Nursing Leadership Team Research Articles

Implementing a Care-Based Nursing Workforce Model: Implications for Missed Care, Teamwork, and Satisfaction.

Nursing care delivery models may serve as a significant factor contributing to nurse satisfaction, frequency of missed care, and patient outcomes. The nursing leadership team at our institution sought to determine if an adaptation of our primary registered nurse (RN) nursing model would enhance satisfaction of bedside nurses and care of patients. An improvement study introducing a care-based delivery model was implemented between January 2023 and January 2024 on a medical-surgical neurology/spinal unit at our organization. Adoption of a care-based nursing model was supported with the delivery of brief education sessions utilizing in situ simulations for development of competencies in teamwork and delegation. During the pilot period, overall satisfaction with job role improved 23%. Six missed nursing care elements and 7 teamwork elements significantly improved. A care-based nursing model may improve staff satisfaction and quality of nursing care.

Improving role allocation for cardiopulmonary resuscitation (CPR) in the emergency department: a quality improvement project

IntroductionIn any healthcare setting, cardiopulmonary resuscitations (CPRs) stand out as demanding and chaotic resuscitation endeavours. Emergency departments (EDs) witness a significant volume of CPRs. Given the critical nature of CPR,...

Reducing Blood Culture Contamination in Adult Patients with Cancer Presenting to the Emergency Department

Background: Infection is one of the most common complications of cancer and cancer treatment. Most patients admitted for fever or infection come through the Emergency Department (ED), which is a primary site for blood culture collection. Contamination of blood cultures complicates the diagnoses, compromises quality of care, leads to unnecessary antibiotic exposure and increases financial burdens. It may also lead to unnecessary removal of central venous access devices or delay of critical therapy or procedures. At our institution, the contamination rate of blood cultures drawn in the ED was over twice that of the remainder of the hospital (2.8 versus 0.8), prompting this quality improvement project. Unlike on hospital floors, nurses, instead of phlebotomists, draw most blood cultures due to the urgency of managing suspected sepsis. Our aim was to decrease the ED contamination rate by 20 percent after the first PDSA cycle, and ultimately bring it on par with the remainder of the hospital. Methods: First, we compared ED contamination rates versus other hospital inpatient floors and outpatient centers over a three-month period. We then evaluated the contamination rates of ED nurses versus ED phlebotomists and peripheral versus central line blood draws. Process mapping and fishbone analysis helped identify practices contributing to higher contamination rates. Key drivers of these practices were diagrammed, and potential interventions were ranked on a prioritization matrix. Results: We identified use of alcohol rather than chlorhexidine swabs for peripheral disinfection and inconsistent techniques of blood draw by nurses as critical contributors to increased contamination rates in the ED. Our intervention was creating premade blood culture kits promoting the use of chlorhexidine swabs through availability and easy access in the fast-paced ED environment. Ten cubic centimeter (cc) syringes in the kits encouraged withdrawal of adequate blood samples in compliance with the 7-10 cc guideline. Designated nursing team leaders checked off ED nurses at the bedside, implementing education and adherence in using the blood culture collection kits. The average number of blood cultures in the emergency department was 1,400. A reduction in blood culture contamination from 2.46 percent to 1.89 percent was seen after two months. Conclusions: A guideline-driven, standardized blood culture collection process followed by ED nurses is vital to reducing blood culture contamination. Chlorhexidine is necessary to maintain the lowest contamination rates. Readily available premade blood culture kits improve compliance with materials and techniques associated with best practices.

Reducing costs and improving patient recovery through a nurse-driven centralized spinal orthoses program on a post-surgical unit: A quality improvement initiative

