Current awareness suts march 2016 (2) by Musgrove Park Hospital Library

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Current Awareness Sign Up To Safety This monthly Current Awareness Bulletin is produced by the Library, 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&#x20AC;şď&#x20AC; http://librarymph.wordpress.com/ Issue 4 March 2016

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

Books

Cochrane Systematic Reviews

UpToDate & DynaMed

Reports, publications and resources

Literature search service

Training and Athens

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

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 Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project Matthew Stephenson, Alexa Mcarthur, Kristy Giles, Craig Lockwood, Edoardo Aromataris, and Alan Pearson Int J Qual Health Care 2016 28: 92-98 http://intqhc.oxfordjournals.org/content/28/1/92.abstract?etoc Title: Safety Standards: Implementing Fall Prevention Interventions and Sustaining Lower Fall Rates by Promoting the Culture of Safety on an Inpatient Rehabilitation Unit Citation: Rehabilitation Nursing, Feb 2016, vol. 41, no. 1, p. 26-32 Author(s): Leone, Rita Marie, Adams, Rachel Joy Abstract: Purpose: The purpose of this article is to review a quality improvement project aimed to examine how nurse leaders in an inpatient rehabilitation (IPR) unit can reduce the number of patient falls by implementing multiple fall prevention interventions and sustain their results by promoting a strong culture of safety on the unit. Design and Methods: A retrospective review of IPR fall rates was performed. Quarterly fall rates were then compared with implementation dates of fall prevention interventions (safety huddles, signage, and hourly rounding). Culture of safety scores were also examined to assess the effect of an enhanced culture of safety on the sustainability of lowered fall rates. Findings: The largest decrease in fall rate was noted after initial revitalization efforts of the IPR unit?s culture of safety concurrently with hourly rounding. Conclusions: Fall rates rise and fall despite multiple fall prevention interventions and encouraging a positive shift in the culture of safety. Clinical Relevance: Physical injuries following a fall can reduce mobility and increase morbidity. Costs associated with falls negatively impact costs and reimbursement. Employing evidence-based fall prevention strategies are then of critical importance to nurse leaders as falls remain an ongoing serious adverse event. References _________________________________________________________________________ _______

Title: Meanings of Falls and Prevention of Falls According to Rehabilitation Nurses: A Qualitative Descriptive Study Citation: Rehabilitation Nursing, Feb 2016, vol. 41, no. 1, p. 46-53 Author(s): Bok, Amy, Pierce, Linda L., Gies, Cheryl, Steiner, Victoria Abstract: Purpose: Guided by Friedemann's theoretical framework, this survey explored the meaning of a fall of an institutionalized older adult or fall prevention to rehabilitation registered nurses and whether the experience changed the nurse's practice. Design: Qualitative, descriptive survey. Methods: A convenience sample of 742 rehabilitation nurses was asked to describe these experiences and the impact on their practice. Findings: Themes discovered related to the meaning of a fall include negative feelings (incongruence) and positive feelings (congruence). Themes related to the meaning of preventing a fall include positive feelings (congruence). Practice change themes emerged from both the experience of a fall and fall prevention. Practice change themes were drawn to Friedemann's (1995) process dimensions. Conclusions and Clinical Relevance: Nurses' experiences and meanings of falls uncovered negative and positive feelings about these falls. New findings of this study were the positive feelings expressed by nurses, when there was no injury or when a fall was prevented. References _________________________________________________________________________ _______ Title: Emergency department management of falls in the elderly: A clinical audit and suggestions for improvement Citation: International Emergency Nursing, Jan 2016, vol. 24, no. 1, p. 2-8 Author(s): Hatamabadi, Hamid Reza, Sum, Shima, Tabatabaey, Ali, Sabbaghi, Mohammad Abstract: Introduction. Falls are a major source of injury in the elderly and their incomplete management is a cause for concern by health systems. The present study looks at the current state of managing fall victims in Iran and offers suggestions for improvement. Methods. This was a clinical care audit comparing the state of current care with an institutionally approved optimum. Patients aged 60 years and over presenting with a fall were evaluated and deficiencies in their care were recorded and categorized. These were presented to an expert panel, where the Delphi method was used to come up with a list of actions to address the deficiencies. Furthermore an educational program was implemented based on these suggestions. Chi-squared and t-test were used to evaluate the efficacy of this program in improving treatment. Linear regression analysis was used to find factors affecting care. Results. Overall 431 cases were reviewed. The most common errors during clinical examination were: not performing Romberg test (92.75%) and lack of physiotherapy consultation (82.75%). The educational program had a modest effect on improving the clinical audit processes (&#xdf ;=3.79; P<0.001) and medical interventions (Ă&#x;=2.004; P=0.002); however, performing the correct diagnostic tests was worse after the program (Ă&#x;=1.21; P=0.008). Conclusion. There is a wide gap between the care services delivered in the management of falls and international standards. Therefore, measures should be adopted to close this gap. Education may have a modest positive effect in this regard. References _________________________________________________________________________ _______ 4

