Evidence-based Screening Tools Research Articles

Bedside Coaching to Improve Nurses’ Recognition of Delirium

Delirium is a widespread complication of hospitalization and is frequently unrecognized by nurses and other healthcare professionals. Patients with neuroscience diagnoses are at increased risk for delirium as compared with other patients. The aims of this quality improvement project were to (1) increase neuroscience nurses' knowledge of delirium, (2) integrate coaching into evidence-based practice, and (3) evaluate the effectiveness of this combined approach to improve nurses' recognition of delirium on a neuroscience unit. Institutional review board approval was obtained. A retrospective chart review of randomly selected patients admitted before the intervention was completed. The (modified) Nurse's Knowledge of Delirium Tool was electronically administered to nursing staff (n = 47), followed within 2 weeks by a didactic presentation on delirium. Bedside coaching was performed over a period of 4 weeks. The (modified) Nurses Knowledge of Delirium Tool was electronically readministered to nurses 4 weeks later to determine the change in aggregate knowledge. A postintervention chart review was conducted. SPSS software was used to analyze descriptive statistics with regard to chart reviews, documentation, and change in questionnaire scores. Findings reveal that neuroscience nurses recognize the absence of delirium 94.4% of the time and the presence of delirium 100% of the time after a didactic session and coaching. The postintervention chart review showed a statistically significant increase (p = .000) in the documentation of delirium screening results. Expert coaching at the bedside may be a reliable method for teaching nurses to use evidence-based screening tools to detect delirium in patients with neuroscience diagnoses.

Mental Health Practice and Attitudes of Family Physicians Can Be Changed!

An adult mental health module was developed in British Columbia to increase the use of evidence-based screening and cognitive behavioral self-management tools as well as medications that fit within busy family physician time constraints and payment systems. Aims were to enhance family physician skills, comfort, and confidence in diagnosing and treating mental health patients using the lens of depression; to improve patient experience and partnership; to increase use of action or care plans; and to increase mental health literacy and comfort of medical office assistants. The British Columbia Practice Support Program delivered the module using the Plan-Do-Study-Act cycle for learning improvement. Family physicians were trained in adult mental health, and medical office assistants were trained in mental health first aid. Following initial testing, the adult mental health module was implemented across the province. More than 1400 of the province's 3300 full-service family physicians have completed or started training. Family physicians reported high to very high success implementing self-management tools into their practices and the overall positive impact this approach had on patients. These measures were sustained or improved at 3 to 6 months after completion of the module. An Opening Minds Survey for health care professionals showed a decrease in stigmatizing attitudes of family physicians. The adult mental health module is changing the way participants practice. Office-based primary mental health care can be improved through reimbursed training and support for physicians to implement practical, time-efficient tools that conform to payment schemes. The module provided behavior-changing tools that seem to be changing stigmatizing attitudes towards this patient population. This unexpected discovery has piqued the interest of stigma experts at the Mental Health Commission of Canada.

Alzheimer’s Disease

Article AbstractAlzheimer's disease is a progressive neurodegenerative disorder that causes severe cognitive decline, functional disability, and eventually death. Although there is no cure for this illness, early diagnosis and treatment can reduce or delay cognitive and functional decline, allow patients to avoid medications that worsen cognition, and give patients a greater opportunity to actively participate in their treatment and plan for the future. In this Webcast, experts discuss the presentation and course of Alzheimer's disease, an evidence-based screening tool that can aid in identifying early signs of cognitive impairment in at-risk patients, and imaging and other biomarker measurement tools that can be used to differentiate between diagnoses or to measure disease progress.See the entire activity.

