Category Archives: Patient Safety

What is the evidence on isolation gowns preventing the spread of infection?

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Kressel, Amy B, et al. “Hospitals learn their collective power: an isolation gown success story.” American journal of infection control 39.1 (2011):76-78.

Srinivasan A ; Song X ; Ross T ; Merz W ; Brower R ; Perl TM A prospective study to determine whether cover gowns in addition to gloves decrease nosocomial transmission of vancomycin-resistant enterococci in an intensive care unit. Infection Control & Hospital Epidemiology, 2002 Aug; 23 (8): 424-8.

Community-acquired MRSA boosts need for awareness: hand hygiene, knowledge block cross-contamination. Same-Day Surgery, 2008 Feb; 32 (2): 17-9.

Kressel AB ; McVey JL ; Miller JM ; Fish LL Hospitals learn their collective power: an isolation gown success story. Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN

Lovitt SA ; Nichols RL ; Smith JW ; Muzik AC ; Pearce PF Isolation gowns: a false sense of security? Dept Surg, Tulane Univ School Med, 1430 Tulane Ave, New Orleans, LA 70112-2669 American Journal of Infection Control, 1992 Aug; 20 (4): 185-91.

McLane C Commentary on Isolation gowns: a false sense of security? AACN Nursing Scan In Critical Care, 1993 Jul-Aug; 3 (4): 23.

Databases searched: PubMed & CINAHL. Keywords: isolation (gown or gowns) and infection

What information is available on patients with central venous catheters ambulating off the nursing unit/ward floor?

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Standardizing central venous catheter care: hospital to home. The Nebraska Medical Center. Standardizing central venous catheter care: hospital to home. Omaha (NE): The Nebraska Medical Center; 2012. 8 p.

Chopra, Vineet, et al. “Hospitalist experiences, practice, opinions, and knowledge regarding peripherally inserted central catheters: A Michigan survey.” Journal of hospital medicine (2013)

Zhao, Vivian M, et al. “Characterization of post-hospital infections in adults requiring home parenteral nutrition.” Nutrition 29.1 (2013):52-59.

Ouanes, Islem, et al. “A model to predict short-term death or readmission after intensive care unit discharge.” Journal of critical care 27.4 (2012):422.e1-422.e9.

Jaffer, Amir K. “Update in hospital medicine: studies likely to affect inpatient practice in 2011.” Cleveland Clinic journal of medicine 78.7 (2011):430-434.

Simcock, L. “Central venous catheters: some common clinical questions.” Nursing times 97.19 (2001):34-36.

What is recommended practice for administering dopamine? What studies are available on dopamine and extravasation?

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Administration. To access DynaMed information on Dopamine Administration
Dopamine

Select “Dosage and Administration” from left menu.

Dynamed also has information about extravasation available by clicking “Warnings” on left menu.

A search of PubMed with keywords dopamine and extravasation produced these results.

Bhosale, Guruprasad P, and Veena RShah. “Extravasation injury due to dopamine infusion leading to dermal necrosis and gangrene.” Journal of Anaesthesiology-Clinical Pharmacology 28.4 (2012):534-535.

Phillips, Reid A, et al. “Deep dopamine extravasation injury: a case report.” Journal of plastic, reconstructive & aesthetic surgery 62.7 (2009):e222-e224.

Chen, J L, and MO’Shea. “Extravasation injury associated with low-dose dopamine.” The Annals of pharmacotherapy 32.5 (1998):545-548.

Bey, D, et al. “The use of phentolamine in the prevention of dopamine-induced tissue extravasation.” Journal of critical care 13.1 (1998):13-20.

Dugger, B. “Peripheral dopamine infusions: are they worth the risk of infiltration?.” Journal of intravenous nursing 20.2 (1997):95-99.

What are the benefits of a pre-shift huddle or patient handoff?

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An integrative review of research on nursing handoffs in acute care settings… Transitions: Unifying Practice, Education, and Research to Improve Health: Communicating nursing research 2011 vol:44 pg:27

Gordon, Morris ; Educational interventions to improve handover in health care: a systematic review. Medical Education 2011 Nov; 45 (11): 1081-9.
http://web.ebscohost.com.proxy.library.emory.edu/ehost/pdfviewer/pdfviewer?sid=cb5c9931-f575-416d-a721-11e07d306885%40sessionmgr115&vid=2&hid=127

Evidence-based inpatient handovers: a literature review and research agenda. Clinical Governance 17.1 (2012):14.

Halm, Margo A. NURSING HANDOFFS: ENSURING SAFE PASSAGE FOR PATIENTS. American Journal of Critical Care 2013 Mar; 22 (2): 158-62.

Staggers, Nancy Research on nursing handoffs for medical and surgical settings: an integrative review. Journal of Advanced Nursing 2013 Feb; 69 (2): 247-62.

Searched CINAHL with keywords: handover, hand off. (Also selected “Evidence Based Practice” limiter)

You can also search Joanna Briggs, under the Clinical Tab in the Nursing Community and cutting and pasting the following search terms into the search box:

Nursing Clinical Handover
Hand off

What is the evidence on the effect of nurses’ sleep habits on patient safety?

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A search of Joanna Briggs, PubMed, and CINAHL identified the following relevant references.

