Does medication safety and diversion education improve medication securement practices in SCU compared to current practice?

Does medication safety and diversion education improve medication securement practices in SCU compared to current practice? Abstract Natasha R. Stankiewicz, MS, RN, NE-BC, CCRN-CMC This safety quality improvement project began as newly hired SCU2 team members saw an opportunity to improve our medication safety practices and culture. The convenience of having certain medications directly available at bedside was priority. There was a lack of awareness and interest in securing medications within the department. However, the risk to our patients, families, visitors and colleagues when medications are left out, available and unsecured was apparent to new staff and others. Prior to our education, the accepted practice of unsecured medications was rampant: medications were left drawn up or exposed, setting in various open areas at bedside or within the room, in clinician’s pockets, and often transferred from one clinician to another during shift handoff. This safety project focused on creating buy-in through multidisciplinary education and analysis; the end goal was to alter the team’s workflow habits by increasing diversion and medication safety knowledge and awareness. SCU2’s Medication Safety QI project began by introducing the topic at two March staff meetings. A clinical pharmacist and nurse manager presented the topic of diversion and safe medication handling. The nurse manager then created and posted a translating evidence into practice (TRIP) sheet and PowerPoint for additional educational opportunity. Evidence included \u3e100,000 healthcare workers are dependent or abusing prescriptions each year, medications drawn up and left at bedside have sterility issues, and substance abuse is the number one reason nurses receive disciplinary action by state boards of nursing. To improve safety, the unit utilized MaineHealth’s Operational Excellence program to develop relevant key performance indicators (KPI). The first KPI focused on the entire team reviewing pharmacy and nurse manager\u27s provided education. All PowerPoint presentations were sent out via email in March, and again, in April. All educational materials were also physically posted on unit. A staff sign-off sheet was available once education was reviewed and understood; this knowledge and understanding was self-reported. SCU2’s education KPI ended in mid-April 2017, and our no meds left unsecured at bedside self-reporting KPI was enacted post-education. Team was encouraged to use MMC’s RL Solutions (Risk Management) program to document medication hazards and errors. Current KPI and focus continues to date. Management solicited feedback continually during introduction, education and implementation processes. Improved awareness and securement of medications post-education and quality improvement project was noted via staff sign-off sheet, self-reported KPI documentation for April-September 2017, and additional feedback will be solicited via anonymous survey post-hardwiring. 93.1% of RNs and 87.8% of staff solicited signed-off on at least one form of education. One medication error noted via RL Solutions system and was reviewed by SCU leadership and Risk Management. Based on these documentations and feedback, overall team buy-in was achieved: safety and diversion education improved medication securement practices post-education. Furthermore, this QI project extended to other units within MMC. Challenges sustaining medication safety practice changes occur during times of increased patient acuity, high patient flow and high census. This quality improvement project for SCU2 will continue until safety and culture improvement is ingrained

Increasing Bedside Medication Safety in an Intensive Care Setting

A PERFORMANCE IMPROVEMENT PROJECT FOR INCREASED BEDSIDE MEDICATION SAFETY The convenience of having certain medications directly available at bedside has long been a priority for a medical intensive care nursing team in an academic tertiary medical center. However, it was apparent to new staff and leadership that there was a lack of awareness and interest in securing medications within the department. This posed a risk to patients, families, visitors and colleagues. Baseline metrics on patient safety were collected and a root cause analysis was conducted. Countermeasures included increased education of medication safety as well as a instituting a KPI which read that 100% of the time all medications would be secured. Since the implementation of the unit’s medication safety and quality improvement project, metrics have demonstrated an improvement in medication safety knowledge and practice. Next steps include continued improvement in medication handling practices to ensure a culture of safety and increased perception of safety by staff, patients & visitors

Improving Revenue Capture and Patient Safety in an ICU Setting

IMPROVING REVENUE CAPTURE AND PATIENT SAEFTY IN AN INTENSIVE CARE SETTING Materials management department is responsible for restocking chargeable supplies in an intensive care unit (ICU) at an academic tertiary medical center. Staff confusion as to what items were considered chargeable often led to low supply par levels resulting in delays of critical patient care. Using baseline metrics, a team of caregivers created several performance improvement goals to increase nursing compliance with appropriate supply charging. The results of a root cause analysis spearheaded the development of a KPI that encompassed staff education, lost charge tracking and charge supply labeling. Post KPI inception, a significant increase in compliance was realized. The next step is to complete a two year retrospective cost benefit analysis to determine lost revenue and compare that to the cost of three automate

1600 RN

Due to a changing employment arena, healthcare organizations are hiring more new graduate RNs into acute care units. MMC’s usual process is to put new hires into night shift. Historically, night shifts have less resource availability. These combined factors left staff feeling unsupported; patient care could be compromised when less support is available to those in the beginning of their careers

Strategies to Improve Resource Availability for New Graduate Nurses in a Critical Care Setting

STRATEGIES TO IMPROVE RESOURCE AVAILABILITY FOR NEW GRADUATE NURSES Due to changes in the employment arena, health care organizations are hiring new graduate RNs into acute care. At an academic tertiary medical center, new hires typically are assigned into a night shift, which traditionally has less resource availability. The results of a recent AHRQ hospital survey on patient culture safety demonstrated that new graduates were feeling unsupported and that patient safety could be potentially compromised. A team of caregivers developed several goals to provide increased support, encouragement and education to night shift new hires. Improvement in overall patient care and safety was an additional objective. A root cause analysis was conducted and the results prompted the creation of night shift resource nursing position. Expectations for this position were delineated followed by recruitment and training. Subsequent tracking demonstrated a marked increase in the percentage of availability of this designated nurse over a period of 6 months, approaching the goal of 100%. Next steps include repeating the AHRG hospital survey as well as to sustain and spread concept

