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Predicting Falls Among Community-Dwelling Older Adults: A Demonstration of Applied Machine Learning

imageData science skills are increasingly needed by informatics nurses and nurse scientists, but techniques such as machine learning can be daunting for those with clinical, rather than computer science or technical, backgrounds. With the increasing quantity of publicly available population-level datasets, identification of factors that predict clinical outcomes is possible using machine learning algorithms. This study demonstrates how to apply a machine learning approach to nursing-relevant questions, specifically an approach to predict falls among community-dwelling older adults, based on data from the 2014 Behavioral Risk Factor Surveillance System. A random forest algorithm, a common approach to machine learning, was compared to a logistic regression model. Explanations of how to interpret the models and their associated performance characteristics are included to serve as a tutorial to readers. Machine learning methods constitute an increasingly important approach for nursing as population-level data are increasingly being made available to the public.

Using Mobile Technologies Among Undergraduate Nursing Students for Academic Purposes in Tertiary Education: A Quantitative Survey

imageMobile devices are increasingly part of daily life, with the benefits of using the technology in nursing education widely recognized. This study explored the use of mobile devices among undergraduate nursing students for academic purposes in South Africa, using a quantitative survey. The majority of participants owned smartphones (87.6%), followed by laptops (76%) and tablets (47.1%). Mobile devices were used to perform academic tasks and communicate and collaborate with peers and teachers, as well as search and access electronic resources. Few of the first year nursing students owned laptops and tablets and used them less frequently than the students from other levels of the study. Equipping nursing students with mobile devices, such as laptops and tablets, particularly first year students, and ensuring that they have adequate skills to use them, is essential to training future nurses who are expected to work in a technology-mediated health environment.

An Analysis of the Application of the Harmony Search Algorithm to Solving the Nurse Rostering Problem

imageThe nurse rostering problem describes the task of distributing nurses over working time slots, called shifts, in such a way that the workforce demand for each shift in a scheduling period is met, while ensuring that each nurse is not overttasked or undertasked. This problem is a major issue in Ghana, which this research aims to tackle. To that end, the performance of a heuristic algorithm that showed promise, called the Harmony Search algorithm, is examined. The algorithm, as applied to solving the nurse rostering problem in a hospital in Ghana, was implemented and evaluated with the Python programming language. The results suggest that the algorithm performs well in generating 1-week duty rosters but falters for extended periods, indicating that it may not on its own be potent enough to handle optimization problems. Finally, we outline some recommendations future researchers may want to note.

Interdisciplinary Optimization of Admission Documentation: Reducing the Bloat

imageMoving toward the electronic health record increases the quality of information gathered. However, nurses argue that the electronic health record is an added burden. The aim of this study was to evaluate the removal of duplicative or unnecessary fields and reordering fields on the admission form to increase documentation that is meaningful to the patient story. A team of approximately 60 interdisciplinary clinicians engaged in document review to evaluate the importance of each field and removal or modification based on those findings. After a review of the 251 fields, the authors reduced the form to 124 fields, and the percentage of unfields by 31%. After outlier removal, the average time to complete the admission form decreased by 2.88 minutes. The new form showed a reduction of 36.71% of the use of the free text advance directive. Additionally, nurses' perceptions of the form significantly improved from pretest to posttest in terms of satisfaction with the form, time to complete, usability and usefulness, question flow, and length of the form. This study shows that an interdisciplinary team can effectively work together to optimize the Adult Admission History Form, increasing the quality of documentation while reducing the time to complete.

