Gina M. Berg

Fall risk associated with inpatient medications.

PURPOSE The association between fall risk and inpatient medications was evaluated. METHODS A retrospective, case-control study was performed to compare the medication use of patients sustaining at least one fall during hospitalization (case group) with a control group of patients who did not fall. Data were collected from medical records and generated reports. A fall was defined by the hospital as an event in which the patient comes to rest on the floor from a lying, standing, or sitting position. Adult patients (≥18 years of age) admitted between January 1 and December 31, 2006, experiencing a fall at least 48 hours after hospital admission were included in the case group. Each case was matched with one control by age (within five years), sex, admission date (within 30 days), patient care unit, and length of stay. Medications administered within 48 hours before the fall for the case group or designated fall date and time for the control group were documented. RESULTS Of the 414 documented fall events, 209 patients met the inclusion criteria. Of those patients, 96 matched control patients on all criteria. Significantly more case patients received a greater number of central nervous system (CNS) agents compared with matched control patients (p = 0.017). There was no statistically significant difference in the number of medications from all other drug classes or the total number of medications received by the groups. CONCLUSION In a sample of hospitalized patients, CNS agents were significantly associated with falls.

Near-infrared spectroscopy measurement of sacral tissue oxygen saturation in healthy volunteers immobilized on rigid spine boards.

Abstract Introduction. Immobilization of patients utilizing rigid spine boards (RSBs) is standard practice in the management of trauma patients. Pressure ulcers have been associated with prolonged immobilization, and the possibility exists that formation may begin when the patient is initially immobilized on the RSB. The effects may not be fully recognized because of limited research on the direct tissue effects of prolonged immobilization. Near-infrared spectroscopy is an emerging tool to measure peripheral tissue oxygen saturation (StO2). The purpose of this research was to study the effects of prolonged spinal immobilization on an RSB on sacral tissue oxygenation of healthy volunteers. Methods. This experimental study measured StO2 in healthy volunteers at baseline and again after 30 minutes of immobilization on an RSB at two sites: the sacral area (intervention) and 8–10 cm above the buttocks (control). Tissue oxygenation was measured with the InSpectra Tissue Oxygenation Monitor (Hutchinson Technology, Hutchinson, MN) by placing the probe at the measurement site and waiting for 15 seconds for equilibration prior to recording StO2. Data were analyzed utilizing mixed-model and within-subjects analysis of variance (ANOVA), chi-square, and t-tests. Results. Seventy-three participants were included in the analysis. A slight majority of participants were female (55%), the average age was 38 years, the average height was 170 cm, and the average weight was 82 kg. There was a significant increase in the StO2 percentage at the sacral (intervention) area following immobilization, p < 0.001, point biserial correlation (rpb) = 0.48. Significant changes in oxygenation were not noted at the control site. Conclusion. An increase in sacral tissue oxygenation following immobilization was a finding consistent with other research. This is likely a result of initial, rapid tissue reperfusion at the time of pressure release. Rapid reperfusion indicates that a period of previous hypoperfusion has occurred. This research indicates that there are detrimental effects of spine board immobilization in healthy volunteers, which suggests that pressure ulcer formation may begin prior to hospital admission with immobilization on an RSB.

Kansas Physician Assistants’ Attitudes and Beliefs Regarding Spirituality and Religiosity in Patient Care

Research indicates patients want to discuss spirituality/religious (S/R) beliefs with their healthcare provider. This was a cross-sectional study of Kansas physician assistants (PA) regarding S/R in patient care. Surveys included questions about personal S/R beliefs and attitudes about S/R in patient care. Self-reported religious respondents agreed (92%) they should be aware of patient S/R; 82% agreed they should address it. Agreement with incorporating S/R increased significantly based on patient acuity. This research indicates Kansas PAs’ personal S/R beliefs influence their attitudes toward awareness and addressing patient S/R.

Evaluation of Process Variations in Noncompliance in the Implementation of Evidence‐Based Sepsis Care

Introduction: Sepsis is recognized as an often‐lethal disease. Recommended guidelines are complex and time sensitive. Response teams (RTs) have demonstrated success in implementation of quality initiatives. The purpose of this study was to evaluate variations in noncompliance with recommended sepsis guidelines overall and between a sepsis‐focused RT and standard care. Methods: This retrospective chart review categorized septic patients based on treatment by a sepsis response team (SRT) versus standard care (non‐SRT). Guideline compliance was based upon the Surviving Sepsis evaluation and treatment guidelines. Results: Patient records for 123 identified septic patients post first‐year implementation were evaluated. Overall, compliance rates were low and there were variations in compliance between the treatment providers. The SRT was more compliant than the non‐SRT. SRT noncompliance was more often due to failure to achieve therapeutic goals within the recommended time. Mortality benefit was not statistically significant between groups; however mortality was higher in the non‐SRT group. Conclusion: Noncompliance is more complex than simple failure to initiate, especially in time‐dependent therapies. The development and education of an RT demonstrates improvement in application of sepsis‐focused therapies over standard care.

Cervical Spinal Clearance: A Prospective Western Trauma Association Multi-Institutional Trial.

