Improving Communication and Collaboration Between Disciplines: Utilization of aDaily Goals Sheet During Daily Multidisciplinary Rounds in the Critical Care Setting

Communication problems have been cited as the “top safety incident” causing patient harm in intensive care units (Halm, 2008). Many concerns related to interdisciplinary communication and collaboration were found in a small, satellite critical care unit of a major teaching facility. This led to missed patient care goals and opportunities for improved patient outcomes, as well as increased length of stay. The researcher used a convenience sample of 40 nurses and advanced care providers and a mixed methods quasi-experimental pre/post survey design to explore whether multidisciplinary rounds utilizing a rounding tool would improve communication and collaboration between advanced care providers and nursing staff, as well as improve understanding of the daily goals of patient care. Quantitative and qualitative data were analyzed yielding mixed results with both positive and negative attributes to interdisciplinary communication and collaboration. Overall, the study supported the use of daily multidisciplinary rounds in the critical care setting utilizing the Daily Goals Sheet to increase interdisciplinary communication and collaboration and improve understanding of the daily goals of patient care, when compared with rounds not using the Daily Goals Sheet. Major limitations of the study were the small sample size and increased workload and staff resistance in using the Daily Goals Sheet and completing the surveys. The most significant implication of this study is that the researcher plans to continue integration of the Daily Goals Sheet into the research study site’s new computer system, as well as to continue future research in this quality improvement area

Development of core pharmacy roles with competency/EPA alignment and levels of entrustment.

The purpose of this two-phase embedded mixed-method project was to investigate the extent to which a consensus exists among pharmacy professionals regarding core practice-ready roles for graduates that align with current pharmacy competencies/EPA statements with entrustment levels. Current competencies/EPAs were perceived as mapping to the core roles developed during this study, with some missing competencies. Some of the EPA levels of entrustment varied depending on the role to which it was mapped. Some levels were different than the current recommended EPA entrustment level recommended to be used by schools/colleges. The development of a set of core roles with the mapping of pharmacy competencies and EPAs is the first step in pharmacy developing an education model like medicine

Structuring communication relationships for interprofessional teamwork (SCRIPT): a cluster randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Despite a burgeoning interest in using interprofessional approaches to promote effective collaboration in health care, systematic reviews find scant evidence of benefit. This protocol describes the first cluster randomized controlled trial (RCT) to design and evaluate an intervention intended to improve interprofessional collaborative communication and patient-centred care.</p> <p>Objectives</p> <p>The objective is to evaluate the effects of a four-component, hospital-based staff communication protocol designed to promote collaborative communication between healthcare professionals and enhance patient-centred care.</p> <p>Methods</p> <p>The study is a multi-centre mixed-methods cluster randomized controlled trial involving twenty clinical teaching teams (CTTs) in general internal medicine (GIM) divisions of five Toronto tertiary-care hospitals. CTTs will be randomly assigned either to receive an intervention designed to improve interprofessional collaborative communication, or to continue usual communication practices.</p> <p>Non-participant naturalistic observation, shadowing, and semi-structured, qualitative interviews were conducted to explore existing patterns of interprofessional collaboration in the CTTs, and to support intervention development. Interviews and shadowing will continue during intervention delivery in order to document interactions between the intervention settings and adopters, and changes in interprofessional communication.</p> <p>The primary outcome is the rate of unplanned hospital readmission. Secondary outcomes are length of stay (LOS); adherence to evidence-based prescription drug therapy; patients' satisfaction with care; self-report surveys of CTT staff perceptions of interprofessional collaboration; and frequency of calls to paging devices. Outcomes will be compared on an intention-to-treat basis using adjustment methods appropriate for data from a cluster randomized design.</p> <p>Discussion</p> <p>Pre-intervention qualitative analysis revealed that a substantial amount of interprofessional interaction lacks key core elements of collaborative communication such as self-introduction, description of professional role, and solicitation of other professional perspectives. Incorporating these findings, a four-component intervention was designed with a goal of creating a culture of communication in which the fundamentals of collaboration become a routine part of interprofessional interactions during unstructured work periods on GIM wards.</p> <p>Trial registration</p> <p>Registered with National Institutes of Health as NCT00466297.</p

A PROPOSED CLINICAL PATHWAY FOR THE MANAGEMENT OF VIOLENT OR POTENTIALLY VIOLENT PATIENTS IN THE INTENSIVE CARE UNIT

Workplace Violence (WPV) is an increasing problem throughout healthcare. Violent events are most commonly attributed to patient-nurse interactions due to the amount of time nurses spend with patients and because nurses comprise the majority of the healthcare workforce. The majority of the current literature on patient-to-nurse violence focuses on the Emergency Department and psychiatric care settings, revealing a gap in our understanding of this phenomenon in clinical areas such as the Intensive Care Unit (ICU). Nurses who provide care in the ICU may be particularly susceptible to WPV due to high patient acuity and other environmental stressors. Clinical pathways are commonly used to translate evidence into practice and are an evidence-based tool utilized by healthcare providers to manage a variety of clinical situations. There is currently no clinical pathway that details the management of violent or potentially violent patients in the ICU. Therefore, the purpose of this Doctor of Nursing Practice (DNP) scholarly project was to develop a clinical pathway for the management of violent or potentially violent patients within the ICU setting through the synthesis of a comprehensive literature review and input from a panel of expert stakeholders using the Delphi Method. In addition, a detailed pilot testing plan for the pathway after completion of this project is proposed