Structure, processes, and initial outcomes of The Ottawa Hospital Multi‐Specialist Limb‐Preservation Clinic and Programme: A unique‐in‐Canada quality improvement initiative

Abstract

In 2017, The Ottawa Hospital initiated a unique-in-Canada quality improvement initiative by opening a novel, multi-specialist limb-preservation clinic. We sought to describe the structure, processes, and initial outcomes of the clinic and evaluate whether it is achieving its mandate of providing high-quality wound clinical care, education, and research. We conducted a descriptive prospective cohort study alongside a nested study of 162 clinic patients requiring serial assessments. There have been 1623 visits, mostly (72.2%) from outpatients. During 17.8% of visits, patients were evaluated by >1 specialist. Therapies provided most often included negative-pressure wound therapy (32.7%), biological wound dressings (21.6%), and total contact casting (18.5%). Furthermore, 1.2% underwent toe/ray amputations or skin grafting in clinic and 22.8% were initiated on antimicrobials. Mixed-effects models suggested that mean wound volumes for those requiring serial assessments decreased by 1.6 (95% confidence interval = −0.86 to −2.27) cm3 between visits. The clinic provided seven rotations to vascular surgery, infectious diseases, dermatology, and palliative care physicians; three nursing preceptorships; and two educational workshops. It also initiated provincial and national vascular health and wound care research initiatives. This study may be used to guide development of other limb-preservation clinics and programmes. Findings support that our programme is achieving its mandate.

Lymphedema rehabilitation: Provision and practice patterns among service providers: National survey

Abstract

Information on the current practices and quantification of lymphedema service may be beneficial to promote and improve the current health care system. Therefore, this study aimed to describe the characteristics of lymphedema practitioners, and lymphedema patients' profiles, and provide a comprehensive picture of lymphedema service provision in Saudi Arabia. A cross-sectional study design used an online survey to gather data. The survey included information about demographic and professional characteristics of lymphedema practitioners, lymphedema profiles, questions on the services provided, and perceived barriers in providing services. Eighteen lymphedema practitioners (38%) responded to the survey. Most of the respondents were physical therapists (94%), who had completed 135 hours of basic training course, and were certified as lymphedema therapists (89%). Most of these practitioners were in Riyadh (58%), Jeddah (25%), and Dammam (17%). About 75% of patients seen by practitioners had secondary lymphedema, predominately breast cancer-related lymphedema (47%). The average number of lymphedema practitioners per service is three. The perceived barriers reported included an inadequate number of certified therapists (100%), difficulties with transportation and lack of financial support (each; 72%), and limited space for lymphedema practice/management (89%). The results suggest lymphedema practitioners provide reasonable services for lymphedema patients; however, services are still limited and needs are unmet. Therefore, more staffing is required to promote awareness of the condition and related services, to develop and implement appropriate educational strategies, and improve geographical and multidisciplinary coordination of the services in Saudi Arabia.

Nurses and Midwives as Global Partners to Achieve the Sustainable Development Goals in the Anthropocene

Abstract

Purpose

To highlight ongoing and emergent roles of nurses and midwives in advancing the United Nations 17 Sustainable Development Goals by 2030 at the intersection of social and economic inequity, the climate crisis, interprofessional partnership building, and the rising status and visibility of the professions worldwide.

Design

Discussion paper.

Methods

Literature review.

Findings

Realizing the Sustainable Development Goals will require all nurses and midwives to leverage their roles and responsibility as advocates, leaders, clinicians, scholars, and full partners with multidisciplinary actors and sectors across health systems.

Conclusions

Making measurable progress toward the Sustainable Development Goals is critical to human survival, as well as the survival of the planet. Nurses and midwives play an integral part of this agenda at local and global levels.

Clinical Relevance

Nurses and midwives can integrate the targets of the Sustainable Development Goals into their everyday clinical work in various contexts and settings. With increased attention to social justice, environmental health, and partnership building, they can achieve exemplary clinical outcomes directly while contributing to the United Nations 2030 Agenda on a global scale and raising the profile of their professions.

Nursing and the Sustainable Development Goals: A Scoping Review

Abstract

Purpose

In 2015, all member states that comprise the United Nations unanimously adopted the Sustainable Development Goals (SDGs), a set of ambitious and inclusive targets toward global economic, social, and environmental betterment. Nurses have a key role to play in the achievement of the SDGs. The aim of this article was to conduct a scoping review to synthesize the literature related to nursing and the SDGs.

