Nursing Assistants Research Articles

P-1265. Risk Factors for Contamination of Healthcare Personnel Gloves and Gown with Candida auris (C. auris)

Abstract Background C. auris is a rapidly emerging pathogen with the ability to spread quickly in healthcare settings. This study aims to describe patient, healthcare personnel (HCP), and environmental risk factors for hospital transmission of C. auris. Methods Patients with a history of C. auris were enrolled at 4 hospitals in the US. Upon enrollment, cultures were obtained from patients’ axilla, groin, finger webs, nares, and perirectal area/stool and from 8 environmental surfaces. The research team observed 10 HCP in each patient room and recorded care tasks and all items touched using a standardized data collection form. Prior to room exit, HCP gloves and gown were cultured. The primary outcome was a surrogate measure for transmission defined as HCP glove and/or gown contamination with C. auris. Results 123 patients were enrolled. 25 patients were negative for C. auris at all body sites upon enrollment and were removed from analyses. Among the 98 colonized patients, transmission to gloves or gown occurred in 285 (29%) observations. 250 (26%) and 118 (12%) of 980 observations resulted in glove and gown contamination, respectively. Gloves and/or gowns of respiratory therapists (36%) and patient care technicians (36%) were most frequently contaminated (Table 1). Care activities with the highest risk of transmission included handling the rectal tube (55%) and providing wound care (53%). Environmental surfaces with the highest risk of transmission were the vital sign monitor, supply cart, and ventilator (42% each) (Fig. 1). Any interactions that involved touching the patient resulted in glove and/or gown contamination in 252 of /747 (34%) of observations, while touching only the environment resulted in contamination in 33/233 (14%) of observations. Environmental surfaces were frequently contaminated (Fig. 2). Most patients were colonized at multiple body sites (Table 2). Conclusion HCP gloves and gowns frequently become contaminated during the routine care of patients with C. auris. Extensive colonization at multiple body sites and shed onto environmental surfaces likely contribute to transmission to HCP. These findings highlight the need for additional study of strategies to interrupt transmission and decrease C. auris-associated morbidity and mortality. Disclosures Anthony Harris, MD, MPH, Innoviva: Advisor/Consultant|UpToDate: Infection Control Editor Susan Huang, MD, MPH, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work Raveena D. Singh, MA, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work Raheeb Saavedra, AS, Xttrium Laboratories: Conducting studies in which participating hospital patients received contributed antiseptic products outside the submitted work

The Effectiveness of Pressure Injury Prevention Education for Patient Care Technicians in an Adult Acute Care Setting: A Quality Improvement Project.

The purpose of this quality improvement project was to determine whether hospital-acquired pressure injuries (HAPIs) could be prevented by implementing an educational tool kit for patient care technicians (PCTs). Data were collected from 24 PCTs and 43 patients in a 26-bed inpatient adult acute care unit at an academic medical center in the mid-Atlantic region of the United States. Outcome data were collected over an 8-week period from September to November 2021. Hospital-acquired pressure injury prevalence was collected using the National Database of Nursing Quality Indicators (NDNQI) survey process. Full- and part-time PCTs' knowledge and attitudes were assessed through modified Pressure Injury Prevention Knowledge and Attitudes towards Pressure Ulcer Prevention Instruments. The PCTs' compliance with prevention strategies was assessed among patients using the modified NDNQI audit scores. Descriptive statistics, Fisher's Exact test, and Mann-Whitney U test were used for analysis. Among the 24 PCTs, 66.7% (n=16) had received prior education on HAPI prevention strategies. Hospital-acquired or unit-acquired pressure injury prevalence rates did not change significantly following the educational intervention. Mean Pressure Injury Prevention Knowledge scores increased from pre- to post-intervention (92.86; SD 9.63 vs 94.05; SD 12.86). Average Attitude towards Pressure Ulcer Prevention scores decreased from pre- to post-intervention (27.79; SD 4.88 vs 21.0; SD 7.51), indicating poorer attitudes toward pressure injury prevention. The mean NDNQI audit scores significantly improved from pre-implementation (M 1.40; SD 0.82, n =20) to measurement following the intervention (M 2.35; SD 0.99, n =23; P=.014). An educational curriculum tailored for PCTs increased HAPI prevention strategies. The project site incorporated the HAPI prevention educational tool kit from this quality improvement project into their annual hospital-wide training for all PCTs to learn and implement HAPI prevention strategies in their work setting.