BackgroundAn external vendor providing off-the-shelf spinal orthoses to inpatients created significant costs and barriers to quality care for spinal surgery patients. A nursing leadership team initiated a quality improvement project to reduce the cost of providing off-the-shelf spinal orthoses and improve the care provided to spinal patients. ObjectiveTo develop and evaluate a nursing-led process for providing off-the-shelf orthoses to spinal surgery patients and eliminate high costs. DesignQuality improvement project evaluated as a retrospective interrupted time-series SettingPost Surgery Inpatient Unit Level II Trauma Center in a United States hospital located in Florida ParticipantsVendor Program: 134 patients; Centralized Program: 155 patients MethodsThe nursing leadership team developed a centralized spinal orthoses program where the bedside nurse fitted the patient with a spinal orthosis, eliminating the need for an external orthotist. The study quantifies changes in study metrics by comparing patients identified through chart review who received care in the vendor program to those who received care in the centralized program utilizing nonparametric statistical techniques. ResultsThe centralized nursing-led spinal orthosis program allowed the unit to mobilize patients more quickly than patients managed under the vendor program (3.85 hr. [95 % CI: 1.27 to 7.26 hrs] reduction; p = 0.004). The overall length of stay was reduced by 0.78 days ([1.34 – 0.02 days]; p = 0.063) or 18.72 h. While the statistical test did not indicate significance, the 18.72-hour reduction in length of stay represents a potential clinically relevant finding. Evaluating patients that suffered a primary spinal injury and no complications (vendor program: 54 patients; centralized program: 86 patients) showed a similar reduction in time to mobilization (4.5 hr reduction [0.53 to 12.93 hrs]; p = 0.025), but the length of stay reduction increased to 1.02 days [0.12 to 1.97 days], a difference determined to be statistically significant (p = 0.014). Centralizing the process for providing off-the-shelf spinal orthoses reduced the cost of a thoracic-lumbar sacral orthosis by $1,483 and the price of a lumbar-sacral orthosis by $1,327. Throughout the study, the new program reduced the cost of providing spinal orthoses by $175,319. ConclusionsThe results demonstrate that the nursing-led centralized spinal orthosis program positively impacted the quality of care provided to our patients while also reducing the cost of delivering the orthoses. Tweetable abstractA nursing-led centralized spinal orthosis program reduces the cost of care while reducing time to mobilization and length of stay.

Exploring Shared Implementation Leadership of Point of Care Nursing Leadership Teams on Inpatient Hospital Units: Protocol for a Collective Case Study.

Nursing leadership teams at the point of care (POC), consisting of both formal and informal leaders, are regularly called upon to support the implementation of evidence-based practices (EBPs) in hospital units. However, current conceptualizations of effective leadership for successful implementation typically focus on the behaviors of individual leaders in managerial roles. Little is known about how multiple nursing leaders in formal and informal roles share implementation leadership (IL), representing an important knowledge gap. This study aims to explore shared IL among formal and informal nursing leaders in inpatient hospital units. The central research question is as follows: How is IL shared among members of POC nursing leadership teams on inpatient hospital units? The subquestions are as follows: (1) What IL behaviors are enacted and shared by formal and informal leaders? (2) What social processes enable shared IL by formal and informal leaders? and (3) What factors influence shared IL in nursing leadership teams? We will use a collective case study approach to describe and generate an in-depth understanding of shared IL in nursing. We will select nursing leadership teams on 2 inpatient hospital units that have successfully implemented an EBP as instrumental cases. We will construct data through focus groups and individual interviews with key informants (leaders, unit staff, and senior nurse leaders), review of organizational documents, and researcher-generated field notes. We have developed a conceptual framework of shared IL to guide data analysis, which describes effective IL behaviors, formal and informal nursing leaders' roles at the POC, and social processes generating shared leadership and influencing contextual factors. We will use the Framework Method to systematically generate data matrices from deductive and inductive thematic analysis of each case. We will then generate assertions about shared IL following a cross-case analysis. The study protocol received research ethics approval (2022-8408) on February 24, 2022. Data collection began in June 2022, and we have recruited 2 inpatient hospital units and 25 participants. Data collection was completed in December 2023, and data analysis is ongoing. We anticipate findings to be published in a peer-reviewed journal by late 2024. The anticipated results will shed light on how multiple and diverse members of the POC nursing leadership team enact and share IL. This study addresses calls to advance knowledge in promoting effective implementation of EBPs to ensure high-quality health care delivery by further developing the concept of shared IL in a nursing context. We will identify strategies to strengthen shared IL in nursing leadership teams at the POC, informing future intervention studies. DERR1-10.2196/54681.

Facilitators of and Barriers to Effective Preceptorships for Pre-licensure Nursing Students: What Nursing Faculty Need to Know.

