Negative Patient Outcomes Research Articles

Hyperkalaemia among hospital admissions: prevalence, risk factors, treatment and impact on length of stay

BackgroundHyperkalaemia is one of the common electrolyte disorders among hospital patients, affected by many risk factors including medications and medical conditions. Prompt treatment is important given its impact on patient mortality and morbidity, which can lead to negative patient outcomes and healthcare resource utilisation. This study aims to describe the prevalence, characteristics, and treatment of patients admitted to hospitals with hyperkalaemia and compare findings between patients with kidney failure on maintenance haemodialysis therapy and patients without kidney failure. It also aims to identify associations between hyperkalaemia and hospital length of stay.MethodsWe undertook a retrospective cohort study on adult patients admitted to Townsville University Hospital between 1st January 2018 and 31st December 2022 (n = 99,047). Patients were included if they had a serum potassium result of 5.1 mmol/L and above during their admission/s. Statistical analysis was conducted using several methods. A Welch’s t test and Chi-square test were employed to assess differences between groups of patients with kidney failure on maintenance haemodialysis therapy and those without kidney failure. For comparison among multiple groups with varying severities of hyperkalaemia, the Kruskal-Wallis test with Mann-Whitney U test and logistic regression were used.Results8,775 hyperkalaemic patients were included in the study, with a mean age of 64.7 years. The prevalence of hyperkalaemia was 8.9% of patients. Risk factors for hyperkalaemia were highly prevalent among those who had the condition during their admissions. Patients with kidney failure on haemodialysis who had hyperkalaemia were, on average, 6 years younger, more often Indigenous, and experienced more severe hyperkalaemia compared to other patients without kidney failure. There was a notable difference in hyperkalaemia treatment between groups with varying degrees of hyperkalaemia severity. Hyperkalaemia was not found to be associated with prolonged hospital stay.ConclusionHyperkalaemia is common among hospital admissions. Patients with kidney failure on haemodialysis are at higher risk of developing severe hyperkalaemia. Treatment for hyperkalaemia was variable and likely insufficient. Timely detection and treatment of hyperkalaemia is recommended.

Why nurses discontinue practice in hospitals? Insights from a qualitative study.

To explore why registered nurses in Italy choose to resign from their positions in hospitals. In recent years, the work environment within hospitals has worsened, with increasing rates of burnout, stress, depression, compassion fatigue, and even suicide among nurses. This has prompted many nurses to either leave their current positions or exit the profession entirely. Previous research has indicated that nurse turnover, especially in hospital settings, poses a significant challenge for society and global healthcare, with insufficient nurse staffing associated with negative patient outcomes. The study used a descriptive phenomenology design, conducting 30 semi-structured interviews with nurses. The Consolidated Criteria for Reporting Qualitative Research have been followed in reporting the methods and findings. The average age of the participants was 32.8 years, the average length of hospital work experience was 5.7 years, and the majority of the participants were female (n=22). Thematic analysis revealed two main themes: individual factors, encompassing "quality-of-life threats" and "personal drive and ambitions", and organizational factors, including "unsustainable working conditions" and "lack of support from employers." There is an urgent need for an evidence-based approach to quality improvement to increase nurses' well-being in the workplace. Organizations aiming to retain nursing staff should prioritize strategies such as promoting work flexibility and addressing concerns related to work-life balance. Effective management engagement and implementation of flexible working arrangements are essential, along with the promotion of organizational values aligned with professionalism to combat negative perceptions of the nursing profession.

Impact of Gestational Diabetes Mellitus on Neonatal Birth Outcomes.