Detection of pneumococcal carriage in asymptomatic healthcare workers

Abstract Background Healthcare workers are at increased risk of exposure to respiratory pathogens including Streptococcus pneumoniae (pneumococcus). While little asymptomatic carriage has been reported in young-to-middle-aged adults, this may be due to non-sensitive diagnostic methods. The aim of the study was to investigate the rates of pneumococcal carriage in a large cohort of healthcare workers using saliva as a respiratory specimen. Methods We evaluated pneumococcal carriage in a convenience sample of saliva, self-collected from asymptomatic healthcare workers (CT, USA) who were testing for SARS-CoV-2 from March 30 to June 11, 2020. DNA extracted from the culture-enriched saliva was later tested using qPCR for piaB, lytA, and serotype. Saliva samples were considered positive for pneumococcus when the piaB Ct value was <40. Results Study participants were 22-74 years old (mean=38.5), 75% female, 75% white, with occupations including registered nurses (48%), medical doctors (23%), and patient care assistants (5%). Overall, 138/1241 (11%) samples from 86/392 (21%) individuals tested piaB-positive at some point during the 4-month study period, with 28 (33%) colonized individuals positive at multiple time points. Carriers reflected the overall study population. No significant demographic characteristics were associated with detection of pneumococcus. Colonized individuals primarily carried serotypes 19F (25.6%) and 3 (12.8%). Conclusions During a period of mandatory masking, we identified a cumulative pneumococcal carriage prevalence of 21% among healthcare workers. This study highlights that healthcare workers may act as unrecognized reservoirs of pneumococcus in the population. Despite long-standing pediatric immunization programs, vaccine-targeted serotypes continue to be prevalent among the adult population.

Penggunaan Crossword-puzzle dan Yes/No Questions dalam pengajaran Parts of Body dan Health Problems pada Siswa SMK Kesehatan

At the vocational high school level in Indonesia, English language teaching is still general with minimal ESP additions, so it is not enough to equip students to be able to communicate using English according to their future field of work. English material in Health Vocational High Schools is less focused on the specific needs of the health sector. The lack of variety of fun learning activities makes students less interested and motivated to learn English, especially related to health terms. Therefore, innovative and comprehensive learning is needed with materials that are appropriate for the needs of students as prospective nursing assistants. One of them is by utilizing crossword puzzle games and yes/no questions. The programs that have been implemented have proven effective in increasing students' interest in learning and their understanding of vocabulary related to body parts and health problems. This shows that a fun and interactive approach can be a good solution in learning English in Health Vocational High Schools.

Improving vascular access knowledge and assessment skill of hemodialysis staff.

