Hospital discharge planning decision tools and algorithms.

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To run the search, copy/paste this into PubMed: 

(((“patient discharge” OR “patient discharge”[MeSH] and (decision making OR “Decision Support Techniques”[Mesh])))) AND (“Outcome and Process Assessment (Health Care)”[Mesh] OR length of stay)

Selected articles include:

Coudeyre, E, et al. “Transcultural validation of the Risk Assessment and Predictor Tool (RAPT) to predict discharge outcomes after total hip replacement.” Annals of physical and rehabilitation medicine 57.3 (2014):169-84.

Hansen, Viktor J, et al. “Does the Risk Assessment and Prediction Tool predict discharge disposition after joint replacement?.” Clinical orthopaedics and related research 473.2 (2015):597-601.

Holland, Diane E, et al. “Developing and testing a discharge planning decision support tool for hospitalized pediatric patients.” Journal for specialists in pediatric nursing 19.2 (2014):149-61.

What evidence is there for using sterile saline/water instead of tap water for enteral/tube feeding flushes and/or free water for enterally fed patients?

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CINAHL search with the following terms:

(enteral feeding OR tube feeding OR enteral nutrition OR feeding tube) AND (sterile OR saline OR water) AND (irrigation OR flush OR flushing)

Allen S. As a Flushing Agent for Enteral Nutrition, Does Sterile Water Compared to Tap Water Affect the Associated Risk of Infection in Critically Ill Patients?. Alabama Nurse [serial online]. March 2015;42(1):5-6. Available from: CINAHL, Ipswich, MA. Accessed June 1, 2015.

“ASPEN Enteral Nutrition Practice Recommendations.” JPEN, Journal of Parenteral and Enteral Nutrition 33.2 (2009):122.

“Enteral tube flushing.” American journal of nursing 105.3 (2005):58.

 

Standardization of nursing documentation and its effects on patient outcomes

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Here is a search strategy that finds 13 articles in PubMed. Go here, click on PubMed, and run this search. Then you can click the Find It at Emory button within an article’s entry to see if Emory has full-text access for an article.

24885821[uid] OR 24313025[uid] OR 21517280[uid] OR 19998628[uid] OR 19181202[uid] OR 18840217[uid] OR 18165723[uid] OR 17430533[uid] OR 16183359[uid] OR 14767231[uid] OR 19207524[uid] OR 8648420[uid] OR 8987274[uid]

Here are three articles that state that standardized documentation improves patient outcomes. The others seem to only briefly mention that standardizing documentation may improve patient outcomes. However, they may give you ideas on how to best standardize documentation.

Huffman, Melinda H, and Jennie ACowan. “Redefine care delivery and documentation.” Nursing Management 35.2 (2004):34-8.

Müller Staub, Maria, et al. “Improved quality of nursing documentation: results of a nursing diagnoses, interventions, and outcomes implementation study.” International Journal of Nursing Terminologies and Classifications 18.1 (2007):5-17.

Müller Staub, Maria. “Evaluation of the implementation of nursing diagnoses, interventions, and outcomes.” International Journal of Nursing Terminologies and Classifications 20.1 (2009):9-15.

Use of Neutral Zone in the operating room

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Recent publications support the use of the Hands-Free Technique, or Neutral Zone, for reducing surgical injuries, most of the evidence for this support comes from studies older than your 5-6 year window of interest.

For example DiGirolamo KM, Courtemanche DJ, Hill WD, Kennedy A, Skarsgard ED,’s “Use of safety scalpels and other safety practices to reduce sharps injury in the operating room: what is the evidence?” Can J Surg. 2013 Aug; 56(4):263-269. PMID 23883497 examines 5 articles reporting effects of hands-free technique. Four showed significant reduction in incidents, the fifth showed no change. However, the studies themselves were published in 1992, 2000, 2002, and 2009. Only the last meets your request for articles from the past 5-6 years.

• The 2009 study, Stringer et al.’s “Hands-free technique in the operating room: reduction of body fluid exposure and the value of a training video.” Public Health Rep. 2009 Ju-Aug;124 Suppl 1:169-79. PMID 19618819, found a 35% reduction in incidents (defined as percutaneous injury, glove tear, and contamination).

Similarly, Walijee JF, Malay S, and Chung KC. “Sharps Injuries: The Risks and Relevance to Plastic Surgeons” Plast Reconstr Surg. 2013 Apr;131(4): 784-91. PMID 23542251, claim an up to 60% reduction in incidents when using a neutral zone, but base this claim on the previously reported study done in 2002.

