Control Wards Research Articles

Bedside or not bedside: Evaluation of patient satisfaction in intensive medical rehabilitation wards.

BackgroundConcerns that bedside presentation (BsP) rounds could make patients uncomfortable led many residency programs to move daily rounds outside the patients’ room (OsPR). We performed a prospective quasi-experimental controlled study measuring the effect of these two approaches on patient satisfaction.MethodsPatient satisfaction was measured using the Picker questionnaire (PiQ). Results are expressed in problematic percentage scores scaled from 0 = best-100 = worst. During three months, 3 wards of a 6 ward medical rehabilitation division implemented BsP and 3 control wards kept their usual organization of rounds. In total, 90 patients of each group were included in the study and completed the PiQ.ResultsSocio-clinical characteristics were similar in both groups: mean age = 67 years (SD = 13), mean Charlson comorbidity index = 8.6 (2.4); mean length of stay = 22 days (12). During their stay, patients in the BsP units had a mean of 14.3 (8) BsP rounds and 0.5 (0.8) OsPR; control patients had a mean of 0.9 (0.7) BsP and 14.8 (7.3) OsPR (p<0.0001). Patients in BsP units reported lower problematic scores regarding coordination of care (39% vs 45%, p = 0.029), involvement of family/friends (29 vs 41%, p = 0.006) and continuity/transition (44% vs 54%, p = 0.020); two questions of the PiQ had worse scores in the BsP: trust in nurses (46.7% vs 30 %, p = 0.021) and recommendation of the institution (61.1% vs 44.4%. p = 0.025). No worsening in dimensions such as respect for patient preferences was seen.ConclusionsBsP rounds influenced the patient-healthcare professionals’ encounter. These rounds were associated with improved patient satisfaction with care, particularly regarding interprofessional collaboration and discharge planning.

Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention

ObjectiveTo evaluate the efficacy of the Patient Reporting and Action for a Safe Environment intervention.DesignA multicentre cluster randomised controlled trial.SettingClusters were 33 hospital wards within five hospitals in the UK.ParticipantsAll...

CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients

BackgroundOlder inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital. This study will test effectiveness of implementing Eat Walk Engage using a multi-site cluster randomised trial to inform transferability of this intervention.MethodsA hybrid study design will evaluate the effectiveness and implementation strategy of Eat Walk Engage in a real-world setting. A multisite cluster randomised study will be conducted in 8 medical and surgical wards in 4 hospitals, with one ward in each site randomised to implement Eat Walk Engage (intervention) and one to continue usual care (control). Intervention wards will be supported to develop and implement locally tailored strategies to enhance early mobility, nutrition, and meaningful activities. Resources will include a trained, mentored facilitator, audit support, a trained healthcare assistant, and support by an expert facilitator team using the i-PARIHS implementation framework. Patient outcomes and process measures before and after intervention will be compared between intervention and control wards. Primary outcomes are any hospital-associated geriatric syndrome (delirium, functional decline, falls, pressure injuries, new incontinence) and length of stay. Secondary outcomes include discharge destination; 30-day mortality, function and quality of life; 6 month readmissions; and cost-effectiveness. Process measures including patient interviews, activity mapping and mealtime audits will inform interventions in each site and measure improvement progress. Factors influencing the trajectory of implementation success will be monitored on implementation wards.DiscussionUsing a hybrid design and guided by an explicit implementation framework, the CHERISH study will establish the effectiveness, cost-effectiveness and transferability of a successful pilot program for improving care of older inpatients, and identify features that support successful implementation.Trial registrationACTRN12615000879561 registered prospectively 21/8/2015.

Effect of a Palliative Care Nurse Champion Program on Nursing Care of Dying Patients in the Hospital: A Controlled before and after Study

