About Amy

Clinical Informationist at EUH Branch Library

Are there any valid instruments for assessing risk for violence in mental health patients and is use of these instruments associated with fewer incidents of assaults on staff by patients?

Posted on October 24, 2011 by Amy

Bottom line: There is some limited evidence that use of risk assessment tools can predict violent behavior by patients and can be associated with reduction in aggressive incidents.

A systematic review in JBI+ COnNECT (JBI Library of Systematic Reviews. 2009;7(6):175-223) identified one retrospective study (Kling, 2006) of a tool to assess inpatients for risk of violent behavior. In PubMed this reference led to other studies, including an RCT (Abderhalden, 2008) and a pilot study (Fluttert 2011)

Kling, R., et al., Use of a violence risk assessment tool in an acute care hospital: effectiveness in identifying violent patients. AAOHN Journal, 2006. 54(11): p. 481-7. (Available in print at Health Sciences Center Library.)
Reviewed charts at 1 acute care hospital for 117 violent patients and 161 randomly selected, nonviolent patients admitted during the same period. Compared findings of a risk assessment tool in these populations. Tool had moderate senstivity (71%) and high specificity (94%). Limitation – only 35% of the non-violent patients and 75% of the violent patients were evaluated using the tool.

Abderhalden C, et al. Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial. Br J Psychiatry. 2008 Jul;193(1):44-50.
Cluster RCT randomized 14 psychiatric units to use of Swiss version of the Brøset Violence Checklist (BVC–CH) or usual care for patients admitted to these units. RESULTS: Adjusted RR indicate 41% reduction in severe aggressive incidents and a 27% decrease in use of coercive measures. There was no decrease in severity of aggressive incidents.

Fluttert FA, et al. The development of the Forensic Early Warning Signs of Aggression Inventory: preliminary findings toward a better management of inpatient aggression. Arch Psychiatr Nurs. 2011 Apr;25(2):129-37.
Describes development of a new risk assessment tool.

PubMed search: “Inpatients/psychology”[mesh] AND “Violence/prevention and control”[mesh] AND assess*

Reviewed 4/18/14 AA

Does double checking by two registered nurses prior to injection of insulin or heparin reduce risk of medication errors?

Posted on September 30, 2011 by Amy

Bottom line: There is little evidence to support or to refute the effectiveness of double-checking by nurses to reduce rates of medication errors.

Wimpenny P and Kirkpatrick P. Roles and systems for routine medication administration to prevent medication errors in hospital-based, acute care settings: a systematic review. JBI Library of Systematic Reviews. 2010;8(10):405-446.

Hughes RG and Blegen MA. Medication administration safety. In: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ. Updated April 2008. http://www.ahrq.gov/qual/nurseshdbk/docs/HughesR_MAS.pdf
Start with the Policies, Procedures and Protocols section on p. 20.

O’Connell B et al. Nurses’ attitudes to single checking medications: before and after its use. Inter J Nurs Practice. 2007; 13: 377-82.

Studies of errors reported by nurses that address double-checking:

Jarman et al. Inter J Nurs Practice. 2002; 8: 330-335. Survey of nurses reporting errors during period of single-checking and period of double-checking. No significant difference in error rates between the two periods.

Stratton KM et al. J Pediatr Nurs. 2004;19(6): 385. Survey of nurses’ perceptions of factors associated with medication errors. For 28% of the errors reported, nurses identified failure to double-check as a reason for the error.

Reviewed 4/14/2014 AA

Does uterine fibroid size or patient weight affect outcome of uterine artery embolization?

Posted on September 18, 2011 by Amy

Review evidence summary of Uterine Fibroids in JBI.

Follow up studies addressing risk factors, such as fibroid size, for treatment failure or complications. Pertinent studies include:

Parthipun AA, et al. Does size really matter? Analysis of the effect of large fibroids and uterine volumes on complication rates of uterine artery embolisation. Cardiovasc Intervent Radiol. 2010Oct;33(5):955-9. Epub 2010 May 5. PubMed PMID: 20442999.

Smeets AJ, Nijenhuis RJ, van Rooij WJ, Weimar EA, Boekkooi PF, Lampmann LE,
Vervest HA, Lohle PN. Uterine artery embolization in patients with a large
fibroid burden: long-term clinical and MR follow-up. Cardiovasc Intervent Radiol.
2010 Oct;33(5):943-8. Epub 2010 Jan 12. PubMed PMID: 20066419

Hirst A, et al. A multi-centre retrospective cohort study comparing the
efficacy, safety and cost-effectiveness of hysterectomy and uterine artery
embolisation for the treatment of symptomatic uterine fibroids. The HOPEFUL
study. Health Technol Assess. 2008 Mar;12(5):1-248, iii. PubMed PMID: 18331704.

