Could There be a Good Side to COVID-19 Pandemic?

As the COVID-19 pandemic unfolded, resulting in loss of lives, burnout, anxiety, and depression related to social distancing and quarantine measures, some positive changes have been reported at the individual, interpersonal, and community level. Self-reflection, social connectedness, connectivity, innovation, and resilience have emerged as positive values that have contributed to decrease in burnout during the post-COVID pandemic era

Residential Segregation, Neighborhood Social and Physical Context in Obesity Disparities in Hispanic Preschoolers: A Conceptual Model

During the last decade, there has been a significant inclusion in obesity prevention studies from individual characteristics to household factors then neighborhood factors. The study of place in the context of early childhood obesity studies has been limited to the food and physical built environment. With the persistent disparities in the prevalence of childhood obesity, and Hispanic minorities being increasingly affected, there is a need to reexamine existing models and develop new model conceptual frameworks to examine the role of place and residential segregation in the context of race, ethnicity, social position, and socioeconomic disparities. In the context of place as a relational space linked to where young children live, play and learn, this paper conceptualizes the role of the neighborhood social and physical factors as well as organizational, household and/or individual factors as mediators of the correlation between residential segregation and obesity in Hispanic preschoolers. In the model, we also attempted to include the role of policies and programs in moderating the negative effects of racial residential segregation and resource inequalities and their interactions with the multiple factors that may contribute to childhood obesity. Recommendations for future research need are identified

Achieving 6th Magnet Designation via Virtual Visit during the COVID-19 Pandemic

Despite the challenges encountered with the arrival of the COVID-19 pandemic, Baptist Hospital of Miami achieved the prestigious American Nursing Credentialing Center Magnet 6th designation. We describe the journey including writing the documents, preparing for the virtual visit, and efforts from key stakeholders to support the virtual site visit with the use of technology, to hold videoconferencing and tours “on wheels.” Nurses showcased their professional practice and excellence in patient care through exemplars and narratives presented during the virtual visit. Last, we provide recommendations for success to organizations contemplating a virtual site visit

Characterization of Patients with Type 2 Diabetes Admitted for Acute Heart Failure During the COVID-19 Pandemic

Background: Cardiomyopathy (CMP) and heart failure (HF) are serious health conditions that impact millions of Americans, including people with Type 2 Diabetes (T2DM). The COVID-19 pandemic presented disruptions, yet it is unclear how it affected those living with T2DM and HF. This study aimed to describe the demographic and clinical characteristics of patients with T2DM and CMP who were hospitalized with acute heart failure (aHF) during the COVID-19 pandemic. Methods: Retrospective study of 288 adults with aHF between May 2020 to June 2021. Descriptive statistics were used to summarize the characteristics of adults hospitalized at a non-profit community hospital in Miami, Florida. Results: Fifty-two percent (n = 150) of the patients had T2DM, 98% were admitted via the Emergency Department, the average age was 73.4 (±14.5) years, 56% were male, 65% were White Hispanic, 20% were White, and 14% were non-Hispanic Black. Ischemic CMP (38%) and diastolic HF (26%) were prevalent in this sample. Patients with T2DM were more likely to be discharged home with home health care (45%) compared to those without T2DM (35%). The home medications reported by the patients included: diuretics (73%), beta-blockers (71%), statins or other agents (65%), Angiotensin-II Receptor Blockers (41%), antiglycemics (39%), calcium channel blockers (27%), and ACE inhibitors (13.7%). Conclusion: This study sheds light on the demographic factors in adults living with CMP, HF, and T2DM during the COVID-19 Pandemic. The prevalence of T2DM, ischemic CMP, and diastolic HF, especially among Hispanics, warrants further research to guide interventions to improve the treatment of these conditions in ethnic minorities

Reducing Urinary Tract Infections in Adult Hospitalized Patients during the COVID-19 Pandemic: A Quality Improvement Project

Background: Catheter-associated urinary tract infections (CAUTIs) remain among the most common healthcare-associated infections, leading to increased morbidity and mortality in hospitalized adult patients. Methods: An interdisciplinary team initiated a quality improvement project to help reduce CAUTIs in a South Florida hospital. The project included using a CAUTI bundle consisting of indwelling catheter protocols, electronic bladder management order sets, nursing staff education, and implementation of external urinary catheters during the years 2020 through 2022. Results: The CAUTI bundle demonstrated positive outcomes in decreasing CAUTI rates. During our fiscal year 2022, there were 63% fewer CAUTIs (n = 23) compared to 2020 (n = 62). Conclusion: We reached our organizational goals of decreasing CAUTI rates to 10% below the national benchmark and improving patient outcomes

