Institute Of Medicine Report Research Articles

Position Statement on Cancer Nursing Leadership.

Position Statement on Cancer Nursing Leadership.

Incident Reporting Systems: How did we get here and where should we go? A narrative review

Since the authoring of the seminal report by the Institute of Medicine (IOM) “To Err is Human: Building a Safer Health System” in 2000, there has been an increased focus on patient safety and the responsibility born by the healthcare system to reduce what are known as adverse events (AE). One of the recommendations of the IOM report was the establishment and development of Incident Reporting System (IRS) that would track AE resulting in serious injury and death. The Joint Commission in the USA similarly requires all hospitals have and use an IRS. The objective of this review is to explore barriers and feature of IRS and patient safety.

Evolution of adverse drug reactions reporting systems: paper based to software based

Adverse Drug Reactions (ADR) add a significant clinical and economic burden to the healthcaresystem of a country. We present an overview of the different approaches of ADR reporting systems worldwide andtheir evolution over time. A systematic review of the literature was made based on PubMed and theCochrane database of systematic reviews. The articles searched for included original articles, WHO and FDAreports and institute of medicine reports. Reporting ADRs is the cornerstone ofdetecting uncommon ADRs once the drugs are on the market. In many countries, ADR reporting is regulated bynational regulatory bodies and various methods are employed to report ADRs. Direct reporting by healthcareprofessionals has been adopted by many developed and developing countries. With emerging new technologies inthe field of medicine, there is a great potential to develop better ADR reporting systems in the countries where theyhave poor reporting. Development and acquisition of newer technologies to promote ADR monitoringand reporting is a necessity for an effective pharmacovigilance system in a country.

Transformational Leadership Meets Innovative Strategy: How Nurse Leaders and Clinical Nurses Redesigned Bedside Handover to Improve Nursing Practice

In 2000, the Institute of Medicine (IOM) published To Err Is Human: Building a Safer Health System, highlighting medical errors resulting from failure in perception, assumption, and communication. The handover process is a high-risk activity prone to the communication vulnerabilities described in the IOM report. The handover project started as a 3-month pilot with plans to expand to the entire facility. The handover education had 4 elements: questionnaire, presentation, video, and simulation. Compliance with the new process was measured using audits completed by the unit managers. Sixty-four registered nurses on 2 acute units were educated by nurse champions. After a successful implementation, the surge of COVID-19 patients in spring of 2020 required us to adjust expectations regarding bedside handover. As the number of hospitalized COVID patients began to decrease, we reinvigorated the project and re-established the expectation that handover be performed at the bedside. A post-questionnaire was completed after implementation and revealed more favorable responses toward bedside handover. We also saw improvements in our patient satisfaction scores (Hospital Consumer Assessment of Healthcare Providers and Systems [HCAHPS]). With direct observation and a checklist, we were able to return to the practice of bedside handover following the surge of COVID-19 patients. As a direct result of the bedside RN involvement, we created and implemented a handover process that prioritized nursing needs and concerns. Our implementation of this evidence-based practice enhanced patient experience and improved safety. Through education, observational audits, and use of a checklist, we were able to re-establish the expectation and practice of handover being completed at the bedside.

Simulated Learning Experience in Advance Care Planning Conversations.

The Centers for Disease Control and Prevention reports that one-third of all Americans have not done any advance care planning, which is essential for maintaining autonomy when people are no longer able to communicate wishes directly at the end of life. The Institute of Medicine reports that providers have limited training in communication techniques and low confidence in holding advance care planning conversations. Forty-four family nurse practitioner students received classroom communication training using evidence-based end-of-life nursing education consortium materials and role-play opportunities. One month later, students participated in a palliative care simulation experience in a high-fidelity simulated medical office environment with standardized patient. The family practice nurse practitioner students were required to communicate bad news of a poor diagnosis to a family member and begin the advance care planning conversation using the SPIKES protocol. Findings include a significant increase in postintervention advance care planning communication knowledge scores and self-confidence in holding these conversations (mean, 30.55 [SD, 2.992]; 95% confidence interval, 29.64-31.46; median, 31; range, 11-35) and satisfaction with the learning experience (mean, 18.14 [SD, 2.11]; 95% confidence interval, 17.50-18.78; median, 19; with range between 13 and 20).

