  
Medical Devices ◽  
Hospital Setting ◽  
Hospitalized Patients ◽  
Evidence Based ◽  
Urinary Catheters ◽  
Decision Tool ◽  
Safety Priority

Indwelling medical devices, including vascular access and urinary catheters, pose a risk for infection, and therefore daily assessment and consideration of their continued need is a patient safety priority. The I-DECIDED® device assessment and decision tool is an evidence-based checklist, designed to improve the assessment, care, and timely removal of invasive devices in acute hospitalized patients. This paper explains each step of the tool, with rationale for inclusion.

scholarly journals Combined Topical and Oral Antimicrobial Therapy for the Eradication of Methicillin-ResistantStaphylococcus aureus(Mrsa) Colonization in Hospitalized Patients

2002 ◽  
Vol 13 (5) ◽  
pp. 287-292 ◽  
Author(s):  
Scott K Fung ◽  
Marie Louie ◽  
Andrew E Simor
Keyword(s):  
Medical Devices ◽  
Antimicrobial Therapy ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Hospitalized Patients ◽  
Urinary Catheters ◽  
Mupirocin Ointment ◽  
Mrsa Colonization

OBJECTIVE: How to eradicate methicillin-resistantStaphylo-coccus aureus(MRSA) colonization in hospitalized patients is uncertain. We reviewed our experience with MRSA decolonization therapy in hospitalized patients.SETTING: An 1100-bed, university-affiliated tertiary care teaching hospital in Toronto, Ontario.DESIGN: Retrospective chart review of 207 adult inpatients with MRSA colonization hospitalized between February 1996 and March 1999.INTERVENTIONS: All patients with MRSA colonization were assessed for possible decolonization therapy with a combination of 4% chlorhexidine soap for bathing and washing, 2% mupirocin ointment applied to the anterior nares three times/day, rifampin (300 mg twice daily) and either trimethoprim/sulfamethoxazole (160 mg/800 mg twice daily) or doxycycline (100 mg twice daily). This treatment was given for seven days.RESULTS: A total of 207 hospitalized patients with MRSA colonization were identified and 103 (50%) received decolonization therapy. Patients who received decolonization therapy were less likely than untreated patientsto have intravenous (P=0.004) or urinary catheters (P<0.001), or extranasal sites of colonization (P=0.001). Successful decolonization was achieved in 90% of the 43 patients who were available for at least three months of follow-up.CONCLUSIONS: Combined topical and oral antimicrobial therapy was found to be effective in eradicating MRSA colonization in selected hospitalized patients, especially those without indwelling medical devices or extranasal sites of colonization.

scholarly journals Changing Behavior among Nurses to Track Indwelling Urinary Catheters in Hospitalized Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Bona Yoon ◽  
Samantha D. McIntosh ◽  
Leslie Rodriguez ◽  
Alma Holley ◽  
Charles J. Faselis ◽  
...  
Keyword(s):  
Large Scale ◽  
Hospital Setting ◽  
Interdisciplinary Team ◽  
Hospitalized Patients ◽  
Learning Objectives ◽  
Small Scale ◽  
Urinary Catheters ◽  
First Line ◽  
Healthcare Interventions ◽  
Tract Infections

Catheter-associated urinary tract infections (CAUTIs) are preventable complications of hospitalization. An interdisciplinary team developed a curriculum to increase awareness of the presence of indwelling urinary catheters (IUCs) in hospitalized patients, addressed practical, primarily nurse-controlled inpatient risk-reduction interventions, and promoted the use of the IUC labels (“tags”). Five thirty-minute educational sessions were cycled over three daily nursing shifts on two inpatient medical floors over a 1-year period; participants were surveyed(n=152)to elicit feedback and provide real-time insight on the learning objectives. Nurse self-reported IUC tagging was early and sustained; after the IUC tag was introduced, there was a significant increase in tagging reported by the end of the block of educational sessions (from 46.2% to 84.6%,P=0.001). Early engagement combined with a targeted educational initiative led to increased knowledge, changes in behavior, and renewed CAUTI awareness in hospitalized patients with IUCs. The processes employed in this small-scale project can be applied to broader, hospitalwide initiatives and to large-scale initiatives for healthcare interventions. As first-line providers with responsibility for the placement and daily maintenance of IUCs, nurses are ideally positioned to implement efforts addressing CAUTIs in the hospital setting.

scholarly journals Reducing urinary catheter use using an electronic reminder system in hospitalized patients: A randomized stepped-wedge trial