Preceptorships offer prelicensure nursing students the opportunity to meet their clinical objectives by working one-on-one with a registered nurse (RN). Although preceptorships can be provided for any clinical course, most prelicensure nursing programs offer them during the final semester. Preceptorships provide a bridge between academic study and the real world of nursing. By acting as a teacher, role model, evaluator, and person who can help a student to socialize with the profession, a preceptor can reduce the reality shock experienced by new nurses and provide them with realistic expectations about the nursing profession. The recent nursing shortage has inadvertently led to a preceptor shortage and forced the nursing leadership to become dependent on available RNs, including those without preceptor training or experience. This practice update paper aimed to address the facilitators and barriers associated with preceptorships for prelicensure nursing students and discuss the proposed solutions for effective clinical preceptorship based on evidence and the author's personal reflections. The major facilitators were the discussion of nursing program expectations, the selection of teaching strategies with real-world examples, the creation of a structured weekly plan to promote learning, and the consideration of alternative teaching approaches. The major barriers were preceptors' dual responsibilities to students and patients, challenging students, and the lack of experienced preceptors. The proposed solutions included obtaining support from the nursing leadership team to ensure that the preceptor had a balanced workload, developing the emotional competence of the preceptor, addressing challenging students through a three-way conference with the student, the preceptor, and the clinical faculty and a written plan to ensure student progress, having the nursing leadership conduct periodic assessments of the preceptor pool, and ensuring that appropriate training was offered to candidates who were willing to become preceptors.

Improving goal setting and achieving in geriatric rehabilitation through participatory action research

Introduction/background summary: In geriatric rehabilitation a means to achieve client centered care is to work collaboratively on setting and achieving goals. This might enhance self-efficacy, motivation, adherence to rehabilitation and goal-specific performance. In this participatory action research (PAR) project, a nursing team investigated for itself how to improve goal setting and achieving.
 Who is it for? The actions the nursing team chose and implemented contribute to improved goal setting and achieving and subsequently enhances client centered care.
 Who did you involve and engage with? This research project took place in a Learning and Innovation Network (LIN) on a geriatric rehabilitation ward, in which students and nurses work together on quality improvement projects. The team consisted of fifteen vocational trained nurses and healthcare assistants and eight nursing students, a nurse team leader and a lecturer practitioner spending a day per week on educational activities.
 What did you do? Facilitated by the lecturer practitioner, the nursing team (both staff and students) conducted a participatory action research project: they reflected on the steps they could take to work collaboratively on improving their practice, constantly evaluating their experiences. Data collected during the participatory action research consisted of, amongst others: student’s notes on patient interviews and interviews with nurses of the team, fieldnotes made by the facilitator during the PAR process. During PAR there is a constant need to feedback information and clarify issues. Therefor data analysis in PAR is partly performed concurrently. Data which had been collected by the facilitator or the nurses or students were used as a basis for planning and reflecting in the project group.
 
 Results: The team identified two themes influencing their goal setting and goal achieving with patients. Firstly, continuity of care is sub-optimal; in their opinion all should work on the same goals. Secondly, patients could be better informed about their rehabilitation path. The team chose to work on better preparation of the multidisciplinary care plan meeting with the patient and at the same time updating the patient record to advance continuity of care. A sound evaluation of the rehabilitation process and preparing the multidisciplinary care plan meeting to attain this, is now part of a shared team practice. During their process the team discovered certain barriers to optimally prepare the multidisciplinary care plan meeting, e.g. to optimally evaluate progress on rehabilitation goals the initial plan needs to be complete; certain barriers hamper preparation with the patient, like cognitive abilities or language problems. New actions have been chosen and are being worked on.
 Learning for the international audience: PAR which involves nurses can be seen as advantageous for facilitating change and improving services. Time and setting for reflection and collective learning supports the nursing team to diagnose their current practice and to improve their practice.
 Next steps: The Learning and Innovation Network was a temporary agreement between the nursing home and the nursing college based on research funding. Because of the positive results on team culture of improvement the Learning and Innovation Network might become a permanent facility.

Reducing blood culture contamination in adult patients with cancer presenting to the emergency department.

