Current awareness suts july 2016

Library Services Musgrove Park and Somerset Partnership

Current Awareness Sign Up To Safety This monthly Current Awareness Bulletin is produced by the Library Team, Musgrove Park Academy to provide staff with a range of resources to support Sign Up To Safety. It includes recently published guidelines and research articles, news and policy items.

This guide provides a selection of relevant resources and is not intended to be a comprehensive list. All websites have been evaluated and details are correct at the time of publications.

Details correct at time of going to print. Please note that resources are continuously updated.

For further help or guidance, please contact a member of library staff.

This guide has been compiled by: Carol-Ann Regan Musgrove Park Hospital Library Service Carol-ann.regan@tst.nhs.uk @musgrovesompar

ď€şď€ http://librarymph.wordpress.com/ Issue 8 July 2016

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Contents Click on a section title to navigate contents Page Recent journal articles

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Books

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UpToDate and Dynamed Plus

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Reports, publications and resources

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Literature search service

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Training and Athens

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Library contact details: Library Musgrove Park Academy Musgrove Park Hospital Taunton Somerset TA1 5DA Tel: 01823 34 (2433) Fax: 01823 34 (2434) Email: library@tst.nhs.uk Blog: http://librarymph.wordpress.com @musgrovesompar

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RECENT JOURNAL ARTICLES BACK TO TOP Some articles are available in the library or on-line via an OpenAthens password by following the fulltext link. If you would like an article which is not available as full-text then please contact library staff.

Please note that abstracts are not always available for articles.

FALLS Title: Is single room hospital accommodation associated with differences in healthcare-associated infection, falls, pressure ulcers or medication errors? A natural experiment with non-equivalent controls.

Citation: Journal of Health Services Research & Policy, 2016, vol./is. 21/3(147-155) Author(s): Simon, Michael, Maben, Jill, Murrells, Trevor, Griffiths, Peter Source: CINAHL

Title: Are older adults receiving evidence-based advice to prevent falls post-discharge from hospital?

Citation: Health Education Journal, 2016, vol./is. 75/4(448-463) Author(s): Lee, Den-Ching A., Brown, Ted, Stolwyk, Rene, O’Connor, Daniel W., Haines, Terry P. Source: CINAHL

Title: Anxiety symptoms during hospitalization of elderly are associated with increased risk of post-discharge falls.

Citation: International Psychogeriatrics, 2016, vol./is. 28/6(951-958) Author(s): Agmon, Maayan, Zisberg, Anna, Tonkikh, Orly, Sinoff, Gary, Shadmi, Efrat Abstract: Background: The aim of this study was to test the association between anxiety at the time of hospitalization and falls occurring within one month of discharge, and to offer potential mechanisms for this association.Methods: One-month, prospective cohort study of 556 older adults in two medical centers in Israel. Anxiety and functional decline were assessed during hospitalization and falls were assessed one month post-discharge.Results: A total of 72 (12.9%) participants reported at least one fall during the 30-day post-discharge period. Controlling for demographics, functional decline and pre-morbid functional status, the odds of falls between discharge, and 1-month follow-up were almost twice as high among patients with anxiety symptoms (OR = 1.89, 95% CI: 1.04-3.48) compared with those who screened negative for anxiety. After accounting for in-hospital functional decline, the 3

relationship between anxiety symptoms and falls decreased by 11% (from OR = 2.13 to 1.89), indicating that the relationship between anxiety and falls was partially mediated by functional decline during hospitalization.Conclusions: Anxiety at time of hospitalization is associated with falls 30-days post-discharge, controlling for several well-known confounders.

This relationship is partially mediated by functional decline. Identifying patients with anxiety for inclusion in targeted rehabilitation interventions may be an important component of fall prevention strategies.

Source: CINAHL

Title: Improvement of Physical Therapist Assessment of Risk of Falls in the Hospital and Discharge Handover Through an Intervention to Modify Clinical Behavior.

Citation: Physical Therapy, 2016, vol./is. 96/6(764-773) Author(s): Thomas, Susie, Mackintosh, Shylie Full Text: Available from EBSCOhost in Physical Therapy Available from Highwire Press in Physical Therapy Available from ProQuest in Physical Therapy Title: Iterative user centered design for development of a patient-centered fall prevention toolkit.

Citation: Applied ergonomics, Sep 2016, vol. 56, p. 117-126 Author(s): Katsulis, Zachary, et al.

Abstract: Due to the large number of falls that occur in hospital settings, inpatient fall prevention is a topic of great interest to patients and health care providers. The use of electronic decision support that tailors fall prevention strategy to patient-specific risk factors, known as Fall T.I.P.S (Tailoring Interventions for Patient Safety), has proven to be an effective approach for decreasing hospital falls. A paper version of the Fall T.I.P.S toolkit was developed primarily for hospitals that do not have the resources to implement the electronic solution; however, more work is needed to optimize the effectiveness of the paper version of this tool. We examined the use of human factors techniques in the redesign of the existing paper fall prevention tool with the goal of increasing ease of use and decreasing inpatient falls. The inclusion of patients and clinical staff in the redesign of the existing tool was done to increase adoption of the tool and fall prevention best practices. The redesigned paper Fall T.I.P.S toolkit showcased a built in clinical decision support system and increased ease of use over the existing version. Copyright © 2016 Elsevier Ltd. All rights reserved.

Source: Medline

Title: A longitudinal qualitative study of health care personnel's perceptions of simultaneous implementation of three risk assessment scales on falls, malnutrition and pressure ulcers.

Citation: Journal of clinical nursing, Jul 2016, vol. 25, no. 13-14, p. 1912-1922 Author(s): Skytt, Bernice, Engström, Maria, Mårtensson, Gunilla, Mamhidir, Anna-Greta 4

Abstract: In this study, the aim was to understand health care personnel's expectations and experiences of participating in an intervention aimed at the implementation of three assessment scales for fall injuries, malnutrition and pressure ulcers, and the performance of preventive measures in these areas over the period of 18 months. Fall injuries, malnutrition and pressure ulcers among older people are challenging issues for caregivers at different levels in the health care system. A descriptive design with a qualitative approach was used to follow health care personnel before, during and after implementation of a care prevention intervention. Twelve health care personnel with different professions at the hospital, primary care and municipal care levels participated in a preventive care introduction. Seminars were held at four occasions, with assignments to be completed between seminars. Lectures and group discussions were performed, and three risk assessment scales were introduced. The participants were interviewed before, during and after the introduction. Manifest and latent content analysis were used. The main results are presented in the theme 'Patient needs are visualised through a gradually developed shared understanding' and in five categories. The work approach of performing three risk assessments simultaneously was perceived as positive and central to ensuring quality of care; it was not, however, perceived as unproblematic. The participants as well as health care team members showed a positive attitude towards and described the advantages of being given opportunities for shared understanding to improve patient safety and to provide structure for the provision of good care. The managerial approach of listening to and acting on issues stressed by health care personnel is important to ensure ongoing and future improvement initiatives. © 2016 John Wiley & Sons Ltd. Source: Medline

Title: Older Adult Falls Seen by Emergency Medical Service Providers: A Prevention Opportunity.

Citation: American journal of preventive medicine, Jun 2016, vol. 50, no. 6, p. 719-726 Author(s): Faul, Mark, Stevens, Judy A, Sasser, Scott M, Alee, Lisa, Deokar, Angela J, Kuhls, Deborah A, Burke, Peter A Abstract: Among people aged ≥65 years, falling is the leading cause of emergency department visits. Emergency medical services (EMS) are often called to help older adults who have fallen, with some requiring hospital transport. Chief aims were to determine where falls occurred and the circumstances under which patients were transported by EMS, and to identify future fall prevention opportunities. In 2012, a total of 42 states contributed ambulatory data to the National EMS Information System, which were analyzed in 2014 and 2015. Using EMS records from 911 call events, logistic regression examined patient and environmental factors associated with older adult transport. Among people aged ≥65 years, falls accounted for 17% of all EMS calls. More than one in five (21%) of these emergency 911 calls did not result in a transport. Most falls occurred at home (60.2%) and residential institutions such as nursing homes (21.7%). Logistic regression showed AORs for transport were greatest among people aged ≥85 years (AOR=1.14, 95% CI=1.13, 1.16) and women (AOR=1.30, 95% CI=1.29, 1.32); for falls at residential institutions or nursing homes (AOR=3.52, 95% CI=3.46, 3.58) and in rural environments (AOR=1.15, 95% CI=1.13, 1.17); and where the EMS impression was a stroke (AOR=2.96, 95% CI=2.11, 4.10), followed by hypothermia (AOR=2.36, 95% CI=1.33, 4.43). This study provides unique insight into fall circumstances and EMS transport activity. EMS personnel are in a prime position to provide interventions that can prevent future falls, or referrals to community-based fall prevention programs and services. Published by Elsevier Inc. 5

Source: Medline

Title: Does vibration training reduce the fall risk profile of frail older people admitted to a rehabilitation facility? A randomised controlled trial.