2019 ◽  
Vol 40 (4) ◽  
pp. 427-431 ◽  
Author(s):  
Brett G. Mitchell ◽  
Maria Northcote ◽  
Allen C. Cheng ◽  
Oyebola Fasugba ◽  
Philip L. Russo ◽  
...  
Keyword(s):  
Focus Group ◽  
Urinary Catheter ◽  
Hospital Setting ◽  
Hospitalized Patients ◽  
Ease Of Use ◽  
Cox Proportional Hazards Model ◽  
Urinary Catheters ◽  
Electronic Reminder ◽  
Reminder System ◽  
The Mean

AbstractObjective:To determine the effectiveness and ease of use of an electronic reminder device in reducing urinary catheterization duration.Design:A randomized controlled trial with a cross-sectional anonymous online survey and focus group.Setting:Ten wards in an Australian hospital.Participants:All hospitalized patients with a urinary catheter.Intervention:An electronic reminder system, the CATH TAG, applied to urinary catheter bags to prompt removal of urinary catheters.Outcomes:Catheterization duration and perceptions of nurses about the ease of use.Methods:A Cox proportional hazards model was used to assess the rate of removal of catheters. A phenomenological approach underpinned data collection and analysis methods associated with the focus group.Results:In total, 1,167 patients with a urinary catheter were included. The mean durations in control and intervention phases were 5.51 days (95% confidence interval [CI], 4.9–6.2) and 5.08 days (95% CI, 4.6–5.6), respectively. For patients who had a CATH TAG applied, the hazard ratio (HR) was 1.02 (95% CI, 0.91–1.14; P = .75). A subgroup analysis excluded patients in an intensive care unit (ICU), and the use of the CATH TAG was associated with a 23% decrease in the mean, from 5.00 days (95% CI, 4.44–5.56) to 3.84 days (95% CI, 3.47–4.21). Overall, 82 nurses completed a survey and 5 nurses participated in a focus group. Responses regarding the device were largely positive, and benefits for patient care were identified.Conclusion:The CATH TAG did not reduce the duration of catheterization, but potential benefits in patients outside the ICU were identified. Electronic reminders may be useful to aid prompt removal of urinary catheters in the non-ICU hospital setting.

Committing to an Infection Prevention Initiative

2021 ◽  
pp. 10-23
Author(s):  
Jennifer Meddings ◽  
Vineet Chopra ◽  
Sanjay Saint
Keyword(s):  
Urinary Tract Infection ◽  
Patient Safety ◽  
Infection Prevention ◽  
Team Building ◽  
Evidence Based ◽  
Urinary Catheters ◽  
Quality Initiatives ◽  
Long Run ◽  
Building Process ◽  
Time And Energy

What motivates a hospital administration to take on an infection prevention initiative? It may simply reflect a hospital’s culture of excellence, a commitment to patient safety, though that may be combined with a determination to keep up with competing institutions or to avoid federal financial penalties. Quality initiatives can drain staff time and energy but save substantial dollars in the long run. Once the decision to proceed with the catheter-associated urinary tract infection initiative is made, hospital leaders start a team-building process, choosing an executive sponsor with experience on the wards, the project’s main venue. The sponsor in turn selects a project manager, who will find physician and nurse champions to carry the goals and content of the initiative to the staff. The initiative calls for the adoption of a bundle of evidence-based behaviors—in this case, to reduce the unnecessary use of indwelling urinary catheters known as Foleys.

Clinical Cybersecurity Training Through Novel High Fidelity Simulations (Preprint)

2018 ◽  
Author(s):  
Christian Dameff ◽  
Jordan Selzer ◽  
Jonathan Fisher ◽  
James Killeen ◽  
Jeffrey Tully
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Medical Devices ◽  
Healthcare Systems ◽  
High Fidelity ◽  
Protected Health Information ◽  
Patient Harm ◽  
Security Vulnerabilities ◽  
Clinical Simulations ◽  
Medical Infrastructure

BACKGROUND Cybersecurity risks in healthcare systems have traditionally been measured in data breaches of protected health information but compromised medical devices and critical medical infrastructure raises questions about the risks of disrupted patient care. The increasing prevalence of these connected medical devices and systems implies that these risks are growing. OBJECTIVE This paper details the development and execution of three novel high fidelity clinical simulations designed to teach clinicians to recognize, treat, and prevent patient harm from vulnerable medical devices. METHODS Clinical simulations were developed which incorporated patient care scenarios with hacked medical devices based on previously researched security vulnerabilities. RESULTS Clinician participants universally failed to recognize the etiology of their patient’s pathology as being the result of a compromised device. CONCLUSIONS Simulation can be a useful tool in educating clinicians in this new, critically important patient safety space.

scholarly journals Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e047102
Author(s):  
Gemma Louch ◽  
Abigail Albutt ◽  
Joanna Harlow-Trigg ◽  
Sally Moore ◽  
Kate Smyth ◽  
...  
Keyword(s):  
Learning Disabilities ◽  
Patient Safety ◽  
Adverse Events ◽  
Grey Literature ◽  
Good Practice ◽  
Hospital Setting ◽  
Eligibility Criteria ◽  
Infant Outcomes ◽  
Safety Outcomes