393 Background: Fever and leukocytosis are among the most common complaints for cancer patients presenting to the Emergency Department (ED). Most patients admitted for fever or infection come through the ED, which is therefore a primary site for blood culture collection. Contamination of these cultures can increase the clinical and financial burdens for the patients, the medical team, and laboratory staff. It may lead to unnecessary removal of central venous access devices or delay of critical therapy or procedures. At our institution, the contamination rate of blood cultures drawn in the ED was more than twice that of the remainder of the hospital (2.8 versus 0.8), prompting this quality improvement project. Unlike on hospital floors, nurses rather than phlebotomists draw the majority of blood cultures due to the urgency of managing suspected sepsis. Our aim was to decrease the contamination rate in the ED by 20 percent after the first PDSA cycle, and ultimately bring it on par with the remainder of the hospital. Methods: First, we compared contamination rates of the ED versus other hospital floors and outpatient centers over three months. We then evaluated the contamination rates of ED nurses versus phlebotomists and peripheral versus central line blood draws. Process mapping and fishbone analysis helped identify practices contributing to higher contamination rates. Key drivers of these practices were diagrammed, and then potential interventions were ranked on a prioritization matrix. Results: We identified the use of alcohol rather than chlorhexidine swabs for peripheral disinfection and inconsistent techniques of blood draw by nurses as the critical contributors to the increased contamination rates in the ED. Our intervention was to create premade blood culture kits that promoted the use of chlorhexidine swabs by ensuring availability and easy access in the fast-paced ED environment. Ten cc syringes in the kits encouraged the withdrawal of adequate blood samples in compliance with the 7-10 cc guideline. Designated nursing team leaders checked off the ED nurses at the bedside, implementing education and adherence to the use of blood culture collection kits. The average number of blood cultures in the emergency department was 1,400. Following two months of these interventions, there was a reduction in blood culture contamination from 2.46 percent to 1.89 percent. Conclusions: A guideline driven, standardized blood culture collection process adhered to by ED nurses is vital to reducing blood culture contamination. Chlorhexidine is necessary to maintain the lowest contamination rates. Readily available and premade blood culture kits improve compliance with the materials and techniques associated with best practices.

Testing for COVID-19 Using a Mobile Clinic Approach: A Collaborative Approach Focused on Underserved and At-Risk Populations in Louisville Kentucky

Testing for COVID-19 is an essential component of pandemic response, but equitable access across the communities has been a challenge due to failure of federally-funded programs to reach areas of greatest need. A partnership between the Louisville Metro Department of Public Health and Wellness, the Kentucky Nurses Association, and community leaders helped enable and facilitate a novel, community-based approach. Using a core of trained nurses and a larger group of volunteers, a mobile testing clinic process was developed and implemented in Louisville, Kentucky. From November 11, 2020 through June 30, 2022, 187 mobile testing clinics were held at 26 unique sites with 9337 tests performed. Sites focused on areas of Louisville where poverty density is the greatest, where recognized outbreaks occurred, and where community partners requested testing access. Fourteen nurse team leaders and more than 750 volunteers supported these efforts which were largely funded by existing resources. Standard Operating Procedures were developed to enable standardized training and activities across all clinics. The result is a process that has continued and has formed the basis for mobile vaccination clinics using many of the same processes.

Strategies and challenges in addressing ethical issues in the hospital context: A phenomenological study of nurse team leaders.

Nurse team leaders encounter considerable ethical challenges that necessitate using effective strategies to overcome them. However, there is a lack of research exploring the experiences of nurse team leaders in Indonesia who face ethical dilemmas in their professional duties. This study aimed to explore nurse team leaders' experiences regarding strategies and challenges in dealing with ethical problems in hospital settings in Indonesia. This qualitative study employed a hermeneutic phenomenology design. Online semi-structured interviews were conducted between November 2021 and February 2022 among 14 nurse team leaders selected using a snowball sampling from seven hospitals (three public and four private hospitals). Van Manen's approach was used for data analysis. The strategies for overcoming ethical dilemmas included (i) seeking the facts, (ii) stepping back, (iii) considering support, and (iv) standing by patients. The challenges for the nurse team leaders in resolving ethical problems consisted of (i) seniority, (ii) trust issue, and (iii) lack of reflection and ethics training. Nurse team leaders recognize their specific roles in the midst of ethical challenges and seek strategies to deal with them. However, a negative working environment might impact ethical behavior and compromise the provision of quality care. Therefore, it is imperative for hospital management to take note of these findings and address issues related to seniority by providing regular ethics training and group reflection sessions to maintain nurses' ethical knowledge in hospital practice. Such interventions can support nurse team leaders in resolving ethical dilemmas and provide a conducive environment for ethical decision-making, ultimately improving patient outcomes.

Who dismantled nursing mentorship systems and how do we get them back?

Who dismantled nursing mentorship systems and how do we get them back?