Objective: Hospitals increasingly appoint nurse champions to improve quality of care. This study investigated the effect of palliative care nurse champions on nursing end-of-life care. Methods: Imbedded in a controlled before-after study (June 2009-July 2012) on care for the dying patient in the hospital, nurses completed questionnaires on end-of-life care within two weeks after the patient’s death. Halfway the study, seven out of 18 participating wards appointed two palliative care nurse champions. Characteristics of end-of-life care were compared for patients who died before and after the introduction of the nurse champion program and with outcomes in 11 control wards. Results: In the intervention wards, data were collected on 81 patients in the pre-intervention period and on 93 patients in the post-intervention period; in control wards these numbers were 114 and 121, respectively (response 54%). After the introduction of the nurse champion program, nurses in the intervention wards more frequently discussed imminent death with patients (35% pre-intervention vs 50% post-intervention, p=0.05), were more frequently aware of psychological symptoms (57% vs 71%, p=0.04), and performed less futile interventions during the final hours (on average 0.8 vs 0.4 out of 4 interventions, p<0.01). These differences were not found in the control wards. No effect was found on nurses’ awareness of patients’ imminent death. Nurses’ median score for quality of dying was lower in the postintervention period (7.5 vs 7.0 on a 0-10 scale; p=0.02). Conclusion: It had a beneficial effect on end-of-life nursing care in hospital. We found increased communication and more awareness of patients’ palliative care needs. Increased awareness seems to have made nurses more critical about the quality of dying.

Effect of a Palliative Care Nurse Champion Program on Nursing Care of Dying Patients in the Hospital: A Controlled before and after Study

Objective: Hospitals increasingly appoint nurse champions to improve quality of care. This study investigated the effect of palliative care nurse champions on nursing end-of-life care. Methods: Imbedded in a controlled before-after study (June 2009-July 2012) on care for the dying patient in the hospital, nurses completed questionnaires on end-of-life care within two weeks after the patient’s death. Halfway the study, seven out of 18 participating wards appointed two palliative care nurse champions. Characteristics of end-of-life care were compared for patients who died before and after the introduction of the nurse champion program and with outcomes in 11 control wards. Results: In the intervention wards, data were collected on 81 patients in the pre-intervention period and on 93 patients in the post-intervention period; in control wards these numbers were 114 and 121, respectively (response 54%). After the introduction of the nurse champion program, nurses in the intervention wards more frequently discussed imminent death with patients (35% pre-intervention vs 50% post-intervention, p=0.05), were more frequently aware of psychological symptoms (57% vs 71%, p=0.04), and performed less futile interventions during the final hours (on average 0.8 vs 0.4 out of 4 interventions, p<0.01). These differences were not found in the control wards. No effect was found on nurses’ awareness of patients’ imminent death. Nurses’ median score for quality of dying was lower in the postintervention period (7.5 vs 7.0 on a 0-10 scale; p=0.02). Conclusion: It had a beneficial effect on end-of-life nursing care in hospital. We found increased communication and more awareness of patients’ palliative care needs. Increased awareness seems to have made nurses more critical about the quality of dying.

Aggression in Psychiatric Wards: Effect of the Use of a Structured Risk Assessment

Health care workers are often exposed to violence and aggression in psychiatric settings. Short-term risk assessments, such as the Brøset Violence Checklist (BVC), are strong predictors of such aggression and may enable staff to take preventive measures against aggression. This study evaluated whether the routine use of the BVC could reduce the frequency of patient aggression. We conducted a study with a semi-random regression discontinuity design in 15 psychiatric wards. Baseline aggression risk was assessed using the Aggression Observation Short Form (AOS) over three months. The BVC was implemented in seven intervention wards, and the risk of aggressive incidents over three months of follow-up was compared with the risk in eight control wards. The analysis was conducted at the ward level because each ward was allocated to the intervention and control groups. At baseline, the risk of aggression varied between wards, from one aggressive incident per patient per 1,000 shifts to 147 aggressive incidents per patient per 1,000 shifts. The regression discontinuity analysis found a 45% reduction in the risk of aggression (Odds Ratio (OR) = 0.55, 95% confidence interval: 0.21–1.43). The study did not find a significant reduction in the risk of aggression after implementing a systematic short-term risk assessment with the BVC. Although our findings suggest that use of the BVC may reduce the risk of aggression, the results need to be confirmed in studies with more statistical power.

A multi-component patient-handling intervention improves attitudes and behaviors for safe patient handling and reduces aggression experienced by nursing staff: A controlled before-after study

This study evaluated an intervention for patient-handling equipment aimed to improve nursing staffs' use of patient handling equipment and improve their general health, reduce musculoskeletal problems, aggressive episodes, days of absence and work-related accidents. As a controlled before-after study, questionnaire data were collected at baseline and 12-month follow-up among nursing staff at intervention and control wards at two hospitals. At 12-month follow-up, the intervention group had more positive attitudes towards patient-handling equipment and increased use of specific patient-handling equipment. In addition, a lower proportion of nursing staff in the intervention group had experienced physically aggressive episodes. No significant change was observed in general health status, musculoskeletal problems, days of absence or work-related accidents. The intervention resulted in more positive attitudes and behaviours for safe patient-handling and less physically aggressive episodes. However, this did not translate into improved health of the staff during the 12-month study period.

