Said Abusalem

Moving Healthcare Quality Forward With Nursing-Sensitive Value-Based Purchasing

Purpose: To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system. Design and Methods: Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP. Findings: Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing. Conclusions: Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs. Clinical Relevance: NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society.

Redefining the standardized infection ratio to aid in consumer value purchasing.

Abstract The derivations of the standardized infection ratio (SIR) are reviewed in this report. To be most understandable to the consumer, the SIR National Benchmark of 1.0 should reflect what is obtainable. The SIR is a tool intended to be used by consumers in value purchasing to compare differences between facilities and thus should not adjust for these differences. Ideally, factors used in risk adjustment should solely be based upon patient characteristics. Thus, facility-specific adjustments (i.e., medical school affiliation, major teaching institution and unit bed size) should be used with caution in calculating the SIR and their use made clearly transparent to health-care consumers. Using data downloaded from the US Department of Health and Human Services’ website, Hospital Compare, we observed an average SIR for central line blood stream infections of 0.568 and an SIR at the peak of the distribution curve approximating 0.35. A suggested methodology to calculate an obtainable SIR is to set the National Benchmark of 1.0 at the location of the distribution curve’s peak. The curve’s peak is more reflective of higher performing facilities. The SIR needs to reflect the expected performance of facilities, which are using up-to-date methods of infection control. The remainder of the facility SIRs can then be adjusted accordingly. It is recommended that the obtainable SIR be calculated every other year using data from the most recent 3 years. This enables the SIR to be reset as the control of health care–associated infections progressively improves.

Factors affecting well-being in adults recently diagnosed with rheumatoid arthritis

This article examines role stress, key psychosocial variables, and well-being in adults recently diagnosed with rheumatoid arthritis. Patients recently diagnosed with rheumatoid arthritis must often learn to balance disease and role-related responsibilities. This was cross-sectional, descriptive study (N = 80). Data were analyzed using correlation coefficients and linear regression models. Participants were predominantly female (78%), married, and employed. Mean age and disease duration were 54.2 years and 24.2 months, respectively. The findings suggest that well-being is influenced by feelings of being self-efficacious and having balance in their roles and less to do with social support received from others.

The incidence of MRSA infections in the United States: is a more comprehensive tracking system needed?

A review of epidemiological studies on the incidence of MRSA infections overtime was performed along with an analysis of data available for download from Hospital Compare (https://data.medicare.gov/data/hospital-compare). We found the estimations of the incidence of MRSA infections varied widely depending upon the type of population studied, the types of infections captured and in the definitions and terminology used to describe the results. We could not find definitive evidence that the incidence of MRSA infections in U.S. community or facilities is decreasing significantly. Of concern are recent data reported to the National Healthcare Safety Network (NHSN) on MRSA bloodstream infections which indicate that by the end of 2015 there had been little change in the average facility Standardized Infection Ratio (0.988), compared to a 2010–2011 baseline and is significantly increased compared to the previous year. This is in contradistinction to the recent Veterans Administration study which reported over an 80% reduction in MRSA infections. However, this discrepancy may be due to the inability to reconcile the baselines of the two data sets; and the observed increase may be artifactual due to aberrations in the NHSN tracking system. Our review supports the need for implementation of a comprehensive tracking and monitoring system involving all types of healthcare facilities for multi-drug resistant organisms, along with concomitant funding for both staff and infrastructure. Without such a system, determining the effectiveness of interventions such as antibiotic stewardship and chlorhexidine bathing will be hindered.

A perspective on the evidence regarding methicillin-resistant Staphylococcus aureus surveillance.

Abstract Two prominent studies have been used by policy makers to prevent the enactment of standards of care regarding active surveillance of patients with methicillin-resistant Staphylococcus aureus in hospital settings. In this brief review and perspective of those studies, we contend that both studies have serious limitations (i.e., the intervention group was not given optimal intervention) that may not have been scrutinized by many policy makers, health officials, and other researchers. These studies seem to have had a disproportionate impact on health-care policy despite their limitations. Furthermore, health-care policy and treatment standards need to reflect the preponderance of evidence with appropriate weight given to research studies based on their strengths and limitations. Only then can treatment standards that are effective against methicillin-resistant Staphylococcus aureus be adopted or refuted.

Home health nurses coping with practice care errors

The Institute of Medicine report from 2000 (To Err Is Human: Building a Safer Health System, National Academy Press, Washington, DC) highlighted the magnitude of practice care errors in the US healthcare system as well as the potentially life-threatening consequences they create. Nurses who make care errors experience a devastating mental and emotional impact and do not know how to deal with the experience. This study assessed how nurses cope with care errors and what strategies they use. A survey design was used for this study and 192 home health nurses completed the survey in a southeastern state. Packets containing sealed surveys, a flier, and a description of the study were mailed to the nurses. Results of the study with home health nurses indicate that nurses felt angry at themselves for making the care errors. Planful problem-solving was the most frequently used coping technique followed by accepting responsibility. The most commonly reported change in practice following a care error experience was paying more attention to detail, followed by personally confirming patient data and changing the organisation of data. Intervention research is needed to help nurses better deal and cope with care errors and to better assess the need for providing such nurses with professional support and counselling after becoming involved in a care error experience.