Building the future geriatrics workforce through transformative interprofessional education and community-engaged experiential learning

Abstract The number of older Americans, ages 65 years and above, is projected to more than double from 46 million in 2014 to 98 million by 2060.1 Despite these projections, the number of health professionals trained to address the needs of this population is declining and a shortage has been projected across the country by 2025.2-4 To address this health workforce gap, the Institute of Medicine report, Retooling for an Aging America5 calls for enhanced geriatric training across health professions, and a growing body of evidence supports the value of interprofessional education (IPE) and collaborative practice. To respond to the urgent need for a better geriatric trained workforce, we developed an interprofessional course, “Scholars and Leaders in Interprofessional Geriatrics (SLIG)”, designed to enable health science students from different professions to acquire knowledge, understanding, and appreciation of integrated ethical geriatric care, in a variety of healthcare settings (i.e., community care, house calls, post-acute rehabilitation care, and hospice), as part of an interprofessional (IP) team. The learning activities include experiential and didactic learning for six weeks. Course learning objectives are aimed at enabling students to: apply patient- and family-centered approaches for addressing health disparities among older adults; define transitional care and explain the factors affecting effective care transitions and strategies for addressing the needs of older adults at various levels of care; and describe the four Interprofessional Education Collaborative (IPEC) competencies5 and apply these to IP team work in a geriatric care setting. Together, these learning objectives address the continuum of care of older adults, including the trajectory of illness, at different levels including transitions of care. Our mixed-methods program evaluation approach utilized the IPECC-Set 38 6,7 self-efficacy tool in a post-program evaluation survey. The IPECC-SET 38 tool assessed students’ self-efficacy in interprofessional collaborative practice. The tool was developed and validated6,7 by the co-authors and colleagues. A program evaluation survey was administered to all students. The data demonstrated that the participating students consider the course to be beneficial, with 100% of students (n = 30) reporting program learning goals were met and that the program addressed all four IPEC domains. We are encouraged by the overwhelmingly positive response by our students to this IPE course and we plan to continue to contribute to developing the future geriatric IP workforce.

Illicit and Prescription Drug Misuse among Sexual Minority Women in the United States: A Protocol for a Scoping Review.

The United States Institute of Medicine (IOM) published reports in 1999 and 2011 identifying drug use as a priority area for sexual minority health research, specifically focused on mechanisms contributing to drug use disparities and the development of tailored interventions. Limited research has prioritized sexual minority women (SMW) with the majority of substance use research among sexual minorities focused on adolescents and men who have sex with men. This scoping review will characterize the research literature related to illicit drug use and prescription drug misuse among SMW and sub-groups within the SMW population. Through this, we will identify: (1) specific substances used; (2) patterns of substance use; (3) risk and protective factors; (4) prevention interventions; and (5) drug treatment programs specific to SMW. This review will include studies with empirical data of illicit or prescription drug misuse among sexual minority women. Peer-reviewed quantitative research conducted in the United States and published in English from 2011-Present will be included. We will search Medline, PsycINFO, and Web of Science databases for relevant articles. Two independent reviewers will screen abstracts and relevant full-text studies for eligibility. Data will be extracted from eligible articles and results will be presented in narrative and tabular form as appropriate. This work will identify gaps of knowledge in the research pertaining to illicit or prescription drug misuse among sexual minority women since the 2011 US IOM report. As a result of this work, we will propose directions for future research to address identified gaps.

What happened to the US cancer cooperative groups? A status update ten years after the Institute of Medicine report.

The US cancer cooperative groups (cooperative groups) were founded in the 1950s to establish a standing infrastructure to conduct multi-institutional cancer clinical trials. Initially funded almost entirely by the US National Cancer Institute (NCI), over the years, the research conducted by the Cooperative Groups has evolved to meet the demands of cancer clinical research, with a scope now encompassing trials to advance cancer treatment, cancer control, biomarker development and validation, and health services research, with a corresponding broadening of their funding sources. The cooperative groups are also a critical mechanism for educating the next generation of cancer clinical trialists from many different disciplines. This review outlines the overall mission, structure, and funding of the cooperative groups, beginning in 1955 when they were first established by the NCI, and describes the considerable progress against cancer achieved over the past decade.