Citation: Disability and rehabilitation, Jun 2016, vol. 38, no. 11, p. 1082-1088 Author(s): Parsons, J, Mathieson, S, Jull, A, Parsons, M Abstract: To determine the effect of Vibration Training (VT) on functional ability and falls risk among a group of frail older people admitted to an inpatient rehabilitation unit in a regional hospital in New Zealand. A randomized controlled trial of 56 participants (mean 82.01 years in the intervention group and 81.76 years in the control group). VT targeting lower limb muscles with a frequency 30-50 Hz occurred three times per week until discharge. Amplitude progressively increased from 2 to 5 mm to allow the programme to be individually tailored to the participant. The control group received usual care physiotherapy sessions. Outcome measures were: Physiological profile assessment (PPA); and Functional Independence measure (FIM) and Modified Falls Efficacy Scale (MFES). There was a statistically significant difference observed between the two groups in terms of FIM score (F = 5.09, p = 0.03) and MFES (F = 3.52, p = 0.007) but no difference was observed in terms of PPA scores (F = 0.96, p = 0.36). Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of VT in conjunction with usual care physiotherapy in terms of improved functional ability. The study design and the small dosage of VT provided may have precluded any change in falls risk among participants. Implications for Rehabilitation Vibration training (VT) may assist in reducing the risk of falling among at risk older people. Current pressures on health systems (ageing population, reduced hospital length of stay) necessitate the development of innovative strategies to maximise the rehabilitation potential of older people. Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of vibration training in conjunction with usual care physiotherapy in terms of improved functional ability.

Source: Medline

Title: Problematising the problem: a critical interpretive review of the literature pertaining to older people with cognitive impairment who fall while hospitalised.

Citation: Nursing inquiry, Jun 2016, vol. 23, no. 2, p. 148-157 Author(s): Rushton, Carole Abstract: This article presents a reflexive account by way of a critical interpretive review of the literature pertaining to falls of older people with cognitive impairment who have been hospitalised in an acute care setting. A key aim of this review was to use thematic analysis and problematisation to challenge assumptions underpinning the current falls literature and to bring into consideration alternate foci of research and new approaches to falls research.

An innovative approach is used to generate descriptive and interpretive summaries of the literature which are presented graphically to reveal the prevailing themes and assumptions within. It is argued that currently, falls research in the context of cognitive impairment is constrained by scientism. Meta-paradigmatic approaches, which have the potential to provide a better understanding of why falls may or may not occur among this particular subgroup of older people, are proposed as an alternative. Š 2016 John Wiley & Sons Ltd. 6

Source: Medline

Title: Global Forum: Fractures in the Elderly.

Citation: The Journal of bone and joint surgery. American volume, May 2016, vol. 98, no. 9, p. e36.

Author(s): Court-Brown, Charles M, McQueen, Margaret M Abstract: Fractures in the elderly are increasing in incidence and becoming a major health issue in many countries. With an increasing number of the elderly living to an older age, the problems associated with fractures will continue to increase. We describe the epidemiology of fractures in the elderly and identify six fracture patterns in the population of patients who are sixty-five years of age or older. We also analyzed multiple fractures and open fractures in the elderly and we show that both increase in incidence with older age. The incidence of open fractures in elderly women is equivalent to that in young men. Many factors, including patient socioeconomic deprivation, increase the incidence of fractures in the elderly. More than 90% of fractures follow low-energy falls and the mortality is considerable. Mortality increases with older age and medical comorbidities, but there is also evidence that it relates to premature discharge from the hospital. Copyright Š 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Source: Medline Full Text: Available from Ovid fulltext collection in Journal of Bone & Joint Surgery - American Volume

PRESSURE ULCERS Title: Identification of Risk Factors for the Development of Pressure Ulcers Despite Standard Screening Methodology and Prophylaxis in Trauma Patients.

Citation: Advances in skin & wound care, Jul 2016, vol. 29, no. 7, p. 329-334 Author(s): Raff, Lauren A, Waller, Holly, Griffin, Russell L, Kerby, Jeffrey D, Bosarge, Patrick L Abstract: To present information about a study of risk factors for development of pressure ulcers (PrUs) in trauma patients. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Describe the previous PrU research, scope of the problem, and methodology of the study.2. Explain the results of the study identifying PrU risk factors for trauma patients. Pressure ulceration prevention has been emphasized over the past several years in inpatient hospital settings with subsequent decreases in the development of pressure ulcers (PrUs). However, there remains a subset of trauma and burn patients that develop PrUs despite standard screening methodology and prophylaxis. This study determines the conditions that predict development of pressure ulcers (PrUs) despite conventional prophylaxis and screening. Demographic and PrU data were collected over a 5-year period from June 2008 to May 2013. Patients diagnosed with 7

PrUs upon arrival in the trauma bay were excluded from analysis. An ordinal logistic regression of PrU stage was used to estimate odds ratios (ORs) and associated 95% confidence intervals (CIs) for the association between characteristics of interest and odds of a PrU. A backward selection process was used to select the most parsimonious model.

During the study period, 14,616 trauma patients were admitted and had available data. A total of 124 patients (0.85%) that met inclusion criteria went on to develop PrUs during their hospital course. Factors associated with the development of PrUs included spine Abbreviated Injury Scale (AIS) >3 (OR, 5.72; CI, 3.63-9.01), mechanical ventilation (OR, 1.95; CI, 1.23-3.10) and age 40 to 64 (OR, 2.09; CI, 1.24-3.52) and age â&#x2030;Ľ 65 (OR, 4.48; CI, 2.52-7.95). Interestingly, head injury AIS >3 was protective from the development of PrUs (OR, 0.56; CI, 0.32-0.96). Hypotension and shock defined as systolic BP <90 mm Hg and base deficit less than -6 were not associated with the development of PrUs. In addition, body mass index was not associated with PrU development. Spinal injuries, older than age 40, and mechanical ventilation predict the development of PrUs for a subset of patients, despite conventional prophylaxis and screening. Advanced prevention methods, such as low-air-loss mattresses for these patient subgroups should be considered immediately upon identification of these risk factors during the hospital course.

Source: Medline

Title: Effects of Electrical Stimulation on Risk Factors for Developing Pressure Ulcers in People with a Spinal Cord Injury: A Focused Review of Literature.

Citation: American journal of physical medicine & rehabilitation / Association of Academic Physiatrists, Jul 2016, vol. 95, no. 7, p. 535-552 Author(s): Smit, Christof A J, de Groot, Sonja, Stolwijk-Swuste, Janneke M, Janssen, Thomas W J Abstract: Pressure ulcers (PUs) are a common and serious problem for wheelchair users, such as individuals with a spinal cord injury (SCI), resulting in great discomfort, loss of quality of life, and significant medical care costs. Therefore, it is of utmost importance to prevent PUs. In this literature overview, the effects of electrical stimulation (ES) on the risk factors for developing PUs in people with an SCI are examined and synthesized from January 1980 to January 2015. Thirty-four relevant studies of PU prevention in SCI were identified. Four were randomized clinical trials, 24 were case series, 6 had other designs.

Three types of ES modalities were identified. The methodological quality varied from poor to fairly strong, with a large variety in used ES parameters. Twenty-three studies were identified describing short-term effects of ES on interface pressure, oxygenation, and/or blood flow, and 24 studies described the long-term effects of ES on muscle volume, muscle strength, and histology. Whereas there is a lack of controlled studies on the effects of ES on PU incidence, which disallows definite conclusions, there is moderate evidence to suggest that ES-induced muscle activation has a positive influence on several risk factors for developing PUs in people with an SCI. Source: Medline

Title: Enhancing Documentation of Pressure Ulcer Prevention Interventions: A Quality Improvement Strategy to Reduce Pressure Ulcers.

Citation: Journal of nursing care quality, Jul 2016, vol. 31, no. 3, p. 207-214 8

Author(s): Jacobson, Therese M, Thompson, Susan L, Halvorson, Anna M, Zeitler, Kristine Abstract: Prevention of hospital-acquired pressure ulcers requires the implementation of evidence-based interventions. A quality improvement project was conducted to provide nurses with data on the frequency with which pressure ulcer prevention interventions were performed as measured by documentation. Documentation reports provided feedback to stakeholders, triggering reminders and reeducation. Intervention reports and modifications to the documentation system were effective both in increasing the documentation of pressure ulcer prevention interventions and in decreasing the number of avoidable hospital-acquired pressure ulcers.

Source: Medline

Title: Prophylactic use of dressings for pressure ulcer prevention in the critical care unit.

Citation: British journal of nursing (Mark Allen Publishing), Jun 2016, vol. 25, no. 12, p. S6., Author(s): Thorpe, Elaine Abstract: Multiple comorbidities and intensive therapy increase the risk of pressure ulcer (PU) development in critical care unit (CCU) patients. Given the high number of risk factors that CCU patients present with, it is important to acknowledge that not all PUs are entirely preventable, and incidence is thought to be between 14% and 42%. The consequences of acquiring a PU in critical care include increased mortality, morbidity and longer length of stay. Implementing prevention strategies as soon as the patient enters the unit can significantly reduce incidence. By adopting a proactive versus reactive mind-set, one CCU abandoned traditional PU risk assessment and implemented a number of intensive interventions, including the use of a prophylactic sacral dressing as an adjunct. As a result, PU incidence fell from 19.9 per 1000 patient population to 0.84 per 1000 patient population in 2014. In addition, 310 PU-free days were achieved.

