Mary Kanak

Predictors of Medication Errors Among Elderly Hospitalized Patients

Medication errors are a serious safety concern and most errors are preventable. A retrospective study design was employed to describe medication errors experienced during 10187 hospitalizations of elderly patients admitted to a Midwest teaching hospital between July 1, 1998 and December 31, 2001 and to determine the factors predictive of medication errors. The model considered patient characteristics, clinical conditions, interventions, and nursing unit characteristics. The dependent variable, medication error, was measured using a voluntary incident reporting system. There were 861 medication errors; 96% may have been preventable. Most errors were omissions errors (48.8%) and the source was administration (54%) or transcription errors (38%). Variables associated with a medication error included unique number of medications (polypharmacy), patient gender and race, RN staffing changes, medical and nursing interventions, and specific pharmacological agents. Further validation of this explanatory model and focused interventions may help decrease the incidence of medication errors. (Am J Med Qual 2008; 23:115-127)

Factors associated with falls during hospitalization in an older adult population.

Background: Falls of hospitalized older adults are of concern for patients, family members, third-party payers, and caregivers. Falls are the most common safety incident among hospitalized patients with fall rates from 2.9–13 per 1,000 patient days. Little effectiveness research has been conducted on nursing interventions and other variables associated with falls of older adults during hospitalization. Purpose: The purpose of this exploratory outcomes effectiveness study was to examine variables associated with falls during hospitalization of older adults. Method: An effectiveness research model composed of patient characteristics, clinical conditions, nursing unit characteristics, medical, pharmacy, and nursing interventions was tested using generalized estimating equations (GEE) analysis. The sample consisted of 10,187 hospitalizations of 7,851 patients, aged 60 or older, admitted for acute care services over a 4-year period. Those included in the sample either had received the Nursing Interventions Classification (NIC) intervention of Fall Prevention (defined as “instituting special precautions with patient at risk for injury from falling” [Dochterman & Bulechek, 2004, p. 363]) or were at risk for falling as defined by a fall risk assessment scale. Data were obtained retrospectively from 9 clinical and administrative data repositories from 1 tertiary care hospital. Discussion: Variables that were positively associated with falls, after controlling for other variables in the model, included several medical and nursing treatments; several types of medications including antidepressants, benzodiazepines, antipsychotic, and psychotropic agents; and several types of nursing treatments including restraints and neurologic monitoring (at low use rates of <2 times a day). Variables inversely associated with falls included registered nurse (RN) skill mix, pressure ulcer care, pain management, and tube care. Conclusions: The study demonstrates the importance of conducting interdisciplinary effectiveness research that includes nursing care. Most of the variables associated with falls were interventions (medical, pharmacy, and nursing). Dose of nursing treatments and RN skill mix were also associated with falls.

Cost of Hospital Care for Older Adults with Heart Failure: Medical, Pharmaceutical, and Nursing Costs

OBJECTIVE To determine the impact of patient characteristics, clinical conditions, hospital unit characteristics, and health care interventions on hospital cost of patients with heart failure. DATA SOURCES/STUDY SETTING Data for this study were part of a larger study that used electronic clinical data repositories from an 843-bed, academic medical center in the Midwest. STUDY DESIGN This retrospective, exploratory study used existing administrative and clinical data from 1,435 hospitalizations of 1,075 patients 60 years of age or older. A cost model was tested using generalized estimating equations (GEE) analysis. DATA COLLECTION/EXTRACTION METHODS Electronic databases used in this study were the medical record abstract, the financial data repository, the pharmacy repository; and the Nursing Information System repository. Data repositories were merged at the patient level into a relational database and housed on an SQL server. PRINCIPAL FINDINGS The model accounted for 88 percent of the variability in hospital costs for heart failure patients 60 years of age and older. The majority of variables that were associated with hospital cost were provider interventions. Each medical procedure increased cost by

Nursing interventions and other factors associated with discharge disposition in older patients after hip fractures.

623, each unique medication increased cost by

The effects of hospitalization on multiple units.

179, and the addition of each nursing intervention increased cost by

Neonatal ethanol exposure: some CNS effects

289. One medication and several nursing interventions were associated with lower cost. Nurse staffing below the average and residing on 2-4 units increased hospital cost. CONCLUSIONS The model and data analysis techniques used here provide an innovative and useful methodology to describe and quantify significant health care processes and their impact on cost per hospitalization. The findings indicate the importance of conducting research using existing clinical data in health care.

Describing Use of Nursing Interventions for Three Groups of Patients

Background: The research on hip fractures has been focused on surgical procedures for hip fracture repair; little is known about the contribution of nursing interventions to outcomes. Objectives: To investigate factors, including nursing interventions, associated with the discharge destination of an older patient population hospitalized for a fractured hip or an elective hip procedure. Nursing interventions used during the hospitalized period are identified. Methods: A design model composed of patient characteristics; clinical conditions; nursing unit characteristics; and medical, pharmacy, and nursing interventions related to the outcome of discharge disposition was tested using generalized estimating equations analysis. A total of 116 variables were examined in a sample of 569 hospitalizations from 524 patients aged 60 years and older admitted for treatment of a hip fracture or elective hip procedure in one tertiary care agency over a 4-year period. Data were obtained retrospectively from five clinical databases. Results: Fifty-four percent of the population was discharged to a location other than to home. The predictors of discharge to home were a younger age, admission from home, and having a spouse, as well as receipt of intravenous solutions, diagnostic ultrasound, a lower number of medications, and moderate use of the nursing intervention of bathing. The identification of nursing interventions indicates that those who received routine nursing care for this condition returned home while those who required interventions for complications or prevention of complications were discharged to an institution. Discussion: Using a standardized nursing language with the hospitals information system can provide nurses and others with information that demonstrates the contribution of nursing care to outcomes, including the outcome of discharge to home.

Cost of care for seniors hospitalized for hip fracture and related procedures

Patients are often cared for on multiple units during the course of a hospitalization. This study used general linear modeling and logistic regression analyses to demonstrate the effect of hospitalization on multiple units upon selected nursing treatments, resource use, and clinical outcomes. Primary medical diagnosis, comorbid medical conditions, and severity of illness were controlled for in the analyses. A significant association was found between hospitalizations on multiple units and selected nursing treatments, resource use, and all clinical outcomes except for mortality. Nurses play a central role in coordinating the care that patients receive across inpatient units and are positioned to develop and implement strategies to mediate the negative impacts associated with patients moving across multiple units.

Cost of hospital care for elderly at risk of falling.

The effects of neonatal ethanol exposure on brain growth and motor performance were investigated in Sprague-Dawley rats. Ethanol 4 g/kg body weight was given daily in divided doses via gastric gavage on days 6 through 16 after birth. The 6 g/kg dose was given similarly but only on day 6 after birth. Differences in body, whole brain, and cerebellar weights and balancing ability were observed on day 17 after birth, i.e., either one or 10 days after completion of the respective treatment schedules. At 70 days of age, body, liver and adrenal weights did not differ among treated and control groups, however differences persisted in whole brain and cerebellar weights and in motor performance in both treated groups as compared with controls. Cerebellar weight was disproportionately affected in treated as compared with control groups. These results suggest that episodic exposure to ethanol during peak brain growth may be as devastating to central nervous system development as chronic exposure to ethanol.