Krista Moe

Major Predictors of Inpatient Falls: A Multisite Study.

Objective: The purpose of this secondary data analysis was to identify key factors predictive of falls in hospitals. Background: Patient falls remain a major concern for hospitals. Falls can increase patient morbidity/mortality and increase legal risk/cost for institutions. While a number of high-risk falls assessments are available, key predictors of falls have not been identified. Methods: A secondary data analysis was performed on 281,865 high-risk falls assessments collected in a multisite study. Results: For the total sample, logistic regression analyses demonstrated that 3 factors, falls within the past 6 months (OR=2.98), confusion (odds ratio, 2.05), taking a laxative (odds ratio, 1.54), are strong predictors of falling. Similar results were found for individual hospitals, different units within hospitals, and urban versus rural hospital locations. Conclusion: Findings suggest that assessments of fall risk should heavily weigh the 3 predictors identified in this study. Another approach would be to intervene based on these predictors.

A Successful Evidence-Based Practice Model in an Acute Care Setting

hospital (redesignated in 2010), 34 projects are ongoing, 9 articles have been published in peer-reviewed jour-nals, numerous presentations of data have occurred, and 9 studies have been funded. In addition to funded studies, presentations, and publications, changes in practice as a result of nurse-initiated projects occur on a regular basis. The success of this EBP plan can be attributed to the presence of the following five components: (a) a clear philosophical direction for nursing in the institution, (b) supportive administrative goals and actions, (c) resources dedicated to the goal of EBP, (d) communication strate-gies designed to facilitate EBP, and (e) clear definitions of the three evaluation processes used in acute care institutions: research, EBP projects, and quality assur -ance (entitled performance improvement in the authors’ institution).

Transforming Practice Through Publication: A Community Hospital Approach to the Creation of a Research-Intensive Environment.

Publication of 28 data-based articles in peer-reviewed journals over a 4-year period is the result of a commitment to conducting and publishing research at a 383-bed Magnet®-redesignated community hospital. The research-intensive environment in nursing at this institution supports publication as the desired outcome of all projects. The provision of appropriate resources, the development of 2 models to guide the conduct of research and nursing leadership that encourages and supports research activities enables nurses to submit manuscripts describing their work. Steps taken to support the publication of findings can be adapted for other practice settings.

Suspected deep tissue injury profile: a pilot study.

PURPOSE: To enhance the learner’s competence with knowledge of the results of research examining suspected deep tissue injury profiles. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: Identify assessment tools and literature reviews of precipitating and contributing factors for suspected deep tissue injury (SDTI). Analyze data findings of precipitating and contributing factors for prediction for SDTI development based on this study’s data. ABSTRACT OBJECTIVE: The purpose of this study was to examine (1) the incidence of potential precipitating events of suspected deep tissue injuries (SDTIs) identified over a 7-day period prior to cutaneous manifestation, (2) physiological variables related to the formation of SDTIs, and (3) the time since precipitating events and the occurrence of the SDTI. DESIGN: A descriptive exploratory study. A retrospective chart review was conducted. SETTING: A 348-bed community Magnet-redesignated hospital, Baptist Health Lexington Kentucky PARTICPANTS: Eighty-five participants with SDTIs identified between January 2008 and March 2010. MAIN OUTCOME MEASURES: Precipitating events evaluated were tissue perfusion, surgery, transfers, mobility, and falls. Physiological variables included anticoagulation, albumin/prealbumin, hemoglobin, partial thromboplastin time, and hemoglobin A1c. Timeline differences between precipitating events and SDTI were measured. MAIN RESULTS: Precipitating events identified from most to least frequent were transfers = 67 (78.8%), tissue perfusion = 36 (42.5%), surgery = 33 (40.2%), mobility = 26 (30.9%), and falls = 14 (16.9%). Of the 85 charts reviewed, 69 of the charts met the criteria for timeline difference between precipitating event and SDTI manifestation. The range of days for precipitating events prior to SDTI manifestation was 1 to 5 days, an average of 2.41 (SD, 1.04) years. Meaningful physiological variables noted were anticoagulation 52 (61.2%), anemia (hemoglobin 6–9 g/dL) 53 (67.1%), and hemoglobin A1c less than 7.5 mmol/L 29 (74.4%). CONCLUSIONS: This exploratory pilot study evaluating patients with SDTI revealed the most common precipitating event was transfers. In addition, the physiological variables that appeared to contribute to the development of SDTIs were anticoagulation and anemia. The range of days for precipitating events prior to SDTI manifestation was 1 to 5 days, an average of 2.41 (SD, 1.04) days.