Vascular access malfunction and failure contribute to morbidity and hospitalization in hemodialysis populations. Although controversy still exists over the identification and appropriate management of access malfunction, recognition of sentinel signs during physical examination remains an efficient way to screen for access malfunction. Dialysis staff are on the front line of providing quality care to dialysis patients, often being the first ones who could detect early physical signs of access malfunction. The study's purpose is to determine the effect of an advanced vascular access educational module presented to hemodialysis nurses and technicians, focusing on physical examination findings to identify a dialysis access at risk for malfunction. Utilizing a quasi-experimental pretest and posttest group design with a nonequivalent comparison control group, the effect of an advanced vascular access education module to improve vascular access knowledge and skill in recognition of sentinel signs of access malfunction was studied in a group of hemodialysis nurses (registered nurses [RNs]) and certified patient care technicians (PCTs). Knowledge post-test scores (RN, M=94.44, SD=7.05; PCT, M=90.83, SD=7.93) were significantly higher than pretest scores (RN, M=79.54, SD=12.47; PCT M=80.67, SD=7.99) in the intervention group (p<0.001) but not in the comparison group. There were no statistically significant differences in mean skill scores between dialysis nurses (p=0.38) and PCTs (p=0.826) or between intervention and comparison groups (p=0.332). This study exposes a critical gap in the transition of vascular access knowledge to the practical skill of access assessment. The findings suggest the need for restructuring the clinical training of dialysis nurses and PCTs in vascular access management and care. Newer active learning educational strategies in physical assessment of hemodialysis vascular access should be explored to further support dialysis nurses and PCTs in providing optimal patient care.

Vaccine hesitancy among health paraprofessionals: A mixed methods study.

The World Health Organization (WHO) defines vaccine hesitancy as "a delay in acceptance or refusal of vaccines despite availability of vaccination services". Vaccine hesitancy has also been declared a top threat to global health. Some employers imposed vaccine mandates during the Covid-19 pandemic resulting in health care employees resigning or being fired rather than receive a vaccine. Healthcare paraprofessionals such as certified nursing assistants, dietary and home health aides are among the most patient facing of all health care providers. Their beliefs and attitudes about vaccines are critical to how they communicate about vaccines with their patients. The objective of this project was to survey health care paraprofessionals to explore their thoughts and opinions about vaccines in general, and Covid-19 vaccines specifically. This was a 25 question, mixed methods, cross sectional email survey. Subjects were recruited from the mailing list of a non-profit organization in the Midwest. This organization is dedicated to bringing a face and a voice to healthcare paraprofessionals engaged in direct patient care. Most respondents were reasonably well informed about vaccines; had received one or more doses of indicated vaccines; used credible resources to learn about vaccines and believed physicians and pharmacists were the most trusted information sources. Qualitative results indicated that respondents expressed support for vaccines but that the support was often qualified in that a respondent may have had both pro and anti-vaccine opinions in the same response. They also expressed that communications about vaccines were often problematic. Additional vaccine-related continuing professional development for healthcare paraprofessionals appears to be indicated. Although attitudes towards vaccines were generally positive, respondents had concerns about the quality of vaccine information. Additional vaccine-related continuing professional development for healthcare paraprofessionals appears to be indicated.

A Comprehensive Review on the Synergy between Emergency Services, Nurses, Assistant Nurses, and Laboratory Teams in Critical Care

Emergency services as well as the nurses, assistant nurses and the laboratory teams, must work hand in hand when providing critical care. In critically-acclaimed cases where time is of the essence, interdisciplinary coordination enhances the diagnosis, delivery of treatments and patient outcomes. The emergency patient is kept safe, rapidly moved, and treated by triage and early care, followed by ward nurses and assistant nurses who can perform continuous observations, supported by laboratory personnel who provide essential information needed for treatment. However, collaboration is often faced with barriers such as communication breakdown, organizational structure, and lack of standard use of technology. Works released between 2010 and 2020 indicate that standardization of information transfer, such as the SBAR model, and embracing clinical information technology, such as EHR, improves team coordination, minimizes adverse events, and shortens reaction time. Also, interdisciplinary training is another important practice that helps ensure that different departments have enough trust for one another, enabling better integration. Since the changes in attitudes towards interdisciplinary collaboration, new technologies such as data sharing and diagnostics have enhanced the flow of information between teams. However, the patchy implementation throughout facilities has hindered this. Other areas that may need to be tackled to improve collaboration and support these initiatives include workload disparities, the number of staff, and other resources available to research and analyse different topics. This review systematically presents data regarding the collaboration of these teams. It highlights the implementation of common processes and information exchange in Main Communication Protocols and effective workflow for coordinating the care for critically ill patients as pillars for better outcomes in patient care in critical care settings.

