Deborah Brosovich

Diabetes teaching is not for the faint of heart: are cardiac nurses up to the challenge?

Background:Patient education of self-care is an integral component of nursing care. Promoting self-care is important for patients with diabetes because day-to-day decision making has a tremendous impact on health. Purpose:To examine diabetes knowledge of nurses working on medical cardiology and cardiovascular surgical intermediate care units. Methods:In this prospective, cross-sectional, correlational study, 90 registered nurses working on medical cardiology and cardiovascular surgical units completed a 20-item survey on diabetes survival skill education. Correlational and comparative statistics were used to analyze data. Results:Subjects (N = 90) were more often female (n = 73; 83.0%) and worked full time (n = 76; 84%); mean (SD) RN experience was 5.6 years (SD, 7.6 years). Total mean score on the Diabetes Survival Skills Knowledge Test (DKSST) was 10.4 (SD, 2.6), reflecting 50% mastery of diabetes survival skill content. Test scores were higher in nurses with greater general comfort in teaching patients about diabetes (P =.04), more years of experience as a nurse (P =.004), more years of work at the current workplace (P <.001), and more years in their current work unit (P <.001). By age, nurses in the oldest quartile (≥37 years) had higher DKSST content area scores in oral glucose-lowering agents (P =.02) and symptom management (P =.01) and had a trend toward higher overall DKSST score (P =.06) and score on blood glucose self-monitoring (P =.06). Sex, formal education level, work commitment, and previous diabetes education were not associated with higher DKSST scores. Conclusion:Nurses knowledge and comfort related to diabetes survival skill teaching were low. The strongest correlate of higher DKSST score was length of time as a nurse. Because previous education and other nurse characteristics were not associated with higher test scores, nurse educators and advanced practice nurses must modify education delivery modalities to improve retention of information used in the delivery of patient education about diabetes survival skills.

Association Between Off-site Central Monitoring Using Standardized Cardiac Telemetry and Clinical Outcomes Among Non–Critically Ill Patients

IMPORTANCE Telemetry alarms involving traditional on-site monitoring rarely alter management and often miss serious events, sometimes resulting in death. Poor patient selection contributes to a high alarm volume with low clinical yield. OBJECTIVE To evaluate outcomes associated with an off-site central monitoring unit (CMU) applying standardized cardiac telemetry indications using electronic order entry. DESIGN, SETTING, AND PARTICIPANTS All non-intensive care unit (ICU) patients at Cleveland Clinic and 3 regional hospitals over 13 months between March 4, 2014, and April 4, 2015. EXPOSURES An off-site CMU applied standardized cardiac telemetry when ordered for standard indications, such as for known or suspected tachyarrhythmias or bradyarrhythmias. MAIN OUTCOMES AND MEASURES CMU detection and notification of rhythm/rate alarms occurring 1 hour or less prior to emergency response team (ERT) activation, direct CMU-to-ERT notification outcomes, total telemetry census, and cardiopulmonary arrests in comparison with the previous 13 months. RESULTS The CMU received electronic telemetry orders for 99,048 patients (main campus, 72,199 [73%]) and provided 410,534 notifications (48% arrhythmia/hemodynamic) among 61 nursing units. ERT activation occurred among 3243 patients, including 979 patients (30%) with rhythm/rate changes occurring 1 hour or less prior to the ERT activation. The CMU detected and provided accurate notification for 772 (79%) of those events. In addition, the CMU provided discretionary direct ERT notification for 105 patients (ventricular tachycardia, n = 44; pause/asystole, n = 36; polymorphic ventricular tachycardia/ventricular fibrillation, n = 14; other, n = 11), including advance warning of 27 cardiopulmonary arrest events (26%) for which return of circulation was achieved in 25 patients (93%). Telemetry standardization was associated with a mean 15.5% weekly census reduction in the number of non-ICU monitored patients per week when compared with the prior 13-month period (580 vs 670 patients; mean difference, -90 patients [95% CI, -82 to -99]; P < .001). The number of cardiopulmonary arrests was 126 in the 13 months preintervention and 122 postintervention. CONCLUSIONS AND RELEVANCE Among non-critically ill patients, use of standardized cardiac telemetry with an off-site central monitoring unit was associated with detection and notification of cardiac rhythm and rate changes within 1 hour prior to the majority of ERT activations, and also with a reduction in the census of monitored patients, without an increase in cardiopulmonary arrest events.