Source: Medline Full Text: Available from Mark Allen Group in British Journal of Nursing; Note: ; Notes: Click on 'Sign in' to top right, then choose OpenAthens option Available from EBSCOhost in British Journal of Nursing Title: Patients at risk of pressure ulcers and moisture-related skin damage.

Citation: British journal of nursing (Mark Allen Publishing), Jun 2016, vol. 25, no. 12, p.

S24., Author(s): Palfreyman, Simon Source: Medline Full Text: Available from Mark Allen Group in British Journal of Nursing; Note: ; Notes: Click on 'Sign in' to top right, then choose OpenAthens option Available from EBSCOhost in British Journal of Nursing 9

Title: Educational campaign to increase knowledge of pressure ulcers.

Citation: British journal of nursing (Mark Allen Publishing), Jun 2016, vol. 25, no. 12, p. S30.

Author(s): Feng, Haixia, Li, Guohong, Xu, Cuirong, Ju, Changping Abstract: A pressure ulcer (PU) steering group was set up in Zhongda Hospital in China to develop a campaign to increase knowledge of PUs, to improve management and reduce incidence. Questionnaires were completed by 275 nurses to ascertain their knowledge of PUs. The initial questionnaire indicated that the nurses had insufficient knowledge of PUs. The steering group then ran a campaign focusing on standardising the management of PUs. The measurement of PU knowledge for all nurses was tested after 2 years of training. After 2 years, the nursing staff's knowledge of PUs had improved. Usage of the Braden scale had risen from (60.0Âą22.9) to (88.0Âą9.0) and showed a statistically significant difference (p<0.01). Moreover, the rate for patients reported as being at high risk of developing a PU had increased from 0.98% in 2012 to 1.24% in 2013, while the occurrence rate of PUs in the hospital had decreased from 0.09% in 2012 to 0.05% in 2013. The campaign significantly enhanced the knowledge of PUs and improved the ability of nursing staff to evaluate PU risks, resulting in a decrease in the occurrence of PUs. Source: Medline Full Text: Available from Mark Allen Group in British Journal of Nursing; Note: ; Notes: Click on 'Sign in' to top right, then choose OpenAthens option Available from EBSCOhost in British Journal of Nursing Title: Cost-effectiveness Analysis of Nutritional Support for the Prevention of Pressure Ulcers in High-Risk Hospitalized Patients.

Citation: Advances in skin & wound care, Jun 2016, vol. 29, no. 6, p. 261-267 Author(s): Tuffaha, Haitham W, Roberts, Shelley, Chaboyer, Wendy, Gordon, Louisa G, Scuffham, Paul A Abstract: To evaluate the cost-effectiveness of nutritional support compared with standard care in preventing pressure ulcers (PrUs) in high-risk hospitalized patients. An economic model using data from a systematic literature review. A meta-analysis of randomized controlled trials on the efficacy of nutritional support in reducing the incidence of PrUs was conducted. Modeled cohort of hospitalized patients at high risk of developing PrUs and malnutrition simulated during their hospital stay and up to 1 year. Standard care included PrU prevention strategies, such as redistribution surfaces, repositioning, and skin protection strategies, along with standard hospital diet. In addition to the standard care, the intervention group received nutritional support comprising patient education, nutrition goal setting, and the consumption of high-protein supplements. The analysis was from a healthcare payer perspective. Key outcomes of the model included the average costs and quality-adjusted life years. Model results were tested in univariate sensitivity analyses, and decision uncertainty was characterized using a probabilistic sensitivity analysis. Compared with standard care, nutritional support was cost saving at AU $425 per patient and marginally more effective with an average 0.005 quality-adjusted life years gained. The probability of nutritional support being cost-effective was 87%. Nutritional support to prevent PrUs in high-risk hospitalized patients is cost-effective with substantial cost savings predicted. Hospitals should implement the recommendations from the current PrU practice guidelines and offer nutritional support to high-risk patients.

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Source: Medline

Title: Feasibility of a patient-centred nutrition intervention to improve oral intakes of patients at risk of pressure ulcer: a pilot randomised control trial.

Citation: Scandinavian journal of caring sciences, Jun 2016, vol. 30, no. 2, p. 271-280 Author(s): Roberts, Shelley, Desbrow, Ben, Chaboyer, Wendy Abstract: Nutrition is important for pressure ulcer prevention. This randomised control pilot study assessed the feasibility of conducting a larger trial to test the effectiveness of a patient-centred intervention for improving the dietary intakes of patients at risk of pressure ulcer in hospital. A 3-day intervention targeting patients at risk of pressure ulcer was developed, based on three main foundations: patient education, patient participation and guided goal setting. The intervention was piloted in three wards in a metropolitan hospital in Queensland, Australia. Participants were randomised into control or intervention groups and had their oral intakes monitored. A subset of intervention patients was interviewed on their perceptions of the intervention. Feasibility was tested against three criteria: ≥75% recruitment; ≥80% retention; and ≥80% intervention fidelity. Secondary outcomes related to effects on energy and protein intakes. Eighty patients participated in the study and 66 were included in final analysis. The recruitment rate was 82%, retention rate was 88%, and 100% of intervention patients received the intervention. Patients viewed the intervention as motivating and met significantly more of their estimated energy and protein requirements over time. This pilot study indicates that the intervention is feasible and acceptable by patients at risk of pressure ulcer. A larger trial is needed to confirm the effectiveness of the intervention in the clinical setting. © 2015 Nordic College of Caring Science.

Source: Medline

SEPSIS Title: Late mortality after Sepsis Author(s): Prescott, HC et al Citation: BMJ, 353(8059) p355

Title: Sepsis: pathophysiology and clinical management Autho(s) : Gotts, JE and Matthay, Michael Citation BMJ, 353(80590 p366-69

Title: Can melatonin be used as a marker for neonatal sepsis?

Citation: Journal of Maternal-Fetal & Neonatal Medicine, 2016, vol./is. 29/17 11

Author(s): El-Mashad, Abdel-Rahman, Elmahdy, Heba, El-Dib, Mohamed, Elbatch, Manal, Aly, Hany Abstract: Background: Melatonin, an indolamine endogenously produced by pineal body, has important role as an anti-oxidant, anti-inflammatory and anti-apoptotic. Whether melatonin concentration changes in neonatal sepsis and whether it can be used as a marker of sepsis is unknown.Objective: The objective of this study is to evaluate melatonin concentration in the serum as a marker for neonatal sepsis and compare it to standard markers.Study Design: We prospectively studied 40 neonates: 20 diagnosed with late neonatal sepsis and 20 healthy neonates as a control group. Markers of sepsis and melatonin concentration were compared between both groups.Results: The sepsis groups had significantly increased immature to total neutrophils ratio (I/T ratio), and high sensitivity C-reactive protein (HsCRP), and decreased platelet count. Melatonin concentration was increased in sepsis group when compared to control group (27.2 ± 3.3 versus 11.4 ± 3.2 pg/ml, p = 0.001), and positively correlated with HsCRP (r = 0.952, p = 0.001) and I/T ratio (r = 0.326, p = 0.015). Combining melatonin to HsCRP increased sensitivity and specificity to detect neonatal sepsis to 97.3 and 93.3%, respectively.Conclusions: Endogenous melatonin concentration is increased in late neonatal sepsis and can potentially be used as a marker for sepsis especially when combined with CRP. Source: CINAHL

Title: Derivation of Novel Risk Prediction Scores for Community-Acquired Sepsis and Severe Sepsis.

Citation: Critical Care Medicine, 2016, vol./is. 44/7(1285-1294) Author(s): Wang, Henry E., Donnelly, John P., Griffin, Russell, Levitan, Emily B., Shapiro, Nathan I., Howard, George, Safford, Monika M. Abstract: Objective: We sought to derive and internally validate a Sepsis Risk Score and a Severe Sepsis Risk Score predicting future sepsis and severe sepsis events among community-dwelling adults.Design: National population-based cohort.Setting: United States.Subjects: A total of 30,239 community-dwelling adults 45 years old or older in the national REasons for Geographic And Racial Differences in Stroke cohort.Interventions: None.Measurements and Main Results: Over a median of 6.6 years (interquartile range, 5.18.1 yr) of follow-up, there were 1,532 first sepsis (prevalence 8.3 per 1,000 person-years) and 1,151 first severe sepsis (6.2 per 1,000 person-years) events. Risk factors in the best derived Sepsis Risk Score and Severe Sepsis Risk Score included chronic lung disease, age 75 years or older, peripheral artery disease, diabetes, tobacco use, white race, stroke, atrial fibrillation, coronary artery disease, obesity, hypertension, deep vein thrombosis, male sex, high-sensitivity C-reactive protein greater than 3.0 mg/dL, cystatin C ≥1.11 mg/dL, estimated glomerular filtration rate less than 60 mL/min/1.73 m, and albumin-to-creatinine ratio protein greater than 30 μg/mg. Sepsis Risk Score risk categories were very low (0-3 points; 2.3 events per 1,000 person-years), low (4-6; 4.1), medium (7-9; 6.5), high (10-12; 9.7), and very high (13-38; 21.1). Severe Sepsis Risk Score risk categories were very low (05 points; 1.5 events per 1,000 person-years), low (6-9; 3.4), medium (10-13; 6.7), high (1417; 9.9), and very high (18-45; 22.1). The Sepsis Risk Score and Severe Sepsis Risk Score exhibited good discrimination (bootstrapped C index, 0.703 and 0.742) and calibration (p = 0.65 and 0.06).Conclusions: The Sepsis Risk Score and Severe Sepsis Risk Score predict 10-year sepsis and severe sepsis risk among community-dwelling adults and may aid in sepsis prevention or mitigation efforts.

