Lynda J. Davidson

The Impact of Staffing on Patient Outcomes Across Specialty Units

Objective Determine the relationships between nursing staffing and specific nurse-sensitive outcomes (central line blood-associated infection, pressure ulcer, fall, medication error, and restraint application duration rates) across specialty units (cardiac and noncardiac intensive care, cardiac and noncardiac intermediate care, and medical–surgical). Background A number of hospital-level studies have demonstrated that lower staffing levels are associated with higher adverse patient outcomes. However, insufficient insight into unit-level staffing relationships is available. Further unit-level inquiry is necessary to fully explicate the relationships between staffing and outcomes and to provide assistance to nurse administrators as they seek to develop blueprints for staffing plans that are linked to quality outcomes. Methods Secondary analysis of prospective, observational data from 95 patient care units (cardiac intensive care, n = 15; noncardiac intensive care, n = 7; cardiac intermediate care, n = 18; noncardiac intermediate care, n = 12, and medical–surgical, n = 43) across 10 acute care hospitals. Results No statistically significant relationships were found between central line infection and pressure ulcer rates and staffing across specialty units. Significant inverse relationships were present between staffing and falls in cardiac intensive care, medication errors in both cardiac and noncardiac intensive care units, and restraint rates in the medical–surgical units. Conclusions Results from this study suggest that the impact of staffing on outcomes is highly variable across specialty units; however, when present, the relationships are inversely related with lower staffing levels, resulting in higher rates of all outcomes.

Technology in nursing education: a study of PDA use by students.

Personal digital assistants (PDAs) were first used by the public in the early 1990 s. Initially used as a device to manage personal information, these devices quickly evolved. Currently, PDAs are capable of storing and exchanging large amounts of information, which truly make them handheld computers. As such, they have great value for professional use. Health care professionals require access to ever-expanding knowledge, and PDAs or other handheld computer devices can serve as valuable tools for education, information storage and retrieval, and clinical practice. This article describes the use of PDAs by undergraduate and graduate nursing students during their educational process. A descriptive study was conducted at a small, private university school of nursing at which all nursing students receive PDAs prior to their first clinical experiences. Findings from the study indicated that students used their PDAs for both classroom and clinical activities and that drug reference software was the most frequently used software application. Information was also obtained about the facilitators and barriers to PDA use.

Microorganisms and Diarrhea in Enterally Fed Intensive Care Unit Patients

Thirty-six intensive care unit patients, receiving aseptic or manually (routine) reconstituted enteral feeding formulas, were evaluated prospectively for the relationship of microbial involvement, gastric pH, and antimicrobial therapy to diarrhea. The routine protocol group had a significantly higher incidence of bacterial contamination than the aseptic protocol group (Fishers exact test, p less than 0.05). There were no significant direct associations between isolate category (Gram-negative bacilli, Gram-positive cocci, Gram-negative cocci, yeast), gastric pH, or antimicrobials and diarrhea. However, two organisms (Group D Enterococci and yeast) were indirectly implicated in some cases of diarrhea.

The effects of psyllium hydrophilic mucilloid on diarrhea in enterally fed patients

OBJECTIVE To investigate the efficacy of psyllium hydrophilic mucilloid (PHM) for prevention of diarrhea and to compare methods of PHM delivery. DESIGN Experimental. SETTING University-affiliated Department of Veterans Affairs Medical Center. SUBJECTS Sixty patients from medical-surgical and intensive care units who received newly initiated enteral feeding via feeding tube. OUTCOME MEASURES Diarrhea, stool frequency and consistency, and feeding tube obstruction. INTERVENTION Receipt of PHM (7 gm, twice-daily) added to continuous feeding or given as a bolus with intermittent feeding, or receipt of No PHM for 7 days after initiation of enteral feeding. RESULTS Fifteen subjects (25%) developed diarrhea (defined as 3 or more liquid stools per day, or 2 or more liquid stools on successive days). There were no significant differences in incidence of diarrhea or percentage of days of diarrhea between subjects who did and did not receive PHM. However, subjects who received PHM in their continuous feedings had a significantly higher number of gelatinous stools, and the combined PHM groups had a significantly lower number of liquid stools and a higher number of normal stools than did subjects who did not receive PHM. For the combined PHM groups, there was a 12% incidence of small-bore feeding tube occlusion--requiring replacement. CONCLUSIONS Further study with a larger sample is necessary to evaluate trends found in this pilot study and to determine PHM efficacy for prevention of diarrhea. PHM administration may result in small-bore feeding tube obstruction, and thus requires adequate dilution and close monitoring.

Staffing and pattern of mechanical restraint use across a multiple hospital system.

BackgroundIn an effort to enhance patient safety in acute care settings, governmental and regulatory agencies have established initiatives aimed at limiting the use of mechanical restraints. Concurrently, hospital staffing levels are undergoing changes raising concerns about the impact these changes may have on restraint use. No studies to date have described the impact these two initiatives have had on restraint use in acute care hospitals. ObjectivesTo determine across a multiple hospital system: (a) the rates, frequencies, duration, and timing of restraint use, and (b) the relationship between restraint use and staffing. MethodsThis was a secondary analysis of prospective, observational data from a large outcomes database for 10 acute care hospitals. Monthly data were obtained from 94 patient care units for periods ranging from 1–12 months for a total of 566 cumulative months during 1999. ResultsThe system restraint application duration rate (total restraint hours/total possible hours) was 2.8% (hospital ranges: 0.3–4.4%). More restraints were applied on night shifts (48.8%;n = 5,296) than on day (33.5%;n = 3,634) or evening shifts (17.7%;n = 1,926) (p < .0001) and most applied at midnight (31.7%;n = 3,441) followed by 0600–0900 (33.3%;n = 3,614). There was a weak positive relationship between staffing and restraint use (r = 0.276, p = .0001) at the system level and units with higher staffing levels also had higher baseline restraint use (p < .0001). ConclusionsRestraint frequency, duration, and timing may have been altered by recent initiatives, and there is beginning evidence that differences exist between community, rural, and tertiary hospitals. While there is a weak positive relationship between higher staffing and restraint use at the system and unit level, further exploration of the influence of other factors, specifically patient acuity, are in order. The finding of unit variability and consistent restraint application times provides a starting point for further quality initiatives or research interventions aimed at restraint reduction.

Developing a Multi-institutional Nursing Report Card

As regulatory and public interest groups demand information on the quality of patient care outcomes produced by their hospitals and care providers, nurse administrators are establishing processes for the effective and efficient definition, retrieval, and reporting of patient outcomes thought to be nursing-sensitive. The authors describe the administrative infrastructure and the data management processes used by one large integrated healthcare system to establish a nursing report card and maintain it for several years.