A78 BILIARY STENT USE IN ERCP: A QUALITY ASSURANCE STUDY ASSESSING ADHERENCE TO CLINICAL GUIDELINES AND COST OUTCOMES

Abstract Background A perceived increase in the use of biliary stents during endoscopic retrograde cholangiopancreatography (ERCP) was observed by our nursing team leader and brought to the attention of the Director of Endoscopy. Purpose To assess a) biliary stent utilization during ERCP, b) the adherence for stent placement based on published guidelines, and c) the associated cost. Method A chart review of all consecutive patients that underwent ERCP for one year (January 2020 to 2021) at the University of Alberta Hospital (UAH) was performed. The need for biliary stent placement was assessed independently by two blinded reviewers and compared with published guidelines. Costs were calculated using Alberta Health Services fee codes. Result(s) A total of 598 patients (316 F) with mean age of 60±19 years (range 3-99 years) underwent 842 ERCPs. Clinical indications for the initial ERCP were common bile duct (CBD) stones (376, 63%), malignant stricture (84, 14%), benign stricture (49, 8%), bile leak (27, 5%), stent removal (15, 3%), and others (47, 8%). Of the 244 patients that had a follow-up ERCP, the most common indications were stent removal (126, 52%), stent replacement (61, 25%), stent placement (28, 11%), and stone extraction (8, 3%). A total of 296 biliary stents were inserted, of which 223 stents (114 plastic, 109 metal) were inserted during the first ERCP (223/598, 37%) and 73 stents (43 plastic, 30 metal) during follow-up ERCP (73/244, 30%). Of the 296 stents, 79 (27%) were inserted for indications not in accordance with published guidelines (63/223 initial ERCP, and 16/73 follow-up ERCP, kappa=0.62). Most of these were placed in CBD stone cases (61/63 initial ERCP, 6/16 follow-up ERCP). In the subgroup of 376 patients with CBD stones, 61 (16%) underwent stent placement not in accordance with published guidelines. The added cost of such stent insertions and follow-up ERCPs for stent removal was $130,000. Conclusion(s) Stent insertion not in accordance with published guidelines was identified in some patients with CBD stones presenting for ERCP. To reduce unnecessary follow-up procedures and healthcare resource utilization, ERCP stent insertion education based on published guidelines, as well as regular practice audit and feedback are required. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Optimizing the Role of the Hospital-Based Nurse Scientist in a Changing Nursing Environment: Recommendations for Nurse Leaders.

Nurses and nurse leaders directing clinical organizations can elevate scholarly inquiry by employing a PhD-prepared hospital-based nurse scientist (HBNS). This individual will shape the culture of clinical inquiry, leading and driving efforts to close the gap between knowledge and practice. As the nursing workforce struggles to recover from the COVID-19 pandemic, now more than ever, collaborations between HBNSs and nurse leaders are essential to explore and test new nursing care delivery systems. Given the national shortage in the PhD-prepared nurse scientist talent pool, attracting and hiring the right candidate is critical. The purpose of this article is to provide practical recommendations for nurse leaders to introduce an HBNS into an organization as an important building block for nursing science and improved clinical practice. The role of the HBNS has evolved in tandem with increased education in the nursing workforce, evidence-based practice, and the explosion of implementation science. Before recruiting an HBNS, the organization must create a job description that outlines responsibilities, paying attention to the HBNS position within the organizational structure. Additionally, leaders must consider the candidate's characteristics for interacting with clinical staff. The senior nursing leadership team must recognize and appreciate the HBNS as a scholar and advisor.

Perceptions of public health nursing Team Leaders (TLs) and Team Supervisors (TSs) on nurse’s development in Fiji

BackgroundNurse team leaders are responsible for contributing to managing the quality of service delivery and facility output of their nurses to ensure there is a high quality of care delivered by the health system. This study aimed to explore the perceptions of public health nursing Team Leaders (TLs) and public health nursing Team Supervisors (TSs) on nurses’ development in Fiji.MethodsA qualitative study was used to gather information using in-depth phone interviews among TLs and TSs comprising Chief Midwifery Nursing Officer (CMNO), Director of Nursing (DON), Sub-divisional Nursing Managers (SDNMs), acting SDNMs and Nursing Manager (NM) at Central health division in Fiji. The data was collected through semi-structured open-ended questionnaires and were audio recorded. The data was analyzed using manual thematic analysis process.ResultsThe study comprised of 26 participants, which included 10 TSs and 16 TLs. Four themes were identified for the results amongst TSs and TLs: ethical development; professional development; psychological development; and recommendations. However, nine sub- themes were identified for TSs and eight sub-themes were identified for the result amongst TLs.ConclusionThis study highlighted that TLs and TSs elaborated on the need for the ethical, professional, psychological development, nursing development and also on the importance of policies and guidelines. Professional ethics should be integrated into the Continuous Profession Development (CPD) points that are used to renew yearly nursing licenses as well as exposing the need for having competencies on professional ethics in nurses’ logbooks. Further research is needed to determine the in-depth barriers.

