Tag Archives: Incidence/Prevalence

Is use of color in the healthcare environment effective at reducing the rate of falls in inpatients?

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Bottom line:  No published research has been identified on the use of color  in hospital settings to reduce falls other than to alert healthcare staff, but there is research on the ability to perceive color in adults with visual impairment, which affects many older patients.

Summary:  For a review of perception of color and discussion of implications for healthcare environments, see
J Clin Nurs. 2009 Feb;18(3):366-72.
Källstrand-Ericson J, Hildingh C. Visual impairment and falls: a register study.
Discussion on p. 369 includes review of literature on color perception in visual impairment.

Searched Joanna Briggs, PubMed, CINAHL, and Web of Science

Reviewed 4/9/2014 ldt

What is the prevalence of falls for hospitalized psychiatric and geriatric patients?

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Observational studies:

Enloe M, et al.  Falls in Acute Care: An Academic Medical Center Six-Year Review.  J Patient Safety.  2005; 1(4): 208-214.
Retrospective study of falls at an academic medical center over 6 years.  RESULTS:  Table 2 shows the unadjusted annual fall rates were 5.86/1,000 patient days on the psychiatry units and Table 3 shows that broken down by age (regardless of service the patient was on), the fall rate for patients age 55-74 was 2.90/1,000 patient days and the rate for patients ages 75 and older was 4.08/1,000 patient days.

Schwendimann R, et al.  Characteristics of hospital inpatient falls across clinical departments.  Gerontology. 2008;54(6):342-8
Prospective study at 1,300 bed academic hospital over 13 weeks.  RESULTS:  Rate of falls on geriatrics units was 10.7/1,000 patient days.

Kerzman H, et al.  Characteristics of falls in hospitalized patients.  J Adv Nursing 2004; 47(2), 223–229.
Retrospective study of falls at a 2000-bed medical center in 1998.  RESULTS:  The rates of falls was 115/1,000 hospital admissions in the geriatric wards and 91 per 1,000 admissions in the psychiatric wards.  Rates per 1,000 inpatient days were not reported.

Does frequency of providing stoma and inner canula care reduce rate of VAP in patients with tracheostomy?

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Bottom line:  There is not much evidence available on this question.  Most recommendations are based on expert opinion.

A search of PubMed and CINAHL for these concepts–tracheotomy, tracheostomy, ventilator-associated pneumonia, prevention–revealed one study specifically examining care of the tracheostomy–Eid RC, et al.  Successful prevention of tracheostomy associated pneumonia in step-down units.  Am J Infect Control. 2011 Aug;39(6):500-5.
Intervention included “drainage and discarding of condensate” in the tubing at least 3 times per day, but this doesn’t say specifically changing the tubing. No additional studies identified that evaluated care of the tracheostomy in preventing outcome of ventilator-associated pneumonia.

Tracheostomy: Stoma Care.  Joanna Briggs Institute, 2010.  States that evidence regarding tracheostomy is mostly based on expert opinion as there are not many published studies on tracheostomy procedures and care.

Tracheostomy:  Management – references guideline that relies on expert opinion in recommendation

Cites this small study that found no statistically significant difference in bacterial colonization between patients who had canula changed daily versus those who did not.

Burns SM, et al.  Are frequent inner cannula changes necessary?: A pilot study.  Heart Lung. 1998 Jan-Feb;27(1):58-62.
This small study that found no statistically significant difference in bacterial colonization between patients who had canula changed daily versus those who did not.  Did not look at ventilator-associated pneumonia rates.

For inpatients, are skin assessments by two staff more accurate than skin assessments by one staff at detecting pressure ulcers and areas at risk for ulcers?

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Bottom line:  Practice guidelines recommend having a standard procedure for assessing and documenting skin and training staff who will be making these assessments, but there is no specific recommendation for the number of staff required for assessing skin.

DynaMed topic on Pressure Ulcers includes a section on prevention screening and section on guidelines.  Prevention/screening section summarizes data on utility of specific structured assessment tools.  There are numerous guidelines, which should document studies on which they base recommendations.  One guideline is Institute for Clinical Systems Improvement (ICSI) guideline on pressure ulcer treatment.

JBI+COnNECT – There are several evidence summaries, but the most relevant ones (ex: Pressure Ulcers: Prevention and Management, seem to  reference the guidelines included in DynaMed, such as that of the Royal College of Nursing.

No identifed recommendations or mention of using more than one person to assess a patient’s skin in the DynaMed or JBI+ information.

PubMed search:  pressure ulcers AND (rater* OR observer*) AND (accura* OR reliabl*)

Yielded studies such as these two that compare use of one nurse to two nurses in documenting skin and found no difference in the number of pressure ulcers documented.  These studies did not address assessment for risk.

Kottner J, Tannen A, Dassen T. Hospital pressure ulcer prevalence rates and number of raters. J Clin Nurs. 2009 Jun;18(11):1550-6.

Kottner J, Tannen A, Halfens R, Dassen T. Does the number of raters influence the pressure ulcer prevalence rate? Appl Nurs Res. 2009 Feb;22(1):68-72. 