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Source: CINAHL Full Text: Available from Ovid fulltext collection in Critical Care Medicine Title: Predicting and Eventually Preventing the Future: Sepsis Risk in CommunityDwelling Adults.

Citation: Critical Care Medicine, 2016, vol./is. 44/7(1425-1426) Author(s): Reilly, John P. Abstract: The author reflects on the highlights of the article "Derivation of a Novel Risk Prediction Scores for Community-Acquired Sepsis and Severe Sepsis" by H. E. Wang and others published in the July 2016 issue of the journal "Critical Care Medicine." Topics covered include the use of the Reason for Geographic and Racial Differences in Stroke (REGARDS) cohort to study sepsis risk in adults, the sepsis risk prediction scores derived from REGARDS, and the different uses of the derived scores.

Full Text: Available from Ovid fulltext collection in Critical Care Medicine Title: Risks and Benefits of Stress Ulcer Prophylaxis for Patients With Severe Sepsis.

Citation: Critical Care Medicine, 2016, vol./is. 44/7(0-5) Author(s): Yusuke Sasabuchi, Hiroki Matsui, Lefor, Alan K., Kiyohide Fushimi, Hideo Yasunaga Abstract: Objectives: The Surviving Sepsis Campaign Guidelines recommend stress ulcer prophylaxis for patients with severe sepsis who have bleeding risks. Although sepsis has been considered as a risk factor for gastrointestinal bleeding, the effect of stress ulcer prophylaxis has not been studied in patients with severe sepsis. Furthermore, stress ulcer prophylaxis may be associated with an increased risk of hospital-acquired pneumonia or Clostridium difficile infection. The aim of this study was to investigate the risks and benefits of stress ulcer prophylaxis for patients with severe sepsis.Design: Retrospective cohort study.Setting: Five hundred twenty-six acute care hospitals in Japan.Patients: A total of 70,862 patients with severe sepsis.Interventions: None.Measurements and Main Results: One-to-one propensity score matching created 15,651 pairs of patients who received stress ulcer prophylaxis within 2 days of admission and those who did not. Patient characteristics were well balanced between the two groups. No significant differences were seen between the stress ulcer prophylaxis group and the control group with regard to gastrointestinal bleeding requiring endoscopic hemostasis (0.6% vs 0.5%; p = 0.208), 30-day mortality (16.4% vs 16.9%; p = 0.249), and Clostridium difficile infection (1.4% vs 1.3%; p = 0.588).

The stress ulcer prophylaxis group had a significantly higher proportion of hospital-acquired pneumonia (3.9% vs 3.3%; p = 0.012) compared with the control group.Conclusions: Since the rate of gastrointestinal bleeding requiring endoscopic hemostasis is not different comparing patients with and without stress ulcer prophylaxis, and the increase in hospitalacquired pneumonia is significant, routine stress ulcer prophylaxis for patients with severe sepsis may be unnecessary.

Full Text: Available from Ovid fulltext collection in Critical Care Medicine 13

Title: Chronic Statin Use and Long-Term Rates of Sepsis.

Citation: Journal of Intensive Care Medicine , 2016, vol./is. 31/6(386-396) Author(s): Wang, Henry E., Griffin, Russell, Shapiro, Nathan I., Howard, George, Safford, Monika M. Source: CINAHL

Title: Clarifying Sepsis Management.

Citation: American Journal of Respiratory & Critical Care Medicine, 2016, vol./is.

193/11(1195-1196) Author(s): Levy, Mitchell M. Source: CINAHL Full Text: Available from ProQuest in American Journal of Respiratory and Critical Care Medicine Title: Comparison of Pediatric Severe Sepsis Managed in U.S. and European ICUs. Citation: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, Jun 2016, vol.

17, no. 6, p. 522-530 Author(s): Giuliano, John S., et al Abstract: Pediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, which may improve the design of future international studies. We conducted a secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies study. Data about PICU characteristics, patient demographics, therapies, and outcomes were compared. Multivariable regression models were used to determine adjusted differences in morbidity and mortality. European and U.S. PICUs. Children with severe sepsis managed in European and U.S. PICUs enrolled in the Sepsis PRevalence, OUtcomes, and Therapies study. None. European PICUs had fewer beds (median, 11 vs 24; p < 0.001). European patients were younger (median, 1 vs 6 yr; p < 0.001), had higher severity of illness (median Pediatric Index of Mortality-3, 5.0 vs 3.8; p = 0.02), and were more often admitted from the ward (37% vs 24%). Invasive mechanical ventilation, central venous access, and vasoactive infusions were used more frequently in European patients (85% vs 68%, p = 0.002; 91% vs 82%, p = 0.05; and 71% vs 50%; p < 0.001, respectively). Raw morbidity and mortality outcomes were worse for European compared with U.S. patients, but after adjusting for patient characteristics, there were no significant differences in mortality, multiple organ dysfunction, disability at discharge, length of stay, or ventilator/vasoactive-free days. Children with severe sepsis admitted to European PICUs have higher severity of illness, are more likely to be admitted from hospital wards, and receive more intensive care therapies than in the United States. The lack of significant differences in morbidity and mortality after adjusting for patient characteristics suggests that the approach to care between regions, perhaps related to PICU bed availability, needs to be considered in the design of future international clinical trials in pediatric severe sepsis.

14

Source: Medline

Title: Prehospital management and identification of sepsis by emergency medical services: a systematic review.

Citation: Emergency medicine journal : EMJ, Jun 2016, vol. 33, no. 6, p. 408-413 Author(s): Lane, Daniel, Ichelson, Robbie I, Drennan, Ian R, Scales, Damon C Abstract: To identify studies describing the accuracy of prehospital sepsis identification and to summarise results of studies of prehospital management of patients with sepsis, severe sepsis or septic shock. We conducted a systematic review to retrieve studies that evaluated the prehospital identification or treatment of patients with sepsis by emergency medical services (EMS). Two authors extracted data describing the study characteristics, incidence of sepsis among EMS-transported patients, criteria used to identify sepsis and specific treatments provided to patients with sepsis. When possible, we calculated the sensitivity and specificity of EMS provider diagnosis of sepsis. Our search identified no randomised controlled trials and 16 cohort studies. Eight studies described the identification of sepsis, seven described prehospital management or treatment of sepsis and one described both.

The most common approach to the identification of sepsis involved applying systemic inflammatory response syndrome criteria or a combination of vital signs, which had sensitivity ranging from 0.43 to 0.86 when used alone or combined with provider impression.

Only four studies collected information required to calculate specificity (0.47-0.87). Metaanalysis was not performed owing to significant heterogeneity and an overall low quality of evidence. A few studies described prehospital sepsis treatment-most commonly intravenous fluid resuscitation. The evidence suggests that identification of sepsis in the prehospital setting by EMS providers is carried out with varied success, depending on the strategy used; however, high-quality studies are lacking. Relying on provider impression alone had poor sensitivity, but some moderate-quality evidence supporting structured screening for sepsis with vital signs criteria demonstrated modest sensitivity and specificity. Additional research to improve diagnostic accuracy and explore improvements in EMS management is needed.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rightsand-licensing/ Source: Medline Full Text: Available from Highwire Press in Emergency Medicine Journal Title: Predictors of early progression to severe sepsis or shock among emergency department patients with nonsevere sepsis.

Citation: International journal of emergency medicine, Dec 2016, vol. 9, no. 1, p. 10., Author(s): Holder, Andre L, Gupta, Namita, Lulaj, Elizabeth, Furgiuele, Miriam, Hidalgo, Idaly, Jones, Michael P, Jolly, Tiphany, Gennis, Paul, Birnbaum, Adrienne Abstract: Progression from nonsevere sepsis-i.e., sepsis without organ failure or shock-to severe sepsis or shock among emergency department (ED) patients has been associated with significant mortality. Early recognition in the ED of those who progress to severe sepsis or shock during their hospital course may improve patient outcomes. We sought to identify 15

clinical, demographic, and laboratory parameters that predict progression to severe sepsis, septic shock, or death within 96 h of ED triage among patients with initial presentation of nonsevere sepsis. This is a retrospective cohort of patients presenting to a single urban academic ED from November 2008 to October 2010. Patients aged 18 years or older who met criteria for sepsis and had a lactate level measured in the ED were included. Patients were excluded if they had any combination of the following: a systolic blood pressure <90 mmHg upon triage, an initial whole blood lactate level â&#x2030;Ľ4 mmol/L, or one or more of a set of predefined signs of organ dysfunction upon initial assessment. Disease progression was defined as the development of any combination of the aforementioned conditions, initiation of vasopressors, or death within 96 h of ED presentation. Data on predefined potential predictors of disease progression and outcome measures of disease progression were collected by a query of the electronic medical record and via chart review. Logistic regression was used to assess associations of potential predictor variables with a composite outcome measure of sepsis progression to organ failure, hypotension, or death. In this cohort of 582 ED patients with nonsevere sepsis, 108 (18.6 %) experienced disease progression. Initial serum albumin <3.5 mg/dL (OR 4.82; 95 % CI 2.40-9.69; p < 0.01) and a diastolic blood pressure <52 mmHg at ED triage (OR 4.59; 95 % CI 1.57-13.39; p < 0.01) were independently associated with disease progression to severe sepsis or shock within 96 h of ED presentation. There were no deaths within 96 h of ED presentation. In our patient cohort, serum albumin <3.5 g/dL and an ED triage diastolic blood pressure <52 mmHg independently predict early progression to severe sepsis or shock among ED patients with presumed sepsis.

