Restraint usage in hospitals. Practice guidelines and alternatives.

Posted on by
Reply

“Restraints are likely to negatively affect patients’ health and therefore a reduction in their usage is recommended for all health-care settings. To date, research on restrictive practices has concentrated on mental health and long-term care settings. To ensure restraints are used as little as possible in the acute-care hospital setting, it seems important to investigate more comprehensively the use of restraints, to include all types of restraints irrespective of ward type or subpopulations and to identify factors associated with restraint use. Restraints are often utilised in hospitals in complex care situations such as with patients at risk of falling or with delirium. When using restraints the consideration of processes like documentation and evaluation shows great potential for improvement. Standardisation of these processes and education of the interprofessional team could be beneficial for raising awareness and for the sustainable reduction of restraint use.”

Thomann, S., Zwakhalen, Richter, Bauer, & Hahn. (2021). Restraint use in the acute-care hospital setting: A cross-sectional multi-centre study. International Journal of Nursing Studies,114, 103807.

Continue reading →

What is the best treatment for hypertensive disorders of pregnancy?

Posted on by
Reply

“All oral anti-hypertensives reduced blood pressure to the reference range in most women. As single drugs, nifedipine retard use resulted in a greater frequency of primary outcome attainment than labetalol or methyldopa use. All three oral drugs—methyldopa, nifedipine, and labetalol—are viable initial options for treating severe hypertension in low-resource settings.” 1

“Labetalol intravenously and methyldopa orally are then the two most frequently used drugs. Short-acting oral nifedipine is suggested to be used only if other drugs or iv access are not available.” 2

(1) Easterling T, Mundle S, Bracken H, Parvekar S, Mool S, Magee LA, von Dadelszen P, Shochet T, Winikoff B. Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial. Lancet. 2019 Sep 21;394(10203):1011-1021. doi: 10.1016/S0140-6736(19)31282-6. Epub 2019 Aug 1. PMID: 31378394; PMCID: PMC6857437.
Free Full Text

(2) Cífková R, Johnson MR, Kahan T, Brguljan J, Williams B, Coca A, Manolis A, Thomopoulos C, Borghi C, Tsioufis C, Parati G, Sudano I, McManus RJ, van den Born BH, Regitz-Zagrosek V, de Simone G. Peripartum management of hypertension: a position paper of the ESC Council on Hypertension and the European Society of Hypertension. Eur Heart J Cardiovasc Pharmacother. 2020 Nov 1;6(6):384-393. doi: 10.1093/ehjcvp/pvz082. PMID: 31841131.
Free Full Text

Further Reading

Deshmukh US, Lundsberg LS, Culhane JF, Partridge C, Reddy UM, Merriam AA, Son M. Factors associated with appropriate treatment of acute-onset severe obstetrical hypertension. Am J Obstet Gynecol. 2021 May 20:S0002-9378(21)00559-7. doi: 10.1016/j.ajog.2021.05.012. Epub ahead of print. PMID: 34023314.
Full Text for Emory Users

Wilkerson RG, Ogunbodede AC. Hypertensive Disorders of Pregnancy. Emerg Med Clin North Am. 2019 May;37(2):301-316. doi: 10.1016/j.emc.2019.01.008. PMID: 30940374.
Full Text for Emory Users

Cox AG, Marshall SA, Palmer KR, Wallace EM. Current and emerging pharmacotherapy for emergency management of preeclampsia. Expert Opin Pharmacother. 2019 Apr;20(6):701-712. doi: 10.1080/14656566.2019.1570134. Epub 2019 Feb 1. PMID: 30707633.
Full Text for Emory Users

Watson K, Broscious R, Devabhakthuni S, Noel ZR. Focused Update on Pharmacologic Management of Hypertensive Emergencies. Curr Hypertens Rep. 2018 Jun 8;20(7):56. doi: 10.1007/s11906-018-0854-2. PMID: 29884955.
Full Text for Emory Users

Anderson CM, Schmella MJ. CE: Preeclampsia: Current Approaches to Nursing Management. Am J Nurs. 2017 Nov;117(11):30-38. doi: 10.1097/01.NAJ.0000526722.26893.b5. PMID: 29035901.
Full Text for Emory Users

Patient participation in recording fluid input/output

Posted on by
Reply

“The accurate documentation and maintenance of fluid balance charts constitute an integral part of nursing care. However, inaccuracies in fluid balance charting by nurses often occur. Inaccurate charting can result in delayed interventions, affecting the safety of patients. It has been found that fluid intake charting in an acute surgical inpatient ward is highly inaccurate. Many expressions of dissatisfaction are evident among medical healthcare professionals and patients regarding the accurate updating of the charts. Therefore, evidence-based measures need to be implemented in order to improve the safety of patient care through accurate recording of patients’ fluid intake”

Liaw, Y., & Goh, M. (2018). Improving the accuracy of fluid intake charting through patient involvement in an adult surgical ward: A best practice implementation project. JBI Database of Systematic Reviews and Implementation Reports.,16(8), 1709-1719.
Full Text for Emory Users

Continue reading →

What are effective interventions to decrease CLABSIs in the long term acute care population?

Posted on by
Reply

This systematic review and meta-analysis examines the impact of quality improvement interventions on central line–associated bloodstream infections in adult intensive care units. Studies were identified through Medline and manual searches (1995–June 2012). The results suggest that quality improvement interventions contribute to the prevention of central line–associated bloodstream infections. Implementation of care bundles and checklists appears to yield stronger risk reductions.

Continue reading →

Do oncology nurse-navigators (ONN) improve patient outcomes?

Posted on by
Reply
Muñoz R, et al.. Multidisciplinary Cancer Care Model: A Positive Association Between Oncology Nurse Navigation and Improved Outcomes for Patients With Cancer. Clin J Oncol Nurs. 2018 Oct 1;22(5):E141-E145.

Muñoz R, Farshidpour L, Chaudhary UB, Fathi AH. Multidisciplinary Cancer Care Model: A Positive Association Between Oncology Nurse Navigation and Improved Outcomes for Patients With Cancer. Clin J Oncol Nurs. 2018 Oct 1;22(5):E141-E145. doi: 10.1188/18.CJON.E141-E145. PMID: 30239520.
Fulltext for Emory Users

Continue reading →

Understanding the importance of timely ECG in the Emergency Department.

Posted on by
Reply

ST-segment elevation myocardial infarction (STEMI) is a life-threatening disease that can result in irreversible myocardial damage when untreated. Delays in treatment, on the order of minutes are associated with increased mortality and worsening cardiac functional outcomes.To facilitate rapid treatment, international guidelines recommend that out-of-hospital clinicians refer patients with symptoms suggestive of STEMI to an emergency department directly or via emergency medical service(EMS) transport.These guidelines recommend the acquisition and diagnostic interpretation of an ECG within 10 minutes of emergency department (ED) arrival.”

Continue reading →