Aims/Background The purpose of this study is to investigate the risk factors for gestational diabetes mellitus (GDM) during pregnancy and its impact on neonatal birth outcomes. Methods A total of 2010 cases of mothers with GDM who underwent routine prenatal examinations and delivered at The Fourth Hospital of Shijiazhuang from June 2021 to April 2022, and their newborns were selected as the GDM group. For comparison, 2087 cases of mothers with normal glucose tolerance (NGT) and their newborns during the same period were selected as the NGT group. Birth outcomes of both groups were compared. Results Pregnant women in the GDM group exhibited significantly higher proportions of advanced age, higher body mass index (BMI), and irregular dietary habits compared to the NGT group (p < 0.05). Conversely, the GDM group had significantly lower proportions of nutrient supplementation and prenatal exercise compared to the NGT group (p < 0.05). The incidences of macrosomia, neonatal hypoglycemia, hyperbilirubinemia, and acute respiratory distress syndrome (ARDS) were significantly higher in the GDM group compared to the NGT group (p < 0.05 for all). Among GDM women with adverse outcomes, significant differences were observed in pre-pregnancy BMI, insufficient or excessive weight gain during pregnancy, and poor glycemic control during pregnancy compared to those without adverse outcomes (p < 0.05 for all). Poor glycemic control during pregnancy, pre-pregnancy BMI, and inadequate or excessive weight gain were significant factors influencing adverse pregnancy outcomes in GDM patients (p < 0.05). Conclusion The risk factors for GDM include advanced maternal age, being underweight, overweight, or obese prior to pregnancy, irregular eating habits, dietary nutritional deficiencies, and lack of prenatal exercise. The incidence of adverse pregnancy outcomes is higher in GDM patients compared to those without GDM. Poor glycemic control during pregnancy and higher pre-pregnancy BMI are significant factors that contribute to negative outcomes for both GDM patients and their newborns.

Prescription for change: Unveiling burnout perspectives among pharmacy leaders

Background: Burnout among pharmacists is increasingly pertinent, with growing demand for effective interventions. Burnout can lead to reduced productivity, increased job turnover, medical errors, poor patient satisfaction, and other negative outcomes for patients and providers. Growing attention to burnout in the pharmacy profession highlights the need for personal, organizational, and systemic solutions. However, the uptake and relative efficacy of different approaches remain unclear, particularly within community pharmacy practice. This study sought the viewpoint of community pharmacy leaders (i.e., community pharmacy managers, district managers, franchisees, owners, and executives from various pharmacy organizations) to characterize burnout from their perspectives. Methods: This qualitative study followed a grounded theory approach. Community pharmacy leaders were interviewed using a semistructured format to gather in-depth insights into their experiences and perspectives on burnout and engagement. Results: Sixteen people were interviewed; interviews lasted 30 to 65 minutes, averaging 51 minutes long. Six themes were identified: perceived disconnection between front-line staff and pharmacy decision-makers, overwhelming work demands, cautious optimism toward the expanding scope of pharmacy practice, the importance of employee recognition and appreciation, appropriateness and use of existing work resources, and multimodal, systemic responsibility and solutions to burnout. Conclusion: Addressing burnout requires a multifaceted approach involving personal, organizational, and systemic interventions. Evidence from this study provides valuable insights into the feasibility and efficacy of specific interventions, informing future strategies to enhance workplace well-being and engagement. The study highlights the importance of managing job demands and maximizing resources, emphasizing that personal approaches alone are insufficient and that organizational and systemic interventions are crucial.

Negative Pressure Wound Therapy with Instillation for Periprosthetic Infection after Breast Reconstruction: A Systematic Review.

Periprosthetic infection after breast reconstruction is not uncommon and can result in loss of the implant pocket and negative patient outcomes. Management of these infections typically involves removal of the prosthesis, treatment with antibiotics, and delayed reconstruction upon infection resolution. The impact of adjunctive use of negative pressure wound therapy with instillation and dwell (NPWTi-d) on breast pocket salvage rates, time to implant reinsertion, and related outcomes was examined. A systematic literature search using PubMed, Cochrane, OVID, Scopus, and Embase was conducted to identify peer-reviewed articles written in English and published between January 2004 and April 2023 that examined NPWTi-d use in the breast pocket with a history of periprosthetic infection after breast reconstruction. Of the 1703 publications, 6 studies met inclusion criteria, representing 115 patients and 122 breasts. The overall breast pocket salvage rate with NPWTi-d across studies was approximately 92%. In the 6 studies that included prosthesis type and radiation history, overall salvage rates were 97.8% (45 of 46) for pockets containing implants and 93.8% (15 of 16) for pockets containing tissue expanders. Salvage rates were 85.7% (12 of 14) and 91.7% (53 of 58) for irradiated and nonirradiated breasts, respectively. Mean time to implant reinsertion ranged from 2.3 to 10.3 days. In this review, antibiotic therapy along with adjunctive use of NPWTi-d for periprosthetic infections after breast reconstructions was associated with high rates of breast pocket salvage and reduced time to implant reinsertion. Larger prospective and randomized trials are needed to better understand and optimize the effectiveness of NPWTi-d in this population.

Angiotensin II receptor blockers and their applications in orthopaedic surgery and musculoskeletal medicine.