Source: Medline Full Text: Available from National Library of Medicine in International Journal of Emergency Medicine Available from BioMed Central in International Journal of Emergency Medicine Available from ProQuest in International Journal of Emergency Medicine Available from National Library of Medicine in International Journal of Emergency Medicine

DETERIORATING PATIENT Title: Vital signs monitoring and nurse-patient interaction: A qualitative observational study of hospital practice Citation: International Journal of Nursing Studies, 2016, vol. 56, p. 9-16 Author(s): Cardona-Morrell, M., Prgomet, M., Lake, R., Nicholson, M., Harrison, R., Long, J., Westbrook, J., Braithwaite, J., Hillman, K. Abstract: Background: High profile safety failures have demonstrated that recognising early warning signs of clinical and physiological deterioration can prevent or reduce harm resulting from serious adverse events. Early warning scoring systems are now routinely used in many places to detect and escalate deteriorating patients. Timely and accurate vital signs monitoring are critical for ensuring patient safety through providing data for early warning scoring systems, but little is known about current monitoring practices. Objective: To establish a profile of nurses' vital signs monitoring practices, related dialogue, and adherence to health service protocol in New South Wales, Australia. Methods: Direct observations of nurses' working practices were conducted in two wards. The observations focused on times of the day when vital signs were generally measured. Patient interactions were recorded if occurring any time during the observation periods. Participants (n = 42) included nursing staff on one chronic disease medical and one acute surgical ward in a large 16

urban teaching hospital in New South Wales. Results: We observed 441 patient interactions.

Measurement of vital signs occurred in 52% of interactions. The minimum five vital signs measures required by New South Wales Health policy were taken in only 6-21% of instances of vital signs monitoring. Vital signs were documented immediately on 93% of vitals-taking occasions and documented according to the policy in the patient's chart on 89% of these occasions. Nurse-patient interactions were initiated for the purpose of taking vital signs in 49% of interactions, with nurse-patient discourse observed during 88% of all interactions.

Nurse-patient dialogue led to additional care being provided to patients in 12% of interactions. Conclusion: The selection of appropriate vital signs measured and responses to these appears to rely on nurses' clinical judgement or time availability rather than on policymandated frequency. The prevalence of incomplete sets of vital signs may limit identification of deteriorating patients. The findings from this study present an important baseline profile against which to evaluate the impact of introducing continuous monitoring approaches on current hospital practice. References Source: BNI

Title: Strengthening the afferent limb of rapid response systems: an educational intervention using web-based learning for early recognition and responding to deteriorating patients.

Citation: BMJ quality & safety, Jun 2016, vol. 25, no. 6, p. 448-456 Author(s): Liaw, Sok Ying, Wong, Lai Fun, Ang, Sophia Bee Leng, Ho, Jasmine Tze Yin, Siau, Chiang, Ang, Emily Neo Kim Abstract: The timely recognition and response to patients with clinical deteriorations constitute the afferent limb failure of a rapid response system (RRS). This area is a persistent problem in acute healthcare settings worldwide. In this study, we evaluated the effect of an educational programme on improving the nurses' knowledge and performances in recognising and responding to clinical deterioration. The interactive web-based programme addressed three areas: (1) early detection of changes in vital signs; (2) performance of nursing assessment and interventions using airway, breathing, circulation, disability and expose/examine and (3) reporting clinical deterioration using identity, situation, background, assessment and recommendation. Sixty-seven registered nurses participated in the randomised control study. The experimental group underwent a 3 h programme while the control group received no intervention. Pretests and post-tests, a mannequin-based assessment and a multiple-choice knowledge questionnaire were conducted. We evaluated the participants' performances in assessing, managing and reporting the deterioration of a patient using a validated performance tool. A significantly higher number of nurses from the experimental group than the control group monitored respiratory rates (48.2% vs 25%, p<0.05) and pulse rates (74.3% vs 37.5%, p<0.01) in the simulated environment, after the intervention. The post-test mean scores of the experimental group was significantly higher than the control group for knowledge (21.29 vs 18.28, p<0.001), performance in assessing and managing clinical deterioration (25.83 vs 19.50, p<0.001) and reporting clinical deterioration (12.83 vs 10.97, p<0.001). A web-based educational programme developed for hospital nurses to strengthen the afferent limb of the RRS significantly increased their knowledge and performances in assessing, managing and reporting clinical deterioration.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rightsand-licensing/ Source: Medline 17

Full Text: Available from Highwire Press in BMJ Quality and Safety Title: The experiences of nurses implementing the Modified Early Warning Score and a 24-hour on-call Mobile Intensive Care Nurse: An exploratory study.

Citation: Intensive & critical care nursing, Jun 2016, vol. 34, p. 25-33 Author(s): Stafseth, Siv K, Grønbeck, Sturle, Lien, Tine, Randen, Irene, Lerdal, Anners Abstract: To explore experiences of nurses implementing and using the Modified Early Warning Score (MEWS) and a Mobile Intensive Care Nurse (MICN) providing 24-hour oncall nursing support. To secure patient safety in hospital wards, nurses may increase the quality of care using a tool to detect the failure of vital functions. Possibilities for support can be provided through on-call supervision from a qualified team or nurse. This exploratory qualitative investigation used focus group interviews with nurses from two wards of a university hospital in Norway. A purposive sample of seven registered nurses was interviewed in focus groups. A semi-structured guide and an inductive thematic analysis were used to identify interview themes. Three themes emerged: (1) experiences with the early recognition of deterioration using the MEWS, (2) supportive collaboration and knowledge transfer between nurses and (3) a "new" precise language using the score for communicating with physicians. The use of scores and support were perceived as improving care for deteriorating patients and for supporting the collaboration of nurses with other professionals. In our study, nurses described increased confidence in the recognition of deteriorating patients and in the management of such situations. The non-critical attitude, supportive communication and interactive learning according to the MICN were essential elements for success. Copyright Š 2015 Elsevier Ltd. All rights reserved.

Source: Medline

PATIENT SAFETY Title: Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study.

Citation: International Journal of Nursing Studies, 2016, vol./is. 60/(263-271) Author(s): Cho, Eunhee, Lee, Nam-Ju, Kim, Eun-Young, Kim, Sinhye, Lee, Kyongeun, Park, Kwang-Ok, Sung, Young Hee Source: CINAHL

Title: Tip of the iceberg: patient safety incidents in primary care.

Citation: BMJ Quality & Safety, 2016, vol./is. 25/7(477-480) Author(s): Sarkar, Urmimala Source: CINAHL 18

Full Text: Available from Highwire Press in BMJ Quality and Safety Title: Patient safety and the problem of many hands.

Citation: BMJ Quality & Safety, 2016, vol./is. 25/7(485-489) Author(s): Dixon-Woods, Mary, Pronovost, Peter J. Source: CINAHL Full Text: Available from Highwire Press in BMJ Quality and Safety Title: Nursing physical assessment for patient safety in general wards: reaching consensus on core skills.

Citation: Journal of Clinical Nursing, 2016, vol./is. 25/13/14(1890-1900) Author(s): Douglas, Clint, Booker, Catriona, Fox, Robyn, Windsor, Carol, Osborne, Sonya, Gardner, Glenn Source: CINAHL

Title: Handwriting and a nurse's duty of care.

Citation: British Journal of Nursing, 2016, vol./is. 25/11(622-623) Author(s): Griffith, Richard Abstract: The article discusses the professional duty of nurses to write clearly and highlights the financial and human cost of poor handwriting. It points out that a nurse's duty of care includes indirect elements such as information sharing, record keeping and the standard of handwriting in addition to direct care and treatment given to patients. It notes that poor handwriting is a significant risk to patient safety and nurses are duty bound to ensure the safety of their patients by writing clearly.

Source: CINAHL Full Text: Available from Mark Allen Group in British Journal of Nursing; Note: ; Notes: Click on 'Sign in' to top right, then choose OpenAthens option Available from EBSCOhost in British Journal of Nursing Title: Prevention strategies for unplanned extubation in NICU - A literature review Citation: Journal of Neonatal Nursing, Jun 2016, vol. 22, no. 3, p. 91-102 Author(s): Morii, Chisako Abstract: Unplanned extubation in neonatal intensive care units is one of the common adverse events for the mechanically ventilated infants. This is a significant patient safety issue and the prevention is very important for both infants and organisations. The purpose of 19

this review is to explore and identify the prevention strategies for unplanned extubation in literature. This literature review discussed prevention strategies in terms of endotracheal tube fixation, use of sedation, use of physical restraints, nursing workload, and quality improvement programme/project. There was limited research in neonatal populations.