Methods

This scoping review utilized Arksey and O’Malley’s five-stage framework. Several electronic databases were searched for literature published from 2015 to 2020 using the key words “nurse OR nurses OR nursing” and “Sustainable Development Goals OR SDGs”.

Findings

A total of 447 articles were identified through the databases searches, of which 35 articles were deemed relevant and included for final review and content analysis. Analysis of relevant literature on nursing and the SDGs revealed two distinct, yet connected, perspectives: the nurse and the profession.

Conclusions

Individual nurses may feel disconnected from the SDGs and struggle to relate the goals to their clinical role, calling for an increase in awareness and education on the goals. The wider profession could also increase both research and policy with relation to the SDGs, strengthening nursing’s position to have a voice in and contribute towards achievement of the goals.

Clinical Relevance

Individual nurses and the wider nursing profession have opportunities to more meaningfully contribute to the SDGs, beginning with an increased awareness through education and a commitment to research and participation in local and global decision making.

The Association Between Quality and Safety Climate of a Hospital Ward, Family Members’ Empowerment, and Satisfaction With Provided Care

Abstract

Purpose

This study was designed to examine the perceptions of ward quality and safety held by family members and nurses, and investigate its impact on family members' empowerment, and satisfaction with patient hospitalization.

Design

A cross-sectional study on two study groups was conducted at a large public hospital in Israel. The first group comprised 86 family members of patients hospitalized for more than 72 hours in acute critical condition in intensive care units (ICU) or general wards (GW). The second group included 101 registered nurses who treated the patients in the ICU or GW.

Methods

Data were collected by a validated self-administered structured questionnaire. All participants voluntarily signed an informed consent and answered questions related to their demographic characteristics, perceptions, and attitudes toward quality and safety climate, empowerment, and satisfaction with the patients' hospitalization. Pearson correlations coefficient, t-test for independent samples, and a multiple regression model were performed to analyze the data.

Findings

The mean age of family members was 51.4 ± 14.1 years and of nurses was 40.9 ± 9.9 years. A significant positive association was found between ward quality and safety climate and empowerment of the family member (r = .716; p < .001); empowerment of the family member and family members' satisfaction with the patients' hospitalization (r = .695; p < .001); and ward safety and quality climate and family members' satisfaction with the patients' hospitalization (r = .763; p <.001). Family members ranked ward quality and safety climate (M = 4.20 ± 0.60 vs. M = 3.61 ± 0.40), and their satisfaction with the patients' hospitalization (M = 4.49 ± 0.69 vs. M = 4.07± 0.54), which were significantly (p < .001) higher than the nurses’ estimate. The significant predictors for family members’ satisfaction with patients' hospitalization were commitment to quality leadership (b = .210; p = .027); implementing a quality improvement (b = .547; p < .001); and hand-off communication (b = .299; p = .001).

Conclusions

Positive relationships between quality and safety climate, empowerment, and satisfaction with patients' hospitalization suggest that by improving the ward quality and safety climate, and family empowerment, we may also improve family satisfaction. Although family members reported being satisfied with hospitalization in the ICU and GW, quality leadership and implementing a quality improvement among the nurses and hand-off communication between nurses and patients' families, will be targeted to improve family satisfaction with the patients’ hospitalization.

Clinical Relevance

Nurses who provide care for patients in a critical condition should maintain high levels of safety and quality care in order to improve the patients’ family empowerment and satisfaction. Specifically, their efforts should target a commitment to quality leadership, implementing quality improvement, and hand-off communication.

Nurse Practitioners’ Implementation of Evidence‐Based Practice Into Routine Care: A Scoping Review

Abstract

Background

Implementation of evidence-based practice (EBP) is essential for ensuring high-quality health care at minimum cost. Although all nurses have a responsibility to implement EBP at an individual patient level, nurse practitioners (NPs) as clinical leaders have additional responsibilities in leading and collaborating with transdisciplinary teams to implement EBP across patient groups and embed practice change into routine care.