Title: Open visiting policy contributes to drop in falls by hospital patients. Citation: Nursing Standard, 2016, vol./is. 30/26(11-) Full text: Available NURSING STANDARD at Library MPH _________________________________________________________________________ _______

PRESSURE ULCERS Preventing device related pressure ulcers Warrington and Halton Hospitals NHS Foundation Trust (WHHFT) has worked effectively over recent years to ensure that there have been significant reductions in pressure ulcers. Find out more about their latest initiatives: http://www.fabnhsstuff.net/2016/02/24/preventing-device-related-pressure-ulcers/

Title: A hands-on teaching aid for pressure ulcer prevention Citation: Nursing Times, Jan 2016, vol. 112, no. 1-2, p. 15., Author(s): Reece, Rachel Abstract: Using a toy doll to teach staff about pressure ulcer prevention helped tissue viability nurses in one trust to raise awareness of pressure ulcers. Full text: Available Library MPH (lib307415) at NURSING TIMES

Title: A Clinical Nurse Specialist-Led Interprofessional Quality Improvement Project to Reduce Hospital-Acquired Pressure Ulcers. Citation: Clinical nurse specialist CNS, Mar 2016, vol. 30, no. 2, p. 110-116 Author(s): Fabbruzzo-Cota, Christina, Frecea, Monica, Kozell, Kathryn, Pere, Katalin, Thompson, Tamara, Tjan Thomas, Julie, Wong, Angela Abstract: The purpose of this clinical nurse specialist-led interprofessional quality improvement project was to reduce hospital-acquired pressure ulcers (HAPUs) using evidence-based practice. Hospital-acquired pressure ulcers (PUs) have been linked to morbidity, poor quality of life, and increasing costs. Pressure ulcer prevention and management remain a challenge for interprofessional teams in acute care settings. Hospitalacquired PU rate is a critical nursing quality indicator for healthcare organizations and ties directly with Mount Sinai Hospital's (MSH's) mission and vision, which mandates providing the highest quality care to patients and families. This quality improvement project, guided by the Donabedian model, was based on the Registered Nurses' Association of Ontario Best Practice Guideline Risk Assessment & Prevention of Pressure Ulcers. A working group was established to promote evidence-based practice for PU prevention. Initiatives such as documentation standardization, development of staff education and patient and family educational resources, initiation of a hospital-wide inventory for support surfaces, and procurement of equipment were implemented to improve PU prevention and management across the organization. An 80% decrease in HAPUs has been achieved since the 5

implementation of best practices by the Best Practice Guideline Pressure Ulcer working group. The implementation of PU prevention strategies led to a reduction in HAPU rates. The working group will continue to work on building interprofessional awareness and collaboration in order to prevent HAPUs and promote an organizational culture that supports staff development, teamwork and communication. This quality improvement project is a successful example of an interprofessional clinical nurse specialist-led initiative that impacts patient/family and organization outcomes through the identification and implementation of evidence-based nursing practice. Title: Hospital-Acquired Pressure Ulcers in the Ambulatory Surgery Setting. Citation: AORN journal, Feb 2016, vol. 103, no. 2, p. 224-228 Author(s): Fuzy, Kelly M, Vega, Rafael A