Training hospital staff on spiritual care in palliative care influences patient-reported outcomes: Results of a quasi-experimental study

Background: Spiritual care is reported to be important to palliative patients. There is an increasing need for education in spiritual care. Aim: To measure the effects of a specific spiritual care training on patients’ reports of their perceived care and treatment. Design: A pragmatic controlled trial conducted between February 2014 and March 2015. Setting/participants: The intervention was a specific spiritual care training implemented by healthcare chaplains to eight multidisciplinary teams in six hospitals on regular wards in which patients resided in both curative and palliative trajectories. In total, 85 patients were included based on the Dutch translation of the Supportive and Palliative Care Indicators Tool. Data were collected in the intervention and control wards pre- and post-training using questionnaires on physical symptoms, spiritual distress, involvement and attitudes (Spiritual Attitude and Involvement List) and on the perceived focus of healthcare professionals on patients’ spiritual needs. Results: All 85 patients had high scores on spiritual themes and involvement. Patients reported that attention to their spiritual needs was very important. We found a significant (p = 0.008) effect on healthcare professionals’ attention to patients’ spiritual and existential needs and a significant (p = 0.020) effect in favour of patients’ sleep. No effect on the spiritual distress of patients or their proxies was found. Conclusion: The effects of spiritual care training can be measured using patient-reported outcomes and seemed to indicate a positive effect on the quality of care. Future research should focus on optimizing the spiritual care training to identify the most effective elements and developing strategies to ensure long-term positive effects. This study was registered at the Dutch Trial Register: NTR4559.

PHS126 - Cost-Effectiveness Analysis of An Automated Medication System Implemented In A Danish Hospital Setting

The objective of this study was to evaluate the cost effectiveness of an automated medication system (AMS) integrating electronic medication administration record (eMAR), automated drug dispensing and barcode assisted. The economic evaluation was performed alongside a controlled before-and-after effectiveness study. The primary outcome measure was number of errors in the medication administration process observed prospectively during a 3-week period. To determine the difference in error rate after implementation of AMS, logistic regression was applied with the presence of error(s) as the dependent variable and time, group and interaction between time and group as the independent variables. The cost analysis used the hospital perspective and employed a short-term incremental costing approach. The total 6-month costs with and without the AMS were calculated as well the incremental costs. The number of avoided administration errors was related to the incremental costs to obtain the cost effectiveness ratio expressed as the cost per avoided administration error. The AMS resulted in an overall reduced risk of errors of 81% in the intervention compared to the control ward (OR 0.19 [0.10-0.34]). The procedural error rate was reduced from 0.20 to 0.002 (OR 0.18 [0.09-0.35]) and the clinical error rate was reduced from 0.03 to 0.01 in the intervention ward (OR 0.24 [0.07-0.83]). The cost analysis showed that the AMS increased the cost with 16,843 €. The cost-effectiveness ratio was estimated at 2.60 € per avoided administration error, 2.91 € per avoided procedural error and 19.38 € per avoided clinical error. The automated medication system was effective in reducing the error rate in the medication administration process at a higher cost. The cost-effectiveness analysis showed that the automated medication system was associated with affordable cost-effectiveness rates.

Feasibility, appropriateness, meaningfulness and effectiveness of patient participation at bedside shift reporting: mixed-method research protocol.

