Accuracy and completeness of records of adverse events through interface terminology

Objective: To determine what adverse events, including pressure ulcers, infection of the surgical site and aspiration pneumonia, nurses record in clinical histories, in terms of diagnostic accuracy and completeness, through ATIC. Method: Observational, descriptive, cross-sectional, multicenter study of 64 medical-surgical and semi-critical units of two university hospitals in Catalonia, Spain, during 2015. e diagnostic accuracy was assessed by means of the correspondence between the event declared in the Minimum Basic Data Set and the problem documented by the nurse. e record was considered complete when it contained the risk of the event, prescriptions of care and a record of the evolution. Results: e sample evaluated included 459 records. e accuracy results of pressure ulcers are highly correlated between the nursing diagnosis recorded and that declared in the Minimum Basic Data Set. e accuracy in surgical site infection is moderate, and aspiration resulting in pneumonia is very low. e completeness of results is remarkable, except for the risk of bronchoaspiration. Conclusion: e adverse event recorded by nurses with greatest accuracy is pressure ulcers

Surveillance nursing diagnoses, ongoing assessment and outcomes on in-patients who suffered a cardiorespiratory arrest

Objective: Th e purposes of this study were to examine the frequency of surveillance-oriented nursing diagnoses and interventions documented in the electronic care plans of patients who experienced a cardiac arrest during hospitalization, and to observe whether diff erences exist in terms of patients' profi les, surveillance measurements and outcomes. Method: A descriptive, observational, retrospective, cross-sectional design, randomly including data from electronic documentation of patients who experienced a cardiac arrest during hospitalization in any of the 107 adult wards of eight acute care facilities. Descriptive statistics were used for data analysis. Two-tailed p-values are reported. Results: Almost 60% of the analyzed patients' e-charts had surveillance nursing diagnoses charted in the electronic care plans. Signifi cant diff erences were found for patients who had these diagnoses documented and those who had not in terms of frequency of vital signs measurements and fi nal outcomes. Conclusion: Surveillance nursing diagnoses may play a signifi cant role in preventing acute deterioration of adult in-patients in the acute care setting

Factores de complejidad de cuidados asociados a la reconsulta en un servicio de urgencias

Objetivo. Analizar la prevalencia de factores de complejidad de cuidados en los pacientes atendidos en el servicio de urgencias y determinar su relación con las reconsultas durante los 30 días posteriores a la vista inicial. Método. Estudio observacional transversal correlacional. Se incluyeron de forma consecutiva todos aquellos pacientes adultos que consultaron al servicio de urgencias de un hospital de tercer nivel durante un periodo de 6 meses. Las variables principales del estudio fueron la reconsulta a los 30 días y 26 factores individuales de complejidad de cuidados categorizados en 5 fuentes (psicoemocional, mental-cognitiva, sociocultural, evolutiva, comorbilidades-complicaciones). Los datos fueron recogidos de la historia clínica electrónica. Resultados. Se incluyeron un total de 15.556 episodios de pacientes. El 82,4% (12.811) presentó algún factor de complejidad de cuidados y el 11,9% (1.088) de los pacientes dados de alta reconsultaron durante los 30 días posteriores. La presencia de mayor número de factores de complejidad de cuidados se asoció a la reconsulta a los 30 días (OR: 1,26; IC 95%: 1,11-1,43; p < 0,05), y los siguientes factores se asociaron con reconsulta: incontinencia, inestabilidad hemodinámica, riesgo de hemorragia, extremo de edad, ansiedad y temor, deterioro de funciones cognitivas y analfabetismo (p < 0,05). Conclusiones. La prevalencia de factores de complejidad de cuidados en pacientes que consultan en el servicio de urgencias es elevada. Los pacientes que reconsultaron a los 30 días presentaron mayor número de factores de complejidad, por lo que su identificación precoz podría ayudar a estratificar los pacientes y diseñar estrategias preventivas para disminuir la incidencia de reconsultas

Care complexity individual factors associated with adverse events and in-hospital mortality