ObjectivesTo produce a narrative synthesis of published academic and grey literature focusing on patient safety outcomes for people with learning disabilities in an acute hospital setting.DesignScoping review with narrative synthesis.MethodsThe review followed the six stages of the Arksey and O’Malley framework. We searched four research databases from January 2000 to March 2021, in addition to handsearching and backwards searching using terms relating to our eligibility criteria—patient safety and adverse events, learning disability and hospital setting. Following stakeholder input, we searched grey literature databases and specific websites of known organisations until March 2020. Potentially relevant articles and grey literature materials were screened against the eligibility criteria. Findings were extracted and collated in data charting forms.Results45 academic articles and 33 grey literature materials were included, and we organised the findings around six concepts: (1) adverse events, patient safety and quality of care; (2) maternal and infant outcomes; (3) postoperative outcomes; (4) role of family and carers; (5) understanding needs in hospital and (6) supporting initiatives, recommendations and good practice examples. The findings suggest inequalities and inequities for a range of specific patient safety outcomes including adverse events, quality of care, maternal and infant outcomes and postoperative outcomes, in addition to potential protective factors, such as the roles of family and carers and the extent to which health professionals are able to understand the needs of people with learning disabilities.ConclusionPeople with learning disabilities appear to experience poorer patient safety outcomes in hospital. The involvement of family and carers, and understanding and effectively meeting the needs of people with learning disabilities may play a protective role. Promising interventions and examples of good practice exist, however many of these have not been implemented consistently and warrant further robust evaluation.

scholarly journals G148(P) Safe and timely stepdown from an internal picu: a patient safety priority but one full of challenges

2020 ◽  
Author(s):  
K Evans ◽  
W Stephenson ◽  
A Porter ◽  
U Senanyake ◽  
J Zoeteman ◽  
...  
Keyword(s):  
Patient Safety ◽  
Safety Priority

scholarly journals 1157. GET IT OUT! Nurses and Clinical Quality Improvement Specialists Drive Initiative to Reduce Standardized Utilization Ratios for Indwelling Urinary Catheters in Hospitalized Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S413-S414
Author(s):  
Aldo Martinez ◽  
Deborah Parilla ◽  
Melissa Green ◽  
Anne Murphy ◽  
Sylvia Suarez-Ponce ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Urinary Tract ◽  
Night Shift ◽  
Healthcare Research ◽  
Hospitalized Patients ◽  
Urinary Catheters ◽  
Clinical Quality ◽  
Tract Infections ◽  
Clinical Quality Improvement ◽  
Critical Reviews

Abstract Background Urinary tract infections (UTIs) account for 34% of all healthcare-associated infections (HAI). Urinary catheters (UC) are placed in 15–25% of hospitalized patients and >75% of HAI UTIs are UC-related. Bacteria introduced via UC can colonize the bladder within 3 days. So, the greatest risk factor for acquiring a catheter-associated urinary tract infection (CAUTI) is prolonged use of indwelling UC. Nursing (RN) staff noted inconsistency with appropriate use of UC and commonly UC remained in place well after their original indication had expired. Methods As part of a multi-faceted approach for quality improvement and patient safety, we rolled out an Agency for Healthcare Research and Quality (AHRQ)-based initiative to reduce UC days/Standardized Utilization Ratio (SUR). Daily critical reviews of the indication for UC were conducted by two groups. First, frontline night shift RN staff identified patients who no longer had a valid justification for continued UC. They handed-off the information to day-shift RNs, who recommend removal of UC during daily rounds with the physician teams. A second review was performed by Clinical Quality Improvement Specialists (CQIS) based on defined criteria from our nursing decatheterization protocol. Their discontinue UC recommendations were also sent to the care teams. The critical reviews of UC for CAUTI reduction started with 4 ICUs in August 2018, with additional ICUs added in December, January and March. Monthly UC SURs were tracked Results Figure 1 shows the number of UCs recommended for removal by RNs vs. CQIS (bars), as well as the percent discordance between RNs and CQIS (line). CQIS identified many more removable UCs than the RNs (888 vs. 256). 211 UC were removed after RN recommendations, and an additional 386 UCs were removed as a result of the CQIS audits. Figure 2 shows the marked corresponding decline in our SUR over this intervention. Conclusion As more units participated in the initiative, we saw increasing numbers of “discontinue UC” recommendations. Over time there was also a moderate decrease in the discordance between RN and CQIS recommendations for UC removal. CQIS routinely identified many more UCs to be removed compared with RNs, and more than doubled the number of discontinued UC. Notably, the UC SUR markedly improved, decreasing from 0.98 to 0.78. Disclosures All authors: No reported disclosures.

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