However, future research and some prevention practices would be beneficial for further reduction of the unplanned extubations. References Source: BNI

Title: Promoting Patient Safety With Perioperative Hand-off Communication Citation: Journal of PeriAnesthesia Nursing, Jun 2016, vol. 31, no. 3, p. 245-253 Author(s): Robinson, Nancy Leighton Abstract: Effective perioperative hand-off communication is essential for patient safety. The purpose of this quality improvement project was to demonstrate how a structured hand-off tool and standardized process could increase effective perioperative communication of essential elements of care and assist in the timely recognition of patients at risk for clinical deterioration in the initial postoperative period. A team-based pilot project used the Iowa Model of Evidence-Based Practice and the principles of Lean Six Sigma to implement Perioperative PEARLS, a perioperative specific hand-off communication tool and a standardized framework for hand-off communication. The implementation of a structured hand-off tool and standardized process supports compliance with regulatory standards of care and eliminates waste from the hand-off process. A review of pre-implementation and post-implementation data revealed evidence of safer patient care. Evidence-based perioperative hand-off communication facilitates expedited patient evaluation, rapid interventions, reduction in adverse events, and a safer perioperative environment.

References Source: BNI

Title: Clinical handover practices in maternity services in Ireland: A qualitative descriptive study.

Citation: Midwifery, Aug 2016, vol. 39, p. 20-26 Author(s): Fealy, Gerard, et al Abstract: the objective was to examine and describe clinical handover practices in Irish maternity services. the study design incorporated interviews and focus group discussions with a purposive sample of healthcare practitioners working in Irish maternity services. five maternity hospitals and fourteen co-located maternity units. midwives, obstetricians and other healthcare professionals, specifically physiotherapists and radiologists, midwifery students and health care assistants working in maternity services. the study participants provided nuanced and differentiated accounts of clinical handover practices, which indicated a general absence of formal policy and training on clinical handover and the practice of midwifery and medical teams holding separate clinical handovers based on their separate, respective needs for transferring information and clinical responsibility. Participants spoke of barriers to effective clinical handover, including unsuitable environments, lack of dedicated time and fatigue during duty shift clinical handover, lack of supportive information technology (IT) infrastructure, and resistance of some staff to the adoption of new technologies to 20

support clinical handover. whether internal and external to clinical handover events, the barriers to effective clinical handover represent threats to patient safety and quality of care, since effective clinical handover is essential to the provision of safe quality care. clear and effective communication between collaborating professionals within maternity teams is essential. Copyright Š 2016 Elsevier Ltd. All rights reserved.

Source: Medline

Title: Assessing the relationship between patient safety culture and EHR strategy.

Citation: International journal of health care quality assurance, Jul 2016, vol. 29, no. 6, p.

614-627 Author(s): Ford, Eric W, Silvera, Geoffrey A, Kazley, Abby S, Diana, Mark L, Huerta, Timothy R Abstract: Purpose - The purpose of this paper is to explore the relationship between hospitals' electronic health record (EHR) adoption characteristics and their patient safety cultures. The "Meaningful Use" (MU) program is designed to increase hospitals' adoption of EHR, which will lead to better care quality, reduce medical errors, avoid unnecessary cost, and promote a patient safety culture. To reduce medical errors, hospital leaders have been encouraged to promote safety cultures common to high-reliability organizations. Expecting a positive relationship between EHR adoption and improved patient safety cultures appears sound in theory, but it has yet to be empirically demonstrated.

Design/methodology/approach - Providers' perceptions of patient safety culture and counts of patient safety incidents are explored in relationship to hospital EHR adoption patterns.

Multi-level modeling is employed to data drawn from the Agency for Healthcare Research and Quality's surveys on patient safety culture (level 1) and the American Hospital Association's survey and healthcare information technology supplement (level 2). Findings The findings suggest that the early adoption of EHR capabilities hold a negative association to the number of patient safety events reported. However, this relationship was not present in providers' perceptions of overall patient safety cultures. These mixed results suggest that the understanding of the EHR-patient safety culture relationship needs further research.

Originality/value - Relating EHR MU and providers' care quality attitudes is an important leading indicator for improved patient safety cultures. For healthcare facility managers and providers, the ability to effectively quantify the impact of new technologies on efforts to change organizational cultures is important for pinpointing clinical areas for process improvements.

Source: Medline

Title: Work conditions, mental workload and patient care quality: a multisource study in the emergency department.

Citation: BMJ quality & safety, Jul 2016, vol. 25, no. 7, p. 499-508 Author(s): Weigl, Matthias, MĂźller, Andreas, Holland, Stephan, Wedel, Susanne, Woloshynowych, Maria Abstract: Workflow interruptions, multitasking and workload demands are inherent to emergency departments (ED) work systems. Potential effects of ED providers' work on care quality and patient safety have, however, been rarely addressed. We aimed to investigate 21

the prevalence and associations of ED staff's workflow interruptions, multitasking and workload with patient care quality outcomes. We applied a mixed-methods design in a twostep procedure. First, we conducted a time-motion study to observe the rate of interruptions and multitasking activities. Second, during 20-day shifts we assessed ED staff's reports on workflow interruptions, multitasking activities and mental workload. Additionally, we assessed two care quality indicators with standardised questionnaires: first, ED patients' evaluations of perceived care quality; second, patient intrahospital transfers evaluated by ward staff. The study was conducted in a medium-sized community ED (16 600 annual visits). ED personnel's workflow was disrupted on average 5.63 times per hour. 30% of time was spent on multitasking activities. During 20 observations days, data were gathered from 76 ED professionals, 239 patients and 205 patient transfers. After aggregating daywise data and controlling for staffing levels, prospective associations revealed significant negative associations between ED personnel's mental workload and patients' perceived quality of care. Conversely, workflow interruptions were positively associated with patient-related information on discharge and overall quality of transfer. Our investigation indicated that ED staff's capability to cope with demanding work conditions was associated with patient care quality. Our findings contribute to an improved understanding of the complex effects of interruptions and multitasking in the ED environment for creating safe and efficient ED work and care systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ Source: Medline Full Text: Available from Highwire Press in BMJ Quality and Safety Title: How safe is primary care? A systematic review.

Citation: BMJ quality & safety, Jul 2016, vol. 25, no. 7, p. 544-553 Author(s): Panesar, Sukhmeet Singh, et al Abstract: Improving patient safety is at the forefront of policy and practice. While considerable progress has been made in understanding the frequency, causes and consequences of error in hospitals, less is known about the safety of primary care. We investigated how often patient safety incidents occur in primary care and how often these were associated with patient harm. We searched 18 databases and contacted international experts to identify published and unpublished studies available between 1 January 1980 and 31 July 2014. Patient safety incidents of any type were eligible. Eligible studies were critically appraised using validated instruments and data were descriptively and narratively synthesised. Nine systematic reviews and 100 primary studies were included. Studies reported between <1 and 24 patient safety incidents per 100 consultations. The median from population-based record review studies was 2-3 incidents for every 100 consultations/records reviewed. It was estimated that around 4% of these incidents may be associated with severe harm, defined as significantly impacting on a patient's well-being, including long-term physical or psychological issues or death (range <1% to 44% of incidents). Incidents relating to diagnosis and prescribing were most likely to result in severe harm. Millions of people throughout the world use primary care services on any given day.

This review suggests that safety incidents are relatively common, but most do not result in serious harm that reaches the patient. Diagnostic and prescribing incidents are the most likely to result in avoidable harm. This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42012002304). Published by 22

the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ Source: Medline Full Text: Available from Highwire Press in BMJ Quality and Safety Title: The daily relationships between staffing, safety perceptions and personality in hospital nursing: A longitudinal on-line diary study.

Citation: International journal of nursing studies, Jul 2016, vol. 59, p. 27-37 Author(s): Louch, Gemma, O'Hara, Jane, Gardner, Peter, O'Connor, Daryl B Abstract: The association between poor staffing conditions and negative patient safety consequences is well established within hospital nursing. However, many studies have been limited to nurse population level associations, and have used routine data to examine relationships. As a result, it is less clear how these relationships might be manifested at the individual nurse level on a day-to-day basis. Furthermore, personality may have direct and moderating roles in terms of work environment and patient safety associations, but limited research has explored personality in this context. To further our understanding of these associations, this paper takes a within-person approach to examine nurses' daily perceptions of staffing and patient safety. In addition, we explore the potential role of personality factors as moderators of daily level associations. We recruited eighty-three hospital nurses from three acute NHS Trusts in the UK between March and July 2013.

Nurses completed online end-of-shift diaries over three-five shifts which collected information on perceptions of staffing, patient-nurse ratio and patient safety (perceptions of patient safety, ability to act as a safe practitioner, and workplace cognitive failure).