Title: Reduction in the incidence of pressure ulcers upon implementation of a reminder system for health-care providers. Citation: Applied nursing research : ANR, Feb 2016, vol. 29, p. 107-112 Author(s): Sebastián-Viana, T, Losa-Iglesias, M, González-Ruiz, J M, Lema-Lorenzo, I, Núñez-Crespo, F J, Salvadores Fuentes, P, ARCE team Abstract: To measure the clinical impact of the introduction of a reminder system for healthcare professionals to alert patients who are at risk for pressure ulcers (PU). This was a pre- and post-test study of patients who were discharged from 6 medical-surgical units of the University Hospital of Fuenlabrada in 2009 and 2010. Beginning in January 2010, implementation of an on-screen list of reminders was automatically updated daily on the units' computers including patient arrival date, last assessment of ulceration risk and location of any PU. The cumulative incidence of PU was measured for patients discharged in 2009 (group A: healthcare professionals were not exposed to on-screen reminder) and 2010 (group B: healthcare professionals were exposed to on-screen reminder list). The relative risk (RR) was estimated. The study was completed with a stratified analysis and binary logistic regression. In group A, there were 84 cases of PU among 9263 patients discharged (0.9%); whereas in group B, there were 59 cases among 9220 patients discharged (0.6%). The RR of PU for group B/group A was 0.706 (p=0.038). In the logistic regression analysis, after adjusting for study variables, the odds ratio of PU B/A was 0.558. A list of on-screen reminders at the beginning of a healthcare professional's shift to inform them of patients at risk for developing a PU was effective at reducing the incidence of these clinical burdens. Copyright © 2015 Elsevier Inc. All rights reserved.

Title: Pressure ulcer and wounds reporting in NHS hospitals in England part 1: Audit of monitoring systems. Citation: Journal of tissue viability, Feb 2016, vol. 25, no. 1, p. 3-15 Author(s): Smith, Isabelle L, Nixon, Jane, Brown, Sarah, Wilson, Lyn, Coleman, Susanne Abstract: Internationally, health-care systems have attempted to assess the scale of and demonstrate improvement in patient harms. Pressure ulcer (PU) monitoring systems have been introduced across NHS in-patient facilities in England, including the Safety Thermometer (STh) (prevalence), Incident Reporting Systems (IRS) and the Strategic 6

Executive Information System (STEIS) for serious incidents. This is the first of two related papers considering PU monitoring systems across NHS in-patient facilities in England and focusses on a Wound Audit (PUWA) to assess the accuracy of these systems. Part 2 of this work and recommendations are reported pp *-*. The PUWA was undertaken in line with 'gold-standard' PU prevalence methods in a stratified random sample of NHS Trusts; 24/34 (72.7%) invited NHS Trusts participated, from which 121 randomly selected wards and 2239 patients agreed to participate. The PUWA identified 160 (7.1%) patients with an existing PU, compared to 105 (4.7%) on STh. STh had a weighted sensitivity of 48.2% (95%CI 35.4%56.7%) and weighted specificity of 99.0% (95%CI 98.99%-99.01%). The PUWA identified 189 (8.4%) patients with an existing/healed PU compared to 135 (6.0%) on IRS. IRS had an unweighted sensitivity of 53.4% (95%CI 46.3%-60.4%) and unweighted specificity of 98.3% (95%CI 97.7%-98.8%). 83 patients had one or more potentially serious PU on PUWA and 8 (9.6%) of these patients were reported on STEIS. The results identified high levels of underreporting for all systems and highlighted data capture challenges, including the use of clinical staff to inform national monitoring systems and the completeness of clinical records for PUs. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Title: Pressure ulcer and wounds reporting in NHS hospitals in England part 2: Survey of monitoring systems. Citation: Journal of tissue viability, Feb 2016, vol. 25, no. 1, p. 16-25 Author(s): Coleman, Susanne, Smith, Isabelle L, Nixon, Jane, Wilson, Lyn, Brown, Sarah Abstract: This is the second of a two related papers describing work undertaken to compare and contrast Pressure Ulcer (PU) monitoring systems across NHS in-patient facilities in England. The work comprised 1) a PU/Wound Audit (PUWA) and 2) a survey of PU monitoring systems. This second paper focusses on the survey which explores differences in the implementation of PU adverse event monitoring systems in 24 NHS hospital Trusts in England. The survey questionnaire comprised 41 items incorporating single and multiple response options and free-text items and was completed by the PUWA Trust lead in liaison with key people in the organisation. All 24 (100%) Trusts returned the questionnaire, with high levels of data completeness (99.1%). The questionnaire results showed variation between Trusts in relation to the recording of PUs and their reporting as part of NHS prevalence and incident monitoring systems and to Trust boards and healthcare commissioners including the inclusion (or not) of device ulcers, unstageable ulcers, Deep Tissue Injury, combined PUs/Incontinence Associated Dermatitis, category ≥ 1 ulcers or category ≥ 2 ulcers, inherited ulcers, acquired ulcers, avoidable and unavoidable ulcers and the definition of Present On Admission. These fundamental differences in reporting preclude Trust to Trust comparisons of PU prevalence and incident reporting and monitoring systems due to variation in local application and data collection methods. The results of this work and the PUWA led to the development of recommendations for PU monitoring practice, many of which are internationally relevant. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