A PROPOSED CLINICAL PATHWAY FOR THE MANAGEMENT OF VIOLENT OR POTENTIALLY VIOLENT PATIENTS IN THE INTENSIVE CARE UNIT

Workplace Violence (WPV) is an increasing problem throughout healthcare. Violent events are most commonly attributed to patient-nurse interactions due to the amount of time nurses spend with patients and because nurses comprise the majority of the healthcare workforce. The majority of the current literature on patient-to-nurse violence focuses on the Emergency Department and psychiatric care settings, revealing a gap in our understanding of this phenomenon in clinical areas such as the Intensive Care Unit (ICU). Nurses who provide care in the ICU may be particularly susceptible to WPV due to high patient acuity and other environmental stressors. Clinical pathways are commonly used to translate evidence into practice and are an evidence-based tool utilized by healthcare providers to manage a variety of clinical situations. There is currently no clinical pathway that details the management of violent or potentially violent patients in the ICU. Therefore, the purpose of this Doctor of Nursing Practice (DNP) scholarly project was to develop a clinical pathway for the management of violent or potentially violent patients within the ICU setting through the synthesis of a comprehensive literature review and input from a panel of expert stakeholders using the Delphi Method. In addition, a detailed pilot testing plan for the pathway after completion of this project is proposed

Discharge Risk Screening and Interdisciplinary Communication: A Method to Mitigate Discharge Delays

Identification of discharge barriers early during the hospital stay is essential to coordinate services post-discharge. Timely discharge of patients when medically safe controls costs, promotes positive health outcomes, and increases quality of care. Discharge planning is a multifaceted interaction that relies heavily on effective communication between all disciplines and the patient. Research suggests interdisciplinary collaboration and effective communication as leading strategies to mitigate discharge delays. The purpose of this study was to examine the impact of interdisciplinary collaboration on discharge planning and length of stay for medical surgical patients. A daily discharge team meeting was implemented as a best practice strategy to identify barriers, discuss recommendations, exchange ideas, and develop a comprehensive discharge plan. The team consisted of nurses, social workers, case managers, physical therapist, occupational therapist, nutritionist, utilization management coordinators, and physicians. Daily interdisciplinary team meetings (IDT) were implemented Monday through Friday at 11:00 a.m. for four medicine teams for four weeks. This evidence-based solution facilitated shared decision making in the discharge process and improved patient satisfaction related to the discharge process. Collaboration among the interdisciplinary team members was assessed post implementation using a modified Nurse-Physician Collaboration tool (Vazirani, Hays, Shapiro, & Cowan, 2005); 92% of the participants surveyed believed the information exchanged during IDT positively impacted patient outcomes. Length of stay was decreased for three of four medical units and avoidable bed days of care reduced for two of the four units. Substantial research has been done to validate interdisciplinary communication as a best practice to improve the discharge process and patient outcomes. This project accomplished its goal of designing a collaborative model, beginning on patient admission, to ensure efficient and effective discharge planning

A Delphi study to strengthen research methods training in undergraduate psychology programmes

Psychology programmes often emphasise inferential statistical tests over a solid understanding of data and research design. This imbalance may leave graduates under-equipped to effectively interpret research and employ data to answer questions. We conducted a two-round modified-Delphi to identify the research methods skills that the UK psychology community deems essential for undergraduates to learn. Participants included 103 research methods instructors, academics, students, and non-academic psychologists. Of 78 items included in the consensus process, 34 reached consensus. We coupled these results with a qualitative analysis of 707 open-ended text responses to develop nine recommendations for organisations that accredit undergraduate psychology programmes—such as the British Psychological Society (BPS). We recommend that accreditation standards emphasise (1) dataskills, (2) research design, (3) descriptive statistics, (4) critical analysis, (5) qualitative methods, and (6) both parameter estimation and significance testing; as well as (7) give precedence to foundational skills, (8) promote transferable skills, and (9) create space in curricula to enable these recommendations. Our data and findings can inform modernised accreditation standards to include clearly-defined, assessable, and widely-encouraged skills that foster a competent graduate body for the contemporary world

Point-of-care ultrasound abnormalities in late onset severe preeclampsia: prevalence and association with serum albumin and brain natriuretic peptide