Aim

To explore the factors affecting the implementation of EBP into routine care by NPs. Specifically, to examine NP beliefs, levels of EBP implementation, and barriers and enablers to EBP implementation into routine care.

Methods

A scoping review was conducted using the Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) framework. The electronic databases CINAHL, Medline, and PsycINFO were searched for studies published between 2009 and 2018 along with gray literature and reference lists of included articles. Abstracts and studies were screened using predefined eligibility criteria. Data extraction was undertaken using a standardized framework and data synthesis completed.

Results

Seven studies were included in the review. Findings indicated NPs valued EBP and believed it to be important in standardizing patient care. NPs’ implementation of EBP was found to be relatively low overall. It was not possible to fully determine the extent to which NPs implemented EBP into routine care. NPs experienced similar barriers to EBP implementation as do nurse generalists such as lack of time, lack of EBP competence, lack of support from colleagues and managers, and inadequate resources. In particular, NPs identified collaborative practice issues as factors affecting EBP implementation. Identified barriers included physician-driven practice and the need to maintain professional and political boundaries. Supportive collaborative relationships and having professional confidence were identified facilitators.

Linking Evidence to Action

An exploration of NPs’ experience of interprofessional collaboration when implementing EBP into routine care is needed to identify requirements for support in this area.

Skin substitutes with noncultured autologous skin cell suspension heal porcine full‐thickness wounds in a one‐stage procedure

Abstract

Clinical application of skin substitute is typically a two-stage procedure with application of skin substitute matrix to the wound followed by engraftment of a split-thickness skin graft (STSG). This two-stage procedure requires multiple interventions, increasing the time until the wound is epithelialised. In this study, the feasibility of a one-stage procedure by combining bioengineered collagen-chondroitin-6-sulfate (DS1) or decellularised fetal bovine skin substitute (DS2) with autologous skin cell suspension (ASCS) in a porcine full-thickness wound healing model was evaluated. Twelve full-thickness excisional wounds on the backs of pigs received one of six different treatments: empty; ASCS; DS1 with or without ASCS; DS2 with or without ASCS. The ASCS was prepared using a point-of-care device and was seeded onto the bottom side of DS1, DS2, and empty wounds at 80 000 cells/cm2. Wound measurements and photographs were taken on days 0, 9, 14, 21, 28, 35, and 42 post-wounding. Histological analysis was performed on samples obtained on days 9, 14, 28, and 42. Wounds in the empty group or with ASCS alone showed increased wound contraction, fibrosis, and myofibroblast density compared with other treatment groups. The addition of ASCS to DS1 or DS2 resulted in a marked increase in re-epithelialisation of wounds at 14 days, from 15 ± 11% to 71 ± 20% (DS1 vs DS1 + ASCS) or 28 ± 14% to 77 ± 26 (DS2 vs DS2 + ASCS) despite different mechanisms of tissue regeneration employed by the DS used. These results suggest that this approach may be a viable one-stage treatment in clinical practice.

A nomogram prediction model for sternal incision problems

Abstract

Presently, the incidence and mortality rates of sternal incision problems (SIPs) after thoracotomy remain high, and no effective preventive measures are available. The data on 23 182 patients at Xinqiao Hospital, Army Medical University treated with median sternotomy from 1 August 2009 to 31 July 2019 were retrospectively reviewed. A prediction model of SIPs after median thoracotomy was established using R software and then validated using the bootstrap method. Next, the validity and accuracy of the model were tested and evaluated. In total, 15 426 cases met the requirements of the present study, among which 309 cases were diagnosed with SIPs, with an incidence rate of 2%. The body mass index (BMI), intensive care unit (ICU) time, diabetes mellitus, and revision for bleeding were identified as independent risk factors for postoperative SIPs. The nomogram model achieved good discrimination (73.9%) and accuracy (70.2%) in predicting the risk of SIPs after median thoracotomy. Receiver operating characteristic curve analysis showed that the area under curve of the model was 0.705 (95% confidence interval [CI]: 0.746-0.803); the Hosmer-Lemeshow test showed that χ 2 = 6.987 and P = 0.538, and the fitting degree of the calibration curve was good. Additionally, the clinical decision curve showed that the net benefit of the model was greater than 0, and the clinical application value was high. The nomogram based on BMI, ICU time, diabetes mellitus, and revision for bleeding can predict the individualised risk of SIPs after median sternotomy, showing good discrimination and accuracy, and has high clinical application value. It also provides significant guidance for screening high-risk populations and developing intervention strategies.

