65 & Thrive: Improving Patient Length of Stay, Readmission, and Quality of Care by Becoming an Age-Friendly Hospital

Data indicates that older persons will increase in numbers along with having an increase of life expectancy in the United States. Kaiser Permanente Los Angeles Medical Center’s Utilization Department developed “65 & Thrive”—an age-specialized initiative to provide holistic care that preserves independence, quality of life, prevents functional and cognitive decline, and promotes both patients and their families to continue thriving. The initiative’s focus is guided by the 5 M’s model on mobility, medication, mentation, multi-morbidity, and what matters. Case management staff were given age-sensitivity trainings, improved workflows and made assessments that identified, addressed, and secured resources for patients throughout their hospitalization. Silver Angel volunteers were specially trained to prevent physical and mental decline and focused on activities to prevent delirium, depression and falls. The volunteers visited with patients daily for these interactions. The initiative was piloted in April 2020 on a stroke telemetry unit and since then the hospital has seen a significant decrease in the overall annual readmission rates by 3.1% when compared to 2019. The average length of stay for older adult patients; however, increased from 4.05 to 4.83 days unfortunately due to COVID-19. This initiative demonstrates the necessity to expand “65 & Thrive” throughout the hospital and ultimately to other Kaiser Permanente medical centers to best provide holistic care to older adults.

Chlorhexidine Gluconate Bathing Program to Reduce Health Care–Associated Infections in Both Critically Ill and Non–Critically Ill Patients

Background Critical care nurses take care of patients with complicated, comorbid, and compromised conditions. These patients are at risk for health care–associated infections, which affect patients’ lives and health care systems in various ways. Objective To gauge the impact of routinely bathing patients with 4% chlorhexidine gluconate solution on the incidence of health care–associated infections in a medical-surgical intensive care unit and a postoperative telemetry unit; to outline the framework for a hospital-wide presurgical chlorhexidine gluconate bathing program and share the results. Methods A standard bathing protocol using a 4% chlorhexidine gluconate solution was developed. The protocol included time studies, training, monitoring, and surveillance of health care–associated infections. Results Consistent patient bathing with 4% chlorhexidine gluconate was associated with a 52% reduction in health care–associated infections in a medical-surgical intensive care unit. The same program in a postoperative telemetry unit yielded a 45% reduction in health care–associated infections. Conclusion A comprehensive daily 4% chlorhexidine gluconate bathing program can be implemented with standardized protocols and detailed instructions and can significantly reduce the incidence of health care–associated infections in intensive care unit and non–intensive care unit hospital settings.

Sensor-integrated tap holder for process uncertainty detection based on tool vibration and axial length compensation sensors

The tapping process is one of the most widespread manufacturing processes for internal threads, usually carried out at the end of the value chain. Any non-compliance with required quality standards or even the destruction of the thread due to process uncertainty in the tapping process is therefore subjected to high rework costs. Possible process uncertainties in the tapping process can be triggered by synchronization errors between feed rate and spindle speed, axis offset, faulty core holes and wear of the tapping tool. In order to detect process uncertainties during tapping and thus provide a basis for initiating countermeasures, a sensor-integrated tap holder was developed. This paper presents the realized concept of a rotating telemetry unit for signal processing, data acquisition and wireless data transmitting via WiFi standard on basis of low-cost embedded systems. Furthermore, two unique sensor concepts for measuring close-to-tool vibrations and the axial length compensation of the tapping tool are shown. Based on the sensor data in combination with feature engineering methods, process uncertainty during tapping are detected.

Reduction of Inpatient Fall Rate in an Adult Acute Care Setting

Practice Problem: Falls are among the most reported hospital-acquired conditions and can lead to severe injuries, increased length of hospital stays, pain, distress, and emotional trauma in the elderly. The Centers for Medicare and Medicaid Services (CMS) identifies falls as preventable and no longer authorizes reimbursement to healthcare systems for treating inpatient fall-related injuries. PICOT: The PICOT question that guided this project was: In adult, acute care patients admitted to the telemetry unit (P), how does implementing evidence-based multimodal fall prevention strategies (I) compared to routine fall prevention strategies (C) affect inpatient fall rate (O) over a period of 6-8 weeks (T)? Evidence: The literature review revealed that using multimodal risk prevention strategies effectively reduces fall risk and fall-related injuries and thus improves patient safety and outcomes. Intervention: A multimodal fall prevention strategy was developed, according to the Morse Fall Risk Assessment score, utilizing tools such as bed alarm on, lights on, a urinal within reach, purposeful hourly rounding, and bedside reporting during shift change. The oncoming shift nurse checked with the off-going shift nurse at the patient’s bedside to ensure that the fall risk patients’ fall precaution strategies had been initiated and maintained throughout the shift. Outcome: The EBP project did not result in an overall reduction in the fall rates; however, the fall rate with injury was low in the telemetry unit. The project resulted in an increase in the staff’s knowledge and awareness of multimodal fall prevention strategies. Conclusion: The reduction in the incidence of falls after the implementation of the EBP project in the telemetry unit was not statistically significant. However, the result indicated a clinically meaningful improvement in fall-related injury outcomes and increased staff knowledge and awareness of the fall prevention strategies.