Angiotensin II receptor blockers (ARBs) are commonly prescribed for hypertension and heart failure, and have well-described antifibrotic properties throughout medical literature. The etiology and pathogenesis of fibrosis is biologically complex with a multitude of factors playing a role in the process. Consequently, pathologic fibrosis may be significant within orthopaedics contributing to post-operative stiffness and, ultimately, negative patient outcomes. The pharmacology of ARBs has been described to combat fibrosis in preclinical settings, while the literature of ARBs antifibrotic properties in relation to orthopaedics remains scarce. However, fibrosis is one of the primary factors contributing to tissue healing and functional recovery in the field of orthopaedic surgery. Fibrosis has specifically been described in relation to shoulder surgery, knee arthroplasty and hip arthroscopy. As such, outcomes of various orthopaedic surgeries are dependent upon a balance between tissue healing and stiffness, both of which may be mediated by a fibrotic response. Importantly, ARBs have recently emerged as a potential therapy to combat fibrosis-mediated stiffness in orthopaedic surgery patients. Thus, the following review article seeks to highlight the basic and clinical science of ARBs with emphasis on their implications and indications for orthopaedic surgery and musculoskeletal medicine.

Hematological Complications From Transcatheter Aortic Valve Replacement (TAVR): Recognition and Treatment.

Transcatheter aortic valve replacement (TAVR) has emerged as a pivotal intervention for patients with severe aortic stenosis who are at high or prohibitive surgical risk. Although TAVR is a minimally invasive procedure, it is linked to serious hematological problems, most notably thrombosis and bleeding. Numerous factors, such as procedural features, patient comorbidities, and anticoagulation management techniques, contribute to these complications. Bleeding complications can be major, minor, or life-threatening. They can be caused by problems with the vascular access site, anticoagulation medication, or coexisting conditions like renal dysfunction and frailty. Hemoglobin drop, overt bleeding, and hematoma signs must all be closely watched to identify bleeding. Careful selection and modification of anticoagulation medication, the use of vascular closure devices, and timely attention to bleeding sites are examples of management techniques. Thrombotic consequences, which include cerebrovascular accidents and valve thrombosis, are caused by endothelial injury, stent implantation, and patient hypercoagulability. Imaging modalities such as computed tomography and transesophageal echocardiography are used in the crucial process of detection. The goal of preventive care is to maximize anticoagulation regimens that are customized to each patient's risk profile, frequently striking a balance between the risk of thrombosis and bleeding. A multidisciplinary strategy that integrates surgical, hematological, and cardiology expertise is necessary for the effective management of these hematological complications. To improve patient outcomes, ongoing research attempts to improve risk stratification and create safer anticoagulation protocols. This review emphasizes how critical it is to identify bleeding and thrombotic events as soon as possible and treat them promptly to reduce the risk of negative outcomes for TAVR patients.

Biopsychosocial Associates of Psychological Distress and Post-Traumatic Growth among Canadian Cancer Patients during the COVID-19 Pandemic.

Understanding both the positive and negative psychological outcomes among cancer patients during the pandemic is critical for planning post-pandemic cancer care. This study (1) examined levels of psychological distress and post-traumatic growth (PTG) among Canadian cancer patients during the COVID-19 pandemic and (2) explored variables that were associated with psychological distress and PTG during the pandemic using a biopsychosocial framework. A cross-section survey was undertaken of patients receiving ongoing care at a regional cancer centre in Ontario, Canada, between February and December 2021. Self-reported questionnaires assessing sociodemographic information, social difficulties, psychological distress (depression, anxiety fear of recurrence, and emotional distress), PTG, illness perceptions, and behavioural responses to the pandemic were administered. Disease-related information was extracted from patient health records. Prevalences of moderate to severe levels of depression, anxiety, fear of recurrence and emotional distress were reported by 26.0%, 21.2%, 44.2%, and 50.0% of the sample (N = 104), respectively. Approximately 43% of the sample reported experiencing high PTG, and these positive experiences were not associated with levels of distress. Social factors, including social difficulties, being female, lower education, and unemployment status were prominent associative factors of patient distress. Perceptions of the pandemic as threatening, adopting more health safety behaviours, and not being on active treatment also increased patient likelihood to experience severe psychological distress. Younger age and adopting more health safety behaviours increased the likelihood of experiencing high PTG. The discriminatory power of the predictive models was strong, with a C-statistic > 0.80. Examining both the positive and negative psychological patient outcomes during the pandemic has highlighted the complex range of coping responses. Interventions that adopt a multi-pronged approach to screen and address social distress, as well as to leverage health safety behaviours, may improve the adjustments in the pandemic aftermath.