To evaluate the feasibility, appropriateness, meaningfulness and effectiveness of bedside shift reporting in a minimum of five interventions and five control wards. Hospitals continually improve their quality of care. Next to improvements in clinical performance, more patient participation is stimulated through different methods. Methods to enhance patient participation such as bedside shift reporting lack rigorously performed research to determine their feasibility, appropriateness, meaningfulness and effectiveness. Small-scale research and a previous pilot study indicate that bedside shift reporting improves patient participation, nurse-nurse communication and nurse-patient communication. The development, implementation and evaluation of bedside shift report are based on the Medical Research Council framework for complex interventions in health care. A matched, controlled, mixed-method, longitudinal study design will be used. The Feasibility-Appropriateness-Meaningfulness-Effectiveness framework will be applied for the quantitative and qualitative evaluation of bedside shift report. A tailored intervention and implementation process for bedside shift report will be developed using diagnostic interviews, co-design and acceptability testing. The intervention will be evaluated before implementation and three times after implementation. Individual and focus group interviews will be performed. Questionnaires, observations and analysis of the medical records and administrative databases will be completed. This study was funded in October 2015. Research Ethics Committee approval was granted in March 2016. There is a pressing need for rigorous research into the effects of interventions for improving patient participation. This study addresses the significance of bedside shift report as an intervention to improve quality of care, communication and patient participation within a large-scale, matched, controlled research design.

ISQUA16-2578CAN PATIENT INVOLVEMENT IMPROVE PATIENT SAFETY? A CLUSTER RANDOMIZED CONTROL TRIAL OF THE PATIENT REPORTING AND ACTION FOR A SAFE ENVIRONMENT (PRASE) INTERVENTION: Table 1

OBJECTIVE: To evaluate the efficacy of the Patient Reporting and Action for a Safe Environment intervention. DESIGN: A multicentre cluster randomised controlled trial. SETTING: Clusters were 33 hospital wards within five hospitals in the UK. PARTICIPANTS: All patients able to give informed consent were eligible to take part. Wards were allocated to the intervention or control condition. INTERVENTION: The ward-level intervention comprised two tools: (1) a questionnaire that asked patients about factors contributing to safety (patient measure of safety (PMOS)) and (2) a proforma for patients to report both safety concerns and positive experiences (patient incident reporting tool). Feedback was considered in multidisciplinary action planning meetings. MEASUREMENTS: Primary outcomes were routinely collected ward-level harm-free care (HFC) scores and patient-level feedback on safety (PMOS). RESULTS: Intervention uptake and retention of wards was 100% and patient participation was high (86%). We found no significant effect of the intervention on any outcomes at 6 or 12 months. However, for new harms (ie, those for which the wards were directly accountable) intervention wards did show greater, though non-significant, improvement compared with control wards. Analyses also indicated that improvements were largest for wards that showed the greatest compliance with the intervention. LIMITATIONS: Adherence to the intervention, particularly the implementation of action plans, was poor. Patient safety outcomes may represent too blunt a measure. CONCLUSIONS: Patients are willing to provide feedback about the safety of their care. However, we were unable to demonstrate any overall effect of this intervention on either measure of patient safety and therefore cannot recommend this intervention for wider uptake. Findings indicate promise for increasing HFC where wards implement ≥75% of the intervention components. TRIAL REGISTRATION NUMBER: ISRCTN07689702; pre-results.

Motivational aftercare planning to better care: Applying the principles of advanced directives and motivational interviewing to discharge planning for people with mental illness.

Improving the input of people with mental illness into their recovery plans can potentially lead to better outcomes. In the present study, we evaluated the introduction of motivational aftercare planning (MAP) into the discharge planning of psychiatric inpatients. MAP is a manualized intervention combining motivational interviewing with advance directives. We measured changes in the level of patient input into discharge planning following training staff in the use of MAP. This included the following: (i) documentation of early relapse signs along with successful past responses; (ii) evidence of aftercare planning; and (iii) the use of the patients' own words in the plan. We used a ward-level controlled before-and-after design comparing one intervention ward with two control wards. We used anonymized recovery plans, with a goal of 50 plans per ward before and after the intervention, to look for evidence of patient input into care planning with a standardized checklist. There were also qualitative interviews with individuals discharged from the unit. We reviewed 100 intervention ward plans and 197 control ones (total n=297). There were no significant differences in recovery plans from intervention and control wards at baseline. Following MAP training, the intervention ward improved significantly (e.g. identification of triggers increased from 52 to 94%, χ2 =23.3, d.f.=1, P<0.001). This did not occur in the control wards. The qualitative data (n=20 interviews) showed improvements in participants' experiences of discharge planning. MAP increased inpatient input into discharge planning and was valued by participants. The effect on subsequent health service use needs evaluation.

Impact of peer-led quality improvement networks on quality of inpatient mental health care: study protocol for a cluster randomized controlled trial.