SEPSIS Sepsis: clinical update Nursing Standard 2016 30(23) p17

Sepsis redefined Editorial in JAMA which looks at the new definitions of sepsis and septic shock from a useful clinical perspective. New Definitions for Sepsis and Septic ShockContinuing Evolution but With Much Still to Be Done Available via: http://jama.jamanetwork.com/article.aspx?articleid=2492856 Main Article The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Available via: http://jama.jamanetwork.com/article.aspx?articleid=2492881

Title: Sepsis and Septic Shock: Lingering Questions Citation: Critical Care Nursing Quarterly, Jan 2016, vol. 39, no. 1, p. 3-13 Author(s): Dumont, Tiffany, Francis-Frank, Lyndave, Chong, Josebelo, Balaan, Marvin R Abstract: Sepsis and septic shock are major health conditions in the United States, with a high incidence and mortality. The Surviving Sepsis Campaign, which was formed in 2002, formulates guidelines for the management of severe sepsis and septic shock and has actually demonstrated a reduction in mortality with institution of "sepsis bundles." Despite this, some elements of the guidelines have been questioned, and recent data suggest that strict compliance with bundles and protocols may not be necessary. Still, prompt recognition and treatment of sepsis and septic shock remain of utmost importance. Title: Back to Fundamentals: Using High- and Low-Fidelity Simulation to Provide Reinforcement of Preventative Measures for Sepsis Citation: Critical Care Nursing Quarterly, Jan 2016, vol. 39, no. 1, p. 14-23 Author(s): Englert, Nadine C, McDermott, Donna Abstract: Health care-associated infections result in a staggering number of preventable patient deaths per year. Numerous point-of-practice initiatives and action plans have been implemented, requiring ongoing and continuing education for practicing clinicians. Equally important is the implementation of prevention practices and protocols throughout programs 8

responsible for preparing health care providers. The use of simulation as an experiential form of learning is effective in nursing education as fundamental concepts and best practices in sepsis prevention are repeated and reinforced. Title: Application of a Framework to Assess the Usefulness of Alternative Sepsis Criteria. Citation: Critical Care Medicine, 2016, vol./is. 44/3(0-8) Abstract: The current definition of sepsis is life-threatening, acute organ dysfunction secondary to a dysregulated host response to infection. Criteria to operationalize this definition can be judged by six domains of usefulness (reliability, content, construct and criterion validity, measurement burden, and timeliness). The relative importance of these six domains depends on the intended purpose for the criteria (clinical care, basic and clinical research, surveillance, or quality improvement [QI] and audit). For example, criteria for clinical care should have high content and construct validity, timeliness, and low measurement burden to facilitate prompt care. Criteria for surveillance or QI/audit place greater emphasis on reliability across individuals and sites and lower emphasis on timeliness. Criteria for clinical trials require timeliness to ensure prompt enrollment and reasonable reliability but can tolerate high measurement burden. Basic research also tolerates high measurement burden and may not need stability over time. In an illustrative case study, we compared examples of criteria designed for clinical care, surveillance and QI/audit among 396,241 patients admitted to 12 academic and community hospitals in an integrated health system. Case rates differed four-fold and mortality three-fold. Predictably, clinical care criteria, which emphasized timeliness and low burden and therefore used vital signs and routine laboratory tests, had the greater case identification with lowest mortality. QI/audit criteria, which emphasized reliability and criterion validity, used discharge information and had the lowest case identification with highest mortality. Using this framework to identify the purpose and apply domains of usefulness can help with the evaluation of existing sepsis diagnostic criteria and provide a roadmap for future work. Full Text: Available from Ovid online collection in Critical Care Medicine Available from Ovid fulltext collection in Critical Care Medicine Title: Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Citation: American Journal of Respiratory & Critical Care Medicine, 2016, vol./is. 193/3(259272) Abstract: Rationale: Reducing the global burden of sepsis, a recognized global health challenge, requires comprehensive data on the incidence and mortality on a global scale.Objectives: To estimate the worldwide incidence and mortality of sepsis and identify knowledge gaps based on available evidence from observational studies.Methods: We systematically searched 15 international citation databases for population-level estimates of sepsis incidence rates and fatality in adult populations using consensus criteria and published in the last 36 years.Measurements and Main Results: The search yielded 1,553 reports from 1979 to 2015, of which 45 met our criteria. A total of 27 studies from seven high-income countries provided data for metaanalysis. For these countries, the population incidence rate was 288 (95% confidence interval [CI], 215-386; τ = 0.55) for hospital-treated sepsis cases and 148 (95% CI, 98-226; τ = 0.99) for hospital-treated severe sepsis cases per 100,000 person-years. Restricted to the last decade, the incidence rate was 437 (95% CI, 9