Are there any valid instruments for assessing risk for violence in mental health patients and is use of these instruments associated with fewer incidents of assaults on staff by patients?

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Bottom line:  There is some limited evidence that use of risk assessment tools can predict violent behavior by patients and can be associated with  reduction in aggressive incidents.

A systematic review in JBI+ COnNECT (JBI Library of Systematic Reviews. 2009;7(6):175-223) identified one retrospective study (Kling, 2006) of a tool to assess inpatients for risk of violent behavior.  In PubMed this reference led to other studies, including an RCT (Abderhalden, 2008) and a pilot study (Fluttert 2011)

Kling, R., et al., Use of a violence risk assessment tool in an acute care hospital: effectiveness in identifying violent patients. AAOHN Journal, 2006. 54(11): p. 481-7. (Available in print at Health Sciences Center Library.)
Reviewed charts at 1 acute care hospital for 117 violent patients and 161 randomly selected, nonviolent patients admitted during the same period.  Compared findings of a risk assessment tool in these populations.  Tool had moderate senstivity (71%) and high specificity (94%).  Limitation – only 35% of the non-violent patients and 75% of the violent patients were evaluated using the tool.

Abderhalden C, et al. Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial. Br J Psychiatry. 2008 Jul;193(1):44-50.
Cluster RCT randomized 14 psychiatric units to use of Swiss version of the Brøset Violence Checklist (BVC–CH) or usual care for patients admitted to these units.  RESULTS: Adjusted RR indicate 41% reduction in severe aggressive incidents and a 27% decrease in use of coercive measures.  There was no decrease in severity of aggressive incidents.

Fluttert FA, et al. The development of the Forensic Early Warning Signs of Aggression Inventory: preliminary findings toward a better management of inpatient aggression. Arch Psychiatr Nurs. 2011 Apr;25(2):129-37.
Describes development of a new risk assessment tool.

PubMed search:  “Inpatients/psychology”[mesh] AND “Violence/prevention and control”[mesh] AND assess*

Reviewed 4/18/14  AA

Does double checking by two registered nurses prior to injection of insulin or heparin reduce risk of medication errors?

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Bottom line:  There is little evidence to support or to refute the effectiveness of double-checking by nurses to reduce rates of medication errors.

Wimpenny P and Kirkpatrick P.  Roles and systems for routine medication administration to prevent medication errors in hospital-based, acute care settings: a systematic review.  JBI Library of Systematic Reviews. 2010;8(10):405-446.

Hughes RG and Blegen MA.  Medication administration safety.  In:  Patient Safety and Quality:  An Evidence-Based Handbook for Nurses.  AHRQ.  Updated April 2008.  http://www.ahrq.gov/qual/nurseshdbk/docs/HughesR_MAS.pdf
Start with the Policies, Procedures and Protocols section on p. 20.

O’Connell B et al.  Nurses’ attitudes to single checking medications:  before and after its use.  Inter J Nurs Practice.  2007; 13: 377-82.

Studies of errors reported by nurses that address double-checking:

Jarman et al.  Inter J Nurs Practice. 2002; 8: 330-335.  Survey of nurses reporting errors during period of single-checking and period of double-checking.  No significant difference in error rates between the two periods.

Stratton KM et al.  J Pediatr Nurs.  2004;19(6): 385.  Survey of nurses’ perceptions of factors associated with medication errors.  For 28% of the errors reported, nurses identified failure to double-check as a reason for the error.

Reviewed 4/14/2014 AA

For patients undergoing cardiac surgery, is perioperative use of milrinone associated with increased risk for developing atrial fibrillation?

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In the Milrinone topic in DynaMed, you can look at the Cautions and Adverse Effects section and see a summary of a prospective cohort study of 232 patients having elective cardiac surgery (Milrinone Use Is Associated With Postoperative Atrial Fibrillation After Cardiac Surgery.  Circulation 2008 Oct 14;118(16):1619.)  The exposure was whether or not the patients received milrinone.  Milrinone used for patients with postbypass LVEF <30%, with evidence of right ventricular dysfunction, or with pulmonary hypertension.
28.9% of patients developed atrial fibrillation.  Rate of developing atrial fibrillation was 58.2% in milrinone group v. 26.1% in the no milrinone  group.

PubMed
Full list of systematic reviews can be seen here: systematic[sb] AND (milrinone OR cardiotonic agents OR inotropic drugs) AND cardiac surgery AND adverse effects

There is a systematic review on the topic (Gillies M, et al.  Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery — a systematic literature review.  Crit Care. 2005 Jun;9(3):266-79. Epub 2004 Dec 16.), but the authors found no studies reporting “data relating to the effect of milrinone on major clinical outcomes or survival in cardiac surgery patients.”   The RCTs included in the review only reported data for a short period of time (up to 24 hours), one of the trials (Doolan, 1997) reported findings of atrial fibrillation.  The rate in milrinone use was very low (5%),  but the study only reported data collected for 4 hours after surgery.

Reviewed 4/14/14  AA