Patient Safety Education 20 Years After the Institute of Medicine Report: Results From a Cross-sectional National Survey.

Educating healthcare professionals in patient safety is essential to achieving sustainable improvements in care. This study aimed to identify the key constituents of patient safety education alongside its facilitators and barriers from a frontline perspective. An electronic survey was sent to 592 healthcare professionals and educators in patient safety education in the United Kingdom. Two independent reviewers conducted a thematic analysis of the free-text data. Themes focused on effective content, learning practices and facilitators and barriers to patient safety education. Of 592 individuals completing the survey, 545 (92%) submitted analyzable responses. Interrater reliability of coding was high with Cohen k value of 0.86. Participants endorsed experiential and interactive learning as ideal modalities for delivery and expressed a need for content to be based on real clinical cases and tailored to the needs of the learners. The most commonly mentioned facilitators were standardization of methods and assessment (49%), dedicated funding (21%), and culture of openness (20%). Staffing problems and high workload (41%) and lack of accessibility of training (23%) were identified as primary barriers of efficacy and uptake. This study identified key factors to the success of patient safety education in terms of content and delivery alongside facilitators and barriers. Future curricula developers and interventions should improve standardization, funding, culture, and access so as to optimize education programs to enhance patient safety.

Empowerment of front-line leaders in an online learning, certificate programme.

To evaluate the effectiveness of an online learning, certificate programme for front-line nurse leaders' sense of empowerment. Front-line leaders play a crucial role in health care. Current training is often inadequate. The Institute of Medicine report on The Future of Nursing: Leading Change, Advancing Health (2010) recommends nurses at all levels receive training for their role. A pre- to post-study design was used; instruments included Conditions for Work Effectiveness Questionnaire, Psychological Empowerment Scale, intent to stay, and self-reported knowledge and effectiveness of intervention questions. This study evaluated the effects of online learning for 29 acute care front-line leaders in the USA and Australia. Structural empowerment significantly improved, pre-assessment (M=18.50, SD=1.6940) to post-assessment (M=19.47, SD=1.6940). There was no significant difference in intent to stay or overall psychological empowerment. Participants agreed (24/29, 83%) the intervention contributed to their 'sense of empowerment in their role' and 'ability to create an empowering work environment'. Online learning was effective and could be integrated into orientation and/or continuing education plans to develop empowering work environments. Online learning may be a means of educating and empowering front-line leaders for their role.

A Nursing Workforce Initiative: Increasing the Latino/Hispanic BSN Workforce.

Of the 3 million nurses in the United States, only 5.4% of registered nurses are Latinos. This is a grave concern since the U.S. Census' projected increase of Latinos in the United States is expected to be 28% by 2060. In 2010, the Institute of Medicine report recommended a diverse workforce in health care to improve health outcomes. However, the increase in the Latino nursing workforce continues to be low compared to with the population of Latinos in the country. The National Association of Hispanic Nurses and the University of Alabama partnered to increase the number of baccalaureate-prepared registered nurses in the workforce. BAMA-Latino Project (BAMA-L) is a Health Resources and Services Administration-funded program to increase the diversity of registered nurses in the nursing workforce. The purpose of this article is to present the development and implementation of BAMA-L.

Using Simulation to Increase Student Confidence with EHR Documentation

In today’s complex and evolving healthcare system, it is crucial for nurses to proficiently comprehend electronic health records (EHR) in the provision of quality, safe, patient care. Accordingly, the Institute of Medicine report in 2003 emphasized informatics as one of the core competencies for nursing education to improve upon. Upon completion of the their first academic clinical experience, the authors found a gap in the student’s ability to perform at the bedside and balance the documentation requirements of the electronic health record. In order to better equip Fort Hays State University Nursing students with the technological skill sets necessary to navigate modern health care informatics, we designed an academic electronic health record (AEHR) training module to incorporate into their regularly scheduled simulation.