Longitudinal interplay between subjective stress, anxiety, depression, and well-being in internet-based stress recovery intervention for nurses.

Cognitive behavioural therapy (CBT) interventions are effective in reducing subjective stress. Nevertheless, the longitudinal links between mental health indicators are rarely studied in intervention research. Therefore, it is unknown how the intervention effects are sustained. The current study investigated mechanisms explaining sustained intervention effects in a sample of medical nurses who receive a CBT-based internet-delivered stress recovery program. A single-group longitudinal study design with three measurement points, pre-test, post-test, and 3-month follow-up, was used in the current study. The sample consisted of nurses and assistant nurses from Lithuania (n=111, age: M (SD) = 41.69 years (10.85)) who had participated in a 6-week CBT internet intervention targeting stress recovery. Data were collected as the randomised control trial, the treatment samples were combined, and the data were analysed using cross-lagged panel analysis with four variables representing the psychological well-being and symptoms of stress, anxiety, and depression. The results revealed that decreased anxiety and increased psychological well-being at post-test predicted reduced stress levels at the 3-month follow-up. In addition, decreased anxiety at post-test predicted decreased depression at follow-up. Decreased anxiety and increased well-being could explain the sustainability of reduced stress following a CBT-based internet intervention for nurses. The implications of this for research and practice are discussed.

The sound of silence: health and social care students’ perspective on how sexual harassment from care recipients is not talked about in vocational education and training

ABSTRACT Sexual harassment is a widespread problem. In care work, a significant proportion of sexual harassment comes from care recipients. Vocational education and training has an important role to play in preparing students to deal with sexual harassment from care recipients, but students describe a silence about sexual harassment in their education. This paper uses theories of gender and institutional betrayal to examine the mechanisms that enable the silence surrounding the sexual harassment from care recipients that students describe exists in health and social care education. The data consists of focus group interviews with 49 students. The findings, derived from the students’ descriptions, indicate that the mechanisms that facilitate the perpetuation of silence regarding sexual harassment are as follows: firstly, assistant nurses are inclined to prioritise the needs of the care recipient, and they are expected to demonstrate loyalty to the care recipient rather than prioritise their own safety. Secondly, managers and future colleagues socialise students into an environment where sexual harassment is condoned.

Occupational groups and risk of suicidal behavior in men: a Swedish national cohort study during 2002–2019

IntroductionThe risk of suicide has been shown to vary by occupation. We aim to identify contemporary occupational groups at greatest risk for suicidal behaviour (fatal and non-fatal), in Swedish men of working-age.MethodsA population-based cohort study of male conscripts without history of self-harm who enlisted during 1968–2001 and were followed-up during 2002–2019 (n = 1 542 665). Occupational groups and suicidal behaviours were identified using national registers. Incidence rate ratios (IRR) for suicidal behaviour at ages 25–65 were calculated among occupational groups, and compared to the incidence rate of the whole cohort.ResultsMajor occupational groups with increased risk for suicidal behavior included elementary occupations, building and manufacturing, service, care and shop sale and mechanical manufacturing and transport. Subgroup analyses revealed particularly high risks for assistant nurses, other service workers not elsewhere classified, building frame and related trades workers and cleaners and helpers.ConclusionsMen with elementary occupations as well as personal care and building and manufacturing workers were at greatest risk. This study provides a comprehensive description of risks for suicidal behaviour among occupational groups in men of working-age. These results suggest occupational groups that should be targeted for general suicide prevention intervention.

