No abstract

This article reports the use of the continuous quality improvement (CQI) process to improve patient outcomes. The FADE method (focus, analyze, develop, and execute) was used to focus on vascular access planning, analyze data concerning intravenous (i.v.) therapy, develop a vascular access planning algorithm, and execute implementation of the algorithm. An evaluation study revealed that patients whose vascular access planning was consistent with the algorithm reported fewer i.v.s, less difficulty starting i.v.s, and less stress; waited significantly less time until central venous line (CVL) placement (for those who received CVLs); and had significantly shorter lengths of stay.

An ongoing progressive mobility program in the neurocritical care population has clinical and financial benefits associated with its implementation and should be considered.

ISSUES AND PURPOSE. This study compared clinical and economic outcomes for infants who were exclusively fed breast milk and infants who were fed commercial formula. DESIGN AND METHODS. A retrospective medical record review from a regional neonatal intensive care unit (N = 80) using consultation logs from the lactation coordinator and a matched sample of formula‐fed infants. RESULTS. Neither clinical (weight gain, length of stay, days of parenteral nutrition) nor economic outcomes (direct variable costs, net revenue) differed significantly between the groups. PRACTICE IMPLICATIONS. While it may not be possible to demonstrate sufficient cost savings while the infant resides within the NICU to justify a lactation coordinator, long‐term clinical and economic outcomes may be sensitive to this specialized nursing service.

Purpose The purpose of this study was to measure the prevalence and configuration of dependent loops in urinary drainage systems in hospitalized, catheterized adults. Subjects The study sample was 141 patients with indwelling urinary catheters. Subjects were hospitalized at an academic health center in northern Florida. Methods We measured the prevalence of dependent loops in urine drainage systems and the incidence of urine-filled dependent loops over a 3 week period. We measured the heights of the crest (Hc), trough (Ht), and, when urine-filled dependent loops were present, the patient-side (Hp) and bag-side (Hb) menisci with a laser measurement system. All variables were measured in centimeters. Results The majority (85%) of observed urine drainage systems contained dependent loops in the drainage tubing and 93.8% of the dependent loops contained urine. Hc and Ht averaged 45.1 ± 11.1 and 27 ± 16.7 cm, respectively. Meniscus height difference (Hb − Hp) averaged 8.2 ± 5.8 and −12.2 ± 9.9 cm when Hp < Hb (65.3%) and Hp > Hb (32.7%), respectively. Conclusions We found that dependent loops are extremely common in urinary drainage systems among hospitalized patients despite manufacturer recommendations and nursing and hospital policies. Maintaining the urine drainage tubing free of dependent loops would require incorporation into nursing care priorities and workflow as inadvertent force on the tubing, e.g., patient movement or nurse contact can change tubing configuration and allow excess drainage tubing to re-form a dependent loop.