The Baptist Health High Risk Falls Assessment: a methodological study.

OBJECTIVE: The purpose of this study was to evaluate the psychometric properties of the Baptist Health High Risk Falls Assessment (BHHRFA). BACKGROUND: The cost of falls and the potential for increased patient morbidity and mortality necessitate the development of a psychometrically sound assessment. METHODS: Based on pilot data, a multisite study was conducted. Assessments were collected on 21 medical-surgical units, 1 rehabilitation unit, 1 psychiatric unit, and 3 critical care units (N = 241599). Sensitivity, specificity, and diagnostic odds ratios (DORs) were calculated. Clinical usefulness in terms of assessment performance time was addressed. RESULTS: Psychometric properties were within a desirable range for each site, critical care patients, and all participants (sensitivity, 0.64-1.00; specificity, 0.50-0.70; and DOR, 4.73-7.0). Although sensitivity at 1 site was high (0.84), specificity was low (0.37). CONCLUSIONS: Results suggest that the BHHRFA is clinically useful for adult inpatients across acute care settings.

The Baptist Health Lexington evidence-based practice model: a 5-year journey.

There are numerous advantages to basing nursing practice on evidence. Improvements in the quality of patient care, better patient outcomes, decreased healthcare costs, and enhanced work satisfaction for nurses have been described in the literature. Baptist Health Lexington, a community hospital, has experienced a successful 5-year journey integrating evidence-based practice as a result of the development of the Baptist Health Lexington Evidence-Based Practice Model. This journey is described below. Yearly activities, examples of projects, and clinical outcomes are presented.

Understanding Colorectal Screening Behaviors and Factors Associated With Screening in a Community Hospital Setting

BACKGROUND Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer death in the United States. More than 2,000 Kentuckians are diagnosed with CRC annually, and more than 800 die from the disease. Little research has been conducted in Kentucky to better understand why individuals are not screened for CRC and what strategies might encourage them to do so. OBJECTIVES The purpose of this study was to evaluate the efficacy of educational materials mailed to participants supporting the need for CRC screening on the decision to complete screening post-hospital discharge. An additional focus was to identify the characteristics of individuals screened and not screened. METHODS A quasi-experimental study was conducted on 167 adult patients discharged from a 383-bed Magnet-designated hospital. An investigator-designed, semistructured telephone interview was conducted to collect data on research-based factors identified to influence CRC screening rates. FINDINGS Although not statistically significant, slightly more patients who remembered receiving educational materials in the mail completed screening. Future educational efforts should focus on the importance of screening and financial resource availability.

Development and psychometric testing of the Honaker Suspected Deep Tissue Injury Severity Scale