Early Identification, Intervention, and Prevention of Hospital-Acquired Pressure Injuries Using a Nurse-Driven Pressure Injury Prevention Program.

The purpose of this quality improvement project was to reduce the hospital-acquired pressure injury (HAPI) rate to less than 1.177 per 1000 patient-days, increase staff competency and care in pressure injury prevention best practices through implementation of a nurse-driven pressure injury prevention program, to engage patients in pressure injury prevention through implementation of skin rounds, and improve staff adherence to documentation requirements for pressure injury interventions on an amputee/stroke unit. HAPIs can lead to negative patient outcomes including pain, infection, extended hospitalization, and morbidity. Using an evidence-based education strategy, the Agency for Healthcare Research and Quality pressure ulcer prevention clinical pathway and skin rounds were implemented. Focused education for nursing, staff competency, daily audits, HAPI rates, and documentation compliance were evaluated pre and post intervention. The HAPI rate reduced from 1.177 to 0.272 per 1000 patient-days. After completion, the unit maintained zero pressure injuries, daily patient care for pressure injuries improved, documentation compliance increased, and staffs' knowledge and skill set in early identification, intervention, and prevention of pressure injuries heightened. A nurse-driven pressure injury prevention program was successful in the reduction of the HAPI rate.

Artificial Intelligence-Based Models for Prediction of Mortality in ICU Patients: A Scoping Review.

Healthcare professionals may be able to anticipate more accurately a patient's timing of death and assess their possibility of recovery by implementing a real-time clinical decision support system. Using such a tool, the healthcare system can better understand a patient's condition and make more informed judgements about distributing limited resources. This scoping review aimed to analyze various death prediction AI (Artificial Intelligence) algorithms that have been used in ICU (Intensive Care Unit) patient populations. The search strategy of this study involved keyword combinations of outcome and patient setting such as mortality, survival, ICU, terminal care. These terms were used to perform database searches in MEDLINE, Embase, and PubMed up to July 2022. The variables, characteristics, and performance of the identified predictive models were summarized. The accuracy of the models was compared using their Area Under the Curve (AUC) values. Databases search yielded an initial pool of 8271 articles. A two-step screening process was then applied: first, titles and abstracts were reviewed for relevance, reducing the pool to 429 articles. Next, a full-text review was conducted, further narrowing down the selection to 400 key studies. Out of 400 studies on different tools or models for prediction of mortality in ICUs, 16 papers focused on AI-based models which were ultimately included in this study that have deployed different AI-based and machine learning models to make a prediction about negative patient outcome. The accuracy and performance of the different models varied depending on the patient populations and medical conditions. It was found that AI models compared with traditional tools like SAP3 or APACHE IV score were more accurate in death prediction, with some models achieving an AUC of up to 92.9%. The overall mortality rate ranged from 5% to more than 60% in different studies. We found that AI-based models exhibit varying performance across different patient populations. To enhance the accuracy of mortality prediction, we recommend customizing models for specific patient groups and medical contexts. By doing so, healthcare professionals may more effectively assess mortality risk and tailor treatments accordingly. Additionally, incorporating additional variables-such as genetic information-into new models can further improve their accuracy.

Head Nurse Leadership: Facilitators and Barriers to Adherence to Infection Prevention and Control Programs-A Qualitative Study Protocol.

The effective management of Healthcare-Associated Infections (HAIs) relies on the implementation of good practice across the entire multidisciplinary team. The organizational context and the role of head nurses influence the team's performance and behavior. Understanding how decision-making processes influence healthcare professionals' behavior in the management of HAIs could help identify alternative interventions for reducing the risk of infection in healthcare organizations. This study aims to explore how the behaviors promoted and actions implemented by the head nurse can influence healthcare professionals' adherence to Infection Prevention and Control (IPC) programs. A multi-center qualitative study will be conducted using a Grounded Theory approach. Observations will be conducted, followed by individual interviews and/or focus groups. A constructive and representative sample of healthcare professionals who care directly for patients will be enrolled in the study. The COnsolidated criteria for REporting Qualitative research (COREQ) checklist will be followed to ensure the quality of this study protocol. A multistep inductive process will be used to analyze the data. The study results will provide an understanding of how nurses perceive the influence of leadership and how they modify their behaviors and activities toward patients according to IPC programs. The study will identify barriers and facilitators to IPC compliance and suggest strategies to minimize negative patient outcomes, such as the development of an HAI.