Patient-Pathologist Consultation

Pathologists are being considered as “Doctor’s doctor”, the reason is not they are far more knowledgeable or experienced than the treating physicians. The only reason is for decades, the only bridges between the patient and Pathologists are the treating physician. Many times, the patient suffering from cancer, doesn’t know that the confirmed diagnosis was not given by the treating physician but by the Pathologist. The input of the pathologist (and radiologist) is often essential to a proper diagnosis, yet rarely is the patient given those reports and rare access to the reporting individuals. To date, Pathologists are advising clinical colleagues on appropriate tests, result-interpretation, follow-up testing and to reach the diagnosis. Various clinico-pathological meetings help in overcoming this hurdle.
 However, in this era of expanding, decentralized health systems and rapidly increasing the complexity of newer laboratory tests, diagnostic algorithms, and guidelines, it is being difficult for treating physicians to stay updated, even in the area of their expertise. One survey of laboratory utilization patterns revealed that primary care physicians were uncertain of up to 23% of tests utilized, with test ordering uncertainty in 14.7% and test interpretation uncertainty in 8.3%. The 2015 Institute of Medicine report, “Improving Diagnosis in Healthcare” recognizes diagnosis as a team effort that requires pathologist input and interaction with clinical colleagues. Educating and providing consultation is a role that pathologists must embrace. On top of this, social media is beginning to change the way that medicine is practiced. It has the power to engage people in public health and policy discussions, establish professional networks and facilitate patients’ access to information about health and services.
 We have integrated social media into our lives by choice and we in the medical practice, amidst our busy schedules, have been using it for easy connectivity with friends and families and also, if not important, for our continued education.3 Various information is available about any disease conditions and available diagnostic methods. Once a patient gets his/her report, they tend to surf on the internet and an overwhelming amount of information present on the internet may not only confuse the patient but also lead to anxiety by going through all the possible consequences which rarely occur. Furthermore, histopathological or cytological reports are better explained by the reporting pathologists. Sometimes, it becomes difficult for treating physicians to explain what exactly does “suggestive of” or “Suspicious” means and what to do next. Limitations and the superiority of any diagnostic tool are better understood by the pathologists. All the issues can be settled with patient-pathologist direct communications. This will help the patient to know the details regarding the test, it’s limitations and its superiority. Direct patient-pathologist communication greatly decreases the burden of treating physicians in counseling the patients., helps to further explain the relevance of the tests and results and have a positive impact on their health and healthcare choices.

Incivility in Healthcare

The link between civility, workplace safety and patient care is not a new concept. The 2004 Institute of Medicine report, emphasised the importance of the work environment in which healthcare professionals provide care. 1 Workplace incivility that is expressed as bullying behaviour was reported by at least 1 in 5 respondents in the NHS Staff survey in 2018. 2 Almost half of these go unreported and that number seems to be falling.

Improving care for cancer survivors

Improving care for cancer survivors

Student-Centered Curricular Revisions to Facilitate Transition from Associate Degree in Nursing to Bachelor of Science in Nursing Education

Curricular revision is an ongoing process. This article reports on curricular redesign process that facilitates transition from associate degree in nursing (ADN) to bachelor of science in nursing (BSN) education. Revisions were based on; course mapping to meet the American Association of Colleges of Nursing Essentials of Baccalaureate Education, review of ADN content duplication, and consideration of student feedback. This article adds to the body of knowledge on registered nurse (RN)-to-BSN curriculum content, revision methods, and support of the seamless transition of students to meet challenges posed by the Institute of Medicine report.

Core competencies for the emerging specialty of pain psychology.

The Institute of Medicine (IOM) has reported that approximately 100 million Americans experience chronic pain. The IOM report on pain and the subsequent National Pain Strategy (NPS) issued by the U.S. Department of Health and Human Services have both noted the educational gaps regarding pain management and highlighted the pivotal role that psychology plays in the field of pain management. Fishman and colleagues (2013) emphasized the need for all providers involved in the study and practice of pain management to acquire a common fund of knowledge and proposed a comprehensive set of core competencies that would apply across multiple professions and specialty areas (e.g., anesthesiology, nursing, and psychology). These core competencies are meant to be tailored to allow each pain-related subspecialty to incorporate the factors and competencies unique to their discipline. To date, the terms pain psychology and pain psychologist are routinely used in public discourse to refer to psychologists practicing integrated, multimodal, and multidisciplinary pain care, but the field of psychology has not yet defined this emerging specialty. It is important for the discipline itself to define these terms and for psychologists to specify the competencies that would be expected of a clinician working as a pain psychologist. The current article represents an initial effort to define the core competencies necessary to fulfill the role of a pain psychologist working in the field of pain management. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An evaluation of whether a gestational weight gain of 5 to 9\u2009kg for obese women optimizes maternal and neonatal health risks

