What is the rationale for consenting to blood transfusions?

Bielby, L J; Stevenson, L; Perillo, J; Glazebrook, B; Beard, P; Hennessy, C; Borosak, M. CONSENT FOR BLOOD TRANSFUSION – ARE WE INFORMING PATIENTS?: P-050. Vox Sanguinis. 105 Supplement 1:82, p. 82. June 2013.

Mahapatra, P; Neffendorf, J E; Wilson, S. <a href="” target=”_blank”>CONSENT FOR BLOOD TRANSFUSIONS – ARE WE MAKING PROGRESS?: 4A-S35-06. Vox Sanguinis. 105 Supplement 1:62-63, p. 62. June 2013.

Davis, R.; Vincent, C.; Sud, A.; Noel, S.; Moss, R.; Asgheddi, M.; Abdur-Rahman, I.; Murphy, M. Consent to transfusion: patients’ and healthcare professionals’ attitudes towards the provision of blood transfusion information. Transfusion Medicine. 2012 Jun;22(3):167-72. doi: 10.1111/j.1365-3148.2012.01148.x. Epub 2012 Apr 23.

Howell, C. A. 1; Forsythe, J. L. R. 2* Patient consent for blood transfusion – recommendations from SaBTO+. Transfusion Medicine. 21(6):359-362, December 2011.

Ohto H; Yonemura Y; Takeda J; Inada E; Hanada R; Hayakawa S; Miyano T; Kai K; Iwashi W; Muto K; Asai FGuidelines for managing conscientious objection to blood transfusion. Japanese Joint Committee on Refusal of Blood Transfusion on Religious Grounds, Waseda Law School, Waseda University, Japan. hit-ohto@fmu.ac.jp Transfusion Medicine Reviews (TRANSFUS MED REV), 2009 Jul; 23 (3): 221-8.

Desborough, Michael J.; Murphy, Michael F.Legal and ethical issues in blood transfusion. British Journal of Hospital Medicine (17508460) (BR J HOSP MED (LOND)), 2013 Jan; 74 (1): C2-4.

Wehrli G; Sazama KUniversal donor education and consent: what we know and where we should go. Department of Pathology, University of Virginia Health System, Charlottesville, Virginia 22908-0286, USA. GWMD@virginia.edu Transfusion, 2010 Nov; 50 (11): 2499-502.

What does research say about nurse fatigue and maximum consecutive hours worked?

An interventional approach for patient and nurse safety: a fatigue countermeasures feasibility study.” Nursing research 59.4 (2010):250.

Are extended work hours worth the risk? American Nurse Today 2013 vol:8 iss:5 pg:8

Tabone S. Data suggest nurse fatigue threatens patient safety: is prescribing the nurse’s work hours the only answer? Texas Nursing, 2004 Feb; 78 (2): 4-7.

Data suggest nurse fatigue threatens patient safety: is prescribing the nurse’s work hours the only answer?… From Nursing that Works, A publication of the Center for American Nurses, Edition #5, May 2004. Colorado nurse 2004 vol:104 iss:4 pg:22

Barker, Linsey M.; Nussbaum, Maury A. Fatigue, performance and the work environment: a survey of registered nurses. Journal of Advanced Nursing , 2011 Jun; 67 (6): 1370-82

Infants at risk: when nurse fatigue jeopardizes quality care.” Advances in neonatal care 6.3 (2006):120.

Streak, Judith Fatigue in the Perioperative Environment: Effects on Worker Performance and Best Practice Management Principles. 2013

How does the safety of medication administration compare when using barcode scanning versus manual methods?

Bottom line:  Properply used barcode medication administration technology reduces the rate of medication errors in acute care settings.

SummarySan 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)

Nursing protocols on managing neurogenic bladder and bowel.

Coggrave, Maureen, C Norton, and J D Cody. “Management of faecal incontinence and constipation in adults with central neurological diseases.” Cochrane Database of Systematic Reviews 1 (2014):CD002115.

Jamison, Jim, S Maguire, and J McCann. Catheter policies for management of long term voiding problems in adults with neurogenic bladder disorders. Cochrane Database of Systematic Reviews 11 (2013):CD004375.

Bowman, Rebecca. Bowel irrigation: clinician information. Evidence summaries. 2017. In: Joanna Briggs Institute (JBI) EBP Database.

Jayasekara, Rasika. Neurogenic bladder disorder (adult): catheter policies. Evidence summaries. 2016. In: JBI.

de Kort, L M O, et al. “The management of adolescents with neurogenic urinary tract and bowel dysfunction.” Neurourology and urodynamics 31.7 (2012):1170-1174.

Adams, Jillian, et al. “Strategies to promote intermittent self-catheterization in adults with neurogenic bladders: a comprehensive systematic review.” Systematic reviews. JBI Libr Syst Rev. 2011;9(34):1392-1446.

National Clinical Guideline Centre. “Urinary incontinence in neurological disease. Management of lower urinary tract dysfunction in neurological disease.” London, UK: National Institute for Health and Clinical Excellence (NICE); 2012. 40 p.

Databases: PubMed, Joanna Briggs, Guideline.gov Keywords: neurogenic bowel, neurogenic bladder, nurse/nursing

Reviewed and updated 4/9/2014 ldt

Updated links 10/16/2017 ldt

For patients on ventilator receiving neuromuscular blockade, how frequently should patient’s response to dose be monitored with peripheral nerve stimulation?

Bottom line: No published evidence compares monitoring frequency (eg, q4, q8, etc.) to determine what is safest and most effective for monitoring dosage of neuromuscular blocking agents.  Professional recommendations advocate every 2-12 hours.