Personality was also assessed within a baseline questionnaire. Data were analysed using hierarchical linear modelling, and moderation effects of personality factors were examined using simple slopes analyses, which decomposed relationships at high and low levels of the moderator. On days when lower patient-nurse ratios were indicated, nurses reported being more able to act as a safe practitioner (p=.011) and more favourable perceptions of patient safety (p=<.001). Additionally, when staffing was perceived more favourably, nurses reported being more able to act as a safe practitioner (p=<.001), more favourable perceptions of patient safety (p=<.001) and experienced less workplace cognitive failure (p=<.001). Conscientiousness and emotional stability emerged as key moderators of daily level associations between staffing and patient safety variables, with many relationships differing at high and low levels of these personality factors. The findings elucidate the potential mechanisms by which patient safety risks arise within hospital nursing, and suggest that nurses may not respond to staffing conditions in the same way, dependent upon personality. Further understanding of these relationships will enable staff to be supported in terms of work environment conditions on an individual basis. Copyright Š 2016 Elsevier Ltd. All rights reserved.

Source: Medline

Title: Feasibility of a hemodialysis safety checklist for nurses and patients: a quality improvement study.

Citation: Clinical kidney journal, Jun 2016, vol. 9, no. 3, p. 335-342 23

Author(s): Thomas, Alison, et al Abstract: Patients with end-stage renal disease are at high risk for medical errors given their comorbidities, polypharmacy and coordination of care with other hospital departments.

We previously developed a hemodialysis safety checklist (Hemo Pause) to be jointly completed by nurses and patients. Our objective was to determine the feasibility of using this checklist during every hemodialysis session for 3 months. We conducted a single-center, prospective time series study. A convenience sample of 14 nurses and 22 prevalent incenter hemodialysis patients volunteered to participate. All participants were trained in the administration of the Hemo Pause checklist. The primary outcome was completion of the Hemo Pause checklist, which was assessed at weekly intervals. We also measured the acceptability of the Hemo Pause checklist using a local patient safety survey. There were 799 hemodialysis treatments pre-intervention (13 January-5 April 2014) and 757 postintervention (5 May-26 July 2014). The checklist was completed for 556 of the 757 (73%) treatments. Among the hemodialysis nurses, 93% (13/14) agreed that the checklist was easy to use and 79% (11/14) agreed it should be expanded to other patients. Among the hemodialysis patients, 73% (16/22) agreed that the checklist made them feel safer and should be expanded to other patients. The Hemo Pause safety checklist was acceptable to both nurses and patients over 3 months. Our next step is to spread this checklist locally and conduct a mixed methods study to determine mechanisms by which its use may improve safety culture and reduce adverse events.

Source: Medline Full Text: Available from National Library of Medicine in Clinical Kidney Journal Title: Role of parents in the promotion of hand hygiene in the paediatric setting: a systematic literature review.

Citation: The Journal of hospital infection, Jun 2016, vol. 93, no. 2, p. 159-163 Author(s): Bellissimo-Rodrigues, F, Pires, D, Zingg, W, Pittet, D Abstract: When a child is hospitalized, parents have to share their role to protect the child with the hospital, and establish a partnership with healthcare workers to deliver safe care to the child, including undertaking good hand hygiene practices. To review the scientific evidence about the participation of parents in the promotion of hand hygiene in paediatric settings. A systematic search of MEDLINE, EMBASE and SciELO databases was undertaken using the following terms: ('hand hygiene'[MeSH] OR 'hand hygiene' OR 'hand disinfection'[MeSH] OR hand disinf* OR hand wash* OR handwash* OR hand antisep*) AND (parent OR caregiver OR mother OR father OR family OR families OR relatives). The Integrated Quality Criteria for Review of Multiple Study Designs tool was used for quality assessment. The literature search yielded 1645 articles, and 11 studies met the inclusion criteria for the final analysis. Most studies were observational, and were based on questionnaires or interviews. Most parents had little knowledge about the indications to perform hand hygiene, but recognized hand hygiene as a relevant tool for the prevention of healthcare-associated infections. Their willingness to remind healthcare workers about a failed opportunity to perform hand hygiene was variable and, overall, rather low. Parents felt more comfortable about reminding healthcare workers about hand hygiene if they had previously been invited to do so. Literature on the subject is scarce. The promotion of hand hygiene by parents should be further explored by research as a potential intervention for enhancing patient safety in paediatric settings. Copyright Š 2016. Published by Elsevier Ltd. 24

Source: Medline

Title: Mental health service changes, organisational factors, and patient suicide in England in 1997-2012: a before-and-after study.

Citation: The lancet. Psychiatry, Jun 2016, vol. 3, no. 6, p. 526-534 Author(s): Kapur, Nav, et al Abstract: Research into which aspects of service provision in mental health are most effective in preventing suicide is sparse. We examined the association between service changes, organisational factors, and suicide rates in a national sample. We did a beforeand-after analysis of service delivery data and an ecological analysis of organisational characteristics, in relation to suicide rates, in providers of mental health care in England. We also investigated whether the effect of service changes varied according to markers of organisational functioning. Overall, 19 248 individuals who died by suicide within 12 months of contact with mental health services were included (1997-2012). Various service changes related to ward safety, improved community services, staff training, and implementation of policy and guidance were associated with a lower suicide rate after the introduction of these changes (incidence rate ratios ranged from 0·71 to 0·79, p<0·0001). Some wider organisational factors, such as non-medical staff turnover (Spearman's r=0·34, p=0·01) and incident reporting (0·46, 0·0004), were also related to suicide rates but others, such as staff sickness (-0·12, 0·37) and patient satisfaction (-0·06, 0·64), were not. Service changes had more effect in organisations that had low rates of staff turnover but high rates of overall event reporting. Aspects of mental health service provision might have an effect on suicide rates in clinical populations but the wider organisational context in which service changes are made are likely to be important too. System-wide change implemented across the patient care pathway could be a key strategy for improving patient safety in mental health care. The Healthcare Quality Improvement Partnership commissions the Mental Health Clinical Outcome Review Programme, National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, on behalf of NHS England, NHS Wales, the Scottish Government Health and Social Care Directorate, the Northern Ireland Department of Health, Social Services and Public Safety, and the States of Jersey and Guernsey. Copyright © 2016 Elsevier Ltd. All rights reserved.

Source: Medline

Title: Therapeutic safe holding with children and young people in hospital.

Citation: Nursing children and young people, May 2016, vol. 28, no. 4, p. 28-32 Author(s): Kennedy, Robert, Binns, Frances Abstract: This article demonstrates how a strategy to improve patient safety and the patient experience in hospital health care was implemented in a large tertiary children's hospital. A children and young people's therapeutic safe holding policy and training programme for all clinical nursing staff was developed and introduced. The strategy aimed to define best practice and equip healthcare professionals with the appropriate tools to deliver care safely, effectively and in the best interests of the child or young person.

Source: Medline 25

Full Text: Available from RCN Publishing in Nursing Children and Young People; Note: ; Notes: Click on 'Sign in' to top right, then choose OpenAthens option

HUMAN FACTORS Title: Strengthening the afferent limb of rapid response systems: an educational intervention using web-based learning for early recognition and responding to deteriorating patients.

Citation: BMJ Quality & Safety, 2016, vol./is. 25/6(448-456) Author(s): Sok Ying Liaw, Lai Fun Wong, Bee Leng Ang, Sophia, Tze Yin Ho, Jasmine, Chiang Siau, Neo Kim Ang, Emily Source: CINAHL Full Text: Available from Highwire Press in BMJ Quality and Safety Title: Iterative user centered design for development of a patient-centered fall prevention toolkit.

Citation: Applied ergonomics, Sep 2016, vol. 56, p. 117-126 Author(s): Katsulis, Zachary, Ergai, Awatef, Leung, Wai Yin, Schenkel, Laura, Rai, Amisha, Adelman, Jason, Benneyan, James, Bates, David W, Dykes, Patricia C Abstract: Due to the large number of falls that occur in hospital settings, inpatient fall prevention is a topic of great interest to patients and health care providers. The use of electronic decision support that tailors fall prevention strategy to patient-specific risk factors, known as Fall T.I.P.S (Tailoring Interventions for Patient Safety), has proven to be an effective approach for decreasing hospital falls. A paper version of the Fall T.I.P.S toolkit was developed primarily for hospitals that do not have the resources to implement the electronic solution; however, more work is needed to optimize the effectiveness of the paper version of this tool. We examined the use of human factors techniques in the redesign of the existing paper fall prevention tool with the goal of increasing ease of use and decreasing inpatient falls. The inclusion of patients and clinical staff in the redesign of the existing tool was done to increase adoption of the tool and fall prevention best practices. The redesigned paper Fall T.I.P.S toolkit showcased a built in clinical decision support system and increased ease of use over the existing version. Copyright Š 2016 Elsevier Ltd. All rights reserved.

Source: Medline

Title: Human factors in healthcare: welcome progress, but still scratching the surface.

Citation: BMJ quality & safety, Jul 2016, vol. 25, no. 7, p. 480-484 Author(s): Waterson, Patrick, Catchpole, Ken Source: Medline 26

Full Text: Available from Highwire Press in BMJ Quality and Safety Title: Need to consider human factors when determining first-line technique for emergency front-of-neck access.

Citation: British journal of anaesthesia, Jul 2016, vol. 117, no. 1, p. 5-7 Author(s): Timmermann, A, Chrimes, N, Hagberg, C A Source: Medline

Title: Examining the effects of an interprofessional crew resource management training intervention on perceptions of patient safety.