Introduction: Measuring the impact of care complexity on health outcomes, based on psychosocial, biological and environmental circumstances, is important in order to detect predictors of early deterioration of inpatients. We aimed to identify care complexity individual factors associated with selected adverse events and in-hospital mortality. Methods: A multicenter, case-control study was carried out at eight public hospitals in Catalonia, Spain, from January 1, 2016 to December 31, 2017. All adult patients admitted to a ward or a step-down unit were evaluated. Patients were divided into the following groups based on the presence or absence of three adverse events (pressure ulcers, falls or aspiration pneumonia) and in-hospital mortality. The 28 care complexity individual factors were classified in five domains (developmental, mental-cognitive, psycho-emotional, sociocultural and comorbidity/complications). Adverse events and complexity factors were retrospectively reviewed by consulting patients' electronic health records. Multivariate logistic analysis was performed to identify factors associated with an adverse event and in-hospital mortality. Results: A total of 183,677 adult admissions were studied. Of these, 3,973 (2.2%) patients experienced an adverse event during hospitalization (1,673 [0.9%] pressure ulcers; 1,217 [0.7%] falls and 1,236 [0.7%] aspiration pneumonia). In-hospital mortality was recorded in 3,996 patients (2.2%). After adjustment for potential confounders, the risk factors independently associated with both adverse events and in-hospital mortality were: mental status impairments, impaired adaptation, lack of caregiver support, old age, major chronic disease, hemodynamic instability, communication disorders, urinary or fecal incontinence, vascular fragility, extreme weight, uncontrolled pain, male sex, length of stay and admission to a medical ward. High-tech hospital admission was associated with an increased risk of adverse events and a reduced risk of in-hospital mortality. The area under the ROC curve for both outcomes was > 0.75 (95% IC: 0.78-0.83). Conclusions: Several care complexity individual factors were associated with adverse events and in-hospital mortality. Prior identification of complexity factors may have an important effect on the early detection of acute deterioration and on the prevention of poor outcomes

Glosario de términos de metodología y lenguajes enfermeros

Este glosario además de dar significado y enriquecer conceptos disciplinares referentes a la metodología y a los lenguajes enfermeros, pretende también ser: por una parte, un Glosario de términos de metodología y lenguajes enfermeros 3 punto de partida para estimular el debate y continuar construyendo conocimiento enfermero, y por otra, un reto que nos ayude a homogeneizar y ordenar el ejercicio profesional

Risk of acute deterioration and care complexity individual factors associated with health outcomes in hospitalised patients with COVID-19: a multicentre cohort study

Background: Evidence about the impact of systematic nursing surveillance on risk of acute deterioration of patients with COVID-19 and the effects of care complexity factors on inpatient outcomes is scarce. The aim of this study was to determine the association between acute deterioration risk, care complexity factors and unfavourable outcomes in hospitalised patients with COVID-19. Methods: A multicentre cohort study was conducted from 1 to 31 March 2020 at seven hospitals in Catalonia. All adult patients with COVID-19 admitted to hospitals and with a complete minimum data set were recruited retrospectively. Patients were classified based on the presence or absence of a composite unfavourable outcome (in-hospital mortality and adverse events). The main measures included risk of acute deterioration (as measured using the VIDA early warning system) and care complexity factors. All data were obtained blinded from electronic health records. Multivariate logistic analysis was performed to identify the VIDA score and complexity factors associated with unfavourable outcomes. Results: Out of a total of 1176 patients with COVID-19, 506 (43%) experienced an unfavourable outcome during hospitalisation. The frequency of unfavourable outcomes rose with increasing risk of acute deterioration as measured by the VIDA score. Risk factors independently associated with unfavourable outcomes were chronic underlying disease (OR: 1.90, 95% CI 1.32 to 2.72; p<0.001), mental status impairment (OR: 2.31, 95% CI 1.45 to 23.66; p<0.001), length of hospital stay (OR: 1.16, 95% CI 1.11 to 1.21; p<0.001) and high risk of acute deterioration (OR: 4.32, 95% CI 2.83 to 6.60; p<0.001). High-tech hospital admission was a protective factor against unfavourable outcomes (OR: 0.57, 95% CI 0.36 to 0.89; p=0.01). Conclusion: The systematic nursing surveillance of the status and evolution of COVID-19 inpatients, including the careful monitoring of acute deterioration risk and care complexity factors, may help reduce deleterious health outcomes in COVID-19 inpatients

Impact of an educational program to reduce healthcare resources in community-acquired pneumonia: The EDUCAP randomized controlled trial