Core Evidence‐Based Practice Competencies and Learning Outcomes for European Nurses: Consensus Statements

Abstract

Background

Consensus on evidence-based practice (EBP) competencies and associated learning outcomes for registered nurses has not yet been achieved in the European context.

Aims

To establish a set of core EBP competencies for nurses and the most important EBP learning outcomes encompassing attitudes, knowledge, and skills dimensions for implementation into nursing education in European countries.

Methods

A multi-phase modified Delphi survey was conducted: Phase 1, a literature review; Phase 2, a two-round consensus of experts; and Phase 3, a Delphi survey. Experts from six European countries participated.

Results

In Phase 1, 88 records were selected and 835 statements extracted, which were grouped according to the seven steps of EBP. After removing 157 duplicates, the remaining competencies (n = 678) were evaluated in Phase 2. Then, a two-round expert consensus was reached, with 24 competencies and 120 learning outcomes identified and divided into affective, cognitive, and skills domains. In Phase 3, based on a Delphi survey expert consensus, all evaluated statements were included in a final set of competencies and learning outcomes. Only two learning outcomes were recommended for allocation to a different domain, and four were reformulated as suggested, with no further changes to the others.

Linking Evidence to Action

The set of EBP competencies and learning outcomes can guide nurse educators, managers, and EBP stakeholders in the development of content that incorporates EBP knowledge, skills, and attitudes into educational programs. Prioritizing the EBP competencies and learning outcomes that are most necessary and adapting them to every context will provide healthcare organizations with guidelines for enhancing the continuing education of nurses. These results could facilitate the development of effective tools for assessing nursing students’ and nurses’ perception of competencies required for EBP processes.

Using the Theoretical Domains Framework to Identify Barriers and Facilitators to Elder‐Friendly Care Implementation Within a Multi‐Site Academic Health Centre

Abstract

Background

Societal demographic shifts are occurring globally. Within Quebec, Canada, the percentage of adults over 65 (older adults) is predicted to increase from 19.3% to >25.9% by the year 2036. Older adults (OAs) experience hospitalizations more frequently than persons aged 15–64 years old, and hospitalizations for OAs can be detrimental due to naturally occurring physiological changes. To address the needs of this population, the Quebec government mandated that all acute care hospitals implement OA-friendly care standards called AAPA (“l’Approche Adaptée à la Personne Âgée”).

Aims

To describe an approach for identifying barriers and facilitators (BFs) to AAPA implementation at the McGill University Health Centre, an academic healthcare centre in Montreal that provides tertiary and quaternary care.

Methods

Our approach included an organizational quality improvement (QI) model based on the Institute for Healthcare Improvement QI approach and the use of the Theoretical Domains Framework (TDF) to guide the assessment of BFs to AAPA implementation. To identify the BFs of AAPA implementation, themes were generated from the raw data.

Results

In total, 32 barriers and 88 facilitators were identified. Each BF was linked to one or more corresponding domain from the TDF. Seven of the most frequently occurring domains were: (1) knowledge, (2) beliefs about consequences, (3) social/professional role and identity, (4) social influences, (5) environmental context and resources, (6) intentions, and (7) goals.

Linking Evidence to Action

A theory-informed approach, such as the TDF, can be used to facilitate the implementation of evidence-based guidelines.