Abstract Background: Pilot studies applying point-of-care ultrasound (POCUS) in preeclampsia indicate the presence of pulmonary interstitial edema, cerebral edema, and cardiac dysfunction. Laboratory markers of oncotic pressure (albumin) and cardiac dysfunction (brain natriuretic peptide [BNP]) may be abnormal, but the clinical application remains unclear. We investigated the prevalence of pulmonary interstitial syndrome (PIS), cardiac dysfunction, and increased optic nerve sheath diameter (ONSD) in late onset preeclampsia with severe features. The primary aim was to examine the association between PIS or ONSD and maternal serum albumin level. The secondary aims were to explore the association between cardiac dysfunction and PIS, ONSD, BNP, and serum albumin level, and between POCUS-derived parameters and a suspicious or pathological cardiotocograph (CTG). Methods: Ninety-five women were enrolled in this prospective observational cohort study. A POCUS examination of lungs, heart and ONSD was performed. PIS was defined as a bilateral B-line pattern on lung US, and diastolic dysfunction according to an algorithm of the American Society of Echocardiography. ONSD > 5.8 mm was interpreted as compatible with raised intracranial pressure (> 20 mmHg). Serum BNP and albumin levels were also measured. Results: PIS, diastolic-, systolic dysfunction, and raised left ventricular end-diastolic pressure (LVEDP) were present in 23 (24%,) 31 (33%), 9 (10%), and 20 (25%) women respectively. ONSD was increased in 27 (28%) women. Concerning the primary outcome, there was no association between albumin level and PIS (p = 0.4) or ONSD (p=0.63). With respect to secondary outcomes, there was no association between albumin level and systolic dysfunction (p = 0.21) or raised LVEDP (p = 0.44). PIS was associated with diastolic dysfunction (p = 0.02), and raised LVEDP (p = 0.009, negative predictive value 85%). BNP level was associated with systolic (p < 0.001)- and diastolic dysfunction (p = 0.003) and LVEDP (p = 0.007). No association was found between POCUS abnormalities and a suspicious/pathological CTG (p = 0.07). Conclusion: PIS, diastolic dysfunction and increased ONSD were common in preeclampsia with severe features. Cardiac ultrasound abnormalities may be more useful than albumin levels in predicting PIS. The absence of PIS may exclude raised LVEDP. The further clinical relevance of PIS and raised ONSD remains to be established. BNP level was associated with cardiac ultrasound abnormalities. Although this study was not designed to directly influence clinical management, the findings suggest that POCUS may serve as a useful adjunct to clinical examination for the obstetric anesthesiologist managing these complex patients

The Role of Self-Compassion as a Moderator in the Relationship Between Burnout and Psychological Wellbeing in Staff Working with People with Learning Disabilities

Objective. Research demonstrates that self-compassion is linked to burnout and other psychological wellbeing outcome measures such as quality of life, stress, depression, and wellbeing. It is known that care occupations, and specifically those who work with individuals with learning disabilities, suffer with burnout and other psychological symptoms such as anxiety and depression. Several studies have examined these relationships in care staff. However, they have not been examined in a UK healthcare context, nor in a sample of learning disabilities staff for whom burnout is prevalent and relevant. With self-compassion as a moderator, this study investigated burnout’s relationship to depression and psychological wellbeing respectively, in a UK learning disabilities staff sample. Methods. 120 adult staff members (97 females and 23 males) aged between 18 and 64 years who work with adults with learning disabilities participated in the study. Participants completed an anonymised online questionnaire comprising the Self-Compassion Scale; the Maslow Burnout Inventory; the Beck Depression Inventory; and the Ryff Scale of Psychological Wellbeing. Results. Self-compassion was at an average level for this sample and depression scores were low. Moderation analyses illustrated that self-compassion significantly moderated the relationship between burnout (personal accomplishment) and psychological wellbeing (positive relationships with others); and burnout (both emotional exhaustion and personal accomplishment) and depression

Translation and psychometric testing of the Norwegian version of the “Patients’ Perspectives of Surgical Safety Questionnaire”

Purpose To translate the Patients’ Perspectives of Surgical Safety (PPSS) questionnaire into Norwegian and to test it for structural validity and internal consistency. Design This is a methodological study. Methods The original 20-item PPSS questionnaire was translated into Norwegian using a model of translation-back translation. We assessed content validity via a pretest with 20 surgical patients. A sample of 218 surgical patients in a university hospital in Norway completed the PPSS questionnaire. Psychometric analysis included item characteristics, and structural validity was evaluated by an exploratory factor analysis. Internal consistency was calculated using Cronbach's alpha. Findings We successfully translated and adapted the Norwegian PPSS questionnaire. Completion rate was 74%. Missing values were less than 5% and all 20 items had a high skewness (≥15 %) ranging from 52.8% to 95.9%. The exploratory factor analysis yielded two significant factors that explained 45.15% of variance. The Cronbach's alpha for Factor 1 “Team interaction safety” was 0.88 and for Factor 2 “Patient's ID safety”, 0.82. Overall, most patients reported a high sense of surgical safety. Conclusions The first Norwegian version of the PPSS measuring surgical patients’ perception shows promising psychometric properties regarding structural validity and internal consistency. However, future research on PPSS should provide an examination of construct validity, validation and testing in other populations of surgical patients. To improve safety of the surgical trajectory, it is necessary to pay more attention to patients’ perceptions of surgical safety.publishedVersio