Optimizing preoperative antibiotic use through improved penicillin allergy documentation.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Penicillin allergy documentation in the electronic health record (EHR) lacks detail with regard to type of reaction, history of reaction, and other tolerated β-lactams. Because of concern for penicillin allergy cross-reactivity with cefazolin, patients with a reported penicillin allergy are frequently prescribed suboptimal preoperative antibiotics, which have been associated with negative patient outcomes, including increased risk of surgical site infection. The purpose of this study was to increase preoperative use of cefazolin via improvement to the documentation of penicillin allergies in the EHR. This single-center, quasi-experimental quality improvement study compared patients with a self-reported penicillin allergy admitted for select elective surgeries before and after implementation of a penicillin allergy questionnaire. The primary outcome was receipt of cefazolin for surgical prophylaxis. Secondary outcomes were the proportion of patients with detailed penicillin allergy documentation, the proportion of patients with surgical site infections occurring within 30 days of surgery, and the proportion of patients who received the full antibiotic dose before the first surgical incision. A total of 100 patients were included in the preintervention group, while 85 patients were included in the postintervention group. Cefazolin use was higher in the postintervention group (13.0% vs 41.2%; P < 0.001). The postintervention group also had a larger proportion of patients with detailed allergy documentation (2.0% vs 50.6%; P < 0.001) and who received the full preoperative antibiotic dose before the first incision (25.0% vs 48.2%; P = 0.001). There was no statistical difference between the groups in the incidence of surgical site infection at 30 days after surgery (3.0% vs 1.2%; P = 0.63). Preoperative cefazolin use was higher in patients with a reported penicillin allergy after implementation of a penicillin allergy questionnaire and EHR documentation tool.

War Injuries and Nurses' Well-Being: Fatigue and Sleep Quality Among Critical Care Nurses in Najran Region, Saudi Arabia.

Introduction Critical care nurses must maintain optimal work performance. Fatigue and sleep disturbance can limit safe practice and cause negative patient outcomes. This study aimed to explore fatigue and sleep quality among critical care nurses in the war zone in Najran City, Saudi Arabia. Methods A cross-sectional research design was used and a convenience sample was applied to include 352 nurses working in critical units at various hospitals in Najran City, Saudi Arabia. A self-administered questionnaire containing three partswas used: demographic characteristics, the Pittsburgh Sleep Quality Index (PSQI), and the Fatigue Severity Scale (FSS). Results The study revealed that 232 nurses (65.9%)reported poor sleep quality. Regarding fatigue levels, 89 nurses (25.2%) reported severe fatigueand 113 (32.1%) reported moderate fatigue. Notably, caring for war-related injuries exhibited a significant positive correlation (r = 0.62, p = 0.0001). Experience correlated negatively (r = -0.47, p = 0.003) with sleep quality and fatigue scores. Most significantly, involvement in caring for war-related injuries showed a strong positive correlation (r = 0.71, p = 0.00001) with FSS scores. Conclusions Poor sleep quality was significantly widespread among the studied nurses. The results indicated that about one-quarter of the studied nurses reported severe fatigue, whichwas alarmingly prevalent among nurses. Nurses involved in caring for war-related injuries exhibited a strong positive correlation with both PSQI and FSS scores. Recommendations The authors recommend developing and implementing counseling and stress management programs to address the unique challenges faced by nurses caring for war-related injuries.

Challenges and Benefits of a Multidisciplinary Approach to Treatment in Clinical Medicine