334-571; τ = 0.38) for sepsis and 270 (95% CI, 176-412; τ = 0.60) for severe sepsis cases per 100,000 person-years. Hospital mortality was 17% for sepsis and 26% for severe sepsis during this period. There were no population-level sepsis incidence estimates from lowerincome countries, which limits the prediction of global cases and deaths. However, a tentative extrapolation from high-income country data suggests global estimates of 31.5 million sepsis and 19.4 million severe sepsis cases, with potentially 5.3 million deaths annually.Conclusions: Population-level epidemiologic data for sepsis are scarce and nonexistent for low- and middle-income countries. Our analyses underline the urgent need to implement global strategies to measure sepsis morbidity and mortality, particularly in lowand middle-income countries. Full Text: Available from ProQuest in American Journal of Respiratory and Critical Care Medicine Title: Improving Outcomes in Patients With Sepsis. Citation: American Journal of Medical Quality, 2016, vol./is. 31/1(56-63) Abstract: Sepsis mortality may be improved by early recognition and appropriate treatment based on evidence-based guidelines. An intervention was developed that focused on earlier identification of sepsis, early antimicrobial administration, and an educational program that was disseminated throughout all hospital units and services. There were 1331 patients with sepsis during the intervention period and 1401 patients with sepsis during the control period. After controlling for expected mortality, patients in the intervention period had 30% lower odds of dying (odds ratio = 0.70, 95% confidence interval [CI] = 0.57 to 0.84). They also had 1.07 fewer days on average in the intensive care unit (95% CI = -1.98 to -0.16), 2.15 fewer hospital days (95% CI = -3.45 to -0.86), and incurred on average $1949 less in hospital costs, although the effect on costs was not statistically significant. Continued incremental improvement and sustainment is anticipated through organizational oversight, continued education, and initiation of an automated electronic sepsis alert function.

Title: Systemic symptoms predict presence or development of severe sepsis and septic shock. Citation: Infectious diseases (London, England), Mar 2016, vol. 48, no. 3, p. 209-214 Author(s): Edman-Wallér, Jon, Ljungström, Lars, Jacobsson, Gunnar, Andersson, Rune, Werner, Maria Abstract: Severe sepsis is a major cause of mortality and morbidity globally. As the time to adequate treatment is directly linked to outcome, early recognition is of critical importance. Early, accessible markers for severe sepsis are desirable. The systemic inflammatory response in sepsis leads to changes in vital signs and biomarkers and to symptoms unrelated to the focus of infection. This study investigated whether the occurrence of any of six systemic symptoms could predict severe sepsis in a cohort of patients admitted to hospital for suspected bacterial infections. A retrospective, consecutive study was conducted. All adult patients admitted during 1 month to a 550-bed secondary care hospital in western Sweden and given intravenous antibiotics for suspected community-acquired infection were included (n = 289). Symptoms (fever/chills, muscle weakness, localised pain, dyspnea, altered mental status and gastrointestinal symptoms) were registered along with age, sex, vital signs and laboratory values. Patients who fulfilled criteria of severe sepsis within 48 h were compared with patients who did not. Odds ratios for severe sepsis were calculated, adjusted for age, sex and comorbidities. Criteria for severe sepsis were fulfilled 10