BACKGROUND For blunt trauma patients who have failed the NEXUS (National Emergency X-Radiography Utilization Study) low-risk criteria, the adequacy of computed tomography (CT) as the definitive imaging modality for clearance remains controversial. The purpose of this study was to prospectively evaluate the accuracy of CT for the detection of clinically significant cervical spine (C-spine) injury. METHODS This was a prospective multicenter observational study (September 2013 to March 2015) at 18 North American trauma centers. All adult (≥18 years old) blunt trauma patients underwent a structured clinical examination. NEXUS failures underwent a CT of the C-spine with clinical follow-up to discharge. The primary outcome measure was sensitivity and specificity of CT for clinically significant injuries requiring surgical stabilization, halo, or cervical-thoracic orthotic placement using the criterion standard of final diagnosis at the time of discharge, incorporating all imaging and operative findings. RESULTS Ten thousand seven hundred sixty-five patients met inclusion criteria, 489 (4.5%) were excluded (previous spinal instrumentation or outside hospital transfer); 10,276 patients (4,660 [45.3%] unevaluable/distracting injuries, 5,040 [49.0%] midline C-spine tenderness, 576 [5.6%] neurologic symptoms) were prospectively enrolled: mean age, 48.1 years (range, 18–110 years); systolic blood pressure 138 (SD, 26) mm Hg; median, Glasgow Coma Scale score, 15 (IQR, 14–15); Injury Severity Score, 9 (IQR, 4–16). Overall, 198 (1.9%) had a clinically significant C-spine injury requiring surgery (153 [1.5%]) or halo (25 [0.2%]) or cervical-thoracic orthotic placement (20 [0.2%]). The sensitivity and specificity for clinically significant injury were 98.5% and 91.0% with a negative predictive value of 99.97%. There were three (0.03%) false-negative CT scans that missed a clinically significant injury, all had a focal neurologic abnormality on their index clinical examination consistent with central cord syndrome, and two of three scans showed severe degenerative disease. CONCLUSIONS For patients requiring acute imaging for their C-spine after blunt trauma, CT was effective for ruling out clinically significant injury with a sensitivity of 98.5%. For patients with an abnormal neurologic examination as the trigger for imaging, there is a small but clinically significant incidence of a missed injury, and further imaging with magnetic resonance imaging is warranted. LEVEL OF EVIDENCE Diagnostic tests, level II.

Acceptability and implementation of debriefings after trauma resuscitation.

Postresuscitation debriefings allow team members to reflect on performance and discuss areas for improvement. Pre-/postsurveys of trauma team members (physicians, mid-level practitioners, technicians, pharmacists, and nurses) were administered to evaluate the acceptability of debriefings and self-perceptions after multidisciplinary trauma resuscitations. After a 3-month trial period, improvements were observed in perceptions of psychological and patient safety, role on team, team communication, and acceptability of the debriefing initiative. Regrouping for a debriefing requires organizational change, which may be more easily assimilated if team members recognize the potential for process improvement and feel confident about success.

Evaluating the quality of online information about concussions.

Objectives:Compare and assess information available on the Internet about the definition, symptoms, treatment, and return to play recommendations after a concussion. Methods:The top 10 websites generated by a Google search on the keyword “concussion” were evaluated by two independent researchers and three medical professionals for definition, signs, symptoms, home treatment, care-seeking advice, and return to play recommendations. The medical professionals also rated their willingness to recommend each website to patients. Results:Each website contained a general list of signs, symptoms, and home treatment. One website advised the use of ibuprofen, four advised against ibuprofen, and five made no medication recommendations. Nine websites contained guidance on seeking physician care, and eight recommended athletes not return to play until cleared by a healthcare professional. Conclusion:Nine of the websites contained information for each section evaluated; however, information was inconsistent. Healthcare providers should be aware of the variable quality of information available on the Internet and guide patients to more optimal resources.

Exposing compassion fatigue and burnout syndrome in a trauma team: a qualitative study

Compassion fatigue (CF) and burnout syndrome (BOS) are identified in trauma, emergency, and critical care nursing practices. The purpose of this qualitative study was to measure CF and BOS in a trauma team and allow them to share perceptions of related stress triggers and coping strategies. Surveys to measure CF and BOS and a focus group allowed a trauma team (12 practitioners) to share perceptions of related stress triggers and coping strategies. More than half scored at risk for CF and BOS. Stress triggers were described as situation (abuse, age of patient) versus injury-related. Personal coping mechanisms were most often reported. Both CF and BOS can be assessed with a simple survey tool. Strategies for developing a program culturally sensitive to CF and BOS are provided.

Usability testing of a fall prevention toolkit.

ABSTRACTObjectives: This study sought to evaluate a fall prevention toolkit, determine its ease of use and user satisfaction, and determine the preferred venue of distribution.Methods: Three forms of assessment were used: focus groups, usability testing, and surveys. Focus group participants were recruited from four locations: two rural health clinics and two urban centers. Usability testing participants were recruited from two rural health clinics. Survey questions included self-reported prior falls, current fall prevention habits, reaction to the toolkit, and demographics.Results: Participants reported the toolkit was attractive, well-organized, and easy to use, but may contain too much information. Most participants admitted they would not actively use the toolkit on their own, but prefer having it introduced by a healthcare provider or in a social setting.Conclusions: Healthcare focuses on customer satisfaction; therefore, providers benefit from knowing patient preferred methods of learning fall prevention strategies.

Trauma patient satisfaction with physician assistants: testing a structural equation model.

Objective: Physician assistants (PAs) are increasingly utilized in the health care workforce and should be aware of how their interpersonal and technical skills are perceived by patients. The purpose of this study was to test associations among Perceived Interpersonal Care, Perceived Technical Care, and Global Satisfaction. Methods: This cross‐sectional telephone survey of recently discharged trauma patients tested a structural equation model which hypothesized that interpersonal satisfaction ratings predicted technical care and global satisfaction ratings. Results: A total of 251 completed surveys were analyzed. Results indicated a relationship among interpersonal care, technical care, and global satisfaction. Satisfaction with interpersonal care predicted satisfaction with technical care. Conclusion: In this study of how satisfied recently discharged trauma patients are with care by physician assistants, perceptions of technical care were associated with perceptions of interpersonal care, or how the patient was treated as a person. Since physician assistants have direct patient contact, this association demonstrates the strength of the PA‐patient relationship as an asset to the health care organization.