Search

Objective To determine whether continuous virtual monitoring, an intervention that facilitates patient observation through video technology, can be used to monitor suicide risk in the general hospital and emergency department (ED). Method This was a retrospective analysis of a protocol in which select patients on suicide precautions in the general hospital and ED received virtual monitoring between June 2017 and March 2018. The primary outcome was the number of adverse events among patients who received virtual monitoring for suicide risk. Secondary outcomes were the percentage of patients for whom virtual monitoring was discontinued for behavioral reasons and the preference for observation type among nurses. Results 39 patients on suicide precautions received virtual monitoring. There were 0 adverse events (95% confidence interval (CI) = 0.000–0.090). Virtual monitoring was discontinued for behavioral reasons in 4/38 cases for which the reason for terminating was recorded (0.105, 95%CI = 0.029–0.248). We were unable to draw conclusions regarding preference for observation type among nurses due to a low response rate to our survey. Conclusions Suicide risk can feasibly be monitored virtually in the general hospital or ED when their providers carefully select patients for low impulsivity risk.

Delirium is a widespread complication of hospitalization and is frequently unrecognized by nurses and other healthcare professionals. Patients with neuroscience diagnoses are at increased risk for delirium as compared with other patients. The aims of this quality improvement project were to (1) increase neuroscience nurses' knowledge of delirium, (2) integrate coaching into evidence-based practice, and (3) evaluate the effectiveness of this combined approach to improve nurses' recognition of delirium on a neuroscience unit. Institutional review board approval was obtained. A retrospective chart review of randomly selected patients admitted before the intervention was completed. The (modified) Nurse's Knowledge of Delirium Tool was electronically administered to nursing staff (n = 47), followed within 2 weeks by a didactic presentation on delirium. Bedside coaching was performed over a period of 4 weeks. The (modified) Nurses Knowledge of Delirium Tool was electronically readministered to nurses 4 weeks later to determine the change in aggregate knowledge. A postintervention chart review was conducted. SPSS software was used to analyze descriptive statistics with regard to chart reviews, documentation, and change in questionnaire scores. Findings reveal that neuroscience nurses recognize the absence of delirium 94.4% of the time and the presence of delirium 100% of the time after a didactic session and coaching. The postintervention chart review showed a statistically significant increase (p = .000) in the documentation of delirium screening results. Expert coaching at the bedside may be a reliable method for teaching nurses to use evidence-based screening tools to detect delirium in patients with neuroscience diagnoses.

Background Falls and delirium in general-hospital inpatients are related to increases in morbidity, mortality, and healthcare costs. Patients fall despite safeguards and programs to reduce falling. Objective The authors sought to determine the prevalence of diagnosed and undiagnosed delirium in patients who fell during their hospital stay. Method The authors performed a retrospective electronic chart review of 252 patients who fell during their hospital stay. Falls were categorized by their severity (i.e., minor, moderate, and major). Demographic information, patient outcomes, and diagnostic criteria for delirium (per DSM–IV) were collected on the day of admission, the day of the fall, and the 2 days preceding the patient's fall. Results Falls in the general hospital were associated with delirium (both diagnosed and undiagnosed), advanced age, and specific surgical procedures. Conclusion Improving the recognition of undiagnosed delirium may lead to sustainable and successful fall prevention programs. Detection of impairments in mental status can assist staff to create individualized patient care plans. Knowledge about which patients are at risk for injury from delirium and falls can lead to improvements in patient safety, functioning, and quality of life.

Article-at-a-Glance Background In a population-based approach, a hospitalwide interprofessional care redesign at Brigham and Women's Hospital (BWH; Boston), was conducted to provide optimal evidence-informed care for patients at risk for delirium, alcohol abuse, and suicide harm (DASH). The initiative involved enhanced screening and the introduction of new care management guidelines and order sets pertaining to the DASH diagnoses. Methods An interprofessional group from medicine, nursing, and psychiatry jointly led a hospitalwide effort for the improvement of care and outcomes of patients presenting with a DASH diagnosis (delirium, alcohol withdrawal, and suicide harm). The care improvement process consisted of four phases: (1) development of guidelines, (2) implementation/rollout, (3) integration into practice, and (4) sustainability, including ongoing practice development and evaluation. Results Implementation outcomes were evaluated using eight parameters—acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. Internal billing data and ICD-9-CM [International Classification of Diseases, Ninth Revision, Clinical Modification] diagnostic codes were used to identify the DASH population. Patients were compared pre- and postprogram implementation for fiscal years 2010 through 2013. The average length of stay, reported as the number of midnights in the hospital, remained consistent for DASH patients—9.3–10.0 days (versus 5.3–6.0 days for BWH overall). The DASH readmission rate decreased by 9%—from 15.1% to 13.7%, approaching the overall BWH rate of 13.3%. Conclusion Close nurse-physician collaboration, including joint leadership and simultaneous rollout for nurses and physicians, contributed to the initiative's effective implementation.

Background Although alcohol use and abuse are common among general-hospital inpatients, many patients are inadequately assessed and treated for alcohol withdrawal. Objective The purpose of this study was to determine whether the implementation of a clinical pathway for the treatment of alcohol withdrawal in medical inpatients would result in improvements in clinical practice and patient outcomes. Method Authors retrospectively reviewed 80 patient records (including 40 of those treated before the implementation of a pathway and 40 of those treated after pathway implementation). Results Assessment procedures and ordering patterns of physicians (medical house staff and staff physicians) shifted in a fashion consistent with the new treatment guidelines. Patient outcomes (e.g., length of stay and the incidence of delirium) improved for those patients who received benzodiazepines within the range of the pathway guidelines. Conclusions Timely assessment and staff education can shift prescription patterns, increase patient monitoring, and reduce costs associated with alcohol withdrawal.