Implementation of an evidence-based practice nursing handover tool in intensive care using the knowledge-to-action framework

Background Miscommunication during handover has been linked to adverse patient events and is an international patient safety priority. Despite the development of handover resources, s tandardised handover tools for nursing team leader s in intensive care are limited. Aims The study aim was to implement and evaluate an evidence- based electronic minimum dataset for nursing team leader shift -to-shift handover in the intensive care unit using the k nowledge- to-action framework. Methods This study was conducted in a 21- bed medical/surgical intensive care unit in Queensland, Australia. Senior registered nurses involved in team leader handover were recruited. Three phases of the knowledge- to-action framework (select, tailor and implement interventions, monitor knowledge use and evaluate outcomes ) guided the implementation and evaluation process. A post -implementation practice audit and survey were carried out to determine nursing team leader use and perceptions of the electronic minimum dataset three months after implementation. Results are presented using descriptive statistics ( median, IQR, frequency and percentage) . Results Overall (86%, n=49) , team leader s used the electronic minimum dataset for handover and communication regarding patient plan increased . K ey content items however were absent from handovers and additional documentation was required alongside the minimum dataset to conduct handover. Of the team leader s surveyed (n=35), those receiving handover perceived the electronic minimum dataset more Page 4 of 24 positive ly than team leader s giving handover (n=35) . Benefits to using the electronic minimum dataset included the pat ient content (48%), suitability for short -stay patients (16%), decreased time updating (12%) and print ing the tool (12%) . Almost half of the participants however, found the minimum dataset contained irrelevant information, reported difficulties navigating and locating relevant information and pertinent information was missing. Suggestions for improvement focused on modifications to the electronic handover interface. Linking evidence to action Prior to developing and implementing electronic handover tools , adequate infrastructure is required to support knowledge translation and ensure clinician and organisational needs are met

Barriers and facilitators to the implementation of an evidence-based electronic minimum dataset for nursing team leader handover: A descriptive survey

© 2017 Australian College of Critical Care Nurses Ltd. Introduction: There is widespread use of clinical information systems in intensive care units however, the evidence to support electronic handover is limited. Objectives: The study aim was to assess the barriers and facilitators to use of an electronic minimum dataset for nursing team leader shift-to-shift handover in the intensive care unit prior to its implementation. Methods: The study was conducted in a 21-bed medical/surgical intensive care unit, specialising in cardiothoracic surgery at a tertiary referral hospital, in Queensland, Australia. An established tool was modified to the intensive care nursing handover context and a survey of all 63 nursing team leaders was undertaken. Survey statements were rated using a 6-point Likert scale with selections from 'strongly disagree' to 'strongly agree', and open-ended questions. Descriptive statistics were used to summarise results. Results and discussion: A total of 39 team leaders responded to the survey (62%). Team leaders used general intensive care work unit guidelines to inform practice however they were less familiar with the intensive care handover work unit guideline. Barriers to minimum dataset uptake included: a tool that was not user friendly, time consuming and contained too much information. Facilitators to minimum dataset adoption included: a tool that was user friendly, saved time and contained relevant information. Identifying the complexities of a healthcare setting prior to the implementation of an intervention assists researchers and clinicians to integrate new knowledge into healthcare settings. Conclusion: Barriers and facilitators to knowledge use focused on usability, content and efficiency of the electronic minimum dataset and can be used to inform tailored strategies to optimise team leaders' adoption of a minimum dataset for handover

Using the Plan-Do-Study-Act cycle to manage interruptions during nursing team leader handover in the intensive care unit: Quality improvement project