The Effectiveness of the Transitional Care Program Among People Awaiting Coronary Artery Bypass Graft Surgery: A Randomized Control Trial

Abstract

Purpose

This study examined the effectiveness of the Transitional Care Program (TCP) on the anxiety, depression, cardiac self-efficacy, number of hospitalizations, and satisfaction with care among people awaiting elective coronary artery bypass graft (CABG) surgery.

Design

The study design was a randomized controlled trial.

Methods

The participants with coronary artery disease who met the study criteria (n = 104) were randomly assigned to the intervention group (n = 52) receiving the TCP plus routine care, or the control group (n = 52) receiving routine care only. The TCP, developed based on the Transitional Care Model, comprised hospital discharge planning and six weekly home telephone follow-ups to provide health education, counseling, monitoring, and emotional support tailored to the individual’s needs. Data were collected at baseline, and then at weeks 1, 6, and 8 after program enrollment. Data were analyzed using descriptive statistics, repeated-measures analysis of variance, and the Z test.

Findings

The intervention group had lower anxiety and depression than did the control group at weeks 1, 6, and 8 after program enrollment. At weeks 6 and 8, the intervention group exhibited higher cardiac self-efficacy and satisfaction with care than the control group. Further, the intervention group had a significantly lower number of hospitalizations than the control group at week 8.

Conclusions

The TCP can reduce anxiety, depression, and number of hospitalizations, while increasing cardiac self-efficacy and satisfaction with care among people awaiting CABG.

Clinical Relevance

Nurses are in a pivotal position to make care transitions safer. Provision of discharge education and regular telephone contacts could enhance positive outcomes regarding patients awaiting elective cardiac surgery.

SfM‐3DULC: Reliability of a new 3D wound measurement procedure and its accuracy in projected area

Abstract

Three-dimensional (3D) wound measurement lacks a gold standard to test accuracy. It is useful to develop procedures to scan wounds and reconstruct their 3D model with low-cost techniques. We present a new procedure (Structure from Motion [SfM]-3DULC) that uses photographs for measuring nine wound variables. We also propose a new variant of ImageJ in which an orthophoto is used to measure the projected area (Ortho-ImageJ). In addition, we compare the wound measurements made by dermatologists and non-experts. A group of five experts in dermatology and five non-specialists measured 33 leg wounds five times per procedure. Intra-rater and inter-rater reliability scores of SfM-3DULC were evaluated with the intraclass correlation coefficient (ICC 2,1). The accuracy of the two new procedures (SfM-3DULC and Ortho-ImageJ) in the measurement of projected area was assessed by comparing their values with those obtained using ImageJ, with the Wilcoxon matched-pairs signed rank test (α = 0.05). This test was also used to analyse the differences between the measurements made by dermatologists and non-experts. All the variables measured by dermatologists using SfM-3DULC showed excellent scores of intra-rater reliability (ICC > 0.99) and inter-rater reliability (ICC > 0.98). No significant differences between the three procedures were found when comparing their projected area values. Significant differences between the measurements of dermatologists and non-experts were found in most of the variables: circularity coefficient, perimeter, projected area, surface area, and reference surface area. The wound measurement procedure SfM-3DULC has an excellent reliability, is accurate for the measurement of projected area, and can be used by dermatologists for wound monitoring in everyday clinical practice.

Understanding Women’s Cardiovascular Health Using MyStrengths+MyHealth: A Patient‐Generated Data Visualization Study of Strengths, Challenges, and Needs Differences

Abstract

Purpose

The purpose of this data visualization study was to identify patterns in patient-generated health data (PGHD) of women with and without Circulation signs or symptoms. Specific aims were to (a) visualize and interpret relationships among strengths, challenges, and needs of women with and without Circulation signs or symptoms; (b) generate hypotheses based on these patterns; and (c) test hypotheses generated in Aim 2.

Design

The design of this visualization study was retrospective, observational, case controlled, and exploratory.