Arleo EK, Masheb RM, Pollak J, McCarthy S, Tal MG. Fibroid volume, location
and symptoms in women undergoing uterine artery embolization: does size or
position matter? Int J Fertil Womens Med. 2007 Mar-Jun;52(2-3):111-20. PubMed
PMID: 18320870.
In print at the WHSC Library

Firouznia K, Ghanaati H, Sanaati M, Jalali AH, Shakiba M. Uterine artery
embolization in 101 cases of uterine fibroids: do size, location, and number of
fibroids affect therapeutic success and complications? Cardiovasc Intervent
Radiol. 2008 May-Jun;31(3):521-6. Epub 2008 Jan 25. PubMed PMID: 18219521.

Siskin GP, et al. UAE versus Myomectomy Study Group. A
prospective multicenter comparative study between myomectomy and uterine artery
embolization with polyvinyl alcohol microspheres: long-term clinical outcomes in
patients with symptomatic uterine fibroids. J Vasc Interv Radiol. 2006
Aug;17(8):1287-95. PubMed PMID: 16923975.

Reviewed 4/18/14 AA

What are the best practices and recommendations for managing flexible budgets and staffing?

Posted on August 19, 2011 by Amy

Guidelines/recommendations for staffing in CINAHL: (MH “Personnel Staffing and Scheduling”) Limits: practice guidelines, standards

If interested in staffing for specific area, such as critical care, just add that term to the search.

Tools, formulas, etc. for working with flexible budgets
Flexible budgets and staffing matrix. In: Nursing Management: Principles and Practice (Gullatte M, ed.) Pittsburgh: Oncology Nursing Society, 2005.
You can review this book in the EUH Branch Library (see the Nursing shelf).
Lots of worksheets and helpful explanation.

Practical Guide to Finance and Budgeting, 2nd ed, edited by K. Waxman, 2008
Online book includes sections on budgeting methods,
Does not include much instruction, but does have a link, How to use the tools on the cd-rom, over on the left side of the page that may provide links to samples of forms, etc. that might prove helpful.

Reviewed 4/25/14 AA

For patients undergoing cardiac surgery, is perioperative use of milrinone associated with increased risk for developing atrial fibrillation?

Posted on August 17, 2011 by Amy

In the Milrinone topic in DynaMed, you can look at the Cautions and Adverse Effects section and see a summary of a prospective cohort study of 232 patients having elective cardiac surgery (Milrinone Use Is Associated With Postoperative Atrial Fibrillation After Cardiac Surgery. Circulation 2008 Oct 14;118(16):1619.) The exposure was whether or not the patients received milrinone. Milrinone used for patients with postbypass LVEF <30%, with evidence of right ventricular dysfunction, or with pulmonary hypertension.
28.9% of patients developed atrial fibrillation. Rate of developing atrial fibrillation was 58.2% in milrinone group v. 26.1% in the no milrinone group.

PubMed
Full list of systematic reviews can be seen here: systematic[sb] AND (milrinone OR cardiotonic agents OR inotropic drugs) AND cardiac surgery AND adverse effects

There is a systematic review on the topic (Gillies M, et al. Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery — a systematic literature review. Crit Care. 2005 Jun;9(3):266-79. Epub 2004 Dec 16.), but the authors found no studies reporting “data relating to the effect of milrinone on major clinical outcomes or survival in cardiac surgery patients.” The RCTs included in the review only reported data for a short period of time (up to 24 hours), one of the trials (Doolan, 1997) reported findings of atrial fibrillation. The rate in milrinone use was very low (5%), but the study only reported data collected for 4 hours after surgery.

Reviewed 4/14/14 AA

How do you ensure proper placement of the vented nasogastric tube?

Posted on August 16, 2011 by Amy

PubMed
Results include a recent systematic review, “Implementation of the evidence review on best practice for confirming the correct placement of nasogastric tube in patients in an acute care hospital,” that aims to define best practices for ensuring proper placement of tube in acute care hospital setting.
http://www.ncbi.nlm.nih.gov/pubmed?otool=emorylib&term=(”Intubation, Gastrointestinal/methods”[MAJR]) AND (suction OR decompression OR medical errors) AND English[lang] AND systematic[sb]
If you want to look at other literature besides systematic reviews, just removew the systematic[sb] from the PubMed search box.

CINAHL
Used search statement similar to PubMed search above. Most of the relevant references were older, so that information should be covered in the systematic review noted in the PubMed search. You can view results here.

Reviewed 4/14/14 AA

What is the evidence for best practices in caring for patients with dementia?

Posted on July 29, 2011 by Amy

For an overview of caring for patients with dementia:
Dementia, Care of Patient. In: Lippincott’s Nursing Procedures and Skills.
Provides overview with references to the literature for care of the patient with dementia. Also includes a list of additional references that you may find helpful.

For guidelines
Alzheimer disease and Dememtia with Lewy Bodies. In: DynaMed.
Go to the Guidelines and Resources Section in each of these entries to see a list of US guidelines. Also, the Treatment Sections include reviews of evidence for management strategies, such as diet, as well as medical therapy.

Reviewed and updated 4/30/2014 ldt

Evidence Matters

Evidence-based information for Emory

Author Archives: Amy