Derivation of a Clinical Prediction Rule for Pediatric Abusive Head Trauma*

Abusive head trauma is a leading cause of traumatic death and disability during infancy and early childhood. Evidence-based screening tools for abusive head trauma do not exist. Our research objectives were 1) to measure the predictive relationships between abusive head trauma and isolated, discriminating, and reliable clinical variables and 2) to derive a reliable, sensitive, abusive head trauma clinical prediction rule that-if validated-can inform pediatric intensivists' early decisions to launch (or forego) an evaluation for abuse. Prospective, multicenter, cross-sectional, observational. Fourteen PICUs. Acutely head-injured children less than 3 years old admitted for intensive care. None. Applying a priori definitional criteria for abusive head trauma, we identified clinical variables that were discriminating and reliable, calculated likelihood ratios and post-test probabilities of abuse, and applied recursive partitioning to derive an abusive head trauma clinical prediction rule with maximum sensitivity-to help rule out abusive head trauma, if negative. Pretest probability (prevalence) of abusive head trauma in our study population was 0.45 (95 of 209). Post-test probabilities of abusive head trauma for isolated, discriminating, and reliable clinical variables ranged from 0.1 to 0.86. Some of these variables, when positive, shifted probability of abuse upward greatly but changed it little when negative. Other variables, when negative, largely excluded abusive head trauma but increased probability of abuse only slightly when positive. Some discriminating variables demonstrated poor inter-rater reliability. A cluster of five discriminating and reliable variables available at or near the time of hospital admission identified 97% of study patients meeting a priori definitional criteria for abusive head trauma. Negative predictive value was 91%. A more completeunderstanding of the specific predictive qualities of isolated, discriminating, and reliable variables could improve screening accuracy. If validated, a reliable, sensitive, abusive head trauma clinical prediction rule could be used by pediatric intensivists to calculate an evidence-based, patient-specific estimate of abuse probability that can inform-not dictate-their early decisions to launch (or forego) an evaluation for abuse.

Future Looks Promising for Mental Illness Prevention

Research over the last decade shows that depression and anxiety are preventable, and psychiatrists are optimistic that advances in averting these and other mental illnesses are on the horizon.

Measuring inappropriate prescriptions in geriatric population: Overview of various screening tools

In this era of growing research, a plethora of effective therapeutic agents has been made available to treat chronic disorders that often accompany advancing age. However, medications often act as a “double edge sword”. Instead of medications being a cure, frequently they cause problems. Thus, managing the medications in elderly patients is truly a challenge for all health professionals. The use of a medication is generally considered appropriate if the expected benefits of the medication outweigh the potential risks. Because older adults are more sensitive to any adverse effects of medications, various lists of medications have been created for guiding clinicians to avoid certain drugs in elderly people. Various screening tools based on explicit (criterion-based) or implicit (judgment-based) prescribing indicators have been devised to detect inappropriate prescriptions of such drugs. The purpose of this evidence-based guideline or screening tool is to improve medication management practices for older adults. In this review we have discussed various methods of finding out inappropriate prescriptions in the elderly which can be referred by health care providers of this population. Therefore, regular application of such inappropriate prescription screening tools should hypothetically reduce the prevalence of adverse drug events, their related morbidity and health care cost.

Childhood Osteoporosis: Screening, Prevention, Treatment, and Safe Handling Practices in a Tertiary Care Pediatric Hospital

Osteoporosis is a challenge facing children of all ages with multiple different health conditions and physical abilities. The reality of this challenge stemmed the development of the child health program's interdisciplinary bone health project team in a tertiary care, in-patient pediatric hospital. The committee's goal was to develop protocols and tools to help identify at-risk children and ultimately prevent fragility fractures in these children. An evidence-based screening tool was developed to allow primary caregivers to quickly recognize the child who is most at risk for osteoporosis and determine the next step to take related to bone health.

Identifying Geriatric Malnutrition in Nursing Practice: The Mini Nutritional Assessment (MNA®)—An Evidence-Based Screening Tool

Protein calorie malnutrition (PCM) is common and often undiagnosed in older adults. Left untreated, PCM carries both clinical and financial risks, including decreased quality of life, declining functionality, the inability to live independently, and increased health care costs. The prevalence of PCM in older adults calls for a systematic and standardized approach to nutrition screening that includes the use of a validated screening tool. Recommended by international organizations, the Mini Nutritional Assessment® (MNA) is highly specific and reliable and the most well-validated nutrition screening tool for adults 65 and older. Simple, noninvasive, inexpensive, and easy for nurses and other clinicians to use, the newest MNA-short form (MNA-SF) can quickly and easily identify older adults who are at risk for malnutrition or malnourished. Nurses are key players in successful malnutrition screening in hospitals, long-term care, home care, and community settings. It is strongly recommended that nurses incorporate the newest MNA-SF into all practice settings where older adults receive care.