Online education in palliative care - A national exploratory multimethod study

BackgroundWith an increased number of people living with multiple progressive diseases, online education courses have been created to address the growing need for competence in palliative care. However, there is limited knowledge about the form and content of these courses, or of participants’ experiences. This study aims to map the status, content, and evaluation of online palliative care courses in Sweden.MethodsThis exploratory study used both quantitative and qualitative methods. The study process involved searching for online palliative care courses on the web and through contact with Swedish palliative care organisations, and then participating in these courses, surveying education providers, and analysing and validating responses. Quantitative data were analysed using descriptive statistics, while thematic analysis was applied to the free-text responses.ResultsNine online courses provided by five different organisations were mapped. These courses educated over 30 000 healthcare professionals, predominantly assistant nurses and registered nurses. There was a large discrepancy between the number of people who enrolled in and the number who completed the online courses. Shortcomings identified related to lack of systematic evaluation from the participants’ perspectives, if and how knowledge was integrated into clinical practice, and difficulties in making the courses sustainable.ConclusionOverarching and national systems for online education are needed. These would require sustainability considerations and guidelines for implementation, evaluation and follow-up of non-university-based online educational initiatives in palliative care. In addition, it is crucial for employers to support professionals undergoing such education, ensuring that they are given opportunities to share their feelings and discuss any challenging thoughts that arise during and after the course.

Attitudes Toward Medical Assistance in Dying Among Swedish Palliative Care Professionals.

Background: The debate over legalizing medical assistance in dying (assisted dying) is ongoing, also in Nordic countries such as Sweden where assisted dying is illegal. A 2020 survey by the Swedish Medical Association highlighted varied perspectives, with 41% of physicians supporting and 34% opposing legalization. Professionals in palliative care were more negative toward it. Objective: To assess attitudes toward the legalization of, and the need for education about, assisted dying among Swedish palliative care professionals. Study Design: A survey with 19 closed- and 2 open-ended questions was administered to the participants of the 2023 Swedish National Conference on Palliative Care (including physicians, nurses, assistant nurses, administrators, and researchers). Results: Of the 866 conference participants who were invited, 444 (51%) participated. Predominantly, the cohort comprised women (89%); 60% were nurses and 17% physicians. The results showed that 38% opposed euthanasia, 36% supported it, and 26% remained undecided, with similar findings regarding physician-assisted suicide. There was a significant trend of increasingly negative attitudes with age and experience in palliative care (p < 0.01). Physicians emerged as the group most opposed to euthanasia (80%), whereas assistant nurses were the most positive, with 13% opposing legalization, and 33% of the nurses opposed euthanasia. The open-ended questions revealed thoughts regarding the complexity of the issue and the need for further discussion and education. Conclusion: In Sweden, where euthanasia and physician-assisted suicide is illegal, more than one-third of palliative care professionals were in favor of legalizing these practices while one-fourth were undecided, these proportions differed markedly between professions. Further, we uncovered a significant need for further discussion and education.

Postimplementation Evaluation in Assisted Living Facilities of an eHealth Medical Device Developed to Predict and Avoid Unplanned Hospitalizations: Pragmatic Trial.

