PubMed search: restraint AND prevalence AND (hospitals OR wards OR units) AND psychiatric
restraint AND prevalence AND (hospitals OR wards OR units) AND (geriatric OR elderly) AND acute care
Riv Psichiatr. 2013 Jan-Feb;48(1):10-22. doi: 10.1708/1228.13611.
Prevalence and risk factors for the use of restraint in psychiatry: a systematic review.
Beghi M, et al.
The Catheter-associated urinary tract infection topic in DynaMed identifies these US guidelines:
Bottom line: Best available evidence suggests that tap water can be used to effectively clean genitalia; daily cleaning of the meatal area and early removal of catheters are associated with reduction in CAUTIs. Some evidence suggests silver-impregnated catheters associated with decreased incidence of bacteriuria. Evidence does not support use of sealed drainage systems (as a single strategy), adding antibacterial solutions to drainage bags, or routinely changing drainage bags (as opposed to changing only when clinically necessary.)
Moola S, Konno R. A systematic review of the management of shot-term indwelling urethral catheters to prevent urinary tract infections. JBI Library of Systematic Reviews. 2010;8(17): 695-729.
Review of studies retrieved from Medline and CINAHL and that included adult patients using urinary catheters 1 to 14 days. Methodologies included first RCTs. If no RCTs available, then non-randomized studies and before and after studies were included. Results section describes findings for various types of intervention strategies.
DynaMed
Heart Failure Structured Management and Education topic
Evidence regarding interventions to reduce readmission include
Systematic review of 8 RCTs compared multidisciplinary education and post-discharge follow-up intervention to usual care by physician after discharge and found that readmission rates were significantly reduced (38.4% v. 49.2%) but did not significantly reduce mortality.
Arch Intern Med 2004 Nov 22;164(21):2315
Systematic review of 18 RCTs compared programs of comprehensive discharge planning v. standard; pooled data over average of 8 months showed readmission in 34.9% of study group v. 43.2% of controls.
JAMA 2004 Mar 17;291(11):1358
Systematic review of studies of varying quality on self-management interventions
BMC Cardiovasc Disord 2006 Nov 2;6:43
Small (n=206) trial of heart failure patients randomized to nurse-run post-discharge follow-up plan versus standard post-discharge care showed reduction in readmission rate for the study group (39% v 54%) – other randomized trials showed no significant difference in readmission between control groups and nurse-management groups
Another systematic review of 21 randomized trials concluded that structured, multidisciplinary post-discharge interventions do affect readmission rate.
Other interventions covered in this DynaMed topic include telephone case management and home visits by nurses and pharmacists. See DynaMed topic above for full summary.
JBI+ COnNECT
(searched heart failure and readmission)
Systematic review of 16 RCTs evaluating effect of care transition interventions on readmission rate
Systematic review of 3 RCTs and 2 quasi-experimental studies evaluating effect of telephone interventions
Systematic review of 10 RCTs evaluating effect of specifically telephone post-discharge nursing care
For studies published since these reviews
PubMed: (“Heart Failure”[Majr]) AND “Patient Readmission”[Majr] AND prevention
Concussion and mild traumatic brain injury. In: DynaMed.
The Guidelines section includes guidelines and their accompanying references to primary literature…
Evaluation and Management of Mild Traumatic Brain Injury, Eastern Association for the Surgery of Trauma
This is a recent (within past 2 years) guideline that summarizes evidence on practices for diagnostic workup, home care (eg, return to work and driving), and management of special populations, such as patients on warfarin.
American College of Emergency Physicians. Clinical Policy: Neuroimaging and Decisionmaking in Adult Mild Traumatic Brain Injury in the Acute Setting.
This is an older but still relevant guideline (2008) that presents evidence to answers the questions of when to order a non-contrast head CT; what is the role for head MRI in the ED, are there serum biormarkers.
Care of the patient with mild traumatic brain injury. Glenview (IL): American Association of Neuroscience Nurses, Association of Rehabilitation Nurses
Summarizes evidence of management of patients with mild traumatic brain injury
PubMed
A search of Clinical Queries provides systematic reviews that may provide more recent appraisal of evidence. These searches identify evidence on treatment and follow-up provided by the emergency department. References to individual studies are in the left column; this list can be modified by changing the study category and scope. References to systematic reviews are in the center column.
Clinical Queries: concussion AND emergency department
Clinical Queries: concussion AND (post-concussion syndrome OR self care OR monitoring)
Bottom line: Properply used barcode medication administration technology reduces the rate of medication errors in acute care settings.
Summary: San TH, et al. Factors affecting registered nurses’ use of medication administration technology in acute care settings: A systematic review. JBI Library of Systematic Reviews. 10(8):471-512, 2012.
Although this systematic review addresses nurses’ attitudes and barries to using technology like barcode scanning, the Background section (p. 474), documents evidence on effectiveness of using barcodes in reducing medication errors.
Cited studies
Poon EG, Keohane CA, Yoon CS, Ditmore M, Bane A, Levtzion-Korach O, et al. Effect of bar-code technology on the safety of medication administration. New Engl J Med. 2010;362(18):1698-707.
Before and after study at academic medical center implementing barcode system. RESULTS: Investigators observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate). 41% reduction in error rate after the barcode system was implemented.
Morriss FH, Abramowitz PW, Nelson SP, Milavetz G, Michael SL, Gordon SN, et al. Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study. Journal Ped. 2009;154(3):363 – 8.
Observational study conducted during the process of installing a barcode medication administration system in a neonatal ICU. RESULTS: 92 398 medication doses were administered to 958 subjects. Relative risk of medication errors when using the barcode system was 0.53 compared to not using the barcode system.
Other studies
See this PubMed search for a focus on quasi-experimental studies:
“Medication Systems, Hospital”[MAJR] AND “Medication Errors/prevention and control”[MAJR] AND (barcodes OR barcoding OR bar codes) AND (comparative OR before and after OR quasi-experimental)
To view a broader set of references on this topic:
“Medication Systems, Hospital”[MAJR] AND “Medication Errors/prevention and control”[MAJR] AND (barcodes OR barcoding OR bar codes)
Evidence Matters 