Reducing Medication Errors Through Workflow Redesign

Lack of medication reconciliation at the point of transitions between skilled nursing facilities/nursing homes (SNF/NHs) and acute care hospitals (ACHs) is a common point of origin for medical errors that cause harm to patients. The goal of this quality improvement initiative was to improve medication reconciliation at the point of transition from the SNF/NH to the ACH which in turn would reduce medication errors, adverse drug events, and medication-induced injury to the vulnerable elderly population. We implemented a workflow redesign process to reconcile the accuracy of residents’ medications at the time of transfer from the SNF/NH to the ACH. After the initiation of a medication reconciliation protocol, 72% (n=13/18) of the medication administration records (MARs) had no medication errors

Treatment-Related Decisional Conflict, Quality of Life, and Comorbid Illness in Older Adults with Cancer

As the aging population in the nation increases, cancer diagnoses in this age group will also increase. The many chronic medical conditions associated with older adults are confounded by a diagnosis of cancer. Older adults with cancer are at risk for physical, psychological, and functional decline as a result of not only the cancer, but also the cancer treatment. In their current research agenda, the Oncology Nursing Society identified the need for research related to multiple comorbidities in older adults with cancer. This study utilized a cross-sectional, descriptive, correlational study design to explore the relationships between and among treatment-related decisional conflict, quality of life, and comorbidity in older adults with cancer. Oncology nurses recruited a sample size of 200 for this study from outpatient medical oncology, radiation oncology, and palliative care practices. Using an anonymous survey method, participants completed three psychometrically-sound instruments, including the Decisional Conflict Scale, Self-Administered Comorbidity Questionnaire, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Bivariate relationships existed between increased levels of decisional conflict and increased quality of life (p = .009) and quality of life and comorbidity (p = .001). All six regression models achieved significance (p \u3c .001). Statistically significant relationships were identified in each of the six regression models. Positive relationships existed between decisional conflict and financial problems, physical function, and global health status/quality of life. Increased emotional function may be predictive of decreased decisional conflict in all of the regression models. Other negative relationships existed between decisional conflict and cognitive function, diarrhea, spiritual support, insomnia, year diagnosed, fatigue, and nausea/vomiting. With their focus on patient-centered care, oncology nurses are a crucial component of the multidisciplinary cancer team that can empower older cancer patients to communicate their values and preferences regarding cancer treatment. Additionally, this study underscores the importance of oncology nurses being prepared to provide high-quality care to geriatric patients with multiple comorbidities. Given the paucity of research on the impact of cancer and its treatment on older adults, there are no published studies that address all of these variables. In light of the regression analyses, further research is needed with regard to emotional function, spiritual support, and symptom management in the setting of decision making in older adults with cancer. Poster presented at: Oncology Nursing Society 42nd Annual Congress in Denver, COhttps://jdc.jefferson.edu/nursingposters/1007/thumbnail.jp

The Big Opportunity: Advancing a Culture of Interprofessionalism

Historically, education has been siloed by disciplines leaving little room for interprofessional education to take place. Culture within an academic organization determines the strategies, modes of operation, goals, values, and terminal student learning outcomes. Using Kotter’s accelerated change management model, as a worksheet for educational cultural change, is an effective method to break complacency, generate ideas, align people, and overcome resistance to change

The time-dependent expression of keratins 5 and 13 during the reepithelialization of human skin wounds

The time-dependent reepithelialization of 55 human surgical skin wounds with a wound age between 8h and more than 2 months was investigated by the immunohistochemical localization of cytokeratins 5 and 13. A complete, rebuilt epidermal layer over the wound area was first detectable in a 5-day-old wound, while all wounds of more than 18 days duration contained a completely reepithelialized wound area. Between 5 and 18 days the basal layer of keratinocytes showed — in contrast to normal skin — only some cells positive for cytokeratin 5. In some, but not all lesions with a wound age of 13 days or more, a basal cell layer completely staining for cytokeratin 5 was demonstrable. This staining pattern was found in all skin wounds with a wound age of more than 23 days. The immunohistochemical detection of cytokeratin 13 which can be observed regularly in non-cornifying squamous epithelia provides no information for the time-estimation of human skin wounds, since no significant temporary expression of this polypeptide seems to occur during the healing of human skin wounds

Psychometric Properties of Standardized Patient and Faculty Rater\u27s Evaluations of Pre-Licensure Nursing Student Competencies

The use of simulation as a teaching modality has been rooted in the military, aviation, space, and engineering for centuries (Bradley, 2006). Clinical simulation allows for training of healthcare providers that might be too costly, risky, or hazardous in the clinical setting (Bradley, 2006). A variety of simulation modalities are used including virtual learning, task trainers, mannequins, and standardized patients (SPs). External demands for improved accountability of clinical performance is requiring nursing educators to reevaluate methods of teaching and how we measure nursing competence (Nehring & Lashley, 2010). Standardized patients have been used in medical school curricula to teach and evaluate clinical competence of medical students for decades (Boulet, 2008). Even though SP programs are used and well-researched in medical schools, the majority of nursing schools have adopted high-fidelity mannequin simulation programs (Sanford, 2010). Standardized patients contribute to increased realism by exposing students to a real patient with opportunities to practice compassionate and empathetic communication skills and receive feedback on how to fine-tune their bedside manner. The capacity to provide compassionate care is the heart and soul of nursing practice as identified by American Association of Colleges of Nursing and the National League of Nursing (Rhodes, Morris, & Lazenby, 2011). SP reliability and validity are well established within medical education, reporting 88-92% agreement on checklists between SPs and faculty. Competency checklists in pre- licensure registered nursing curricula have not been accompanied with equally rigorous psychometric evaluation thus it is unclear whether SP utility in nursing is equivalent to medical education. This study examines the inter-rater reliability and percent agreement of standardized patients and faculty checklist scores when evaluating pre-licensure nursing students. Data analysis of SP and faculty scores found significant agreement (94%-98%) as seen in medical education decades ago. Low internal consistency measures and moderate kappa scores suggest additional research is needed working with multi-site, large sample sizes using the same methodology, cases, and checklists. Nursing programs primarily using mannequins have not been able to realize the potential of using SPs, not only in the evaluation of competence, but also in laying the foundation of practicing and reflecting on humanistic care

Prevalence of Binge Eating Disorder in an Insurance-Based Weight Management Center

Purpose: This project was anticipated to demonstrate an increase in the number of those diagnosed with BED according to Diagnostic and Statistical Manual (DSM) 5 criteria, diagnosed with ICD-10 code F50.8 or R63.2 and treated according to best practice guidelines. Background: Binge eating disorder (BED) is the most common eating disorder in the United States, more than both anorexia and bulimia combined. It affects 3.5 percent of women, 2 percent of men and 30 percent of those seeking weight management. Design: This evidenced-based project consisted of a retrospective analysis of 150 patients seen in a weight management clinic setting since implementing the ICD-10 coding system 02/09/16. Findings: Results demonstrated the prevalence of BED in this weight management center was 27.5%, 44% were diagnosed with an ICD 10 code, and approximately 20% were provided with evidence based treatments. Clinical Implications: Understanding the prevalence of BED demonstrates the need for increased screening methods to optimize the likelihood patients obtain empirically supported treatment