Introduction: Intensive care unit (ICU) nursing team leader (TL) handover is a process that is at risk for miscommunication, compromising patient safety. Interruptions during this process have the potential to increase miscommunication. Bedside handover and use of a structured handover tool are two strategies advocated internationally to improve safety of handover. Study objectives: This quality improvement project employed the Plan-Do-Study-Act (PDSA) cycle to improve handover processes during nursing TL handover, including to reduce interruptions post-implementation of a multidimensional strategy. Methods: The project was conducted in a 21-bed adult medical/surgical ICU, at a tertiary referral hospital, in Queensland, Australia. All TLs were invited to participate, with consent provided to observe and record process details of handover. Baseline data indicated that TLs experienced frequent interruptions during handover. An audit of the source and reason interruptions occurred informed the development of an intervention that included education sessions focussed on safe handover practices, hands on training using an evidence-based electronic minimum dataset to discuss patient information and the relocation of handovers from the central ICU desk to the bedside. Data were analysed using descriptive statistics (median, IQR, frequency and percentages). Results: Handovers during the baseline period (n = 40) were conducted at the central desk and attracted 64 interruptions, equivalent to one interruption every 23 min. After implementation of the improvement strategy (n = 49 handovers), 52 interruptions occurred at the bedside, equivalent to one interruption every 29 min. During both the baseline period and post-intervention nurses were the main source to interrupt handovers to exchange greetings with the TL and to discuss patient and organisational updates. Conclusion: The PDSA provided a structure to understand the problem, develop an improvement strategy and inform future work to effectively manage interruptions during nursing TL handover

GrameneMart: the BioMart data portal for the Gramene project

Gramene is a well-established resource for plant comparative genome analysis. Data are generated through automated and curated analyses and made available through web interfaces such as GrameneMart. The Gramene project was an early adopter of the BioMart software, which remains an integral and well-used component of the Gramene website. BioMart accessible data sets include plant gene annotations, plant variation catalogues, genetic markers, physical mapping entities, public DNA/mRNA sequences of various types and curated quantitative trait loci for various species. Database URL: http://www.gramene.org/biomart/martview

Developing a minimum dataset for nursing team leader handover in the intensive care unit: A focus group study

Background Despite increasing demand for structured processes to guide clinical handover, nursing handover tools are limited in the intensive care unit. Objectives The study aim was to identify key items to include in a minimum dataset for intensive care nursing team leader shift-to-shift handover. Methods This focus group study was conducted in a 21-bed medical/surgical intensive care unit in Australia. Senior registered nurses involved in team leader handovers were recruited. Focus groups were conducted using a nominal group technique to generate and prioritise minimum dataset items. Nurses were presented with content from previous team leader handovers and asked to select which content items to include in a minimum dataset. Participant responses were summarised as frequencies and percentages. Results Seventeen senior nurses participated in three focus groups. Participants agreed that ISBAR (Identify-Situation-Background-Assessment-Recommendations) was a useful tool to guide clinical handover. Items recommended to be included in the minimum dataset (≥65% agreement) included Identify (Name, age, days in intensive care), Situation (Diagnosis, surgical procedure), Background (Significant event(s), management of significant event(s)) and Recommendations (Patient plan for next shift,tasks to follow up for next shift). Overall, 30 of the 67 (45%) items in the Assessment category were considered important to include in the minimum dataset and focused on relevant observations and treatment within each body system. Other non-ISBAR items considered important to include related to the ICU (Admissions to ICU, staffing/skill mix, theatre cases) and patients (Infectious status, site of infection, end of life plan). Items were further categorised into those to include in all handovers and those to discuss only when relevant to the patient. Conclusions The findings suggest a minimum dataset for intensive care nursing team leader shift-to-shift handover should contain items within ISBAR along with unit and patient specific information to maintain continuity of care and patient safety across shift changes

Implementation and evaluation of an electronic minimum dataset for nursing team leader handover in the intensive care: An interventional study