Cluster randomized trial of the impact of an obesity prevention intervention on child care center nutrition and physical activity environment over two years

Objective: The prevalence of obesity among preschool-aged children in the United States remains unacceptably high. Here we examine the impact of Healthy Caregivers-Healthy Children (HC2) Phase 2, a child care center (CCC)-based obesity prevention intervention on changes in the CCC nutrition and physical activity environment over two school years. Design: This was a cluster randomized trial with 12 CCC receiving the HC2 intervention arm and 12 in the control arm. The primary outcome was change in the Environment and Policy Assessment and Observation (EPAO) tool over two school years (Fall-2015, Spring-2016 and Spring-2017). Changes in EPAO physical activity and nutrition score were analyzed via a (1) random effects mixed models and (2) mixed models to determine the effect of HC2 versus control. Setting: The study was conducted in 24 CCCs serving low-income, ethnically diverse families in Miami-Dade County. Participants: Intervention CCCs received (1) teachers/parents/children curriculum; (2) snack, beverage, physical activity, and screen time policies; and (3) menu modifications. Results: Two-year EPAO nutrition score changes in intervention CCCs were almost twice that of control CCCs. The EPAO physical activity environment scores only slightly improved in intervention CCCs versus control CCCs. Intervention CCCs showed higher combined EPAO physical activity and nutrition scores compared to control CCCs over the 2-year study period (β=0.09, P=0.05). Conclusions: Obesity prevention programs can have a positive impact on the CCC nutrition environment and can promote healthy weight in early childhood. CCCs may need consistent support to improve the physical activity environment to ensure the policies remain intact

The Creation of a Critical Care Admission Pressure Injury Prevention Cart to Reduce Hospital-Acquired Pressure Injuries

The goal of this process improvement initiative is to reduce hospital-acquired pressure injuries related to Covid-19 with Critical Care patients. Critically ill and ventilated patients require prone position therapy and prolonged ventilator times place the patient at risk for hospital acquired conditions and pressure injuries. The Critical Care team created a Critical Care Admission Pressure Injury Prevention Cart that contains preventative dressings for all pressure areas at risk. The Critical Care Admission Pressure Injury Prevention Cart has significantly reduced the pressure injury rate. With the emergence of the pandemic and additional surges, pressure injuries continued to be on the rise due to prone position therapy. The Critical Care team worked with the system and developed prone position protocols, which included preventative dressings for all areas at risk. Prior to the implementation of the admission cart, Critical Care ended fiscal year 2022, quarter one, with fifty-three hospital acquired pressure injuries. Last December and early January 2022 there was another surge of Covid-19. The Critical Care team implemented the admission cart in January 2022. From January 2022 through September 2022, there has been an 98% reduction. The cart has been successful for Critical Care, and Baptist Hospital implemented the cart in all high acuity areas. This cart was a multidisciplinary practice, which consists of nursing, the wound and skin team, respiratory care, and leadership working together towards the goal of patient safety and pressure injury prevention

Improving the Timing of Insulin Administration in Adult Acute Care Patients

Background: The correct timing of insulin administration in diabetic patients admitted to the hospital is important for the prevention of transient and serious glycemic deviations that could lead to negative patient outcomes. In November 2021, a South Florida Hospital identified an area of opportunity for quality improvement related to the process of subcutaneous insulin administration. In addition to bar code scanning, manual verification of the insulin dose by the primary nurse and another nurse was required prior to administration. Patients were experiencing delays in the timing of their insulin dose and nurses were reporting frustration with the process. Methods: The project followed the Plan-Do-Study-Act (PDSA) cycle for performance improvement. Results: The change in medication administration workflow resulted in achievement of administering insulin within 30 minutes of the scheduled time. Ninety percent of the nurses surveyed reported improvement in their workflow when giving subcutaneous insulin to their patients (n=112). Conclusion: Interdisciplinary collaboration, innovation in education of the nursing staff, monitoring adherence to the process, and sustaining engagement among stakeholders contributed to the success of this initiative, resulting in improved workflow in subcutaneous insulin administration. Keywords: Bar code medication administration, insulin, safety, quality improvemen