Traditional paper documentation of cardiopulmonary arrest (CPA) events is often inaccurate and incomplete. Electronic documentation supports appropriate process improvements and optimal patient care ...and contributes to greater accuracy in national databases from which national benchmarks are derived. The aim of this quality improvement initiative was to compare the timeliness and accuracy of paper-based versus electronic documentation of live CPA events.
Nurses on four medical-surgical pilot units received training on the use of a handheld electronic device with a documentation app (Full Code Pro) to document live CPA events. The data were downloaded into an Excel file and compared for completeness and accuracy with the data downloaded from the LIFEPAK 15 defibrillator using CODE-STAT 10.0 software. Electronic documentation and traditional paper documentation of events from units where the intervention wasn't implemented (control units) were also compared with the CODE-STAT data.
There were 26 CPA events: six on the pilot units were documented using the electronic app, 12 on the pilot units were documented using the paper-based method (the latter were excluded from analysis), and eight on the control units were documented using the existing paper forms. Data accuracy was significantly greater in the electronic group compared with the paper-based group for recorded rhythm (100% versus 13%, P = 0.01) and end-tidal carbon dioxide (67% versus 0%, P = 0.02). The electronic method significantly outperformed the paper-based method in legibility (100% versus 13%, P < 0.01). Staff reported increased satisfaction with the electronic documentation method.
Using electronic handheld devices to document live resuscitation events demonstrated the inaccuracies of paper-based documentation, supporting the findings of previous studies. Electronic documentation was superior to paper in overall documentation quality and allowed providers to identify and quickly document the initial rhythm of the event. A larger study using electronic documentation to capture more ventricular fibrillation and ventricular tachycardia arrests would show a greater accuracy of timing, which would have large positive effects on overall resuscitation quality.
Systematic screening improves delirium identification among hospitalized older adults. Little data exist on how to implement such screening.
To test implementation of a brief app-directed protocol ...for delirium identification by physicians, nurses, and certified nursing assistants (CNAs) in real-world practice relative to a research reference standard delirium assessment (RSDA).
Prospective cohort study.
Large urban academic medical center and small rural community hospital.
527 general medicine inpatients (mean age, 80 years; 35% with preexisting dementia) and 399 clinicians (53 hospitalists, 236 nurses, and 110 CNAs).
On 2 study days, enrolled patients had an RSDA. Subsequently, CNAs performed an ultra-brief 2-item screen (UB-2) for delirium, whereas physicians and nurses performed a 2-step protocol consisting of the UB-2 followed in those with a positive screen result by the 3-Minute Diagnostic Assessment for the Confusion Assessment Method.
Delirium was diagnosed in 154 of 924 RSDAs (17%) and in 114 of 527 patients (22%). The completion rate for clinician protocols exceeded 97%. The CNAs administered the UB-2 in a mean of 62 seconds (SD, 51). The 2-step protocols were administered in means of 104 seconds (SD, 99) by nurses and 106 seconds (SD, 105) by physicians. The UB-2 had sensitivities of 88% (95% CI, 72% to 96%), 87% (CI, 73% to 95%), and 82% (CI, 65% to 91%) when administered by CNAs, nurses, and physicians, respectively, with specificities of 64% to 70%. The 2-step protocol had overall accuracy of 89% (CI, 83% to 93%) and 87% (CI, 81% to 91%), with sensitivities of 65% (CI, 48% to 79%) and 63% (CI, 46% to 77%) and specificities of 93% (CI, 88% to 96%) and 91% (CI, 86% to 95%), for nurses and physicians, respectively. Two-step protocol sensitivity for moderate to severe delirium was 78% (CI, 54% to 91%).
Two sites; limited diversity.
An app-directed protocol for delirium identification was feasible, brief, and accurate, and CNAs and nurses performed as well as hospitalists.
National Institute on Aging.
A daily management system (DMS) can be used to implement continuous quality improvement and advance employee engagement. It can empower staff to identify problems in the care environment that impact ...quality or workflow and to address them on a daily basis. Through DMS, improvement becomes the work of everyone, every day. The authors of this 2-part series describe their work to develop a DMS. Part 1 describes the background and organizing framework of the program.
Our city was significantly impacted by the initial COVID-19 outbreak in the United States. We describe how members of our Quality and Safety team were able to leverage skills in relational ...coordination and process improvement to respond to rapidly changing needs in a flexible and effective way.
A daily management system (DMS) can be used to implement continuous quality improvement and advance employee engagement. It can empower staff to identify problems in the care environment that impact ...quality or work flow and to address them on a daily basis. Through a DMS, improvement becomes the work of everyone, every day. The authors of this 2-part series describe their work to develop a DMS. Part 2 describes the implementation and outcomes of the program.
Our city was significantly impacted by the initial COVID-19 outbreak in the United States. We describe how members of our Quality and Safety team were able to leverage skills in relational ...coordination and process improvement to respond to rapidly changing needs in a flexible and effective way.
Beth Israel Deaconess Medical Center (BIDMC) has implemented a staff-led problem-solving process where staff members work together to identify and solve problems in the care environment. By involving ...staff, the solutions that are identified improve the effectiveness and efficiency with which care is provided, and the solutions are designed for easy adoption into current workflow. To support this work, BIDMC has identified key staff members, known as fellows, who are clinical nurses who receive training in change management theory. The fellows attend other units’ huddles to provide coaching in problem identification, problem statement determination, and innovative solution development. With the support of the fellows, most units have matured in their problem identification and problem-solving skills. There remains a small number of units that have not progressed in the implementation despite education, coaching, and support from the fellows. The purpose of this study was to examine if the staff’s collective cognitive styles were correlated with the units’ progression in implementing the staff-led problem-solving process. This was done by comparing the staff’s spread of scores on the Adaption-Innovation in the Workplace (AI-W) scale (Xu & Tuttle, 2012), with the unit’s score on the Unit Maturation Assessment Tool (UMAT), which was developed by the fellows to assess unit progress. This study also explored the effect of an educational intervention on Kirton's (2003) adaption-innovation theory and the unit’s subsequent scores on the UMAT. The findings in this study were, for the most part, consistent with what would be expected according to Kirton's (2003) adaption-innovation theory. Two of two advanced units showed an optimal spread of scores on the AI-W. One of two intermediate units showed a suboptimal spread of scores on the AI-W. In three of four units, UMAT scores increased following education about cognitive style. The study concluded that there are benefits to assessing the cognitive style of the group as a way to predict the ease with which units may adopt a staff-led problem-solving process. Education about cognitive style can help staff understand their own and others’ preferred problem-solving style, which may help promote the successful implementation of this work.
