Risk Management

Study Finds Link Between HAIs and Nurse Understaffing

June 4, 2019

A unit-level nurse staffing study conducted by Columbia University School of Nursing found an association between nurse understaffing and healthcare-associated infections (HAIs) in patients, demonstrating that understaffing increases the risk of HAIs, which adds billions to healthcare costs annually. HAIs included in the analysis were urinary tract infections, bloodstream infections, and cases of pneumonia. The study, published recently in the Journal of Nursing Administration and titled “Nurse Staffing and Healthcare Associated Infection, Unit-level Analysis,” was conducted using cross-sectional data from a large urban hospital system.

According to the study, which examined data from more than 100,000 patients, 15 percent of patient-days had one shift understaffed with registered nurses (defined as registered nurse [RN] staffing below 80 percent of the unit median for a shift) and 6.2 percent had both day and night shifts RN understaffed. Patients on units with both shifts understaffed with RNs were 15 percent more likely to develop HAIs on or after the third day of exposure to these periods of understaffing than were patients in units with both day and night shifts adequately staffed. The study also found units were understaffed with nursing supporting staff, defined as licensed practical nurses and nurse assistants, and this also increased patients’ risk of HAIs.

“As they often serve as coordinators within multidisciplinary healthcare teams, nurses play a critical role in preventing HAIs, which is a top priority for improving quality of care and reducing hospital costs,” said lead author Jingjing Shang, PhD, associate professor at Columbia Nursing. “Being at the forefront of infection control and prevention is a unique responsibility and opportunity for nurses, and our study shows that hospital administrators should ensure adequate nurse staffing to provide the safest patient care. This could be achieved through better nurse recruitment and retention practices, together with methods of managing burnout and fatigue.”

According to the study’s authors, when a unit was understaffed, nurses in the unit experienced excessive workloads. Such working conditions may compromise infection prevention practices and surveillance activities intended to recognize the signs and symptoms of infection. In addition, continuous understaffing may negatively impact nurses’ wellbeing and patient care.

HAIs are serious but often preventable problems associated with high morbidity and mortality. Given the danger and prevalence of the condition, with approximately four percent of patients having one or more HAIs during their hospital stays, the U.S. government has taken steps to curbing the incidence of HAIs. For example, the Department of Health and Human Services has made eliminating HAIs a core feature of the department’s national health care improvement action plan. The Centers for Medicare & Medicaid Services also included HAIs in evaluating the performance of hospitals participating in its value-based purchasing programs.

In addition to Shang, the study’s other Columbia Nursing authors were: Jianfang Liu, PhD; Elaine Larson, PhD; and Patricia W. Stone, PhD. Funding for the study was provided by Health Information Technology to Reduce Healthcare-Associated Infections (HIT-HAIs) R01NR010822 by the National Institute of Nursing Research.

Source: Columbia University School of Nursing


Penn Study Links Nurse Work Environments and Patient Outcomes

March 26, 2019

Nurses play critical roles in patient safety and are often the last line of defense against medical errors and unsafe practices. Considerable research has explored the relationship between the nurse work environment and a variety of patient and nurse quality and safety outcomes. But until now, no synthesis of this body of research has been made to clearly articulate the association between nurse work environments and healthcare quality, safety and patient and clinician well-being. The nurse work environment refers to organizational elements that influence nursing care quality, such as nurse-physician collaboration, nurse manager support, and nurse involvement in decisions affecting clinical care.

A new meta-analysis from Penn Nursing's Center for Health Outcomes & Policy Research (CHOPR) has synthesized 16 years of studies to show the association between the nurse work environment and four sets of outcomes: nurse job outcomes, nurse assessments of quality and safety, patient health outcomes, and patient satisfaction. The article, "A Meta-Analysis of the Associations Between the Nurse Work Environment in Hospitals and 4 Sets of Outcomes," is set for publication in an upcoming issue of the journal Medical Care.

"Our quantitative synthesis of the results of many studies revealed that better work environments were associated with lower odds of negative outcomes ranging from patient and nurse job dissatisfaction to patient mortality," said lead-investigator Eileen T. Lake, PhD, MSN, FAAN, the Jessie M. Scott Endowed Term Chair in Nursing and Health Policy.

The researchers did a systematic review of studies from around the world that reported empirical research using the Practice Environment Scale of the Nursing Work Index. Those studies reported data from more than 2,600 hospitals, 165,000 nurses and 1.3 million patients about the practice environment, nurse job outcomes, safety and quality ratings, patient outcomes, and patient satisfaction.

"Our results support the unique status of the nurse work environment as a foundation for both patient and provider well-being that warrants the resources and attention of health care administrators," says Lake.

Co-authors of the article include University of Pennsylvania alumna Jordan Sanders, of the University of Vermont Medical Center; Rui Duan, MS, and Yong Chen, PhD, both of the Perelman School of Medicine, University of Pennsylvania; and Kathryn A. Riman, BSN, BSPH, RN, and Kathryn M. Schoenauer, both of CHOPR. The study was supported in part by NIH grants 1R01LM012607 and 1R01AI130460 and a research grant from Penn Nursing's Office of Nursing Research.

Source: Penn Nursing's Center for Health Outcomes & Policy Research


Diagnostic Errors and Test Results Top ECRI Institute's Patient Safety List

March 11, 2019

ECRI Institute names diagnostic errors and improper management of test results in electronic health records (EHRs) among the most serious patient safety challenges facing healthcare leaders in 2019. Released in conjunction with National Patient Safety Awareness week, ECRI’s Top 10 Patient Safety Concerns for 2019 raises the profile of safety issues that pose risks to patients and healthcare providers.

“Medical errors are the third leading cause of death in the country,” says Marcus Schabacker, MD, PhD, president and CEO of ECRI Institute. “This guidance can help healthcare leaders and clinicians save lives.”

Diagnostic errors and managing test results remain in the top spot two years in a row. While many healthcare providers rely on EHRs to help with clinical decision support and tracking test results, technology is just one tool in the diagnostic process, according to William Marella, executive director of operations and analytics, ECRI Institute PSO.

“We have to recognize the limits of current technology and ensure that we have processes in place to close the loop on diagnostic tests,” says Marella. “This safety issue cuts across acute and ambulatory settings, requiring teamwork across the health system.”

ECRI Institute’s 2019 list of concerns addresses systemic issues facing health systems, such as behavioral health concerns, clinician burnout, and skills development. Mobile health technology, number four on the list, opens up a world of opportunities by transporting healthcare to the home, but also presents potential risks.

The report also highlights ongoing clinical issues with infections from peripheral IV lines, sepsis, and antimicrobial stewardship. In the outpatient setting, at least 30 percent of antibiotic use is unnecessary.

ECRI’s list of patient safety concerns does not necessarily represent the issues that occur most frequently or are most severe. It identifies new risks, how existing concerns may be changing because of new technology or care delivery models, and persistent issues that need renewed attention or that might have additional solutions.

Topics are selected each year by a broad multi-disciplinary team of patient safety analysts, infection preventionists, and clinicians at ECRI Institute. They identify safety concerns based on member inquiries, root cause analyses, and adverse events submitted to ECRI’s Patient Safety Organization (PSO). ECRI Institute PSO has received more than 2.7 million event reports and reviewed hundreds of root-cause analyses since 2009.

Source: ECRI Institute

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