BACKGROUND: Additional healthcare visits and rehospitalizations after discharge are frequent among patients with community-acquired pneumonia (CAP) and have a major impact on healthcare costs. We aimed to determine whether the implementation of an individualized educational program for hospitalized patients with CAP would decrease subsequent healthcare visits and readmissions within 30 days of hospital discharge. METHODS: A multicenter, randomized trial was conducted from January 1, 2011 to October 31, 2014 at three hospitals in Spain. We randomly allocated immunocompetent adults patients hospitalized for CAP to receive either an individualized educational program or conventional information before discharge. The educational program included recommendations regarding fluid intake, adherence to drug therapy and preventive vaccines, knowledge and management of the disease, progressive adaptive physical activity, and counseling for alcohol and smoking cessation. The primary trial endpoint was a composite of the frequency of additional healthcare visits and rehospitalizations within 30 days of hospital discharge. Intention-to-treat analysis was performed. RESULTS: We assigned 102 patients to receive the individualized educational program and 105 to receive conventional information. The frequency of the composite primary end point was 23.5% following the individualized program and 42.9% following the conventional information (difference, -19.4%; 95% confidence interval, -6.5% to -31.2%; P = 0.003). CONCLUSIONS: The implementation of an individualized educational program for hospitalized patients with CAP was effective in reducing subsequent healthcare visits and rehospitalizations within 30 days of discharge. Such a strategy may help optimize available healthcare resources and identify post-acute care needs in patients with CAP. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN39531840

Acuity, nurse staffing and workforce, missed care and patient outcomes. A cluster-unit-level descriptive comparison

Aim: To compare patient acuity, nurse staffing and workforce, missed nursing care and patient outcomes among hospital unit-clusters. Background: Relationships among acuity, nurse staffing and workforce, missed nursing care and patient outcomes, are not completely understood. Method: Descriptive design with data from four unit-clusters: medical, surgical, combined and stepdown units. Descriptive statistics were used to compare acuity, nurse staffing coverage, education and expertise, missed nursing care, and selected nurse-sensitive outcomes. Results: Patient acuity in general (medical, surgical and combined) floors is similar to step-down units, with an average of 5.6 required RN hours per patient day. In general wards, available RN hours per patient day reach only 50% of required RN hours to meet patient needs. Workforce measures are comparable among unit-clusters, and average missed nursing care is 21%. Patient outcomes vary among unit-clusters. Conclusion:Patient acuity is similar among unit-clusters, whilst nurse staffing coverage is halved in general wards. While RN education, expertise and missed care are comparable among unitclusters, mortality, skin injuries and risk of family compassion fatigue rates are higher in general wards. Implications for nursing management: Nurse managers play a pivotal role in hustling policy-makers to address structural understaffing in general wards, to maximize patient safety outcomes

Influencia del uso de la terminología ATIC en la seguridad de los enfermos ingresados: impacto en la comunicación profesional y los resultados clínicos