Reduction of Inpatient Fall Rate in an Adult Acute Care Setting

Practice Problem: Falls are among the most reported hospital-acquired conditions and can lead to severe injuries, increased length of hospital stays, pain, distress, and emotional trauma in the elderly. The Centers for Medicare and Medicaid Services (CMS) identifies falls as preventable and no longer authorizes reimbursement to healthcare systems for treating inpatient fall-related injuries. PICOT: The PICOT question that guided this project was: In adult, acute care patients admitted to the telemetry unit (P), how does implementing evidence-based multimodal fall prevention strategies (I) compared to routine fall prevention strategies (C) affect inpatient fall rate (O) over a period of 6-8 weeks (T)? Evidence: The literature review revealed that using multimodal risk prevention strategies effectively reduces fall risk and fall-related injuries and thus improves patient safety and outcomes. Intervention: A multimodal fall prevention strategy was developed, according to the Morse Fall Risk Assessment score, utilizing tools such as bed alarm on, lights on, a urinal within reach, purposeful hourly rounding, and bedside reporting during shift change. The oncoming shift nurse checked with the off-going shift nurse at the patient’s bedside to ensure that the fall risk patients’ fall precaution strategies had been initiated and maintained throughout the shift. Outcome: The EBP project did not result in an overall reduction in the fall rates; however, the fall rate with injury was low in the telemetry unit. The project resulted in an increase in the staff’s knowledge and awareness of multimodal fall prevention strategies. Conclusion: The reduction in the incidence of falls after the implementation of the EBP project in the telemetry unit was not statistically significant. However, the result indicated a clinically meaningful improvement in fall-related injury outcomes and increased staff knowledge and awareness of the fall prevention strategies.

Comparison of novel wearable cardiac monitors to yield accurate exercising ECG and heart rate data in horses

Exercise associated deaths (EADs) in horses are a problem for the equestrian industry. Sudden death (SD) is responsible for approximately 20% of EADs. The underlying cause of SD is suspected to be cardiovascular disease but often cannot be determined post-mortem. User-friendly cardiac monitors are needed for large scale investigations of arrhythmias associated with SD in horses. We hypothesised that novel wearable devices would provide exercising electrocardiograms (ECGs) of sufficient diagnostic quality for this purpose. Diagnostic quality of ECGs generated by two wearable devices (W2nd™ and Polar Equine™) were compared to simultaneous recordings with a telemetry unit (Televet™) in 5 Thoroughbreds completing 43 separate submaximal exercise tests on a high-speed treadmill. Maximal heart rate (HRmax) generated by mobile applications (HRmaxapp), HRmax after manual correction (HRmaxcorr), percentage of diagnostic ECGs (%diag) at the gallop, and overall quality assessed by visual analogue scale (VAS) were assessed by a blinded observer. HRmaxcorr did not differ significantly between groups. HRmaxapp was significantly lower for W2nd (166.8/min, 95% confidence interval (CI): 160.5-173.1/min) but did not differ significantly between Televet (178.8/min 95% CI: 165.8-191.1/min) and Polar (181.3/min, 95% CI: 174.5-188.1/min). HRmaxcorr was accurate and precise in all runs. HRmaxapp was within a priori limits of agreement in 16/23 W2nd and 18/19 Polar recordings. %diag was significantly lower (77.1%, 95% CI: 67.4-86.8) for W2nd than Polar (100%, 95% CI: 89.9-110.3). VAS was lower for W2nd (46.2, 95% CI: 35.5-57.0) than Polar (90.6, 25% CI: 79.4-101.9). In conclusion, wearable devices appear to be promising tools for investigation of equine exercising arrhythmias in large-scale studies.

Are Registered Nurses Working in an Acute Care Environment Facing Burnout during the Covid-19 Pandemic?

Burnout has been an important and frequently discussed topic in nursing research even prior to the COVID-19 pandemic. Most notably, burnout has previously been identified as one of the major stressors that Registered Nurses have left the acute care field, and now, the COVID-19 pandemic is adding to the already stressful typical workday of an acute care registered nurse. A pilot study was completed on a COVID telemetry unit at a suburban hospital.

Preoperative Chlorhexidine Gluconate Bathing on a Military Medical-Surgical Unit

ABSTRACT INTRODUCTION AND SCOPE OF THE PROBLEM Surgical site infections (SSIs) are associated with increased length of hospital stays, poor patient outcomes, and increased health care costs making prevention of SSI a high priority for the U.S. Military Health Care System. The focus of this project was to develop and pilot a preoperative antiseptic bathing regimen on an inpatient medical-surgical telemetry unit using 4% chlorhexidine gluconate (CHG), and to compare SSI rates with this new protocol to previous SSI rates on the unit. MATERIALS AND METHODS A literature review guided the development of the protocol and clinical question. A unit project was conducted using SSI rates from an inpatient military medical-surgical telemetry unit over 4 yr. From 2014 to 2016, 3 yr before implementing the protocol, a non-standardized CHG scrub was compared to 12 mo after implementing the standardized 4% CHG protocol in 2017 using up to four daily washings (three evenings and one morning surgery) on inpatient admissions to the unit. SSI rates were compared. RESULTS After implementing a 4-d preoperative bathing regimen with 4% CHG for patients scheduled for surgery, SSI rates decreased from an average rate of 0.0072 infections (7.2 infections per 1,000 surgeries) to 0.0035 infections (3.5 infections per 1,000 surgeries) in the subsequent year of data collection. Although not a statistically significant change, further analysis using a Bayesian Poisson regression model found an 84% probability the new protocol would lower SSI rate by 1 or more cases per 1,000 surgeries on this inpatient unit. CONCLUSION The findings suggest the proposed approach to control infection that may reduce the number of SSIs on a military medical-surgical unit, but this needs to be demonstrated through further longitudinal research on military surgical units.