How to pivot and make any Magnet® site visit successful.

How to pivot and make any Magnet® site visit successful.

Acuity-Based Staffing in Labor and Delivery Using Electronic Health Record Data.

Planning safe and effective nurse staffing can be challenging for nurse leaders of labor and delivery units due to the dynamic nature of birth and unpredictable fluctuations in census and acuity. The electronic health record (EHR) has a vast source of patient data that can be used to retrospectively review patient needs and nurse staffing gaps that can serve as a basis for prospective planning for nurse staffing. This quality improvement project was initiated with the goal of developing real-time and longitudinal reports to quantify hourly nurse staffing needs based on patient census, acuity, and required clinical interventions from data that are contained with the EHR. The plan was to determine trends and nurse staffing needs for each 24-hour period every day of the week and identify ongoing staffing patterns to meet the Association of Women's Health, Obstetric, and Neonatal Nurses' (AWHONN) staffing guidelines. The obstetric nursing leadership team worked with the information technology specialists and developed an algorithm that identifies patient acuity level, indicated clinical interventions, and outlines necessary staffing requirements to provide safe high-quality care. Various reports were built in the EHR to inform the nursing leadership team about nurse staffing on a real-time and historical basis. The reports provided quantitative data that supported a budgetary increase in nurse staffing and a more flexible nurse staffing scheduling system to meet the needs of the patients. The project was successfully implemented in all four of the hospital system maternity units. Use of EHR in labor and delivery units is nearly universal. Working with the information technology specialists to integrate nurse staffing data into the EHR is one way to align nurse staffing with the AWHONN nurse staffing standards in real-time and for projections of nurse staffing needs based on unit historical patient data.

Using Simulation to Identify Latent Safety Threats in the Labor and Delivery and Mother-Baby Units as Well as in the NICU

The literature supports simulation as a tool to improve quality of care, timeliness, and efficiency. The Women and Children’s Services (WCS) nursing leadership team sought to identify latent safety threats when responding to low-frequency, high-risk perinatal and neonatal emergencies. How does the use of simulated emergencies identify latent safety threats to improve patient safety and quality in the perinatal and neonatal population? Identification of latent safety threats and system issues that can be mitigated assists the team in providing safer and more efficient care to their patients.

Effect of Applying Nursing Team Leader Combined with Quality Control Nurses in Nursing Management of Intensive Care Department

Effect of Applying Nursing Team Leader Combined with Quality Control Nurses in Nursing Management of Intensive Care Department

Improved 30-Day Heart Failure Readmissions Following Implementation of an Advanced Cardiovascular Education (ACE) Academy.

Heart failure readmissions are common, though some are preventable through evidence-based management. Despite outperforming national benchmarks for 30-day readmissions, compliance with an evidence-based institutional heart failure management pathway was inconsistent. The purpose of this project was to reduce 30-day heart failure readmission rates through an educational intervention and an electronic health record (EHR) redesign. The cardiac services nursing leadership team conducted an education and documentation needs assessment to identify knowledge gaps and practical barriers to effective utilization of evidence-based interventions for heart failure management. This intervention included an Advanced Cardiovascular Education (ACE) Academy and an EHR workflow redesign for clinical and supportive nursing staff. The 30-day heart failure readmission rates reduced immediately following the intervention, and rates continued to decrease over a 3-year follow-up. Even among hospitals outperforming national benchmarks, 30-day heart failure readmissions can be reduced and sustained with enhanced education and EHR redesign.

A referral pathway for stoma patients.

Alison Roberts, Nurse Team Leader, Respond Healthcare (alison.roberts@respond.co.uk) was a runner-up in the Stoma Nurse of the Year category of the British Journal of Nursing Awards 2021.