Stankiewicz-Isidor syndrome: expanding the clinical and molecular phenotype

Purpose: Haploinsufficiency of PSMD12 has been reported in individuals with neurodevelopmental phenotypes, including developmental delay/intellectual disability (DD/ID), facial dysmorphism, and congenital malformations, defined as Stankiewicz-Isidor syndrome (STISS). Investigations showed that pathogenic variants in PSMD12 perturb intracellular protein homeostasis. Our objective was to further explore the clinical and molecular phenotypic spectrum of STISS. Methods: We report 24 additional unrelated patients with STISS with various truncating single nucleotide variants or copy-number variant deletions involving PSMD12. We explore disease etiology by assessing patient cells and CRISPR/Cas9-engineered cell clones for various cellular pathways and inflammatory status. Results: The expressivity of most clinical features in STISS is highly variable. In addition to previously reported DD/ID, speech delay, cardiac and renal anomalies, we also confirmed preaxial hand abnormalities as a feature of this syndrome. Of note, 2 patients also showed chilblains resembling signs observed in interferonopathy. Remarkably, our data show that STISS patient cells exhibit a profound remodeling of the mTORC1 and mitophagy pathways with an induction of type I interferon-stimulated genes. Conclusion: We refine the phenotype of STISS and show that it can be clinically recognizable and biochemically diagnosed by a type I interferon gene signature

Diagnostic implications of genetic copy number variation in epilepsy plus

Objective Copy number variations (CNVs) represent a significant genetic risk for several neurodevelopmental disorders including epilepsy. As knowledge increases, reanalysis of existing data is essential. Reliable estimates of the contribution of CNVs to epilepsies from sizeable populations are not available. Methods We assembled a cohort of 1255 patients with preexisting array comparative genomic hybridization or single nucleotide polymorphism array based CNV data. All patients had epilepsy plus, defined as epilepsy with comorbid features, including intellectual disability, psychiatric symptoms, and other neurological and nonneurological features. CNV classification was conducted using a systematic filtering workflow adapted to epilepsy. Results Of 1097 patients remaining after genetic data quality control, 120 individuals (10.9%) carried at least one autosomal CNV classified as pathogenic; 19 individuals (1.7%) carried at least one autosomal CNV classified as possibly pathogenic. Eleven patients (1%) carried more than one (possibly) pathogenic CNV. We identified CNVs covering recently reported (HNRNPU) or emerging (RORB) epilepsy genes, and further delineated the phenotype associated with mutations of these genes. Additional novel epilepsy candidate genes emerge from our study. Comparing phenotypic features of pathogenic CNV carriers to those of noncarriers of pathogenic CNVs, we show that patients with nonneurological comorbidities, especially dysmorphism, were more likely to carry pathogenic CNVs (odds ratio = 4.09, confidence interval = 2.51-6.68; P = 2.34 x 10(-9)). Meta-analysis including data from published control groups showed that the presence or absence of epilepsy did not affect the detected frequency of CNVs. Significance The use of a specifically adapted workflow enabled identification of pathogenic autosomal CNVs in 10.9% of patients with epilepsy plus, which rose to 12.7% when we also considered possibly pathogenic CNVs. Our data indicate that epilepsy with comorbid features should be considered an indication for patients to be selected for a diagnostic algorithm including CNV detection. Collaborative large-scale CNV reanalysis leads to novel declaration of pathogenicity in unexplained cases and can promote discovery of promising candidate epilepsy genes

Diagnostic implications of genetic copy number variation in epilepsy plus

OBJECTIVE: Copy number variations (CNVs) represent a significant genetic risk for several neurodevelopmental disorders including epilepsy. As knowledge increases, reanalysis of existing data is essential. Reliable estimates of the contribution of CNVs to epilepsies from sizeable populations are not available. METHODS: We assembled a cohort of 1255 patients with preexisting array comparative genomic hybridization or single nucleotide polymorphism array based CNV data. All patients had "epilepsy plus," defined as epilepsy with comorbid features, including intellectual disability, psychiatric symptoms, and other neurological and nonneurological features. CNV classification was conducted using a systematic filtering workflow adapted to epilepsy. RESULTS: Of 1097 patients remaining after genetic data quality control, 120 individuals (10.9%) carried at least one autosomal CNV classified as pathogenic; 19 individuals (1.7%) carried at least one autosomal CNV classified as possibly pathogenic. Eleven patients (1%) carried more than one (possibly) pathogenic CNV. We identified CNVs covering recently reported (HNRNPU) or emerging (RORB) epilepsy genes, and further delineated the phenotype associated with mutations of these genes. Additional novel epilepsy candidate genes emerge from our study. Comparing phenotypic features of pathogenic CNV carriers to those of noncarriers of pathogenic CNVs, we show that patients with nonneurological comorbidities, especially dysmorphism, were more likely to carry pathogenic CNVs (odds ratio = 4.09, confidence interval = 2.51-6.68; P = 2.34 × 10-9 ). Meta-analysis including data from published control groups showed that the presence or absence of epilepsy did not affect the detected frequency of CNVs. SIGNIFICANCE: The use of a specifically adapted workflow enabled identification of pathogenic autosomal CNVs in 10.9% of patients with epilepsy plus, which rose to 12.7% when we also considered possibly pathogenic CNVs. Our data indicate that epilepsy with comorbid features should be considered an indication for patients to be selected for a diagnostic algorithm including CNV detection. Collaborative large-scale CNV reanalysis leads to novel declaration of pathogenicity in unexplained cases and can promote discovery of promising candidate epilepsy genes.status: publishe