Identifying Transfer of Care Gaps: Electronic Health Record Capture of Perioperative Handoff Communications

Transitions in patient care are held together by interdisciplinary handoff communications intended to coordinate the patient\u27s ongoing care requirements. Patients with complexity in care encumber the transfer of care process requiring a higher level of care coordination between the interdisciplinary team (Coleman, 2003; Naylor et al., 2004). While the literature is abundant on the characteristics and quality of handoff communications, it is limited on the requirements of what data is necessary for ongoing care following transfer communications (Galatzan & Carrington, 2018). This dissertation explores the verbal information transferred during Operating Room (OR) to Post Anesthesia Care Unit (PACU) nursing handoff communications and whether the data is captured in the electronic health record (EHR) to represent the information critical to ongoing patient care and care planning. the study builds on the Kennedy Integrated Theoretical Framework (KITF) (Kennedy, 2012) integrating cognition theory, patterns of knowledge theory, and clinical communication space theory to support the human-technology characteristics within perioperative handoffs. Evidence of wisdom was present in the KITF in addition to elements of non-verbal communication patterns emerging from shared common ground contributed to the framework\u27s expansion. to understand the contributions of the perioperative nursing interface terminology, the Perioperative Nursing Data Set (PNDS), makes to postsurgical care transitions, the study examines nursing diagnoses, interventions, interim outcomes and goals relationships to the handoff data communicated between OR and PACU Registered Nurses. Study findings revealed a complex fragmented process of verbal communications and electronic documentation for the handoff process. While the EHR is prominent in data procurement for the handoff process, the design of handoff artifacts (e.g., paper, electronic) significantly impact the value of information received. Incomplete handoff tools or missing EHR data adds to a cycle of information decay while contributing to increase cognitive load and potentiating opportunities for information and knowledge loss. the absence of nursing diagnoses in the automation of the PNDS challenges the integrity of the language within the documentation platform and raises considerations for hierarchical representation within interface terminologies. This study reinforces literature to reconsider user requirements in the design and functionality of healthcare information technology (HIT) to enable data and information flow and preserve knowledge development. the inclusion of mobile technology, cognitive support aids including clinical decision support tools, and other HIT will further enable the effectiveness of transfer communication, knowledge development, and the safety of ongoing patient care

A norma ISO 18.104: 2003 como modelo integrador de terminologias de enfermagem

This paper presents the ISO 18.104:2003 as an integrative model of nursing terminology. It describes the standard, studies and experiences with its use and discusses possibilities to develop knowledge in the field. The standard has been shown to be effective in developing reference terminologies, and as a standard method for interoperability and reuse. Studies have internal limitations such as language and notations unknown to nursing. Correspondence of the model with classifications used in health services and practice is incipient, which hinders its applicability and development due to the lack of examples to be analyzed and discussed.Este estudio tiene como objetivo presentar la ISO 18.104:2003 como modelo integrador de terminologías de enfermería; él describe la norma, investigaciones y experiencias de su uso y discute las posibilidades del desarrollo de conocimiento en el área. La norma se muestra efectiva para la composición de terminologías de referencia y como método estándar para la interoperabilidad y uso. Se verificó que las investigaciones poseen limitaciones internas, como lenguaje y notaciones desconocidas por la enfermería. Es incipiente la correspondencia del modelo con las clasificaciones utilizadas en los servicios y en la práctica, lo que impide su análisis. Se considera que hay poca correspondencia del modelo con las clasificaciones utilizadas en los servicios y en la práctica profesional, lo que impide su aplicabilidad y su evolución, por la ausencia de ejemplos a ser analizados y discutidos.Este estudo teve como objetivo apresentar a ISO 18.104:2003 como modelo integrador de terminologias de enfermagem, descrevendo a norma, pesquisas e experiências de seu uso e discutindo as possibilidades de desenvolvimento do conhecimento na área. A norma se mostra efetiva para a composição de terminologias de referência e como método padrão para a interoperabilidade e reuso. Verificou-se que as pesquisas possuem limitações internas, como linguagem e notações desconhecidas pela enfermagem. É incipiente a correspondência do modelo às classificações utilizadas nos serviços e na prática, o que impede sua análise. Considera-se que há pouca correspondência do modelo às classificações utilizadas nos serviços e na prática profissional, impedindo sua aplicabilidade e evolução, pela ausência de exemplos a serem analisados e discutidos

