Transitional care of nurses to older adults with artificial pacemaker

ABSTRACT Objective: to understand how the transitional care of nurses to olde adults with artificial pacemaker occurs. Method: a qualitative research, carried out in a philanthropic hospital in the city of Salvador, Bahia, Brazil. Fourteen nurses working in surgical and cardiac inpatient units participated. Data were collected between August and November 2020, through semi-structured interviews, and analyzed using the methodological framework Discourse of the Collective Subject and discussed in the light of Afaf Meleis’ theory of transitions. Results: nurses’ incipient knowledge about transitional care was identified. It was observed that the nursing discharge report is a facilitating instrument for transitional care. Final considerations: the study pointed out that the transitional care of nurses to older adults with artificial pacemakers does not have a theoretical foundation, reporting as a priority the care with the pacemaker identification card and with the surgical wound.

Clinical Predictors of Coccidioidomycosis from a Cross-Sectional Study

Demographic and clinical indicators have been described to support identification of coccidioidomycosis (CM); however, the interplay of these conditions has not been explored in a clinical setting. In 2019, we enrolled 392 participants in a cross-sectional study for suspected CM in emergency room and inpatient units within Coccidioides endemic regions. We aimed to develop a predictive CM model among participants presenting with suspected CM. We applied LASSO (least absolute shrinkage and selection operator) to select predictors of CM and report results from univariable and multivariable logistic regression models. Univariable models identified elevated eosinophil count as a significant predictive feature of CM in both inpatient and outpatient settings. Our multivariable outpatient model identified rash (OR=9.74, p= 0.047, 95%CI=1.03–92.24) as a predictor of CM. Our results suggest preliminary support for the development of a CM prediction model for use in the clinical setting.

Healthcare Professionals’ Perceptions of Support for Family Members in Specialist Palliative Care Inpatient Units – a Qualitative Descriptive Study

Purpose: The aim of this study was to describe healthcare professionals’ (HCPs) perceptions of the support for family members (FMs) of palliative care cancer patients in specialist palliative inpatient units. Methods: A qualitative descriptive design was applied. The data were collected with focus group interviews and analysed with inductive content analysis.Results: Information sharing was recognised as an essential element of support. Also, emotional support, discussions and additional support were offered. Practices to improve support of FMs included a possibility to allocate recourses to the families, systematic support and strengthening HCPs’ competence in family care. Conclusions: The opportunities to implement support focusing directly on FMs were described as restricted. Organisational resources were limited in inpatient units. HCPs felt that they did not have enough time to spend with FMs, and the facilities were also not always suitable to support FMs’ presence and participation. Therefore, there is a need for systematic support and interventions for FMs that could be implemented in inpatient units by the HCPs as a part of the daily care. Furthermore, additional training for the HCPs in palliative family care is needed.

Nursing qualifications needed in municipal emergency inpatient units. A qualitative study

Background Providing care to older individuals with complex needs and patients with chronic illness is a concern worldwide. In Norway, this situation led to the transfer of responsibility for care and treatment to the municipalities. Providing emergency care at the municipal level – thereby reducing the need for emergency hospital admissions – is part of the Coordination Reform in Norway. This reform from 2012 warrants a reconsideration of which nursing qualifications are needed in the municipalities. The aim of the study is to explore which professional qualifications nurses need to provide emergency care in municipal emergency inpatient units. Method A qualitative design with a hermeneutic approach was employed. Interviewing physicians about nursing qualifications may be considered inappropriate. We believe that this is important for developing knowledge that can strengthen interprofessional cooperation in emergency situations. Three focus groups were conducted. Physicians with experience in municipal emergency inpatient units were interviewed. Results We synthesised three themes from the data: (1) broad medical knowledge; (2) advanced clinical skills; and (3) ethical qualifications and a holistic approach. The first theme is about knowledge, the second is about skills, and the third conveys the need for overall competence. Conclusions Nurses working in municipal emergency inpatient units need advanced ethical qualifications, which integrate broad medical knowledge, advanced clinical skills and the ability to take a holistic approach. They have a considerable responsibility to work independently and safely in a setting where both the patient and the patient’s family play important roles. Establishing arenas for collaborative practice between physicians and nurses on clinical issues may be a way of strengthening patient safety and nurses’ clinical judgement.