by 90/289 patients (31.1%). Altered mental status (OR = 4.29, 95% CI = 2.03-9.08), dyspnea (OR = 2.92, 95% CI = 1.69-5.02), gastrointestinal symptoms (OR = 2.31, 95% CI = 1.144.69) and muscle weakness (OR = 2.24, 95% CI = 1.06-4.75) were more common in patients who had or later developed severe sepsis. Systemic symptoms in combination with other signs of infection should be considered warning signs of severe sepsis. Title: Association Between Index Hospitalization and Hospital Readmission in Sepsis Survivors. Citation: Critical care medicine, Mar 2016, vol. 44, no. 3, p. 478-487 Author(s): Sun, Alexander, Netzer, Giora, Small, Dylan S, Hanish, Asaf, Fuchs, Barry D, Gaieski, David F, Mikkelsen, Mark E Abstract: Hospital readmission is common after sepsis, yet the relationship between the index admission and readmission remains poorly understood. We sought to examine the relationship between infection during the index acute care hospitalization and readmission and to identify potentially modifiable factors during the index sepsis hospitalization associated with readmission. In a retrospective cohort study, we evaluated 444 sepsis survivors at risk of an unplanned hospital readmission in 2012. The primary outcome was 30-day unplanned hospital readmission. Three hospitals within an academic healthcare system. Four hundred forty-four sepsis survivors. Of 444 sepsis survivors, 23.4% (95% CI, 19.6-27.6%) experienced an unplanned 30-day readmission compared with 10.1% (95% CI, 9.6-10.7%) among 11,364 nonsepsis survivors over the same time period. The most common cause for readmission after sepsis was infection (69.2%, 72 of 104). Among infection-related readmissions, 51.4% were categorized as recurrent/unresolved. Patients with sepsis present on their index admission who also developed a hospital-acquired infection ("second hit") were nearly twice as likely to have an unplanned 30-day readmission compared with those who presented with sepsis at admission and did not develop a hospitalacquired infection or those who presented without infection and then developed hospitalacquired sepsis (38.6% vs 22.2% vs 20.0%, p = 0.04). Infection-related hospital readmissions, specifically, were more likely in patients with a "second hit" and patients receiving a longer duration of antibiotics. The use of total parenteral nutrition (p = 0.03), longer duration of antibiotics (p = 0.047), prior hospitalizations, and lower discharge hemoglobin (p = 0.04) were independently associated with hospital readmission. We confirmed that the majority of unplanned hospital readmissions after sepsis are due to an infection. We found that patients with sepsis at admission who developed a hospitalacquired infection, and those who received a longer duration of antibiotics, appear to be high-risk groups for unplanned, all-cause 30-day readmissions and infection-related 30-day readmissions.

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

DETERIORATING PATIENT Title: Vital signs monitoring and nurse-patient interaction: A qualitative observational study of hospital practice. Citation: International journal of nursing studies, Apr 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: 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. To establish a profile of nurses' vital signs monitoring practices, related dialogue, and adherence to health service protocol in New South Wales, Australia. 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 urban teaching hospital in New South Wales. 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. The selection of appropriate vital signs measured and responses to these appears to rely on nurses' clinical judgement or time availability rather than on policy-mandated 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. Copyright ÂŠ 2015 Elsevier Ltd. All rights reserved. Title: Improving Escalation of Care: Development and Validation of the Quality of Information Transfer Tool. Citation: Annals of surgery, Mar 2016, vol. 263, no. 3, p. 477-486 Author(s): Johnston, Maximilian J, Arora, Sonal, Pucher, Philip H, Reissis, Yannis, Hull, Louise, Huddy, Jeremy R, King, Dominic, Darzi, Ara Abstract: To develop and provide validity and feasibility evidence for the QUality of Information Transfer (QUIT) tool. Prompt escalation of care in the setting of patient deterioration can prevent further harm. Escalation and information transfer skills are not currently measured in surgery. This study comprised 3 phases: the development (phase 1), validation (phase 2), and feasibility analysis (phase 3) of the QUIT tool. Phase 1 involved identification of core skills needed for successful escalation of care through literature review and 33 semistructured interviews with stakeholders. Phase 2 involved the generation of validity evidence for the tool using a simulated setting. Thirty surgeons assessed a 12