[spa] INTRODUCCIÓN: En la prestación y en la gestión de los cuidados, las enfermeras requieren lenguajes que ayuden a obtener datos precisos y fiables que garanticen la calidad, continuidad y seguridad de los cuidados, contribuyendo a evaluar el cuidado y los resultados en salud. La terminología ATIC es una herramienta de conocimiento disciplinar desarrollada para la práctica asistencial que pretende, como instrumento clínico, ayudar a las enfermeras a generalizar el registro del proceso enfermero, fomentando la práctica reflexiva. OBJETIVO: Evaluar la contribución de la terminología ATIC a la seguridad de los pacientes y a la comunicación profesional en términos de precisión diagnóstica, exhaustividad y coherencia de los registros. METODOLOGÍA: La tesis se estructuró en tres estudios: (1) Observacional, descriptivo, transversal y multicéntrico, con 409 participantes, para evaluar los conocimientos y la comprensión de las enfermeras acerca de intervenciones de vigilancia y control de la terminología ATIC; (2) Observacional, descriptivo, transversal, y multicéntrico, con el análisis de 459 registros de pacientes que habían sufrido un evento adverso como úlcera por presión, infección del sitio quirúrgico o aspiración con resultado de neumonía, para determinar la precisión diagnóstica y la exhaustividad de los registros y (3) Observacional, descriptivo, transversal, y multicéntrico, con una muestra de 44.932 registros de la población general de pacientes hospitalizados y dos subgrupos específicos con una muestra de 800 pacientes ingresados por neumonía adquirida en la comunidad (NAC) o fractura de cuello de fémur (FCF), para establecer el grado de coherencia entre diagnóstico, intervenciones y resultados de evolución. RESULTADOS: Las enfermeras asistenciales tienen un elevado nivel de conocimientos de las intervenciones de vigilancia y control ATIC, comprenden su significado y, en general son capaces de emplear estos conceptos de forma adecuada en su práctica. Las enfermeras comunican con una muy elevada precisión diagnóstica y exhaustividad los registros de eventos adversos de úlcera por presión, con elevada precisión diagnóstica y exhaustividad los registros de eventos relacionados con la infección de sitio quirúrgico y con baja precisión diagnóstica y exhaustividad media, los registros de los eventos de aspiración con resultado de neumonía El grado de coherencia entre el registro del diagnóstico enfermero y las intervenciones de vigilancia y control es muy elevado tanto en la población general de pacientes hospitalizados como en las poblaciones específicas de neumonía adquirida en la comunidad (NAC) y fractura de cuello de fémur (FCF). El nivel de coherencia entre las intervenciones de vigilancia y control y el registro de su medida como variables de evolución es alto, en la población general de pacientes hospitalizados, así como en el grupo específico de pacientes ingresados por neumonía adquirida en la comunidad (NAC) y medio en el caso de los pacientes hospitalizados por fractura de cuello de fémur (FCF). CONCLUSIÓN : El uso de la terminología ATIC contribuye a la seguridad de los pacientes y a la comunicación profesional con adecuada precisión diagnóstica, exhaustividad y coherencia de los registros enfermeros.[eng] INTRODUCTION: In the provision and the management of care, nurses require languages that help to obtain accurate and trustworthy data that guarantee the quality, continuity and safety of the care, contributing to on assessment of care and the outcomes in health. AIM: Evaluating the contribution of ATIC terminology of patient safety and the professional communication in terms of diagnostic accuracy as completeness and coherence of records. METHODOLOGY: This thesis was structured in three studies: (1) Observational, descriptive, transversal and multicentric, with 409 participants, in order to evaluate nurse’s knowledge and understanding of ATIC terminology; (2) Observational, descriptive, transversal and multicentric, with the analysis of 459 patient records who had suffered an adverse event in order to determine diagnostic accuracy and completeness of the records, and (3) Observational, descriptive, transversal, and multicentric, with the sample of 44.932 records of patients and two specific subgroups with a sample of 800 patients, in order to determine the level of coherence between diagnostic, interventions and evolution outcomes. RESULTS: The nurses showed a high level of knowledge of the ATIC surveillance and control interventions and have a very high level of understanding. The nurses communicated with very high diagnostic accuracy and completeness of records of adverse events ulcer pressure, with high diagnostic accuracy and completeness, the records of events related to the infected surgical wound and with low diagnostic accuracy and average completeness, the records of events of aspiration with outcome of pneumonia. The coherence level between the records of nurse diagnostic and the surveillance and control intervention is very high and between the surveillance and control interventions, the record if its measurement as evolution of variables is high, in the general population of inpatients as well as the specific population of patients admitted for community-acquired pneumonia (CAP) and femur neck fracture (FNF). CONCLUSION: The use of ATIC terminology contributes to improving professional communication and the safety inpatient

Mapping the diagnosis axis of an interface terminology to the NANDA International Taxonomy

Background: Nursing terminologies are designed to support nursing practice but, as with any other clinical tool, they should be evaluated. Cross-mapping is a formal method for examining the validity of the existing controlled vocabularies. Objectives: The study aims to assess the inclusiveness and expressiveness of the nursing diagnosis axis of a newly implemented interface terminology by cross-mapping with the NANDA-I taxonomy. Design/Methods: The study applied a descriptive design, using a cross-sectional, bidirectional mapping strategy. The sample included 728 concepts from both vocabularies. Concept cross-mapping was carried out to identify one-to-one, negative, and hierarchical connections. The analysis was conducted using descriptive statistics. Results: Agreement of the raters" mapping achieved 97%. More than 60% of the nursing diagnosis concepts in the NANDA-I taxonomy were mapped to concepts in the diagnosis axis of the new interface terminology; 71.1% were reversely mapped. Conclusions: Main results for outcome measures suggest that the diagnosis axis of this interface terminology meets the validity criterion of cross-mapping when mapped from and to the NANDA-I taxonomy