660. Effect of the COVID-19 Pandemic on Blood Culture Contamination Rates and Quality Improvement Processes

Background Blood cultures are the gold standard for diagnosing bloodstream infections and a vital part of the work-up in systemic infections. However, contamination of blood cultures represents a significant burden on patients and the healthcare system with increased hospital length of stay, unnecessary antibiotics, and financial cost. The data discussed here offer insight into blood culture contamination rates before and through the COVID-19 pandemic at a community hospital and the processes that were affected by the pandemic. Methods Blood culture contaminations were determined by using the number of sets of blood cultures with growth and the presence of an organism from the National Healthcare Safety Network's (NHSN) commensal organism. Contamination rates were evaluated by status as a standard unit or a COVID-19 isolation unit in either the emergency department (ED) or inpatient floor units. The identified four groups had different processes for drawing blood cultures, particularly in terms of training of staff in use of diversion devices. The electronic medical record was used to track contaminations and the use of diversion devices in the different units. Results The inpatient COVID units were consistently elevated above the other units and the institutional contaminant goal of 2.25%, ranging from 9.6% to 13.3% from 4/2020-9/2020. Those units were the primary driver of the increase in overall contamination rates. COVID ED nursing staff (that had previously undergone training in the use of diversion devices) used diversion devices to draw 51 of 133 (38.3%) cultures compared to only 15 of 84 (17.9%) on the COVID inpatient units. Figure 1. Comparison of contamination rates in the ED vs the inpatient units from all campuses from September 2019 through September 2020. The blue line represents the hospital goal of 2.25% contamination rate. Solid lines represent total contamination rates including COVID isolation units whereas dotted lines represent units excluding COVID isolation units. Figure 2. Comparison of the non-COVID vs COVID isolation units in the emergency department and inpatient units. The red line represents the hospital goal of less than 2.25% for blood culture contamination rate. Table of Contaminants vs. Total Collected Blood Cultures in Each Unit by Month Figure 3. Raw data from Figure 2. Total blood culture contaminations from each unit by month compared to total blood culture collections from each unit by month. Conclusion Evaluation revealed that nursing staff with less training in blood culture collection, particularly the use of diversion devices, were the primary staff collecting blood cultures in the inpatient COVID units. The difference in training is felt to be the primary driver of the increase in contaminants in the inpatient COVID units. The marked increase in contaminations highlights the difficulties of maintaining quality control processes during an evolving pandemic and the importance of ongoing efforts to improve the quality of care. These findings demonstrate the importance of training and routine use of procedures to reduce contaminations even during. Disclosures All Authors: No reported disclosures

Implementation of Daily Pharmacy Student New Medication Education During Hospitalization to Improve Patient Satisfaction

Introduction: Studies have shown that patients would like to receive more medication education while hospitalized. Higher patient satisfaction has been correlated with lower mortality and fewer hospital readmissions. Methods: This was a quasi-experimental study. Four Doctor of Pharmacy students were assigned 1 medicine inpatient unit to provide education on new medications during the study period, June to September. The primary endpoint was the change in HCAHPS scores for the medication communication domain composite for the intervention unit and a similar control unit that was not receiving the intervention from the pre-intervention to the intervention periods. Results: A total of 124 patients were educated during the intervention period, with an average age of 65 and 2.2 new medications. Average HCAHPS scores for the medication communication domain for the intervention unit increased from 68% pre-intervention to 91% during the intervention ( P = .389) while the control unit remained unchanged at 78% both pre- and during the intervention ( P = .13). Conclusion: An increase in the medication communication HCAHPS score for the intervention unit was observed, while the control unit remained stable. This study has the potential to drive change by implementing pharmacy students throughout inpatient units to educate patients on new medications thereby improving patient satisfaction.

Effect of physical therapy on impairments in COVID-19 patients from intensive care to home rehabilitation: A rapid review

Objective: Guidelines regarding physical therapy for COVID-19 patients are often based on expert opinion. Recent clinical trials have reported effects on several rehabilitation outcomes in COVID-19 patients. This review summarizes the effects of physical therapy in COVID-19 patients. Data sources: PubMed, Web of Science and Scopus databases were systematically searched for studies investigating the effect of any physical therapy modality on impairments in adult COVID-19 patients. Included studies were (non)-randomized controlled trials, pre-experimental studies, and cohort studies in which a pre–post analysis was performed. Data extraction: After the screening process, data of interest were extracted from eligible studies and their risk of bias was assessed. Included outcome measures were divided into 3 groups: pulmonary function, physical function, and psychosocial function. Data synthesis: A total of 15 studies were included in this review. Physical therapy seems to have positive effects on pulmonary function, physical function, and psychosocial function. However, these effects differ between clinical settings (e.g. home care, intensive care unit, inpatient units). Due to the low-to-moderate quality of the included studies, no robust conclusions can be drawn. Conclusion: Further high-quality research is required, taking into account the different clinical settings, in order to draw conclusions about the effectiveness of physical therapy on impairments in COVID-19 patients. Lay Abstract Guidelines regarding physical therapy for COVID-19 patients are often based on expert opinion or on evidence from studies of physical therapy in patients with other diseases. More and more clinical studies are investigat-ing the effect of physical therapy on the recovery of COVID-19 patients. Prior to this review, the importance of physical therapy for COVID-19 patients was not clear. This review summarizes the effects of physical therapy in COVID-19 patients. We reviewed and assessed the quality of the existing literature on this topic. Fifteen studies with a total of 1,341 COVID-19 patients were included in this review. Physical therapy appears to improve lung function, physical function, and psychosocial func-tion in COVID-19 patients. However, the effect can differ between clinical settings; for example, home care, intensive care unit, or other inpatient units. Due to the low-to-moderate quality of the included studies, no robust conclusion can be drawn. Further high-quality research is needed, taking into account the different clinical settings.