BackgroundMaternal obesity has a wide range of health effects on both the pregnant woman and developing fetus. The clinical significance of these disorders, combined with a dramatically increasing prevalence of obesity among pregnant women has precipitated a major health crisis in the United States. The most commonly used recommendations for gestational weight gain were established by the Institute of Medicine (IOM) in 2009 and have become well known and often adopted. The authors of the IOM report acknowledged that the recommended gestational weight gain of 5 to 9 kg for obese women whose body mass index was greater than 30 kg/m2 was based on very little empirical evidence. The objective of this study was to evaluate whether a 5 to 9 kg weight gain, for obese women, optimized a set of maternal and neonatal health outcomes.MethodsData containing approximately 12,000,000 birth records were obtained from the United States Natality database for the years 2014 to 2016. A Bayesian modeling approach was used to estimate the controlled direct effects of pre-pregnancy body mass index and gestational weight gain.ResultsObese women gaining less than 5 kg during pregnancy had reduced maternal risks for gestational hypertension, eclampsia, induction of labor and Caesarian section. In contrast, maternal gestational weight gain of less than 5 kg was associated with increased risks for multiple adverse neonatal outcomes with macrosomia the exception. Obese women who gained more than 9 kg during pregnancy had increased risk for multiple maternal and neonatal adverse outcomes.ConclusionsObese women who were observed to gain less than 5 kg during gestation had reduced odds of several peripartum disorders. However, this lower gestational weight gain was associated with an increase in multiple risks for the neonate.

Racial and Ethnic Disparities in Radiology: A Call to Action

The US health care system is in the midst of incredible transformation. High-value, high-quality health care is the ultimate goal. Guided by the Institute of Medicine report “Crossing the Quality Chasm,” the focus is to deliver care that is safe, efficient, effective, timely, patient centered, and equitable. Equity is the principle that quality of care should not vary based on patient characteristics, such as race or ethnicity. Even with the same insurance and socioeconomic status and when comorbidities, stage of presentation, and other confounders are controlled for, minorities often receive a lower quality of health care than their white counterparts. These racial and ethnic disparities in quality of care contribute to disparities in health outcomes and higher costs. Radiology is not exempt from this issue, as disparities related to imaging services have been reported in the literature. The root causes of racial and ethnic disparities in health care are complex and include the negative impact of the social determinants of health, limited access to care, as well as health system, provider, and patient factors. The field of radiology has a unique opportunity to engage in efforts to improve quality, address disparities, and achieve equity. A call to action is necessary, with a focus on addressing social determinants of health; creating culturally, linguistically, and health literacy-appropriate outreach and services; investing in cross-cultural education; and diversifying the radiology workforce. Ultimately, radiologists can provide equitable access to radiology care and promote person-centered care solutions that are tailored to the needs of diverse populations.

Physician Engagement: A Key Concept in the Journey for Quality Improvement.

In the 2001 Institute of Medicine report on patient outcomes in the United States, one of the key concepts was the importance of collaboration within the health care team by using quality improvement methodologies as a foundation and using data to drive change and improve patient outcomes and ultimately the health of the nation. Ensuring that all health care providers have a voice at the table on key initiatives has been a challenge to implement, especially when attempting to involve frontline staff including physicians and nurses. In regard to the particular organization to be discussed, it was important to have an understanding of what issues resonated with physicians and the health care team as a whole in order to successfully integrate their expertise into committee work and practice changes that were priorities for the organization. As a starting point, a review of physician engagement strategies was completed and priorities were matched according to physician specialty and interest. Due to the increasing external pressure to examine and improve outcomes in hospital-acquired infections and in particular, reduction of central line-associated blood stream infections, catheter-associated urinary tract infections, surgical site infections, and Clostridium difficile infections, these areas were the focus of the initial physician-led teams. The positive outcomes in both physician engagement and satisfaction as well as patient outcomes were evidence to pursue additional team approaches in complication reviews, employee injury teams, and mortality risk reduction.