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.

 

Effect of early ambulation on length of stay in ICU patients

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When using PubMed, make sure and go to the Woodruff Health Sciences Center Library’s homepage at http://health.library.emory.edu and click PubMed or use this direct link to Emory University’s instance of PubMed: http://www.ncbi.nlm.nih.gov/pubmed?otool=emorylib. When using Emory University’s instance of PubMed, you will be able to click the Find it at Emory button within entries for articles to determine if Emory has full-text access to articles.

Here is the search technique I used:
(early ambulation OR “early mobility”) AND (critical care OR intensive care units OR icu) AND length of stay
Filters I used: meta-analysis, systematic review, English

Please paste the following search into PubMed to see 8 articles that appear to be helpful and are systematic reviews, one of the highest levels of evidence.

24424616[uid] OR 23127305[uid] OR 24222709[uid] OR 22147819[uid] OR 21164413[uid] OR 21169829[uid] OR 20048676[uid] OR 20001881[uid]

Patient ambassadors – evidence of effects on patient care/surveys/etc.

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When using PubMed, a database of 24 million articles, make sure and go to the Woodruff Health Sciences Center Library’s homepage at http://health.library.emory.edu and click PubMed or use this direct link to Emory University’s instance of PubMed: http://www.ncbi.nlm.nih.gov/pubmed?otool=emorylib. When using Emory University’s instance of PubMed, you will be able to click the Find it at Emory button within entries for articles to determine if Emory has full-text access to articles.

Here are the broad search techniques I used:

  1. (data collection OR consumer satisfaction OR outcome and process assessment OR healthcare quality assurance) AND ((marketing of health services AND professional-patient relations) OR (patients AND (ambassador OR ambassadors)) OR (sitter OR sitters) AND ambassador)))

Filter I used: English

  1. (consumer satisfaction OR outcome and process assessment OR healthcare quality assurance) AND (volunteer[tiab] OR volunteers[tiab]) AND patients AND (acute OR hospital OR hospitals)

Filters I used: meta-analysis, review, systematic review, English; note that [tiab] finds articles in which the search term appears in the title or abstract of the article

Please paste the following search into PubMed to see 10 articles that appear to be useful that were found with the aforementioned broad searches:

17057604[uid] OR 12465218[uid] OR 11951690[uid] OR 10169030[uid] OR 7896552[uid] OR 10124795[uid] OR 10124795[uid] OR 12569993[uid] OR 3648555[uid] OR 11129764[uid] OR 20464736[uid]

The only article of the 10 that specifically mentions ambassadors is entitled “Integrating palliative medicine….” Two other articles mention volunteers, and other articles provide ideas on how employees can effectively market services to patients. There are numerous other articles on using employees to market services; a different search technique would need to be created to find all of them. I included the article on negative emotion evaluations because patient ambassadors are responsible for addressing patients’ nonclinical needs (their actions thus primarily affect patients’ emotions).