Quality of Life for Saudi Patients With Heart Failure: A Cross-Sectional Correlational Study

Introduction: Heart failure is a major public health issue and a growing concern in developing countries, including Saudi Arabia. Most related research was conducted in Western cultures and may have limited applicability for individuals in Saudi Arabia. Thus, this study assesses the quality of life of Saudi patients with heart failure. Materials and Methods: A cross-sectional correlational design was used on a convenient sample of 103 patients with heart failure. Data were collected using the Short Form-36 and the Medical Outcomes Study-Social Support Survey. Results: Overall, the patients’ scores were low for all domains of Quality of Life. The Physical Component Summary and Mental Component Summary mean scores and SDs were (36.7±12.4, 48.8±6.5) respectively, indicating poor Quality of Life. Left ventricular ejection fraction was the strongest predictor of both physical and mental summaries. Conclusion: Identifying factors that impact quality of life for Saudi heart failure patients is important in identifying and meeting their physical and psychosocial needs.

Mounting evidence supports universal surveillance for MRSA in preoperative patients.

The thrust of the evidence-based review, “Universal screening for methicillin-resistant Staphyloccus aureus in surgical patients,” in the Journal of the American College of Surgeons in ecember 2010 was to comment on the conflicting data rearding universal screening for methicillin-resistant Staphylooccus aureus (MRSA) in the surgical patient. An article from he Journal of the American Medical Association (JAMA) by arbarth and colleagues was used as the selected article to illustrate the conclusions.The commentary used this article as supporting evidence for not performing universal screening. However, in the analysis the following interpretation was made, “Also, only 43% of patients in the intervention group actually had changes made to their perioperative antibiotics because of time needed to get MRSA test results back.” In contradistinction, the Methods section of the JAMA article stated that of 386 identified MRSA carriers, 120 (31%) were not identified until after surgical intervention because of time delay and the urgency of surgery. Of the remaining 266 patients, 151 did not receive antibiotic prophylaxis against MRSA (57%). What can possibly be concluded when 57% of carriers, who were identified before surgery, were not given MRSA prophylaxis? In addition, it was stated that “especially in abdominal surgery, surgeons were reluctant to add vancomycin to the standard prophylactic regimen.” There is no question that preoperative screening in emergency patients will not be as effective if the results are not known before surgery and aminioglycosides were not given preoperatively. This patient group needs to be separated out in any data analysis. In addition, as the JAMA article pointed out, all of the 26 patients detected during outpatient visits had decolonization treatment and adequate prophylaxis and none developed a MRSA surgical infection. The vast majority of patients undergoing surgery do so on an elective or semielective basis. At our local hospitals, 80% of the patients fall into this category.

Staff-developed infection prevention program decreases health care-associated infection rates in pediatric critical care.

The health care team identified the causes of health care–associated infections (HAI) and developed interventions in a pediatric intensive care unit in Gaza. A quasi-experimental pretest-posttest design was used. All 26 full-time staff members in the pediatric intensive care unit participated. The HAI rate decreased significantly from the first to the second year following the implementation of the intervention (208 vs 120.55, odds ratio: 3.21, 95% confidence interval: 1.87-5.11; P < .001).

View point: gaps in the current guidelines for the prevention of Methicillin-resistant Staphylococcus aureus surgical site infections

The authors advocate the addition of two preventative strategies to the current United State’s guidelines for the prevention of surgical site infections. It is known that Staphylococcus aureus, including Methicillin-resistant Staphylococcus aureus (MRSA), carriers are at a higher risk for the development of infections and they can easily transmit the organism. The carriage rate of Staph. aureus in the general population approximates 33%. The CDC estimates the carriage rate of MRSA in the United States is approximately 2%. The first strategy is preoperative screening of surgical patients for Staph. aureus, including MRSA. This recommendation is based upon the growing literature which shows a benefit in both prevention of infections and guidance in preoperative antibiotic selection. The second is performing MRSA active surveillance screening on healthcare workers. The carriage rate of MRSA in healthcare workers approximates 5% and there are concerns of transmission of this pathogen to patients. MRSA decolonization of healthcare workers has been reported to approach a success rate of 90%. Healthcare workers colonized with dangerous pathogens, including MRSA, should be assigned to non-patient contact work areas. In addition, there needs to be implemented a safety net for both the worker’s economic security and healthcare. Finally, a reporting system for the healthcare worker acquisition and infections with dangerous pathogens needs to be implemented. These recommendations are needed because Staph. aureus including MRSA is endemic in the United States. Policies regarding endemic pathogens which are to be implemented only upon the occurrence of a facility defined “outbreak” have to be questioned, since absence of infections does not mean absence of transmission. Optimizing these policies will require further research but until then we should error on the side of patient safety.