PURPOSE: This article describes the development of the Honaker Suspected Deep Tissue Injury Severity Scale (HSDTISS). The aims of the instrument are to (a) accurately evaluate the severity of the suspected deep tissue injury (SDTI), (b) determine progression of SDTI, and (c) demonstrate utility of the instrument in the clinical setting. INSTRUMENT: The HSDTISS contains 3 items: total surface area size, skin integrity, and wound color/tissue assessment. The total surface area size item is scored on a scale of 1 to 8, the skin integrity item is scored on a scale from 1 to 3, and the wound color/tissue assessment item is scored on a scale of 1 to 7. A cumulative score is calculated for the HSDTISS; it ranges from 3 to 18. METHODS: Content validity and interrater reliability testing were calculated. Content validity was evaluated by reviewing the items and scorings of the HSDTISS. Validation was derived from 10 content experts who participated in 2 rounds of evaluation and feedback. Intraclass correlation was used to evaluate the interrater reliability of the HSDTISS in a group of 21 clinicians (6 physical therapists and 15 RNs) by using the HSDTISS to evaluate photographs of 3 patients with SDTIs upon initial assessment and at discharge. The clinical utility of the instrument was determined by evaluation and subsequent comments received from 10 staff nurses within the hospital. RESULTS: Feedback from content experts supported content validity of the instrument. Calculation of an intraclass correlation coefficient showed strong interrater reliability (r = 0.997, P < .001). The time involved to complete assessment of 6 photographs was 8.2 ± 2.3 minutes, suggesting that the HSDTISS is straightforward and easy to use. CONCLUSION: Findings from this study suggest that the HSDTISS accurately diagnoses wound severity among patients with SDTI. Further testing is needed to confirm these results in a larger group of clinicians with variable expertise in wound care. Further testing is needed to confirm these results among a larger group of clinicians.

Astym therapy improves function and range of motion following mastectomy

Hypersensitive scar tissue formation along the incision line and drain site is a common side effect following mastectomy. If this scar tissue is not addressed, it can lead to decreased flexibility and function in the involved upper quadrant. Astym® treatment is a new approach to soft tissue injuries, and is evidenced in animal studies to promote the healing and regeneration of soft tissues. It has also been found to reduce pain and increase function in people with soft tissue dysfunction. The aim of Astym treatment is to engage the regenerative mechanisms of the body in order to resorb scar tissue, stimulate tissue turnover, and regenerate soft tissues. Handheld instrumentation is applied topically to locate and treat the underlying dysfunctional soft tissue through specific protocols for the application of particular pressures and shear forces. The purpose of this study was to examine the effects of Astym treatment on activities of daily living in women who had undergone a mastectomy following a diagnosis of breast cancer. A quasi-experiment involving 40 women, following a mastectomy, evaluated five outcome measures pre- and post-Astym treatment. All five measurement scores: Disabilities of the Arm, Shoulder, and Hand Outcome Measure; a clothing questionnaire on their ability to wear a bra; Patient-Specific Functional Scale; active range of motion of shoulder flexion; and active range of motion of abduction were also measured and all demonstrated significant changes. In this study, Astym treatment improved active range of motion in the involved quadrant and also improved function in patients following a mastectomy.

Test-retest and Internal Consistency of the Disability of Arm, Shoulder and Hand (DASH) Outcome Measure in Assessing Functional Status among Breast Cancer Survivors with Lymphedema

Background: The Disability of Arm, Shoulder and Hand (DASH) outcome measure is a self‐report questionnaire that can be used with breast cancer survivors (BCS) to measure physical, social and psychological functioning of the upper limb. The internal consistency of the DASH outcome measure has been demonstrated in BCS but there is limited psychometric support for use of the DASH with BCS with lymphedema. Purpose: The purpose of this study was to determine test‐retest reliability and internal consistency for the use of the DASH among BCS with lymphedema. Methods: Following Institutional Review Board approval, test‐retest reliability was evaluated as follows: participants completed the DASH outcome measure at the initial physical therapy evaluation and again 2‐3 hours later by telephone interview (n=19). In order to test internal consistency of the DASH among BCS with lymphedema, a retrospective chart review of DASH scores (n=144) was conducted in a hospitalbased outpatient physical therapy facility. Coefficients reflecting internal consistency were calculated at initial evaluation (n = 144), 30 day re‐evaluation (n=44) and discharge (n=59). Results: Strong test re‐test reliability (ICC=0.97) and internal consistency (&agr;= 0.97, 0.92, and 0.98) were established. Conclusions: The DASH is a reliable measure of upper extremity function among BCS with lymphedema.