Introduction: The multidisciplinary approach in healthcare unites professionals from different fields to deliver patient-centered care. This collaborative team, comprising care partners, hospitalists, nurses, pharmacists, and others, operates with shared goals, leveraging electronic records, regular assessments, and patient involvement. Objective: In this review, we aim to investigate the challenges and benefits of a multidisciplinary approach to treatment in clinical medicine. Methodology: In our study, we included English studies from online databases such as Web of Science, Scopus, Google Scholar, PubMed, and the Cochrane Library using the following keywords “delusions”, “pharmacotherapy”, “psychotherapy”, and “antipsychotics” till January 2024. Results: The result of the search using our search strategy was 2367 articles. We screened these articles to choose the articles related to our topic. We did a full-text screening of 344 articles after excluding the remaining articles by title and abstract screening. Finally, we used 50 articles to gather information about our topic and write this review. Scientific Novelty: Lies in its integration of diverse expertise, methodologies, and perspectives to address complex healthcare challenges. Practical Significance of the Results Obtained: Its practical significance lies in improving patient outcomes, optimizing resource utilization, and fostering innovation through collaborative problem-solving and evidence-based practices. Conclusion: This literature review focused on the multidisciplinary approach in medicine to ensure quality healthcare for patients. Stressing the advantages such as decreasing negative patient outcomes and increasing treatment strategies by collaboration among health care professionals.

Ultrasound assessment of diaphragmatic dysfunction in non-critically ill patients: relevant indicators and update.

Diaphragm dysfunction (DD) can be classified as mild, resulting in diaphragmatic weakness, or severe, resulting in diaphragmatic paralysis. Various factors such as prolonged mechanical ventilation, surgical trauma, and inflammation can cause diaphragmatic injury, leading to negative outcomes for patients, including extended bed rest and increased risk of pulmonary complications. Therefore, it is crucial to protect and monitor diaphragmatic function. Impaired diaphragmatic function directly impacts ventilation, as the diaphragm is the primary muscle involved in inhalation. Even unilateral DD can cause ventilation abnormalities, which in turn lead to impaired gas exchange, this makes weaning from mechanical ventilation challenging and contributes to a higher incidence of ventilator-induced diaphragm dysfunction and prolonged ICU stays. However, there is insufficient research on DD in non-ICU patients, and DD can occur in all phases of the perioperative period. Furthermore, the current literature lacks standardized ultrasound indicators and diagnostic criteria for assessing diaphragmatic dysfunction. As a result, the full potential of diaphragmatic ultrasound parameters in quickly and accurately assessing diaphragmatic function and guiding diagnostic and therapeutic decisions has not been realized.

Empathy and mental health in veterinary medicine.

In veterinary medicine, the relationship between empathy and mental health presents a complex and important aspect of professional well-being. Veterinarians are frequently exposed to numerous work-related stressors and are therefore more likely to experience mental health disorders and commit suicide. Due to the specific nature of the profession, veterinarians deal with negative patient outcomes, inform owners of unfavourable news, handle heavy workloads, and professional isolation. Psychological stress is a result of all these factors coming together, and it can lead to anxiety, depression, burnout, and even frequently reported suicide. Animal euthanasia has been recognised as a unique professional risk factor that can have harmful psychological effects on veterinary professionals.This paper explores the role of empathy in the mental health of veterinarians and other veterinary staff, and how this might contribute to their vulnerability to psychological stress and suicidal ideation. Empathy plays an important role in interpersonal interactions, while also influencing human-animal relationships, which adds a whole new level of complexity to the doctor-patient dynamic in this field. Veterinarians are responsible for providing compassionate care for both the animals they treat and their owners. They must manage the emotionally demanding work while preserving their mental health by balancing between providing empathetic care and sustaining their own emotional boundaries. To alleviate the negative effects of psychological stress, veterinary professionals require interventions such as peer support groups, stress management training, and mental health support programmes.

A Quality Improvement Project to Increase Compliance With a Facility Protocol on Surgical Antimicrobial Prophylaxis.

Surgical site infections (SSIs) contribute to negative outcomes for patients and health care organizations. Compliancewith clinical practice guidelines likely can help prevent SSIs. An interdisciplinary team at a regional referral center in Michigan sought to reduce SSIs by improving compliance with the facility's preoperative antibiotic selection, dosing, timing, and redosing protocol. The interventions for the quality improvement project included adding the preprocedural antibiotics and doses to the master OR schedule; holding an education session for all preoperative nurses, intraoperative nurses, and anesthesia professionals; and posting a reference guide in the preoperative and intraoperative areas. Compliance with the facility's protocol for antibiotic selection, dosing, and timing significantly improved. However, SSI rates and compliance with redosing recommendations did not change significantly. The team decided to add the antibiotic order information to the master OR schedule permanently. The team plans to consider providing education sessions on administering preprocedural antibiotics outside the OR.

Missed nursing care and stoma care: an Italian survey.