The proportion of very old adults in the population is increasing, representing a significant challenge. Due to their vulnerability, there is a higher frequency of unplanned hospitalizations in this population, leading to adverse events. Digital tools based on artificial intelligence (AI) can help to identify early signs of vulnerability and unfavorable health events and can contribute to earlier and optimized management. This study aims to report the implementation in assisted living facilities of an innovative monitoring system (Presage Care) for predicting the short-term risk of emergency hospitalization. We describe its use and assess its performance. An uncontrolled multicenter intervention study was conducted between March and August 2022 in 7 assisted living facilities in France that house very old and vulnerable adults. The monitoring system was set up to provide alerts in cases of a high risk of emergency hospitalization. Nurse assistants (NAs) at the assisted living facilities used a smartphone app to complete a questionnaire on the functional status of the patients, comprising electronic patient-reported outcome measures (ePROMs); these were analyzed in real time by a previously designed machine learning algorithm. This remote monitoring of patients using ePROMs allowed notification of a coordinating nurse or a coordinating NA who subsequently informed the patient's nurses or physician. The primary outcomes were the acceptability and feasibility of the monitoring system in the context and confirmation of the effectiveness and efficiency of AI in risk prevention and detection in practical, real-life scenarios. The secondary outcome was the hospitalization rate after alert-triggered interventions. In this study, 118 of 194 (61%) eligible patients were included who had at least 1 follow-up visit. A total of 38 emergency hospitalizations were documented. The system generated 92 alerts for 47 of the 118 (40%) patients. Of these 92 alerts, 46 (50%) led to 46 health care interventions for 14 of the 118 (12%) patients and resulted in 4 hospitalizations. The other 46 of the 92 (50%) alerts did not trigger a health care intervention and resulted in 25 hospitalizations (P<.001). Almost all hospitalizations were associated with a lack of alert-triggered interventions (P<.001). System performance to predict hospitalization had a high specificity (96%) and negative predictive value (99.4%). The Presage Care system has been implemented with success in assisted living facilities. It was well accepted by coordinating nurses and performed well in predicting emergency hospitalizations. However, its use by NAs was less than expected. Overall, the system performed well in terms of performance and clinical impact in this setting. Nevertheless, further work is needed to improve the moderate use rate by NAs. ClinicalTrials.gov NCT05221697; https://clinicaltrials.gov/study/NCT05221697.

Influence of the Nursing Assistant Role in Nurse Satisfaction, Efficiency, and Patient Satisfaction in the Postanesthesia Care Unit

PurposeIn response to nurse concerns of the need for additional support from unit nursing assistants (NA) at the bedside, we set a goal to improve RN satisfaction with the role of the NA in the postanesthesia care unit (PACU). DesignProspective pre/post design. MethodsUsing LEAN methodology, the NA role was expanded to encompass their full scope of practice at the bedside, and the responsibility of performing patient transport from the PACU was reallocated to a Centralized Transport Service over a 6-month period. FindingsThe total number of transports performed by NA decreased by approximately 20%. Time spent waiting for a Centralized Transporter decreased from an average of 56 to 11 minutes. RN satisfaction increased in the 3 areas explored, with a 12.5% increase in median overall satisfaction with the NA role. Our facility’s Hospital Consumer Assessment of Healthcare Providers and Systems scores also increased from previous months after this project, alluding to more effective care delivered to patients in the PACU. ConclusionsRealignment of roles can promote efficiency and throughput. Communication fosters teamwork and can improve staff satisfaction.

ATUAÇÃO DO ENFERMEIRO NA ASSISTÊNCIA SEXUAL AOS IDOSOS: UMA REVISÃO DA LITERATURA

The aging process causes significant changes in human beings throughout life, which can be positive or negative and promote a new perception about the way of living. Among the areas directly influenced by the changes arising from the aging process, sexuality is revealed to be something permeated by prejudices and taboos. Therefore, the general objective of this study is to analyze, through a bibliographic review, the importance of the role of nurses in sexual assistance to the elderly, as well as to describe the main practices used by these professionals with this population. This is an integrative review of the literature that sought to answer the following guiding question: what does the scientific evidence published in the last six years (2019-2024) recommend regarding the role of nurses in sexual assistance to the elderly? The electronic databases used to select the articles were: Latin American Literature in Health Sciences (Lilacs), Nursing Databases (BDENF) and Scielo: (Scientific Electronic Library Online). After applying the pre-established criteria in the research, the search in the Lilacs, Scielo and Bdenf databases through the BVS – Virtual Health Library at the electronic address https://bvsalud.org/ resulted in a total of 11 articles. It was concluded that nurses play a fundamental role in sexual assistance to the elderly, and can use different practices and interventions to guide, inform and assist this population in clarifying doubts, preventing STIs, among other aspects. Among the interventions used by nurses in this context, educational actions, individual and collective consultations, discussion groups, lectures, and actions aimed at detecting and preventing diseases stand out.