Introduction: Miscommunication during handover has been linked to adverse patient events and is an international priority. There is widespread use of clinical information systems in intensive care units (ICU) however, evidence-based electronic handover tools are limited. Study objectives: The aim was to implement and evaluate an evidence-based electronic minimum dataset (eMDS) for ICU nursing team leader (TL) shift-to-shift handover using the Knowledge-to-Action (KTA) framework. Methods: The study was conducted in a 21-bed medical/surgical ICU, at a Queensland tertiary referral hospital. Consenting nurses involved in TL handover were recruited. Four phases of the KTA (barriers and facilitators, tailored interventions, monitor knowledge use and evaluate outcomes) guided the research. Pre-implementation, the barriers and facilitators to eMDS use were assessed via a survey; three months post-implementation a practice audit and survey identified uptake and TL perceptions of the eMDS. Results are summarised using descriptive statistics. Results: On the pre-implementation survey (n = 39) nurses identified a time-consuming tool that contained too much information as the most common barrier and a user-friendly tool that saved time and contained relevant information as the most common facilitator. Findings informed strategies employed (education, champions, reminders, ad-hoc audit and feedback) to implement the eMDS. Post-implementation, audit results showed 42 of 49 (86%) TLs used the eMDS for handover and communication of patient plans increased. Key eMDS items were absent and additional documentation was required alongside the eMDS. Survey findings identified benefits to eMDS use such as patient content, suitability for short-stay patients, decreased time updating and printing the tool. But, almost half the participants found the eMDS contained irrelevant information, reported difficulties navigating and locating specific information and important content was missing. Conclusion: Adequate infrastructure is required to facilitate eMDS use. The design needs to flexible, modifiable, seamless to navigate and contain content that promotes succinct and informative handovers

New Distributional Records of the Ohio Shrimp, Macrobrachium ohione Smith (Decapoda: Palaemonidae) in Arkansas

The Ohio shrimp (Macrobrachium ohione) is a migratory (amphidromous) river shrimp that occurs in some Arkansas rivers. It is known from the Upper Missouri River from its mouth downstream to the Gulf of Mexico, but shrimp abundance has declined, particularly upstream of Louisiana. Ohio Shrimp has also been collected in the lower reach of the Missouri River not far from the confluence of the Mississippi River in St. Louis County. Dams and alterations in channel flow are hypothesized to have impacted upriver migrations of shrimp. Current range, abundance, and life history of Ohio shrimp is relatively unknown in the Mississippi River basin in reaches distant from sea water. Here, we report recent collections of Ohio shrimp in Arkansas rivers that were notably greater than 800 km from the Gulf of Mexico

Measurement of the quenching factor of Na recoils in NaI(Tl)

Measurements of the quenching factor for sodium recoils in a 5 cm diameter NaI(Tl) crystal at room temperature have been made at a dedicated neutron facility at the University of Sheffield. The crystal has been exposed to 2.45 MeV mono-energetic neutrons generated by a Sodern GENIE 16 neutron generator, yielding nuclear recoils of energies between 10 and 100 keVnr. A cylindrical BC501A detector has been used to tag neutrons that scatter off sodium nuclei in the crystal. Cuts on pulse shape and time of flight have been performed on pulses recorded by an Acqiris DC265 digitiser with a 2 ns sampling time. Measured quenching factors of Na nuclei range from 19% to 26% in good agreement with other experiments, and a value of 25.2 \pm 6.4% has been determined for 10 keV sodium recoils. From pulse shape analysis, the mean times of pulses from electron and nuclear recoils have been compared down to 2 keVee. The experimental results are compared to those predicted by Lindhard theory, simulated by the SRIM Monte Carlo code, and a preliminary curve calculated by Prof. Akira Hitachi.Comment: 21 pages, 13 figure

Cosmic Acceleration, Dark Energy and Fundamental Physics

A web of interlocking observations has established that the expansion of the Universe is speeding up and not slowing, revealing the presence of some form of repulsive gravity. Within the context of general relativity the cause of cosmic acceleration is a highly elastic (p\sim -rho), very smooth form of energy called ``dark energy'' accounting for about 75% of the Universe. The ``simplest'' explanation for dark energy is the zero-point energy density associated with the quantum vacuum; however, all estimates for its value are many orders-of-magnitude too large. Other ideas for dark energy include a very light scalar field or a tangled network of topological defects. An alternate explanation invokes gravitational physics beyond general relativity. Observations and experiments underway and more precise cosmological measurements and laboratory experiments planned for the next decade will test whether or not dark energy is the quantum energy of the vacuum or something more exotic, and whether or not general relativity can self consistently explain cosmic acceleration. Dark energy is the most conspicuous example of physics beyond the standard model and perhaps the most profound mystery in all of science.Comment: 10 pages, 8 figures, invited review for Journal of the Physical Society of Japan, in pres