Kozier and Erb's Fundamentals of Nursing [3rd Australian edition]

Kozier and Erb's Fundamentals of Nursing prepares students for practice in a range of diverse clinical settings and help them understand what it means to be a competent professional nurse in the twenty-first century. This third Australian edition has once again undergone a rigorous review and writing process. Contemporary changes in the regulation of nursing are reflected in the chapters and the third edition continues to focus on the three core philosophies: Person-centred care, critical thinking and clinical reasoning and cultural safety. Students will develop the knowledge, critical thinking and clinical reasoning skills to deliver care for their patients in ways that signify respect, acceptance, empathy, connectedness, cultural sensitivity and genuine concern

Comprehensive geriatric assessment in perioperative care: a protocol for a systematic review and qualitative synthesis

INTRODUCTION: Comprehensive geriatric assessment (CGA) is an intervention that has been deployed in the perioperative setting with the aim to improve outcomes for older patients admitted to hospital. Older patients undergoing surgery are more likely to have postoperative complications, a longer hospital stay and be discharged to a care facility. Despite the increasing application of this intervention within surgical services, the evidence for CGA remains limited in this group. The aim of this systematic review is to describe CGA as in intervention applied to surgical populations in randomised controlled trials (RCTs) as well as the outcomes assessed. METHODS AND ANALYSIS: A systematic search of RCTs of CGA in surgery will be run in Embase, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Cochrane library. Further articles will be identified from reference lists in relevant studies found in the search. A narrative synthesis will be undertaken outlining specialties included, detailed descriptions of the intervention and outcomes. ETHICS AND DISSEMINATION: No ethical approval is required. The results of this review will be published and used as the basis of work to optimise this intervention for future trials in surgical populations. PROSPERO REGISTRATION NUMBER: This review is registered with PROSPERO CRD42020221797

Improving nursing adherence to pediatric pain management bundle using the PDSA cycle

Given the current standards, pediatric post-operative pain management can be a distressing outcome to the patient and family. Adequate management of post-op pain in this population is a challenge despite the availability of evidence-based interventions combined to form care bundles. Tonsillectomies are common procedures in the pediatric population and often include moderate to severe pain with ineffective pain relief. Inadequate pain management leads to unplanned admissions, longer post anesthesia care unit (PACU) stays, slower oral intake, and longer recovery periods. In this project, two interventions were tested using the plan-do-study-act (PDSA) model for rapid cycle improvements. The first intervention was to improve the nurse\u27s knowledge of the pain management bundle. The second intervention was the modification of workflows to enhance the delivery of education to the patient and family. The objectives of this project were to increase nursing knowledge on evidence-based pain management bundles, reduce post-operative provider encounters for pain related complaints, improve the implementation of evidence-based practice pain management bundles, and standardize successful practice interventions

Applicability of the nursing interventions classification in the psychiatric outpatient care setting

