Proactive Leadership Attention to Outcomes

Abstract Category: Practice Innovation / Evidence-Based Practice Purpose: The purpose of this initiative was to implement evidence-based rounding in the Intensive Care Unit to decrease CLABSI rates to zero, and maintain zero CAUTI incidences; to empower staff to be proactive versus reactive; to increase staff awareness of hospital acquired infection risks and criteria; to reinforce current bundle compliance and alternatives to lines and catheters; and to obtain “real time results” related to high risk patients. Methods: Biweekly rounds were designed evaluating necessity, management and documentation of patients with central access and urinary catheters. Rounds were conducted by: Clinical RN Project lead, Chief Nursing Officer; Chief Medical Officer; Director of ICU; ICU Clinical Educator; Infection Control Practitioner; and Director of QI/PI. Nurses caring for targeted patients prepared a PLATO rounding checklist prior to rounding. The PLATO team rounded with unit staff and leadership to go through checklist. Findings: In the four months prior to the PLATO intervention, the average CLABSI rate in the ICU was 3.37. In the three months post-PLATO intervention, the ICU CLABSI rate has remained at zero. The CAUTI rate in the ICU has also been maintained at zero. Discussion: Through the proactive collaborative intentional rounding with clinical nurses, quality department personnel, and executive and unit leadership, patient outcomes were positively affected in the ICU patient population. Implications for Practice: Collaborative intentional rounding has positive implications for patient outcomes. Opportunities for improvement were identified, that could impact catheter-related infections such as: the management of glucose, alternatives to line and catheter (midlines and external catheter use), and the utilization of mupirocin in new central lines and review of indications of urinary catheter reinsertion. Opportunities also exist to expand the outcomes measured beyond CAUTI and CLABSI, such as ventilator-assisted pneumonia. When implemented, the effects of proactive leadership rounding can impact patient outcomes positively

Proactive Leadership Attention to Outcomes

Abstract Category: Practice Innovation / Evidence-Based Practice Purpose: The purpose of this initiative was to implement evidence-based rounding in the Intensive Care Unit to decrease CLABSI rates to zero, and maintain zero CAUTI incidences; to empower staff to be proactive versus reactive; to increase staff awareness of hospital acquired infection risks and criteria; to reinforce current bundle compliance and alternatives to lines and catheters; and to obtain “real time results” related to high risk patients. Methods: Biweekly rounds were designed evaluating necessity, management and documentation of patients with central access and urinary catheters. Rounds were conducted by: Clinical RN Project lead, Chief Nursing Officer; Chief Medical Officer; Director of ICU; ICU Clinical Educator; Infection Control Practitioner; and Director of QI/PI. Nurses caring for targeted patients prepared a PLATO rounding checklist prior to rounding. The PLATO team rounded with unit staff and leadership to go through checklist. Findings: In the four months prior to the PLATO intervention, the average CLABSI rate in the ICU was 3.37. In the three months post-PLATO intervention, the ICU CLABSI rate has remained at zero. The CAUTI rate in the ICU has also been maintained at zero. Discussion: Through the proactive collaborative intentional rounding with clinical nurses, quality department personnel, and executive and unit leadership, patient outcomes were positively affected in the ICU patient population. Implications for Practice: Collaborative intentional rounding has positive implications for patient outcomes. Opportunities for improvement were identified, that could impact catheter-related infections such as: the management of glucose, alternatives to line and catheter (midlines and external catheter use), and the utilization of mupirocin in new central lines and review of indications of urinary catheter reinsertion. Opportunities also exist to expand the outcomes measured beyond CAUTI and CLABSI, such as ventilator-assisted pneumonia. When implemented, the effects of proactive leadership rounding can impact patient outcomes positively

Relationship of Staff Engagement and Perception of Safety Scores with Patient Outcomes