Methods

We used existing de-identified PGHD from a mobile health application, MyStrengths+MyHealth (N = 383). From the data, women identified with Circulation signs or symptoms (n = 80) were matched to an equal number of women without Circulation signs or symptoms. Data were analyzed using data visualization techniques and descriptive and inferential statistics.

Findings

Based on the patterns, we generated nine hypotheses, of which four were supported. Visualization and interpretation of relationships revealed that women without Circulation signs or symptoms compared to women with Circulation signs or symptoms had more strengths, challenges, and needs—specifically, strengths in connecting; challenges in emotions, vision, and health care; and needs related to info and guidance.

Conclusions

This study suggests that visualization of whole-person health including strengths, challenges, and needs enabled detection and testing of new health patterns. Some findings were unexpected, and perspectives of the patient would not have been detected without PGHD, which should be valued and sought. Such data may support improved clinical interactions as well as policies for standardization of PGHD as sharable and comparable data across clinical and community settings.

Clinical Relevance

Standardization of patient-generated whole-person health data enabled clinically relevant research that included the patients’ perspective.

The perioperative and long‐term fates of patients with chronic limb‐threatening ischaemia who underwent secondary major amputations

Abstract

This study investigated the perioperative and long-term fates of patients with chronic limb-threatening ischemia (CLTI) who underwent secondary major amputations. From April 2010 to December 2018, 1653 CLTI patients primarily underwent endovascular therapy (EVT). Of these patients, 138 who underwent secondary major amputations were included in this study. The primary outcome measure was the mortality. Prognostic factors associated with perioperative (30-day) and late mortality (after 30 days) were assessed. The 30-day mortality was 9.6%. Patients who died during the perioperative period had lower ejection fractions on echocardiography than those in the perioperative survivors (49.5 ± 14.9% vs 58.6 ± 12.4%, P = .018). None of the other clinical characteristics were significantly associated with perioperative death. Two-years postoperatively, 49.6%, 12.2%, and 4.3% of the patients had died, had contralateral amputations, and had additional above-knee amputations, respectively. In the alive patients who had not undergone additional amputation at 2 years, only 25.9% were ambulatory, whereas 51.7% and 22.4% were in wheelchairs and bedridden, respectively. An age ≥80 years and serum albumin <3.0 g/dL were significantly associated with late mortality (P = .032 and P = .042, respectively). In conclusion, the perioperative and long-term fates after secondary major amputation in CLTI patients who underwent EVT were considerably poor.

Best Practices to Verify Ongoing Placement of NG or OG Tube After Initial X‐ray Confirmation

Abstract

Background

Many patients in intensive care units (ICU) require nasogastric (NG) or orogastric (OG) tubes. These patients often require a combination of sedatives that can alter level of consciousness and impair cough or gag reflexes. Such factors can lead to NG/OG tube displacement. Using a misplaced tube can lead to aspiration, lung injury, infection, and even death.

Aims

To standardize ongoing verification of NG tube placement practices in our 34-bed Medical-Surgical ICU.

Methods

The Johns Hopkins Nursing Model was utilized to guide this project. A literature review and critical appraisal were performed to establish NG/OG tube best practices. Best practices were implemented and assessed (via a survey and charting audits).

Results

Fifteen publications were identified and appraised as Level 4 and 5 sources. Best evidence supported that at the time of radiographic confirmation of the tube site, it should be marked with inedible ink or adhesive tape where it exits the nares; tube location should be checked at 4-hour intervals; and placement/patency should be checked in patients who complain of pain, vomiting, or coughing. Following the practice change, N = 40 nurses indicated improvement in verification of NG/OG tube knowledge, “OK to use” order was verified for 89% of patients, and 63% of tubes were marked with tape at the exit site.

Linking Action to Evidence

Adherence to current, evidence-based strategies for NG/OG tube verification promotes patient safety. Monitoring practice changes is critical to determine whether a best practice is sustained. Electronic health records must be current to guide and support evidence-based nursing practice.

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