Identifying Geriatric Malnutrition in Nursing Practice: The Mini Nutritional Assessment (MNA®)—An Evidence-Based Screening Tool

Protein calorie malnutrition (PCM) is common and often undiagnosed in older adults. Left untreated, PCM carries both clinical and financial risks, including decreased quality of life, declining functionality, the inability to live independently, and increased health care costs. The prevalence of PCM in older adults calls for a systematic and standardized approach to nutrition screening that includes the use of a validated screening tool. Recommended by international organizations, the Mini Nutritional Assessment® (MNA) is highly specific and reliable and the most well-validated nutrition screening tool for adults 65 and older. Simple, noninvasive, inexpensive, and easy for nurses and other clinicians to use, the newest MNA-short form (MNA-SF) can quickly and easily identify older adults who are at risk for malnutrition or malnourished. Nurses are key players in successful malnutrition screening in hospitals, long-term care, home care, and community settings. It is strongly recommended that nurses incorporate the newest MNA-SF into all practice settings where older adults receive care.

Waking Up to the Risks of Online Direct-to-Consumer Advertising of Sleep Apnea Screening Tests

Waking Up to the Risks of Online Direct-to-Consumer Advertising of Sleep Apnea Screening Tests

Impact of Systematic Palliative Care Screening Program Across a Tertiary Care Hybrid Health System (418-B)

1.Recognize the benefits of a system wide palliative care screening program.2.Identify strategies to implement a case management based palliative care screening program.3.Recognize the components of electronic palliative care screening tool. Across the care continuum, there is an increasing need for systematic palliative care and hospice screening to meet the needs of all patients. Historically, many post discharge scoring systems and strategies have been developed to stratify patient need for palliative and hospice care. A model for case management based electronic palliative care screening and referral was developed and evaluated in a hybrid academic and community health system. A multidisciplinary palliative care team and governance structure was created with representation from all five hospitals of a hybrid health system in Northern Virginia. An evidence-based palliative care screening tool was developed and implemented in Allscripts, an electronic case management database. Domains of the tool included both general and ICU elements. Reporting functions in Allscripts provided the capability to measure both the screening compliance in identified subsets and utilization of primary and secondary palliative care and hospice. A palliative care scorecard was created to measure the program's impact on quality, service and community metrics. There was a high utilization of the palliative care screening tool by case managers and social workers, which resulted in increased access and referrals to palliative and hospice care; decreased time from admission to palliative care consultation; and a cost savings. Systematic palliative care screening has significant impact on the delivery of high quality care. The palliative care screening program would not have been successful without support from Inova's senior leadership. The screening program resulted in improved communication between case management, physicians, nurses, and other health care providers. Continued success from the palliative care screening tool would provide the rationale for expanding palliative care services and screening initiatives into other care settings, such as home health and nursing homes.

Bridging the Gap Between Hospital and Home

Advanced cardiovascular interventions and an aging population contribute to the growing prevalence of patients with heart failure (HF). Improved medical management, while decreasing mortality, has increased morbidity and cost, with a majority of expense related to preventable hospitalizations. Evidence-based guidelines for discharge instruction, when successfully administered, reduce readmission rates in high-risk HF patients, leading to improved quality of life and economic savings. Unfortunately, effective delivery is complex and time consuming, placing a high demand on already overworked bedside nurses. Failure to provide complete discharge instructions results in nonadherence to treatment regimens and lack of essential follow-up, the most commonly identified reasons for acute HF exacerbations and readmissions. To improve quality of care, hospitals need to adopt a new model that incorporates delivery of intensive, 1-on-1 education to high-risk HF patients during the hospital stay with continuing support, guidance, and education throughout the transition from hospital to home. This can be achieved through implementation of a 2-tiered model that incorporates a risk-assessment tool with utilization of a HF nurse educator. The simple, evidence-based bedside screening tool will allow medical-surgical nurses to quickly identify and refer HF patients at high risk of readmission to a HF nurse educator. With an advanced degree and specialized training, the nurse educator is responsible for providing in-depth discharge teaching and bridging the gap from hospital to home. The end result is improved self-management, increased quality of life, reduced hospital admissions, and an associated decrease in societal costs of HF.

Antiretroviral Therapy and Tuberculosis: What's the Connection and What's the Way Forward?