Citation: Journal of interprofessional care, Jul 2016, vol. 30, no. 4, p. 536-538 Author(s): Wu, Wan-Ting, Wu, Yung-Lung, Hou, Shaw-Min, Kang, Chun-Mei, Huang, ChiHung, Huang, Yu-Ju, Wang, Victoria Yue An, Wang, Pa-Chun Abstract: This article reports the results from a study that employed an interprofessional crew resource management (CRM) education programme in the emergency and critical care departments. The study aimed to investigate the effectiveness of this intervention of participants' satisfaction and safety attitude changes using a satisfaction questionnaire and the Human Factors Attitude Survey (HFAS). Overall, participants responded positively to the CRM training-93.4% were satisfied, 93.1% agreed that it enhanced patient safety and care quality, 85.7% agreed that it increased their confidence, 86.4% agreed that it reduced practice errors, and 90.8% agreed that it would change their behaviours. Overall, the participants reported positive changes in their attitudes regarding 22 of the 23 HFAS questions.

Source: Medline

Title: Human factors in the emergency department: Is physician perception of time to intubation and desaturation rate accurate?

Citation: Emergency medicine Australasia : EMA, Jun 2016, vol. 28, no. 3, p. 295-299 Author(s): Cemalovic, Nail, Scoccimarro, Anthony, Arslan, Albert, Fraser, Robert, Kanter, Marc, Caputo, Nicholas Abstract: The main objective of the present study was to examine the perceived versus actual time to intubation (TTI) as an indication to help determine the situational awareness of Emergency Physicians during rapid sequence intubation and, additionally, to determine the physician's perception of desaturation events. A timed, observation prospective cohort study was conducted. A post-intubation survey was administered to the intubating physician. Each step of the procedure was timed by an observer in order to determine actual TTI. The number of desaturation events was also recorded. One hundred individual intubations were included. The provider perceived TTI was significantly different and underestimated when compared with the actual TTI (23 s, 95% confidence interval (CI) 20.4-25.49 vs 45.5 s, 95% CI 40.2-50.7, P < 0.001, respectively). Pearson correlation coefficient of perceived TTI to 27

actual TTI was r(2) = 0.39 (95% CI 0.21-0.54, P < 0.001). The provider perceived desaturation rate was also significantly different from actual desaturation rate (13, 95% CI 312 vs 23, 95% CI 13-29, P = 0.05, respectively). The overall time to desaturation was 65.1 s.

Our findings have shown that provider's perception of TTI occurs sooner than actually observed. Also, the providers were less aware of desaturation during the procedure. Š 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Source: Medline

Title: Implicit Coordination Strategies for Effective Team Communication.

Citation: Human factors, Jun 2016, vol. 58, no. 4, p. 595-610 Author(s): Butchibabu, Abhizna, Sparano-Huiban, Christopher, Sonenberg, Liz, Shah, Julie Abstract: We investigated implicit communication strategies for anticipatory information sharing during team performance of tasks with varying degrees of complexity. We compared the strategies used by teams with the highest level of performance to those used by the lowest-performing teams to evaluate the frequency and methods of communications used as a function of task structure. High-performing teams share information by anticipating the needs of their teammates rather than explicitly requesting the exchange of information. As the complexity of a task increases to involve more interdependence among teammates, the impact of coordination on team performance also increases. This observation motivated us to conduct a study of anticipatory information sharing as a function of task complexity. We conducted an experiment in which 13 teams of four people performed collaborative searchand-deliver tasks with varying degrees of complexity in a simulation environment. We elaborated upon prior characterizations of communication as implicit versus explicit by dividing implicit communication into two subtypes: (a) deliberative/goal information and (b) reactive status updates. We then characterized relationships between task structure, implicit communication, and team performance. We found that the five teams with the fastest task completion times and lowest idle times exhibited higher rates of deliberative communication versus reactive communication during high-complexity tasks compared with the five teams with the slowest completion times and longest idle times (p = .039). Teams in which members proactively communicated information about their next goal to teammates exhibited improved team performance. The findings from our work can inform the design of communication strategies for team training to improve performance of complex tasks. Š 2016, Human Factors and Ergonomics Society.

Source: Medline

Title: Human Factors and Human Nature in Cardiothoracic Surgery.

Citation: The Annals of thoracic surgery, Jun 2016, vol. 101, no. 6, p. 2059-2066 Author(s): Fann, James I, Moffatt-Bruce, Susan D, DiMaio, J Michael, Sanchez, Juan A Source: Medline

Title: Human factors in general practice - early thoughts on the educational focus for specialty training and beyond.

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Citation: Education for primary care : an official publication of the Association of Course Organisers, National Association of GP Tutors, World Organisation of Family Doctors, May 2016, vol. 27, no. 3, p. 162-171 Author(s): McKay, John, Pickup, Laura, Atkinson, Sarah, McNab, Duncan, Bowie, Paul Abstract: In the third article in the series, we describe the outputs from a series of roundtable discussions by Human Factors experts and General Practice (GP) Educational Supervisors tasked with examining the GP (family medicine) training and work environments through the lens of the systems and designed-centred discipline of Human Factors and Ergonomics (HFE). A prominent issue agreed upon proposes that the GP setting should be viewed as a complex sociotechnical system from a care service and specialty training perspective. Additionally, while the existing GP specialty training curriculum in the United Kingdom (UK) touches on some important HFE concepts, we argue that there are also significant educational gaps that could be addressed (e.g. physical workplace design, work organisation, the design of procedures, decision-making and human reliability) to increase knowledge and skills that are key to understanding workplace complexity and interactions, and supporting everyday efforts to improve the performance and wellbeing of people and organisations. Altogether we propose and illustrate how future HFE content could be enhanced, contexualised and integrated within existing training arrangements, which also serves as a tentative guide in this area for continuing professional development for the wider GP and primary care teams.

Source: Medline

Title: Learning from the patient: Human factors engineering in outpatient parenteral antimicrobial therapy.

Citation: American Journal of Infection Control, 2016, vol./is. 44/7(758-760) Author(s): Keller, Sara C., Gurses, Ayse P., Arbaje, Alicia I., Cosgrove, Sara E. Source: CINAHL BACK TO TOP

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BOOKS BACK TO TOP If you are unable to find a book, or require a book that is not on this list, please ask library staff who will be able to locate the book for you using interlibrary loan.

A list of regional books available on Quality Improvement / Patient Safety:

QI book list.docx

Safer healthcare Charles Vincent.

This is available as a pdf. http://www.swahsn.com/free-online-book-safer-healthcare-strategies-for-the-real-world-nowavailable/

We now have a subscription to EBL Electronic Books and would be interested to know if there are any titles you feel would be of benefit to be added to our collection. The catalogue can be browsed here; you will need your OpenAthens password to access it. You can request books either on the site itself or by emailing us on library@tst.nhs.uk

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UPTODATE and DYAMED PLUS BACK TO TOP

UpToDate Access is available to MPH staff only but topics from UpTodate can be supplied to Sompar staff on request. OpenAthens password required. 

Falls in older persons: Risk factors and patient evaluation

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Falls: Prevention in nursing care facilities and the hospital setting

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Prevention of pressure ulcers

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Evaluation and management of severe sepsis and septic shock in adults

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Assessment and emergency management of the acutely agitated or violent adult

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Prevention of adverse drug events in hospitals

Please contact library staff for details on how to access this resource; you will need an Athens password if accessing from home.

Dynamed Plus Access is available to Sompar staff only but topics from UpTodate can be supplied to MPH staff on request. Open Athens password required

Falls in the elderly Pressure ulcer Sepsis in adults Sepsis treatment in adults Please contact library staff for details on how to access this resource; you will need an Athens password if accessing from home.

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REPORTS, PUBLICATIONS AND RESOURCES

BACK TO TOP BACK TO TOP

E learning for Falls The NHS eLearning Repository has a number of modules on falls. You will need to create an account to access.

For more information see: http://www.elearningrepository.nhs.uk/search/node/falls%20type%3Aelearning_resource

Quality Improvement / Patient Safety resources:

Learning to make a difference https://www.rcplondon.ac.uk/projects/learning-make-difference-ltmd West of England Patient Safety Collaboration http://www.weahsn.net/what-we-do/enhancing-patient-safety/patient-safety-collaborative/

Faculty of medical leadership and management https://www.fmlm.ac.uk/themes/quality-improvement Quality Watch (useful for data) http://www.qualitywatch.org.uk/

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LITERATURE SEARCH SERVICE BACK TO TOP Looking for the latest evidence-based research but havenâ&#x20AC;&#x2122;t got time to trawl the databases?

Do you need a literature search carried out?

Do you need to find evidence to support an improvement?

Do you want to know how something has been done elsewhere and whether it worked?

Library staff provide a literature search service for busy clinicians who are pressed for time.

To request a search please complete and return the attached form ,providing as much information as possible. Alternatively if you would like an assisted search training session, where we will sit down with you and go through the steps of a literature search, then please contact the library.

TRAINING AND ATHENS BACK TO TOP Most electronic resources are available via an Athens password. You can register for this via the Library intranet page, or from home at www.swice.nhs.uk and following the link for Athens selfregistration.

Please note that registering from home will take longer as it will need to be verified that you are NHS staff/student on placement.

The library offers training on how to access and use Athens resources, as well as an introductory course on critical appraisal. You can book a course through the Learning and Development intranet page, or by contacting the library directly.

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