Joanna Briggs Institute
No documents focusing on sleep and patient safety

CINAHL
The search (MH “Nursing Staff, Hospital” OR MH “Nurses+”) AND (safety OR error*) AND sleep LIMITERS: Research articles identified observational studies on effects of sleep on safety, including Johsnon 2014, Lockley 2007, Admi 2008, Biddle 2011, and Muecke 2005.  There was at least one study evaluating an intervention (Scott 2010). No articles by Geiger-Brown, who has written on nurses and sleep, appeared in search results above or in this search: sleep AND safety AND geiger-brown.

A search of Geiger Brown and sleep in CINAHL identified these papers.

PubMed

A search for articles by Geiger-Brown and sleep in PubMed identified an additional article that specifically mentions safety:
Sleep, sleepiness, fatigue, and performance of 12-hour-shift nurses. Chronobiol Int. 2012 Mar;29(2):211-219.

An additional search in PubMed for “Nurses”[Mesh] AND “Sleep”[Mesh] AND (“Safety”[Mesh] OR “Medical Errors”[Mesh]) found the following two articles.

Dorrian, Jillian, et al. “Sleep and errors in a group of Australian hospital nurses at work and during the commute.” Applied Ergonomics 39.5 (2008):605-613.

Dorrian, Jillian, et al. “A pilot study of the safety implications of Australian nurses’ sleep and work hours.” Chronobiology international 23.6 (2006):1149-1163.

Reviewed and updated 4/8/2014 ldt

What are the recommendations for use of graduated compression stockings in hospitalized patients?

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For medical patients:

DVT prophylaxis for medical patients. In: DynaMed Plus. References two practice guidelines that address use of stockings in hospitalized medical patients.

American College of Chest Physicians (ACCP) suggests usage of the stockings or intermittent pneumatic compression if risk factors for VTE and high risk for bleeding are present. Chest. 2012; 141 (2 Supp). Section 2.7 reviews evidence for use of compression stockings or other mechanical devices in hospitalized medical patients.

American College of Physicians (ACP) does not recommend use of graduated compression stockings for thromboprophylaxis. Ann Intern Med 2011 Nov 1;1559):625-632.
The section “Comparative Effectiveness of Mechanical Devices versus No Mechanical Devices” (p. 627) summarizes evidence and references studies.

There are additional recommendations for compression stockings in medical patients in DynaMed Plus:See prevention section of entry for Deep Vein Thrombosis.

Documents from the Joanna Briggs Institute EBP Database reviewed evidence and provided recommendations for use of compression stockings in hospitalized patients but did not specifically discuss frequency of changing stockings or other aspects of their use other than using knee-length stockings in surgical patients who are for some reason unable to tolerate the thigh-length stockings.  See these documents for summaries and references to the evidence.

To retrieve the following documents use the Joanna Briggs Institute EBP Database. Copy and paste the document title in the search box.

  • Search for “Deep vein thrombosis prophylaxis” to find latest evidence summaries.
  • Search for “Graduated compression stockings clinician information” to find latest evidence summaries.

For surgical patients:

See guidelines section in entry forDeep vein thrombosis (DVT) prophylaxis for surgical patients. In: DynaMed Plus. To view summary of specific evidence, view section for a surgical specialty (e.g., general and abdominal surgery, neurosurgery, etc.)

To retrieve the following documents use the Joanna Briggs Institute EBP Database. Copy and paste the document title in the search box.

  • Search for “Hip fracture management older people” to find the latest recommended practices.
  • Search for “Graduated compression stockings for the prevention of post-operative venous thromboembolism” to view a 2008 technical report.

Reviewed and updated 4/8/2014 ldt

Does hourly rounding reduce the risk of accidental falls in a cardiovascular surgical unit?

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A CINAHL search for (rounds OR rounding) AND falls AND (cardiac OR coronary OR cardiovascular) did not retrieve any results.

A search for (rounds OR rounding) AND falls AND (surgical OR surgery OR postoperative) retrieved 13 references, including these studies in medical-surgical units:

Effects of rounding on patient satisfaction and patient safety on a medical-surgical unit. Woodward JL; Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2009 Jul-Aug; 23 (4): 200-6.

Hourly Rounding: A Replication Study. Olrich, Todd; Kalman, Melanie; Nigolian, Cindy; MEDSURG Nursing, 2012 Jan-Feb; 21 (1): 23-36.

A search in PubMed found these two additional articles.

Krepper, Rebecca, et al. “Evaluation of a Standardized Hourly Rounding Process (SHaRP).” Journal for healthcare quality 36.2 (2014):62-69.
The first took place in two 32-bed cardiovascular surgery nursing units.

Ciccu Moore, Rita, et al. “Care and comfort rounds: improving standards.” Nursing management 20.9 (2014):18-23.
This study took place in an orthopaedic and surgical rehabilitation ward.

See also Does hourly or intentional rounding reduce the rate of accidental falls in acute care facilities?

See also Are inpatients with cardiac conditions or on diuretic therapy at risk for falls and is there any evidence of interventions to reduce falls in this population?
This blog entry references a couple of papers in the search  results that include patients with cardiac conditions in their populations.  You might be able to extrapolate strategies to your population.

Reviewed and updated 4/8/2014 ldt