ASSISTÊNCIA DE ENFERMAGEM A MULHERES VÍTIMAS DE VIOLÊNCIA SEXUAL

Sexual violence is a public health problem affecting millions of women worldwide, with severe consequences for their physical and mental health. In this context, nursing plays a fundamental role in attending to women who suffer domestico/sexual violence, highlighting the need for a victim-centered approach. Objective: To analyze the role of nursin in attending to victims of sexual violence, identifying challenges and perspectives for improving assistance. Methodology: Integrative literature review using databases: PubMed, Google Scholar, SciELO, and Virtual Health Library-BVS, including articles and publications from the last five years (2019-2023). Results: Significant challenges were identified in care, including lack of training, inadequate resources, and social stigma. Nursing plays a crucial role in welcoming and caring for victims, requiring a humanized and empathetic approach. Discussion: Nursing assistance to victims of sexual violence is essential for their recovery. It is necessary to invest in continuous training, adequate resources, and combating social stigma.Conclusion: Implementing standardized care protocols and providing psychosocial support to nursing professionals is also essential. Improving nursing assistance can enhance care effectiveness and promote the integral recove of affected women.

Nurse Care Management of Opioid Use Disorder Treatment After 3 Years

The Primary Care Opioid Use Disorders (PROUD) treatment trial was a 2-year implementation trial that demonstrated the Massachusetts office-based addiction treatment (OBAT) model of nurse care management for opioid use disorder (OUD) increased OUD treatment in the 2 years after implementation began (8.2 more patient-years of OUD treatment per 10 000 primary care patients). The intervention was continued for a third year, permitting evaluation of 3-year outcomes. To compare OUD medication treatment in intervention and usual care clinics over 3 years of implementation. This is a preplanned secondary analysis of a cluster randomized implementation trial, conducted in 6 health systems in 5 states (2 primary care clinics per health system) with clinic randomization stratified by system (assignment notification February 28, 2018 [August 31, 2018, in 1 system]). Data were obtained from electronic health records and insurance claims. Eligible patients were those aged 16 to 90 years visiting intervention or usual care clinics from 3 years before to 2 years after randomization. Patients new to clinics during the third year after randomization could not be included because COVID-19-era transitions to virtual care precluded assignment of patients to clinics. Data analysis occurred from November 2023 to September 2024. Clinics were randomized to intervention or care as usual. Intervention included 3 implementation components: salary for 1 full-time OBAT nurse per intervention clinic; training and ongoing technical assistance for nurses; and 3 or more primary care buprenorphine prescribers. Patient-years of OUD treatment (buprenorphine or extended-release naltrexone) per 10 000 primary care patients in the 3 years postrandomization. Mixed-effect models adjusted for baseline values of the outcome and included a health system-specific random intercept to account for correlation of clinic pairs within a system. Prerandomization, a total of 290 071 primary care patients were seen, including 130 618 in intervention clinics (mean [SD] age, 48.6 [17.7] years; mean [SD] female, 59.3% [4.0%]) and 159 453 in usual care clinics (mean [SD] age, 47.2 [17.5] years; mean [SD] female, 64.0% [5.3%]). Over 3 years postrandomization, intervention clinics provided 19.7 (95% CI, 11.1-28.4) more patient-years of OUD treatment per 10 000 primary care patients compared with usual care clinics. In this secondary analysis of the PROUD cluster randomized trial, after an added year of the intervention, OUD treatment continued to increase in intervention clinics compared with usual care. The treatment increase over 3 years exceeded that of the first 2 years, suggesting that implementation of the Massachusetts OBAT model leads to ongoing increases in OUD treatment among primary care patients in the third year of implementation. ClinicalTrials.gov Identifier: NCT03407638.