BackgroundQuality improvement networks are peer-led programmes in which members of the network assess the quality of care colleagues provide according to agreed standards of practice. These networks aim to help members identify areas of service provision that could be improved and share good practice. Despite the widespread use of peer-led quality improvement networks, there is very little information about their impact. We are conducting a cluster randomized controlled trial of a quality improvement network for low-secure mental health wards to examine the impact of membership on the process and outcomes of care over a 12 month period.MethodsStandalone low secure units in England and Wales that expressed an interest in joining the quality improvement network were recruited for the study from 2012 to 2014. Thirty-eight units were randomly allocated to either the active intervention (participation in the network n = 18) or a control arm (delayed participation in the network n = 20). Using a 5 % significance level and 90 % power, it was calculated that a sample size of 60 wards was required taking into account a 10 % drop out. A total of 75 wards were assessed at baseline and 8 wards dropped out the study before the data collection at follow up. Researchers masked to the allocation status of the units assessed all study outcomes at baseline and follow-up 12 months later. The primary outcome is the quality of the physical environment and facilities on the wards. The secondary outcomes are: safety of the ward, patient-rated satisfaction with care and mental well-being, staff burnout, training and supervision. Relative to control wards, it is hypothesized that the quality of the physical environment and facilities will be higher on wards in the active arm of the trial 12 months after randomization.DiscussionTo our knowledge, this is the first randomized evaluation of a peer-led quality improvement network that has examined the impact of participation on both patient-level and service-level outcomes. The study has the potential to help shape future efforts to improve the quality of inpatient care.Trial registrationCurrent Controlled Trials ISRCTN79614916. Retrospectively registered 28 March 2014]

The Impact of Trained Volunteer Mealtime Assistants on the Dietary Intake of Older Female In-Patients: The Southampton Mealtime Assistance Study.

Malnutrition among older hospital inpatients is common and is associated with poor clinical outcomes. Time-pressured staff may struggle to provide mealtime assistance. This study aimed to evaluate the impact of trained volunteer mealtime assistants on the dietary intake of older inpatients. Quasi-experimental two year pre and post- test study of the introduction of volunteer mealtime assistants to one acute medical female ward, with contemporaneous comparison with a control ward. Two acute medical female wards in a university hospital in England. Female acute medical inpatients aged 70 years and over who were not tube fed, nil by mouth, terminally ill or being nursed in a side room. The introduction of volunteer mealtime assistants to one ward to help patients during weekday lunchtimes in the intervention year. Patients' background and clinical characteristics were assessed; 24-hour records were completed for individual patients to document dietary intake in both years on the two wards. A total of 407 patients, mean (SD) age 87.5 (5.4) years, were studied over the two-year period; the majority (57%) needed mealtime assistance and up to 50% were confused. Patients' clinical characteristics did not differ between wards in the observational or intervention years. Throughout the intervention year volunteers provided mealtime assistance on weekday lunchtimes on the intervention ward only. Daily energy (median 1039 kcal; IQR 709, 1414) and protein (median 38.9 g: IQR 26.6, 54.0) intakes were very low (n=407). No differences in dietary intake were found between the wards in the observational or intervention years, or in a pre-post-test comparison of patients on the intervention ward. Data were therefore combined for further analysis to explore influences on dietary intake. In a multivariate model, the only independent predictor of energy intake was the feeding assistance required by patients; greater need for help was associated with lower energy intake (P<0.001). Independent predictors of protein intake were the feeding assistance given (P<0.001) and use of sip feeds; sip feed users had slightly higher protein intakes (P=0.014). Trained volunteers were able to deliver mealtime assistance on a large scale in an effective and sustainable manner, with the potential to release time for nursing staff to complete other clinical tasks. The study participants had a low median intake of energy and protein highlighting the importance of patient factors associated with acute illness; a stratified approach including oral and parenteral nutritional supplementation may be required for some acutely unwell patients. The level of mealtime assistance required was the factor most strongly associated with patients' poor intake of energy and protein and may be a useful simple indicator of patients at risk of poor nutrition.