deteriorating postoperative patient in a simulated ward and escalated their care to a senior colleague. The face and content validity were assessed using a survey. Construct and concurrent validity of the tool were determined by comparing performance scores using the QUIT tool with those measured using the Situation-Background-AssessmentRecommendation (SBAR) tool. Phase 3 was conducted using direct observation of escalation scenarios on surgical wards in 2 hospitals. A 7-category assessment tool was developed from phase 1 consisting of 24 items. Twenty-one of 24 items had excellent content validity (content validity index >0.8). All 7 categories and 18 of 24 (P < 0.05) items demonstrated construct validity. The correlation between the QUIT and SBAR tools used was strong indicating concurrent validity (r = 0.694, P < 0.001). Real-time scoring of escalation referrals was feasible and indicated that doctors currently have better information transfer skills than nurses when faced with a deteriorating patient. A validated tool to assess information transfer for deteriorating surgical patients was developed and tested using simulation and real-time clinical scenarios. It may improve the quality and safety of patient care on the surgical ward. Full Text: Available from Ovid online collection in Annals of Surgery Available from Ovid fulltext collection in Annals of Surgery Title: Factors Influencing Registered Nurses' Decision to Activate an Adult Rapid Response Team in a Community Hospital. Citation: Dimensions of critical care nursing : DCCN, Mar 2016, vol. 35, no. 2, p. 99-107, Author(s): Jackson, Shirley, Penprase, Barbara, Grobbel, Claudia Abstract: One factor impacting patient outcomes in the acutely deteriorating patient is a delay by nursing staff to activate a rapid response team (RRT); however, a gap in knowledge exists concerning factors influencing activation of an RRT by nursing staff working in adult areas outside the medical-surgical and telemetry setting. The purpose of this study was to examine beliefs and behaviors that influence registered nurses' decision to activate an adult rapid response team in a community hospital that includes 3 specialties: medical-surgical and telemetry, peripartum, and psychiatric areas. One hundred sixty-three nurses were surveyed using a 17-item Likert-style instrument to assess registered nurses' beliefs and attitudes on and barriers to utilizing an RRT. The survey was analyzed yielding 3 factors: RRT barriers, RRT positive/intent to activate, and patient management beliefs. Barriers cited by other research to activate RRT including criticism by the team and perception that the RRT increases workload or reduces skills were not found to be influential considerations. A significant difference was found among the 3 specialty groups related to RRT positive/intent to activate (F2,159 = 6.09, P = .003) and patient management beliefs (F2,159 = 5.87, P = .003). A strong negative correlation was found between years of experience as an RN and RRT barriers (Ď 161 = -0.250). Organizations should examine RRT activation delays particularly in the area of calls to covering physicians prior to RRT activations. Differences between specialty groups highlight the need for education across specialties on the recognition of the acutely deteriorating patient. The findings indicate that the inexperienced nurse requires support from experienced colleagues and temporary adjustments to workload during situations of acute deterioration of a patient.

Title: Defining patient deterioration through acute care and intensive care nurses' perspectives. Citation: Nursing in critical care, Mar 2016, vol. 21, no. 2, p. 68-77 Author(s): Lavoie, Patrick, Pepin, Jacinthe, Alderson, Marie Abstract: To explore the variations between acute care and intensive care nurses' understanding of patient deterioration according to their use of this term in published literature. Evidence suggests that nurses on wards do not always recognize and act upon patient deterioration appropriately. Even if resources exist to call for intensive care nurses' help, acute care nurses use them infrequently and the problem of unattended patient deterioration remains. Dimensional analysis was used as a framework to analyze papers retrieved in a nursing-focused database. A thematic analysis of 34 papers (2002-2012) depicting acute care and intensive care unit nurses' perspectives on patient deterioration was conducted. No explicit definition of patient deterioration was retrieved in the papers. There are variations between acute care and intensive care unit nurses' accounts of this concept, particularly regarding the validity of patient deterioration indicators. Contextual factors, processes and consequences are also explored. From the perspectives of acute care and intensive care nurses, patient deterioration can be defined as an evolving, predictable and symptomatic process of worsening physiology towards critical illness. Contextual factors relating to acute care units (ACU) appear as barriers to optimal care of the deteriorating patient. This work can be considered as a first effort in modelling the concept of patient deterioration, which could be specific to ACU. The findings suggest that it might be relevant to include subjective indicators of patient deterioration in track and trigger systems and educational efforts. Contextual factors impacting care for the deteriorating patient could be addressed in further attempts to deal with this issue. © 2014 British Association of Critical Care Nurses.