Antiretroviral Therapy and Tuberculosis: What's the Connection and What's the Way Forward?

Screening for Psychosocial Risk at Pediatric Cancer Diagnosis

To investigate the feasibility of integrating an evidence-based screening tool of psychosocial risk in pediatric cancer care at diagnosis. Parents of children newly diagnosed with cancer received either the Psychosocial Assessment Tool (PAT; n=52) or psychosocial care as usual (n=47; PAU), based on their date of diagnosis and an alternating monthly schedule. Time to completion of the PAT, time to communication of PAT results to clinical care teams, distribution of PAT risk scores, and identification of psychosocial risks in the medical record were examined. Of families receiving the PAT, 88% completed it within 48 hours. PAT was scored and results communicated within 48 hours in 98% of cases. Most families (72%) were classified as Universal risk based on the underlying Pediatric Psychosocial Preventative Health Model, 24% were classified as Targeted risk, and 4% scored in the Clinical range. Significantly more psychosocial risks were recorded in the medical record during PAT intervals than during PAU. An evidence-based psychosocial screener is feasible in pediatric oncology care and is associated with documentation of psychosocial risks in the medical record. Although the majority of families report low levels of psychosocial risk, about one-quarter report problems.

Across the ditch: the collective diabetic foot assessment

Results Fifty three (n=53) Māori patients were recruited for this study with a median age of 54 years (IQR: 45.5 – 61.5 years). We found that Māori had a median duration of diabetes for 15 years, were obese (median body mass index 35.7) with sub-optimal glycaemic control (HbA1c >8% 42%). Podiatric specific characteristics revealed good arterial flow (IQR: Right ankle-brachial index dorsalis pedis 1.1) and a median neuropathy score of 2 (IQR 0, 4). Half the cohort displayed restriction in movement of the right ankle joint (n= 31) and first metatarsophalangeal joints (n=29). Foot education was favourable with positive benefits such as daily foot inspection (n=52). Using a modified classification tool which targets the risk factors collectively, thirty two (60%) patients were identified as requiring regular podiatry management. Conclusions A standardised evidence-based screening and assessment tool could be widely applied by primary care health podiatrists in the detection of imminent diabetes-related foot pathology and to support disease management. This collective assessment would be of particular benefit to communities, including Maori; where the incidence of diabetes and its complications is higher.

Triaging dysphagia: nurse screening for dysphagia in an acute hospital

To (1) develop a dysphagia screening tool to triage all patients at risk of aspiration/dysphagia on admission to acute hospital wards, (2) evaluate tool reliability, (3) evaluate nursing compliance and (4) develop a robust dysphagia training programme. Failure to diagnose dysphagia has significant medical and economic costs. Dysphagia screening reduces pneumonia threefold. Most nurse-screening tools have focused on stroke. However, many other conditions are associated with dysphagia. A multidisciplinary team developed a nurse-administered, evidence-based swallow screening tool for generic acute hospital use. Prospective, quasi-experimental. Nurses were assessed for knowledge pre- and post-training. All patients were nurse-screened for dysphagia on admission. All patients were reviewed by speech pathologists to determine screening accuracy. Results were not blinded. The one page tool encompassed (1) diagnostic categories, (2) patient/carer interview, (3) dysphagia indicators and (4) if applicable, water swallow test. Thirty-eight nurses participated in a seven-week study; 442 patients were screened on two general medical wards. Three speech pathologists counter-assessed each patient by clinical examination or chart review. Sensitivity was 95%; specificity was 97%. Positive predictive value was 92%; negative predictive value was 98%. 3.4% of clinical screening decisions were incorrect. Compliance rate was 85%. Caution is advised in interpretation of the results due to lack of blinding. Initial results suggest that the dysphagia screening tool is a quick and robust tool for triaging individuals with dysphagia. Training is critical to successful screening. Twenty-five to 30% of acute hospitalised individuals have dysphagia. All adult acute patients are screened for dysphagia using the Royal Brisbane and Women's Hospital dysphagia screening tool. Patients are triaged into categories of 'those requiring additional specialist intervention' and 'those who can proceed directly to regular diets and liquids'. Improved quality of care and cost savings is likely.