Summary:  ASA.  Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administrationAnesthesiology.  2009; 110(2): 218-230.
Page 221 begins review of recommendations and evidence for effectiveness of methods for detecting respiratory depression, and on p. 222, recommendation by expert consensus for monitoring after single injection and continuous infusion depend on class of drugs (neuraxial lipophilic opioids v. neuraxial hydrophilic opioids), clinical condition of patient and concurrent medications.

AACN Procedure Manual for Critical Care, 6th ed. [In print at EUH]

Recommends train of four (TOF) testing every 4-8 hours during infusion after patient is stable and after optimal dose for neuromuscular blockade is achieved (p. 310.)  References guidelines (see below.)

Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patientCrit Care Med.  2002;30:142-156.
In the monitoring section, the guidelines recommend monitoring but do not provide specifics.  They do however, cite a study (Kleinpell) that surveys ICUs about their practices, as well as one prospective study (Strange) that compares TOF to clinical assessment and one retrospective study (Frankel) about implementing standards for monitoring in a surgical unit.

(“Monitoring, Physiologic”[MAJR]) AND “Neuromuscular Blockade”[MAJR] AND (train-of-four OR electric stimulation) AND (prospective study OR observational study OR cohort study OR comparison study)
Here is a PubMed search for comparison and cohort studies evaluating train-of-four.  Some are evaluating specific devices or stimulation methods.  Baumann (2004) and Strange (1997) address the use of the TOF itself.

There is also an RCT by Rudis (1997) that compares clinical assessment to TOF for reduction in dose of neuromuscular nondepolarizing agent to maintain paralysis .

Reviewed by John Nemeth 4/14

Is there evidence on fall prevention audit tools and how to get nurses engaged in preventing falls?

Articles are arranged by topic.

Engagement of nurses in fall prevention efforts; these articles cover a variety of techniques

Colon Emeric, Cathleen S, et al. “CONNECT for Better Fall Prevention in Nursing Homes: Results from a Pilot Intervention Study.” Journal of the American Geriatrics Society 61.12 (2013):2150-2159.

Lea, Emma, et al. “Beyond the ‘tick and flick’: facilitating best practice falls prevention through an action research approach.” Journal of clinical nursing 21.13-14 (2012):1896-1905.

Barker, Anna, et al. “The 6-PACK programme to decrease fall-related injuries in acute hospitals: protocol for a cluster randomised controlled trial.” Injury prevention 17.4 (2011):e5-e5.

Bonuel, Nena, et al. “Best practice fall prevention strategies. CATCH!” Critical care nursing quarterly 34.2 (2011):154-158.

Healey, Frances. “A guide on how to prevent falls injury in hospitals.” Nursing older people 22.9 (2010):16-22.

Koh, S L, et al. “Impact of a fall prevention programme in acute hospital settings in Singapore.” Singapore medical journal 50.4 (2009):425-432.

Koh, Serena S L, et al. “Nurses’ perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals.” BMC health services research 8(2008):105-105.

Ireland, Sandra, et al. “The real world journey of implementing fall prevention best practices in three acute care hospitals: a case study.” Worldviews on evidence-based nursing 10.2 (2013):95-103.

Saint, Sanjay, et al. “Introducing the patient safety professional: why, what, who, how, and where?” Journal of patient safety 7.4 (2011):175-180.

Tzeng, Huey-Ming. “Nurses’ caring attitude: fall prevention program implementation as an example of its importance.” Nursing forum 46.3 (2011):137-145.

Unruh, Lynn, ManishaAgrawal, and SusanHassmiller. “The business case for transforming care at the bedside among the “TCAB 10” and lessons learned.” Nursing administration quarterly 35.2 (2011):97-109.

Stetler, C B, et al. “Integration of evidence into practice and the change process: fall prevention program as a model.” Outcomes management for nursing practice 3.3 (1999):102-111.

Dean, Erin. “Reducing falls among older people in hospital.” Nursing older people 24.5 (2012):16-16, 19.

Rask, Kimberly, et al. “Implementation and evaluation of a nursing home fall management program.” Journal of the American Geriatrics Society 55.3 (2007):342-349.

Audit

Audit criteria

Chapman, Joanne, Deborah Bach, and Kristiina HyrkÃs. “Testing the sensitivity, specificity and feasibility of four falls risk assessment tools in a clinical setting.” Journal of nursing management 19.1 (2011):133-142.

Poe, Stephanie S, et al. “The Johns Hopkins Fall Risk Assessment Tool: postimplementation evaluation.” Journal of nursing care quality 22.4 (2007):293-298.

Perell, K L, et al. “Fall risk assessment measures: an analytic review.” The journals of gerontology. Series A, Biological sciences and medical sciences 56.12 (2001):M761-M766.

Oliver, D, et al. “Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies.” BMJ. British medical journal 315.7115 (1997):1049-1053.

Taylor, Jo A, et al. “A model quality improvement program for the management of falls in nursing homes.” Journal of the American Medical Directors Association 8.3 Suppl (2007):S26-S36.

Milisen, Koen, AnneliesGeeraerts, and EddyDejaeger. “Use of a fall prevention practice guideline for community-dwelling older persons at risk for falling: a feasibility study.” Gerontology 55.2 (2009):169-178.

Wong Shee, Annkarin, BevPhillips, and KeithHill. “Comparison of two fall risk assessment tools (FRATs) targeting falls prevention in sub-acute care.” Archives of gerontology and geriatrics 55.3 (2012):653-659.

Koh, Serena Siew Lin, et al. “Fall incidence and fall prevention practices at acute care hospitals in Singapore: a retrospective audit.” Journal of evaluation in clinical practice 13.5 (2007):722-727.

Reviewed by John Nemeth 4/14