Another study, Jagger et al. “Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation” J Am Coll Surg. 2010 Apr;210(4):496-502. PMID 20347743 shows data on the percentage of surgical incidents that occur during “passing/between steps” but does not comment on specific intervention reductions.

In short, with the one exception of Stringer et al.’s 2009 article studies on the efficacy of the Hands-Free Technique, or Neutral Zone, appear to be 10-15 years old. Such older studies include:
• Berguer R, Heller PJ. “Preventing sharps injuries in the operating room.” J Am Coll Surg. 2004 Sep;199(3):462-7. PMID 15325617 Review of available evidence, often cited as offers summary of 2000 and 2002 data.
• Stringer B, Infante-Rivard C, Hanley JA. “Effectiveness of the hands-free technique in reducing operating theatre injuries.” Occup Environ Med. 2002;59(10):703-707. Reports 59% reduction.
• Folin A, Nyberg B, Nordström G. “Reducing blood exposures during orthopedic surgical procedures.” AORN J. 2000 Mar; 71(3):573-6, 579, 581-2. Small sample size, reported significant reduction for “scrub people” not for “first assistants” or “surgeons.”

For inpatients and outpatients, how frequently is Vitamin D screening conducted and how frequently is it done on request versus routinely?

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Bottom line:  Apart from special populations with known risk for Vitamin D deficiency, there is no evidence regarding practices of Vitamin D screening in general inpatient or outpatient populations.

PubMed search:   vitamin d AND “mass screening”[mesh] AND routine*
This search includes 2 papers published in American Family Physician in 2013.  They present opposing viewpoints on routine screening.  It is probably worth looking at those papers, especially the reference lists.
No papers reported on provider practices regarding Vitamin D screening.

A broader PubMed search of vitamin D and “mass screening”[mesh] seems to address screening in special populations, such as pregnant women, the elderly, and individuals with diabetes.

Web of Science:  Similar results to the PubMed search were found. A recent review presents evidence on Vitamin D screening.

Kulie, Teresa, et al. “Vitamin D: an evidence-based review.” Journal of the American Board of Family Medicine 22.6 (2009):698-706. (cited 33 times)
The last sentence of abstract reads: Unfortunately, little evidence guides clinicians on when to screen for vitamin D deficiency or effective treatment options.

You might be able to use the National Ambulatory Medical Care Survey to determine an estimation of how many patient visits included vitamin D tests, but you wouldn’t be able to tell if they were routine.  There is also a National Hospital Care Survey that might provide similar data; again you wouldn’t be able to tell if they were ordered as a routine or in response to clinical findings or patient history.  If you are interested, we can investigate that further.

Measuring blood pressure (BP) on arm; nursing interventions to facilitate BP control

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Measuring blood pressure (BP) on the arm:

1) DynaMed Plus is a evidenced-based medicine tool that provides bulleted summaries on given topics. Take a look at their blood pressure measurement and monitoring pages, in particular the Manual BP Measurement section for evidence based recommendations and links to the referenced studies. There is also a section on Guidelines and Resources which provides links to the  American Heart Association recommendations which are summarized here: Am Fam Physician 2005 Oct 1;72(7):1391

Nursing interventions in ambulatory settings to facilitate patient’s BP control

2) A few articles may be found in PubMed on nurse-led care for controlling blood pressure may be found using searches: a) blood pressure AND intervention AND nurse AND ambulatory and b) “Blood Pressure Monitoring, Ambulatory”[Mesh] and “Nurses”[Mesh]

Please see below for some helpful citations.

Cheng, Mei, et al. “The effect of continuous nursing intervention guided by chronotherapeutics on ambulatory blood pressure of older hypertensive patients in the community.” Journal of clinical nursing 23.15-16 (2014):2247-54.

Bosworth, Hayden B, et al. “Home blood pressure management and improved blood pressure control: results from a randomized controlled trial.” Archives of internal medicine 171.13 (2011):1173-80.

Ulm, Kurt, et al. “Effect of an intensive nurse-managed medical care programme on ambulatory blood pressure in hypertensive patients.” Archives of cardiovascular diseases 103.3 (2010):142-9.

Bosworth, Hayden B, et al. “Hypertension Intervention Nurse Telemedicine Study (HINTS): testing a multifactorial tailored behavioral/educational and a medication management intervention for blood pressure control.” The American heart journal 153.6 (2007):918-24.