Enhanced performance feedback and patient participation to improve hand hygiene compliance of health-care workers in the setting of established multimodal promotion: a single-centre, cluster randomised controlled trial

Hand hygiene compliance of health-care workers remains suboptimal despite standard multimodal promotion, and evidence for the effectiveness of novel interventions is urgently needed. We aimed to assess the effect of enhanced performance feedback and patient participation on hand hygiene compliance in the setting of multimodal promotion. We did a single-centre, cluster randomised controlled trial at University of Geneva Hospitals (Geneva, Switzerland). All wards hosting adult, lucid patients, and all health-care workers and patients in these wards, were eligible. After a 15-month baseline period, eligible wards were assigned by computer-generated block randomisation (1:1:1), stratified by the type of ward, to one of three groups: control, enhanced performance feedback, or enhanced performance feedback plus patient participation. Standard multimodal hand hygiene promotion was done hospital-wide throughout the study. The primary outcome was hand hygiene compliance of health-care workers (according to the WHO Five Moments of Hand Hygiene) at the opportunity level, measured by direct observation (20-min sessions) by 12 validated infection control nurses, with each ward audited at least once every 3 months. This trial is registered with ISRCTN, number ISRCTN43599478. We randomly assigned 67 wards to the control group (n=21), enhanced performance feedback (n=24), or enhanced performance feedback plus patient participation (n=22) on May 19, 2010. One ward in the control group became a high-dependency unit and was excluded from analysis. During 1367 observation sessions, 12 579 hand hygiene opportunities were recorded. Between the baseline period (April 1, 2009, to June 30, 2010) and the intervention period (July 1, 2010, to June 30, 2012), mean hand hygiene compliance increased from 66% (95% CI 62-70) to 73% (70-77) in the control group (odds ratio [OR] 1·41, 95% CI 1·21-1·63), from 65% (62-69) to 75% (72-77) in the enhanced performance feedback group (1·61, 1·41-1·84), and from 66% (62-70) to 77% (74-80) in the enhanced performance feedback plus patient participation group (1·73, 1·51-1·98). The absolute difference in compliance attributable to interventions was 3 percentage points (95% CI 0-7; p=0·19) for the enhanced performance feedback group and 4 percentage points (1-8; p=0·048) for the enhanced performance feedback plus patient participation group. Hand hygiene compliance remained significantly higher than baseline in all three groups (OR 1·21 [1·00-1·47] vs 1·38 [1·19-1·60] vs 1·36 [1·18-1·57]) during the post-intervention follow-up (Jan 1, 2013, to Dec 31, 2014). Hand hygiene compliance improved in all study groups, and neither intervention had a clinically significant effect compared with control. Improvement in control wards might reflect cross-contamination, highlighting challenges with randomised trials of behaviour change. Swiss National Science Foundation.

Patient participation in postoperative care activities in patients undergoing total knee replacement surgery: Multimedia Intervention for Managing patient Experience (MIME). Study protocol for a cluster randomised crossover trial.

BackgroundPatient participation is an important indicator of quality care. Currently, there is little evidence to support the belief that participation in care is possible for patients during the acute postoperative period. Previous work indicates that there is very little opportunity for patients to participate in care in the acute context. Patients require both capability, in terms of having the required knowledge and understanding of how they can be involved in their care, and the opportunity, facilitated by clinicians, to engage in their acute postoperative care. This cluster randomised crossover trial aims to test whether a multimedia intervention improves patient participation in the acute postoperative context, as determined by pain intensity and recovery outcomes.Methods/designA total of 240 patients admitted for primary total knee replacement surgery will be invited to participate in a cluster randomised, crossover trial and concurrent process evaluation in at least two wards at a major non-profit private hospital in Melbourne, Australia. Patients admitted to the intervention ward will receive the multimedia intervention daily from Day 1 to Day 5 (or day of discharge, if prior). The intervention will be delivered by nurses via an iPad™, comprising information on the goals of care for each day following surgery. Patients admitted to the control ward will receive usual care as determined by care pathways currently in use across the organization. The primary endpoint is the “worst pain experienced in the past 24 h” on Day 3 following TKR surgery. Pain intensity will be measured using the numerical rating scale. Secondary outcomes are interference of pain on activities of daily living, length of stay in hospital, function and pain following TKR surgery, overall satisfaction with hospitalisation, postoperative complications and hospital readmission.DiscussionThe results of this study will contribute to our understanding of the effectiveness of interventions that provide knowledge and opportunity for patient participation during postoperative in-hospital care in actually increasing participation, and the impact of participation on patient outcomes. The results of this study will also provide data about the barriers and enablers to participation in the acute care context.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12614000340639 Trial Registration date 31/03/2014.