Rasch analysis of a palliative care self-efficacy instrument for nursing assistants

This study used Rasch models to evaluate the psychometric properties of a self-efficacy instrument focused on psychosocial aspects of palliative care developed for nursing assistants (NAs). NAs from 6 skilled nursing facilities in Illinois, U.S. (n=102) were divided into intervention and control groups and answered 16 questions at baseline and 1-month follow-up. A total of 84 NAs completed assessments at both times. The rating scale structure improved when 3 instead of 5 response categories were used. After removing 4 items, the instrument demonstrated unidimensionality and local independence. A person-item threshold map indicated a ceiling effect. For the intervention group, 2 items and 1 item became easier and more difficult respectively post-training. With adjustments, the 12-item instrument became an adequate measure of palliative care self-efficacy. By using PCSE-NA as a tool to assess palliative care self-efficacy of NAs, geriatric nurses can identify weaknesses of and ways to improve training for NAs.

Effectively Addressing Hospital-Acquired Pressure Injuries With a Multidisciplinary Approach.

Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national HAPI rate of 3.5% of observed patients. In rapid response, a multidisciplinary team was formed to address and improve the HAPI rate via a quality improvement project. To achieve the goal of decreased pressure injuries or ulcers, a team of nurses, patient care technicians, nutritionists, infectious disease specialists, radiologists, surgeons, vascular technicians, supply chain administrators, case management and social workers, hyperbaric medicine specialists, and wound care experts was created. The team completed a gap analysis and discovered inconsistencies in documentation and care practices that led to HAPI rates above the national average. The team then standardized a policy, standardized documentation of wounds, and provided staff education. Measures were implemented to proactively prevent pressure injuries. There was a 4.2 percentage point decrease in HAPIs from the beginning of the project (5.76%) to the last survey (1.59%). However, this difference was not statistically significant (P = .07). Overall, there were 6 fewer patients (8 vs 2 patients) with hospital-onset observed injury. Additionally, the length of stay decreased by 46%. Documentation of skin assessments within 24 hours of admission improved to 100%. We implemented a quality improvement program across 10 service lines, monitoring pressure injuries, HAPI incidence, and length of stay in 480 patients over 2 years. Although the reduction in HAPI was not statistically significant (P = .07), our program positively impacted the hospital's response to pressure injuries and warrants further replication.

Assessing the Effectiveness of a Non-Punitive Fall Prevention Program.

Our single-center, quality improvement project evaluated the impact of a fall reduction plan while using a Just Culture Algorithm that included weekly fall reviews involving front line staff using a non-punitive structure. The project has shown successful results. Prior to starting the program, data at this institution indicated falls were higher than the national fall rate of 3-5 per 1000 patient days. To achieve the goal of reducing the fall rate to below 3.1, an interdisciplinary fall committee was formed, consisting of nurses, nursing leaders, patient care technicians, pharmacists, and physical therapists. The committee operated in a non-punitive format and included all staff members directly involved in fall-related incidents. Protocols for implementing an evidence-based prevention program were developed to (1) address environmental concerns, (2) educate clinical workers and patients' families, (3) enforce interventions, (4) conduct weekly non-punitive, round table discussions, and (5) provide leadership support. Measures were implemented to proactively prevent falls. Data was collected and reported to all departments monthly. Following implementation of the program, results showed a statistically significant decrease in average fall rates per 1000 patient days from pre-intervention (4.05) to post-intervention (2.54) (P = .0001). Results showed improvement below the national average (3-5 falls per 1000 patient days), resulting in cost savings for the institution due to fewer falls. Inpatient medical-surgical and progressive care units had a noteworthy decline in the total number of falls, with notable estimated cost savings. Preventative interventions have shown effective results with compassionate, non-punitive leadership, an interdisciplinary team, and continuous follow-up education. Heeding to the Just Culture Algorithm as the foundation of weekly reviews, staff were empowered to engage in fall reduction strategies. A comprehensive weekly fall review program with ongoing staff education and transparent data reporting yielded a significant, sustained reduction in patient falls, with a substantial cost savings in excess of $1.6 million dollars over the life of the program.