BACKGROUND AND OBJECTIVES: Unplanned extubation can be a significant event that places the patient at risk for adverse events. Our goal was to reduce unplanned extubations to <1 unplanned extubation per 100 patient-intubated days. METHODS: All unplanned extubations in the NICU beginning in October 2009 were audited. Data collected included time of day, patient weight, and patient care activity at the time of the event. Bundles of potentially better practices were implemented in sequential Plan-Do-Study-Act cycles. Rates of unplanned extubation (number per patient-intubated day) for each month were analyzed by using control charts, and causes of unplanned extubation were analyzed by using Pareto charts. RESULTS: We found a significant decrease in the unplanned extubation rate after implementation of the first bundle of potentially better practices in May 2010 (2.38 to 0.41 per 100 patient-intubated days). Several more Plan-Do-Study-Act cycles were conducted to sustain this improvement. A persistent reduction in the unplanned extubation rate (0.58 per 100 patient-intubated days) began in February 2013. Causes included dislodgement during care and procedures and variation in the fixation of the endotracheal tube. The majority of events occurred in very low birth weight infants during the daytime shift. CONCLUSIONS: Unplanned extubations in the NICU can be reduced by education of staff and by implementing standard practices of care. Sustainability of any practice change to improve quality is critically dependent on culture change within the NICU. We suggest that the benchmark for unplanned extubation should be a rate <1 per 100 patient-intubated days.
Every day parents make choices about the source of water their families consume. There are many contributing factors which could affect decisions about water consumption including taste, smell, color, safety, cost, and convenience. However, few studies have investigated what parents with young children think about water quality and safety in the US and how this affects the choices they are making. This study aimed to describe the perceptions of parents with regard to water quality and safety and to compare bottled water and tap water use, as well as to examine motivation for water choices. We conducted an online questionnaire to survey parents living in Pennsylvania about water quality and safety, and preference for bottled versus tap water. Parents were recruited through child care centers, and 143 surveys were returned. The survey results showed high overall scores for perception of tap water quality and safety, and a preference for tap water over bottled water. We found that parents were concerned for the environmental impact that buying bottled water may have but were also concerned about potential contamination of tap water by natural gas drilling processes and nuclear power plants. These findings regarding parental concerns are critical to inform pediatric health care providers, water sellers, and suppliers in order that they may provide parents with the necessary information to make educated choices for their families.
Purpose: Nurse led patient education programs to improve patient understanding of the signs and symptoms (s/s) of a stroke and their personal stroke risk factors can play a significant role in preventing secondary stroke. No such initiatives could be found for an urban academic medical center in the United States when conducting a literature search, despite a Healthy People 2020 edict to address stroke awareness in adults. The goal of this project was to improve patient understanding of s/s of stroke as well as personal risk factors, and to ensure smooth patient transitions to the community. Method: A tool was developed for charge nurses to use when providing education to patients. The tool included patient demographic information and patient specific stroke risk factors. The previously used script for phone calls included signs and symptoms but was modified to include personal risk factors and corresponding behavior modification. All patients, discharged to home with a diagnosis of stroke or transient ischemic attack (TIA), were called within two weeks of discharge per the Joint Commission Comprehensive Stroke Center recommendation. Two attempts were made to reach each patient and a detailed log was maintained to track patient’s response to questions. Results: In the two months prior to the project being initiated, there were 37 patients reached via phone who had been discharged home from the stroke unit with a diagnoses of stroke or TIA. Of the 37 called, there were 5 who were unaware of the s/s of a stroke. For the two months since beginning the intervention, 42 successful calls were made to patients discharged home. Of these 42, only 2 patients did not know the s/s of stroke or their personal risk factors (p value: 0.16). Conclusions: This project allowed for a new approach to patient focused, nurse led education to improve patient understanding of the s/s of a stroke and individual risk factors. There was a ten percent improvement in the number of patients with an understanding of the s/s of a stroke. An encouraging outcome from this project was an improvement in RN Communication scores on patient’s HCAHPS surveys in the two months since starting the intervention.
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