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AimsPatients are harmed or die every year because of unsafe, inappropriate or inadequate healthcare delivery. Registered Nurses are a recognized patient safety strategy. However, variability in research findings indicate the relationship is not as simple as "more nurses=better outcomes." Hence, currently there exists no evidence-based frontline nursing care model. One emerging model is the Clinical Nurse Leader care model.DesignThis Hybrid Type II Implementation-Effectiveness study will evaluate the effect of the care model on standardized quality and safety outcomes and identify implementation characteristics that are sufficient and necessary to achieve outcomes.MethodsThis study leverages a natural experiment in 66 clinical care units in nine hospitals across five states in the United States that have implemented the Clinical Nurse Leader care model.ResultsFindings will elucidate Registered Nurse's mechanisms of action as organized into frontline models of care and link actions to improved care quality and safety.

Context and implementation approaches can impede the spread of patient safety interventions. The objective of this article is to characterize factors associated with improved outcomes among 9 hospitals implementing a medication safety intervention. Nephrotoxic Injury Negated by Just-in-Time Action (NINJA) is a pharmacist-driven intervention that led to a sustained reduction in nephrotoxic medication-associated acute kidney injury (NTMx-AKI) at 1 hospital. Using qualitative comparative analysis, the team prospectively assessed the association between context and implementation factors and NTMx-AKI reduction during NINJA spread to 9 hospitals. Five hospitals reduced NTMx-AKI. These 5 had either (1) a pharmacist champion and >2 pharmacists working on NINJA (Scon 1.0, Scov 0.8) or (2) a nephrologist-implementing NINJA with minimal competing organizational priorities (Scon 1.0, Scov 0.2). Interviews identified ways NINJA team leaders obtained pharmacist support or successfully implemented without that support. In conclusion, these findings have implications for future spread of NINJA and suggest an approach to study spread of safety interventions more broadly. [ABSTRACT FROM AUTHOR]

Objectives: (1) To identify which United Nations Convention on the Rights of the Child (CRC) recommended child protection (CP) measures, such as policy, reporting systems, and services for child abuse and neglect (CAN) victims, individually or in combination, were most important in establishing a basic level of child protection in 42 countries; and (2) to assess whether these measures were necessary or sufficient to achieve basic child protection in developing and industrialized countries. Method: Child protection and/or rights expert respondents from 42 countries completed a questionnaire on CRC Article 19 (CRC19) required CP measures implementation and rated their country's effectiveness in implementation, the current level of effectiveness of child protection, and the relevance of improvements in child protection since the CRC was adopted in 1989. Information from the Committee on the Rights of the Child Concluding Observations, as well as UNICEF and WHO indicators on child health and protection issues were used to check and supplement responses. Qualitative comparative analysis (QCA) was used to identify child protection measure implementation effectiveness. Results: Results indicate that child protection judged as comparatively more successful among study countries is a result of having the following measures in place from two types of social programs: a CP infrastructure (legislation plus services) and at least one information-based intervention support program. Conclusions: Fourteen (33%) countries were determined to have established at least a basic CP system toward protection of children from violence and maltreatment. These countries reported having the three required elements described above. The study reinforces the need for governments to take a systems approach to child protection, including policy/legislation, information-based programs and social services, as well as professional training and public awareness raising. The top-ranked countries included: Australia, Bahrain, Belgium, Brazil, Canada, Estonia, Germany, Italy, Jordan, Lebanon, Malaysia, Republic of Korea, the Russian Federation, and the United Kingdom. Practice implications: Governments need to establish CP systems with multiple, well-integrated, effective CP measures as elaborated above, working with trained professionals and also raising public awareness to ensure successful protection for all children in every country. Partial measures are not effective. Further, in addition to establishing, implementing, and evaluating the effectiveness of professional interventions, the actual outcomes for children, not studied or reported on here, need to be the priority focus for child protection going forward. (Contains 2 tables and 1 figure.)

Purpose: In efforts to improve patient care, collaborative approaches to care have been highlighted. The teamlet model is one such approach, in which a primary care clinician works consistently with the same clinical staff member. The purpose of this study is to identify the characteristics of high-performing primary care teamlets, defined as teamlets with low rates of ambulatory care sensitive emergency department (ACSED) visits and ambulatory care sensitive hospital admissions (ACSAs)., Methods: Twenty-six individual qualitative interviews were performed with physicians and their teamlet staff member across 13 teamlets. Potentially important characteristics related to high-performing primary care teamlets were identified, calibrated, and analyzed using qualitative comparative analysis (QCA)., Results: Key characteristics identified by the QCA that were often present in teamlets with low rates of ACSED visits and, to a lesser extent, ACSAs were staff proactiveness in anticipating physician needs and physician-reported trust in their staff member., Conclusion: This study suggests that physician trust in their staff and proactiveness of staff in anticipating physician needs are important in promoting high-performing teamlets in primary care. Additional studies are indicated to further explore the relationship between these characteristics and high-performing teamlets, and to identify other characteristics that may be important., Competing Interests: Conflict of interest: None., (© Copyright by the American Board of Family Medicine.)