Abstract Category: Research Purpose: To explore clinical nurses’ perception of engagement and patient safety and evaluation of correlation between engagement and perception of patient safety to patient outcomes. Methods: Exploratory component of clinical nurses’ perceptions of engagement and patient safety involved a nontraditional qualitative descriptive research design with focus group led by staff nurse unit-based practice council chairs and thematic analysis. Correlational component consisted of parametric statistical analysis of National Database of Nursing Quality Indicators (NDNQI) RN Satisfaction scores, Agency for Healthcare Research and Quality Hospital Survey of Patient Safety Culture scores (PSCS), and patient outcomes data from 2012, 2014, and 2016. Findings: Findings revealed statistically significant correlated relationships between NDNQI RN satisfaction (reflected in practice environment score (PES) & PSCS (r=0.756, p=0.004); PES & patient falls (r=0.577, p=0.049); and between handoff reports (element of PSCS) & patient falls (r=0.726, p=0.008). Focus group themes include: team building activities, being engaged with patient, teamwork, and being emotionally attached related to engagement; and staffing/assignment, patient care, and teamwork related to safety. Discussion: Evidence exists of a relationship between higher RN job satisfaction and/or a positive patient safety culture and patient outcomes; but limited studies exist showing a statistically significant relationship. Furthermore, limited studies have been conducted exploring perceptions of nurses and whether there is a relationship between perceptions and actual outcomes. The results of this study show there is statistically significant correlation between RN satisfaction and falls (higher RN satisfaction, lower number of falls); and between handoffs (an element of safety perception) and falls (higher perception of handoffs as important, lower number of falls). The common themes for engagement that transcended across groups were teamwork and being emotionally attached and caring and for safety common theme was staffing, acuity and assignment. Implications for Practice: By keeping staff engaged and patient safety-centered and focusing on what nurses themselves perceive as elements of staff engagement and patient safety, leaders can potentially positively affect patient outcomes. Having nurses themselves work collaboratively to identify how they affect patient outcomes through a deeper understanding, translates to a stronger safety culture and enhanced patient care

Kinetic Monte Carlo Modelling to Study Diffusion in Zeolite. Understanding the Impact of Dual Site Isotherm on the Loading Dependence of n-Hexane and n-Heptane Diffusivities in MFI Zeolite, as Revealed by QENS Experiments

ENERGIE:MATERIAUX+HJO:NLAInternational audienceThis study concerns the diffusion of single-component molecules in zeolites, characterised by an isotherm represented by a dual-site Langmuir model with a point of inflection. The systems investigated are n-hexane and n-heptane in MFI zeolite at 300 K. Experiments conducted using the Quasi-Elastic Neutron Scattering (QENS) technique have demonstrated that this inflection has an impact on the loading dependence of the transport Dt and corrected DC diffusion coefficients of these systems. The results of these experiments are described here. A Kinetic Monte Carlo study is then conducted, showing how the energy levels of the molecule adsorption sites in a zeolite affect the loading dependence of the diffusion coefficients of these molecules

Anionic redox topochemistry for materials design: chalcogenides and beyond

Topochemistry refers to a generic category of solid-state reactions in which precursors and products display strong filiation in their crystal structures. Various low-dimensional materials are subject to this stepwise structure transformation by accommodating guest atoms or molecules in between their 2D slabs or 1D chains loosely bound by van der Waals (vdW) interactions. Those processes are driven by redox reactions between guests and the host framework, where transition metal cations have been widely exploited as the redox center. Topochemistry coupled with this cationic redox not only enables technological applications such as Li-ion secondary batteries but also serves as a powerful tool for structural or electronic fine-tuning of layered transition metal compounds. Over recent years, we have been pursuing materials design beyond this cationic redox topochemistry that was mostly limited to 2D or 1D vdW systems. For this, we proposed new topochemical reactions of non-vdW compounds built of 2D arrays of anionic chalcogen dimers alternating with redox-inert host cationic layers. These chalcogen dimers were found to undergo redox reaction with external metal elements, triggering either (1) insertion of these metals to construct 2D metal chalcogenides or (2) deintercalation of the constituent chalcogen anions. As a whole, this topochemistry works like a “zipper”, where reductive cleavage of anionic chalcogen–chalcogen bonds opens up spaces in non-vdW materials, allowing the formation of novel layered structures. This Perspective briefly summarizes seminal examples of unique structure transformations achieved by anionic redox topochemistry as well as challenges on their syntheses and characterizations

QENS and the benefit of diffusion measurements over different length scales

The quasi-elastic neutron scattering (QENS) technique was first used to derive self-diffusivities of hydrocarbons in zeolites, but transport diffusivities of deuterated molecules and of molecules which do not contain hydrogen atoms can now be measured. The technique allows to probe diffusion over length scales ranging from an Å to hundreds of Å. The mechanism of diffusion can thus be followed from the elementary jumps between adsorption sites to Fickian diffusion. Since the space and time scales of the neutron techniques match closely the ones covered by molecular simulations, one expects, and usually finds, good agreement between neutrons and simulations. The neutron data give therefore reference values, so that lower values obtained by other techniques measuring diffusion over longer length scales have to be explained by additional transport barriers