CULTURAL CHANGE AND LEADERSHIP Title: Cultural Tightness–Looseness and Perceptions of Effective Leadership. Citation: Journal of Cross-Cultural Psychology, 2016, vol./is. 47/2(294-309) Previous research has investigated the relationship between cultural values and leadership. This research expands on this tradition and examines how the strength of social norms— or tightness–looseness—influences perceptions of effective leadership. Full text at: http://www.gelfand.umd.edu/pages/papers/Atkas.2015.TLLeadership.pdf

MEDICATION Reducing medication (TTOs) delays when patients are ready to leave hospital Read how Shrewsbury and Telford Hospitals are managing this http://www.fabnhsstuff.net/2016/02/24/reducing-medication-ttos-delays-patients-ready-leavehospital/

RESTRICTIVE PRACTICE (restraint) Title: An integrative review exploring decision-making factors influencing mental health nurses in the use of restraint. Citation: Journal of Psychiatric & Mental Health Nursing, 2016, vol./is. 23/2(116-128), 13510126

Title: Physical restraint: experiences, attitudes and opinions of adult intensive care unit nurses. Citation: Nursing in Critical Care, 2016, vol./is. 21/2(78-87), 13621017

Title: Changing the Practice of Physical Restraint Use in Acute Care. Citation: Journal of Gerontological Nursing, 2016, vol./is. 42/2(17-26) Author(s): Lach, Helen W., Leach, Kathy M. Full Text: Available from ProQuest in Journal of Gerontological Nursing

HUMAN FACTORS A human factors approach to improving electronic performance measurement of venous thromboembolism prophylaxis Molly J. Horstman, Jennifer B. Cowart, Nicole L. Mcmaster-Baxter, Barbara W. Trautner, and Diana E. Stewart Int J Qual Health Care 2016 28: 59-65 Abstract: http://intqhc.oxfordjournals.org/content/28/1/59.abstract?etoc

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. 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

Safer healthcare: strategies for the real world In their new book Dr Almaberti and Professor Vincent argue that we need to see safety through the patientâ&#x20AC;&#x2122;s eyes, consider how safety is managed in different contexts, and develop a wider vision in which patient safety is recast as the management of risk over time. Free access available to ebook: http://www.springer.com/gb/book/9783319255576?utm_source=charityemail&utm_medium=email&ut m_campaign=february-2016&pubid=healthfoundation&description=february2016&dm_i=4Y2,425FM,59C5M1,EP8MY,1

COCHRANE SYSTEMATIC REVIEWS BACK TO TOP Corticosteroids for treating sepsis Djillali Annane , Eric Bellissant , Pierre Edouard Bollaert , Josef Briegel , Didier Keh and Yizhak Kupfer Online Publication Date: December 2015 Bed rest for pressure ulcer healing in wheelchair users (New Protocol) Zena EH Moore , Menno T van Etten and Jo C Dumville Online Publication Date: December 2015 Reconstructive surgery for treating pressure ulcers(New Protocol) Jason KF Wong , Kavit Amin and Jo C Dumville Online Publication Date: January 2016

Dressings and topical agents for treating pressure ulcers (New Protocol) Maggie J Westby , Jo C Dumville , Marta O Soares , Nikki Stubbs , Gill Norman and Christopher N Foley Online Publication Date: November 2015 Interventions for preventing and reducing the use of physical restraints in long-term geriatric care Ralph Möhler , Tanja Richter , Sascha Köpke and Gabriele Meyer Online Publication Date: February 2011

Seclusion and restraint for people with serious mental illnesses Eila ES Sailas and Mark Fenton Online Publication Date: January 2000 (still used as current evidence)

UPTODATE & DYNAMED BACK TO TOP What’s new from our clinical decision-making tools on the topic of dementia.

UpToDate 

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 17

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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

DynaMed 

Falls in the elderly

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Pressure ulcer

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Sepsis treatment in adults

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Sepsis in children

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Sepsis treatment in children

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Late-onset neonatal sepsis

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

REPORTS, PUBLICATIONS AND RESOURCES

Sepsis e learning modules A selection available here: http://www.library.sath.nhs.uk/blog/2016/02/25/sepsis-elearning-modules/

Free app to support Culture Change & Workforce Transformation Do OD is the expert resource on Organisational Development for the NHS, delivered by NHS Employers in partnership with the NHS Leadership Academy. The NHS OD community came together to create a new tool to support Culture Change in organisations. More details here: http://www.fabnhsstuff.net/2016/02/15/free-app-to-supportculture-change-workforce-transformation/

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.