A s is so often the case, research projects are born out of nurses asking "why" questions about their practice. This project was no different and is best illustrated with this patient story.Max, in his early 60s, was an un-kept, homeless man admitted to the hospital with a large myocardial infarction for a nearly five-week stay. His size (six foot, 4 inches, 420-pound frame) and illness had a strong effect on the staff's ability to provide care. He did not fit in the bed, and the pressure on his legs and heels, as well as the presence of 3+ pitting edema, led to sloughing of his skin. The insertion site from the coronary angiogram and intraaortic balloon pump procedures done on admission had not healed due to the presence of a body rash from the use of multi-. Prevention of incontinence-related skin breakdown for acute and critical care patients: Comparison of two products. Urologic Nursing, 32(3).Perineal protection products were compared for their efficacy in preventing skin breakdown in the hospitalized patient with urinary and/or fecal incontinence. Each product was used for the duration of the hospital stay with daily observations for perineal skin condition. Results indicated the spray product and wipe product were comparable in rate of skin breakdown prevention. Findings suggest the wipe product is more cost-effective for use during hospitalization, and the spray product preserves skin integrity over a longer period of time, beyond average hospitalization duration.Key Words: Urinary/fecal incontinence, dermatitis, skin care/nursing, cost-benefit analysis, dermatologic agents/therapeutic use.

BACKGROUND: The incidence rate of stroke in hospitalized patients ranges between 2% and 17% of all strokes—a higher rate than in the community. Delays in recognition and management of stroke in hospitalized patients lead to worse outcomes. At our hospital, the existing in-hospital stroke (IHS) code showed low usage and effectiveness. In a quality improvement (QI) project, we aimed to improve the identification of and the quality of care for inpatient strokes. METHODS: A nurse-driven IHS protocol was implemented, which alerted a specialized stroke team and cleared the computed tomography (CT) scanner. The protocol focused on prioritizing staff education, simplifying the process, empowering staff to activate an IHS code, ensuring adequate support and teamwork, identifying well-defined quality metrics (eg, time to CT and documentation tool use), and providing feedback communication. We analyzed 2 years of postimplementation IHS data for impact on stroke detection and outcomes. RESULTS: In the 2 years post QI, there was a more than 10-fold increase in IHS (pre-QI, n = 8; first year post QI, n = 94; second year post QI, n = 123). In the post-QI cohort, after excluding patients with missing information (n = 26), 69 cases had new stroke diagnoses (63 ischemic, 6 hemorrhagic), and 148 were stroke mimics. The mean (SD) time from IHS to CT was 18.7 (7.0) minutes. Of the 63 new ischemic stroke cases, 25 (39.7%) were treated with thrombolytic therapy and/or mechanical thrombectomy. CONCLUSION: The new IHS protocol has led to a marked increase in cases identified, rapid evaluation, and high utilization rate of acute stroke therapies.

Background Prior studies have indicated high rates of vascular risk factors, but little is known about stroke in Hmong. Methods and Results The institutional Get With The Guidelines (GWTG) database was used to identify patients discharged with acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage between 2010 and 2019. Hmong patients were identified using clan names and primary language. Univariate analysis was used to compare Hmong and White patients. A subarachnoid hemorrhage comparison was not conducted because of the small sample size. We identified 128 Hmong patients and 3084 White patients. Hmong patients had more prevalent hemorrhagic stroke (31% versus 15%; P <0.0016). In the acute ischemic stroke cohort, compared with White patients, Hmong patients were younger (60±13 versus 71±15 years; P <0.0001), presented to the emergency department almost 4 hours later; and had a lower thrombolysis usage rate (6% versus 14%; P =0.03496), worse lipid profile, higher hemoglobin A 1C , similar stroke severity, and less frequent discharge to rehabilitation facilities. The most common ischemic stroke mechanism for Hmong patients was small‐vessel disease. In the intracerebral hemorrhage cohort, Hmong patients were younger (55±13 versus 70±15 years; P <0.0001), had higher blood pressure, and had a lower rate of independent ambulation on discharge (9% versus 30%; P =0.0041). Conclusions Hmong patients with stroke were younger and had poorer risk factor control compared with White patients. There was a significant delay in emergency department arrival and low use of acute therapies among the Hmong acute ischemic stroke cohort. Larger studies are needed to confirm these observations, but action is urgently needed to close gaps in primary care and stroke health literacy.

When choosing interventions for the individual experiencing fatigue, be aware of demographic data and use assessment techniques to promote positive health practices.

No abstract