Bottom line: There is no published evidence documenting role of the unit clerk or coordinator in intentional or hourly rounding.
Details: Searched Joanna Briggs, CINAHL, PubMed for combinations of these concepts.
hourly, intentional, comfort rounding, rounds, unit clerk, unit coordinator
Reviewed 4/11/2014 ldt
Matar, Dany S, et al. “Achieving and sustaining ventilator-associated pneumonia-free time among intensive care units (ICUs): evidence from the Keystone ICU Quality Improvement Collaborative.” Infection control and hospital epidemiology 34.7 (2013):740-743.
This retrospective analysis of the Michigan Keystone intensive care unit (ICU) collaborative showed that a zero rate of VAP could be attained and sustained for a considerable period of time in adult ICUs.
Berenholtz SM, et al. “Collaborative cohort study of an intervention to reduce ventilator-associated pneumonia in the intensive care unit. Infection control and hospital epidemiology 32.4 (2011):305-314.
Study of an intervention consisting of the Comprehensive Unit-Based Safety Program (CUSP) and a ventilator care bundle of five evidence-based practices from the Centers for Disease Control and Prevention. Reduced rates of VAP by up to 71% at 112 Michigan intensive care units (ICUs).
Reviewed and updated 4/24/2014 ldt
Bottom line: There is no clear documentation in the literature designating intentional breaks in the skin, due to incisions, chest tubes, etc., as specifically not intact skin.
Summary:
CDC Key Terms
http://www.cdc.gov/nhsn/PDFs/HSPmanual/7_HPS_keyTerms.pdf
Non-intact skin is defined as “areas of the skin that have been opened by cuts, abrasions, dermatitis, chapped skin, etc.”
Larson E, et al. Prevalence and correlates of skin damage on the hands of nurses. Heart Lung. 1997 Sep-Oct;26(5):404-412.
This epidemiologic study of skin damage on nurses’ hands describes specifications for non-intact skin. Table II (p. 406) describes completely intact skin as that without abrasions or fissures.
Several nursing blogs include discussions of the ambiguity of how to document skin intactness for patients with surgical incisions.
Reviewed 4/25/2014 ldt
Webster J, et al. Gauze and tape and transparent polyurethane dressings for central venous catheters. Cochrane Database Syst Rev. 2011 Nov 9;(11):CD003827.
Reviewed six studies; “four compared gauze and tape with transparent polyurethane dressings (total participants – 33) and two compared different transparent polyurethane dressings (total participants = 126).” A four-fold increase in CLABSIs was found with polyurethane dressings. However, because of a risk of bias and wide confidence intervals the “true effect could be as small as 2% or as high as 17-fold.”
McCann M, Moore ZE. Interventions for preventing infectious complications in haemodialysis patients with central venous catheters. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD006894.
Includes review of one study (n=58) on use of polyurethane transparent dressings and gauze in hemodialysis patients. There was no statistically significant difference in incidence of central line site infection or central-line associated bacteremia between gauze and polyurethane.
Gillies D, et al. Central venous catheter dressings: a systematic review. J Adv Nurs. 2003 Dec;44(6):623-32.
Searched Cochrane databases, Medline, CINAHL, and CancerLit. Identified and reviewed 8 studies that evaluate various dressings in the incidence of CVC-related infection and in catheter-related sepsis in hospitalized patients.
RESULTS: Studies included comparison of gauze/tape v. Opsite IV 3000; Opsite v. Opsite IV 3000; Tegaderm v. Opsite IV 3000; Tegaderm v. Opsite.
In the 6 studies with pooled data, odds ratios did not favor either group for incidence of infection. Review was limited in that all studies had small populations.
See Table 4 for summary of meta-analysis.
Hoffman K, et al. Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection risks. JAMA. 1992 Apr 15;267(15):2072-6
This is a systematic review of 7 studies, but a couple of the studies compared gauze plus a topical antiseptic preparation to occlusive dressing without the topical.
Reviewed and updated 4/24/2014 ldt
Bottom line: 4.46% of RN staff nurses left their EDs in 2007. It took an average of 57 days to fill vacancies. Data is from a survey of 700+ emergency departments in the US. Private, not-for-profit, teaching hospitals accounted for 36% of institutions represented and private, not-for-profit, non-teaching hospitals accounted for 22%.
Couselman FL, et al. A study of the workforce in emergency medicine: 2007. Am J Emerg Med. 2009; 27: 691-700
The study was funded by American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, Emergency Medicine Foundation, Emergency Medicine Residents’ Association, ENA, GE Healthcare, and the Society for Academic Emergency Medicine.
Reviewed 4/21/2014 ldt
See these selected articles identified in PubMed
Reviewed and updated 4/11/2014 ldt
ait Bottom line: No national benchmark for restraint use in rehabilitation facilities was identified in the NDNQI, but one study published data on prevalence (restraint use per 100 patient days) of physical restraints prior to implementing a reduction program in this setting.
Minnick AF, et al. Prevalence and variation of physical restraint use in acute care settings in the US. J Nurs Scholarsh. 2007;39(1):30-37.
Prevalence of physical restraint on 18 randomly selected days found a prevalence of 50 uses per 1,000 patient days.
Amato S, et al. Physical restraint reduction in the acute rehabilitation setting: a quality improvement study. Rehabil Nurs. 2006;31(6):235-241.
This prospective study measured restraint use before and after a multi-pronged approach to decreasing the use of restraints in a stroke rehabilitation unit and a brain injury rehabilitation unit. Restraint use before the intervention started:
Stroke Rehab Unit: 216.6 hours per 100 patient days
Brain Injury Rehab Unit: 1054.3 hours per 100 patient days
Kwok T, et al. Does access to bed-chair pressure sensors reduce physical restraint use in the rehabilitative care setting? J Clin Nurs. 2006 May;15(5):581-7.
Reports on use of physical restraints by providing the percentage of patients who were physically restrained for some portion of their hospital stay.
Gallinagh R, et al. The use of physical restraints as a safety measure in the care of older people in four rehabilitation wards: findings from an exploratory study. Int J Nurs Stud. 2002;39(2):147-156.
Uses percentages of patients and not restraint use/1000 patient days.
Reviewed 4/10/2014
Evidence Matters 