Transforming Synergy Care Delivery Model into an Effective Nursing Shift Report Tool

Background: The complexity of hospitalized patients with acute and chronic illnesses poses challenges for effective communication among nurses. Nursing shift report (NSR) plays a crucial role in communicating and planning patient care to ensure continuity, quality, and safety of patient care. Suboptimal shift reports may misdirect nursing surveillance and fail to recognize/interpret serious patient complications. A preliminary study involving interviews of staff nurses on current shift report practices revealed that NSRs lacked structure, was task-oriented and inconsistent. Nurses desired a standardized, efficient and systematic shift report. Our study aimed to develop a NSR tool using the American Association for Critical Care Nurses (AACN) Synergy model, systematically capturing the holistic care needs of patients and their families. Method: The Synergy Model-integrated NSR tool was developed with thirteen staff nurses working at seven different units in a hospital. The nurses were first educated about the Synergy model and its eight patient characteristics (Vulnerability, Stability, Resiliency, Predictability, Resource Availability, Participation in Care, Participation in Decision-making, Complexity). Then nurses integrated the patient characteristics into the NSR tool. Results: Identified were unit specific and common care elements across units to be included onto a NSR, matching them with each patient characteristics. A synergy rating scale was incorporated into the tool to allow nurses to score patient's conditions and care needs. The total sum would help nurses quickly judge the overall severity of the patient's condition. Nurses felt that structured and focused information of the tool would prevent information being left out of the reporting process. Conclusion/Implications: Nurses perceived the new NSR tool would be an effective, systematic process with widespread implications for improvements in quality of care and patient safety. The conversion of this paper-based shift report into a mobile shift reporting tool is in progress to support safe, efficient, and patient-centered bedside handoffs

The Feasibility of a Using a Smart Button Mobile Health System to Self-Track Medication Adherence and Deliver Tailored Short Message Service Text Message Feedback

BACKGROUND: As many as 50% of people experience medication nonadherence, yet studies for detecting nonadherence and delivering real-time interventions to improve adherence are lacking. Mobile health (mHealth) technologies show promise to track and support medication adherence. OBJECTIVE: The study aimed to evaluate the feasibility and acceptability of using an mHealth system for medication adherence tracking and intervention delivery. The mHealth system comprises a smart button device to self-track medication taking, a companion smartphone app, a computer algorithm used to determine adherence and then deliver a standard or tailored SMS (short message service) text message on the basis of timing of medication taking. Standard SMS text messages indicated that the smartphone app registered the button press, whereas tailored SMS text messages encouraged habit formation and systems thinking on the basis of the timing the medications were taken. METHODS: A convenience sample of 5 adults with chronic kidney disease (CKD), who were prescribed antihypertensive medication, participated in a 52-day longitudinal study. The study was conducted in 3 phases, with a standard SMS text message sent in phases 1 (study days 1-14) and 3 (study days 46-52) and tailored SMS text messages sent during phase 2 (study days 15-45) in response to participant medication self-tracking. Medication adherence was measured using: (1) the smart button and (2) electronic medication monitoring caps. Concordance between these 2 methods was evaluated using percentage of measurements made on the same day and occurring within ±5 min of one another. Acceptability was evaluated using qualitative feedback from participants. RESULTS: A total of 5 patients with CKD, stages 1-4, were enrolled in the study, with the majority being men (60%), white (80%), and Hispanic/Latino (40%) of middle age (52.6 years, SD 22.49; range 20-70). The mHealth system was successfully initiated in the clinic setting for all enrolled participants. Of the expected 260 data points, 36.5% (n=95) were recorded with the smart button and 76.2% (n=198) with electronic monitoring. Concordant events (n=94), in which events were recorded with both the smart button and electronic monitoring, occurred 47% of the time and 58% of these events occurred within ±5 min of one another. Participant comments suggested SMS text messages were encouraging. CONCLUSIONS: It was feasible to recruit participants in the clinic setting for an mHealth study, and our system was successfully initiated for all enrolled participants. The smart button is an innovative way to self-report adherence data, including date and timing of medication taking, which were not previously available from measures that rely on recall of adherence. Although the selected smart button had poor concordance with electronic monitoring caps, participants were willing to use it to self-track medication adherence, and they found the mHealth system acceptable to use in most cases

Becoming Don of the Doff: Navigating the Complexity of Donning and Doffing Personal Protective Equipment in the Home

Purpose: The safety of care providers and patients is paramount while caring for people with infectious diseases, including those with confirmed or suspected SARS-CoV-2 infection and COVID-19 disease. Existing policies and protocols for donning and doffing personal protective equipment (PPE) are primarily for institutional settings such as hospitals, not for home visits for patient care. We describe a protocol for donning and doffing PPE in home settings. Methods: We used an iterative, rapid-prototyping approach to develop the protocol. A small workgroup created preliminary drafts, drawing on hospital-based protocols and modifying them, whilst undertaking simulations. Wider input was solicited via two webinars; one regional (Hamilton, Ontario) with palliative clinicians, and one national (Canada) with varying professions. We also consulted a group of infectious disease experts. A “how to” video accompanies the protocol. Results: Twelve versions were produced, with major changes occurring within the first six versions. A national webinar mid-development provided further validation and minor modifications. Subsequent versions involved minor changes including the concentration of diluted bleach solution to clean eyewear. The protocol has four phases: 1) Preparing, 2) Entering the Home, 3) Leaving the Home, and 4) After the Visit and Reprocessing. In addition to PPE-related equipment, the protocol requires additional materials including two pails for transporting supplies, plastic bags, hand sanitizer, disinfectant wipes, and printed easy-to-use checklists. Conclusions: This protocol addresses gaps in COVID-19 related guidelines, specifically the process of donning and doffing PPE during home visits while supplementing jurisdictional PPE guidelines and protocols.http://deepblue.lib.umich.edu/bitstream/2027.42/162547/1/813-20_preprint_final.pdfDescription of 813-20_preprint_final.pdf : Main ArticleSEL

Strategies for the successful implementation of disinfecting port protectors to reduce CLABSI in a large tertiary care teaching hospital

Disinfecting port protectors are a supplement to the central line–associated bloodstream infection prevention bundle as an optional recommendation from the Centers for Disease Control and Prevention. Despite evidence of effectiveness, few centers have successfully reported systematic, sustained implementation of these devices. In this article, we discuss a successful implementation in a large tertiary care teaching hospital, using an evidence-based, multidisciplinary approach

Distemper, extinction, and vaccination of the Amur tiger

Canine distemper virus (CDV) has recently emerged as an extinction threat for the endangered Amur tiger (Panthera tigris altaica). CDV is vaccine-preventable, and control strategies could require vaccination of domestic dogs and/or wildlife populations. However, vaccination of endangered wildlife remains controversial, which has led to a focus on interventions in domestic dogs, often assumed to be the source of infection. Effective decision making requires an understanding of the true reservoir dynamics, which poses substantial challenges in remote areas with diverse host communities. We carried out serological, demographic, and phylogenetic studies of dog and wildlife populations in the Russian Far East to show that a number of wildlife species are more important than dogs, both in maintaining CDV and as sources of infection for tigers. Critically, therefore, because CDV circulates among multiple wildlife sources, dog vaccination alone would not be effective at protecting tigers. We show, however, that low-coverage vaccination of tigers themselves is feasible and would produce substantive reductions in extinction risks. Vaccination of endangered wildlife provides a valuable component of conservation strategies for endangered species