Knowledge management, health information technology and nurses' work engagement.

Knowledge management (KM) extends the health information technology (HIT) literature by addressing its impact on creating knowledge by sharing and using the knowledge of health care professionals in hospitals. The aim of the study was to provide insight into how HIT affects nurses' explicit and tacit knowledge of their ongoing work processes and work engagement. Data were collected from 74 nurses in four wards of a Dutch hospital via a paper-and-pencil survey using validated measurement instruments. In a quasiexperimental research design, HIT was introduced in the two experimental wards in contrast to the two control wards. At the time of the HIT introduction, a pretest was administered in all four wards and was followed by a posttest after 3 months. Data were analyzed via partial least squares modeling. Generally, nurses' tacit knowledge (i.e., their insight into and their capacity to make sense of the work processes) appears to be a significant and strong predictor of their work engagement. In contrast, nurses' explicit knowledge (i.e., information feedback about patients and tasks) only indirectly affects work engagement via its effect on tacit knowledge. Its effect on work engagement therefore depends on the mediating role of tacit knowledge. Interestingly, introducing HIT significantly affects only nurses' explicit knowledge, not their tacit knowledge or work engagement. Nurses' tacit and explicit knowledge needs to be systematically distinguished when implementing HIT/KM programs to increase work engagement in the workplace. Tacit knowledge (insight into work processes) appears to be pivotal, whereas efforts aimed only at improving available information will not lead to a higher level of work engagement in nurses' work environments.

A pilot study to assess the effectiveness and cost of routine universal use of peracetic acid sporicidal wipes in a real clinical environment

Peracetic acid sporicidal wipes have been shown to be an effective disinfectant, but in controlled test environments. Their high cost may restrict use. This pilot study investigated the efficacy and compared the costs of routine universal use of peracetic acid sporicidal wipes versus sporicidal quaternary ammonium compound and alcohol wipes in the disinfection of a hospital environment. The routine universal use of peracetic acid wipes (Clinell Sporicidal; GAMA Healthcare Ltd, London, UK) was allocated to a study ward, whereas the control ward continued with the use of quaternary ammonium compound wipes (Tuffie 5; Vernacare, Bolton, UK) and alcohol wipes (PDI Sani-Cloth 70; PDI, Flint, UK). Twenty high-touch areas in the 2 wards were sampled for the presence of indicator organisms. The weekly detection rates of indicator organisms and weekly healthcare associated infection (HCAI) rates in the 2 wards were compared and examined for decreasing trends over the trial period. The detection rates of indicator organisms and HCAI rates were not significantly different in the 2 wards, and did not decrease significantly over the trial period. However, the peracetic acid wipes seem to be more effective against gram-negative organisms but at a significantly higher cost. Further prospective studies are needed to assess the cost-effectiveness of peracetic acid wipes.

Study protocol Implementation of the Veder contact method (VCM) in daily nursing home care for people with dementia: an evaluation based on the RE-AIM framework

ABSTRACTObjectives: People with dementia in nursing homes benefit from person-centred care methods. Studies examining the effect of these methods often fail to report about the implementation of these methods. The present study aims to describe the implementation of the Veder contact method (VCM) in daily nursing home care.Method: A process analysis will be conducted based on qualitative data from focus groups with caregivers and interviews with key figures. To investigate whether the implementation of VCM is reflected in the attitude and behaviour of caregivers and in the behaviour and quality of life of people with dementia, a controlled observational cohort study will be conducted. Six nursing home wards implementing VCM will be compared with six control wards providing Care As Usual. Quantitative data from caregivers and residents will be collected before (T0), and 9–12 months after the implementation (T1). Qualitative analysis and multilevel analyses will be carried out on the collected data and structured based on the constructs of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance).Conclusion: By using the RE-AIM framework this study introduces a structured and comprehensive way of investigating the implementation process and implementation effectiveness of person-centred care methods in daily dementia care.

6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial

Objective To evaluate the effect of the 6-PACK programme on falls and fall injuries in acute wards. Design Cluster randomised controlled trial. Setting Six Australian hospitals. Participants All patients admitted...