In Italy, nursing research has paid special attention to 'missed nursing care'. The studies carried out, varying in tools and settings, describe considerable percentages of missed care. In the field of stoma care, the phenomenon has not been investigated to date. To investigate the prevalence of missed nursing care (MNC) in the Italian ostomy patient population and the most relevant causes suggested for this by stoma care nurses. Cross-sectional study. The Italian version of the MISSCARE survey was used with some questions related to the stoma care pathway. The survey was targeted at hospitals in the country with dedicated services and/or pathways for ostomy patients, between February and April 2023. A total of 461 questionnaires were sent out, 214 (53.3%) were analysed. The majority of the participants were female (160, 76.2%), median age of 50 years (35.0-53.8). The most common qualification was a Bachelor's degree (n=117; 54.9%) and work experience in stoma care was more than 10 years in 95 cases (50.3%). Prominent instances of MNC were identified, with hand washing (score 4.6 out of 5), compilation of nursing documentation and hygiene/skin care (score 4.5 out of 5) and patient/family education (score 4.4 out of 5) emerging as the most prevalent. The most notable omissions in the stoma care process encompassed educational facets, clinical monitoring, a comprehensive discharge plan, and diligent follow-up. Among the most frequent reasons were staff shortages (score 3.1 out of 4), unsuitable nurse-patient ratios (score of 3 out of 4) and insufficient numbers of experienced stoma care personnel (score of 3 out of 4). A substantial number of basic and clinically relevant nursing interventions were perceived to be missed, and this may lead to an increase in negative outcomes for ostomy patients.

An Effective Methodology for Scoring to Assist Emergency Physicians in Identifying Overcrowding in an Academic Emergency Department in Thailand

BackgroundEmergency Department (ED) overcrowding is a global concern, with tools like NEDOCS, READI, and Work Score used as predictors. These tools aid healthcare professionals in identifying overcrowding and preventing negative patient outcomes. However, there’s no agreed-upon method to define ED overcrowding. Most studies on this topic are U.S.-based, limiting their applicability in EDs without waiting rooms or ambulance diversion roles. Additionally, the intricate calculations required for these scores, with multiple variables, make them impractical for use in developing nations.ObjectiveThis study sought to examine the relationship between prevalent ED overcrowding scores such as EDWIN, occupancy rate, and Work Score, and a modified version of EDWIN newly introduced by the authors, in comparison to the real-time perspectives of emergency physicians. Additionally, the study explored the links between these overcrowding scores and adverse events related to ED code activations as secondary outcomes.MethodThe method described in the provided text is a correlational study. The study aims to examine the relationship between various Emergency Department (ED) overcrowding scores and the real-time perceptions of emergency physicians in every two-hour period. Additionally, it seeks to explore the associations between these scores and adverse events related to ED code activations.ResultsThe study analyzed 459 periods, with 5.2% having Likert scores of 5–6. EDOR had the highest correlation coefficient (0.69, p < 0.001) and an AUC of 0.864. Only EDOR significantly correlated with adverse events (p = 0.033).ConclusionEDOR shows the most robust link with ‘emergency physicians’ views on overcrowding. Additionally, elevated EDOR scores correlate with a rise in adverse events. Emergency physicians’ perceptionof overcrowding could hint at possible adverse events. Notably, all overcrowding scores have high negative predictive values, efficiently negating the likelihood of adverse incidents.

Shame in patient-health professional encounters: A scoping review.

Shame can arise during patient-health professional encounters when discussing traumatising and stigmatising topics and can contribute to negative patient outcomes. This review aims to summarise what is known regarding shame in patient-health professional encounters. We conducted a scoping review using Levac and colleagues' approach and reported the findings using the PRISMA Extension for Scoping Reviews. We searched four databases (CINAHL, PsychINFO, PubMed and SocINDEX) for empirical studies that involved shame in patient-health professional encounters contextualised by trauma or stigma and were published in English. We categorised what is known regarding shame in empirical studies using inductive content analysis. We also collected stakeholders' perspectives on the review findings through an online survey. Our initial search yielded 3658 articles, of which 37 were included. We summarised the literature into four categories: (1) What health professionals say they do in patient-health professional encounters, (2) What health professionals think patients feel in patient-health professional encounters, (3) Patients' descriptions of their own shame during patient-health professional encounters and (4) Health professionals' descriptions of their own shame during patient-health professional encounters. Shame can arise in a variety of circumstances during patient-health professional encounters. More research is needed to identify what specific communication strategies used by health professionals during patient-health professional encounters contribute to or avoid patient shame.