Prevention of fetal alcohol spectrum disorders

Alcohol use among women of childbearing age is a leading, preventable cause of birth defects and developmental disabilities in the United States. Although most women reduce their alcohol use upon pregnancy recognition, some women report drinking during pregnancy and others may continue to drink prior to realizing they are pregnant. These findings emphasize the need for effective prevention strategies for both pregnant and nonpregnant women who might be at risk for an alcohol-exposed pregnancy (AEP). This report reviews evidence supporting alcohol screening and brief intervention as an effective approach to reducing problem drinking and AEPs that can lead to fetal alcohol spectrum disorders. In addition, this article highlights a recent report of the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect that describes effective interventions to reduce alcohol use and AEPs, and outlines recommendations on promoting and improving these strategies. Utilizing evidence-based alcohol screening tools and brief counseling for women at risk for an AEP and other effective population-based strategies can help achieve future alcohol-free pregnancies.

CD6-3 Development and implementation of an evidence-based podiatric screening tool for diabetes-related foot complications among M ¯aori

CD6-3 Development and implementation of an evidence-based podiatric screening tool for diabetes-related foot complications among M ¯aori

Vulnerable Elders

IN 2004, STATE-LEVEL ADULT PROTECTIVE SERVICE AGENcies across the United States received more than 600 000 reports of elders who were in need of protection. The New York City Department of Aging estimates 50 000 cases of elder mistreatment in the boroughs, even though only 1600 instances are reported. Some elders experience physical abuse, caregiver neglect, and financial exploitation, but the most common report to adult protective service agencies in the United States is self-neglect, a syndrome that afflicts vulnerable older adults who are not able to meet basic needs. Self-neglect, often discounted as a harmless peculiarity of old age, is actually an independent risk factor for early death. Elders neglecting themselves usually live alone. They display behaviors such as piling garbage inside the home, allowing food to spoil, failing to maintain utilities in the home, ignoring serious medical issues, and even lying in their own excrement. In most jurisdictions, elder self-neglect is a reportable form of elder mistreatment, as are physical abuse, caregiver neglect, and financial exploitation. Americans are fiercely independent, a highly valued personal trait respected by most health care professionals. In some instances, however, when older persons no longer can care for themselves, their personal health, well-being, and even their lives are at risk. Research is needed to develop evidence-based screening tools so that clinicians and their caregiving teams know when and how to intervene. Title XX of the Social Security Act, passed in 1974, mandates states to develop and maintain protective service agencies for senior citizens. Since 1981, each state has established its own agency dedicated to protecting vulnerable older persons. By law, these agencies are charged with receiving reports of suspected abuse from family members and persons known by elderly individuals, conducting investigations, and delivering services to elderly individuals whose cases are substantiated. However, the characteristics underlying causes and effects of self-neglecting behavior are poorly defined and not well understood. Unsafe Environments

START (screening tool to alert doctors to the right treatment) an evidence-based screening tool to detect prescribing omissions in elderly patients

Inappropriate prescribing encompasses acts of commission i.e. giving drugs that are contraindicated or unsuitable, and acts of omission i.e. failure to prescribe drugs when indicated due to ignorance of evidence base or other irrational basis e.g. ageism. There are considerable published data on the prevalence of inappropriate prescribing; however, there are no recent published data on the prevalence of acts of omission. The aim of this study was to calculate the prevalence of acts of prescribing omission in a population of consecutively hospitalised elderly people. A screening tool (screening tool to alert doctors to the right treatment acronym, START), devised from evidence-based prescribing indicators and arranged according to physiological systems was prepared and validated for identifying prescribing omissions in older adults. Data on active medical problems and prescribed medicines were collected in 600 consecutive elderly patients admitted from the community with acute illness to a teaching hospital. On identification of an omitted medication, the patient's medical records were studied to look for a valid reason for the prescribing omission. Using the START list, we found one or more prescribing omissions in 57.9% of patients. In order of prevalence, the most common prescribing omissions were: statins in atherosclerotic disease (26%), warfarin in chronic atrial fibrillation (9.5%), anti-platelet therapy in arterial disease (7.3%) and calcium/vitamin D supplementation in symptomatic osteoporosis (6%). Failure to prescribe appropriate medicines is a highly prevalent problem among older people presenting to hospital with acute illness. A validated screening tool (START) is one method of systematically identifying appropriate omitted medicines in clinical practice.