Standardized nursing terminologies (SNT) have been developed to describe the nursing process systematically. The aim of this research was to study the applicability of the Nursing Interventions Classification (NIC) in the psychiatric outpatient care setting in Finland. The research includes three phases. In the first phase using an integrative literature review we identified nursing interventions in research publications (n=60) and used the NIC to analyze the identified interventions. In the second phase, we used an ethnographically oriented work-place study to identify interventions in the clinical setting. This included observations and interviews and the findings were analyzed together with nurses (n=17). The core interventions were identified using the Delphi method. The panelists consisted of nurses and nurse managers (round one n=54, round two n=26). In the third phase we identified nursing interventions in nursing progress notes (n=1150) and in nursing care summaries (n=17) and mapped these into the NIC. In all we identified 105 different nursing interventions, of which 95% could be mapped into the NIC. The emphasis was in interventions aiming at behavioral change and more specifically interventions that support coping by building on patients’ strengths. In nursing documentation, the most frequent interventions were Surveillance and Care Coordination. The group delivery method was common in all phases. The findings of this study emphasize the need for a systematic terminology to describe nursing interventions for nurses to conceptualize their work, to make the work visible and to ensure the quality of nursing documentation. The broad coverage, descriptiveness of the interventions and the taxonomical structure of the NIC support its applicability. However, the interventions in the classification were found to be overlapping which limits the systematic transfer of information and the possibilities for secondary use of data. Additional limitations are the lack of semantic coherence with the concepts used in research and the difficulty of describing interventions delivered using the group method. This research generated recommendations for the development of the classification. The most central ones include the need to include multiple methods in the research and development and the integration of concepts used in research literature.Hoitotyön interventioiden luokituksen soveltuvuus aikuispsykiatrian avohoitoon Hoitotyön systemaattinen kuvaaminen edellyttää yhteisen kielen ja käsitteistöjen käyttöä. Tässä tutkimuksessa selvitetään hoitotyön interventioiden luokituksen (Nursing Interventions Classification, NIC) soveltuvuutta aikuispsykiatrian avohoitoon. Tutkimus koostuu kolmesta osavaiheesta. Ensimmäisessä vaiheessa integratiivisen kirjallisuuskatsauksen avulla tutkimuksista (n=60) tunnistettiin hoitotyön interventioita ja nämä analysoitiin NIC-luokituksen avulla. Toisessa vaiheessa hyödynnettiin etnografista työntutkimusta. Hoitotyön interventioita tunnistettiin hoitajien työtä havainnoimalla ja hoitajia haastattelemalla. Analysointi tapahtui yhdessä hoitajien (n=17) kanssa. Ydininterventioiden tutkimus tapahtui sähköistä Delfoi-menetelmää hyödyntäen. Panelisteina toimivat sairaanhoitajat ja hoitotyön lähijohtajat (ensimmäisellä kierroksella n=54, toisella kierroksella n=26). Kolmannessa vaiheessa tutkittiin hoitotyön päivittäiskirjauksia (n=1150) ja hoitotyön yhteenvetoja (n=17), joista tunnistetut interventiot yhdistettiin NICluokitukseen. Tutkimuksessa tunnistettiin yhteensä 105 interventioita, joista 95 %:lle löytyi vastine luokituksesta. Keskeisiä interventioita kirjallisuuskatsauksessa, etnografisessa työntutkimuksessa ja ydininterventioiden tutkimuksessa olivat käyttäytymisen muutokseen tähtäävät psykososiaaliset interventiot ja erityisesti voimavaralähtöinen selviytymiskyvyn tukeminen. Hoitotyön kirjauksissa korostuivat seuranta ja hoidon koordinointi. Interventioiden ryhmämuotoinen toteutustapa oli yleinen kaikissa tutkimusvaiheissa. Tutkimuksen tulokset korostavat yhteisten käsitteiden tarvetta hoitotyön interventioille työn käsitteellistämisen, näkyväksi tekemisen ja kirjaamisen laadun näkökulmista. Tutkitun luokituksen soveltuvuutta tukevat sen kattavuus, käsitteiden hyvä tunnistettavuus ja hierarkkinen rakenne. Luokituksen interventiokäsitteet ovat osittain päällekkäisiä heikentäen sen systemaattista käytettävyyttä ja tiedon toisiokäytön mahdollisuuksia. Soveltuvuutta rajoittavat myös luokituksen vähäinen yhteys tutkimuskirjallisuudessa käytettyihin käsitteisiin ja vaikeus kuvata ryhmämuotoisia interventioita. Tutkimus antaa suosituksia luokituksen jatkokehittämiselle. Keskeisimpänä ovat monimenetelmäisyys tutkimuksessa ja kehittämisessä sekä tutkimuskirjallisuuden käsitteistöjen vahvempi integroiminen luokitukseen

Development of a Fall Prevention Bundle with Evidence-Based Tools for Hospitalized Adults

Problem One million hospitalized people fall annually in the United States, and up to a third are preventable. Context Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria. Interventions A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions. Measures Outcome measures observe for total fall count and the rate of falls with injury. Three balancing measures monitor for patient mobility, physical restraints, and employee injuries during the effort to reduce patient falls. Results Since January 2022 (i.e., six months), the unit has had zero injury falls and achieved eighty-nine consecutive days without a patient fall. The total fall count is constant at both the unit and hospital levels; however, there is a shift in fall severity. There have been no moderate-harm, major-harm, or sentinel event patient falls since the onset of this quality improvement process. The balancing measures are all favorable. Conclusions Increased awareness and focus on fall prevention positively affected safety culture and reduced patient harm. Outcomes endorse leveraging the expertise of the CNL and Human-Centered Leader, inviting participation in change by engaged teams, and a little luck to avoid disruptions at critical times in the project lifespan. Applied interventions are generalizable to other interprofessional teams