For patients presenting with concussion, what is the evidence for management in the emergency department, home care, and follow-up?

Concussion and mild traumatic brain injury.  In: DynaMed.

The Guidelines section includes guidelines and their accompanying references to primary literature…

Evaluation and Management of Mild Traumatic Brain Injury, Eastern Association for the Surgery of Trauma
This is a recent (within past 2 years) guideline that summarizes evidence on practices for diagnostic workup, home care (eg, return to work and driving), and management of special populations, such as patients on warfarin.

American College of Emergency Physicians. Clinical Policy: Neuroimaging and Decisionmaking in Adult Mild Traumatic Brain Injury in the Acute Setting.
This is an older but still relevant guideline (2008) that presents evidence to answers the questions of when to order a non-contrast head CT; what is the role for head MRI in the ED, are there serum biormarkers.

Care of the patient with mild traumatic brain injury. Glenview (IL): American Association of Neuroscience Nurses, Association of Rehabilitation Nurses
Summarizes evidence of management of patients with mild traumatic brain injury

PubMed

A search of Clinical Queries provides systematic reviews that may provide more recent appraisal of evidence.   These searches identify evidence on treatment and follow-up provided by the emergency department.  References to individual studies are in the left column; this list can be modified by changing the study category and scope.  References to systematic reviews are in the center column.

Clinical Queries:  concussion AND emergency department

Clinical Queries:  concussion AND (post-concussion syndrome OR self care OR monitoring)

 

What does the literature say regarding postoperative care for uterine embolization patients?

Patient care issues surrounding the uterine artery embolization procedure for the treatment of uterine fibroids. Images. 1999 vol:18 iss:3 pg:4

Uterine artery embolization.” AORN journal 73.4 (2001):790-2, 794-8.

Uterine artery embolization in the management of vaginal bleeding from cervical pregnancy: a case series. Journal of reproductive medicine 2005 vol:50 iss:11 pg:844

Baakdah, Hanadi, and TogasTulandi. “Uterine fibroid embolization.” Clinical obstetrics and gynecology 48.2 (2005):361-368.

Siskin, Gary P, et al. “III. Uterine fibroid embolization: pain management.” Techniques in vascular and interventional radiology 5.1 (2002):35-43.

Searched CINAHL & PubMed. Keywords: postoperative care and uterine embolization

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)

Continuous renal replacement therapy

Roeder, Vickey R. “Putting the ‘C’ back into continuous renal replacement therapy.” Nephrology nursing journal 40.6 (2013): 509-516.

Palevsky, Paul M, et al. “KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury.” American journal of kidney diseases 61.5 (2013):649-672.

Galvagno Jr., Samuel M, et al. “Practical considerations for the dosing and adjustment of continuous renal replacement therapy in the intensive care unit.” Journal of critical care 28.6 (2013):1019-1026.

Uchino, V, et al. “Validity of low-intensity continuous renal replacement therapy*.” Critical care medicine 41.11 (2013):2584-2591.

Rahman, Muhammad Aziz. Renal dialysis: modalities. Evidence summaries. 2013. In: Joanna Briggs Institute EBP Database.

Diagnosis and management of adults with chronic kidney disease. Southfield (MI): Michigan Quality Improvement Consortium; 2013 May. 1 p.

Honore, Patrick, et al. “Nutritional and metabolic alterations during continuous renal replacement therapy.” Blood purification 35.4 (2013):279-284.

Maursetter, Laura, C E Kight, J Mennig, and R M Hofmann. “Review of the mechanism and nutrition recommendations for patients undergoing continuous renal replacement therapy.” Nutrition in clinical practice 26.4 (2011):382-390.

Continuous renal replacement therapy (CRRT).” The Internet journal of anesthesiology 21.1 (2009).

Databases: PubMed, CINAHL, Joanna Briggs, Guideline.gov

Reviewed and updated 4/9/2014 ldt

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

Patient and family stroke education

Cheng, Ho Y, Sek YChair, and Janita PChau. “The effectiveness of psychosocial interventions for stroke family caregivers and stroke survivors: A systematic review and meta-analysis.” Patient education and counseling 95.1 (2014):30-44.

Cameron, Vanessa. “Best practices for stroke patient and family education in the acute care setting: a literature review.” Medsurg nursing 22.1 (2013):51-5, 64.

Shyu, Yea-Ing L, et al. “A family caregiver-oriented discharge planning program for older stroke patients and their family caregivers.” Journal of clinical nursing 17.18 (2008):2497-2508.

Cameron, Jill I, and Monique A MGignac. “‘Timing It Right’: a conceptual framework for addressing the support needs of family caregivers to stroke survivors from the hospital to the home.” Patient education and counseling 70.3 (2008):305-314.

O’Farrell, B, and D Evans. The continuum of care: the process and development of a nursing model for stroke education. Axone 20.1 (1998):16-18.

Olson, DaiWai, et al. Transition of care for acute stroke and myocardial infarction patients: from hospitalization to rehabilitation, recovery, and secondary prevention. Evidence report/technology assessment 202 (2011):1-197.

Hafsteinsdottir, T B, et al. “Educational needs of patients with a stroke and their caregivers: a systematic review of the literature.” Patient education and counseling 85.1 (2011):14-25.

Reviewed and updated 4/21/2014 ldt